Flare or Antagonist protocol is an IVF protocol where the pituitary gland isn’t suppressed before the ovaries are stimulated as it gets a better ovarian response for women with low ovarian reserve. Typically this protocol is chosen when there’s a history of poor response to previous treatments or when blood results show low anti-Mullerian hormone (AMH) and high follicle stimulating hormone (FSH) levels.
The big advantage of this protocol is that it’s possible to give higher levels of ovarian stimulation without increasing the risk of ovarian hyper-stimulation syndrome (OHSS) for these women.
- This is usually in a 6-week cycle, with birth control pills for the first 4 weeks to ‘down regulate’ the ovaries
- This is followed by daily follicle stimulating hormone (FSH) or human menopausal gonadotropin (hMG) injections that stimulate the ovaries for 8-12 days
- Daily injections of GnRH antagonist are added after 4-5 days of stimulation
- This continues until follicles have reached mature sizes and a human chorionic gonadotropin (hCG) injection is given to stimulate the eggs to undergo their final maturation and detach from the walls of the follicles (which also makes retrieving them much easier)
- The eggs are collected
- Embryo transfer is usually 3-5 days later
- Progesterone pessaries are given until the pregnancy test and will continue until the 12th week of the pregnancy