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,
First I would like to congratulate you for all of your success in your career. When you retire, the reproductive medicine community will be missing a force!
My question is this: I’ve had 8 early losses all before 6 weeks, no live births. I am 32 years old. I’ve tried intralipids, steroids, I’ve done medicated cycles with progesterone and estradiol, lovenox, baby aspirin, letrozole. You name it. I’ve had a battery of testing done for RPL including antiphospholipid testing, thyroid, sonohystogram, X Ray of tubes, karyotype. All normal.
I suspect I have an implantation issue due to endometriosis. I haven’t been diagnosed with endo but I have all of the symptoms.
My husband and I cannot afford IVF. Are there any other treatment options for us?
Thank you
Hello Dr, my HCG level 9 days post 5 day transfer was 166, at 12 days it had only risen to 260. Does this mean it cannot progress?
You need to repeat the hCG level test, 2 days after the last one and then in about 12 days, do an ultrasound.
Good luck!
Geoff Sher
Dr Sher, when a miscarriage occurs who is to blame for the abnormality – the egg or the sperm or both? It is almost always seen as the egg but I read recently the sperm plays a part also. Is this true, and if so to what degree?
In my opinion. More than 70% of the time it is the egg…
Geoff Sher
I found out that I only have one working tube. My doctor believes I was just born without one. When we started to try I was having issues with ovulating. I responded well to Clomid. My husband was deployed for a year and since he has been back I have been taking Clomid, but only had one month when the dominate follicles were on my “good” side. This month I have decided to not take clomid to see if the medication might be messing with my natural ovulation between sides. What do you recommend for people only having one tube?
It depends on the cause of the blockage. The reason is that if you were born without the tube the other one is probably OK. If it blocked later, it usually is due to inflammation (which often can occur without symptoms) which can be unsuspected, and if the latter, then the open tube will likely be damaged and IVF would be the way to go. I suggest a laparoscopy to determine this definitively.
Geoff Sher
I’m 41 years old and will be 42 in May 2018. I was born with gastrochisis and only have one tube and functioning ovary because my left is mangled in scar tissue. I underwent IVF 10 years ago because my tube was blocked and it was a horrible experience which led to my divorce. Five and a half years ago I finally met the right man and of course we decided not to rush into having kids and making sure our relationship was solid. I feel very blessed today and lucky to have this incredible man in my life and he said that he knew when I met him that I may or may not be able to have kids and he’s okay with that. A lot less pressure for me. I know some of you may not agree that we waited but I refused to have kids with the wrong person. After having tried for a year we are now going to a fertility clinic. Last month (February 2018) my count was 5 then only 3 and none matured or released. This month (March 2018) they saw 2 and I’m on day 4. I am starting medication tonight to elevate my FSH level to see if one or both will mature and release. My next ultrasound is on Monday. Apparently my right tube is no longer blocked. I am super nervous and praying that this will work. It would be a blessing to have kids as we both love children. We are so good together and we would have so much to give to our child. I’m not sure what my odds are at this point. Can it happen? Can my antral follicle count change from month to month? With these stats am I too close to menopause? What are my odds, could both mature and release? I can’t find any information regarding my actual reserve count or any chart? If you’re reading this and have answers whether positive or negative it would be appreciated.
I cannot say I blame you in any way for deferring having a family, but alas, at 42Y with diminishing ovarian reserve you now have a significant issue on hand.
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those 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 age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can 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 older women and those 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 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, http://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