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.
i am 43 and had a tubal ligation 18 years ago and last year a uterine ablation. i had 4 healthy babies in my twenties with no complications. am i a candidate for IVF?
Yes you could do IVF , provided you have adequate ovarian reserve. However, please consider the following:
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those who (regardless of age) have 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 age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can 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 older women and those 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 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
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
Hi Dr.sher,
Is it better to do egg retrieval , freeze for 4 months and then do fertilization or just do a fresh egg retrieval and fertilize st the same time? I am 39 and progressing with my third cycle. Due to travel plans Weill not be able to fertilize till December. I will still be 39 in December ( but closer to 40). Will some eggs be lost in that? Regards.
Freezing eggs can compromise them. It is far better to fertilize them and if storing them is the objective, to freeze blastocysts (advanced embryos rather than eggs.
Geoff Sher
Hi Dr Sher,
My name is Holly and I’m located in Melbourne Australia. I just suffered my 8th pregnancy loss and I am devastated. Earlier this year due to medical error I was left infertile and my only way going forward is IVF. From falling pregnant naturally to having the wrong thing removed has just left me devastated.
Previously I had 7 pregnancies, one inter uterine twin pregnancy which stopped growing at 6 weeks, terminated at 9 and multiple ectopics in my right Fallopian tube.
I did have a little endometriosis removed but not much.
I’ve had inter uterine killer cells tested at levels of 20 but have elevated ANA levels of 1:680.
I message you in some type of hope that you may be able to lead me to something or anything for treatment. The stress of everything has left me unable to function properly.
Thank you for reading my message.
I am 42 with Amy or 6.7 (UK) and fsh of 13. I have had three cycles. Cycle 1 with bemfola, certrotise and icsi – 4 eggs, w fertilised, 1 blast (phs abnormal). Cycle 2 300 bemfola 150 menopur, cetrotise started later, 3 eggs zero fertilised with icsi. Third cycle long protocol bcp with synarel, 5 days of 450 fostimon and 7 days 450 meriofert. 7 eggs, 1 fertilised (all looked mature). Do you think the LH stims could be causing the fertilisation issues as I had better fertilisation in cycle 1? What would you recommend? Thank you
Dear Dr,
I just wanted to get some advice about our current situation. I am now 40 years old. 3 years ago I had a baby girl, she was conceived naturally after only 2 months trying! She was delivered by C section and i sustained a large 15cm bladder tear during the surgery. As a result recovery took some time. We delayed trying for a second baby for a year after her birth. When we started trying and nothing was happening, i went to the Dr and got some tests done. I had high FSH and 3.1 pmol AMH and my Dr told me that the only hope was IVF with donor eggs. at that stage I was really shocked and not ready to go down the IVF route. We couldn’t believe that this was happening to us after it being so easy the first time we conceived. We went to a clinic that uses NAPRO technology as i felt it was less invasive and more ‘natural’. We have been with them down 18 months. We were initially on Letrozole and Clomid, then i went on to PUregon and Ovidrel trigger, my response was much better on Puregon. However following a hysteroscopy last year we discovered i had Ashermans’ syndrome resulting from C section. Adhesions were subsequently removed. We are still with the clinic doing ovulation induction. Last week however we had a consultation with an IVF clinic and the Dr really gave us very little hope with IVF. He said we probably only had a 5% chance naturally and maybe 15-20% with IVF. my husband also got tested and his semen analysis results were sub optimal with 3% morphology. he said egg quality is obviously an issue as I have had not had one positive pregnancy test in the last two years. When I asked him about improving egg quality, he was quite dismissive of interventions such as diet and supplements and said that really they have little impact. So we are now at a crossroads – do you think we should just do nothing or give IVF a go? Will IVF clinics even take us? Do you think we should try clinics that ‘specilise’ in reduced ovarian reserve and have high success rates with women aged 40 -42. Do you think we are a difficult case?
Thus, as a first step, in my opinion, the adhesions (synechechea) in your uterus (Asherman he Asherman syndrome adds another complication as it will compromise implantationsyndrome) need to be surgically addressed and thereupon the ability of your endometrium to respond adequately to estrogen should be thoroughly assessed. If after the surgery, the use of estrogen/vaginal Viagra results in a good lining, then (and only then) should you consider proceeding. In my considered opinion, At 40y , if indeed your AMH is as low as 3pmol/L, you would be advised to use an egg donor. I think using own eggs is a bad idea.
I strongly recommend that you visit http://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.
•Secondary Infertility: Addressing the Root Causes
•Early Pregnancy Loss: Causes and a Rational Approach to
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting 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
•How Many Embryos should be transferred: A Critical Decision in IVF.
•Avoiding High Order Multiple Pregnancies (Triplets or Greater) with IVF
•The Role of Nutritional Supplements in Preparing for IVF
•Male Factor Infertility
•Routine Fertilization by Intracytoplasmic Sperm Injection (ICSI): An Argument in Favor
•IVF for Women Who Have Previously Conceived (Secondary Infertility).
•IVF Egg Donation: A Comprehensive Overview
•IVF-Gestational Surrogacy: An Overview
•Asherman syndrome
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•A Thin Uterine Lining: Vaginal Viagra is Often the Answer (update)
If you are interested in my advice or medical 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.
Also, my 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