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,
Is it pretty normal for progesterone level to fluctuate? My levels pre frozen embryo transfer was estrogen @ 176.2 and then the progesterone was @ 32.7. Yesterday 4 days post transfer my estrogen was 451 then my progesterone was 17.4. Can this be considered as a good indication? Thank you doctor!
It can fluctuate, but this [P4] is a little on the lowish side.
Geoff Sher
Hello Dr. Sher,
I was incredibly lucky, because our first IVF was successful and we had our son in December 2015. We are now dealing with secondary infertility. Before our first IVF, our diagnosis was DOR for me and male factor infertility for my husband. We did IVF with ICSI and assisted hatching. Transferred two day 3 fresh embryos and one implanted and was viable, another one implanted, but was not viable. The 2 embryos were not of great quality. We froze 2, but their quality was really poor.
I am concerned that since the frozen embryos were not of great quality, our FET will not be successful and we’d have to do another full IVF. I was already dreading that, but I just had a blow last week when I found out that my day 3 FSH came back at 20. When we last tested it in 2014 it was 8.1. LH now is 8.2 and Estradiol at 74. I am now over 35 yrs. Have you seen any success with IVF with such high levels of FSH? I heard that some clinics have cutoff values of well below 15, so I am nervous that we may not be able to even try. What protocols typically work for severe DOR cases? Thank you for any info you can provide!
Indeed, success can happen with DOR. It all depends on how severe the DOR is (as evidenced by your AMH level), your age and the protocol used for ovarian stimulation:
Women who (regardless of age) have diminished ovarian reserve (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, 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
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
hi doctor sher, after a fet cycle, i was prescribed 600 mg daily progesterone suppositories but asked doctor to convert IM injections 50 mg daily. my progesterone in 7 weeks was 26 but i m currently 10 weeks 1 day with a healthy heartbeat of 178 and measuring fetus of 10 weeks 5 day but progesterone dropped to 15.3 despite 59 mg IM shots daily. do you think it is normal? i m planning to ask for proluton 500 mg depot weekly and may be back to additional vaginal suppositories. my obygyn doesnt even follow progesterone levels and i m a little panicked at this point. what would you suggest?
It is on the lowish side, but frankly, in my opinion adding progesterone atthis stage will improve matters. Discuss with your doctor.
Geoff Sher
Hi!
I had some blood work done on day 3 of period and results are following:
FSH 4,42 IU/L
E2 45,5 pg/mL
LH 3,64 mIU/mL
Prolactin 10 ng/mL
TSH (ultrasensitive hTSH) 1.91 uUI/ml
Vaginal ultrasound (cycle day 24)showed multiple cyst on left ovary and 2,8×2,9 cm cyst an right ovary.
Are these lab results normal or indicative of PCOS?
Thank you..
They are normal…in my opinion.
Geoff Sher
hi dr Sher
Thank you for the reply. So if triptorelin can delay the period on the cycle of scheduled embryo transfer, Then should i take the progynova on the 5th day after my period comes( wait for period first) or should i just take it on day 5th on the scheduled period regardless period come or not?
Thank you
You need a vaginal ultrasound and a blood estradiol test to look for a cyst.
Geoff Sher