What is a Long Down-Regulation (long Down Reg) IVF cycle?

Posted on 2 June 2022

IVF Cycle Info

Ovarian down regulation is a term used by doctors to describe suppression of natural cyclic ovarian activity. In IVF (Invitro fertilisation), down-regulation can be used to “turn off” the ovaries before starting the process of controlled ovarian stimulation.  Goals are to better control and co-ordinate egg maturation during IVF treatment.

Medications used to down regulate a woman’s cycle prior to the commencement of follicle stimulation can include the combined oral contraceptive pill (OCP) and/or Gonadotropin Releasing Hormone (GnRH) agonists (receptor activating drugs) or analogues (look alike molecules).

Long Down Regulation Protocol

Using a long protocol, down-regulation is scheduled to commence in the cycle before IVF treatment takes place. It can commence of your period day 1 but can also commence in the mid luteal phase (after ovulation), depending on your doctor’s individualised plan for your cycle.

Long down regulation IVF protocols require more days of medication and do take longer prior to embryo transfer.

Who may benefit for a Long Down Regulation cycle?

Long Down Regulation cycles can offer advantages to women suffering conditions such as endometriosis and adenomyosis and can also help some woman who are classes as IVF low responders achieve more eggs per cycle.

A long down regulation cycle plan can also allow a woman to “schedule” her IVF cycle in her calendar at a time that is most convenient for her to undergo treatment, around work commitments, personal leave and to ensure her preferred caring doctor can be present to care for her during treatment.

Who should avoid long Down Regulation

Down regulation cycles carry a higher risk of ovarian Hyperstimulation Syndrome and for this reason for many women and couples where a high ovarian reserve is present, would not be chosen as first line IVF management.


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