If it is impossible to get pregnant, many women have to resort to assisted reproductive technologies. At the end of the preparatory stage, when the woman passes all the necessary tests, the fertility specialist will choose the optimal protocol for her - her personal infertility therapy regimen. Two types of schemes are widely used in Russia - long and short protocols. We will talk about the short one in this article. Let's consider in detail its pros and cons, advantages, description and detailed diagram by day.
What it is?
A short IVF protocol is considered to be more gentle than a long one, since with it hormonal stimulation of the ovaries does not have the same scope and scale as with any subspecies of the long protocol. A woman cannot independently choose the type and scheme of treatment, her reproductive physician must decide on a specific protocol, who, when choosing, will rely on the results of analyzes, on the features of the endocrine system of a particular patient, on her age and reasons for childlessness.
If the doctor recommends a short IVF protocol, then he has every reason for this.
The short protocol always begins on the 3rd day of the menstrual cycle and lasts no more than 28-36 days, while hormonal stimulation itself takes no more than 10-16 days. The ultra-short protocol lasts no more than 26-30 days, the stage of hormonal stimulation in this case takes no more than 7-10 days. Compare yourself: a long protocol sometimes lasts up to one and a half months, in an extra-long one - up to six months.
It turns out that the inevitable aggressive effect of hormones on the body of the fair sex in the short-type protocol is reduced to minimum values, which makes the protocol easier for the patient's well-being and minimizes possible complications and consequences.
Advantages and disadvantages
The main advantage of the short-type regimen is that there are fewer hormonal drugs that a woman will have to take in the first phase of the menstrual cycle. This not only saves women's health, but also significantly reduces the cost of IVF, because almost half of the total cost of the protocol consists of the cost of expensive hormonal drugs.
Shorter protocols are generally considered to be the most preferred for women with normal or large ovarian reserve, with satisfactory or good egg quality. If the oocytes are weak and not viable, if they cannot be fertilized even in the laboratory, a long protocol is more suitable.
Often short protocols are recommended for women over the age of 35-37 years, but there is one important condition - all the functions of their sex glands (ovaries) must be preserved to this age in full. Quite often, changing the protocol from a long but unsuccessful one to a short one leads to the desired result - pregnancy occurs.
The undoubted advantage of the short-type protocol is the relatively low risk of developing such an unpleasant and even dangerous complication as ovarian hyperstimulation syndrome. This IVF regimen is easier for patients to tolerate.
Among the disadvantages that each treatment regimen necessarily has, two aspects of short-type protocols deserve special attention:
- the likelihood of arbitrary ovulation, which will not make it possible to obtain oocytes and the protocol will have to be interrupted and repeated after 2-3 months;
- short hormonal stimulation does not allow obtaining a large number of oocytes, so there is no possibility of choosing the highest quality cells. Usually, everything that is received is subject to fertilization. This increases the risk of replanting low-quality embryos. IVF success rate in the short protocol is always lower than in the long one.
Stages of the treatment cycle
The short protocol least of all resembles violent interference in the work of the female body. It fully corresponds to its biological nature and proceeds in accordance with the natural cycle.
After the onset of menstruation, the woman should go to the doctor and get an appointment for the beginning of the protocol. On the 3rd day of the cycle, hormonal drugs are taken. When the follicles mature, other hormones are stimulated to ovulate. After that, after 36 hours, the woman is punctured of the follicles and the oocytes that are mature and ready for fertilization are taken.
At the next stage, the eggs are fertilized with the sperm of a spouse, partner or donor (depending on the conditions of IVF). After a few days in the nutrient solution and after assessing the quality of the embryos by the embryologist, the embryos are transferred to the uterus.
If the protocol is successful, the embryo (or several at once) are implanted into the endometrium of the uterus, and pregnancy begins.
On the 3rd day of the menstrual cycle, a woman is taken drugs that partially block the work of the pituitary gland with agonists (for example, "Dexamethasone"). Simultaneously with this, stimulation is carried out with follicle-stimulating drugs and menopausal gonadotropins ("Meriofert"). After the puncture of the follicles, the woman begins to take progesterone preparations in order to maintain the second phase of the cycle and, under favorable conditions, facilitate the implantation and bearing of the fetus.
Scheme in stages by day
There are three main types of short protocols, which differ slightly mainly in the selected hormonal drugs. It:
- hormone agonist protocol;
- hormonal antagonist protocol;
- ultra-short protocol with antagonist drugs.
In a protocol with agonists, stimulation with "Dexametozone" or other hormones that belong to menopausal gonadotropins, or GnHRH agonists ("Decapeptyl") begins on day 2 of the menstrual cycle and ends on day 5.
On the 14th day of the cycle, follicle puncture is performed. A step-by-step description of the procedure will help a woman not be afraid of taking eggs: everything takes place under anesthesia and lasts no more than 15 minutes. When the patient falls asleep after the introduction of intravenous anesthesia, doctors with a long needle under ultrasound control make a puncture in the back wall of the vagina, get to the ovaries and "suck" through the needle into special sterile containers the follicular fluid with the oocytes in it. This concludes the procedure.
When a woman wakes up, she is prescribed progesterone drugs to maintain the second phase and is allowed to go home until the day of embryo transfer.
How a woman's well-being will change during a short protocol is an ambiguous question. Some do not show any significant changes. Others tolerate it more difficult, it all depends on individual sensitivity. From day 3 of the cycle, when there is stimulation with GrGNG agonists, as well as drugs "spurring" ovulation (Puregon, Gonal), there may be feelings of bloating in the abdomen, hot flashes, mild nausea and occasional headaches may appear.
Many women note an extremely unstable psychological and emotional state, in which tears are replaced by anxiety, and laughter is replaced by a depressive state. This is a side effect of agonists and antagonists. This will gradually pass, you just need to be patient.
Every two days a woman will need to visit the clinic and do an ultrasound so that the doctor can track the maturation of the follicular vesicles on the gonads. In case of an abnormal reaction of the ovaries to hormones, the dose and frequency of the drug can be changed by the doctor at his discretion. Stimulation with hormones lasts no more than two weeks.
Features of the
Almost all of the drugs that will be prescribed by a doctor to stimulate the ovaries are in injectable form. This means that the woman will have to take injections. It is inconvenient to visit the clinic every day at the same time, so doctors allow subcutaneous and intramuscular injections at home.
In this case, it should be taken into account that skipping the next injection is unacceptable. It can lead to the failure of the entire treatment course and to the reduction of the efforts of doctors to zero.
Subcutaneous injections are injected into the abdomen, intramuscular injections are made in the standard place for such cases - the buttocks. Hormone therapy differs from treatment with other medications in that the drug needs to be injected at the same time intervals every day, increasing or decreasing the dosage is prohibited. Only the attending physician can make adjustments to the short circuit (yes to the long one too).
With a normally flowing short-type protocol, follicles on the ovaries should increase by an average of two millimeters every day, and the thickness of the endometrium should increase by at least one millimeter per day. When growth is more intense, the doctor may reduce the dose of medication. If growth is insufficient, the dose may be increased.
As soon as the follicles (at least three) reach 17-22 mm, the doctor prescribes a single injection of any drug that is considered an ovulation trigger. Under the influence of such hormones, the eggs are detached from the inner walls of the follicular vesicles and remain in the follicular fluid. They will be easy to "get" by puncture.
Reviews
In their reviews, women often give examples of their own short protocol schemes with an indication of drugs and dosages. Those who are just entering the protocol and turn to the all-knowing Internet for opinions and advice should in no case rely on other people's protocols, since their own treatment regimens may differ, as drugs and dosage differ.
Many women recommend following a protein diet and drinking enough fluids to avoid gonadal hyperstimulation, which still exists with a short protocol.
Proper nutrition even before entering into the protocol, taking vitamins will not only help to survive the stimulation stage more easily, but will also help to improve the quality of eggs.
Shorter protocols, unfortunately, are less successful, as evidenced by most reviews of women who received such treatment. However, those who did not give up and after three months made a second attempt, quite often say that with subsequent short protocols, the likelihood of getting pregnant increases.
After a short protocol, even if it was not completed successfully, the reproductive system "restarts", and about a quarter of couples with endocrine or implicit causes of infertility manage to conceive a child in a completely natural way.
For what a short IVF protocol is, see the next video.
