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The "flare" protocol uses Lupron to cash in on the fact that Lupron initially causes the pituitary gland to secrete large amounts of FSH and LH. So, in addition to the FSH and LH that you get in the shots, the Lupron boosts the amount of circulating FSH and LH and this (hopefully) coaxes another couple of follicles to start developing. After a few days, the "flare" effect is gone and the Lupron then acts to supress the release of FSH and LH from the pitutiary gland and prevent premature ovulation.

The "microdose" flare is a variation of the standard "flare" protocol. You take smaller amounts of Lupron (hence "microdose") twice a day and this prolongs the "flare" effect for a few more days. It also mimics the "natural" release of FSH and LH which is pulsitile (released in periodic pulses, not a steady flow). The microdose flare is now more common than the original flare protocol because it appears to work a little better. It is the protocol of choice in "poor" responders.

Hope this clears up the mumbo-jumbo and jargon overload.

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Dear Dr. Smith: yes, your explanation does clear the jargon up very nicely. It is now straight in my head.

Thank you again for all your time and trouble. Much appreciated!!

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Dr. Smith,

I am 39 years only and last month I had a failed IVF cycle and was only able to produce 2 follicles & eggs which resulted in one 8-cell embryo. I did the transfer regardless and the embryo did not implant. Since donor eggs are not an option for me, my RE has suggested using a Microdose flare Lupron protocol with 4 amps Gonal-F and 4 amps of Menopur. I am a poor responder with FSH of 6.9 at baseline. Do you think that the Microdose flare Lupron protocol will help me to produce more follicles & eggs so I can have a greater chance of getting pregnant? My original protocol was GnRh antagonist flare that started with 3 amps Gonal-F & 1.5 amps Menopur and then was increased to 4 amps of each medication when I was not responding to the original dose. I previously had a cyst removed on my left ovary last year and had a cyst drained on my right ovary at the same time. In my IVF cycle, my left ovary did not respond and the right one gave me only 2 follicles/eggs.

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Dr. Smith:
How would you determine whether a patient is a poor responder.

I had my first IVF on 2 units of Repronex with 2 Gonal F, 17 eggs retrieved, 9 fertilized.

2nd Cycle, 1 Repronex and 3 Gonal F, 10 eggs retrieved, 5 fertilized.

I talked to another physcian who recommended micro dose Lupron. Do you think it will benefit me?

Thank you.

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Gina A and YF - Your questions are outside my area expertise and should be directed to Dr Jacob on the Infertility 101 Message Board. He is more qualified to answer questions about the various stimulation protocols available and their proper application to specific patient populations. Please post your questions on Dr Jacob's message board.

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Please post your questions on Dr Jacob's Infertility 101 Message Board. He's an RE and I think he may be able to help.

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Doctor,
I am advised to go thro flare protocol? For how many cycles birth control pills to be taken? Is it for 2 cycles before the stimulation or 1 cycle . Pl. advice.

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Sorry, I'm not a physician. Your question is of a medical nature and is out of my field of expertise. Please post on Dr Jacob's Infertility 101 board.

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