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 doctor!
Thanks for taking a time to answer. ..
So I just started suppression with decapeptyl 3 days ago.I am turning 40 in 2 weeks. I had failed ivf last month ( stimulated with fostimon 300mg and menogon 150; 7 eggs retrieved, 2 embryos transferred)
Currently my doc wants decapeptyl for 14 days and then to start 300 of menopur.
My concern is the LH in menopur and my age. You seem to prefer stimulation with fsh medication if I understand correctly?
Second question is about early egg retrieval.
I read some studies recommended trigger at leading follicle around 16-18 instead of 22 mm. What do you do in patients my age? Do you wait till follicles are bigger?
BTW my FSH was 2.6, serum LH 2.2 and AM 0.7 not sure if that is helpful
I am 35yrs and my husband 36yrs. We have been married since 7 yrs but I am not being able to concieve.I have undergone 7 times Ivf procedure which includes 3 times blastocyst transfer and 4 times embryo transfer…but everytime it failed…only once it had reached biochemical pregnancy and once clinical pregnancy where my hcg reached 175 but again started declining.My husbands sperm count is low ..even he had been on medications for 2 yrs but no improvement,our last ivf we had gone for donor embryo transfer but that also failed.i had done endometrial receptivity test which is normal.what should i do now
Hello Dr Sher,
I just turned 40 yo, AMH .994, and FSH 11.4, heterozygous MTHFR A1298C . When I started down this road in 2015, I was 37 and believed we had to do IVF because my husband had had a vasectomy in 2005. The first RE I saw found polyps which he removed in at the end of 2015 with a hysteroscopy. I then had a HSG and my new RE found that I had a uterine septum and mild endo stage 1 and performed a laparoscopy in early 2017.
May 2016 – husband had a vasectomy reversal which wasn’t successful
Feb 2017 – husband had a MESA, retrieved sperm which was 7% motility
April 2017 – First IVF Cycle
primed with bcp, used baby aspirin
Stimmed for 12 days with375 follistim and 75 menopur, added cetrotide the ovidrel trigger
Estrogen levels were at 2511 on the day of trigger
Retrieved 7, 6 mature, 1 fertilized w/ICSI, came back abnormal from PGS testing
Husband’s sperm was 1% motility after thaw
September 2017 – 2nd IVF Cycle – took DHEA for several months prior
Primed with estrogen
Stimmed for 9 days with 10/10 microdose lupron, then added 450 follistim and 150 menopur, added cetrotide the ovidrel trigger
Had lead follicle
Retrieved 1, 1 fertilized, 1 frozen embryo
Estrogen levels = 1899 at trigger
Husband also had a fresh PESA done same day: 40% motility, 5 vials retrieved
November 2017 – 3rd IVF Cycle – Cancelled Cycle
Primed with estrogen
Stimmed for 11 days, 450 follistim, 75/150 menopur, then cetrotide and ovidrel trigger
February 2018 – 4th Cycle
Convinced my RE to reduce the estrogen for priming to 1x/day vs 2x/day
Stimmed for 11 days with clomid, hgh, 450 follistim, 159 menopur, then cetrotide and then hcg trigger
Estrogen level = 2119 at trigger
Retrieved 6, 4 mature, 0 fertilized – was told some of the sperm had rear-facing heads but that they chose the ones that were normal, 27% motility at thaw
So now we’re at the present day and I’m thinking about a 5th cycle. What I haven’t told you yet is that in 2017, I was dealing with highest amount of work stress than I have EVER dealt with. Is it possible this influenced my egg quality? I have since reduced my work stress and am thinking about my next cycle. I am planning to be diligent about taking supplements (for endo, probiotic and greens support) and weekly acupuncture. My RE wants to try a natural cycle but continue to use clomid and is ok with me priming with HGH for 30 days prior. After some reading, I’ve noticed that not a lot of docs recommend stimming with clomid nor menopur as that could harm egg quality. What are your thoughts about that? Also, in that situation, I would like to do a natural start, no clomid, no menopur, prime with hgh, and use microdose lupron and follistim and potentially add menopur near the end of stims to help mature the eggs. I am also not planning to take DHEA as part of my supplement regiment. So the 5th Cycle would look like this:
Priming with HGH
Start with microdose lupron, add follistim, then add menopur and cetrotide and trigger
Would love to know your thoughts. Thank you for taking the time to respond. I honestly never thought I would be even thinking about a 5th cycle but I am where I am.
Thank you.
Hi Vicky!
There are so many issues that cannnot address them all adequately here. I truly believe we should talk. Here are a few of them:
1. The ovarian protocol that in my opinion needs to be thoroughly reviewed and reviewed in light of your DOR:
2.Endometriosis and IVF
3. Age/DOR and the biological clock
3. Use of DHEA
4. Ovidrel trigger (dosage and timing)
4. Vasectomy and TESE
5. Multiple cycles of IVF
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
Hi Dr. Sher,
Thank you very much for taking questions on this forum! It is a great service you are providing to those who are anxiously waiting for answers.
I had my first TVUltraSound 25 days after a FET. We were able to see a gestational sac, a yolk sac and a fetal pole but no heartbeat yet. From LMP I am 6w3d, but the fetal pole measured CRL 2.65mm and 6w0d (or so I saw on the screen – I was not told this). Should there have been a heartbeat by now? If not do you see them catch up in a week, when I go for a repeat? My HCG has been strong at 300+ and 900+ on 11 and 13 days past a 5 day FET and has consistently doubled every 2 days until 5000, every 3 days until 10000, and every 4 days until 21000 (two days before ultrasound). We transferred 2 embryos which we thought were causing high betas, but there is only one sac, yolk and fetal pole. The embryos were not graded great quality (grade 6CC, hence the concern) but were PGS normals.
My questions are:
Should there have been a heartbeat by now?
Is the CRL small compared to the calculations from LMP?
Do you often see them catch up in growth in the early 6-7 weeks?
Would you expect to see the heartbeat in a week? (7w3d from LMP)
Do the high betas not mean anything? (21000 at 6w1d from LMP)
Regards,
Robin
The high beta’s are proof of implantation but not necessary a viable pregnancy. However, the US done at 6 weeks can be inconclusive and I would recommend repeating it in 1 wek and then making a definitive conclusion.
Geoff Sher
What are your thoughts of a doctor or a nurse who doesn’t tell the patient to take Lupron, Synarel, Antagon or Cetrotide, mainly cetrotidebecsuse that was previously prescribed to her but the nurse and or doc tells her all the meds to take and the dosage during this cycle leading up to trigger and retrieval and adter every visit they say take thia and that and this much but never include the cetrotide so she never takes it and now after having 12 eggs she ovulated the day of retrieval and now has zero eggs… So my question is, is it normal for a doc to feel someone would not need a medicine to prevent ovulation before retrieval?
I really do not feel comfortable commenting on this here.
Sorry!
Geoff Sher