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.
I recently had a AAA graded embryo that was sent for PGD testing. The cells showed No data. The embryologists received the no data results and unthawed the embryo to retrieve more cells in order to test once more. The second test showed No data as well. Is it possible that this AAA grade embryo is abnormal causing the No data results? Or is it just as possible that this embryo is normal. I am 41 years old and also have another AAA, and AAB graded embryo that was PGD tested. Both embryos have been PGD tested as normal. At time of retrieval 2 months ago I had 15 follicles and 12 of which were functioning. 9 eggs were retrieved, 8 mature, 7 fertilized, 6 were 5 day blasts. All 6 were PGD tested – 2 were normal and 1 no data.
Trecia
That is very unusual. I would point out that thawing frozen embryos to retest them chromosomally, only to refreeze and then rethaw again for an FET is very stressful on the embryos, so handled. i do not advocate it.
Good luck!’
Geoff Sher
Dear Dr. Sher,
I’m 31 years old and have had 10 unsuccessful IUIs with frozen donor sperm (On #11 now, as my insurance requires 12 “attempts” before it will cover infertility treatment and natural conception is not an option for my wife and me). My gut tells me that my inability to conceive is immune related—definitely implantation-related. I have very regular menstrual cycles, follicle growth is regular/consistent with every cycle, and evidence of ovulation is pretty clear. My lining thickness is always at least 9mm before triggering. I have no history of menstrual/gynecological issues, aside from a few small fibroids found when I began the process. Sonohysterogram confirmed that they would not be a factor in implantation. HSG was regular. Day 3 Fertility profile was perfect. I take 100mg of progesterone vaginally staring 2 days after IUI (I have no evidence of luteal phase defect/low progesterone—this is more a precaution than anything).
I don’t have any diagnosed autoimmune conditions, but I can’t think of any other explanation for my inability to conceive. I also had one chemical pregnancy on IUI #4 and nothing since. I understand that with IVF, we will learn whether or not embryo quality is good, but I’d like to be proactive with the implantation issue because I truly feel this is where the problem lies. The only issue I have had since trying to conceive is very, very mild uterine cramping on and off during the entire two week wait. It is not painful, but I have an awareness of it. No one has been able to offer a reasonable explanation for this symptom. I have taken a couple months off randomly and there is no cramping, nor had I ever experienced cramping during my luteal phase before trying to conceive. It is only IUI cycles, and it is not just immediately following IUI. In fact, the cramping often subsides for a few days to a week following IUI, and then resumes.
I’m considering changing REs if I have to go forward with IVF, since I don’t feel my current RE has invested much in my case at this point. I’m also concerned she might be a bit “by the book” and will be unwilling to pursue immune testing prior to or during the IVF process. I see there is a SIRM location in New York, but it is really not an option for me to travel for treatment, so I was wondering if you knew of any folks in the Boston area that are immune friendly when is comes to implantation issues.
Thank you for your wonderful work and informative blog. I have found this information very interesting and enlightening during this process.
Any insight you might have would be greatly appreciated.
Thank you for your time,
Emma
I absolutely agree with you. Unless there is a male factor here, it sounds very much like you have an implantation dysfunction, probably immunologic.
Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, find the “search bar” and 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
•Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Induction of Ovulation With Clomiphene Citrate: Mode of Action, Indications, Benefits, Limitations and Contraindications for its use
•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?
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•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)
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Uterine Fibroids and Fertility
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•How Many Embryos should be transferred: A Critical Decision in IVF.
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Hi Doctor,
I am 39 year old female AMH 2.68 FSH 6.74 AND MY Antral Follicle Count was 36.
I am in my first IVF treatment… Took BCP for 14 days and then Menopur 150mg, Gonal F 300. on Day 5 ultrasound had 6 follicles over 10mm but my E2 was 930. Started Cetrotide on Day 6. My Day 8 Ultrasound still showed only 6 follicles ranging from 10mm-18mm and me E2 was 1978.
Day 10 Ultrasound showed 6 follicles with E2 at 3792.
My question is: Is there a reason you believe my E2 is high but not producing that many follicles?
With my AFC so high and AMH and FSH at pretty good levels for my age I thought I would produce many more follicles. Doesn’t it correlate?
Also, with my levels and age, is this a similar protocol you like to start women on or do you prefer another?
Thanks in advance! 🙂
Frankly, if you are talking about 3792 pg/ml (rather than pMol/L), you should have MANY more follicles with that E2 level.
Geoff Sher
Hi Dr Sher
I read on your blog that for alloimmune issues, intralipids are infused every 2-4 weeks for 24 weeks. How do we decide on the number of weeks, 2, 3 or 4 weeks? Is there a difference between 2 and 3 weeks, is one safer for the embryo?
Thanks
No data to show any real benefit and thus probably no difference. However, my preference is to recommend 2 weekly infusions…just in case.
Geoff Sher
Hi Dr. Sher,
What are your thoughts on thawing previously frozen embryos for pgs testing and then re-freezing? We have 6 frozen untested embryos.
It will be too stressful for the embryos and thus in my opinion would be counter-productive.
Geoff Sher