Protocols, DHEA and more --PART 1

In the last week or two I have seen quite a bit of discussion and questions about what drugs are in which protocols, along with interest in a supplement (DHEA) for women who have poor response to ovarian stimulation. So, the scientist in me consulted Dr Google and his peers and gathered a bit of data and some helpful links, which I thought I would share. You certainly should pursue your own research, as well as discuss ALL MEDICATIONS AND TREATMENTS with your RE. Also, please note this information is certainly NOT exhaustive, but will hopefully be informative.

PART 1 Protocols

I'm going to briefly describe a few things then refer you to a great website with nice diagrams. Okay, its here -- but will you still read mine?

There are 3 basic types:
1. Lup.ron
2. Antagonist
3. Microdose Lup.ron Flare

All these protocols generally begin with a course of BCP to suppress the hormone axes. The main differences are in the method used to prevent ovulation prior to the desired time (ie the maturation of multiple follicles).

Two of the protocols use Lup.ron early in the cycle to suppress your pituitary gland. This will suppress the release of various hormones which allows for multiple follicles to be recruited into development (that's right, your in the army now). Once the pituitary is shut down, stimulation drugs are given and can be carefully controlled (usually -- yeah I know, a bunch of you have had OHSS!). Lup.ron's suppression also stops your body's own release of LH, thus preventing ovulation, again allowing multiple follicles to reach maturity. This lack of LH surge is why we take the hCG trigger shot, as hCG mimics the surge.

In the antagonist protocols, rather than use a drug early on to shut things down, stimulation meds are given along side your body's own hormones. Then as multiple follicles are approaching maturation, the antagonist (Cet.rotide, Gan.irelix) is used to prevent the LH surge. Again hCG is used to trigger full maturation/ovulation. Antagonists only take 24hrs to shut down the pituitary, whereas Lup.ron takes 10 days for complete suppression (this is why under the standard Lup.ron protocol you take it for so long). Antagonists are generally taken for a few days near the end of your cycle.

In the microdose flare Lup.ron protocol, a short period of suppression is used. In tiny doses Lup.ron actually stimulates the release of your body's own FSH from the pituitary, for several days before the suppressive action kicks in. This results in a "flare" of natural FSH. This natural flare of FSH is combined with drugs containing FSH to stimulate the ovaries. This is the protocol of choice or last resort in "poor responders." (I don't believe this would be used in cases such as PCOS, since they potentially have issues with over response).

AGAIN consult this lovely website. It has simple charts with a break down of the timeline and explains all the protocols. In regards to the Microdose Flare Lup.ron Protocol, I also found this site very informative (ignore the Beverly Hills nonsense at the top). It also discusses other standard protocols as well.

I hope this is helpful to some when you are reading about a friends travails during a cycle. Please, if you note any errors or have other sites to recommend, please email me or leave them in the comments and I will update.

Tomorrow (or maybe Friday) ... DHEA. Is it the cure-all for you crusty ovaries? (God I hope so!) Stay tuned for Part 2.