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.
Dr. My very first IVF has failed this month. 42 yrs old. amh=0.35
I do not have money to do another IVF this year. Is it possible to fall pregnant naturally in the next cycle after a failed IVF? Is this just wishful thinking?
Also, can patients with low AMH levels eventually fall pregnant naturally or with IVF/IUI?
Although unlikely, it is possible. BUT time is against you and you really do need IVF/ICSI/PGS…see below:
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
Hi
Hi Dr Sher,
I have been on bcp for 12 years DIANE35(-progestogen cyproterone acetate and ethinyl estradiol). I have also been on 100mg cyproterone acetate for the 1st 10 days of my active pill for 12 years as well. I am preparing to freeze my eggs as I am 35 years old. I am wanting to stay on the bcp up untill my egg harvest. I have weaned myself off the cyproterone acetate and will be off it for 4 months before harvesting my eggs. What are my chances of getting a good number of eggs/and if that quality eggs with potential qaulity future embryos without coming off the bcp?
Thanks in advance
Hi!
Geoff Sher
hi dr Sher
I’m 35yo. Low AMH 0,6 FSH 16. Mosaic karyotype. One ovary left due to big cysts. Started IVF- ICSI cycle last March with PGS yielded two blastocysts( one normal blastocyst and one autosomal after PGS result out).
I’m on my final step which is embryo transfer( hysteroscopy was normal)and from the pgs tested embryo i got only one normal. I read your blog about Immunologic implantation can happen even when the woman didn’t realise she was pregnant. I did pgs because from my karyotype test i was diagnosed mosaic.
1. should i try transfer that one normal pgs in the hope there is no implantation problem and do nipt at week 16 to make sure embryo can progress normally?
2. Or should i have evaluation on the NKa cells activation first before transferring? Because you said in your blog only 2 centers that are reliable of having this test and both are in the US. i live outside the US i have no idea how to send the blood for such a long journey? Will it be okay once it arrive?
My hospital here offers this test but i’m afraid it’s not accurate and i just wasting money. Really confused about this.
What is your best suggestion?
Appreciate your reply.
Regard
Lin
Indeed, I personally would suggest that NKa testing be done first. Go to google and look up Reprosource in Boston, MA and contact them. They will provide you with details on how to safely get the test done there.
Good luck!
Geoff Sher?
Hello Dr. Sher,
I’m almost 43, have never been pregnant, and just failed my 4th IVF cycle. We did 2 cycles with one provider last year and used a lupron flare protocol both times. Each time (though the follicles never got larger than 12-13 mm on sono) we retrieved 8 eggs. 6 fertilized the first time and 5 the second time (both traditional IVF) and by day 3 we had 3 promising embryos the first time and 2 the next. All, however didn’t make it to day 5 – not dividing the way expected and looking fragmented.
We tried a different clinic for 2 cycles this year. This time prior to cycle used extended estrogen priming x 1 month and prometrium x 10 days. During cycle used menopur (150), gonal F (300), clomid, dexamethasone, cetrotide the last 5 days till trigger with novorel/pregnyl (10,000) followed by lupron trigger x 2. The first time we retrieved 13 eggs, fertilized 8 with ICSI and got 1 to blast testing but unfortunately it had trisomies on two chromosomes. The second time we added omnitrope and calcium ionophore to the above regimen. This time we retrieved 18 eggs, fertilized 10 with ICSI, 4 looked promising on day 3 but NONE of them made it to blast on day 5 nor day 6. All stalling/dividing slowly and looking fragmented. All follicles in both of these cycles were much bigger – getting to 20-22 mm on sono.
I just want to know if I should chalk all this up to my age and proceed with egg donor or do you feel there is anything to change in protocol or my health itself that may help my aged eggs do better at getting to blast.
Thank You for your help and advice.
Rachel
hi dr Sher
1. i have monosomy X chromosome( mosaic turner), my estradiol level below average, also have DOR. Had big dermoid cysts removed on both ovary causing removal of left ovary and left tube. First Pregnancy after dermoid cyst surgery but loss at 7 wks. Could it be because of my incomplete x chromosome( monosomy)?
2. does my mosaic turner rule out immunologic implantation dysfunction cause of my loss?( anatomical cause was observed and clear)
Regard,
Hera
1. i have monosomy X chromosome( mosaic turner), my estradiol level below average, also have DOR. Had big dermoid cysts removed on both ovary causing removal of left ovary and left tube. First Pregnancy after dermoid cyst surgery but loss at 7 wks. Could it be because of my incomplete x chromosome( monosomy)?
A: It is likely to be due to the chromosomal abnormality, in my opinion.
2. does my mosaic turner rule out immunologic implantation dysfunction cause of my loss?( anatomical cause was observed and clear)
A: No it does not rule it out!
Geoff Sher