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,
I’m not sure where to start. My husband and I have had unprotected sex for 5 years and I’ve never been pregnant. We have seriously been trying in the last 6 months to no avail. His testosterone is below average and so is his sperm count but it’s not too bad. He is 39. I am 34, I was diagnosed with thyroid disease and hypothyroid 3 years ago. I also have PCOS and insulin resistance. All of which is now under control through medications (armour thyroid and metformin). My TSH is non existent and has always been depressed. I’ve seen two OBGYNs with hope of help to get pregnant. I had an HSG which was clear, my progesterone is sub par but my egg reserve is fine. My concerns are if I will be able to get pregnant naturally? does my body have the capability of carrying a baby? Due to my health issues would it be better to have intervention rather than a natural pregnancy so to select the ‘best eggs’? I have a lot of questions and I don’t feel heard by either OBGYN. They tell me to use ovulation kits and maybe take clomid. But I feel like I need more guidance and support from someone throughout this whole process to make sure that I am healthy and so is the baby. Should I consider seeing a fertility specialist/ reproductive endocrinologist? Or should am I over thinkint thinking? Thank you for your time! Tarah
Absolutely! You need a thorough infertility evaluation. On the face of it there are a few very obvious leads…a) thyroid disease which is often autoimmune and can be associated with an immunologic implantation dysfunction; b) male factor c) Egg/embryo competency.
If you are interested in my advice or medical 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.
Also, my 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
Dear Dr Sher,
Please help! I have DOR but I was ovulating every month and getting embryos on natural cycles. In February my doctor decided to put me on birth control pills( BCP) because he wanted to get my hormones in the optimal range and especially LH below 10. I did ovulate that month while on BCP but he decided to keep me on the pills in the luteal phase as well. At one point I became seriously overusppressed( FSH, LH, E2 all zero). In March he reduced to dose of BCP to half so as to allow for the FSH to go up but nothing grew. In April he stopped BCP all together but nothing is growing. E2 is still undetectable and FSH has hit the roof at 60( a few days ago, I think it must be higher now!). I am devastated!!!!! I used to ovulate every month despite my DOR. a) What happened? I know my hormones are not suppressed anymore but can the ovary as an organ be suppressed? b) What should I do now? Should i go back to BCP to lower FSH or just leave my body alone and wait?On one hand my body doesn’t like BCP evidently but on the other hand my ovaries will shut down with this very high fsh and not produce anything..I am torn, confused and extremely worried…..
Very brespectfully, I do not agree with this approach. An elevated FSH suggests a reduction in the number of eggs you have, but reducing the FSH by using a BCP WILL NOT impact the number of eggs you have available or your response to subsequent ovarian stimulation…in my opinion.
If you are interested in my advice or medical 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.
Also, my 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
Geoff Sher
Good morning Dr. Sher,
I am still in the testing process prior to IVF treatment. I am nearing the end of my “test” cycle. I had a positive LH surge on 04/20/18 and went in for ultrasound and bloodwork the following day 04/20/18.
There was a busted follicle on the left ovary (the fluid still present on the ultrasound). My question is, with the positive LH surge and a visible busted follicle, is it still possible that a egg was not actually released from this dominant follicle? And if so, what is the chance of having no egg released even with the positive surge and busted follicle visible?
I know that the blood work should tell us for certain rather an egg was released or not but the possibility of no egg being released is bothering me because I have no knowledge of the odds.
Thank you in advance for any help with this question,
Anna
LH Surge was 04/19/18 and Ultrasound was 04/20/18.
It is very likely that you did indeed ovulate.
Good luck!
Geoff Sher
It is very likely that you did in fact ovulate!
Good luck!
Geoff Sher
Hi Dr. Sher,
I have TTC for 2 years and have not falling pregnant at all. I’ve had 7 failed IUI’s and recently completed FET on Monday, only to have gotten my period early this morning. Both my husband and I have 2 children from a previous marriage, my youngest is 8. We desperately want our own child.
I was diagnosed with Graves Disease a year after my youngest was born, which is very controlled with meds. However, I have no TSH and still have antibodies.
Could me taking Estrace and Prometrium be causing me not to conceive. Or could it be the Graves Antibodies?
I am aware of IVIG and Intralipid Therapy options.
Thanks
Christina
I suspect that you could have an implantation dysfunction linked to autoimmune thyroid disease. 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
Dr. Sher,
I had 2 cycles of IVF. The first was done back in 2012, resulting in 3 embryos. We did a fresh transfer on 2 day 3 embryos and ended up with successful implantation and pregnancy of healthy baby girl. Recently under gone 2nd cycle with total of 24 embryos, no donors. First transfer 2 embryos unsuccessful implantation. Then it was suggested to have genetic screening on 8. Then again transferred 2 embryos which resulted in failure. Then had endometrial receptivity array and transferred 2 embryos with success. Hcg 488 10days then 1900 3 days later. First ultrasound at 7 weeks revealed twins with same heart rate and both fetuses same size. Ultrasound at 10 weeks revealed baby A healthy size heart rate 170s. Baby B no heart beat smaller diagnosed vanishing twin at 8 or 9 weeks. RE said it had to be something lethal. Maybe I should have asked more questions because now I’m worried surviving baby will miscarry as well. I haven’t had any spotting just light dull cramping. What could have caused baby B to have no heart beat? The only thing I could think of was possibly the umbilical cord implantation.
I forgot to mention that with 2 cycle all were 5 day blasts and frozen transfers.
It was more than likely a lethal chromosomal issue with baby B. Baby A will likely be fine! Few realize how common it is for a pregnancy to start off with twins and reduce spontaneously to a single healthy baby.
Good luck!
Geoff Sher
Goo