The sample schedule and calendar below is for IVF stimulation using the flare protocol.
- The flare protocol is used to “jump start” ovarian response to stimulation in poor responders, in women of advanced reproductive age, and in women with low ovarian reserve.
- As women lose eggs due to aging, it can be hard to stimulate ovaries to produce enough follicles and eggs for a good chance for success with in vitro fertilization.
- This sample in vitro fertilization cycle shows a microdose Lupron flare plan with timing of drugs, ovarian stimulation monitoring, and IVF procedures.
Flare IVF Protocol Calendar
USING BIRTH CONTROL PILLS
| Sunday | Monday | Tuesday | Wednesday | Thursday | Friday | Saturday |
|---|---|---|---|---|---|---|
| 1 Birth control pill |
2 Birth control pill |
3 Last birth control pill (of about 14 pills) |
4 No meds |
5 No meds Baseline blood and ultrasound |
6 Start diluted lupron (DL) twice daily |
7 DL twice daily |
| 8 DL twice daily Start of stimulation shots |
9 DL twice daily Stimulation day 2 |
10 DL twice daily Stimulation day 3 |
11 DL twice daily Stimulation day 4 Blood and ultrasound |
12 DL twice daily Stimulation day 5 |
13 DL twice daily Stimulation day 6 |
14 DL twice daily Stimulation day 3 Blood and ultrasound – follicles now are ready HCG trigger shot at night |
| 15 | 16 Egg Retrieval Procedure |
17 Fertilization check in morning Start progesterone |
18 | 19 Embryo Transfer Procedure Day 3 transfer of cleavage stage embryos |
20 | 21 Embryo Transfer Procedure Day 5 transfer of blastocyst stage embryos |
| 22 | 23 | 24 | 25 | 26 | 27 | 28 |
| 29 | 30 Blood pregnancy test |
Key to flare IVF calendar:
Blood and ultrasound = blood test for IVF hormone values (estrogen levels in IVF stimulation are important) and transvaginal ultrasound to measure the follicle sizes in the ovaries. These visits usually take about 20-30 minutes in our offices and can be scheduled as early as 6:30AM.
DL = diluted Lupron, a subcutaneous injection of a very low dose of Lupron. This drug is taken twice daily starting on the third pill free day (after the last birth control pill).
Stim = ovarian stimulation. Involves subcutaneous injection of a medication containing follicle stimulating hormone (FSH), which causes multiple follicles containing eggs to develop in the ovaries. Ovarian stimulation with a flare usually lasts about 8-11 days.
HCG injection = subcutaneous or intramuscular injection of a medication called HCG, which causes the eggs to complete the maturation process.
Progesterone = vaginal cream or suppositories or intramuscular injection of a medication (female hormone) called progesterone. This drug helps to prepare a receptive uterine lining for embryo implantation.
Egg retrieval procedure = procedure to get eggs from the ovaries
Embryo transfer procedure = procedure to put embryos in the uterus
The example above is a typical flare stimulation cycle. Most patients will need 3 or 4 visits for monitoring the stimulation (shown as “Blood and Ultrasound” on the calendar) before the HCG trigger shot. It depends on the woman’s response to the ovarian stimulating medications.
