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.
Dr Sher, Thank you very much for being a beacon of logical and enlightening information. I have read nearly every word of your published content and have been empowered to take an active role in my fertility issues through your virtual mentoring. I just turned 39, have DOR and have been labeled a poor responder after 6 IUIs and a failed IVF (traditional antagonist protocol). Fortunately, I discovered you before commencing my second IVF cycle (RE “wants to try” a stop Lupron protocol). My first IVF failed as you described due to premature luteinization. Without an agonist at the end of my last cycle to adequately recruit my antral follicles and suppress LH, we watched 11 follicles on CD2 receive increasingly excessive stimulation without controlling LH(starting at 300IU of GonalF and 150IU of Menopur, ending after 14 days of stimulation at 450IU of GonalF and 225IU of Menopur!!!). On CD9, two days after a dominant follicle was identified, Ganirelix was introduced, as you say “shutting the gate after the horse had left”. 48 hours prior to ER there were 4 follicles over 14mm, but only 3 left at the time of ER, resulting in 2 embryos, both fertilized via ICSI. Unfortunately, having survived the extremes of this cycle, our one poor over stimmed soldier, transferred as day 5 early blastocyst, but failed to make in any further. I am actively negotiating with my RE to incorporate your A/ACP methodology and these questions:
1) Is 7 days of Lupron 0.25mg/day with a 3 day overlap of BCP sufficient to provide optimal follicle recruitment or should the dosage be 0.5mg/day?
2) The following study recommends the minimally effective dose of Ganirelix as 0.25mg but you recommend half that dose, would you mind elaborating on your choice?
https://academic.oup.com/humrep/article/13/11/3023/701498?searchresult=1
Is half the 0.25mg dose acceptable because you recommend it begin starting CD2 and not later as traditional antagonist protocols recommend? Would taking 0.25mg every other day be as effective in your opinion as this study suggests?
https://academic.oup.com/humrep/article/20/11/3192/2913821?searchresult=1
Thank you!!!
1) Is 7 days of Lupron 0.25mg/day with a 3 day overlap of BCP sufficient to provide optimal follicle recruitment or should the dosage be 0.5mg/day?
A: I would use o.5mg Lupron daily
2) The following study recommends the minimally effective dose of Ganirelix as 0.25mg but you recommend half that dose, would you mind elaborating on your choice?
A: Based upon several thousand cases…I respectfully disagree. 125mcg is sufficient but 250mcg, while unnecessary probably wont do harm.
Is half the 0.25mg dose acceptable because you recommend it begin starting CD2 and not later as traditional antagonist protocols recommend? Would taking 0.25mg every other day be as effective in your opinion as this study suggests?
A: I would stay with a daily dosage
Good luck!
Geoff Sher
Thank you!!!
Hello Dr. Sher,
I am 41 yo with a very low AMH- .4. I am recently married- 12/31/17. We have tried naturally since November. I am supposed to get my period on Sunday (if not Pregnant- we did try). If not pregnant, I will start our first IVF cycle next week. We are planning a Micro Flare protocol starting with BCP. I am very nervous that the results will be very poor. I am told by friends that BCP is absolutely the wrong way to go (too much suppression) and by starting with BCP, our retrieval is sure to be very low. My doctor did mention that some doctors use HGH, but said we would’t be doing that (at least initially). Is HGH used across the country? We are in Texas. Besides being 41 with low AMH, I am very healthy. I take all the right vitamins (including COQ10, no DHEA), eat the right diet, Acupuncture weekly for past 5 weeks and to continue. HSG was normal. I do ovulate. My cycle is short- every 24 days. Should I ask my Doctor about the Antagonist protocol with HGH? I am anxious and needing to trust my d
doctor, but friends and the internet have me conflicted.
Hi, Dr. Sher. Thank you for all that you do here. I have question about FET. Do you prefer natural FET or medicated?
Which day after increase LH do you prescribe progesterone? Do you do ET after 4 days progesterone administration or 5 days? Thank you
All my FET’s are done in medicated cycles and the transfer is done o day-6 of progesterone.
Geoff Sher
Hi Dr Sher,
What is a safe level of E2 and progesterone favourable for FET? I see a wide range of values from different resources. Please what are your thoughts on this subject? Thank you.
High E2 levels of even 2000pg /ml are safe, but a better question is what is advisable and what should target E2 blood levels be. The answer is that it largely depends on the mode of administration. For example , when oral or vaginal estrogen is used levels of 200-300pg/ml are acceptable, while when intramuscular estradiol valerate is 500-1000pg/ml is my target.
Geoff Sher
With the news about AMH and FSH not being predictive of pregnancy rates after all in younger women, how does that affect those #s being indicators of premature ovarian failure?
For context, after a time of e2 being 600 at age 36, it plunged down and FSH went to 89, Amh nearly undetectable. AFC of 3. I was diagnosed with POF, unexplained. Is there any way it could be wrong/still fluctuating? I never stopped having periods.
AMH/basal FSH are simply indicators of ovarian reserve (the # of eggs still remaining in the ovaries), not of egg quality. And obviously the fewer eggs available, the lower the yield of embryos.
Geoff Sher