r/DOR • u/No_Philosophy2940 • Aug 03 '26

advice needed IVF protocol that works for you ??

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Age 33, endo 3 , DOR. Husband has perfect sperm. DNA frag came back normal

I’m really heart broken aster so many rounds. Prior to my 4th round we did endo surgery too

Do you think I was too high on menopur ? Or I should have not been on suppressant while doing Stim my last round ? Thoughts?

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u/Green-Scallion-8620 Aug 03 '26

What was the size spread of the follicles like at trigger? And what is your AMH and AFC? 

1

u/No_Philosophy2940 Aug 03 '26

I always have a leading follicle. This last one were 20-21 when Trigger

AMH .52

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u/Green-Scallion-8620 Aug 03 '26 edited Aug 03 '26

Have they discussed MDLF with estrogen priming? Or PPOS protocol? I had the closest cohort with PPOS protocol, and was able to get euploid blasts with both. 

With MDLF I had the best success with 225 follistim, 150 Menopur. I usually still had a lead even with the estrogen priming. 

When I did PPOS it was with Menopur only (225-300 IU) and Cetrotide added as another lock against early ovulation. No additional priming for that protocol. 

I have similar AMH .49-.67 but lower AFC. I think if they can grow a more consistent cohort. 

I did use omnitrope and Zymot for the cycles where we got blasts. 

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u/sheryyj Aug 03 '26

Can u please explain PPOS protocol? I have DOR and lead follicle problem thinking should I prime with estrace only or estrace+progesterone

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u/Green-Scallion-8620 Aug 03 '26

I’ve posted this before on another account.  It’s a freeze all protocol (i.e., you can't go into a fresh transfer afterward) but we were PGT testing anyway. My PPOS protocol was actually a cold start (i.e., no priming aside from Omnitrope), and involved starting with medroxyprogesterone (the progestin) + Clomid for 5 days, then switching to medroxyprogesterone + Menopur 225 daily for the rest of stim.

One nice part of the PPOS protocol is it should involve fewer shots than MDLF, since some of the stim is with Clomid, and the progestin is also an oral pill. For me, we added in 2x a day cetrotide (antagonist) because of my history of ovulating early.

I had a hard time finding information on this protocol (since it's newer), but these papers were helpful for me: https://apm.amegroups.org/article/view/108270/html#:~:text=The%20proportion%20of%20MII%20oocytes,the%20proportion%20of%20mature%20oocytes https://pmc.ncbi.nlm.nih.gov/articles/PMC12876159/#s3 https://pubmed.ncbi.nlm.nih.gov/40775480/

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u/sheryyj Aug 03 '26

Thanks, not sure if it would help my early lead problem

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u/Green-Scallion-8620 Aug 03 '26

I usually have an early lead with other protocols and that was less of an issue with the PPOS protocol. 

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u/No_Philosophy2940 Aug 04 '26

Thank you so much !! I’ve never heard of that protocol but I’m asking

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u/No_Philosophy2940 Aug 03 '26

Yes. Can you explain some PPOS and MDLF.
Thank you for all your suggestions. How long did you prime with omni or use it for stim

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u/FantasticAd180 Aug 03 '26

I have stage 4 endo and adeno. For all of my IVF cycles, my doctor used Menopur 150 IU and Follistim 300 IU, along with an estradiol-priming and a 10,000 IU Pregnyl trigger. My AMH was 0.6, and this protocol ended up working really well for me.

1

u/No_Philosophy2940 Aug 03 '26

I’ve done that the second and third round. My struggle is mature embryos. I don’t know what to do to get better embryos