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.
Dear Dr. Sher, I have premature ovarian failure (32 years), my partner has chromosomal translocation (42 years). With this “extreme” diagnosis we have tried IVF with donor oocytes (27 years, 22 eggs), the result was 4 high quality embryos after PGD in 2014 (what we considered to be a fantastic result). First KET failed, after second we have a healthy child. Third KET failed, I have taken 6-month break and tried KET with the last embryo. It has failed again, hcg negative once more. We want to try again with new donor but with such high-quality embryos what we can do differently? What should we check? My uterus lining is thick enough (1 cm) and totally ok according to the hysteroscopy (it was done twice), we both were cured of chlamydia three years ago. My thyroid tests and liver is also ok (liver results are sometimes a slightly over average but it can be caused by hormones to stimulate uterus lining and genetic disposition in my family). We both are healthy, sporty, BMI ok, with no serious health issues. The IVF center is in the Czech Republic, the best so far with excellent results in PGS/PGD/cryo-conservation and many clients from Europe (we had very bad results from other clinics, we got just a huge bill but no embryo to be transferred). Is there anything specific we should check by me or by embryos next time? Embryos had different RH factor than me. Or should we stop trying after this diagnosis and results? I feel that after this disappointment I could be happy enough with one child. Thank you in advance for your help, you are doing a fantastic job here. Sorry for my English. Lucy
Since these were PGS tested embryos and were normal, the translocation should not be an issue: Please see below:
Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
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 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.
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•IVF: How Many Attempts should be considered before Stopping?
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•IVF Failure and Implantation Dysfunction:
•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!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
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
Hi Dr. Sher,
How many days of bed rest is recommended for a 5 day FET? I took off a week last time and got pregnant but then miscarried a few weeks after.
Is this strictly bed rest or more like relaxing at home do you recommend and how many days?
Absolute bed rest beyond 12 hours post ET, is in my opinion not necessary.
Geoff Sher
Hi, Dr. Sher. I have a question regarding future IVF cycles for myself. I currently have 1 day 5 pgs normal embryo frozen at grading of 3BB. I have one day 6 pgs normal embryo frozen at a grading of 6AB. I was 34 at the time they both were frozen. I’m thinking of going back to IVF in my early 40’s. What are success rates for a woman in her 40’s using an embryo from her 30’s. Is the success rate high? I don’t even know if we should put the money into a frozen transfer if success is low. I would be devastated if it didn’t lead to a pregnancy. Thanks for the time!
If they were frozen correctly by vitrification, the time lapse should not make a difference.
Geoff Sher
Hi Dr Sher,
Just had a failed first IVF cycle. I’m 34 years old, with normal hormoneand AMH levels. On the antagonist protocol I had 21 eggs retrieved, 15 mature. 12 made it to embryo. By day 3, 2 were developing normally, 6 were behind, and the rest gone. By day 5, none had developed into blastocysts. Our treating team said they were shocked by the result. My partner’s sperm is normal as well. Is this an egg problem? What can be changed as I did respond very well to the stimulation?
Dear Dr Sher,
I am a 40 year old woman, turning 41 in May. I have been through 3 rounds of IVF using ICSI. The first round when I was 35 resulted in the birth of my beautiful 5 year old daughter.
The second round at 40 years of age produced a pregnancy which turned out to be a missed miscarriage at 7 weeks 4 days. The D&C 2 weeks later confirmed an actual pregnancy.
The 3rd attempt just 7 months later ended when no eggs were collected at egg collection?? I’m struggling to understand how I’ve gone from 6 eggs on the 2nd cycle to none in the 3rd in only 7 months? A test was carried out in theatre to see if the trigger shot was done properly and it was,as a pregnant result was found.
I was on the highest dose of Merional and certatide. Gonassi was used for the trigger. Drs mumbled something about the possibility of faulty meds, but I can’t see how that could ever be proved.
Is the miscarriage and now no eggs on egg collection what I’m starting to fear, that I’m now too old to conceive with out using doner eggs?
Desperately trying to find some answers as I’m devastated at what’s happened.