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.
Hello,
I had a 5 day FET today. During the transfer while the tube was inserted I got emotional and teared up. I tightened my stomach when I pushed back my tears. My nurse said he still. And I did immediately but it happened twice during the transfer. Now I am terrified I did something that causes damage to the embryos. I asked my nurse after the transfer and she said it’s fine. You were just moving your uterus. But honestly I don’t think she would tell me if there was a problem. Should I be worried?
Hopefully the movement won’t be a mitigating factor.
Good luck!
Geoff Sher
hi dr Sher
Forgot to add that i had infection in my uterus and small myoma( infection was treated with antibiotics and myoma was removed through hysteroscopy). Can these be the cause for chemical pregnancy?
Regards,
Laura
Possible but I doubt this is the cause.
Geoff Sher
hi dr Sher
1. Does 10%degree of turner syndrome mosaicism( karyotype 45xx(3),46xx(27) out of 30 cells being examined) have huge impact on ovary producing embryo aneuploidy and can cause first trimester miscarriage?
2. My 2nd pregnancy end up in chemical because on day 12 of the cycle doctor found 23mm mature follicles but not yet ovulated( released) so she gave LH injections to help ovulation but unfortunately ended up in chemical pregnancy( blood test show very low number of hcg which is only 10). Does this because of abnormal embryo( since my karyotype is not normal- turner mosaicism) or any tendency because IID( implantation dysfunction)?
3. Since i have only ONE normal PGS tested embryo what is the effective way to maximise the chance of implantation in uterus ( beside IID test which is not available in my country) because i don’t want to lose the only normal embryo and start the cycle all over again?
Regard,
Laura
1. Does 10%degree of turner syndrome mosaicism( karyotype 45xx(3),46xx(27) out of 30 cells being examined) have huge impact on ovary producing embryo aneuploidy and can cause first trimester miscarriage?
A: It probably will impact the % of aneuploid eggs but does not preclude the production of normal (euploid) eggs.
2. My 2nd pregnancy end up in chemical because on day 12 of the cycle doctor found 23mm mature follicles but not yet ovulated( released) so she gave LH injections to help ovulation but unfortunately ended up in chemical pregnancy( blood test show very low number of hcg which is only 10). Does this because of abnormal embryo( since my karyotype is not normal- turner mosaicism) or any tendency because IID( implantation dysfunction)?
3. Since i have only ONE normal PGS tested embryo what is the effective way to maximise the chance of implantation in uterus ( beside IID test which is not available in my country) because i don’t want to lose the only normal embryo and start the cycle all over again?
Hello Dr Sher! Thank you for this amazing blog! I am 35 years old and have DOR. I am mentally exhausted from IVF cycles and decided to try natural IVF over this summer. I read a great article from you stating that a sustained rise in FSH just before getting a period(3-6 days) is required to turn primary follicles into antral follicles. I ovulated a few days ago and I am now thinking to take Prometrium 400mg from CD19-26 for suppressing my elevated FSH as I want to do natural IVF next cycle a) Will Prometrium allow for this rising curve in FSH before getting a period? b) My lining at ovulation was just 6mm. Will taking Prometrium on CD19-26 help me get a period or mess things up like making it not show up at all? I am looking forward to your answers! Thank you so very much!
Anne
I would not recommend Prometrium just before a cycle. I am also NOT a fan of NC IVF….especially not in women with DOR. The lining is also an issue. It needs to reach at least 8mm (in my opinion) prior to spontaneous or induced ovulation.
In my opinion, against the backdrop of age and diminished ovarian reserve (DOR), the protocol used for ovarian stimulation is one of the most important drivers of egg “competence” (quality) and the number, yielded.
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
Hi dr Sher
Thank you for the quick reply. But i had been pregnant before( eventhough miscarried at 8 wks but i was able to see heartbeat and sac) and chemical pregnancy, does it rule out NK cells activation or immunological problem in my body as i heard that almost 80% of miscarriage happened during first trimester mostly because of chromosomal problem in the embryos? If i have NK cells or immunological problem, my first pregnancy wouldn’t have been survived at least until 8 wks would it?
Regards,
Maria
It could indeed be immunologic because this can manifest with infertility, IVF failure or miscarriage.
Geoff Sher