19,771 Comments

1. Katie on February 6, 2018 at 3:00 pm

   Dr. Sher, I’m on birth control while waiting for our next FET attempt. I’m on a low dose (Alesse) pill, one that I’ve been on before. But I’m a week in now and starting spotting last night, now much moreso.

   This SAME thing happened in prep for our last (unsuccessful) FET. I spotted/bled for about 2-3 weeks on the pill.

   What could this be? Or is it just my body adjusting to the pill/hormones?

   • Dr. Geoffrey Sher on February 6, 2018 at 5:41 pm

     It is likely your body adjusting and in my opinion is not any cause for alarm.

     Geoff Sher

2. Valerie on February 6, 2018 at 11:27 am

   Dr. Sher, currently starting my 3rd IVF protocol. First two failed win nothing to freeze. My RE has me on Microdose Lupron 10 units once a day, but following the long lupron calendar so I won’t start stims for another week. I can’t find anything that suggests the use of Microdose Lupron in this manner. I’ve voiced my concern to them and their response is I’m on a long lupron protocol with Microdose Lupron to prevent too much suppression, but I don’t feel confident in this approach.

   • Dr. Geoffrey Sher on February 6, 2018 at 2:16 pm

     Hi Valerie,

     Frankly I agree with your RE to use this dosage of Lupron in a long protocol arrangement, provided the dosage and type of gonadotropin is optimal and the timing and dosage of the hCG trigger is ideal.

     Here is the protocol I advise for women 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

3. JT on February 6, 2018 at 8:02 am

   Hi,

   I had 0,2 mg of gonapeptyl as trigger shot in our IVF, because I have PCOS, plenty of follicles and a risk of OHSS. I don’t think gonapeptyl is an hCG trigger, but GnRH agonist .. What’s your opinion using that as a trigger shot? I had very poor result in IVF.. 🙁

   • Dr. Geoffrey Sher on February 6, 2018 at 2:13 pm

     Some clinicians, when faced with a risk of OHSS developing will deliberately elect to reduce the dosage of hCG administered as a trigger in the hope that by doing so the risk of critical OHSS developing will be lowered. It is my opinion, that such an approach is not optimal because a low dose of hCG (e.g., 5000 units, hCGu or 250mcg hCGr) is likely inadequate to optimize the efficiency of meiosis particularly when it comes to cases such as this where there are numerous follicles. It has been suggested that the preferential use of an “agonist (Lupron/Gonapeptyl/Buserelin/Aminopeptidyl etc.) trigger” in women at risk of developing severe ovarian hyperstimulation syndrome could potentially reduce the risk of the condition becoming critical and thereby placing the woman at risk of developing life-endangering complications. It is with this in mind that many RE’s prefer to trigger meiosis by way of an “agonist (Lupron) trigger rather than through the use of hCG. The agonist promptly causes the woman’s pituitary gland to expunge a large amount of LH over a short period of time and it is this LH “surge” that triggers meiosis. The problem with using this approach, in my opinion, is that it is hard to predict how much LH will be released in by the pituitary gland. For this reason, I personally prefer to use hCG for the trigger, even in cases of ovarian hyperstimulation hyperstimulated, with one important proviso…that being that is she underwent “prolonged coasting” in order to reduce the risk of critical OHSS, prior to the 10,000 unit hCGu “ trigger”.

     Geoff Sher

4. Blossom on February 6, 2018 at 3:08 am

   Dear Dr Sher, I ‘m 46, in the process of preparing for FET. 1st attempt failed, and was cancelled by RE; Endo lining was 8mm after 5-7 days of estradiol, but US on the day before scheduled transfer after progesterone therapy showed the lining had degenerated. RE thinks inadequate estrogen support. What do you think is responsible for this and what is your advise or what protocol will you use for next cycle to maximize/improve outcome? Do you recommend herbals?

   • Dr. Geoffrey Sher on February 6, 2018 at 4:10 am

     There are different protocols used by different doctors.This is something you need to discuss with your RE.

     I do not believe Herbals will help.

     Geoff Sher

5. Ann on February 6, 2018 at 12:05 am

   I just finished off my 1st (failed) IVF. I am 37 and have 2 previous children and have gone through 5 years of unexplained infertility. I was on 450 of Follistim daily after a cold start, ending with 4 days of cetrotide with the stims. I had 10 follicles >18mm and was triggered with hcg 10000. There were only 3 were retrieved, rest were empty, and only one fertilized. RE has never checked AMH. FSH and LH have always been normal. She thinks we need to go straight to donor egg after this one shot. Would there be a better protocol?