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 am 42 and have recently started an IVF journey, with my first egg retrieval yesterday. Based on scans and blood tests I was responding well, and by day 9 had 7-8 follicles measuring between 16mm – 21mm. Blood work also indicated all going well. At the egg retrieval however only 2 eggs were able to be collected. The Dr did not know why. I have since read about empty follicle syndrome (EFS) and how a major cause of it is human error (protocol, trigger shot timing etc). Do you have much experience with EFS, and what would you advise someone who has had only 2 eggs retrieved of 7-8 good sized follicles? Thank you.
Dear Dr Sher
I am 37 years old with DOR, my AMH at 36 was 0.8ng/ml. I did three IVF cycles in 2017,
IVF 1: Gonal F 150, Luveris 75, Orgalutren .25, retrieved three eggs, all three were grade A embryos, frozen at 3day.
IVF2: Follistim 150; Menopur 150, Orgalutran .25, Retrieved three eggs, none fertilised. IVF 3: Gonal F 150. Luvesris 75 and Orgalutron .25, Retrieved 3 eggs, two fertilised to AA, transferred both with triple endometrial lining at 10.1, Beta 1 at 14dp3dt 13, Beta 2 at 16dp 5, it was a chemical.
This year I did my fourth IVF cycles Gonal F: 300 and Cetrotide: .25 mg, Retrieved 11 eggs, 6 fertilised, 2 survived to blast, I PGS normal (4 tested, 2 Abnormal, 1 No DNA detected) which was transferred on a medicated FET cycle with estrogen and Progesterone support, again triple endometrial line with 10.2 at transfer. I got Beta of 9.26 and my Dr has determined it will be another chemical. My hysteroscopy was normal NK cell activity was normal (Biopsy last year). My RE thinks it continues to be an embryo quality issue and not uterine issues.
I wanted to ask you
1. Do i still have a chance of having my own genetic child and continue to STIM and bank embryos or should I move on to dodnor egg?
2. Should I consider a mini-ivf to get better quality eggs?
3. Do you think this might be implantation dysfunction, what kind of diagnostics would you recommend and what kind of treatment?
4. Should I PGS test embryos or go for non PGS fresh transfers? Would it be recommended to transfer two or one at a time? Thank you for the opportunity to share my story and struggle and I would be very grateful for suggestions and advice.
1. Do i still have a chance of having my own genetic child and continue to STIM and bank embryos or should I move on to dodnor egg?
A: You could still be successful with own eggs (see below)
2. Should I consider a mini-ivf to get better quality eggs?
A: In my opinion, mini-IVF is really a waste of effort and money in women with DOR. You get fewer quality eggs/embryos and the success rate is too low ((arounsd 10% per ER)
3. Do you think this might be implantation dysfunction, what kind of diagnostics would you recommend and what kind of treatment?
A: It could be and this should also be investigated, but themlore likely explanation is egg quality linkerd to the lrotocol used for ovarian stimulation.
4. Should I PGS test embryos or go for non PGS fresh transfers? Would it be recommended to transfer two or one at a time?
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, 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
•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
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
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.
Hi Dr. Sher — I have gone through 3 IUIS and 4 IVFS with one successful birth. The problem is, I have never produced enough eggs to freeze. I respond well to the stim protocol (many follicles and anywhere between 12-21 egg shave been retrieved each cycle) – but I haven’t made it to day 5 with more than 1 or 2 embryos to transfer. My protocols have been gonal F/Menopur. I have done 2 cycles with Lupron and 2 with Cetrotide. It’s worth mentioning that I am anovulatory and have been for many years. I hardly ever get a period on my own. I am 36 — bad eggs since I started this process at 33. I’m starting to think our baby was a miracle…is there any hope to get more good embryos out of the cycle? My hormone levels (FSH and LH are within normal). Thank you.
Hi. I have DOR and am 40yrs old. My FSH is 18 (doubled since last year), AMH 0.323, and 5 follicles on day 4 of cycle. How successful would an IVF be with my eggs? I have the opportunity to use donor embryos. She was 38 when the eggs were retrieved and 4 out of 9 embryos made it to blast. She had twins with two of them and donating the other two (which are frozen). They are grades 1 and 2 and GES of 70 and 80. One was frozen day 5 and one day 6. I have a child from an IVF you did back in 2013. (I will forever be grateful!) I had a failed FET in 2017 at St Louis. So would I be more successful with my eggs, donor embryos, or neither? Thank you and God bless you immensely for helping women like me.
Donor egg-IVF would most certainly be much more likely to succeed but you might still be able to succeed with own eggs.
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those 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 age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can 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 older women and those 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 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, 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
•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 Dr. good morning!
For my FET I am taking progyluton 3 times daily from cd2. And then endometrin from cd 14. My FET will be this Saturday. Does this sound like a normal protocol? Isn’t it a bit simple?
It is a BCP and in my opinion can be used to lead up to a cycle of FET but not during the FET cycle itself.
Geoff sher