What is a Long Down-Regulation (long Down Reg) IVF cycle?
Ovarian down regulation is a term used by doctors to describe suppression of natural cyclic ovarian activity.
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. This is sometimes termed a “long protocol” approach. 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 (GnRH 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 with 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. It is possible to have a fresh embryo transfer in a long down regulation cycle type, if appropriate in your clinical circumstances.
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 classed as IVF low responders to 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.
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Lovers intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.