What does IVF downregulation mean ?

I love answering patient's questions about IVF , because I think the more they understand about what we are doing, the better they'll be able to appreciate the difference between a good IVF clinic and a bad IVF clinic.
Someone asked me what does down-regulation mean, and why do we need to do this ?
When growing egg during an IVF cycle, we use 2 processes - one is super ovulation, while the other is downregulation. Think of these as the 2 levers which allow us to precisely control your egg production.
Super ovulation , as the name suggests, uses hormones to help you to grow lots of eggs. These are natural hormones, and since we give them in a higher dose, they help to prevent your follicles from dying, so that you grow many follicles in the IVF cycle.
Down-regulation means we also need to give you another set of hormones , to prevent these follicles from rupturing on their own once they become mature .
While we stimulate your ovaries to grow lots of follicles ( which contain the eggs) , we also need to switch off your pituitary at the same time, so that these follicles don't rupture on their own.
Down-regulation can either be done by using GnRH agonists, using what is called a long protocol or a short protocol; or by using GnRH antagonists. Both these methods are equally effective, and the advantage of the GnRH antagonists is that you need to take them for fewer days.
These injections are given subcutaneously ( under the skin), and are easy to self-administer.
You can learn how to take your injections at

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Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.