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,
I have been on the bcp for 12 years (DIANE-progestogen called cyproterone acetate and an estrogen called 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 have female pattern hair loss and the treatment has kept my hair quite stable.
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. As coming off is detrimental to my hair.
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/quality eggs without coming off the bcp.
I understand I need to come off the bcp for the period of the harvest.
My dermatologists has told me I need to come off the bcp for a few months until my periods normalise. To maximise egg numbers. However my fertility specialist has told me she is happy for me to stay on it right up until harvest.
I am confused. I want to get a good egg count/but would also like to try and keep my hair.
Thanks for your advice.
I respectfully disagree. Provided it is used properly, the BCP usage will NOT compromise either egg quality or quantity. Quite the reverse…it is my opinion that it can benefit both. One often hears the expressed opinion that the BCP suppresses response to ovarian stimulation. This is not the case, provided that the BCP is overlapped with administration of an agonist (e.g. Lupron, Buserelin, Superfact) for several days leading up to the start of menstruation and the initiation of ovarian stimulation cycle with gonadotropin drugs. If the latter precaution is not taken, and the cycle of stimulation is initiated coming directly off the BCP the response will often be blunted and subsequent egg quality could be adversely affected. The explanation for this is that in natural (unstimulated) as well as in cycles stimulated with fertility drugs, the ability of follicles to properly respond to FSH stimulation is dependent on their having developed FSH-responsive receptors . Pre-antral follicles (PAF) do not have such primed FSH receptors and thus cannot respond properly to FSH stimulation with gonadotropins. The acquisition of FSH receptor responsivity requires that the pre-antral follicles be exposed to FSH, for a number of days (5-7) during which time they attain “FSH-responsivity” and are now known as antral follicles (AF). These AF’s are now able to respond properly to stimulation with administered FSH-gonadotropins. In regular menstrual cycles, the rising FSH output from the pituitary gland insures that PAPs convert tor AF’s. The BCP (as well as prolonged administration of estrogen/progesterone) suppresses FSH. This suppression needs to be countered by artificially causing blood FSH levels to rise in order to cause PAF to AF conversion prior to COS commencing, otherwise pre-antral-to –antral follicle conversion will not take place in an orderly fashion and the follicles will not readily respond to gonadotropins (FSH) , thereby delaying follicle development by up to 7 days and compromising egg quality. GnRH agonists (e.g. Lupron, Buserelin, Superfact) , cause an immediate surge in release of FSH by the pituitary gland thus causing conversion from PAF to SAF. This is why, women who take a BCP to launch a cycle of COS need to have an overlap of the BCP with an agonist.
By overlapping the BCP with an agonist for a few days prior to menstruation the early recruited follicles are able to complete their developmental drive to the AF stage and as such, be ready to respond appropriately to optimal ovarian stimulation. Using this approach, the timing of the initiation of the IVF treatment cycle can readily and safely be regulated and controlled by varying the length of time that the woman is on the BCP.
Good luck!
Geoff Sher
Thank you for your response, Dr. Sher. Given the number of follicles that I’ve produced in these previous cycles and their fertilization rates, do you think I should proceed with a 5th round of IVF using an A/ACP protocol like you recommend with the hopes to get successful eggs at this age? Or do you think I should just go to donor at this point regardless, given my age?
Thank you once again for your guidance.
Rachel
It might be worth another try…
Geoff Sher
Hello,
In 2011 we did IVF for the first time and got pregnant with twins the first try but at that time they implanted the embryos at day 3. In 2017 four were thawed and only one was implanted but it didn’t end in a positive test. We thawed the remaining three and implanted the only one that survived and didn’t end up pregnant. Early 2018, we did a fresh cycle, placed two embryos and ended up with a chemical pregnancy. We had six embryos frozen and in July we thawed two and resulted in a negative test. I’m going to be 34 in August and my husband is already 34. We are frustrated with four attempts at another FET and not getting positive results. I came across your page and read a little Immunologic Implantation Dysfunction and was wondering if that’s something we are dealing with. With the small synopsis I’ve given you do you think we maybe struggling with this? If so is it something I could suggest to my doctor?
Thanks,
Brittany
Hi Dr. Sher, first off thank you for your time and information. I am 32 and have MRKH (no uterus), PCOS “like tendencies” and very high AMH. We have a surrogate ready to carry for us again and I have done 4 rounds of IVF in Toronto with the following results:
2016 at age 30
Round 1: BCP, low dose Purgon, orgalutran (starting 3 days in) and full 10,000 HGC trigger. 32 eggs retrieved – 16 post mature, 8 mature and 8 immature. 4 fert. Through ICSI and 2 frozen on day 3 one resulting in my daughter.
Round 2: no BCP, same protocol, Lupron only trigger – 22eggs, 7 fert and 0 on day 5/6
Round 3: no BCP, metform, puregon and luveris(75) with Orgalutran(starting day 3). 5,000 hcg trigger = 14 eggs – 6 fert – 2 blasts one tested abnormal, one dying at thaw.
2018 at age 32 with higher AMH than previous rounds
Round 4: no BCP. metformin slightly higher dose of Purgon, luveris (75) with Orgalutran(starting day 5). 25 eggs – 11 fert – 5 frozen on day 3 – 2 dying at thaw, a 5 and 6 celled Enbryo transfered and one 6 celled day 3 still frozen. We are 4 days post transfer and I don’t expect good news so my question is what can we do better for round #5 as we cannot go beyond a 6th round.
Many many thanks! Your webinars and book has been a wonderful resource.
This could well have to do with the protocol used for ovarian stimulation…in my opinion.
Here is the protocol I advise for women who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur—no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://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.
• Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
• Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
• A personalized, stepwise approach to IVF
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
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
Dr Sher, how much importance do you place on testing of embryos? I hear people talk about AA, AB, BB, C etc grading of embryos & I wonder just how much of that matters? Either an embryo is good & normal or not aneuployd or not right? I feel like the whole testing & grading business has gone too far and otherwise good embryos are labelled as poor or average when they are probably fine. In utero normally they either take or they don’t, the body doesn’t grade them. My first IVF cycle at age 37 only produced one blastocyst and I figured it would either work or it wouldn’t. It wasn’t tested, we transferred it and that embryo is now my one year old daughter. I am about to embark on another round now at age 39 and again will not be pgs testing (it isn’t mainstream here in Australia, and is very expensive if your clinic offers it) I’ve read much of your literature about the mosaic phenomenon & autocorrecting. How relevant is that?
Testing will not improve embryo quality. It simply hels identify the best embryos for transfwer. Ultimately when the right embryo is transferred (PGS or no PGS), a viable pregnancy is likely to occur. So I woulkd not necessarily push for PGS.
Good luck!
Geoff Sher