Patient's question:
Irregular menstruation, usually delayed by 15 to 30 days before the period comes, light flow, prolonged follicular development, small follicles, generally around 1.5 to 1.8 centimeters in size, the follicles do not rupture or discharge. Menstruation began at the age of 14, with periods occurring every 28 to 30 days, lasting 5 to 6 days, with a moderate flow, neither too much nor too little. At the age of 18, due to rheumatoid-like knee pain, three injections of imported hormone-based medication, "Kenalog," were administered. From then on, menstruation became irregular, and weight gain occurred rapidly, increasing from 98 pounds to over 140 pounds.Doctor's answer:
(1) Long protocol: GnRHa is administered during the luteal phase before the treatment cycle or on the second day of the treatment cycle, continuing until hCG injection. Starting from the day of GnRHa administration, gonadotropin preparations such as hMG or FSH are added for ovulation induction between days 14-21. This regimen utilizes the down-regulation effect, which is the suppression of endogenous gonadotropin secretion caused by high-dose, continuous GnRHa stimulation. The long protocol is currently the most commonly used hyperstimulation protocol.(2) Short protocol: GnRHa is started on day 2 of the menstrual cycle, and gonadotropins are administered concurrently until hCG injection. This protocol primarily leverages the transient surge of FSH and LH (flare-up) after GnRHa use, reducing the dosage and duration of exogenous gonadotropin administration. The short protocol is suitable for patients with poor response to hyperstimulation in the long protocol.
(3) Ultrashort protocol: GnRHa is used for a short duration from days 2-4 of the menstrual cycle, while hMG and other gonadotropin preparations are initiated on day 3. This regimen relies solely on the surge of FSH and LH (flare-up) caused by GnRHa administration. The ultrashort protocol is suitable for older patients or those with poor ovarian response.