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, I’m supposed to start PIO on Sunday (FET next Thursday). Went in today for a lining check and it was only 5.5. Doctor said we will most likely have to push transfer back a week to get my lining where we want it to be, but I’m going back in on Saturday to see if it’s grown enough to proceed with next Thursday transfer.
I’m on estrace 2 mg 3 x day and vaginal viagra 25 mg 3 x day.
My questions:
1) how quickly can lining grow? Is there a chance that between today and Saturday my lining will increase to 8 mm?
2) if my lining is not adequate on Saturday, would you recommend staying on meds another week and pushing transfer back a week until lining is thick enough OR canceling transfer and starting all over? Is extending transfer out a week detrimental to cycle success/implantation?
Thank you in advance.
1) how quickly can lining grow? Is there a chance that between today and Saturday my lining will increase to 8 mm?
A: 48-72h
2) if my lining is not adequate on Saturday, would you recommend staying on meds another week and pushing transfer back a week until lining is thick enough OR canceling transfer and starting all over? Is extending transfer out a week detrimental to cycle success/implantation?
A: If your lining is <8mm on Saturday I would cancel/defer the FET cycle.
Geoff Sher
Hi. My name is Meedi. I am 30 years old and till now unable to have a child .we have been trying from three years , had graves disease and thyroidectomy so the dosage is adjusted for more than a year. I have .75 AMH with one tubes blocked and same ovary displaced. Recommended that only ivf is a chance for us. First trial eas with bemfola 300 and orgalutran. Second trial was with bemfola 450 and orgalutran.third trial was with elonva and same orgalutran and bemfola.Have had three stimulations but got only two eggs everytime so refused to continue than i was prescribed with DHEA from last four months.Have been on synarel nasal spray for more than a month and began another stimulation with fostimon 150 and gonal f 300 for 6 days later continued with gonal f 450 to day 19 .just got two eggs 22mm and 17 mm respectively. They retrieved eggs and they did not fertilized and i am told that they were empty so they cant be fertilized. I am very much concerned about my own eggs.dont want to have donor eggs.is there any chance for me to have only one good egg?? Do you think thete is any hope? If yes , how do you think i can be achieved. I am very much eager to see your reply.
You clearly have diminished ovarian reserve (DOR) which sets you up for a poor response to stimulation.This could explain your low egg yield and the ’empty follicles’. You need a careful review of your protocol for ovarian stimulation.
In my opinion, the protocol used for ovarian stimulation, against the backdrop of age, and ovarian reserve are the drivers of egg quality and egg quality is the most important factor affecting embryo “competency”.
Women 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 effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, 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 women 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 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, https://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
Does it mean i have no hope for having at least a single good egg from my body for my entire life??
Dr. Sher,
For the past 8 years I’ve had recurrent ectopics and early pregnancy losses. I’m 32. I’ve had every test you can think of (all normal) and every treatment except for IVF.
Are you still doing phone consults?
I absolutely am doing phone3/Skype consultations and I think we should talk. Please call Julie at 702-533-2691 and set up a Skype consultation with me to discuss in detail.
Geoff Sher
Hi Dr. Sher,
My husband’s sperm used for IVF with ICSI was 11 days old and whiter than usual. Is sperm this old okay to use or has it begun to break down? If it has begun to break down but successfully fertilizes an egg via ICSI, are the embryos more likely to have issues?
Thanks for your guidance.
11 days is OK, but only if the sperm was frozen during that time.
Geoff Sher
reply
Dr Sher, I understand you do not suggest the use of DHEA. What do you suggest in the form of supplementation/intervention to improve egg quality?
There is very little that can be done to enhance egg quality aside from selecting an ideal protocol for ovarian stimulation. However, folic acid, Vitamin D3 and CoEnzyme Q-10 might help.
Geoff Sher