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,
Do any of these have a chance?
Trisomy 9, Monosomy 13
Complex Mosaic
Triploid
Mosaic Trisomy 14, Monosomy X
Monosomy 18, Monosomy 21
Thank you for all you do.
Elizabeth,
In my opinion …no! But there could be others that would disagree!
Sorry!
Geoff Sher
Dr.Sher, I saw fetal pole this week on Ultrasound measuring 3.1mm but my hcg level did not rise but it went from 3036 to 3075 this week. Last week ultrasound we only saw yolk sac and no fetal pole. We see progression on ultrasound but the Hcg numbers are really whacky. Can you please advice
Repeat the beta hCG in 2 days and provided the level ids rising, repeat the US in 1 week!
Good luck!
Geoff Sher
Dr Sher
I started fertility treatments this summer age 40. AMH .86….none of them worked. I responded ok in terms of follicle production. First IVF cycle I did injectables menopur and gonal F…then a Lupron trigger (as I know you don’t agree with) Out of the 24 follicles..they got 15 eggs…12 mature and 9 fertilized..I only wound up with two blasts(one early and one full) graded fair and a MORULA on day five. They were implanted and this resulted in a chemical pregnancy. I read you book and understand it has to do with being older and making weak eggs etc. The second cycle the Dr dialed down the amount of menopur and used HCG trigger etc…same results in terms of eggs 12 retrieved and 6 fertilized by day five only 2 blasts one early and one late..this did not result in any pregnancy. I am about to start my third IVF. I threw in an IUI just for fun as my friend had 6 IUIS and ^ IVF cycles and wound up pregnant on an IUI at age 41. anyway 7 days after the IUI my progesterones is only at 8.6 I will take the supplements but doubt I’m pregnant. basically I would like some input for my next cycle. Doc said at this point he will do an AGONIST cycle using Lupron in the beginning. what is your input? thank you so much . I read your book pretty thoroughly and these protocols for the most part I understand but I don’t understand what it means to start me out with LUPRON as an agonist…thank you
colleen
Hi Dr Sher
I just completed my FET at my local clinic. I was diagnosed with high NKC and TNF and given humira and intralipid before transfer. I got my bfp this week (hcg betas doubling as expected) and was then given another shot of humira and intralipid treatment 2 days ago. But I woke up this morning with joint pain everywhere. Could this be a sign that i am not reacting well to the humira and possibly affect my pregnancy or is this normal?
I do not prescribe Humira. I suggest you discuss this with your treating RE.
Geoff Sher
I am just looking for some advice. I am currently waiting to miscarry at 7 weeks (sac measuring 6+4). This was a pregnancy resulting from ivf with pre genetic screening of the embryos which was normal. For this pregnancy I had interlipids, clexane, aspirin progesterone, inofolic and steroids(20mg).
We had done a frozen embryo transfer before this and it resulted in a chemical pregnancy.
Prior to the ivf route I had a stillbirth at 24 weeks due to a placental abruption, followed by two natural pregnancies resulting in the birth of my two healthy girls ., followed by 10 early miscarriages all between 6-8 weeks. (All natural conceptions)
I have had Chicago bloods done which showed increased nk cells. I have blood clotting screening which showed no abnormalities . The ivf clinic did do test that showed a c4m2 variance for myself and my husband.
The fertility clinic have now suggested maybe sending slides to America after d and c to do more test to check lining of uterus. I am not keen on having another d and c if it is not necessary .
Really I’m just looking for advice to see if there is anything realistically I can do as I have one frozen embryo left and feel as if I have exhausted all avenues in Ireland and wondering if you could offer any new advice
Thank you
This sounds like it could be an alloimmune (rather than autoimmune) implantation dysfunction. Please read the relevant articles on my blog (see below).
Autoimmune IID: Here an immunologic reaction is produced by the individual to his/her body’s own cellular components. The most common antibodies that form in such situations are APA and antithyroid antibodies (ATA).
But it is only when specialized immune cells in the uterine lining, known as cytotoxic lymphocytes (CTL) and natural killer (NK) cells, become activated and start to release an excessive/disproportionate amount of TH-1 cytokines that attack the root system of the embryo, that implantation potential is jeopardized. Diagnosis of such activation requires highly specialized blood test for cytokine activity that can only be performed by a handful of reproductive immunology reference laboratories in the United States.
Alloimmune IID, i.e., where antibodies are formed against antigens derived from another member of the same species, is believed to be a relatively common immunologic cause of recurrent pregnancy loss.
Autoimmune IID is often genetically transmitted. Thus it should not be surprising to learn that it is more likely to exist in women who have a family (or personal) history of primary autoimmune diseases such as lupus erythematosus (LE), scleroderma or autoimmune hypothyroidism (Hashimoto’s disease), autoimmune hyperthyroidism (Grave’s disease), rheumatoid arthritis, etc. Reactionary (secondary) autoimmunity can occur in conjunction with any medical condition associated with widespread tissue damage. One such gynecologic condition is endometriosis. Since autoimmune IID is usually associated with activated NK and T-cells from the outset, it usually results in such very early destruction of the embryo’s root system that the patient does not even recognize that she is pregnant. Accordingly the condition usually presents as “unexplained infertility” or “unexplained IVF failure” rather than as a miscarriage.
Alloimmune IID, on the other hand, usually starts off presenting as unexplained miscarriages (often manifesting as RPL). Over time as NK/T cell activation builds and eventually becomes permanently established the patient often goes from RPL to “infertility” due to failed implantation. RPL is more commonly the consequence of alloimmune rather than autoimmune implantation dysfunction.
However, regardless, of whether miscarriage is due to autoimmune or alloimmune implantation dysfunction the final blow to the pregnancy is the result of activated NK cells and CTL in the uterine lining that damage the developing embryo’s “root system” (trophoblast) so that it can no longer sustain the growing conceptus. This having been said, it is important to note that autoimmune IID is readily amenable to reversal through timely, appropriately administered, selective immunotherapy, and alloimmune IID is not. It is much more difficult to treat successfully, even with the use of immunotherapy. In fact, in some cases the only solution will be to revert to selective immunotherapy plus using donor sperm (provided there is no “match” between the donor’s DQa profile and that of the female recipient) or alternatively to resort to gestational surrogacy
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.
•The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 2- Making a Diagnosis
•Immunologic Dysfunction (IID) & Infertility (IID):PART 3-Treatment
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report
•Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
•Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
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