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 Ive done my transfer today and I had 3 embryos (1AB and 2 : 1BB) what are my chances of getting pregnant with the 1 AB?
I cannot answer that authoritatively without MUCH more information …sorry!
Geoff Sher
Hello Dr. Sher, I had a 4bb transfer on March 19 with my beta 10 days later, it was a 5 day blastocyte. My hcg was 40 on first check. I did do home tests day 4,5,6 and 7 with them all coming back negative. My RE RN basically said I wasn’t out of the game yet, but I am concerned at how low that number was. Is there really such thing as a late implantation or should I just prepare for the worst? Thank you..
I would retest your blood beta hCG.
Geoff Sher
Hi Dr. Sher. Me and my boyfriend had uroplasma about two years ago. We both were treated with Dyxocylyn, however now I found out that I am still positive for uroplasma. My gynocolgist presribed Metronidazole this time. Is this a good antibiotic to treat uroplasma? And is it posible for this to come back even when you are in a monogamus relationship?
Thank you!
Ureaplasma urealyticum is a bacteria that belongs to the mycoplasma family. It can be detected in the reproductive tract of as many as 40% of individuals (male and female). Ureaplasma probably does not prevent normal conception in the majority of cases, because the uterine cavity remains sterile even in women whose cervical mucous cultures positive for the organism. However, when present in the woman’s cervical secretions, the organism can be unintentionally dragged into the uterine cavity through introduction of a catheter into the uterus at the time of embryo transfer (ET) or intrauterine insemination (IUI). Molecular biologists have shown that contamination of rapidly growing cell cultures, by this organism and its close “relative”, mycoplasma hominis rapidly destroys such cells. The implanting embryo is indeed an example of an organism that comprises rapidly growing cells in a biological culture medium (the uterine lining), and as such, the cells of the trophoblast that form the “root system” of the embryo are vulnerable to intrauterine infection with Ureaplasma. However, even if the uterine cavity were to become infected, the infection willl be purged with the shedding of the infected lining at the time of the next menstruation.
While infection with Ureaplasma rarely produces symptoms in the woman, it sometimes causes symptomatic prostatitis or epydidimitis in men. Although ureaplasma can be transmitted from one partner to the other by sexual intercourse, it may also be acquired by other means, since a large percentage of couples in monogamous relationships will culture positive for the organism. It is very difficult for the organism to grow in the laboratory. Accordingly, the reproductive secretions of both partners should be evaluated (sperm and cervical mucus) individually. Successful culturing of ureaplasma requires a specialized media in which the specimens can be transported safely from the physician’s office to the microbiology laboratory.
If both partners culture negative, we can assume that there is no infection present. However, if one partner cultures positive and the other negative, we would err on the side of caution, by assuming that the negative result was caused by the difficulty in culturing the organism. When ureaplasma is detected in the reproductive secretions of either partner, both should be treated concurrently with the appropriate antibiotic (doxycycline, zithromax, erythromycin, ciprofloxin, or metronidazole; cleomycin).
Unfortunately, in approximately 30-40% of couples infected ureaplasma urealyticum, the bacteria will have built resistance to mainstay traditional antibiotics such as tetracyclines (e.g. doxycycline) and erythromycin (e.g. Zythromax) derivatives. In such cases, ciprofloxin or metronidazole (Flagyl) therapy might be needed. This is the reason that we prefer to document cure by reculturing each partner prior to beginning ovarian stimulation for an IVF cycle.
Several authors have shown a difference in pregnancy rates among patients with ureaplasma infection who were treated with antibiotics and those who were not. Other reports have not been able to identify an effect on outcome from ureaplasma infection. Thus, until the final verdict is in regarding the roll of ureaplasma with regard to its effect on IVF implantation, we prefer to err on the side of caution and ensure that this organism is absent in cervical secretions and semen before transferring embryos. To this end, my patients all receive prophylactic antibiotic therapy around the time of embryo transfer. This is administered as oral ciprofloxin. A day or two prior to embryo transfer, vaginal cleomycin suppositories are added.
Geoff Sher
Dear Dr Sher,
Can you please clarify something about prolonged coasting ?
In the following link you say that “provided the [E2] is >2500pg/ml, I stop the agonist AND the gonadotropin stimulation”: https://www.drgeoffreysherivf.com/preventing-severe-ovarian-hyperstimulation-syndrome-with-prolonged-coasting/.
However, in this other link about the same subject you say that “Avoiding OHSS through Prolonged Coasting (PC) is a procedure introduced by us in 1991. It involves abruptly stopping gonadotropin therapy while continuing to administer the GnRH agonist ”: https://haveababy.com/fertility-information/ivf-authority/severe-ovarian-hyperstimulation
Which one is the correct approach for prolonged coasting? Stopping gonadotropin therapy while continuing to administer the GnRH agonist? Or stopping both at the same time?
This is correct!
“Avoiding OHSS through Prolonged Coasting (PC) is a procedure introduced by us in 1991. It involves abruptly stopping gonadotropin therapy while continuing to administer the GnRH agonist ”
Geoff Sher
Hi there!
Could you please let me know what is your earliest recommended day to do a pregnancy test post ivf?
I had my egg retrieval on 3/21/18 , 2 embryos were transferred on 3/24 .
My doc recommends day 16 post retrieval but my previous clinic did 12 days post testing…2ww is really stressful. .. also I am on 400 MG of progesterone 3x daily.
I feel pms like and I would rather know…:(
I do the 1st beta-hCG blood test 8 days post-blastocyst transfer and repeat it 2 days later and on fay 12 and 14 following a day 3 transfer.
Good luck!
Geoff Sher