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 am 38 with low ovarian reserve which protocol would you recommend I use for Ivf? Thank u!
Hi. I am 40
Copy??
Geoff Sher
Hello dr. Sher.
Can it do harm to take DHEA when the blood result for DHEA, DHEA -S and testosteron are in the normal range?
Do you have perhaps other tips/ advices for egg maturation?
Thank you again for your time.
Kinds regards, Eleanore
Dear Dr Sher,
I’m 43-yrs old, pregnant (13.5 weeks) with donor egg (27-yr old repeated (5X) donor) following FET.
Based on my donors genetic profile, her risk of Downs is 1/1440, and overall general abnormalities 1/499.
I just underwent 1st trimester screen, and got puzzling results, which the Dr+counselor weren’t sure how to explain, hence I’m turning to you.
After NT measurement + PAPP-A/HCG, my Downs risks if 1/90 (adjusted to donor’s age). The Dr isn’t sure whether the tests truly reflect Downs or placental dysfunction due to the following variables:
-previous complete uterine rupture
-NT 2.6mm
-*PAPP-A 0.14 MoM
-HCG 0.55 MoM
I asked this Dr if IVF reduces blood test scores but she wasn’t sure.
This is the 2nd embryo to be transferred : 1st didn’t implant. I only have 3 left and am confused that they’re all ‘abnormal’.
What do you please think is happening (I’m taking the cell-free blood test next week).
Thank you very much
I suggest you do an amniocentesis to make absolutely certain all is well!
Good luck!
Geoff Sher.
Dr. Sher, I was under IVF/PGS and altogether I got 10 blastos but only 1 out of 10 was euploid (3mosaics). This is the point… after 2 miscarriages from natural conceptión (the heart at the 11th week stopped in both cases…and the biopsy showed aneuploid fetus). On my stims the embryos always present a considerable fragmentation rate and always produces a 6-day blastos. However, my eggs rate maturation is over 90% with the average of 11 oocytes retrieved per stim and with 85% fertilized. The problem comes on day 3/4 when the embryos start to arrest or present more fragmentation. TUNNEL and FISH was already performed and it was negative for SDF. Could you, Dr. Sher, add any light to a diagnosis or how to proceed from now on? In your opinion my case is for egg or sperm donation?
Hi Janne,
I really would need much more information regarding u=your age, your ovarian reserve (AMH) and the exact protocol used for ovarian stimulation to =comment authoritatively. There is little doubt that the most important factors influencing egg/embryo “competency” is the age of the woman and the protocol used.
Here is the protocol I advise for women, <40Y who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur---no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://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
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
If you are interested in seeking my advice or 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 .
*FYI
The 4th edition of my newest 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