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—a quick question: I’m in the midst of a cycle from frozen donor eggs. We had 12 eggs to begin with. Nine fertilized. On Monday, we transferred one very high quality expanded blastocyst. The lab froze two more early blastocysts that day and kept six under observation for possible day-six freezing. But by day six, all of the remaining six had stopped developing, so they discarded all of them. I’m glad that the embryo that they transferred was very good quality and that there were two blasts to freeze on day five, but it doesn’t seem great that all six remaining embryos stopped developing. Is that a bad sign for my chances for success with the embryo that they transferred? The donor is 23 years old, if that makes a difference. Thanks!
The expanded blastocyst transferred should have a good chance. Sad that so many embryos failed to progress. To be honest, i am not a fan of donor eggs that were frozen. I use fresh donors. In my opinion,. results are far better.
Good luck!
Geoff Sher
Dear DR Sher.
I am a 46 yr female with two failed IVF cycles, one with my eggs and one with donor eggs. In both cases, blastocysts were transfered with the blastocycts from donor being grade A. Am about to commence a new cycle with donor eggs and now the doctor is considering the use of intralipids to address possible immune issues as we are not able to do tests for NK cells in my country
When exactly would be best to start the intralipids, my doctor recommends 10 days before the transfer.
Is this a good time?
Many thanks
Yes it is a good time! However, please read 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
Hello Doctor. I did my 5 day embryo transfer on April 14 and today is my first HCG. It came positive and its 463. But i do have minor cramps like feeling that occurs like few times in a day. Is it good sign? I went through miscarriage post my first transfer after 3.5 weeks of my 5 day embryo transfer. So bit worried
Hi Sriram,
Your concern is understandable, but alas…only time will tell. Wait a week or two and have an ultrasound examination. That should provide a sense of finality. Frankly, given the information you provide, there is no good reason for current concern.
Good luck and G-d bless!
Geoff Sher
Hi Dr Sher,
I have unexplained infertility with recurrent pregnancy loss. I have had a total of 6 miscarriages . We have done ivf with pgs normal embryos that were all graded good quality . I became pregnant each time and miscarried . We have used immune protocols and even tried IVIG with high dose prednisone aspirin and lovenox on my last cycle and still had a loss. We decided to use a surrogate and most recently had a pregnancy that just ended at 7 weeks with a blighted ovum via a surrogate . At this point our local RE has no answers to why are embryos continue to miscarry in myself and a proven surrogate we used . We have had genetic testing and just about every test you can have done for infertility. Do you have any suggestions for us? Is there a chance a person is just not compatible with another person to have a baby? Is my egg and my husbands sperm just not compatible to produce a full term viable baby? How can this be tested if there is such a disorder ? We still have 6 great embryos and aren’t sure how to move forward with no clear cut answers to what is wrong . Thanks
Hi Dr. Sher. I went in for my first ultrasound at 5 weeks, 5 days today and we saw two sacs– both with yolks and fetal poles measuring 6 weeks. However, there was also a significant pocket of blood just above the sacs (at least that’s how it looked on the ultrasound pictures).
I haven’t had any bleeding or spotting yet, but my doctor told me to stay on guard– that this could mean impending miscarriage (s) OR could mean nothing and go away on its own.
Have you seen this before? How often? What is it called and what causes it? In your frank opinion, is it likely I will miscarry one or both babies? Could this have been caused by lifting my son (27 pounds) a lot? (I lift him frequently throughout the day).
I’m to try to take it easy from now until next scan on May 2nd. And I absolutely will try to minimize all play lifting throughout the day, however I have to still put my son in his crib and lift him in and out of his high chair/carseat. Am I absolutely setting myself up for failure?
Also stopping my baby aspirin.
For reference, betas were:
8 dp5dt: 245
10dp5dt: 629
13dp5dt: 2746
I’m thankful for any information/advice you can give me. I passed out in the doctor’s office I was so worried (and sick with morning sickness).
This is a retrochorionic hematoma. In most cases, if it does not expand further (get larger), it should absorb allowing one or both pregnancies to proceed uneventfully.
Good luck! Please keep me in the loop!
Geoff Sher