It is performed either by a Single subcutaneous injection of Depot GnRH agonist with effect lasting for 4-8 weeks or by Short acting GnRH agonists administered daily until the day of hCG injection.
Short Protocol is used in selected cases with irregular infrequent periods. Short acting GnRH agonist is administered daily from day 2 of the cycle until the day of hCG administration.
Monitoring Pituitary Down Regulation . In cycles where FSH and LH levels have been high in the early follicular phase, the GnRH agonists are administered. Effective down regulation is judged by endometrial thickness less than 4mm and number of small follicles (<8 mm) less than 4. Hormone levels (LH < 5 IU/L, E2 < 50 pg/ml and Progesterone < 1 ng/ml) may be estimated to supplement the sonographic findings.
Some women experience minor side effects from these which include headaches and menopause like symptoms such as hot flushes and vaginal dryness. These problems are temporary.
Gonadotrophins Administration Numerous eggs must be grown to insure fertilization and progression to the embryo stage. FSH is administered which directly stimulate the ovaries causing egg recruitment and then also support the eggs growth and development. FSH is available as HMG, FSH and recombinant FSH (rFSH) injections.