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. Thank you in advance for reading my long message. Here’s a bit of background information. I turned 40 in July. I have 3 healthy children, ages 12, 8.5 and 3. My 3 year old is an IVF baby (5 day FET).
I’m currently 7 weeks, 3 days pregnant. I had a FET on July 21. My LMP was on July 3. My hcg numbers have been as follows:
10 days past 5dt (15dpo): 65.6 …prog 18
12 days past 5dt (17dpo): 82.8…prog 28
14 days past 5dt (19dpo):208…
16 days past 5dt (21 dpo): 428…..prog 22.7
19 days past 5dt (24 dpo): 906…prog 26.4
26 days past 5dt (31dpo):3638
Today (7 weeks, 3 days pregnant) the heartbeat measured at 128 bpm. Three days ago, the heartrate was 115 bpm. Today, the CRL measured at 6.35mm (6 weeks, 3 days). My fertility doctor is concerned because the fetus is measuring a week behind, and because my sac is measuring smaller than it should be at this stage (I believe the sac is measuring at 14 or 15 mm). He also saw a small clot on my uterus (measuring around
11.15 mm).
My ob is optimistic because the heartrate is strong.
I’d love to hear your thoughts. Thank you so much.
I am not that pessimistic based upon the information you provide here.
Please keep me updated.
Good luck!
Geoff Sher
Hi Dr.Sher ,
Thanks for answering my earlier question. I had normal ovarian reserve with 13 follicles between 2014 and 2016 and froze 12 oocytes and my cycle was 200 Iu and 250 Iu puregon with ganirelix on 6th day. Currently I am undergoing third round and because I am 39, i am taking orgalutro pre treatment and then 300 IU puregon with ganirelix. I will be making embryos this time. When i talked to a doctor, she mentioned that she stims with >400 iu and I was given very less dose of only 200 iu ( I was 35 then). Is my dose too low? I only want to do retrieval only one more time and my doctor says that too high of a dose is not recommended. Also my sister (43 years) had breast cysts in her mammogram. They were not cancerous and I don’t have any family history of any cancers. Is it safe to go through high estrogen cycle for me? Regards.
This is something that you need to take advice from your primary treating MD on.
I wish you well!
Geoff Sher
Hi Doc
My first IVF failed in Jul. 42yrs old with low AMH. I cant afford to have another IVF anytime soon. I was thinking of doing an IUI in the meanwhile…..what are your thoughts?
Also, I have not had my period as yet this cycle .. 8 days late. HPT was negative. Are cycles usually delayed after a failed IVF?
Thank you for so promptly replying to every question. Your advice is so valued
Hi Mesh!
I hear you!
But you need to know that at 42y of age, the chance that any attempted cycle of IUI will be successful is likely to be <2%.
G-d bless!
Geoff Sher
Dr Sher hello and thanks for this wonderful blog.I am totally confused and I need your help. Nine days post ovulation I had fsh 4, lh 13, E2 206 and P4 12. There was an 18.6mm structure which my doctor called a bad quality follicle as he believed that most of the e2 was coming from the corpus luteum. Today CD2( about 5-6 days after those results above) there is an 19,7 mm structure with FSH being 5, Lh 6, E2 188 and P4 0.2. a)Is this structure a NEW follicle or could this be the OLD one we saw in the last monitoring that somehow had an increase in e2 levels but hardly grew in size?b) Can an estrogen producing cyst keep increasing the estradiol levels or does it keep them stable?(its size constant). I can’t work out the answers to the the above. I will hugely appreciate your help.
Sounds like a progression of the original one.
Geoff Sher
Hi, I’m 38 with DOR and Hashimoto’s. My AMH is 0.7 and cycle day 3 follicle count is usually around 8 (lowest ever was 5 once). I tried a few IUIs which failed. My follicles grew ok during those. I’m currently undergoing my first IVF. But that one is getting cancelled because my estrogen is rising very slowly (from the 30s to only 50s after 5 days of stims). My protocol was Microdose Lupron (20 units of MDL twice a day, low dose HCG 20 units once a day, 300 then 450 of Gonal-f once a day) with a Birth Control lead-in. Besides the estrogen issue, at the baseline ultrasound right before starting stims, there were zero visible follicles (when I usually have 8 on cycle day 3). What changes should I consider going into the next round? Thanks!
In my opinion, against the backdrop of age and diminished ovarian reserve (DOR), the protocol used for ovarian stimulation is one of the most important drivers of egg “competence” (quality) and the number, yielded.
Women 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 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, https://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