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,
Your site is a wonderful resource, with lots of very interesting and informed articles, thank you. I have a question regarding the use of Viagra in protocols. I am 33, have a balanced translocation and live in Spain (clinic is IVI). We have had 1 failed normal IVF before the BT diagnosis (my husband also has a severely low sperm count (200,000)), and have had one IVF/PGD cycle with double ER last year in which a total of 18 eggs were collected, 9 fertilised, 4 to PGD and all UBT. We are now on our second IVF/PGD cycle. We have had 2 ERs already, which have yielded 6 and 3 eggs respectively. I appear to have few follicles, and of very varied sizes, and at the last ER of the two, 3 out of 6 follicles were empty. My RE has put me on a different protocol for this current ER (no.3), I have had BCP for 10 days, then estradiol pills for 12 days, then estrogen patches added for another 8 days, then back on BCP for 10 days, and now on 5 day wait before starting Viagra suppositories (50g/twice a day) and Femara (2×2.5mg/day) for 4 & 5 days respectively, and then on day 3 of this starting Gonal (225) and Menopur as usual. Will then have ER, fertilisation (we bank eggs not embryos), PGD and fresh day 5 transfer of any normals. As I understand it, the use of Viagra is to help increase blood supply to the ovaries to help combat the empty follicles and size variations. I was wondering if you had ever heard of Viagra being used for this, rather than for increasing lining?
Many thanks in advance
Natalie
Sorry Natalie, I am respectfully totally unfamiliar with this approach to stimulation or this use of Viagra. By the way it has absolutely no effect on the ovaries. Viagra administered vaginally improves uterine lining in many cases, by improving uterine blood low…not ovarian blood flow.
Finally, in my opinion, you would be much better off banking blastocysts (advanced embryos) that have been PGS tested, than eggs.
If I were treating you, I would recommend a modified, robust, long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing)-normal blastocysts, to make hay while the sun still shines.
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)
•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.
•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 Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it Happens and how it can be Prevented.
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
•Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
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
Dear doctor
We know to take the trigger shot 36 hours before egg collection time. How much leeway is there for the egg collection time as first attempt I was told my egg ovulated early (they were half an hour late in EPU) so there was no follicle/egg, and second time the specialist did not perform EPU until 1 hour after designated time. This time there was a follicle but no egg inside. Could the delay of 1/2 to 1 hour have affected the result so there was (1) no follicle at EPU or (2) no egg?
Kind regards
Shirley
In my opinion no! A half hour longer wait should not make a difference. I would say that premature ovulation and empty follicle syndrome are usually linked to premature luteinizatio, What this suggests is thatvthe protocol used for ovarian stimulation might need to be reviewed/revised.
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)
•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?
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
•Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
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
Dear Dr Sher,
My estrogen is very slow to climb. LH rises and FSH rises as they should but E2 keeps taking a long time to increase. Would starting an estrogen patch help to increase estrogen? Or is there any remedy for this?
Sincerely,
Alison
s Increasing the estradiol by using exogenous estrogen (orally, skin patches or injecting) does not signify follicle growth, nor does it necessarily influence this. Also, unless you are receiving LH injections in the form of Luveris or menotropin (e.g. Menopur), the LH level should not really increase.
Geoff Sher
Dear Dr Sher,
1- Is administration of Ganirelix every other day during CD2 to CD6 as effective as continued daily administration during these early days?
2- what is the daily general LH increase? For example if on CD5 LH is 6, can it go to 16 on CD6?? Or does it increase by a gradual % increase like 25% a day?
1- Is administration of Ganirelix every other day during CD2 to CD6 as effective as continued daily administration during these early days?
A: Not in my opinion. Daily administration of even half the usual 250mg daily would be acceptable though.
2- what is the daily general LH increase? For example if on CD5 LH is 6, can it go to 16 on CD6?? Or does it increase by a gradual % increase like 25% a day?
A: It should not increase if you are on Ganirelix suppression.
Geoff Sher
Dear Dr Sher
When 450iu Gonal F is given CD2 to CD4 and dose reduced to 225iu Gonal F from CD5 to CD8 and then further reduced beyond this till trigger, does it reduce follicles in people with DOR? As I understand in a natural cycle the FSH drops after initial rise to develop a dominant follicle. So I am wondering if in a medicated cycle, a gradual reduction of FSH will compromise follicle development and reduce follicles?
No it will not! Once the initial pushnis given in the ist 2 days of stimulation and the FSH receptors in the follicle granulosa cells are primed, there is usually no need to maintain the same push. You can back off the dosage and development will continue unimpeded.
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)
•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?
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to 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
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