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:
Just wanted to get your input on my results so far after three IVF cycles. I have no diagnosed fertility issues and have a history of pretty normal cycles. All my fertility tests came back as normal. I did have a uterine fibriod removed prior to starting treatment. My concern is that with cycles 2 and 3, I’m getting a decent number of eggs but not a lot of mature eggs. Are there better protocols that focus more on quality not quanity of eggs, especially for women over 40?
Cycle 1
Age: 40
Protocol: Antagonist Cycle with Estrace Priming (Estrace by mouth; then Follistim, Menopur and Centrotide; Lupron trigger)
Results: 8 eggs retrieved, 7 mature and fertilized, 2 embryos, both abnormal
Cycle 2
Age 40
Protocol: Stop Lupron/Luteal Phase Lupron into Stimulated IVF (10 units Lupron until period; then 225 Menopur and 300 Follistim; HGC trigger)
Results: 14 eggs, 8 mature, 6 embryos, 1 normal
Did ERA mock cycle prior to transfer cycle- came back receptive
FET – failed, negative beta
Cycle 3
Age: 41
Same protocol as Cycle 2 (used Gonal-F instead of Follistim)
Results: 19 eggs retrieved, 9 mature, 6 fertilized
Waiting on results of number of embryos then PGS
I think we should talk so I can critique the stimulation when justifiable.
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.
•Egg Maturation in IVF: How Egg “Immaturity”, “Post-maturity” and “Dysmaturity” Influence IVF Outcome:
•Commonly Asked Question in IVF: “Why Did so Few of my Eggs Fertilize and, so Many Fail to Reach Blastocyst?”
•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?
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented..
•“Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
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,
I was wondering if I should be concerned that most of my embryos are not ready on day 5 as blastocytes, and they are waiting to see how they are on day 6. I had 30 eggs retrieved, 27 mature, 20 fertilized on day 1, 17 made it to day 3 and then only 1 to day 5 blastocyte. I have 13 that they are waiting to see if they make it to day 6. Should I be concerned? Is there any difference with day 5 or 6 blastocytes in regards to success rates or why there are so many that are slow growing? Thanks so much
In my opinion day-6 blastocysts are still pretty good! perhaps not as good as day-5 expanded blastocysts are…but still pretty good!
Good luck!
Geoff sher
Hi Dr, I’ve just had 12 eggs retrieved 11 mature, 3 fertilised and had a freeze all due to ohss, I have 3 embryos frozen the day of retrieval, We have just been to see the embryologist who has said we can start FER treatment cycle, he has sent us away to decide if we want two embryos transfered or one, what would your advice be? Many thanks
Hi Nic,
Conventional wisdom would say 1 transferred at a time,. but in many cases (with a few exceptions), I still advocate for 2.
Geoff Sher
Hi I am 29 year old. I had one miscarriage at 6 weeks in 2015. I got pregnant with clomid in ine try at that time. After that we are trying from almost 1 years with letrozole with no luck . Then I got diagnosed with severs endometriosis in March 2017 . Had lapro done to remove it. My Gynecologist suggest me to go for Ivf. We did IVF in January 2018 but unfortunately it failed. After that we did 2 frozen embryo transfer both results in BFN. I am so depressed now. I still have two frozen embryo (4BB and 3BB). But I am don’t want to go for another fet as i think those gonna fail to. I also have hypothrodism for which I am taking letrozole. So do you think I must be having this NK cell activated. Can you please suggest me what should I do
Dear Doctor
> Me Jamal 37 years old (168cm height&72Kgs) and wife-Rani 27 years old (150cm height & 57 Kgs).
> Married in 2011 (7 years now) and got pregnant two times spontaneously in 2012 and 2013 but left in ectopic pregnancy (Right Salpingectomy & Left Sapligostomy done)
> In 2014 Hysterosaplingography test revealed Bilateral Tubal Block
AMH-9.3
FSH-3.98 and LH -4.35
> In 2015 undergone our first IVF
?ICSI in August 2015, (Antagonist Protocol) 13 Eggs Retrieved, Matured 6, Fertilized 5, Cleaved 4
?Estradiol – >3000 pg/ml, Progesterone – 2.49 ng/ml
?FET in November 2015, Transferred 2 ( 4 Cell Grade 1A), Ended in Chemical Pregnancy
?January, 2016 [ANTI CARDIO LIPIN 1gM- 1.3 U/ml, LUPUS ANTICOAGULENT – Negative, APTT TEST-24 Sec., CONTROL – 28 Sec.]
?May, 2016 [ T3 – .964 ng/ml, T4 -7.85 ug/dl , TSH – 3.01]
?UTERINE DOPLPLER – Endometrium-10.5 mm, Pattern-Triple line morphology
?FET in June 2016, Transferred 2 ( 4 Cell Grade 2), Ended in Chemical Pregnancy
> In 2018 undergone our Second IVF
?January, 2018 [TSH-2.04 ui/ml, LH-3.42 miU/ml, FSH-7.34 miu/ml, Prolactin 6.82 ng/ml ] TEST-24 Sec., CONTROL – 28 Sec. ]
?ICSI in March, 2018 (Antagonist Protocol) 13 Eggs Retrieved, Matured 13, Fertilized 11, Day 5 Embryos- 8 ( Grade 1)
?Endometrium Thick -13 mm
?ET in March 2018, Transferred 2 (Early Blastocysts), Ended in Negative (BHCG-4)
?Remaining 2 Day 6 Embryos (4BB, 4 CB)
?April, 2018 [ USG-Pelvic Scan: Uterus Normal, Uterus Thickness 8mm, Fluid Filled I Multiple Small Follicles arrayed peripherally. ]
?May,2018 [ESR- 406 pg/ml, Antibody Screen (Indirect Oocmb’s Test) INDIRECT COOMBS-Negative, Vitamin D 25 Hydroxy – 41.8 ng/ml ]
From the tests we did, it’s clear that there is no issues other than bilateral Tubal Block (We didn’t to any PGD/ karyotype test) though we ended up in recurrent IVF failure (Probably implantation failure)
So would like to know what may be causing this problem? What kind of tests i need to perform to diagnose problems if any. I would like to check in all aspects before getting ready for my next transfer.
Is hirsutism affect IVF cycle?
Please advise me on the same. Thanks.