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,
I just finished my first egg retrieval for IVF. A little bit about my background is that i have unexplained infertility. Doctors can’t pinpoint what the reason is exactly for not ovulating and getting my menstrual cycle on my own. I have two children, one was natural, and the second child I took clomid and got pregnant on the first try. I started seeing a reproductive endocrinologist for the first time last July in order to help us have another child. I did 3 rounds of clomid with no success, then switched to Menopur and had 4 iui’s with no success. We decided to persue IVF. My first cycle was cancelled because the Dr said I didn’t respond the way he would have liked me to (part of it is that he wanted to see more follicles). This cycle looked good, as they said I had about 6-8 follicles for retrieval. A little bit about my medical history is that I have good ovarian reserve, my tubes are open, and my husband’s sperm count is good. So they put me on Lupron, gonal f, and Menopur, then ovidrel 35.5 hours prior to retrieval. After the retrieval, they told me I only had two eggs and the rest of the follicles didn’t contain eggs. I’m a little perplexed as to why they weren’t able to see that from the get go prior to undergoing the retrieval. What would be the case? Does medication have something to do with it? I’ll be 35 next month, not sure if that has something to do with it either. I just know I feel disspointed because I thought the doctors knew what they were doing. I’m not trying to do the blame game, but I paid out of pocket and it would have been good to work with what I thought was the case. Is there any advise you can give me on this? I know all it takes is one healthy embryo, but it would have been nice to freeze more, now I just have to wait and hope for the best.
Thank you so much for your time.
If the dosage of Ovidrel given as a trigger was as low as you report, that would definitely explain your poor egg yield and quality. You would have needed 500mcg Ovidrel in my opinion …or 10,000U hCG. I think we should talk because your poor reproductive performance could be linked to underlying pathology such as endometriosis or an implantation dysfunction.
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
I’m a 32 year old woman. my amh is 3 which is low. I have tried to have children for almost 4 years. I have regular cycle 27-30 days.
First ivf i was on synarela and gonal-f 300. Had only one follikel and that was empty. 2 ivf , I went for short protocol with menopure 450 ie for 10 days and ovitrelle 33 hours before egg collection. I had 3 follicles one was to small at 9mm and 2 large at 18mm at egg collection were both empty. There were no eggs. I will have a conversation with the doctor on Tuesday. want a last try. What can be done differently. have i run out of eggs. Do you think i have any chance with ivf.
Your AMH was likely measured in picomols/L. If so then you have severely diminished ovarian reserve (DOR) and will need a complete review and revision of the protocol used for ovarian reserve. Your empty follicle was likely due to premature luteinization, another suggestive indication that the protocol needs to be revised.
In my opinion, the protocol used for ovarian stimulation, against the backdrop of age, and ovarian reserve are the drivers of egg quality and egg quality is the most important factor affecting embryo “competency”.
Women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
Please visit my new Blog on this very site, https://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
• IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
• The Fundamental Requirements For Achieving Optimal IVF Success
• Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the “Conventional” Antagonist Approach
• 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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
• Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
• Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
• 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?
• Blastocyst Embryo Transfers should be the Standard of Care in IVF
• Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
• Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
• Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
• Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
• Preimplantation Genetic Testing (PGS) in IVF: It should be Used Selectively and NOT be Routine.
• 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
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
• 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.
• The Role of Nutritional Supplements in Preparing for IVF
• Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
• IVF Egg Donation: A Comprehensive Overview
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
Hello. My husband and I did an IVF cycle with a previous doctor. We did a fresh transfer of one embryo & didn’t have luck. We had one left that was frozen that we did a frozen embryo transfer. It did not work either. We changed doctors. The new doctor said we would have had to get lucky based on the quality of the embryo. He wanted to do a surgery to rule out endometriosis. He found significant endometriosis & removed it. We just did another cycle with the new doctor. We had 8 eggs. 4 mature & all 4 fertilized. However, on the day of our day 5 transfer we got a call saying none of them made it. We have an appointment with him. What are some questions or things to point out?
Hi Dr Sher
I am 34. Got only one normal embryo from PGS result.
1. I had mild endometriosis removed via hysteroscopy. I am planning to do FET in August. I’m afraid if developing placenta will attach to the scar tissue from the surgery incision, will it happen and harm the baby?
2. Is there any relationship between endometriosis and NK cells? Will NK cells mistakenly attack the implanted embryo since i had mild endometriosis?
3. I have no symptom( my menstruation period always normal, always exact on 28 days plus minus one day, no abnormal
vaginal bleeding/ heavy period just that the flow is very short usually only 3 days) but turns out that i have mild endometriosis and one polyp. how to make sure i am free from those? Regular hysteroscopy surgery or just leave it since i don’t show any symptom?
4. My dr plans to use progynova before and after FET. How long is safe to use?
5. Should we use oestrogen only hormon
Replacement therapy(HRT) or combined estrogen & progestin to treat endometriosis?
6. I had mosaic chromosome x(45xx,46xx 10%), mild endometriosis, polyp. What other tests you recommend before FET to increase the likelihood of pregnancy since i only had one normal embryo?
Appreciate your time. Thank you
Regards,
Sandra
Hi dr Sher
I just had my hysteroscopy done two days ago prior to FET. My dr found one small uterine polyp and took it for biopsy. Also mild endometriosis and they remove the excess tissue. My question is
1. should i be worried with the pathology result of the polyp?
2. Can endometriosis grow back during pregnancy( my dr prescribed me progynova 2mg 2 pills to be taken twice daily)? Any ways to prevent endometriosis to form?
3. Would it be any complication later in pregnancy if i’ve been diagnosed mild endometriosis?
4.does removal of polyps and endometriosis increase implantation?
5. How long should we do hysteroscopy in a lifetime to check inside of uterus for endo/polyps?
Regards,
Sandra
1. should i be worried with the pathology result of the polyp?
A: It is probably quite benign..but wait for pathology report.
2. Can endometriosis grow back during pregnancy( my dr prescribed me progynova 2mg 2 pills to be taken twice daily)? Any ways to prevent endometriosis to form?
A: No it wont grow back during pregnancy and there is no way to totally cure the condition.
3. Would it be any complication later in pregnancy if i’ve been diagnosed mild endometriosis?
A: Not likely.
4.does removal of polyps and endometriosis increase implantation?
A: The polyp yes but endo…probably not
5. How long should we do hysteroscopy in a lifetime to check inside of uterus for endo/polyps?
A: Only if investigation for reproductive failure ids needed.
Geoff Sher