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.
I am about to start my second cycle of stimulation and retrieval. (Have not yet done a transfer) last week I spent 5 days taking Acyclovir because of an oral herpes outbreak. Is there any reason to think this will affect the quantity or quality of the eggs that are about to be retrieved? If so I would be willing to wait for my next cycle to proceed….
I do not believe it will do harm.
Geoff Sher
Hi Dr. Sher..
So this is an odd question. I was on CC ( cycle days 3-7) and Menopur 75 ( cycle days 5 – 9). Had an US on CD 10 that showed 1 follicle at 18mm and 2 follicles between 15 and 17mm. My estrogen levels on that they were 1050. My lining was only 7mm. In the hopes of improving my lining, I had to wait to trigger with Ovidrel until CD 13 ( 4 days after last menopur shot). I know this is not exactly coasting, but since you are an expert and pioneer on that method, would you be able to tell me if my cycle is wasted? From what i´ve read only, if you wait more than 3 days to trigger after withdrawal from gonadotropins, chance of implantation are very very reduced. I am not doing IVF, only timed intercourse. So basically my question is, after a 4 day withdrawal, did my follicles continue to grow? ( or at least kept their size? or do they regress without endogeneous fsh support?) and does the possible drop in estrogen ( which I read happens with withdrawal) imposibilate conception? thank you so much!
Respectfully, in my opinion, the use of this approach in the non-hyperstimulated patient has little merit. Further, I am not a fan of clomiphene in this setting…whether used alone or in combination with gonadotropins.
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
Can the uterine lining be too thick for FET? I’m at 12 now and transfer it’s on 3/2
In the absence of uterine pathology…in my opinion, no! 12mm is ideal!
Geoff Sher
Hi Dr. Sher,
Is there any reason to do an amnio if you’ve done CCS testing, cell free dna test and targeted ultrasound and these look okay? Is there something amnio catches that these tests might miss?
Background: I am now 18 weeks via IVF. History of repeated miscarriages and blood clotting disorder. I have had D&C to find rare trisomies (15 & 19) . CCS showed trisomies 13 & 19.
I understand the risk of amnio, and want to understand the risk of NOT doing amnio with my history.
Thanks so much for your guidance.
Yes I would recommend an amnio because PGS (CCS testing) is not fool proof !
Geoff Sher
Hi Dr. Sher,
Thank you for all of the information on your site. I am wondering what your thoughts are on vitrifying grade CC blastocysts, particularly in a couple with only 2 higher grade blasts available. Would you recommend CC blasts be frozen?
Also, I have two frozen blastocysts that have been PGS (with NGS) tested. One had an “inconclusive” result, and the other is reportedly aneuploid with trisomy 2 and 14. Would you advise for or against transferring both of these blasts together?
Thank you so much!
I would be reluctant to transfer an embryo with trisomies on two chromosomes as in my opinion it is probably not viable.Also, I would only zsuggest freezing expanded blastocysts.
Geoff Sher