The Short Protocol: 5 Reasons To Have It

01 Apr The Short Protocol: 5 Reasons To Have It

IVF patients want to know they’re on the right protocol. Which is best – the short protocol or the long one? The answer depends on each individual patient, so ignore most of what you read online. Other protocols exist, including minimal stimulation, the flare protocol and natural IVF. All three show promising data.

But let’s stick to the big two for now: long and short. And guess what? No definitive large-scale trial exists to make a clear case for one over the other. You’ll read about the benefits of each, but there’s no game-changer research yet. This may strike IVF patients as odd. What it really means is that a clinic’s decision on your protocol is subjective and rarely black and white.

Personally, and based on the success rates and experience of the IVF patients we’ve helped over the years, 95% of which were on the short (antagonist) protocol, we think the short protocol is best. Here are five reasons why.

1. Short protocols are better for your body.

Starting your IVF medication on day two of your bleed, not preceded by lengthy down-regulation medication, is a more natural approach. Long-protocol IVF cycles were the gold standard for many years. But side effects of traditional down-regulation medication, taken for weeks to bring your reproductive system to a shuddering halt, can be unpleasant. Physically and mentally, patients tend to prefer the simplicity of the short protocol. Success rates for short and long protocols are similar. So why go long if it’s not medically necessary?

2. Short protocols are easier to manage.

IVF is stressful at the best of times. Avoiding unnecessary down regulation means patients get to egg retrieval quicker and with less fuss. The timeframe from your first injection on the short protocol to your trigger shot could be 10 days. It’s five to six weeks on the long protocol.

If you need to plan a trip abroad for treatment on the short protocol, you can take birth-control pills to time your bleed. While taking BCPs is marginally less optimal than starting your injections not preceded by them, they’re still a great way to manage your treatment. You can’t plan an IVF trip in advance on the long protocol. BCPs are also easier to take than down-regulation drugs.

3. Short protocols are cheaper.

Short protocols save you money. The standard down-regulation medications used on long protocols (Buserelin, Leuprorelin, etc) are expensive. While IVF medication is more competitively priced these days, the short protocol is still better for your bank balance. You’ll also need fewer scans and monitoring trips on the short protocol, reducing transport costs and general inconvenience.

Of course, some long protocols are less onerous than others and some down-regulation drugs are cheaper. It’s always worth checking with your fertility clinic if (a) a long protocol is still advisable and (b) if cheaper down-regulation medication can be used. Some affordable down-regulation drugs can be taken at the same time as your FSH injections.

4. Short protocols can be safer.

OHSS is taken seriously by all fertility clinics. And the risks of OHSS seem to be lower on the short protocol. This is because the short, focused span of a short cycle allows more control over your treatment. We await definitive, research, but fast responders (e.g. PCOS patients) with an OHSS risk on short protocols see fewer postponements.

It’s also worth noting that poor responders and/or older women tend to fare better on the short protocol. Short protocols can be more reactive: their simplicity is their trump card.

5. Short protocols get you back quicker.

IVF is a numbers game. The long view has to anticipate repeat cycles. You can start a new treatment cycle, fresh or frozen, more quickly after a short-protocol cycle. This is quite important. IVF patients have limited timeframes for their treatments, particularly those with poor ovarian reserve.

You typically have to wait three months before trying again after the long protocol. Not true for the short protocol, where it’s possible to start a new cycle on your withdrawal bleed after a negative result. For sanity’s sake, and to allow for three cycles within, say, six months, the short protocol allows you to plan a sharper, big-picture treatment regime.

The short protocol isn’t perfect. It may produce fewer follicles and embryos. The risk of birth defects is marginally higher than via the long protocol (but still low). And clinical-pregnancy and live birth rates are sometimes lower after the short protocol for certain patients. But looking at the benefits of short protocols overall, they’re a safer bet for most IVF patients. Ask your fertility doctor for his opinion, based on your case and nobody else’s.