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,
My husband and I have had 4 miscarriages. The first 3 were loss of heartbeat around 8weeks of pregnancy. After those we had a HSG to see what was going on and it turned out I had Asherman’s Syndrome with extensive scarring and adhesions, which resulted from an agressive D&C, from a retained placenta. I had 2 corrective surgeries and we got pregnant 6 months later, that pregnancy was ectopic and my right tube had to be removed. So we moved on to IVF. I had another hysteroscopy with scar tissue removal, before starting stims and after egg retrieval ended up with 8 (5) day blast. We did a fresh 5 day transfer which resulted in a healthy full term baby girl. We waited 9 months to try for another baby and did our first FET which didn’t work. My RE chalked it up to embryo quality and we did a second FET the next month which also didn’t work. My RE then did a hysteroscopy and cleared more scar tissue. I did estrace and provera for a month and then we transferred 2 embryos, which I found out today also didn’t work. So here I am 3 FET’s later and no success, my lining was good, my hormones were good and I dont understand why these haven’t worked. Do you have any suggestions of what I should do to try and make my next transfer successful? Any test’s or procedures I should request my RE do? We have 3 blast left and I desperately want this to work. Thanks in advance for any assistance you can give to my situation.
It is likely that there is scarring in the uterine cavity, affecting endometrial receptivity. This is the likeliest explanation.
Perhaps we should talk!
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
My wife is 38 and doing ivf. She got all the way to the trigger shot but during the time she was taking shots up to the trigger shot she was not prescribed Lupron, Synarel, Antagon or Cetrotide. The day of retrieval she was feeling pain and said it felt like her eggs or follicles were too big. We get to the doc and he checked her for her eggs, I was in other room about to fill up a cup for the semen. I get a knock at the door and the assistance says do not continue because your wife has ovulated. My wife told me she knew why but didnt wamt to tell me til we left the doc. She said they never prescribed her Lupron, Synarel, Antagon or Cetrotide and she feels that that is what caused her to ovulate before expected. She doesn’t want to bring it to their attention but I think she should. If we decided to go thru the process over and it is because it it their fault I feel they need to be reimbursing or paying for her next set of meds which she has delpinished and they said passed her amount that insurance pays. So my question is during the time she took the shots to make the follicles grow and right before the trigger shot until the time of retrieval should her doc or nurse have prescribed or told her she should be taking either Lupron, Synarel, Antagon or Cetrotide to prevent early ovulation? Because I read “You can rest assured that your clinic is monitoring you very closely and the chance of you ovulating prior to egg collection is extremely slim, and almost zero if you are receiving the medication to prohibit ovulation such as Lupron, Synarel, Antagon or Cetrotide.” Should I be concerned her doc didmt five her this to take or tell her to take it? And if they said they did although they did not am I able to use, get a reimbursement, or have them pay for what ever we can have covered due to use doing this process alrwady and them messing it up for us. It wasn’t her fault she ovulated. It should he theirs right?
Obviously, different RE’s use varied approaches to stimulation. This having been said, I personally always use Down-regulation long protocols that involve the use of a BCP, Lupron and in some cases also an antagonist to avoid precisely what you have described happened in your case.
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
Dear Dr Sher
I would be most grateful for your most expert advice.
I had a little boy with my husband when I was 32.He was conceived naturally after 16 months of trying.He is fit and healthy.
We tried to conceive again but after 2 years were diagnosed with unexplained fertility and started ivf.
AMH was 16
Cycle 1- long protocol. Down regulated with depot injection and then stimulated with menopur 187.5iu. Trigger with Ovitrelle 250
10 eggs, 6 fertilised, one day 3 (8 cell “good quality”) transferred. Negative outcome and developed severe OHSS within a week of trigger and had to be hospitalised but not drained. Other embryos did not make it to blastocyst.
Cycle 2-Short Antagonist protocol. No down reg. northisterone pill for 10 days, stimulation with menopur 150iu for 11 days (evening)and started certitude 0.25mg on day 3 every morning. trigger with 10,000 units pregnyl. 11 eggs retrieved, 9 fertilised 2 made good quality blasts. One was transferred but negative outcome. Mild/moderate OHSS. No hopsitalisation.Frozen cycle for blast transfer negative outcome.
Cycle 3- now aged 37, AMH 11.
Another short protocol same as the last time but triggered with Ovitrelle 250iu and Buserelin 0.5ml. 16 eggs retrieved. 12 fertilised. On day 3 I had 3 8 cell embryos of good but not top quality. Consultant encouraged going to day 5 and freeze to eliminate risk of OHSS. Sadly all were early blasts on day 6 and graded too poor to freeze of transfer.
Where should we go from here? Are there other tests we should do?
Is it worth doing a DNA fragmentation test? What protocol would you recommend if we were to try again or is our only hope with donor eggs?
Thank you in advance
Hi Dr Sher. Is an estrogen level of 35 pg/ml on day 3 of stims quite low? Or is that quite normal on the day 21 lupron start protocol? Im on 300 Gonal F and 5u lupron.
Quite normal. You need several more days to make a judgement.
Geoff Sher
Hi Dr.Sher
My husband was prescribed clomid to try and improve his sperm he has less an 1 million ! He had side effects aswell hormones are all within normal range testosterone is normal range mid rage! After 3 months on clomid his went down to 0! Who could this happen and it’s that typical and will it ever improve again!
Clomiphene therapy (25mg daily for 3 months) will only work when the man has a low FSH (12MIU/ml it points to end-organ testicular dysfunction. I frankly do not believe that the clomiphene caused your partner’s sperm parameters to tank. Perhaps he had deteriorating end-organ testicular function that was progressive and and the clomiphene was an incidental exercise of futility. Clomiphene therapy (25mg daily for 3 months) will only work when the man has a low FSH ( 12MIU/ml it points to end-organ testicular dysfunction and taking clomiphene won’t help (in my opinion). If this assessment is correct it is possible that sperm function might not correct. Do an FSH/LH/Testosterone measurement and thereupon wait a full sperm cycle (3 months) and repet the semen analysis.
Geoff Sher.