Ask Our Doctors – Archive
Our Medical Directors are outstanding physicians that you will find to be very personable and compassionate, who take care to ensure that you have the most cutting-edge fertility treatments at your disposal. This is your outlet to ask your questions to the doctors.
HI Dr Sher, i have had 8 failed IVF’s 6 of which where fresh cycles on the last cycle which was a FET we transferred 2 hatching blasts all we had, i fell pregnant but lost the pregnancy at 7 weeks, incomplete miscarriage took 2 weeks to fully pass everything, I am 37 i have good AMH at 27.7 I am in Australia my FSH is always at 4 never changes from cycle to cycle. I produce good amounts of eggs, last time i got 29 20 mature 15 fertilized, had 11 top quality day 3 embryos but by day 5 only had one left. My partner is a smoker and drinks a bit his sperm seem ok, but we had no fertilization at all with normal ivf first cycle, so every other cycle have been ICSI. Are my eggs just plain crap, or do i have hope. Last cycle we added prednisone and aspirin and intralipids, and i did fall pregnant but i lost the baby. I have an Auto immune issue called AS (Ankylosing spondylitis). Last cycle i stimmed with menopur only started at 175 and ended up at 225 added ogralutran at day 4, we have also done long protocol with gonal f only and a nasel spray and also a short protocol with luveris and gonal f, none of these have given us any more than 3 blasts max, even though i get more than 20 eggs each pick up. Is there anything i can do or are we doomed to never having babies together. I have had 3 babies with my ex husband, i had a tubal ligation in 2004 after the birth of my son. So is it just that now I am to old even though my levels are still very good. Or is it something else that is causes such poor blasts and outcomes. Thanks for reading this.
I do not think you are too old or that you intrinsically have bad eggs.When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
The most common causes of implantation dysfunction are:
a)A “thin uterine lining”
b)A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c)Immunologic implantation dysfunction (IID)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women.
Please visit my new Blog on this very site, find the “search bar” and type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
•Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What does it Involve?
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies?
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 2- Making a Diagnosis
•Immunologic Dysfunction (IID) & Infertility (IID):PART 3-Treatment
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
The most common causes of implantation dysfunction are:
a)A “thin uterine lining”
b)A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c)Immunologic implantation dysfunction (IID)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women.
Please visit my new Blog on this very site, find the “search bar” and type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
•Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 2- Making a Diagnosis
•Immunologic Dysfunction (IID) & Infertility (IID):PART 3-Treatment
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Hi Dr. Sher, I recently had my first failed IVF cycle. I have a two year old daughter that I conceived naturally by taking 2.5 mg of Fermara with no trigger shot. Since that pregnancy, we have tried to have a second child with many failed attempts at IUI (7.5 mg of Fermara and Trigger) and now our first failure with IVF. During this process I learned that I have a low AMH .95. I am 34 years old and all other tests came back in the normal range. My husband also has normal sperm. During this IVF attempt, they had me on 2 weeks of birth control and then transitioned over to 450 of Follistim and 20 mg of mini-HCG. I had 7 “mature follicles” (the seven were all above 14 mm at the time of trigger and I believe about 4 of them were in the 16-18 range) at the time of the trigger shot and a total of 8 follicles showing up. At retrieval they were only able to retrieve 5 eggs, 3 of which were mature. All 3 fertilized properly and all three made it to the day 5 transfer. We transferred 2, one was an early blastocyst and the other was a 5AA blastocyst. The 3rd they monitored until day 6 and said it was not of good quality to freeze. We just received the news that this cycle did not result in pregnancy. My questions to you are the following: 1) Based on this information, if you were my provider would you use a different protocol for medications on my next cycle? 2) Is there anything that can be done to ensure that I will have more mature follicles on the next cycle at retrieval and also follicles that actually release an egg since 3 of mine were not able to have an egg retrieved? 3) Based on my AMH level do you feel that we can have success with another round of IVF or is it going to be an uphill battle that won’t be beneficial? 4) Is there anything that I can do before another cycle to be more successful? Ex. Taking CoQ10 or any other supplements, etc. Thank you so much for your time.
1) Based on this information, if you were my provider would you use a different protocol for medications on my next cycle?
A: I certainly would. I would use a robust modified long protocol (the agonist/antagonist conversion protocol-A/ACP) with human growth hormone augmentation…see below
2) Is there anything that can be done to ensure that I will have more mature follicles on the next cycle at retrieval and also follicles that actually release an egg since 3 of mine were not able to have an egg retrieved?
A: Please read the article below on “Empty Follicle Syndrome”
3) Based on my AMH level do you feel that we can have success with another round of IVF or is it going to be an uphill battle that won’t be beneficial?
A: Yes I do…but I think you should also consider “Embryo Banking” and PGS embryo selection.
4) Is there anything that I can do before another cycle to be more successful?
A: Mos supplements do not really help. However, please read the article below on “Nutritional Supplements in IVF”.
Please visit my new Blog at http://goo.gl/4hvjoP, find the “search bar” and type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
•Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Dear Dr Sher,
I had a hysteroscopy last week and minor scar tissue/ adhesions were reported. I saw the video and they looked like white fluffy clouds. I have already had a chemical pregnancy after IVF and 1 failed FET & 2 years unexplained infertility. I have no history of prior pregnancy/ miscarriage/ surgery/ other trauma to the uterus prior to this hysteroscopy. The only risk factor I have was a prior chlamydia infection. The doctor said he cleared everything but that he does not think it was such a significant cause for my unexplained infertility”/ failed embryo transfers. He has always informed me that I have had a perfect triple lining during ultrasound and my period are largely regular and medium flow. I am currently taking antibiotics post hysteroscopy for 1 week but no other treatment. I have been advised that I can continue with embryo transfer after 2 cycles as I have more frozen embryos. I am feeling very confused.How can I know if the scar tissue will recur or even if it is completely removed? Even before the hysteroscopy nothing was visible on ultrasound/ HSG. What further treatments/ investigations are indicated in such a case? Do you think it is the likely cause of my infertility? Would you recommend a laparoscopy in my case to look for further pelvic adhesions? My doctor previously advised he does not think it is necessary as IVF is more efficient than laparoscopy.
Thanking you so much for any guidance!
I would agree with your doctor regarding not doing a laparoscopy and as far as hystroscopic findings are concerned, it does not sound like a big issue either.
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
The most common causes of implantation dysfunction are:
a)A “thin uterine lining”
b)A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c)Immunologic implantation dysfunction (IID)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women.
Please visit my new Blog on this very site, find the “search bar” and type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
•Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 2- Making a Diagnosis
•Immunologic Dysfunction (IID) & Infertility (IID):PART 3-Treatment
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
•Endometriosis and Infertily
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Dear Dr. Sheer,
Today on 8dp3dt I had my first beta hcg result. It is 66. Is this a good number?
Yes Lijana…although a little early, this is hopeful!
Repeat in 2 days.
Good luck!
Geoff Sher
So I am on day 3 of coasting have about 16 follicles between 18 and 22mm and another 15 over 15mm – waiting on e2 levels to decide weather we wait another day or trigger this evening. Which gives better results pregnal or ovitrel? My doctor says she won’t give me the 10000u but maybe 7500 if e2 levels are low enough… any advise at this stage. I personally think I should coast for another day and push for the full hcg?