Advanced Fertility Center of Chicago ivf

Lupron Down-Regulation Ovarian Stimulation Protocol for IVF
Also called "Long Lupron" or "Luteal Lupron"

Ovarian stimulation protocols for in vitro fertilization using Lupron (leuprolide acetate) or GnRH-agonist drugs.

There are 2 basic ways that we use the GnRH-agonist medications such as Lupron in conjunction with the FSH product in IVF stimulation protocols:

Long protocols - also called "down regulation" or "mid-luteal Lupron" protocols

  • The "long protocol" used to be the most commonly used IVF protocol in the US. Now the antagonist (Ganirelix) protocols are used more.
  • Success rates are the same with less injections and lower risk for ovarian hyperstimulation syndrome if we use an antagonist protocol instead of Lupron down-regulation.
  • With this Lupron protocol, the Lupron starts about 7 days before the next expected period - called "mid-luteal" timing
  • The FSH drug is usually started within the first 2-7 days after the period begins
  • The leuprolide acetate dose is often reduced when the FSH product is started
  • The dose and brand name for the FSH product (e.g. Follistim, Gonal-F, Menopur) varies according to the preferences of the physician and the patient's situation
  • Most women get a starting dose between 150 and 375 units of FSH product per day
  • The dose is adjusted as the stimulation progresses
Stimulated ovary for ivf

Ultrasound of multiple follicles (black circles) in a stimulated ovary
Yellow cursors outline a 15 mm follicle

How is the monitoring of IVF stimulation done?

  • We try to stimulate the woman to get at least 3 or 4 follicles with sizes of 14-20mm diameter. Ideally, there would be about 8 follicles in this range. We want more eggs because the number of eggs we get correlates with success rates.
  • Blood hormone levels and developing follicle sizes are monitored.
  • Ultrasound is used to measure the follicles
  • Estrogen hormone blood levels are important. Estrogen (actually estradiol) levels are usually under 60 pg/ml at cycle baseline and rise significantly as multiple follicles develop.
  • Peak estradiol levels on the day of the HCG shot are usually 1000 to 4000 pg/ml.
  • The stimulating process usually takes 8-10 days

Estrogen hormone levels in IVF cycle

Graph showing estrogen hormone levels during an IVF stimulation
Estradiol starts low and rises to 1000 to 4000 pg/ml by the time of the HCG injection

  • The HCG shot is needed to induce final egg maturation. It is given when the estrogen level and the follicle measurements look best for successful IVF outcome.
  • The egg retrieval procedure is planned for 34-36 hours after HCG injection - shortly before the woman's body might release the eggs (ovulate).
See a sample calendar that shows timing of office visits and IVF procedures

What if this stimulation protocol does not work well?

Some women do not respond well to the long protocol using leuprolide. They do not make enough follicles to give a good chance for pregnancy from IVF with this regimen.

Stop Lupron Protocol

Some women will be "over-suppressed" by the standard long protocol, or are low responders for some other reason. A "stop Lupron" protocol is one possibility for better response to stimulation.

With this protocol, the leuprolide is started at the same time in the cycle, but usually at a lower dose, often at 5 units daily instead of 10 units. It is then stopped completely after the woman gets her period and the FSH product is started.

The LH suppressing ability of this protocol is not as complete as with a standard long protocol. However, the risk for a premature LH surge is still low, and blood tests can be done during the cycle to watch for any LH hormone spikes.

Antagonist stimulation or a microflare protocol are options for IVF stimulation other than the long protocol.

Overview about ovarian stimulation for IVF

4920 N. Central Ave
Suite 2C

Chicago, IL 60630

Phone: (773) 794-1818
Fax: (773) 794-1819

30 Tower Court
Suite F
Gurnee, IL 60031

Phone: (847) 662-1818
Fax: (847) 662-3001

820 E. Terra Cotta Ave (Rte 176)
Suite 118
Crystal Lake, IL 60014

Phone: (815) 356-1818
Fax: (815) 356-1866



I am so grateful for Advanced Fertility Center. I just had my son Leland. I want to thank Dr. Catenacci and all of the nurses that helped us. Especially Ashley in the Crystal Lake office. You made this process easier by being supportive and positive. Thank you very much!


Dr. Sherban and his staff are the most amazing, compassionate, and supportive people. After almost 5 years of trying to conceive, going through numerous tests and meeting with another clinic closer to home, who told me my chances even with IVF were still very low, a good friend recommended advanced fertility center of Chicago. Best decision we ever made! We now have 2 amazing children who are now 5 and 3 years old! I cannot stress enough how amazing this staff is, they make you feel like family!


Our experience was amazing with Dr. Cantanucci and all of the nurses (especially Ashley). After ttc for 4 years and at 41 years of age, we became pregnant after 1 round of IVF, and had our beautiful boy this past October. Can't thank them enough!


2/7/15 our son was born all thanks to the assistance of Dr. Sherbahn and his staff. Everyone was so helpful and here for all our questions, worries, etc. They want this for you just as much as you want this for you! Handled with pure professionalism and care from the very start! Thank you advanced fertility!