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, I Had a Day 5 FET 12 days ago and my Beta results on HCG put the number at 1433 (day 12). Is this a good number?
Looks quite promising Goldy!
Good luck!
Geoff Sher
Hi, greetings from lebanon
I’m 36 as well my husband, i have DOR with AMH 0.9, i have undergone 5 failed ivf cycles. The last one was a duo stimulatio technic. I started with elonva injection at day 2 of the cycles then i took 5 cetrotide injection started at day 6 of the cycle and 1 puregon 300 at day 9 of the cycle, the retrieval was on the day 12 of the cycle, 3 eggs were retrieved, no fertilization was conducted as the eggs were immature.
Then i started the second round of medication at day 16 of the period with 3 cetrotide injections for 3 days then i started puregon 600, cetrotide was renewed also, in total i did 12 puregon 600 injection and 10 cetrotides. 3 eggs were retrieved and unfortunatly also the 3 were immature and no fertilization conducted.
NB: I’m taking supplements (fertiva and duo joya)
My question is, it was the appropriate protocol for me? Anything else can be done? I’m desperate to have my first baby.
I appreciate you answer
Regars
I am 40 with DOR, AMH .863. I had a spontaneous pregnancy at 38 which resulted in a miscarriage at 14 weeks due to Turners Syndrome. My first IVF cycle was the Long Lupron Protocol which resulted in three mature eggs, only one fertilized with ICSI, and transferred on day 3 and was a BFN. The second IVF cycle was an Atagonist Protocol which consisted of GonalF on day 3 and Menopur and Ganirelix on day 7 but this cycle was cancelled and converted to an IUI due to one dominant follicle and also was a BFN. My last and third IVF cycle was also the Long Lupron Protocol but this time with high dosage of GonalF compared to the first and this cycle resulted in four mature eggs, all fertilized with ICSI, made it past day 3, but on day 6 the news that I got was that two didn’t make it and the other two didn’t meet the standards of freezing. I have a consultation with my Dr. in two weeks but he thinks I should consider donor eggs and I’m not ready for that. Is there any hope or ideas of what protocol would be best and should I consider another clinic.
Of course donor eggs is a good option…and the one that would be the most likely to be successful. But also please consider tyhe folowing:
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 my advice or medical services, I urge you to contact my patient concierge, ASAP to set up a Skype or an in-person consultation with me. You can also set this up by emailing concierge@sherivf.com or by calling 702-533-2691 and/or 800-780-743. You can also enroll for a consultation with me, 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 .
Geoffrey Sher MD
Hi dr sher- I am 39 with one child. I was induced d/t high bp and suffered from a post partum hemorrhage, retained placenta and my uterus measured 5 weeks behind throughout my pregnancy. I recently transferred donor embryos and was encouraged to transfer 2 as the grading was not great and my lining was 7mm. The female donor was 24. As it turns out both stuck and I am extremely concerned about my health given my age and history. My husband and I are considering selective reduction. Do you agree? Also, is this something I can have done at your dallas location? Thank you.
I wish I could assure you that all will be right. I suggest you find a high-risk OB (Perinatologist) to manage your pregnqancy. Hopefully all will go well for you.
Geoff Sher
I just received my Pgs results and I have 2 mosaic embryos. One is a low level -13 female and the other is a low level +21 male. Would you recommend transferring either of these two? If you do, which would you transfer first?
I would be hesitant to transfer the trisomy 21 embryo (Down syndrome) but I would transfer the monosomy 13.
Good luck!
Geoff Sher