D. Treatment Plan
An individualized treatment plan will be discussed with you prior to starting and again at baseline ultrasound so you will know what to anticipate. It is of utmost importance that we have your current telephone numbers so that we can always reach you and/or your partner in case there is a change in the treatment plan.

Currently there are 3 common protocols for the use of above medications: the Long Protocol, the Antagonist Protocol and the Flare Protocol.
 
E. Long Protocol
The long protocol is used in patients who have good ovarian reserve and are not at high risk of severe OHSS (How To Avoid OHSS). Leuprolide is usually started after ovulation has been confirmed by a progesterone blood test but before menses. Alternatively it can be started while the patient is on pre-treatment with oral contraceptives.  It is given as once-a-day subcutaneous injection in the morning. This protocol was originally described by Dr. Chetkowski in 1989 (Dr. Chetkowski’s CV Publication # 12) and popularized by Dr. David Meldrum. It is still considered the gold standard to which newer protocols are routinely compared.

When leuprolide is to be begun before the onset of menses, we recommend that a barrier method of contraception (condoms, diaphragm or spermicidal jelly) be used during that cycle. If your period is more than 2-3 days delayed, please call the office to schedule a sensitive blood pregnancy test. While there is no evidence that leuprolide would cause any congenital anomalies, it might interfere with implantation of the fertilized egg in the uterus.