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.
Hi, Dr. Sher,
I am 39 and just completed my 6th IVF cycle in the past 2.5 years.
1st cycle, no blast.
2nd cycle 1 blast, neg preg test.
3rd cycle, 1 day 3 transferred, neg preg test.
4th cycle, 1 pgs tested normal embryo transferred, neg preg test.
5th cycle, 1 blast and 1 morula transferred, neg preg test.
6th cycle, 4 fertilized normally. none made it to day 3 stage.
I consistently produce 7-8 eggs and have between 4-5 fertilize normally each time. Fibroids and immunology have been ruled out. Husband has azoospermia so epipdidymal sperm was used via icsi each cycle. The 6th cycle was menopur 150/ gonal f 300 and clomid 100mg daily for approx. 2 weeks. The other cycles were menopur/gonal f only. Could the protocol of the 6th cycle be the reason I had the worst outcome to date? Are we completely out of the running for having a biological child? What protocol or supplement would you recommend if were to try one last cycle?
I would also like to add that in this last cycle, during my monitoring, they counted 3 follicles on the right and 1 on the left. However, at retrieval they extracted 2 eggs from the right and 6 from the left stating that it is hard to see follicles on the left due to intestines blocking during u/s; also stated that when pelvis is relaxed during retrieval, they can see more. In the past they have found at times 2 more follicles on the left than were seen on u/s; however an extra 5 seemed a bit high. Is it possible that I was overstimulated on the left and the follicles developed beyond the normal size? I have asked repeatedly for the size of the left follicles at retrieval but have not yet been given an answer, which I find strange.
Hello Dr. SherSher at my first ultrasound my follicle measured 10mm. At the second a week latter it measured 11mm. I was given clomid 100 for 5 days. When I went back a week later my follicle was still at 11mm. I am 43 and my Dr. said I have a %2 chance of getting pregnant with my own eggs and I should consider using a donor. He he correct?
Hi Vanessa,
I agree that at v43y it is tough to conceive with own eggs, whether naturally or with IVF. Ideally you need egg donation. However, I do not agree with clomiphene for women over 40y. It simply is highly unlikely to work. If you try it should be with IVF.
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
I am 31 years old, I have undergone 1 IUI & 3 IVF cycles (2 fresh, 1 FET) all failing in the last year. All the embryos I have transferred have been grade A (our clinic does not offer pgs testing), the fresh transfers were day 3 (grade A, 8 Cells) and the FET was 2 Pre Blasts day 5. I have a history of endometriosis, I’ve had 4 laparoscopic surgeries due to a reoccurring endometrioma on my right ovary, with the last surgery removing my right ovary (the dr explained my right ovary to be vastly enlarged with a complex mass of endo and was the size of a baseball). The endo had attached itself to my bowels as well as my bladder and my ovaries were fused to my uterus on the front and back side in each of the surgeries. (my last surgery was March 2016) I did an endometrial scratch before my second fresh transfer, my blood work, lining and response to the medicine have all been “text book perfect” according to my ER. I have brought up multiple times to my Dr that I have had issues with Endometriosis in the past, and he always brushes off the issue stating that none of the test they have ran or the fluids they have collected from my egg retrievals have not shown any trace of it. But everywhere I have read states that with endo patients have a surgery to “clean out” any endo before doing IVF. My Dr doesn’t agree with this, but after so many fails and no other explanation, I’m at a loss. What is your opinion?
Hello Dr.
I had a chemical pregnancy with my first transfer, one dr. told me to get tested for ERA and second Dr. said no need we should proceed with the second transfer. The main infertility cause is a male factor. What would you advise from your experience?
Thank you
I am not a strong believer in ERA but there is no harm in doing it!
Geoff Sher
Dr. Sher,
When our 5-day blastocyst was frozen, it was given a grade 4 expansion (best grade according to the lab). The lab punctured a small hole in the zona to biopsy the blast. When it was thawed on the day of transfer, the embryo was completely outside of its zona, likely a grade 6 expansion.
1) Is this normal for the embryo to be completely outside of the shell after de-thawing and prior to transfer?
2) Does being out of the zona prior to transfer cause damage to the embryo or implantation?
Thank you!
1) Is this normal for the embryo to be completely outside of the shell after de-thawing and prior to transfer?
A: Yes…and in fact it is a good development.
2) Does being out of the zona prior to transfer cause damage to the embryo or implantation?
A: Not if you have a good embryologist loading the catheter.
Good Luck!
Geoff Sher