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Flare Protocols

There are two Flare Protocols, and they’re usually chosen after a poor response to previous treatments or blood results show low ovarian reserve. The “Flare” or “Antagonist” protocol doesn’t suppress the pituitary gland before stimulation, and this gets a better response for women with low ovarian reserve. This protocol makes it possible to give higher levels of ovarian stimulation without an increased risk of ovarian hyper-stimulation syndrome (OHSS).

Flare Protocol

      • Usually in a 6-week cycle, with birth control pills for the first four weeks to “down-regulate” the ovaries
      • Daily follicle-stimulating hormone (FSH) or human menopausal gonadotropin (hMG) injections then stimulate the ovaries for 8-12 days
      • Daily injections of GnRH antagonist are added after 4-5 days of stimulation
      • Once follicles have reached mature sizes, a human chorionic gonadotropin (hCG) injection stimulates the eggs to undergo their final maturation and detach from the follicle walls
      • 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

Micro Flare Protocol

The Micro Flare (Lupron agonist) protocol is a potent in-vitro fertilization protocol that’s often the last resort before donor eggs. The advantage of this protocol lies in a unique property of “Lupron” (a gonadotropin release hormone (GnRH) agonist):

  • Lupron in tiny amounts (about a 1/6thto 1/10th of the standard dose) 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 combines with high doses of external FSH given as part of the standard IVF protocol. The combination provides the ovaries maximum stimulation to develop eggs and follicles


A 6-week cycle, with birth control pills for four weeks to “down-regulate” the ovaries and make sure the corpus luteum from the previous cycle won’t be activated.

  • Birth control pills for a month
  • No medication for 2-3 days
  • Mini doses of Lupron stimulate the pituitary to release FSH (typically 50ug twice a day)
  • After five days, Lupron begins to suppress the pituitary to prevent premature ovulation, with Lupron 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
  • Ultrasound monitors progress
  • When follicles reach a mature size, a human chorionic gonadotropin (hCG) injection stimulates the eggs to mature and detach from the follicle wall
  • Eggs are then collected
  • Progesterone support starts
  • Embryo transfer is usually 3-5 days later

Photo by Markus Spiske on Unsplash