IVF medication protocols can be one of the most confusing parts of fertility treatment. In this solo episode, reproductive endocrinologist Dr. Sasha Hakman explains how IVF medications actually work, why different patients may need different stimulation protocols, and how factors like AMH, ovarian reserve, age, previous IVF response, and risk of ovarian hyperstimulation syndrome (OHSS) influence treatment decisions.
In this episode, we cover:
How the hypothalamic-pituitary-ovarian (HPO) axis controls the menstrual cycle, including the roles of gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone
How IVF medications recruit multiple follicles and why AMH, antral follicle count, and ovarian reserve influence your stimulation protocol and medication dose
The main IVF stimulation medications, including recombinant FSH, human menopausal gonadotropin (hMG/Menopur), GnRH agonists, GnRH antagonists, and hCG
How IVF trigger shots work, including Lupron vs. hCG, dual or co-triggers, double Lupron triggers, final egg maturation, and meiosis
The antagonist IVF protocol, how Ganirelix and Cetrotide help prevent premature ovulation, and why this is one of the most commonly used IVF protocols
Ovarian hyperstimulation syndrome (OHSS), how hCG and vascular endothelial growth factor (VEGF) contribute to risk, and why trigger selection matters for high responders
The microdose Lupron flare protocol, who may benefit from it, and why Dr. Sasha often considers it for diminished ovarian reserve or a previous poor response to IVF stimulation
The long Clomid protocol, Provera protocols, and mini IVF, including when lower-dose stimulation may make sense and why mini IVF does not automatically mean better egg quality
IVF add-ons including letrozole, Clomid, and Omnitrope (growth hormone), what the research actually shows, and why letrozole may be useful for breast cancer, endometriosis, and other estrogen-sensitive conditions
IVF priming with birth control, estrogen, testosterone or AndroGel, and growth hormone, plus why Dr. Sasha does not routinely recommend DHEA supplementation
How estrogen priming and luteal-phase starts may help patients with diminished ovarian reserve (DOR) prevent early follicle recruitment and improve follicle synchrony
Why a previous IVF cycle can provide valuable information for choosing your next protocol, and the surprising research on repeating the same IVF protocol vs. switching protocols after a poor response
Why there is no single “best” IVF protocol and when individualized protocols may matter most, particularly for patients approaching or over 40, diminished ovarian reserve, poor egg maturity, or previous failed IVF cycles
Episodes Dr. Sasha mentions:
IVF 101: A foundational breakdown of IVF, follicle development, and the IVF process
Dr. Sasha's IVF cycles at 32 and 37: Dr. Sasha shares the different medication protocols she personally used and how her blastocyst yield compared between cycles five years apart
Quick terminology guide:
HPO axis = hypothalamic-pituitary-ovarian axis | GnRH = gonadotropin-releasing hormone | FSH = follicle-stimulating hormone | LH = luteinizing hormone | AMH = anti-Müllerian hormone | hMG = human menopausal gonadotropin | hCG = human chorionic gonadotropin | OHSS = ovarian hyperstimulation syndrome | VEGF = vascular endothelial growth factor | DOR = diminished ovarian reserve
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