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.
Please dr. Sher what you think is going on with my cycle when my e2 levels haven’t dropped on day 4 of coasting. .. I really need your advise.
am a 35 yo woman who had 2 failed IVFs. We are blessed with a 4 year old son who was conceived without help.
The only issue is slight DOR (9-11 AF). The first IVF I had 9 eggs, 5 fertilized with ISCI and 3 were alive on day 3. Transfered two, and BFN.
The second, we had 8 eggs and all fertilized. None made it to day 5.
For both cycles, we were on HGH, coQ10, DHEA.
My husbands insurance recently changed and we now can do another 2 or maybe three IVFS that are covered.
We are in the process of adoption but this made us pause. Is it worth another shot if the egg quality is our issue? I am not too keen on donor eggs at the moment.
Thanks for any insight or help you can provide!
Yes indeed it is worth trying again. But please first consider the following.
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
The most common causes of implantation dysfunction are:
a)A “thin uterine lining”
b)A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c)Immunologic implantation dysfunction (IID)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women.
Please visit my new Blog on this very site, 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•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 Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
•Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 2- Making a Diagnosis
•Immunologic Dysfunction (IID) & Infertility (IID):PART 3-Treatment
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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.
Geoff Sher
Thank you,Dr!
Very interesting. Since my eggs on the second IVF all arrested before transfer, do you think that implantation would still be the major cause? I had a great lining at 17 mm but definitely could be IID. If it is just egg quality, can that be improved with lifestyle factors, a different protocol or even just “luck of the draw”? Thanks again
Dear Dr Sher,
I desperately need your help!
I have high fsh, highest day 3=40 and day 4=45 on that same cycle this September. I had AMH tested in November and it is 0.20pmol or 0.028ng/ml which is undetectable. My AFC remains constant at 4 antral follicles. Sometimes 5. My periods were coming every month but now i am on day 60 of a cycle(last period was December 6th).
I know things are tragic and that the chances of working very minimal but still want to keep trying.
I was advised to use this protocol. Can you please tell me your opinion?
I should take norethisterone to get a period.
I start BCP(yasmin) on day 1-5 and i take those for 2 weeks.
I get another period and i start letrozole on day 2.
I also start fsh injections of day 2-3, 300iu of fsh.
I start the antagonist(orgalutran) on day 6 of stimulation unless the follicles are greater than 12 mm in which case i start it earlier.
I continue to take 2 injections from this point onward(orgalutran and fsh) until further instructed.
I trigger with pregnyl 5000 per ampule( i take 3 ampules so 15000)
What do you think?
1) will i respond to this protocol?
2) will it be too suppressive for me?
3) will it shut my ovaries down?
4) is 300iu too much? should i go for less?
5) what else can be done to improve this protocol?
6) should i try with ivf or resort to other methods like mini-ivf? ( i have heard it helps to get the same number of follicles but with better quality, it doesn’t shut the ovaries down and can do consecutive cycles). Which route is better for my case? So confused.
I am not sure about using moderate to high stims. My last ivf cycle was in July and that was before fsh climbed to 40. It was an antagonist protocol 450iu of fsh. I got 5 follicles, 2 eggs, one egg was bad and one was saved. I now have a partner and want to transfer an embryo if i get there. However a chain of bad things started to happen after this ivf cycle in July. In August i got a very low estradiol reading on day 3 for the first time( 22pmol), in September fsh climbed to 40 on day 3 for the first time, in October fsh came down to 10 but LH was 17, in December fsh went back to 28 and estradiol was less than 55pmol. I had AMH tested in November and it came back at 0.20pmol. I am now on day 60 without a period. So things got a turn for the worse after that ivf cycle. I don’t know if it was the high stims or not-but i am bit fearful.
Please please Dr Sher answer my questions! I have no-one else to ask. I live in a very small country with very few RE who have little experience on high fsh. Travelling to the US is extremely hard due to financial reasons. I feel lost as what to do next! I still want to fight with my own eggs and not donor(not an option for me for various reasons). I am dying to hear from you……
Best regards
Kihem
Hi Kihem,
I wish I could be encuraging but it appears that you are premenopausal with severe DOR. The oly option for you is IVF with egg donation.
Sorry!
Geoff Sher
Dr. Sher it’s my fourth day of coasting and bloods have not dropped since yeaterday they are still at 5000. What would you do? Are my follicles going to be too big at time of egg collection.
Hi,
I’m 38 year old. Amh 0.7. First ivf in oct/nov 2015 produced 11 eggs
on flare protocol. 7 mature. 6 fertilized w icsi. All 6 graded top
quality (1 or 2+) by clinic. Clinic does standard 2 day transfers.
Transferred 3 and bfn. Immunology panel after revealed elevated coag
factor II. Planning FET in Fefeb. Is asa 81mg daily enough? Should I
be doing anything else or looking into this factor II more? Anti- cardio lipids were also slightly high at 14.
Thank you for your time.
Karen
Hi Karen,
You have a low AMH and clearly if this is correct, have DOR. This plus the fact that with advancing age egg quality declines means that means that time is of the essence and that you should be considering using a modified, robust, long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend “Staggered IVF” with “embryo banking” of PGS normal blastocysts, to make hay while the sun still shines. I do not prescribe ASA. Depending on the type of Thrombophilia you have, you might need additional folic acid and/or Lovenox/clexane when pregnancy is diagnosed.
I strongly recommend that you visit my NEW personal website at http://www.DrGeoffreySherIVF.com and when you reach the home page, go to my new Blog 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the “Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•The “Biological Clock” and How it Should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 and set up an one hour Skype consultation with me to discuss your case in detail.
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.
Geoff Sher