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 am a 39 year old woman that has had 2 IVF cycles. I had a stimulation cycle with puregon and orgalutron on day 6. Now after 1.5 years, I am attempting my third cycle. My old doctor is suggesting the same protocol . I am currently trying to choose between two protocols – one is starting with orgalutron for 2 days and then going to puregon (300 IU) and the second one is starting with birth control on day 2 and taking birth control for 4 days and then stop for 5 days and then start clomid for 3 days and then clomid+ menopar (300iu) for 3 more days and then just menopar. I am 39 and my AMH is 0.67 ( was lower even during my second IVF but had 7 eggs retrieved and successful). Other readings have not changed much. What do you recommend? You had mentioned for a woman of age 39, orgalutron pre treatment or estrogen priming is bettyer. I really don’t know what the second plan is. Is starting BC on day 2+ BC for 4 days + nothing for 3 days+ clomid for 3 days+ clomid and menopar and then just menopar a good protocol for older women like me? Regards. Madu
In my opinion, either approach is suboptimal.
Here is the protocol I advise for women, <40Y 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
I am 8 weeks pregnant and have multiple autoimmune diseases. My doctor recently told me that my Tregs are low, and that I need another IVIG infusion to help with this. How does the IVIG help and am I at an increased risk for miscarriage due to this? Also my white blood cell count is very high (23). Thank you!
Frankly, in my opinion, another IVIG infusion at this stage will not have any real benefit!
Geoff Sher
Hi Dr Sher I had one failed ivf did the
Agonist flare protocol with superfeact which yielded 12 follicles 8 mature then left 2
Remaining embryos day five both transferred and did not take. Since then I found out I had a uterine
Polyp/fibroid which was removed and now ultrasound looked clear.
I just turned 39 few weeks ago and have one beautiful 4 year old boy.
Do you think I should
Stick
With same protocol for second ivf or do estrogen priming? We are doing one last round with my own eggs
Then using donor eggs.
What are
Your thoughts? THanks In advance!
Hi Nicole,
I would need much more information to answer authoritatively!
Sorry!
Geoff Sher
Hi Dr Sher
What size should a follicle be on the day of retrieval (not on trigger day).
Thank you.
>18MM WITH HALF OF ALL REMAINING FOLLICLES >15MM.
GEOFF SHER
Dear Dr Sher, We are currently trying to have a baby vie egg donor. I’ve had two early miscarriages. Have been tested for anti-Phospholipid and my husband for Karotype and both were fine. Is there anything you’d suggest to try regarding vitamins, food or any other treatments or blood tests. Thanks so much, Katherine