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, we have been on menopur and gonal for the last 10 days and centrotide for 7 last one this morning. We are supposed to trigger tonight for egg retrieval Sunday morning. This mornings lh level was 24.6 mIU/mL and progesterone was .76 my/ml. Lh has been 3 or under up until today. Are we too late has ovulation already started? Thank you for your time and opinion.
It sounds as if you might be having premature luteinization coming. Recheck the progesterone level tomorrow.
Good luck!
Geoff Sher
First would like to thank you for providing so much of good information. My wife is 32 and she just completed her first cycle of IVF and 5 day embryo transferred post pgs. Her first beta hcg came positive and the value is 199.8. Post 48 hours we took second level beta hcg test and it came 357.8. Hope this is good sign. I heard that the count should double every two days. So was curious to check everything is fine.
Looks very promising!
Good luck!
Geoff Sher
Hi Dr. Sher,
I am 39 and have had two rounds of IVF (antagonist protocol with 150 Gonal-F and just 75 of Menopur as my LH is a bit higher than my FSH). Both times I had very few eggs collected (5 and 4) but they transferred two Grade A 3-day embryos each time. The first time one implanted but I had a very low beta hCG from the start, and although it doubled well the embryo stopped developing at about week 6. The second time neither of the embryos implanted. Before the third round they decided to do some clotting and antibody tests. All antibodies were negative but I found out I am homozygous for the C677T mutation and my C protein functional was 55%. All other results were normal.
I have been reading about the c667t mutation and thrombophilia, but I’m still not sure whether this is a factor in implantation failure and very early pregnancy loss, or if my results definitely indicate that I am thrombophilic. Most of the information I have found points to miscarriage later on in the pregnancy.
I guess my questions for you are:
1) Can clotting disorders be related to implantation failure and very early pregnancy loss?
2) Do my results indicate thrombophilia, and do you think they should do something different this time round (e.g. different protocol, heparin, etc.)?
3) With a homozygous C677T mutation, should I be taking folic acid (I have read some advice saying this should be avoided) or is it better to take L-Methylfolate combined with vitamin b12? Should I be taking any other supplements? About ten years ago I had a vitamin b-12 deficiency (levels at 165 pg/mL) but since then I have been taking a vitamin b1-b6-b12 supplement with 500 mcg of b12 every two weeks, which has raised the levels to 700 or so.
Thank you so much for taking the time to answer, and for any help you can give!
1) Can clotting disorders be related to implantation failure and very early pregnancy loss?
A: It is in my opinion very unlikely that a thrombophilia will cause implantation to fail or result in early miscarriage. It probably does cause later miscarriages and can compromise placentation though.
2) Do my results indicate thrombophilia, and do you think they should do something different this time round (e.g. different protocol, heparin, etc.)?
A: Yes to both those questions….but I do not believe the thrombophilia is responsible for IVF failure.
3) With a homozygous C677T mutation, should I be taking folic acid (I have read some advice saying this should be avoided) or is it better to take L-Methylfolate combined with vitamin b12? Should I be taking any other supplements? About ten years ago I had a vitamin b-12 deficiency (levels at 165 pg/mL) but since then I have been taking a vitamin b1-b6-b12 supplement with 500 mcg of b12 every two weeks, which has raised the levels to 700 or so.
A: This is controversial but it is still my opinion that Lovenox + folate may be the way to go.
Good luck!
Geoff Sher
Hi Dr Sher I am 38 and have a 3 and half year old son who I got pregnant easily and had him at age 34 and had miscarriage at 36&1/2 and now gone through 4 unsuccessful IUIs and now approaching IVF, I have unexplained secondary infertility and low ovarian reserve. Hoping for another little one soon. Any advice for me?
It is one thing for a woman who has never been able to conceive (primary infertility) to come to grips with undergoing In Vitro Fertilization. It is quite another matter for someone who has successfully achieved a pregnancy in the past having to come to terms with a subsequent inability to conceive (secondary infertility). When this happens, it raises issues of guilt, a declining sense of self-worth and ultimately self-recrimination. The ramifications often impact family relationships involving partners and siblings. The truth is that secondary infertility can be just as difficult for individuals and family to deal with as primary infertility.
There are many factors that contribute to the problem of secondary infertility. These include:
Social and marital factors: In this modern day and age where at least one in two marriages ends in divorce, it is not surprising that there would be an inevitable hiatus in childbearing. This often results in a considerable delay in re-initiating family building. Since the biological clock keeps on ticking in the interim, advancing age can, and often does, have a profound affect on a woman’s ability to subsequently conceive and successfully complete a pregnancy. In my experience, this is one of the most common reasons for secondary infertility. In addition, by the time a decision is made to enter a new relationship, many men and women will have undergone a prior sterilization procedure which now needs to be addressed. To make matters worse, many such men and women first opt for surgical reversal of their occlusive surgery, only to learn in the end that the procedures were not successful, and they now need to consider in vitro fertilization (IVF) in one form or another.
Financial factors: Here, the cost of raising a child often weighs heavily, especially in this present tough economic climate. This is becoming more of an issue as women playing an ever increasing role as a primary bread winner.
Career demands: There can be little doubt that when it comes to climbing the career ladder, women are considerably disadvantaged by the fact that pregnancy and the immediate demands of child rearing take away from their ability to compete with men. As such, many women choose to delay having another child until such time as they have been able to make up for prior lost opportunity.
Medical barriers to fertility: Certain common medical conditions, while not absolutely precluding pregnancy, make it much more difficult to conceive.
Endometriosis: It is not uncommon for women with endometriosis to achieve a pregnancy, but find difficulty in doing so again at a later date. The reason for this is that while most women with endometriosis have patent fallopian tubes, the environment surrounding their tubes is compromised due to pelvic toxins that are produced by the endometriotic implants. These toxins compromise egg fertilization potential, making it more difficult for sperm in the fallopian tube to fertilize the egg upon its arrival there. As such, endometriosis is one of the commonest causes of secondary infertility.
Tubal damage due to prior pelvic inflammatory disease: In first world countries, the early and often indiscriminate use of antibiotics for the slightest symptom has led to the point where an acute attack of pelvic inflammatory disease is often masked. As such, less than 30% of American women with tubal damage have knowledge that their tubes are compromised and that they might have subsequent difficulty in conceiving. Since, in many such cases the tubal damage will not have totally blocked both tubes, some of the women so affected might experience a pregnancy but have difficulty in conceiving again later down the line.
Dysfunctional ovulation: Since ovulation as well as normal hormonal support of the early implanting embryo are both essential for a healthy pregnancy to occur, it follows that women with irregular or dysfunctional ovulation (e.g., polycystic ovarian syndrome – PCOS, persistent follicular luteal phase deficiencies or post birth control pill ovulatory problems) might sporadically conceive and thereupon find it difficult to do achieve another pregnancy later on.
Immunologic Implantation Dysfunction (IID): has become ever more apparent that immunologic factors play an important role in achieving healthy implantation. Women with endometriosis (regardless of its severity), those with a personal or family history of autoimmune diseases such as lupus erythematosus, rheumatoid arthritis and thyroid autoimmunity (TAI), and some cases where the man and the woman share certain genetic similarities (alloimmune implantation dysfunction), will have activated CTL/NK cells that can inhibit or compromise healthy implantation. This is an often overlooked cause of secondary infertility. Most such autoimmune/alloimmune cases require selective immunotherapy and IVF.
Antisperm Antibodies: Although infrequent, some cases of secondary infertility might also be caused by the woman harboring antisperm antibodies. In such cases IVF is mandated.
Previous post-pregnancy uterine infection: Retention of products of conception after the birth of a child, miscarriage, or abortion can so damage the uterine lining as to result in subsequent implantation failure. Unless specifically looked for, this will usually be unknown to the patient, who will simply present with secondary infertility. Treatment is often difficult because such patients might not respond adequately to surgical removal of intrauterine scar tissue or to hormonal or Viagra therapy
Male immunologic factors: Most men who have undergone a previous vasectomy more than 10 years earlier, will have antisperm antibodies that will interfere with fertilization. Such cases require IVF with intracytoplasmic sperm injection (ICSI). Here we offer a few words of caution to men who are considering undergoing surgical reversal of vasectomy. Always first have a test done to exclude the presence of circulating antisperm antibodies, because in such cases, even if the reversal is successfully performed, they will not be able to initiate a pregnancy without IVF/ICSI.
Whatever the cause, secondary infertility often affects older couples disproportionately, creating a sense of urgency and even desperation in achieving a viable pregnancy before time runs out. It is for this reason that IVF becomes the treatment of choice in such cases. However, even IVF becomes progressively less successful with advancing age of the woman (whose eggs are being fertilized). In such cases it is important for the couple to be realistic with regard to their expectations. Here, options that include embryo banking and egg donation should be carefully considered.
Another important point is that whenever a regularly ovulating younger woman (under 36 years of age) with patent fallopian tubes is diagnosed with secondary infertility, it is essential to consider underlying endometriosis or non-obstructive tubal disease as a possible cause. In such cases, IVF is again the treatment of choice.
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.
Hi I’m 12 day past transfer of a 5day already hatching embryo my first beta was at 10dpt andmy hcg was 25 now today it is 30 while I know this is low they want to recheck everything in 4 days instead of 2 is there any hope that this may go on to be a viable pregnancy even with the low rising betas??
Hi Christina,
Sadly, this does not look very promising.
Geoff Sher