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. I’ve had a failed IVF Cycle. Had my period for 3 days and then it stopped. Been spotting for three days now. Uncomfortable feeling in my abdomen. Is this normal after a failed IVF? Should I be concerned?
I doubt that there is reason for any concern but please discuss with your doctor.
Geoff Sher
Hi- I had a failed IVF egg retrieval cycle, my doctor told me that the follicle had collapsed- that he still tried to aspirate them but that they were empty. I am wondering if this means that I ovulated early- he seemed to indicate that could have happened. I have been reading that sometimes people ovulate 24 hours after a trigger shot. Also when should a patient optimally have their last vaginal ultrasound prior to retrieval? And what are the benefits of taking birth control pills during stimulation? I did not take birth control my doctor said I didn’t need to. thank you!
Frequently, when following vigorous and often repeated flushing of follicles at egg retrieval they fail to yield eggs, it is ascribed to “Empty Follicle Syndrome.” This is a gross misnomer, because all follicles contain eggs. So why were no eggs retrieved from the follicles? Most likely it was because they would/could not yield the eggs they harbored.
This situation is most commonly seen in older women, women who have severely diminished ovarian reserve, and in women with polycystic ovarian syndrome (PCOS). In my opinion it is often preventable when an optimal, individualized and strategic protocol for controlled ovarian stimulation (COS) is employed and the correct timing and dosage is applied to the “hCG trigger shot.”
Normally, following optimal ovarian stimulation, the hCG “trigger shot” is given for the purpose of it triggering meiosis (reproductive division) that is intended to halve the number of chromosomes from 46 to 23 within 32-36 hours. The hCG trigger also enables the egg to signal the “cumulus cells” that bind it firmly to the inner wall of the follicle (through enzymatic activity), to loosen or disperse, so that the egg can detach and readily be captured at egg retrieval (ER).
Ordinarily, normal eggs (and even those with only one or two chromosomal irregularities) will readily detach and be captured with the very first attempt to empty a follicle. Eggs that have several chromosomal numerical abnormalities (i.e., are “complex aneuploid”) are often unable to facilitate this process. This explains why when the egg is complex aneuploid, its follicle will not yield an egg…and why, when it requires repeated flushing of a follicle to harvest an egg, it is highly suggestive of it being aneuploid and thus “incompetent” (i.e., incapable of subsequently propagating a normal embryo).
Older women, women with diminished ovarian reserve, and those with polycystic ovarian syndrome, tend to have more biologically active LH in circulation. LH causes production of male hormone (androgens, predominantly testosterone), by ovarian connective tissue (stroma/theca). A little testosterone is needed for optimal follicle development and for FSH-induced ovogenesis (egg development). Too much LH activity compromises the latter, and eggs so affected are far more likely to be aneuploid following meiosis.
Women with the above conditions have increased LH activity and are thus more likely to produce excessive ovarian testosterone. It follows that sustained, premature elevations in LH or premature luteinization (often referred to as a “premature LH surge”) will prejudice egg development. Such compromised eggs are much more likely to end up being complex aneuploid following the administration of the hCG trigger, leading to fruitless attempts at retrieval and the so called “empty follicle syndrome.”
The developing eggs of women who have increased LH activity (older women, women with diminished ovarian reserve, and those with PCOS) are inordinately vulnerable to the effects of protracted exposure to LH-induced ovarian testosterone. Because of this, the administration of medications that provoke further pituitary LH release (e.g., clomiphene and Letrozole), drugs that contain LH or hCG (e.g., Menopur), or protocols of ovarian stimulation that provoke increased exposure to the woman’s own pituitary LH (e.g., “flare-agonist protocols”) and the use of “late pituitary blockade” (antagonist) protocols can be prejudicial.
The importance of individualizing COS protocol selection, precision with regard to the dosage and type of hCG trigger used, and the timing of its administration in such cases cannot be overstated. The ideal dosage of urinary-derived hCG (hCG-u) such as Novarel, Pregnyl and Profasi is 10,000U. When recombinant DNA-derived hCG (hCG-r) such as Ovidrel is used, the optimal dosage is 500mcg. A lower dosage of hCG can, by compromising meiosis, increase the risk of egg aneuploidy, and thus of IVF outcome.
There is in my opinion no such condition as “Empty Follicle Syndrome.” All follicles contain eggs. Failure to access those eggs at ER can often be a result of the protocol used for controlled ovarian stimulation.
•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
•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 .
*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
Dear Dr. Sher,
I got back the results of my first eggretrieval having five pgs normal tested embryos. I am very lucky because at my age of 30, I already have diminished ovarian reserve and fsh of 10 (my mum had menopause at 37). I know, that I need to do all retrieval now because later it might be impossible (already this time I had a very high dosage, androgen, growth hormon, metformin..)
I aim for having 3 (maybe 4) children and now, I don’t know if 5 normal embryos are enough or if I should do another eggretrieval to be sure having enough resulting in a birth (storage). My clinic has success rate for blastocyctstransfer of 80 %. I am still afraid if they could be destroyed in defrosting or other reasons why it should not work. For me, it is a difficult decision I have to do now because it is not possible for me to decide this a few years later.
What would you recommand me? Are 5 blastocysts a good number in general and for 3-4 children?
Thanks for helping me to take a decision.
Sophia
Respectfully Sophia, no one anywhere has an 80% success rate per blastocyst transfer.
Yes! I think it is a good idea to bank more PGS normal blastocysts for future dispensation.
Good luck!
Geoff Sher
Hi Dr. Sher,
I’m 27 years old and have had two clinical miscarriages (both prior to 10 weeks), three biochemical pregnancies lost at 5-6 weeks, with one living 15 month old daughter (conceived naturally). First was a loss at 7 weeks, then two chemical pregnancies, our daughter, another chemical, and another clinical miscarriage (this one had great doubling betas, and a low average heart rate).
We’ve had a lot of testing done, including karyotypes for both of us which were normal, and I had a carrier screening done and I am not a carrier of any of the 300 things it tested for. His semen parameters were a little on the low side for motility (30%) and morphology (66%), and that test was done back in 2016. My TSH was tested prior to my pregnancy with my daughter, and it was normal. After my daughter, I was diagnosed with postpartum thyroiditis, and later hashimotos. I tested positive for peroxidase and thyroglobulin antibodies. I currently take levothyroxine and I’ve started vitamin d3, magnesium, selenium, and inositol supplements in the last week. My TSH was about 3.5 during pregnancy #5, and 1.2 during pregnancy #6.
Other tests I’ve had include the following and have all been normal:
[2016]
Factor V Leiden
Anticardiolipin ABS IGG/IGM
Beta 2 glycoprotein IGG/IGM
Lupus Inhibitor
Lupus Anticoagulant
Homoglobin and Hematocrit
Anti Mullerian Hormone
MTHFR
AMH
Blood type A+
Prolactin
[2018]
Factor II
Protein C
Protein S
Homocystein
Antithrombin III
I had a saline infusion sonogram in 2016 which showed a small band of tissue…it looked like a small septum. That was removed in July 2016, and we conceived our daughter that next cycle. My doctor said it was so minuscule once she got inside to see though that she wasn’t sure if you could even call it a septum and if it really was doing any harm.
Anyway, we aren’t really sure what to do next. We can get pregnant really easily but can’t seem to hold onto them (thank goodness for our daughter though!!) Wondering if we should get his semen re-checked? What do you think about his previous levels? Also wondering if there’s any other testing I should do, or if anything I had done back in 2016 needs to be rechecked? We don’t live in a town with an RE and I’m not sure what to do next.
Thank you for your time!!
Do you know of a dr in Florida that could or would prescribe intralipid infusions for my upcoming August IVF? Please help me. I can’t find anyone. I
Sorry!
Geoff Sher