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.
Hello Dr Sher and thank you in advance for sharing your expertise!
I am 40 soon to be 41, and my partner is 43 and we are in the UK. I have elevated TSH level and take thyroxine for this, but no thyroid antibodies and no other issues( other than immunes)
We have undergone 2 IVF cycles. Both flare protocol, maximum doses, producing 11 eggs, 7 fertilised. The first cycle( no immune treatment) I had a split transfer, day 3 and 2 x BC blasts day 5 and one BC blast to freeze. HCG was 2 , BFN
2nd cycle, immune treatment with humira & IVIG to treat elevated cytokines and NK cells. Same protocol, 11 eggs, 7 fertilise and 4 to day 5. 2 x AB blasts & 1 BC blast transferred. 1 BC frozen. BFN
We did not have PGS testing though I asked for it on the 2nd cycle.
We are now having further tests, Sperm DNA fragmentation, DQ Alpha Match, karyotyping and LIT, a biopsy etc. Would you suggest doing PGS on my next cycle? I am meeting with the clinics embryologist this week as the clinic are not pro PGS but they will do it if you ask for it.
Would you also recommend to freeze the embryos ( maybe batch) and do a FET instead of a fresh where my body can be in an optimal condition for transfer or is fresh always preferable?
and last question, do you think it is worth doing PGS on the frozen embryos we have or will the thawing/ refreezing cause undue stress on the embryos?
Thank you so much in advance!
I have just completed the first cycle of a x3 cycles, mild IVF. After seeing 8/9 follicles only 5 were mature enough for collection and all three on the left were empty. Out of the remaining two only one fertilized and that failed to go beyond the 4 cell stage.
I am 43. A decent ovarian reserve and regular periods. I have mild/moderate Adenomyosis. I had one pregnancy (to 8 weeks) on IUI a year and a half ago. Since then no luck with three further IUIs thus the move to IVF. Any suggestions for the next two cycles?
Hi Nicola,
Very respectfully, I am totally against mini-IVF for older women and for thjose with diminished ovarian reserve.Results are very poor!
In my opinion, the protocol used for ovarian stimulation, against the backdrop of age, and ovarian reserve are the drivers of egg quality and egg quality is the most important factor affecting embryo “competency”.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
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.
•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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•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)
•Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
•Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•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 Testing (PGS) in IVF: It Should be Used Selectively and NOT be Routine.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•PGS in IVF: Are Some Chromosomally abnormal Embryos Capable of Resulting in Normal Babies and Being Wrongly Discarded?
•PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
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 book,”In Vitro Fertilization, the ART of Making Babies” is now available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoffrey Sher MD
Hello Dr Sher, I saw you advocate the double trigger – would you recommend 2 x Ovitrelle 250mg or a combination of Ovitrelle and another (e.g. Buserelin)? thanks
It is NOT a double trigger that I advocate. It is a single trigger with 2X 250mcg ovidrel.
Geoff Sher
HCG level of 22.6(2.26mlU) at 15DPO- Should I still be hopeful?
Repeat in 2 days to see if it doubles.
Good luck!
Geoff Sher
Sorry Dr. Sher, one more question: In your experience, how much does BMI affect uterine lining measurement? More specifically could a “healthy” but lower BMI of 19 make it harder to get lining up to 8 mm? I’ve always struggled with my lining (gets to about 7) and wondering if my weight might have something to do with that. I definitely eat well/hearty so I’m not restricting or “dieting” by any means, but if stuffing my face to put on a few pounds will help thicken my lining, I’m definitely open to it. Do you think body weight is a factor here or no?
Hi Katie,
If you eat well (no anorexia) and you menstruate regularly, I do not think BMI will play a big role.
Good luck!
Geoff Sher