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,
My age is 30.I fall under unkown infertility.This is my first ivf cycle. last month i have my first ET and resulted negative. Doctor transferred 3 Embryos of Grade A with 10cell,8cell and 8 cell. But none of the embryo implanted. I had Endometrium size around 9.3mm. and I don’t have any Thyroid or pcod or any other harmone imbalance issues. my doctor is suggesting for second ET after a month using some gel one day before the ET. I would like to know is there any other reasons i need to investigate before going for ET. or any additional support for implantation.
Hi Dr. Sher, i was wondering if you recommend Valium before an FET or if you prefer ibuprofen. I believe my clinic perscribes ibuprofen 800mg an hour before transfer, but I’m reading a lot of conflicting info on whether ibuprofen is something i should take and it’s starting to make me a bit nervous. If i have the choice between Valium, Xanax, ibuprofen or taking nothing at all before FET, which is the best option? THANK YOU!!
I do not like Ibuprophen because it is an antiprostaglandin and prostaglandins play a role in the implantation process. I prescribe Valium.
Good luck!
Geoff sher
Thank you! Do you think Xanax be okay instead of the Valium or i should stick to the Valium?
Dr sher, can you please advise?
My husband and I have had four cycles of ivf with all negative pregnancy results. I have never been pregnant. Normal semen analysis on all occasions. First treatment was with the NHS after all initial bloods & scans were considered normal.
14 eggs were collected. 8 fertilised & 2 transferred on day 3. Negative result.
A year later after continuing to try naturally we attended a private clinic in Belfast. We had icsi on this cycle. December 2016.
16 eggs were collected, 13 inseninated, 8 fertilised. 2 embryos stage 8 were transferred on day 3. Negative result. 0 frozen. Developed OHSS and hospitalised for 3 days.
In March 2017 we had icsi again at the clinic. 32 eggs were collected, 22 were inseminated, 14 fertilised, 0 transferred 0 frozen. Over stimulated. Money refunded by clinic and apology given from clinic manager. Drug for down reg was prostap.
Our last icsi was October 2017. Drug protocol changed to menopur & ceriotide for stims and ovitrelle/suprecur as trigger.
18 eggs were collected, 13 inseminated, 7 fertilised. 2 embryos transferred on day 3. Both at stage 9. Nil frozen. Chemical pregnancy (hormone level at 21) on first blood test. Negative pregnancy result.
I am considering asking my GP to check my thyroid again. I would be very greatful for all advice you can give. Many thanks.
Dear Dr. Sher,
Is Prometrium taken vaginally equally as effective as Endometrin for progesterone supplementation?
I believe so!
Geoff Sher
Hi Dr. Sher,
My wife is 34 year old and with low AMH (.6 and then 1.1 two different results) . Her left over is not visible in ultrasound and RE only got eggs from right overy. She went through 2 iui and 1 ivf cycle(this month). None of those worked. For IVF she got only 3 eggs from right overy and those only survived through day 3 with 5 cells. Her RE is not confident to through next cycle. Please let us know if something can be done to improve her chances. She took 300 follistism and 150 menopur(first 3 days only 75) for 9 days and then ganirelix for 3 days.
Thank you Suresh!
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”.
Women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
Please visit my new Blog on this very site, https://www.drgeoffreysherivf.com, find the “search bar” and 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 Approach
• 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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
• 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?
• Blastocyst Embryo Transfers should be the Standard of Care in IVF
• Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
• Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
• 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
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
• Traveling for IVF from Out of State/Country–
• A personalized, stepwise approach to IVF
• How Many Embryos should be transferred: A Critical Decision in IVF.
• The Role of Nutritional Supplements in Preparing for IVF
• Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
• IVF Egg Donation: A Comprehensive Overview
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