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
How reliable NIPT test compare to amniocentesis to determine that the embryo will likely to be normal and result in viable pregnancy?
Regard,
Belle
About 90% reliable!
Geoff Sher
Hello Doc,
I have been trying IVF unsuccessfully for three attempts. My doc now suggested undergoing ERA to figure out if my endometrium is receptive. How reliable or useful is this test?
(2) During my FET, I am typically on vivelle dot patches followed by progesterone injections. My lining is around 8mm every time. However, I do read some papers where they report going on birth control for 4 weeks, having a bleed and then beginning a FET. Do you think this would be a good approach to try?
Respectfully, I am not a believer in ERA.
Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
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.
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•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?
•Blastocyst Embryo Transfers should be the Standard of Care in IVF
•IVF: How Many Attempts should be considered before Stopping?
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•IVF Failure and Implantation Dysfunction:
•The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 1-Background
•Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 2- Making a Diagnosis
•Immunologic Dysfunction (IID) & Infertility (IID): PART 3-Treatment
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management 🙁 Case Report)
•Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
•Intralipid (IL) Administration in IVF: It’s Composition; how it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
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 .
*The 4th edition of 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
Hello Dr Sher
I have message before and just wanted an opinion if you felt you could give it. Just had another fet cancelled after taking trigger shot, my estradiol levels had dropped from cd7 to cd9
I’ve had two scans and bloods on both days.
1st fet was homogeneous and thickend. 2nd fet lining triple stripe by day 9, 11.1mm but E2 dropped significantly for a cancellation. I will add this was a natural cycle due to the overstimulated lining last few times last fet was 9th ivf, we have one amazing frostier which I can’t seem to get to transfer.
My question is why would E2 rapidly fall when the lining was thick?
Appreciate you don’t have my notes but just a little desperate to understand why?
Many thanks Lynsey
I think we need to talk so I can get the information needed to answer authoritatively.
Geoff Sher
PH: 800-780-7437
Hi dr Sher
1.What is the percentage of frozen embryos survive thawing process before transferring to uterus?
2. I heard that IVF with ICSI slightly increase the chance of having girl than boy because ‘girl’ sperm move slower which makes embryologist easy to ‘catch’ and directly inject to the egg, while ‘boy’ sperm move faster and ‘hard’ to ‘catch’. Is this accurate?
Regards,
Sandra
1.What is the percentage of frozen embryos survive thawing process before transferring to uterus?
A: Around 90% of blastocysts survive.
2. I heard that IVF with ICSI slightly increase the chance of having girl than boy because ‘girl’ sperm move slower which makes embryologist easy to ‘catch’ and directly inject to the egg, while ‘boy’ sperm move faster and ‘hard’ to ‘catch’. Is this accurate?
A: Afraid not!!
Geoff Sher
Hi. Sher.WE TRIED WITH OUR MOSAIC EMBRYOS BUT NO PREG.I AM 41.HUSBAND HAS AZOOSPERMIA. WE HAVE SPERMS OBTAINED BY TESE. I PRODUCE MANY EGGS (18) WITH SHORT PROTOCOL.I DONT HAVE ANY IDEA ABOUT THE QUALITY OF TESE OBTAINED SPERMS. WELL WE CANT PRODUCE HEALTY EMBRYOS,NONE OUT OF 7.18 EGGS , 15 MATURE, 7 UNHEALTY EMBRYOS.NONE WENT DAY 5.2 FROZEN DAY 3 BUT NO PREG. WITH THEM DUE TO MOSAICSM.
MY HORMON LEVELS ARE GOOD. NOW WE WILL TRY ONCE MORE.BUT I CANT DECIDE WHERE TO GO.
1. FIRST OPTION:THE LAST CLINIC IS SO PESSTIMISTIC AND I DONT LOVE THIS. AND I DONT KNOW HOW WELL IS THEIR LAB.BUT AGREED ON USING YOUR PROTOCOL NEXT TIME.
2.OPTION : TO GO AN EXPENSIVE AND SUCCESFULL CLINIC (ABOVE 40) BUT THAT CLINIC IS IN A DISTANT CITY AND DOCTOR WONT USE YOUR PROTOCOL . I THINK THIS DISTANT CLINIC HAS THE BEST LAB. BUT IT WILL BE VERY STRESSFULL TO MAKE IT THERE.
3. OPTION : A CLINIC NEAR , WITH A BETTER LAB. THAN THE FIRST ONE BUT WONT BE ABLE TO USE YOUR PROTOCOL.
WELL FOR THIS LAST TRY WHICH OPTIO9N DO U RECOMMEND US ? PLEASE HELP