Dr. Geoffrey Sher on October 23, 2018 at 5:48 am

Your FSH of 85 coupled with your symptoms of hot flashes suggests that you are perimenopausal. If so, yopu would need egg donation. To make certain I would do an AMH blood test.

Egg donation is the process by which a woman donates eggs for purposes of assisted reproduction or biomedical research. For assisted reproduction purposes, egg donation typically involves in vitro fertilization (IVF) technology, with the eggs being fertilized in the laboratory, unfertilized eggs may be frozen and stored for later use. Egg donation is a third party reproduction as part of assisted reproductive technology (ART).
For many women, disease and/or diminished ovarian reserve precludes achieving a pregnancy with their own eggs. Since the vast majority of such women are otherwise quite healthy and physically capable of bearing a child, egg donation (ED) provides them with a realistic opportunity of going from infertility to parenthood.
Egg donation is associated with definite benefits. Firstly, in many instances, more eggs are retrieved from a young donor than would ordinarily be needed to complete a single IVF cycle. As a result, there are often supernumerary (leftover) embryos for cryopreservation and storage. Secondly, since eggs derived from a young woman are less likely than their older counterparts to produce aneuploid (chromosomally abnormal) embryos, the risk of miscarriage and birth defects such as Down’s syndrome is considerably reduced.
Egg Donation-related, fresh and frozen embryo transfer cycles account for 10%-15% of IVF performed in the United States. The vast majority of egg donation procedures performed in the U.S involve women with declining ovarian reserve. While some of these are done for premature ovarian failure, the majority are undertaken in women over 40 years of age. Recurrent IVF failure due to “poor quality” eggs or embryos is also a relatively common indication for ED in the U.S. A growing indication for ED is in cases of same-sex relationships (predominantly female) where both partners wish to share in the parenting experience by one serving as egg provider and the other, as the recipient.
Ninety percent of egg donation in the U.S is done through the solicitation of anonymous donors who are recruited through a state-licensed egg donor agency. It is less common for recipients to solicit known donors through the services of a donor agency, although this does happen on occasion. It is also not easy to find donors who are willing to enter into such an open arrangement. Accordingly, in the vast majority of cases where the services of a known donor is solicited, it is by virtue of a private arrangement. While the services of non-family members are sometimes sought, it is much more common for recipients to approach close family members to serve as their egg donor.
Some recipients feel the compulsion to know or at least to have met their egg donor, so as to gain first hand familiarity with her physical characteristics, intellect, and character. This having been said, in the U.S. it is much more common to seek the services of anonymous donors. In terms of disclosure to their family, friends and child(ren), recipients using anonymous donors tend to be far more open than those of known donors about the nature of the child’s conception. Most, if not all, egg donor agencies provide a detailed profile, photos, medical and family history of each prospective donor for the benefit and information of the recipient. Agencies generally have a website through which recipients can access donor profiles in the privacy of their own homes in order to select the ideal donor.
Interaction between the recipient and the egg donor program may be conducted in-person, by telephone or online in the initial stages. Once the choice of a donor has been narrowed down to two or three, the recipient is asked to forward all relevant medical records to their chosen IVF physician. Upon receipt of her records, a detailed medical consultation will subsequently held and a physical examination by the treating physician or by a designated alternative qualified counterpart is scheduled. This entire process is usually overseen, facilitated and orchestrated by one of the donor program’s nurse coordinators who, in concert with the treating physician, will address all clinical, financial and logistical issues, as well as answering any questions. At the same time, the final process of donor selection and donor-recipient matching is completed.
Egg donor agencies usually limit the age of egg donors to women under 35 years with normal ovarian reserve in an attempt to minimize the risk of ovarian resistance and negate adverse influence of the “biological clock” (donor age) on egg quality.
No single factor instills more confidence regarding the reproductive potential of a prospective egg donor than a history of her having previously achieved a pregnancy on her own, or that one or more recipients of her eggs having achieved a live birth. Moreover, such a track record makes it far more likely that such an ED will have “good quality eggs”. Furthermore, the fact that an ED readily conceived on her own lessens the likelihood that she herself has tubal or organic infertility. This having been said, the current shortage in the supply of egg donors makes it both impractical and unfeasible, to confine donor recruitment to those women who could fulfill such stringent criteria for qualification.
It is not unheard of for a donor who, at some point after donating eggs, finds herself unable to conceive on her own due to pelvic adhesions or tubal disease, to blame her infertility on complications caused by the prior surgical egg retrieval process. She may even embark upon legal proceedings against the IVF physician and program. It should therefore come as no surprise that it provides a measurable degree of comfort to ED program when a prospective donor is able to provide evidence of having experienced a relatively recent, trouble free spontaneous pregnancy.
Screening of Donors
Genetic Screening: The vast majority of IVF programs in the U.S. follow the recommendations and guidelines of the American Society of Reproductive Medicine (ASRM) for selectively genetic screening of prospective egg donors for conditions such as sickle cell trait or disease, thalassemia, cystic fibrosis and Tay Sachs disease, when medically indicated. Consultation with a geneticist is available through about 90% of programs.
Most recipient couples place a great deal of importance on emotional, physical, ethnic, cultural and religious compatibility with their chosen egg donor. In fact they often will insist that the egg donor be heterosexual.
Psychological Screening: Americans tend to place great emphasis on psychological screening of egg donors. Since most donors are “anonymous,” it is incumbent upon the ED agency or the IVF program to determine the donor’s degree of commitment as well as her motivation for deciding to provide this service. I have on occasions encountered donors who have buckled under the stress and defaulted mid-stream during their cycle of stimulation with gonadotropins. In one case, a donor knowingly stopped administering gonadotropins without informing anyone. She simply awaited cancellation, which was effected when follicles stopped growing and her plasma E2 concentration failed to rise.
Such concerns mandate that assessment of donor motivation and commitment be given appropriate priority. Most recipients in the U.S. tend to be very much influenced by the “character” of the prospective egg donor, believing that a flawed character is likely to be carried over genetically to the offspring. In reality, unlike certain psychoses such as schizophrenia or bipolar disorders, character flaws are usually neuroses and are most likely to be determined by environmental factors associated with upbringing. They are unlikely to be genetically transmitted. Nevertheless, egg donors should be subjected to counseling and screening and should be selectively tested by a qualified psychologists. When in doubt, they should be referred to a psychiatrist for more definitive testing. Selective use of tests such as the MMPI, Meyers-Briggs and NEO-Personality Indicator are used to assess for personality disorders. Significant abnormalities, once detected, should lead to the automatic disqualification of such prospective donors.
When it comes to choosing a known egg donor, it is equally important to make sure that she was not coerced into participating. We try to caution recipients who are considering having a close friend or family member serve as their designated egg donor, that in doing so, the potential always exists that the donor might become a permanent and an unwanted participant in the lives of their new family.
Drug Screening: Because of the prevalence of substance abuse in our society, we selectively call for urine and/or serum drug testing of our egg donors.
Screening for STDs: FDA and ASRM guidelines recommend that all egg donors be tested for sexually transmittable diseases before entering into a cycle of IVF. While it is highly improbable that DNA and RNA viruses could be transmitted to an egg or an embryo through sexual intercourse or IVF, women infected with viruses such as hepatitis B, C, HTLV, HIV etc, must be disqualified from participating in IVF with egg donation due to the (abeit remote) possibility of transmission, as well as the potential legal consequences of the egg donation process being blamed for their occurrence.
In addition, evidence of prior or existing infection with Chlamydia or Gonococcus introduces the possibility that the egg donor might have pelvic adhesions or even irreparably damaged fallopian tubes that might have rendered her infertile. As previously stated, such infertility, subsequently detected might be blamed on infection that occurred during the process of egg retrieval, exposing the caregivers to litigation. Even if an egg donor or a recipient who carries a sexually transmittable viral or bacterial agent is willing to waive all rights of legal recourse, a potential risk still exists that a subsequently affected offspring might in later in life sue for wrongful birth.
Screening of the Recipient

Medical Evaluation: while advancing age, beyond 40 years, is indeed associated with an escalating incidence of pregnancy complications, such risks are largely predicable through careful medical assessment prior to pregnancy. The fundamental question namely: “is the woman capable of safely engaging a pregnancy that would culminate in the safe birth of a healthy baby” must be answered in the affirmative, before any infertility treatment is initiated. For this reason, a thorough cardiovascular, hepatorenal, metabolic and anatomical reproductive evaluation must be done prior to initiating IVF in all cases.
Infectious Screening: the need for careful infectious screening for embryo recipients cannot be overemphasized. Aside from tests for debilitating sexually transmittable diseases, there is the important requirement that cervical mucous and semen be free of infection with ureaplasma urealyticum. This organism which rarely causes symptoms frequents the cervical glands of 15-20% of women in the U.S. The introduction of an embryo transfer catheter via a so infected cervix might transmit the organism into an otherwise sterile uterine cavity leading to early implantation failure and/or first trimester miscarriage.
Immunologic Screening: Certain autoimmune and alloimmune disorders (see elsewhere) can be associated with immunologic implantation dysfunction (IID). In order to prevent otherwise avoidable treatment failure, it is advisable to evaluate the recipient for autoimmune IDD and also to test both the recipient and the sperm provider for alloimmune similarities that could compromise implantation.
Disclosure and Consent
Preparation for egg donation requires full disclosure to all participants regarding what each step of the process involves from start to finish, as well as potential medical and psychological risks. This necessitates that significant time be devoted to this task and that there be a willingness to painstakingly address all questions and concerns posed by all parties involved in the process. An important component of full disclosure involves clear interpretation of the medical and psychological components assessed during the evaluation process. All parties should be advised to seek independent legal counsel so as to avoid conflicts of interest that might arise from legal advice given by the same attorney. Appropriate consent forms are then reviewed and signed independently by the donor and the recipient couple.
Most embryo recipients fully expect their chosen donor to yield a large number of mature, good quality eggs, sufficient to provide enough embryos to afford a good chance of pregnancy as well as several for cryopreservation (freezing) and storage. While such expectations ore often met, this is not always the case. Accordingly, to minimize the trauma of unexpected and usually unavoidable disappointment, it is essential that in the process of counseling and of consummating agreements, the respective parties be fully informed that by making best efforts to provide the highest standards of care, the caregivers can only assure optimal intent and performance in keeping with accepted standards of care. No one can ever promise an optimal outcome. All parties should be made aware that no definitive representation can or will be made as to the number or quality of ova and embryos that will or are likely to become available, the number of supernumerary embryos that will be available for cryopreservation or the subsequent outcome of the IVF donor process.
TYPES OF EGG DONATION

Conventional Egg Donation: This is the basic format used for conducting the process of egg donor IVF. It involves synchronizing the menstrual cycles of both the recipient and the donor by placing the donor and the recipient on a birth control pill so that both parties start stimulation with fertility drugs simultaneously. This ultimately allows for precise timing of the fresh embryo transfer. Using this approach, the anticipated egg donation birth rate is >50% per cycle.
Preimplantation Genetic Sampling (PGS)-Egg Donation: The recent introduction of complete numerical chromosomal assessment (karyotyping) using metaphase Comparative Genomic Hybridization (mCGH) and Next Generation Gene sequencing (NGS) has the potential to change the manner in which egg donation will be performed in the future. CGH/NGS allows full egg/embryo chromosome analysis providing a 70- 80% assurance that the embryo(s) so selected for transfer are highly likely to be “competent” (i.e. capable of producing a healthy baby). Such PGS-egg selection provides about a 50% chance of a baby per transfer of an embryo derived through fertilization of a pre-vitrified euploid egg. This is at least double that reported when conventional egg donation is used. As a result, mCGH/NGS-Egg Donation allows for excellent results when one or two embryos are transferred, virtually eliminating the risk of “high order” multiple pregnancies (triplets or greater). Moreover, since numerical chromosomal irregularities (aneuploidy) are responsible for most miscarriages, the use of CGH also significantly reduces this dreaded complication.
PGS egg selection of necessity mandates the use of Staggered (ST)- IVF. Here the egg donor cycle is divided into two parts. The first involves the egg retrieval, fertilization, embryo biopsy for PGS analysis and embryo cryostorage. The second part involving warming or thawing of the frozen embryo(s) and the subsequent transfer of “competent” embryo(s) to the recipient’s uterus is conducted electively at least several weeks later once the results of PGS testing are available. Since, with St-IVF the egg retrieval and embryo transfer are separated in time, the retrieval can be performed without first having to synchronize the menstrual cycles of the recipient and the egg the donor. In fact, the recipient does not even have to be available when the egg donor is going through cycle. All that is needed is for designated sperm to be available (fresh or frozen) on the day of egg retrieval. This avoids unnecessary travel and inconvenience, and minimizes stress and cost.
Donor Egg Banking: Another imminent advance is the introduction of egg banking. Being able to freeze and bank donor eggs would solve most of these challenges. By using PGS in combination with a egg vitrification (ultra-rapid freezing), we are now capable of improving the birth rate per warmed/thawed egg by a factor of 3-4 fold (from a previous average of <8% per egg to about 27%). Through an electronic catalogue, recipients will be able to select and purchase 1-3 CGH-normal eggs from the comfort of their homes. Thereupon, the selective transfer of 1 or 2 embryos derived from such chromosomally normal eggs could achieve a 50-60% pregnancy rate without the risk of initiating high-order multiple pregnancies in the process. Through this process, the cost, inconvenience and risks associated with “conventional” fresh egg donor cycles would also be reduced significantly.
Financial Considerations
The fee paid to the egg donor agency per cycle usually ranges between $2,000 and $8,000. This does not include the cost associated with psychological and clinical pre-testing, fertility drugs, and donor insurance, which commonly range between $3,000 and $6,000. The medical service costs of the IVF treatment cycle ranges between $8,000 and $14,000. The donor stipend can range from $2,000 too as high $50,000 depending upon the exotic requirements of the recipient couple as well as supply and demand. Thus the total out of pocket expenses for an egg donor cycle in the United States range between $15,000 and $78,000, putting egg donation outside the financial capability of most couples needing this service.
The growing gap between need and affordability has spawned a number of creative ways to try and make IVF with egg donation more affordable. Here are a few examples:
•Egg banking (see above)
•Egg Donor Sharing, where one comprehensive fee is shared between two recipients and the eggs are then divided between them. The downside is that fewer eggs are available embryos for transfer and/or cryopreservation.
•Egg Bartering, where in the course of conventional IVF, a woman undergoing IVF remits some of her eggs to the clinic (who in turn provides it to a recipient patient) in exchange for a deferment of some or all of the IVF fee. In my opinion, such an arrangement can be fraught with problems. For example, in the event that the woman donating some of her eggs fails to conceive while the recipient of her eggs does, it is very possible that she might suffer emotional despair and even go so far as to seek out her genetic offspring. Such action could be very damaging to both her and the recipient, as well as the child.
•Financial Risk Sharing. Certain IVF programs offer financial risk sharing (FRS) which most recipient couples favor greatly. FRS offers qualifying candidates a refund of fees paid if egg donation is unsuccessful. FRS is designed to spread the risk between the providers, and the recipient couple.
Moral, Legal & Ethical Considerations: The “Uniform Parentage Act” which has been adopted by most states in the United States declares that the woman who gives birth to the child will be regarded as the rightful mother. Accordingly, there has to date not been any grounds for legal dispute when it comes to maternal custody of a child born through IVF with egg donation in the majority of states. In a few states such as Mississippi and Arizona the law is less clear but nevertheless, as yet, has not been contested.
The moral-ethical and religious implications of egg donation are diverse and have a profound effect on cultural acceptance of this process. The widely held view that everyone is entitled to their own opinion and has the right to have such opinions respected, governs much of the attitude towards this process in the U.S. The extreme views on each end of the spectrum hold the gentle central swing of the pendulum in place. This attitude is a reflection of the general acceptance in the united states of diverse views and opinions and the willingness to allow free expression of such views and beliefs provided that they don’t infringe on the rights of others.
So where do we go from here? Can and should we, cryopreserve and store eggs or ovarian tissue from a young woman wishing to defer procreation until it becomes convenient? And if we do this, would it be acceptable to eventually have a woman give birth to her own sister or aunt? Can or should we store viable ovarian tissue through generations. Should egg donation simply become a future source of embryos generated for the purpose of providing stem cells, to be used in the treatment of disease states or to “manufacture” fetuses as a source of spare body parts? If the answer to even some of these questions is yes…what about the checks and balances. Who will exercise control and where what form should such control take? Are we willing to engage this slippery slope where the disregard for the dignity of the human embryo leads us to the point where the rights of a human being are more readily ignored? …………………… Personally, I hope not.
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

Addendum #1:
Optimizing International Access to Sher-IVF Services in Las Vegas.

Geoffrey Sher MD

Couples from all over the world seek access to IVF services at Sher-IVF in Las Vegas, NV. In fact about 70% of our patients emanate from out-of-state or from abroad. Most tend to be older, have failed IVF numerous times, have had repeated pregnancy losses or have complex reproductive issues. This article explains how we treat such patients at Sher-IVF and how we are able to provide seamless care in a caring and non-stressful environment. In one case, after experiencing 22 consecutive IVF failures, a couple who journeyed to see me from Melbourne, Australia, had a baby following a single IVF attempt. My approach is to individualize care and target those factors that adversely affect IVF outcome.
At Sher-IVF, IVF cycles are batched into about 8-10, 1-2 week cycles per year (dependent on whether we do fresh embryo transfers or frozen embryo transfers (FET)…which means that patients will almost always know well in advance of treatment, when they need to be at our centers for IVF. This makes the process very convenient for both patients and staff. It also allows us to quality assure the embryology laboratory between cycle batches and so optimize care and outcome.
HOW SHER-IVF PROVIDES OPTIMAL TREATMENT AT A DISTANCE:
•Setting Up a Skype Consultation
The initial step in treatment is to schedule a consultation with me. Patients living outside of the geographic catchment area of our Sher-IVF, (Las Vegas, NV) clinic generally schedule a consultation via Skype. I find that this is much more personal than a telephone consultation and is the closest thing to meeting me in person. You can schedule this consultation by going to my website, http://www.SherIVF.com where you can enroll online, by calling the Sher-IVF at 1-800-780-7437, or by emailing Julie Dahan (patient Concierge) at JulieD@sherIVF.com. Prior to your consultation with me you will be sent a questionnaire that asks for information relating to your medical and reproductive history. You will also be asked to provide copies of whatever medical records (from prior treatment and procedures) you might have available. If you have difficulty in completing the Questionnaire, please contact Julie by phone or email her and she will help you do this.
•The Initial Physician Consultation
You will thereupon be scheduled for initial Skype or an in-person consultation with me at which time I will review all available medical records, ask additional relevant questions and offer a preliminary opinion. I will at that time provide you with my personal cell phone # and will request that you contact me immediately with any future questions or concerns, so that I can address these immediately and in so doing, avoid any misunderstandings. This will be followed by one or more free, follow-up consultations with me to endorse or revise that opinion contingent upon supportive clinical and laboratory testing that I might recommend be performed in the interim. Within 24 hours of our initial consultation, you will receive a follow-up email from me which summarizes your case, my opinion and recommends tests needed. The email communication will also provide you with a list of suggested, supportive articles that I have written on my blog, http://www.SherIVF.com, along with directions on how to access these.
•The Consultation w/Clinical Director and Financial Advisor
Within one or two working days of our initial meeting, you be contacted by my office to set up a consultation with our Office Administrator to cover the logistical and financial considerations associated with doing IVF with me at Sher-IVF in Las Vegas. This consultation is free and in no way binds you to us. It is simply intended to provide you with relevant information, in case you should choose to do IVF here in Las Vegas, with me. At the same time, you will be familiarized with the logistics, time constraints, structure and process involved in an IVF cycle at Sher-IVF. Our approach enables patients to plan their treatment with precision, even months in advance. We will also go over our protocols for performing IVF in 1-2 week batches or “cycles” throughout the year so that our patients rarely need to spend more than two (2) weeks away from home to complete a full cycle of treatment. A Clinical Coordinator will be assigned to chaperone you through your IVF cycle and she will interact with you and your primary care OB/GYN (as required) on a regular and ongoing basis.
•Reaching the Crossroad: The Decision on Whether to Proceed
After completion of the above consultations, you will be asked to contact us with a firm decision as to whether/when you wish to undergo IVF treatment at Sher-IVF. Only after making such a commitment will you be expected to make a modest financial commitment to secure your place on our IVF calendar at a designated and mutually agreed upon time.
•The consultation with a Nurse, Case manager:
Once you have committed to, and have committed to a specific IVF cycle, you (and your partner…as applicable) will be scheduled to have a detailed consultation with a Nurse Coordinator who will develop a detailed, color-coded electronic calendar outlining all aspects of your management and treatment. This will include all diagnostic steps and therapeutic procedures required to ensure that that your planned cycle of IVF can be conducted as scheduled, and without a hitch. The Clinical Coordinator and her team of nursing and administrative personnel will in effect, hand-hold and triage you through all required steps and thereupon will schedule you with follow-up consultations. You will also be provided with contact information by which to reach the Clinical Coordinator, at will.
•Follow-up Physician consultation:
Once all records are available, test results are in, and your IVF cycle is scheduled, you will again consult with me for a free, follow-up consultation at which time we will review everything in detail and if needed make adjustments. Thereupon I might require further free consultations with you and you would of course be free to visit with, or call me on my cell phone with any issues. I ask is that you do not email or text me. I prefer to be contacted by phone so that we can discuss matters of concern rather than have me respond with one-liners via electronic communication.

•Ongoing Interaction and Follow-up
Our staff will at all times endeavor be affable and available to you upon request and will endeavor to maintain regular contact with you throughout. However, we are all human, and thus are capable of erring at times ….So, if anything is not in keeping with your expectations, I ask that you bring the matter(s) to our/my attention immediately so that we can address any/all issues in a timely manner.
•How to Reach Us and Where to Stay
We will gladly advise and assist you in obtaining the most affordable transportation and accommodations. Couples who elect to undergo IVF will find that accommodations in, and airfare (especially if scheduled well in advance) to Las Vegas, likely be relatively reasonable. In fact, we can assist you in obtaining very affordable quality accommodations in close proximity to our facilities.
•Getting You Ready to Go…Conveniently and On Time
We work with you to get all of your required tests done through your own doctor’s office. Remember, your primary OB/GYN is just as capable as we to facilitate or perform virtually all the necessary tests and procedures you may need, in your hometown environment.
Once we have reviewed all your test results, a customized protocol of treatment will be developed and then be emailed to you. Your assigned Clinical Coordinator will provide you with a detailed calendar and will review it with you in person or by telephone, prior to initiating your IVF cycle of treatment.
•The IVF Cycle:
Your cycle begins with the Birth Control Pill (BCP),starting no later than day 7 of menstruation. Depending upon your scheduled date for IVF, you will continue taking the BCP Pill for 11-30 days. This will be outlined in detail on the calendar we provide you with. It will also direct you when to begin your injections. Once you have taken an agonist (e.g. the Lupron, Superfact, Buserelin) for 3-5 days, the BCP will be stopped. You can expect to menstruate 3-8 days after stopping the BCP. Your blood estradiol (E2) level will be measured at the onset of menstruation. An E2 level of less than 70 pg/ml (200pmol/L) provides relative assurance that you have not formed an ovarian cyst and that you are ready to begin Gonadotropin (fertility hormone medication) injections. You will also have an ultrasound examination to ensure that you have no obvious cysts.
Depending on the stimulation protocol selected, you will at this point either continue with daily agonist injections (The conventional down-regulation protocol) or switch to an antagonist (Ganirelix, Cetrotide, Orgalutron) daily injections (the Agonist/Antagonist Conversion Protocol-A/ACP). Once again, your calendar will direct you as to when you should start the injections at home and plan on arriving at the center in Las Vegas for monitoring 7-8 days later. Please note that you will also be taking other medications during your cycle of treatment. This may include daily human growth hormone (HGH) until the day of hCG “trigger” and/or , low dosage oral steroid therapy (dexamethasone/prednisone) starting early in the stimulation and continuing to the 10th week of pregnancy,
If you have a thin uterine lining, you might receive vaginal sildenafil (Viagra) suppositories from the early stage of ovarian stimulation to the day of the hCG “trigger” . In the case of embryo recipient cycles (e.g. egg donation, gestational surrogacy, low dosage oral steroid therapy (dexamethasone/prednisone) will start early in the stimulation and continue to the 10th week of pregnancy. Treatment of an underlying immunologic implantation dysfunction (IID) may in addition require that you receive an intravenous infusion of 20% Intralipid (IL) about 10-14 days prior to embryo transfer (ET) and/or low molecular heparinoid (Lovenox or Clexane). This might need to be repeated one or more times after a positive beta-hCG pregnancy test depending on the type of immune issue involved in your case.
Once you arrive at Sher-IVF in Las Vegas for treatment, regular (usually daily) monitoring of blood E2 levels will begin along with ultrasound monitoring of your ovarian response and development of your uterine lining. Typically, egg retrieval will take place 2-8 days after your arrival at the clinic for monitoring. Fresh ET usually involves blasto

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Denise on October 23, 2018 at 6:39 pm

Dear Dr. Sher,
I have the MTHFR single mutation (A1298c) and PAI-1 4G/5G (heterozygous for the 4G/5G deletion/insertion allele). I have had 5 miscarriages – these losses were assumed to be due to aneuploidy, but only two were confirmed after D&C.

I just had my second FET two weeks ago and am pregnant. I have not taken Lovenox in any of my past losses and am wondering if I should with this current pregnancy.

1) How would you know if a loss was caused by a blood clot?
2) Would you recommend Lovenox for me? If so, when would you stop and start?
3) Is there any association between Lovenox and Autism?

Thanks!
Lucy on October 23, 2018 at 4:10 pm

Hi Dr. Sher,
I hope you are doing great! We are not at the ivf stage yet but I started femara this cycle. I had an ultrasound yesterday and they found 3 mature follicles, 2 on my right side and one on my left. I was told they all look the same size, around 16-18mm so I would possibly release 3 eggs. I have ovulated naturally from my left side the last 3 cycles. The follicle on my left looks good and black but the 2 on my right look a bit more greyish. Could that be “bad eggs” since my right ovary hasn’t been producing eggs lately or could I still release 3? I was told that I should ovulate between October 26th and the 28th. I do chart and temp and also use the Ava bracelet and so far they all say I’m going to ovulate on the 26th. If you could shed some light into this I would really appreciate it. We are considering ivf if medicated cycles don’t work. I’m 30, no fertility issues but several mcs due to low progesterone and very high Estrogen.
Joy on October 23, 2018 at 12:23 pm

Please can i take DHEA suppliment to boost my egg quantity to conceieve fast.doctor say my AMH are low no enough egg .but am only 33yrs old
Lucy on October 23, 2018 at 7:00 am

About an hour after my frozen egg transfer I have had severe diarrhoea lasting a couple of hours and now am fine. Will this have ruined my chances of the embryo implanting?
Dr. Geoffrey Sher on October 23, 2018 at 5:48 am

Your FSH of 85 coupled with your symptoms of hot flashes suggests that you are perimenopausal. If so, yopu would need egg donation. To make certain I would do an AMH blood test.

Egg donation is the process by which a woman donates eggs for purposes of assisted reproduction or biomedical research. For assisted reproduction purposes, egg donation typically involves in vitro fertilization (IVF) technology, with the eggs being fertilized in the laboratory, unfertilized eggs may be frozen and stored for later use. Egg donation is a third party reproduction as part of assisted reproductive technology (ART).
For many women, disease and/or diminished ovarian reserve precludes achieving a pregnancy with their own eggs. Since the vast majority of such women are otherwise quite healthy and physically capable of bearing a child, egg donation (ED) provides them with a realistic opportunity of going from infertility to parenthood.
Egg donation is associated with definite benefits. Firstly, in many instances, more eggs are retrieved from a young donor than would ordinarily be needed to complete a single IVF cycle. As a result, there are often supernumerary (leftover) embryos for cryopreservation and storage. Secondly, since eggs derived from a young woman are less likely than their older counterparts to produce aneuploid (chromosomally abnormal) embryos, the risk of miscarriage and birth defects such as Down’s syndrome is considerably reduced.
Egg Donation-related, fresh and frozen embryo transfer cycles account for 10%-15% of IVF performed in the United States. The vast majority of egg donation procedures performed in the U.S involve women with declining ovarian reserve. While some of these are done for premature ovarian failure, the majority are undertaken in women over 40 years of age. Recurrent IVF failure due to “poor quality” eggs or embryos is also a relatively common indication for ED in the U.S. A growing indication for ED is in cases of same-sex relationships (predominantly female) where both partners wish to share in the parenting experience by one serving as egg provider and the other, as the recipient.
Ninety percent of egg donation in the U.S is done through the solicitation of anonymous donors who are recruited through a state-licensed egg donor agency. It is less common for recipients to solicit known donors through the services of a donor agency, although this does happen on occasion. It is also not easy to find donors who are willing to enter into such an open arrangement. Accordingly, in the vast majority of cases where the services of a known donor is solicited, it is by virtue of a private arrangement. While the services of non-family members are sometimes sought, it is much more common for recipients to approach close family members to serve as their egg donor.
Some recipients feel the compulsion to know or at least to have met their egg donor, so as to gain first hand familiarity with her physical characteristics, intellect, and character. This having been said, in the U.S. it is much more common to seek the services of anonymous donors. In terms of disclosure to their family, friends and child(ren), recipients using anonymous donors tend to be far more open than those of known donors about the nature of the child’s conception. Most, if not all, egg donor agencies provide a detailed profile, photos, medical and family history of each prospective donor for the benefit and information of the recipient. Agencies generally have a website through which recipients can access donor profiles in the privacy of their own homes in order to select the ideal donor.
Interaction between the recipient and the egg donor program may be conducted in-person, by telephone or online in the initial stages. Once the choice of a donor has been narrowed down to two or three, the recipient is asked to forward all relevant medical records to their chosen IVF physician. Upon receipt of her records, a detailed medical consultation will subsequently held and a physical examination by the treating physician or by a designated alternative qualified counterpart is scheduled. This entire process is usually overseen, facilitated and orchestrated by one of the donor program’s nurse coordinators who, in concert with the treating physician, will address all clinical, financial and logistical issues, as well as answering any questions. At the same time, the final process of donor selection and donor-recipient matching is completed.
Egg donor agencies usually limit the age of egg donors to women under 35 years with normal ovarian reserve in an attempt to minimize the risk of ovarian resistance and negate adverse influence of the “biological clock” (donor age) on egg quality.
No single factor instills more confidence regarding the reproductive potential of a prospective egg donor than a history of her having previously achieved a pregnancy on her own, or that one or more recipients of her eggs having achieved a live birth. Moreover, such a track record makes it far more likely that such an ED will have “good quality eggs”. Furthermore, the fact that an ED readily conceived on her own lessens the likelihood that she herself has tubal or organic infertility. This having been said, the current shortage in the supply of egg donors makes it both impractical and unfeasible, to confine donor recruitment to those women who could fulfill such stringent criteria for qualification.
It is not unheard of for a donor who, at some point after donating eggs, finds herself unable to conceive on her own due to pelvic adhesions or tubal disease, to blame her infertility on complications caused by the prior surgical egg retrieval process. She may even embark upon legal proceedings against the IVF physician and program. It should therefore come as no surprise that it provides a measurable degree of comfort to ED program when a prospective donor is able to provide evidence of having experienced a relatively recent, trouble free spontaneous pregnancy.
Screening of Donors
Genetic Screening: The vast majority of IVF programs in the U.S. follow the recommendations and guidelines of the American Society of Reproductive Medicine (ASRM) for selectively genetic screening of prospective egg donors for conditions such as sickle cell trait or disease, thalassemia, cystic fibrosis and Tay Sachs disease, when medically indicated. Consultation with a geneticist is available through about 90% of programs.
Most recipient couples place a great deal of importance on emotional, physical, ethnic, cultural and religious compatibility with their chosen egg donor. In fact they often will insist that the egg donor be heterosexual.
Psychological Screening: Americans tend to place great emphasis on psychological screening of egg donors. Since most donors are “anonymous,” it is incumbent upon the ED agency or the IVF program to determine the donor’s degree of commitment as well as her motivation for deciding to provide this service. I have on occasions encountered donors who have buckled under the stress and defaulted mid-stream during their cycle of stimulation with gonadotropins. In one case, a donor knowingly stopped administering gonadotropins without informing anyone. She simply awaited cancellation, which was effected when follicles stopped growing and her plasma E2 concentration failed to rise.
Such concerns mandate that assessment of donor motivation and commitment be given appropriate priority. Most recipients in the U.S. tend to be very much influenced by the “character” of the prospective egg donor, believing that a flawed character is likely to be carried over genetically to the offspring. In reality, unlike certain psychoses such as schizophrenia or bipolar disorders, character flaws are usually neuroses and are most likely to be determined by environmental factors associated with upbringing. They are unlikely to be genetically transmitted. Nevertheless, egg donors should be subjected to counseling and screening and should be selectively tested by a qualified psychologists. When in doubt, they should be referred to a psychiatrist for more definitive testing. Selective use of tests such as the MMPI, Meyers-Briggs and NEO-Personality Indicator are used to assess for personality disorders. Significant abnormalities, once detected, should lead to the automatic disqualification of such prospective donors.
When it comes to choosing a known egg donor, it is equally important to make sure that she was not coerced into participating. We try to caution recipients who are considering having a close friend or family member serve as their designated egg donor, that in doing so, the potential always exists that the donor might become a permanent and an unwanted participant in the lives of their new family.
Drug Screening: Because of the prevalence of substance abuse in our society, we selectively call for urine and/or serum drug testing of our egg donors.
Screening for STDs: FDA and ASRM guidelines recommend that all egg donors be tested for sexually transmittable diseases before entering into a cycle of IVF. While it is highly improbable that DNA and RNA viruses could be transmitted to an egg or an embryo through sexual intercourse or IVF, women infected with viruses such as hepatitis B, C, HTLV, HIV etc, must be disqualified from participating in IVF with egg donation due to the (abeit remote) possibility of transmission, as well as the potential legal consequences of the egg donation process being blamed for their occurrence.
In addition, evidence of prior or existing infection with Chlamydia or Gonococcus introduces the possibility that the egg donor might have pelvic adhesions or even irreparably damaged fallopian tubes that might have rendered her infertile. As previously stated, such infertility, subsequently detected might be blamed on infection that occurred during the process of egg retrieval, exposing the caregivers to litigation. Even if an egg donor or a recipient who carries a sexually transmittable viral or bacterial agent is willing to waive all rights of legal recourse, a potential risk still exists that a subsequently affected offspring might in later in life sue for wrongful birth.
Screening of the Recipient

Medical Evaluation: while advancing age, beyond 40 years, is indeed associated with an escalating incidence of pregnancy complications, such risks are largely predicable through careful medical assessment prior to pregnancy. The fundamental question namely: “is the woman capable of safely engaging a pregnancy that would culminate in the safe birth of a healthy baby” must be answered in the affirmative, before any infertility treatment is initiated. For this reason, a thorough cardiovascular, hepatorenal, metabolic and anatomical reproductive evaluation must be done prior to initiating IVF in all cases.
Infectious Screening: the need for careful infectious screening for embryo recipients cannot be overemphasized. Aside from tests for debilitating sexually transmittable diseases, there is the important requirement that cervical mucous and semen be free of infection with ureaplasma urealyticum. This organism which rarely causes symptoms frequents the cervical glands of 15-20% of women in the U.S. The introduction of an embryo transfer catheter via a so infected cervix might transmit the organism into an otherwise sterile uterine cavity leading to early implantation failure and/or first trimester miscarriage.
Immunologic Screening: Certain autoimmune and alloimmune disorders (see elsewhere) can be associated with immunologic implantation dysfunction (IID). In order to prevent otherwise avoidable treatment failure, it is advisable to evaluate the recipient for autoimmune IDD and also to test both the recipient and the sperm provider for alloimmune similarities that could compromise implantation.
Disclosure and Consent
Preparation for egg donation requires full disclosure to all participants regarding what each step of the process involves from start to finish, as well as potential medical and psychological risks. This necessitates that significant time be devoted to this task and that there be a willingness to painstakingly address all questions and concerns posed by all parties involved in the process. An important component of full disclosure involves clear interpretation of the medical and psychological components assessed during the evaluation process. All parties should be advised to seek independent legal counsel so as to avoid conflicts of interest that might arise from legal advice given by the same attorney. Appropriate consent forms are then reviewed and signed independently by the donor and the recipient couple.
Most embryo recipients fully expect their chosen donor to yield a large number of mature, good quality eggs, sufficient to provide enough embryos to afford a good chance of pregnancy as well as several for cryopreservation (freezing) and storage. While such expectations ore often met, this is not always the case. Accordingly, to minimize the trauma of unexpected and usually unavoidable disappointment, it is essential that in the process of counseling and of consummating agreements, the respective parties be fully informed that by making best efforts to provide the highest standards of care, the caregivers can only assure optimal intent and performance in keeping with accepted standards of care. No one can ever promise an optimal outcome. All parties should be made aware that no definitive representation can or will be made as to the number or quality of ova and embryos that will or are likely to become available, the number of supernumerary embryos that will be available for cryopreservation or the subsequent outcome of the IVF donor process.
TYPES OF EGG DONATION

Conventional Egg Donation: This is the basic format used for conducting the process of egg donor IVF. It involves synchronizing the menstrual cycles of both the recipient and the donor by placing the donor and the recipient on a birth control pill so that both parties start stimulation with fertility drugs simultaneously. This ultimately allows for precise timing of the fresh embryo transfer. Using this approach, the anticipated egg donation birth rate is >50% per cycle.
Preimplantation Genetic Sampling (PGS)-Egg Donation: The recent introduction of complete numerical chromosomal assessment (karyotyping) using metaphase Comparative Genomic Hybridization (mCGH) and Next Generation Gene sequencing (NGS) has the potential to change the manner in which egg donation will be performed in the future. CGH/NGS allows full egg/embryo chromosome analysis providing a 70- 80% assurance that the embryo(s) so selected for transfer are highly likely to be “competent” (i.e. capable of producing a healthy baby). Such PGS-egg selection provides about a 50% chance of a baby per transfer of an embryo derived through fertilization of a pre-vitrified euploid egg. This is at least double that reported when conventional egg donation is used. As a result, mCGH/NGS-Egg Donation allows for excellent results when one or two embryos are transferred, virtually eliminating the risk of “high order” multiple pregnancies (triplets or greater). Moreover, since numerical chromosomal irregularities (aneuploidy) are responsible for most miscarriages, the use of CGH also significantly reduces this dreaded complication.
PGS egg selection of necessity mandates the use of Staggered (ST)- IVF. Here the egg donor cycle is divided into two parts. The first involves the egg retrieval, fertilization, embryo biopsy for PGS analysis and embryo cryostorage. The second part involving warming or thawing of the frozen embryo(s) and the subsequent transfer of “competent” embryo(s) to the recipient’s uterus is conducted electively at least several weeks later once the results of PGS testing are available. Since, with St-IVF the egg retrieval and embryo transfer are separated in time, the retrieval can be performed without first having to synchronize the menstrual cycles of the recipient and the egg the donor. In fact, the recipient does not even have to be available when the egg donor is going through cycle. All that is needed is for designated sperm to be available (fresh or frozen) on the day of egg retrieval. This avoids unnecessary travel and inconvenience, and minimizes stress and cost.
Donor Egg Banking: Another imminent advance is the introduction of egg banking. Being able to freeze and bank donor eggs would solve most of these challenges. By using PGS in combination with a egg vitrification (ultra-rapid freezing), we are now capable of improving the birth rate per warmed/thawed egg by a factor of 3-4 fold (from a previous average of <8% per egg to about 27%). Through an electronic catalogue, recipients will be able to select and purchase 1-3 CGH-normal eggs from the comfort of their homes. Thereupon, the selective transfer of 1 or 2 embryos derived from such chromosomally normal eggs could achieve a 50-60% pregnancy rate without the risk of initiating high-order multiple pregnancies in the process. Through this process, the cost, inconvenience and risks associated with “conventional” fresh egg donor cycles would also be reduced significantly.
Financial Considerations
The fee paid to the egg donor agency per cycle usually ranges between $2,000 and $8,000. This does not include the cost associated with psychological and clinical pre-testing, fertility drugs, and donor insurance, which commonly range between $3,000 and $6,000. The medical service costs of the IVF treatment cycle ranges between $8,000 and $14,000. The donor stipend can range from $2,000 too as high $50,000 depending upon the exotic requirements of the recipient couple as well as supply and demand. Thus the total out of pocket expenses for an egg donor cycle in the United States range between $15,000 and $78,000, putting egg donation outside the financial capability of most couples needing this service.
The growing gap between need and affordability has spawned a number of creative ways to try and make IVF with egg donation more affordable. Here are a few examples:
•Egg banking (see above)
•Egg Donor Sharing, where one comprehensive fee is shared between two recipients and the eggs are then divided between them. The downside is that fewer eggs are available embryos for transfer and/or cryopreservation.
•Egg Bartering, where in the course of conventional IVF, a woman undergoing IVF remits some of her eggs to the clinic (who in turn provides it to a recipient patient) in exchange for a deferment of some or all of the IVF fee. In my opinion, such an arrangement can be fraught with problems. For example, in the event that the woman donating some of her eggs fails to conceive while the recipient of her eggs does, it is very possible that she might suffer emotional despair and even go so far as to seek out her genetic offspring. Such action could be very damaging to both her and the recipient, as well as the child.
•Financial Risk Sharing. Certain IVF programs offer financial risk sharing (FRS) which most recipient couples favor greatly. FRS offers qualifying candidates a refund of fees paid if egg donation is unsuccessful. FRS is designed to spread the risk between the providers, and the recipient couple.
Moral, Legal & Ethical Considerations: The “Uniform Parentage Act” which has been adopted by most states in the United States declares that the woman who gives birth to the child will be regarded as the rightful mother. Accordingly, there has to date not been any grounds for legal dispute when it comes to maternal custody of a child born through IVF with egg donation in the majority of states. In a few states such as Mississippi and Arizona the law is less clear but nevertheless, as yet, has not been contested.
The moral-ethical and religious implications of egg donation are diverse and have a profound effect on cultural acceptance of this process. The widely held view that everyone is entitled to their own opinion and has the right to have such opinions respected, governs much of the attitude towards this process in the U.S. The extreme views on each end of the spectrum hold the gentle central swing of the pendulum in place. This attitude is a reflection of the general acceptance in the united states of diverse views and opinions and the willingness to allow free expression of such views and beliefs provided that they don’t infringe on the rights of others.
So where do we go from here? Can and should we, cryopreserve and store eggs or ovarian tissue from a young woman wishing to defer procreation until it becomes convenient? And if we do this, would it be acceptable to eventually have a woman give birth to her own sister or aunt? Can or should we store viable ovarian tissue through generations. Should egg donation simply become a future source of embryos generated for the purpose of providing stem cells, to be used in the treatment of disease states or to “manufacture” fetuses as a source of spare body parts? If the answer to even some of these questions is yes…what about the checks and balances. Who will exercise control and where what form should such control take? Are we willing to engage this slippery slope where the disregard for the dignity of the human embryo leads us to the point where the rights of a human being are more readily ignored? …………………… Personally, I hope not.
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

Addendum #1:
Optimizing International Access to Sher-IVF Services in Las Vegas.

Geoffrey Sher MD

Couples from all over the world seek access to IVF services at Sher-IVF in Las Vegas, NV. In fact about 70% of our patients emanate from out-of-state or from abroad. Most tend to be older, have failed IVF numerous times, have had repeated pregnancy losses or have complex reproductive issues. This article explains how we treat such patients at Sher-IVF and how we are able to provide seamless care in a caring and non-stressful environment. In one case, after experiencing 22 consecutive IVF failures, a couple who journeyed to see me from Melbourne, Australia, had a baby following a single IVF attempt. My approach is to individualize care and target those factors that adversely affect IVF outcome.
At Sher-IVF, IVF cycles are batched into about 8-10, 1-2 week cycles per year (dependent on whether we do fresh embryo transfers or frozen embryo transfers (FET)…which means that patients will almost always know well in advance of treatment, when they need to be at our centers for IVF. This makes the process very convenient for both patients and staff. It also allows us to quality assure the embryology laboratory between cycle batches and so optimize care and outcome.
HOW SHER-IVF PROVIDES OPTIMAL TREATMENT AT A DISTANCE:
•Setting Up a Skype Consultation
The initial step in treatment is to schedule a consultation with me. Patients living outside of the geographic catchment area of our Sher-IVF, (Las Vegas, NV) clinic generally schedule a consultation via Skype. I find that this is much more personal than a telephone consultation and is the closest thing to meeting me in person. You can schedule this consultation by going to my website, http://www.SherIVF.com where you can enroll online, by calling the Sher-IVF at 1-800-780-7437, or by emailing Julie Dahan (patient Concierge) at JulieD@sherIVF.com. Prior to your consultation with me you will be sent a questionnaire that asks for information relating to your medical and reproductive history. You will also be asked to provide copies of whatever medical records (from prior treatment and procedures) you might have available. If you have difficulty in completing the Questionnaire, please contact Julie by phone or email her and she will help you do this.
•The Initial Physician Consultation
You will thereupon be scheduled for initial Skype or an in-person consultation with me at which time I will review all available medical records, ask additional relevant questions and offer a preliminary opinion. I will at that time provide you with my personal cell phone # and will request that you contact me immediately with any future questions or concerns, so that I can address these immediately and in so doing, avoid any misunderstandings. This will be followed by one or more free, follow-up consultations with me to endorse or revise that opinion contingent upon supportive clinical and laboratory testing that I might recommend be performed in the interim. Within 24 hours of our initial consultation, you will receive a follow-up email from me which summarizes your case, my opinion and recommends tests needed. The email communication will also provide you with a list of suggested, supportive articles that I have written on my blog, http://www.SherIVF.com, along with directions on how to access these.
•The Consultation w/Clinical Director and Financial Advisor
Within one or two working days of our initial meeting, you be contacted by my office to set up a consultation with our Office Administrator to cover the logistical and financial considerations associated with doing IVF with me at Sher-IVF in Las Vegas. This consultation is free and in no way binds you to us. It is simply intended to provide you with relevant information, in case you should choose to do IVF here in Las Vegas, with me. At the same time, you will be familiarized with the logistics, time constraints, structure and process involved in an IVF cycle at Sher-IVF. Our approach enables patients to plan their treatment with precision, even months in advance. We will also go over our protocols for performing IVF in 1-2 week batches or “cycles” throughout the year so that our patients rarely need to spend more than two (2) weeks away from home to complete a full cycle of treatment. A Clinical Coordinator will be assigned to chaperone you through your IVF cycle and she will interact with you and your primary care OB/GYN (as required) on a regular and ongoing basis.
•Reaching the Crossroad: The Decision on Whether to Proceed
After completion of the above consultations, you will be asked to contact us with a firm decision as to whether/when you wish to undergo IVF treatment at Sher-IVF. Only after making such a commitment will you be expected to make a modest financial commitment to secure your place on our IVF calendar at a designated and mutually agreed upon time.
•The consultation with a Nurse, Case manager:
Once you have committed to, and have committed to a specific IVF cycle, you (and your partner…as applicable) will be scheduled to have a detailed consultation with a Nurse Coordinator who will develop a detailed, color-coded electronic calendar outlining all aspects of your management and treatment. This will include all diagnostic steps and therapeutic procedures required to ensure that that your planned cycle of IVF can be conducted as scheduled, and without a hitch. The Clinical Coordinator and her team of nursing and administrative personnel will in effect, hand-hold and triage you through all required steps and thereupon will schedule you with follow-up consultations. You will also be provided with contact information by which to reach the Clinical Coordinator, at will.
•Follow-up Physician consultation:
Once all records are available, test results are in, and your IVF cycle is scheduled, you will again consult with me for a free, follow-up consultation at which time we will review everything in detail and if needed make adjustments. Thereupon I might require further free consultations with you and you would of course be free to visit with, or call me on my cell phone with any issues. I ask is that you do not email or text me. I prefer to be contacted by phone so that we can discuss matters of concern rather than have me respond with one-liners via electronic communication.

•Ongoing Interaction and Follow-up
Our staff will at all times endeavor be affable and available to you upon request and will endeavor to maintain regular contact with you throughout. However, we are all human, and thus are capable of erring at times ….So, if anything is not in keeping with your expectations, I ask that you bring the matter(s) to our/my attention immediately so that we can address any/all issues in a timely manner.
•How to Reach Us and Where to Stay
We will gladly advise and assist you in obtaining the most affordable transportation and accommodations. Couples who elect to undergo IVF will find that accommodations in, and airfare (especially if scheduled well in advance) to Las Vegas, likely be relatively reasonable. In fact, we can assist you in obtaining very affordable quality accommodations in close proximity to our facilities.
•Getting You Ready to Go…Conveniently and On Time
We work with you to get all of your required tests done through your own doctor’s office. Remember, your primary OB/GYN is just as capable as we to facilitate or perform virtually all the necessary tests and procedures you may need, in your hometown environment.
Once we have reviewed all your test results, a customized protocol of treatment will be developed and then be emailed to you. Your assigned Clinical Coordinator will provide you with a detailed calendar and will review it with you in person or by telephone, prior to initiating your IVF cycle of treatment.
•The IVF Cycle:
Your cycle begins with the Birth Control Pill (BCP),starting no later than day 7 of menstruation. Depending upon your scheduled date for IVF, you will continue taking the BCP Pill for 11-30 days. This will be outlined in detail on the calendar we provide you with. It will also direct you when to begin your injections. Once you have taken an agonist (e.g. the Lupron, Superfact, Buserelin) for 3-5 days, the BCP will be stopped. You can expect to menstruate 3-8 days after stopping the BCP. Your blood estradiol (E2) level will be measured at the onset of menstruation. An E2 level of less than 70 pg/ml (200pmol/L) provides relative assurance that you have not formed an ovarian cyst and that you are ready to begin Gonadotropin (fertility hormone medication) injections. You will also have an ultrasound examination to ensure that you have no obvious cysts.
Depending on the stimulation protocol selected, you will at this point either continue with daily agonist injections (The conventional down-regulation protocol) or switch to an antagonist (Ganirelix, Cetrotide, Orgalutron) daily injections (the Agonist/Antagonist Conversion Protocol-A/ACP). Once again, your calendar will direct you as to when you should start the injections at home and plan on arriving at the center in Las Vegas for monitoring 7-8 days later. Please note that you will also be taking other medications during your cycle of treatment. This may include daily human growth hormone (HGH) until the day of hCG “trigger” and/or , low dosage oral steroid therapy (dexamethasone/prednisone) starting early in the stimulation and continuing to the 10th week of pregnancy,
If you have a thin uterine lining, you might receive vaginal sildenafil (Viagra) suppositories from the early stage of ovarian stimulation to the day of the hCG “trigger” . In the case of embryo recipient cycles (e.g. egg donation, gestational surrogacy, low dosage oral steroid therapy (dexamethasone/prednisone) will start early in the stimulation and continue to the 10th week of pregnancy. Treatment of an underlying immunologic implantation dysfunction (IID) may in addition require that you receive an intravenous infusion of 20% Intralipid (IL) about 10-14 days prior to embryo transfer (ET) and/or low molecular heparinoid (Lovenox or Clexane). This might need to be repeated one or more times after a positive beta-hCG pregnancy test depending on the type of immune issue involved in your case.
Once you arrive at Sher-IVF in Las Vegas for treatment, regular (usually daily) monitoring of blood E2 levels will begin along with ultrasound monitoring of your ovarian response and development of your uterine lining. Typically, egg retrieval will take place 2-8 days after your arrival at the clinic for monitoring. Fresh ET usually involves blasto

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