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,
On the first day of my FET my doctor told me I should be getting lots of rest for the first 24 hours and not carry heavy things for two weeks to support implantation. The problem is that I have a 20-pound baby to carry around all day. I also slept under warm covers and suddenly realized I was overheating. This happened in the first 24 hours. I read that overheating isn’t good for the embryos. Do you think that these things could have prevented implantation? I just did my tranfer yesterday and I’m very worried. Please let me know.
Thank you,
Sherry
No! I do nit believe it would have an adverse effect!
Geoff Sher
I was told that taking estrogen pills “pauses” your cycle. For example, if I start taking estrogen pills on cycle day 3 (i.e. 3 days after period started), my body will stay at cycle day 3 for any number of days I continue taking the pills. Once I stop the pills, my body gets back to normal. So, according to the calendar I’m now at cycle day 10, but because of the estrogen pills my body thinks it’s still at cycle day 3. I’m using this as preparation for IVF but I’m having a difficult time understanding this concept. Can you help me out? Thanks!
Thank you doctor! I do not believe the prior use of Finasteride is a factor. Your age and normal ovarian response/reserve are both in your favor. i do NOT agree with the dosage of Ovidrel at 250mcg. That is like receiving 5,000-6000U hCHu and that is about half of what is required. You need 10,000U hCG or 500mcg Ovidrel for the trigger in my opinion. And while a late antagonist suppression protocol is OKL, i think it can be improved upon.
Here is the protocol I advise for women, <40Y who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur---no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://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.
• The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
• 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
• Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
• Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in 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
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
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
It is true…It can postpone the cycle.
Geoff Sher
Hi dr SHER
Is it possible to still get a period without ovulating? I’m just coming off several months of back to back egg reteievals and giving my body a rest this month before I start BCP again for another egg retrieval. However, my OPK strips have failed to detect an LH surge, and my BBT has failed to rise. I’m currently CD21, whereas I used to always ovulate CD14 prior to all these IVF cycles. This is the first time since January that I haven’t been on either BCP preparing for a cycle or on stim meds. Do you think my cycles are all messed up now? I’m worried I might be going into menopause since I have DOR (was 0.6 in February 2018). I really need my period to start so I can resume BCP for my next IVF- can I start BCP without getting a period?
Yes, you can menstruate without functional ovulation. This is not uncommon after several IVF’s. I would not be overly concerned.
Geoff Sher
Dear Dr Sher
I’m a 33 year old female physician with no medical co-morbidities a 42 year old husband with hypercholestrolemia, obstructive sleep apnea with a BMI of 31. We have a diagnosis of unexplained infertility after 2 years of trying to conceive. We just had a first failed IVF cycle. He did take Finasteride 1.25mg for 15 years in his 20’s and 30’s for male pattern hair loss- but has stopped now for > 3 years.
I have a normal HSG, normal pelvic usg, AFC: 5 and 9. My ovarian reserve is normal. My cycles are 36 day cycles- although long, they are fairly regular, with biochemical evidence of ovulation around d20. My husband’s basic sperm analysis is normal aside from being slightly reduced.
For this IVF protocol: Baseline Day 2 bloods were: estrogen 134, progesterone 1, LH 2, and FSH 8. The protocol used was Gonal-F 200 IU starting on D3 with the addition of Orgulatran from D6 250mcg at 5PM daily. Bloods on D 8 were estrogen 2630, progesteron 1, LH: low. Bloods on D9 were estrogen 2909, progesterone 1, LH 20mm: 1 follicle. I was asked to trigger with Ovidrel 250mcg at 1130PM on D9. Drug free on D10, Egg collection on D11 at 1130AM.
Egg collection revealed 10 eggs. 2 successful normal fertilizations, 3 immature eggs, 4 abnormal fertilization, and 1 egg with no signs of maturation. None of which reached a successful d5 blastocyst, as they arrested at D3.
I have read through your blogs and notice that the protocol used is quite different from the ones you prescribe. ( for example: you recommend Ovidrel 500mcg for triggering)
I would like to have your thoughts on :
-if the prolonged use of Finasteride can affect sperm DNA. Is there any way to test this?
– our absence of successful blastocyst
– our causes of ‘ abnormal fertilisation’
– usage of anti-oxidants: Po melatonin 3mg, co-enzyme q 10, fish oil and vitamin e
Thank you very much for your kind assistance.
I am preparing for my last embryo transfer. I had a D&E in August (16 week loss) and a MRI to confirm Adenomyosis in the beginning of September. At my baseline ultrasound last Wednesday the tech noted a possible 9x5mm fibroid with blood flow near the endometrium. Yesterdays ultrasound she noted it is now 16mm but not near the endometrium. With my MRI in September they didn’t note any fibroids. Is it possible for a fibroid to grow that quick? Should I cancel my last transfer because of it? The nurse at my clinic said it isn’t likely to be a fibroid since I just had a MRI. I wanted a second opinion before I transfer my last embryo. Thank you so much for your help.