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 Geoffery,
I was wondering if you can help advise with my situation. I did a FET on March 29th,2016. First beta test was on April 11 and it came back at 43. the nurse told me its very low and should retest again to see if it will increase or go down. I tested again at april 13 and it came back at 74 and again on April 15 and it was 122. So its increasing but still very low. WHat do you advise. Is there any hope?
Thanks veyr much.
This could be a failing implantatation.
Keep repeating the beta evey 2 days to see if it is doubling … and then in about 3 weeks, do an Ultrasound to see if the pregnancy is viable.
Geoff Sher
Dear Dr Sher, I have just turned 45 and am assessing my fertility given my age. I have not started any treatment/IVF yet. I would like to use my own eggs. My reproductive organs and hormones are all normal: day 2 FSH (5.2 IU/L), LH ( 5.5 IU/L ), Oestradiol (298pmol/L); day 21 Progesterone (46.6nmol/L). At a recent ultrasound, my (natural/unstimulated) antral follicle count (day 7) was 9 small follicles (mean 7mm) in one ovary and 3 large follicles (mean 15mm) in the other. I have regular periods, and a very healthy diet and lifestyle. However, my AMH level is low (2.3 pmol/L). Does this mean I have low ovarian reserve despite the other normal results? Should I try banking embryos, staggered IVF and genetic testing? In my country, clinics only allow “own egg” transfers until age 46 so I only have 10 months left. Given this short time, should I attempt 3 consecutive monthly egg banking or rest 1 month in between? Should I test myself for DHEA/testosterone and if this is low, supplement this? I have seen your webinar about the stimulation protocol for diminished ovarian reserve. Is there anything else I can do to improve my chances? I am willing to travel overseas if I have to. Many thanks for all your helpful information. I have also just purchased your book.
Hi Eva,
At 45y, the chance of success with own eggs is extremely small. I suggest you go to egg donor-IVF.
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
•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
•IVF Egg Donation: A Comprehensive Overview
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
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
Good Morning Dr. Sher.
I would like to seek your guidance on the below.
I am going in for a FET, currently ,my doctor has put me on estrogen and steroids and has planned the ET for Day 19, ( 5 day blastocyst transfer).
My question is , I know for sure that typical ovulation day is around D16 and not D14, this has been tested even multiple times with an ovulation kit. So will my endometrium be receptive to a blastocyst only from D21 or D22?
In this case, should we do the ET later than D19 or is D19 an optimal time. I am concerned about this point because in the past I have had implantation failure and would like to ensure that the lining is receptive during ET.
Thank you in advance.
Regards
Dhivya.
Once you are on hormonal therapy you are guided by the time on the hormones. Your own cycle and how it runs, is not relevant.
Geoff Sher
Please could you help me with a few questions.
I am just over 7 weeks pregnant. At 6w4d I had an ultrasound which could not identify a gestational sac in the uterus. Tubes etc were checked but nothing significant was seen. I have been bleeding since around 5 weeks. This started quite light and was on and off spotting mainly pink throughout the day. On ocassions I had some red blood on wiping. Now it has progressed and I am getting period type cramps and it’s all red blood but not soaking through pads but still a lot on wiping. I had a beta at 7 weeks which was only 119 and another a couple of days later had gone up to 130. I have the final beta today. I think they are concerned it may be ectopic. Do you think this could be the case? There has been mention of taking methotrexate which I really wanted to avoid as at my age I can’t afford to take 6 months off from IVF. Are there any other options to deal with this? What would you recommend? Is it likely I could miscarry naturally with all the bleeding and now cramps?
You probably had a chemical pregnancy that is self-resolving now.
Geoff Sher
Hi Dr Sher, I am doing a cycle overseas (I am in Australia) and I have always had problems with uneven follicle growth, so this last month I took Estrogen 2mg x 2 daily and Testosterone 12.5mg daily from a few days after ovulation until my period came. On day 2 before starting Ganirelix I had a scan and had 17 follicles (which is great for me!! usually 8-10 AFC) all of 6-7mm. My E2 160pmol/L, FSH 6, LH 2. Progesterone 1.4pmol/L.
I then started Ganerilix (Orgalutran 25o) from CD 2 – CD8 inclusive to try to stop dominant follicle from developing. Before starting sims I had a blood test – E2 165pmol/L, FSH 10, LH 1.0, Progesterone 3.5pmol/L.
I then started Stims on CD9 300IU FSH and 150IU Menopur. I had to stop and cancel the cycle because I had a scan on CD10 (after 1 day of sims) and I had a 14mm follicle or cyst (I also had a 10mm follicle). The others were all 7mm. How would this have happened? Is it likely the oestrogen or testosterone priming could have caused a cyst? Or is it possible that the Ganirelix didn’t suppress follicle growth and the 14mm follicle/cyst was actually just a dominant follicle developing? I am wondering how my progesterone went up? Thats why I suspected perhaps it was a follicle and was close to ovulation?? Help please!! I am doing Augment IVF overseas and really need to maximise my chances by having a good cycle.
Respectfully…starting a stimulation directly after having had your FSH suppressed on estrogen will severely curtail response in my opinion. You would as I see it have to verlap with an agonist (e.g Lupron) for several days before the stimulation starts to fully recruit responsive antral follicles.
In natural (unstimulated) as well as in cycles stimulated with fertility drugs, the ability of follicles to properly respond to FSH stimulation is dependent on their having developed FSH-responsive receptors . Pre-antral follicles (PAF) do not have such primed FSH receptors and thus cannot respond properly to FSH stimulation with gonadotropins. The acquisition of FSH receptor responsivity requires that the pre-antral follicles be exposed to FSH, for a number of days (5-7) during which time they attain “FSH-responsivity” and are now known as antral follicles (AF). These AF’s are now able to respond properly to stimulation with administered FSH-gonadotropins. In regular menstrual cycles, the rising FSH output from the pituitary gland insures that PAPs convert tor AF’s. The BCP as well as prolonged administration of estrogen) suppresses FSH. This suppression needs to be countered by artificially causing blood FSH levels to rise in order to cause PAF to AF conversion prior to COS commencing, otherwise pre-antral-to –antral follicle conversion will not take place in an orderly fashion and the follicles will not readily respond to gonadotropins (FSH) , thereby delaying follicle development by up to 7 days and compromising egg quality. GnRH agonists (e.g. Lupron, Buserelin, Superfact) , cause an immediate surge in release of FSH by the pituitary gland thus causing conversion from PAF to SAF. This is why, women who take a BCP to launch a cycle of COS need to have an overlap of the BCP with an agonist.
By overlapping the BCP/estrogen with an agonist for a few days prior to menstruation the early recruited follicles are able to complete their developmental drive to the AF stage and as such, be ready to respond appropriately to optimal ovarian stimulation. Using this approach, the timing of the initiation of the IVF treatment cycle can readily and safely be regulated and controlled by varying the length of time that the woman is on the BCP.
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
•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)
•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?
•Functional” Ovarian Cysts and IVF
•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
•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?–
•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
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
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