CPP Protocol
May 23, 2024
What is the CPP Protocol?
The “CPP Protocol” refers to a series of three medications that you can take orally.
You may be familiar with Claritin and Pepcid, over-the-counter medications approved for allergy relief and gastrointestinal irritation respectively. They are both histamine receptor blockers; Claritin blocks H1 and Pepcid H2, and together they can deactivate part of an immune system reaction. A stronger immune system modulating medication is Prednisone. This is prescription-only, for it has a more material range of side effects.
Who may benefit from the CPP Protocol?
The CPP protocol may be beneficial for patients with recurrent pregnancy loss (RPL) despite the transfer of euploid embryos. RPL is defined by two or more failed clinical pregnancies. Euploid embryos are embryos that have been screened using PGS (PreImplantation Genetic Screening) in a previous fresh IVF/ICSI cycle.
The CPP protocol has not been validated in peer reviewed studies.
We reserve the CPP protocol to Frozen Embryo Transfer (FET) plans where one or two euploid embryo(s) will be transferred.
Who cannot use the CPP Protocol?
Due to the Prednisone, the CPP protocol is contraindicated for those with a diabetic condition.
What are the side effects?
No side effects are routinely anticipated from Claritin or Pepcid.
Prednisone, however, has health implications when used long term or at high doses. There is also some controversy as to safety in early pregnancy. Like any drug, there are risks involved with taking steroids. Some studies have shown an association between first trimester systemic corticosteroid use and oral clefts or decreased birth weight; however, information is conflicting and likely related to dose. For this reason, we use low doses and stop the medication early in pregnancy and preferentially limit its use to transfer cycles that are associated with the highest pregnancy rates per transfer.
What else do I need to do when taking the CPP protocol?
We ask that you discontinue using all caffeinated products one month prior to your estimated embryo transfer. This includes products such as coffee, tea and chocolate. You will need to refrain from caffeine throughout the FET process and first trimester of pregnancy.
Medication Instructions
The medications start two days before the estimated date of embryo transfer. Your nurse will provide these instructions again, with specific dates, as part of your FET schedule.
CLARITIN 10 mg orally once a day - starting 2 days before transfer
Claritin is an over the counter medication that may be purchased through the pharmacy of your choosing. It will be located with the allergy medication.
PEPCID - 20 mg orally twice daily - starting 2 days before transfer
Pepcid is an over the counter medication that may be purchased through the pharmacy of your choosing. It will be located with the stomach medication.
PREDNISONE - 10 mg orally once a day - starting 2 days before transfer
Prednisone is a prescription medication. Your clinical team will provide this prescription once your FET cycle has begun. The medications will continue unchanged through to your scheduled pregnancy test.
Claritin and Pepcid will continue to 12 weeks of pregnancy.
Prednisone will continue daily at 10 mg until a positive pregnancy test. The dose will then be decreased to 5 mg daily. At the 7th week of pregnancy the medication will be stopped upon ultrasound review.
In the event of a negative pregnancy test, Claritin and Pepcid will both be stopped. Prednisone will be decreased to 5 mg daily for one week and then stopped.
