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.
Hey Dr. Sher, I’m pretty sure our FET this month failed (will confirm tomorrow). The way I best deal with the grief is by planning next steps.
I have hypothalamic amenorrhea so my cycles are nonexistent and I don’t ovulate on my own. My question is in regards to timing of the next FET. Is there any reason why I couldn’t get a bleed (once I stop my PIO and estrogen) and then go right into the next FET cycle?
Also, is Lupron prior to estrogen really necessary if I do not ovulate on my own?
I do not see any reason why not!
Good luck!
Geoff Sher
Dr. Sher, I have been struggling with infertility treatment for the past two years. I just turned 44 and have two healthy boys we conceived naturally with relative ease when I was 32 and 37. My husband and I really want a third. I have a high follicle count and great day 3 testing, but irregular menstrual cycles due to hypothalamic amenorrhea. (I am fit, a runner.) In our first infertility treatment cycle, I got pregnant with IUI but sadly had a pregnancy loss at 13 weeks due to a chromosomal abnormality. After that, we went straight to IVF with PGS/freeze all. I have a great response to menopur and hcg trigger, producing 12-20 eggs each cycle at retrieval, 80-90% of which fertilize on their own, most look good quality on day 3 but then there is a fall off resulting in 1-4 blasts each cycle that they are able to test/freeze.
On my first cycle, I produced one good PGS tested embryo out of 4 blasts. The frozen transfer resulted in a chemical pregnancy (HCG level 12. I had an ERA and it showed that I was pre receptive: the transfer was done 24 hours too early. Despite my high number of follicles, it took me six cycles before I got another PGS tested normal embryo. The transfer occurred a few weeks ago with the new timing (6 days of progesterone), again my lining was around 12, everything in the cycle went well and the RE said the transfer placement was a success. I took it easy and did all the right things. Alas, we just found out that it did not take. My RE said there was no explanation for why it failed- she was surprised. The only possibility she could think of is that perhaps I have scar tissue that prevented implantation, although I’ve had an HSG.
My husband and I are devastated and wondering how to proceed. I thought if I got a PGS tested embryo and the timing was determined, it would work. What else could explain the problems? Given my age, we are wondering if it is worth it to continue trying. If so, with the same PGS/FET protocol? Anything else I should try? I really hate to give up.
Thanks in advance for your insight.
Hi Dr Sher, what in your view is the possible reason why a day 3 embryo that looks perfect starts to slow down on day 4. I know the embryo’s genome activates, but is slow development from day 4 onwards a sign it is chromosomally abrnomal, a mitochondrial issue or a genome activation issue and is there any belief that the sperm genome is to blame? Have you seen any slow developers on day 4 that have gone on to produce babies? Mine was only partially compacting on the morning of day 5, but was a perfect grade embryo on day 3 with 8 cells.
An embryo that fails to reach blastocyst by day 6 post-fertilization is “incompetent” and cannot propagate a pregnancy. In my opinion, this is in the vast majority of cases due to a numerical chromosomal irregularity (aneuploidy). Accordingly, in my opinion, such embryos would not have propagated a pregnancy had they been transferred earlier.
Geoff Sher
Hi Dr. Sher,
I’m 35, I ovulate regularly, HSG clear, and have been so far only on Clomid + timed intercourse in an effort to get pregnant. My AMH was recently tested at 2.96. My husbands semen analysis showed morphology to be at 0% but so far no Dr’s are addressing that as a potential issue. What is your opinion on 0% morphology? Is continuing to attempt timed intercourse or IUI using injectables likely to work?
Respectfully, ovulation induction with either timed intercourse or IUI will not suffice. You need IVF
Male infertility is reported as a factor in 30-50% of infertility cases. In fact, many fertility specialists will recommend a semen analysis as one of the very first tests that should be done. It is relatively simple, inexpensive and yields much information.
The two main causes of male factor infertility can be divided into either problems in manufacturing sperm or problems in getting sperm outside of the body (ejaculation of viable sperm). Sperm manufacturing problems can arise from problems in the testicle itself or from signaling problems from the brain to the testicle. Problems in ejaculation of sperm can arise from obstructions such as previous vasectomies to spinal cord injuries resulting in damage of nerves that innervate the testicle and male reproductive tract.
The initial work up for sperm problems should include a comprehensive semen analysis which will evaluate the semen against fertility standards. These include the volume of the ejaculate (2-6mL), concentration of sperm (>20M/mL), motility (>50%) and morphology (Strict >14%). The semen analysis will frequently drive the remainder of the male evaluation if warranted. For example, in severe male factor cases, where concentration is extremely low, a hormonal and genetic evaluation of the male partner including an FSH, LH, total testosterone level, TSH and prolactin might be indicated. These tests will assist in determining if the problem lies in the proper signaling of the testicle from the brain in order to manufacture sperm.
A further evaluation including a blood karyotype will further assist in determining if there is a genetic abnormality in the male causing lack of sperm manufacturing. Once these things are ruled out, then issues of obstruction must be considered. This will usually involve a urologist who specializes in male infertility. After a thorough history and physical exam of the male partner, a urologist might perform an ultrasound of the testicle, a dye test (vasogram) of the male reproductive tract, and possibly a biopsy of the testicle. There are all rather minor procedures that require very little down time.
Treatment of male factor infertility can range from intrauterine inseminations to in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). In severe cases, it might be necessary to biopsy the testicle, a procedure called “testicular sperm extraction” (TESE). The biopsied sperm cells can then be used to inject into the eggs for hopeful fertilization. This procedure can diagnose as well as treat severe male factor cases.
Some cases of male factor infertility are beyond using the male partner’s sperm, and in these cases, there is still hope by using donor sperm. The use of donor sperm is safe and effective.
I strongly recommend that you visit http://www.DrGeoffreySherIVF.com. Then go to my Blog and access the “search bar”. 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.
•The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
•Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•The Fundamental Requirements For Achieving Optimal IVF Success
•Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
•Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
•A personalized, stepwise approach to IVF
•Routine Fertilization by Intracytoplasmic Sperm Injection (ICSI): An Argument in Favor
•Hormonal Treatment of Male Infertility
•Hormonal Treatment of Male Infertility
•Antisperm Antibodies, Infertility and the Role of IVF with Intracytoplasmic Sperm Injection (ICSI)
•Varicocele and Male Infertility: When and how should it be treated?
•The Sperm Chromatin Structure Assay (SCSA): A Measure of the Potential of Sperm to Help Propagate a Viable Pregnancy
•Deciding Between Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF).
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!IUI-Reflecting upon its Use and Misuse: Time for a Serious “Reality Check
•Micro-IVF: Often Preferable to Ovarian Stimulation with or Without IUI
•Induction of Ovulation With Clomiphene Citrate: Mode of Action, Indications, Benefits, Limitations and Contraindications for its ue
•Clomiphene Induction of Ovulation: Its Use and Misuse!
If you are interested in my advice or medical services, I urge you to contact my concierge, Julie Dahan ASAP to set up a Skype or an in-person consultation with me. You can also contact Julie by phone or via email at 702-533-2691/ Julied@sherivf.com. You can also apply online at http://www.SherIVF.com.
Also, my book, “In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoffrey Sher MD
Please help me what is the meaning of hsg?
Hysterosalpingogram (a Dye Xray to test tubal patency and the contour of the uterine cavity.
Geoff Sher