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,
we had a ivf cycle last month where 10 eggs were fertilzed and by day 3 we have( 2 -8cell, 2-4 cell, 1- 2 cell, 1-10 cell, 2- 6 cell) embroys……..but by day 5 , 3 early blastocycst and finallhy only 1 blastocycst made it…………I read it could be sperm issue but embrologyst said sperm looks fine and could be egg quality…………Also i got email from my Dr suggesting to take DHEA 25mg and CoQ10.
I read your article reg DHEA usage, seems it could be harmful also as i have high AMH and normal FSH. Can you please suggest if we should go thru some tests to determine if we need DHEA or can egg quality be tested?
Very respectfully,
This is likely an ovarian stimulation egg-related issue. Your protocol for stimulation needs to be carefully reviewed and if need be, be revised.
As for DHEA, in my opinion it should not be used.
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.
•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?
•Why did my IVF Fail
•IVF Should Supplant Tubal Fertility Surgery.
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•Staggered IVF
•Preimplantation Genetic Testing (PGS) in IVF: It should be Used Selectively and NOT be Routine.
•IVF: Selecting the Best Quality Embryos to Transfer
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•PGS in IVF: Are Some Chromosomally abnormal Embryos Capable of Resulting in Normal Babies and Being Wrongly Discarded?
•PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
•IVF outcome: How Does Advancing Age and Diminished Ovarian Reserve (DOR) Affect Egg/Embryo “Competency” and How Should the Problem be addressed.
•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
•How Many Embryos should be transferred: A Critical Decision in IVF.
•The Role of Nutritional Supplements in Preparing for IVF
•The Basic Infertility Work-Up
•Potential Downsides of DHEA Supplementation in Preparing for IVF: Why take the Risk?
•IVF and the use of Supplementary Human Growth Hormone (HGH) : Is it Worth Trying and who needs it?
•Routine Fertilization by Intracytoplasmic Sperm Injection (ICSI): An Argument in Favor
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
Hi Dr Sher,
How accurate is the PGS test result? If embryo tested says normal does it mean no abnormality and will it be attached and achieve successful pregnancy? Any additional test?
Regards,
Silvia
No! It does only rule out chromosomal numerical irregularities which account for about 70% of embryo abnormalities in total.
Geoff Sher
Hi Dr,
Thank you for responding.
I talked Re here and they said will take antognist aproach and here is the plan.
1. Start with BCP 10 days.
2. 3rd day of mensus start medication (300 u Gonal-F + Menopur 75 u)
3. This will continue for 8-10 days based on growth.
4. Last 3 days they vll also give cetride .25mg in morning.
Last time we had almost similar protocol but without menopur from 1st day (it was started on day 5th.) which lasted 8 days only and we had 10 mature eggs which fertilized but non made it to day 5……..Do you think stimulation effects egg quality?
Is this a good stimulation plan?
l rnD onlie some and see our schedule to be very short( 10 days bcp and 8 days medication) wondering if you can guide…..
Dear Dr Sher,
I have a 3 year old, conceived naturally. I am now undergoing IVF with PGD testing, as I have had 2 subsequent pregnancies with 8 week miscarriages.
After a failed transfer last year, my specialist found I have high circulating NK cells.
My next transfer of a PGD normal blastocyst involved 10mg daily prednisolone, but this also failed.
I was advised to continue on prednisolone to prepare for another transfer, however I then ovulated early (at day 9) and have spotted throughout the entire cycle – the transfer was cancelled. It is very unusual for me to have any mid-cycle spotting.
My questions for you are:
1. Can prednisone cause early ovulation and/or mid cycle spotting?
2. Is it worthwhile retesting my circulating NK cells whilst on prednisone, to ensure the count is lowering to normal levels, but not below normal levels? Is this possible or useful?
Thanks very much for your time, Dr Sher.
Kind regards,
Kellie
1. Can prednisone cause early ovulation and/or mid cycle spotting?
A: In my opinion…highly unlikely!
2. Is it worthwhile retesting my circulating NK cells whilst on prednisone, to ensure the count is lowering to normal levels, but not below normal levels? Is this possible or useful?
A: In my opinion, Prednisone (without being combined with 20% intralipid infusion) will do little..if anything, to reduce NK cell activation. Both MUST be used.
Geoff Sher
Hi Dr Sher,I always seem to have empty follicles on CD21 start lupron down reg protocol despite using 10,000iu pregnyl trigger. But no empty follicles on straight antagonist protocol. I’ve read your empty follicle article. In your experience, what could be causing this? Is it the lupron?
I would need to discuss this with you in order to answer authoritatively.
Geoff Sher
Dr Sher is the composition of menopur, for example 300iu, made up of 300iu FSH and 300iu LH? And 225iu is 225iu FSH and 225iu LH? Or is that not the ratio of FSH to LH in menopur?
300U FSH + 300U combination LH and hCG. and 225U FSH + 225U LH/hCG.
Geoff Sher