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.
Hello Dr Sher, why do you recommend stimulation medication is start with the onset of menses? What is the reason for this?
The stimulation medication can start a few days later as long as the agonist down regulation and/or the antagonist blockade of the pituitary gland is onboard by then.
Geoff Sher
I’m 53 years old and would like to know is it possible to have IVF (my own egg)? I still have my monthly period.
I am afraid not!
Geoff Sher
How long is the ideal amount of time in which to go off of birth control before starting treatment for freezing eggs? I’m 31yo with endometriosis and have been on birth control for the last 6 years consistently, and on and off for several years prior to that. I also had my AMH result in a .68 last month and follicle count was 14 (9 and 5). 🙁 So! I’m curious if going off of birth control for 1-2 months or more will help to increase my very low egg count and make a more successful egg freezing cycle. Thank you for your insights.
No need to go off it at all!
Here is the protocol I advise for women, <40Y who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur---no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://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.
• Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
• Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
• A personalized, stepwise approach to IVF
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
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 had posted a few important questions about my pregnancy couple of hours back. I was trying to check if any response to the query has been provided, however I am not able to locate the query/response.
I have just seen today’s posts and have responded to your previous one.
Geoff Sher
Hello,
Last LMP – 14 Feb 2018.
I have had 3 U/s scans, first one on 24 March, second on 31 March and third on 14 April. First scan showed twins with bpm of 100 and 98bpm (CRL 2.43 and 2.24). Second scan showed twins with bpm of 135 and 126bpm (CRL 8.66 and 9.67). Third scan showed twins with only 174bpm with no cardiac activity for Fetus 2 (CRL 22.29 and 16.56), They will do another scan in a weeks time. I am stressed out. Can the cardiac activity again come back for the one which doesn’t have any right now?hope this will not impact the remaining twin?
In the u/s report it mentions –
Shows a gravid uterus with two, welldefined gestational sacs within. Yolk sac and fetal pole are seen in Sac 1.
Fetal pole is seen in Sac 2.
There is evidence of small retrochorionic clot.
AUA for the active one is 9weeks 0 days and the other one is 8weeks 1 day.
Unfortunately, the absence of a HB of the one conceptus suggests that sadly t has succumbed. This one will likely absorb over a few weeks leaving the other one intact and hopefully healthy!
G-d bless!
Geoff Sher