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.
Hello, if having a DQ alpha match, does not harm an embryo, why would treatment not be done to lower NK cells in a case where both are present?
That is precisely the point. It is only where both co-exist (DQa match + NKa+) that treatment is truly warranted.
Geoff Sher
Hi Dr. Sher
I started my first ivf in Sep, I’m on bc for a week now. Do you think it’s safe for me to take a flu shot at this stage? Egg retrieval maybe 2nd week of Nov. Also for my husband, is he free to take flu shot now? Thank you!
Sincerely,
Dina
Check with your doctor but this is a vaccine using inactivated virus so it is safe…in my opinion.
Geoff Sher
I wanted to ask you your thoughts. I have an unexplained uterine failure. My lining simply does not grow anymore past 4. I have never had an abortion, never had a DNC, and never had any miscarriage. I am 32 and have had two successful pregnancies in my twenties. I have tried vaginal and oral estrogen, injectible estrogen, vaginal viagra, and terbutaline. My lining never wants to grow past a 4. The ONLY thing I can think of that has changed from my previous pregnancies is prolonged used of zzzquil for insomnia. Probably 4-5 years of use. I was reading the antihistamine can cause issues with uterine lining growth? What are your thoughts on this. I was going to try to zombie it out for a month or two to see if my lining comes back.
If Vaginal Viagra and estrogen did not cause the endometrium to thicken, it could be due to intractable basal endometrial damage due to endometritis as a result of some retained products of conception following the delivery of your last baby.
Geoff Sher
Hello doctor, I was told by my doctor to start gonapeptyl 0.1mg on day two of my cycle and merional 75iu on day 3 but I was mistakenly given both injections on day 2. Would that affect my treatment
I don’t think it matters. This is a “flare protocol”.
Good luck!
Geoff Sher
Hi Dr. Sher, My husband and I recently had a failed round of IVF. We are in South Korea. Although our doctor here speaks English, we are nevertheless experiencing a fairly wide information gap due to language/cultural barriers. We are unsure of what went wrong, and equally unsure of what we should do next. I am 42, with very low AMH and DOR. I took Gonal F 225 for 3 days only. On day 4, I was told that I had only one follicle, which, to the doctor’s surprise, already looked mature. A blood test showed an estradiol level of 425. Egg retrieval was hastily scheduled for the next day. I took Cetrotide the morning prior to retrieval, and injected Ovidrel just 12 hours before retrieval. No egg was retrieved. Now my doctor recommends a “natural cycle with a few injections” next.
I feel the first attempt was very rushed. Any insight you could offer as to what went wrong, and whether you agree with our doctor’s opinion for next steps would be truly appreciated.
Allison
Respectfully,
This protocol was in my opinion not optimal.
Women who (regardless of age) have diminished ovarian reserve (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, www. SherIVF.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
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.
Thank you for this advice and information. I have been carefully reading your articles. Do you recommend A/ACP with or without estrogen priming?