The Micro Flare (Lupron agonist) protocol is considered the most potent in-vitro fertilization protocol available and is often the last resort before donor eggs are used and may be the treatment of choice for women who respond poorly to other drug protocols. The advantage of this protocol lies in a special property of “Lupron” (a gonadotropin release hormone (GnRH) agonist):
- When Lupron is given in tiny amounts (about a 1/6th to 1/10th of the normal dose) it stimulates the release of natural follicle-stimulating hormone (FSH) from the pituitary for several days before it suppresses the ovaries
- During this ‘flare’ period the ovaries get extra stimulation from the woman’s own natural FSH
- This is then combined with high doses of external FSH that’s given as part of normal IVF protocol, and the combination give the ovaries maximum stimulation to develop eggs and follicles.
This is a 6-week cycle, with birth control pills for 4 weeks to ‘down-regulate’ the ovaries and make sure the corpus luteum from the previous cycle won’t be activated by the hormones used.
- Birth control pills for a month
- No medication for 2-3 days
- Mini doses of Lupron are given to stimulate the pituitary to release its store of FSH (the flare effect) with a dose that’s typically 50ug twice a day
- After 5 days Lupron begins to suppress the pituitary to prevent premature ovulation, and Lupron is continued up to the day of the hCG injection
- FSH injections are given from the fourth or fifth day after the last birth control pill to stimulate follicular development in the ovaries
- Progress is monitored with ultrasound
- When the follicles reach a mature size the Lupron and FSH are stopped, a human chorionic gonadotropin (hCG) injection is given and the eggs to undergo their final maturation and detach from the follicle wall
- The eggs are collected
- Progesterone support starts
- Embryo transfer is usually 3-5 days later
Some women don’t respond very well to any IVF protocols and develop enough mature eggs for a realistic chance of success, which makes IVM protocols worth considering, while the option of donor eggs and IVF removes the issues of reduced ovarian reserve and poor egg quality and dramatically increases success rates.