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 Dr. Sher,
A little over 2 years ago, I was diagnosed with Premature Ovarian Failure at the age of 29. I also have Endometriosis which has resulted in 9 surgeries. I was pretty much told I could never have a baby. My OBGYN sent me to a infertility specialist that confirmed the same diagnose. The following year, I got pregnant but had a miscarriage shortly there after. I went back to the infertility specialist and he said that since I got pregnant probably means I have some eggs just not a lot. Also, none one could ever tell me why I have POF, they did lots of tests but they just said it was due to all my many surgeries for Endometriosis. That still doesn’t sit well with me as I think there is a root cause, but no one has figured that out. Well my infertility specialist then decided we could do IVF since I did get pregnant. We did 3 months of prep dosing me with high levels of estrogen and then we did the IVF last Fall 2017. After 9 days of taking Gonal F, Menopur, and Lupron; my IVF failed because my follicles wouldn’t grow. I had 12 in total. Since then I have been taking a more holistic approach and got pregnant again but had another miscarriage, but now have found that I have very low progesterone. I’m currently taking a ton of supplements my doctor put me on and only real medication I’m on is estrogen and Synthroid for my hypothyroidism. I also take 2 tinctures of herbal medicine; 1 is for days 1-14 and 2nd is for days 15-28 with a combination of progesterone cream that I increase during the second part of the month.
I’m not happy with my current state as I feel like no one knows what to do with me.
Questions:
1-What do you think caused POF? And can we reverse it?
2-Do I have empty follicles? Do you think I have any eggs left? My AMH is extremely low.
3-Would clomid help me?
4-What do you think I should do next?
I REALLY appreciate your help. I’m at a lost and don’t know what to do. We want a baby so badly and we are just praying for a miracle. Also, my hubby has been tested and everything is good with him.
Thank you,
Kimberly Jones
der sher, i m in a natural cycle to obtain the follicule, how is your protocol in this treatment? dou you use ganirelix? i only use ganirelix when follicules are 15 mm or more. how can affect this medicament in a natural cycle? in the first cycle i had my cycle was bloked because of ganirelix when foliculle of 14 mm, now i started on day 12 when follicule 15 mm and estradiol 95, this is done correctly?many thanks for yoyr help
Hi Dr. Sher, I am 39 and DH is 43. I have PCOS and husband has motility issue. We have gone through 3 failed IUI and 3 failed IVFs (IVF all happened in 2018). First IVF, 9 eggs retrieved, 7 fertilized (ICSI) but no blast on day 5, still transferred two 10 cells embryos which resulted in negative. I was concerned of lab experience then I switched clinic with more experience. Second IVF cycle, Gonal-F was increased, and I have 7 eggs with 5 fertilized. this round, I have 1 1BB blastcytes and one close to morale which both were transferred. After egg retrieval, I have severe OSHH which required bedrest. However, this cycle still resutled negative pregnancy. Third cycle of IVFs, Gonal-F was increased and we have 17 egg retrieved with 12 matured but only 5 fertilized. Out of 5, we got 1 2BB blast and 1 morale which both transferred. This cycle, I started to bleed 4 days post 5 day embryo transfer for about 4 days and during these 4 days, i also have very bad bloating, low grade fever and abdominal cramp.
We are at the point not sure what to do next and quite can’t figure out should we change clinic since this clinic is a lot more protocolized and the first clinic is very academic. We did not do PGS as I don’t think our embryo will survive the freezing process.
I am on prenatal vitamin and Co-enzyme q10 and my husband is on Co-enzyme and L-carnitine. All the IVF cycles I have used Gonal-F/menapure/cetrotide.
I want to get your thoughts on what we should do next and is there any test we should request when we talked to our physician.
Thanks much.
Min
Hi dr, I am 41 and have a 20 month old baby boy. My husband and I want a second baby and my levels have shifted since I was 38. My fSH was a 5 now it’s a 12. We took clomid and it Gave me cysts so now have been on famara the last 5 months and my cycle is 28 days and ovulation, I am doing an hsg test tomorrow to open my tubes. I did that test 2 years ago and a month later got pregnant with my son. So we are tying that again. My question is can I still release a healthy egg even if my amh levels have dropped now that I am 41. At what point should we move on to ivf if we still aren’t falling pregnant? I don’t want to miss my window and I keep reading about woman getting pregnant at 40-44 with very low reserve. I just need some guidance thank you so much!
Hi, Erika;
Similarly, I discovered my infertility when I was 28 after trying for nearly a year. At my second appointment with my first fertility specialist, she uncovered my seven endometriomas, one of which was nearly 11 cm. Three months after my laparoscopy, my thyroid failed and I was prescribed 50 mg of Synthroid. Fast-forward three years after my lap; I have been through an SO-IUI and a day3FET (IVF) and have been through two HSGs (patent), have taken too many medications to mention, including all that you have mentioned, including a blood thinner to improve the uterine lining, and have been on prenatal, CoQ10, VitaminD, Zinc, Beef Liver supplement, and cod liver oil. Also, recently stopped the Synthroid (have been Gluten-free since my diagnosed hypothyroidism and have since got my thyroid back to normal). Both failed. My current (now third) fertility specialist recommends another lap to inspect possible toxins from the initial lap followed by a tubal ligation to prevent possible toxins from leaking into my uterus. Without definitively knowing the cause of my infertility (very well attributed to stage IV endo), she suspects that my tubes are most likely diseased. These are her suspicions and a way of changing the current state of my uterus so that the next IVF is not simply insanity. I hope some of this info helps you plan your next move.
Dr. Sher, your thoughts on the discussed possible second laparoscopy to check on the status of my endometriosis and perform a tubal ligation are sincerely appreciated.
Thank you so much.
Respectfully Virginia,
At 41y of age with diminished ovarian reserve, you should only be doing IVF at this time and you should do it with preimplantation genetic screening.
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, and/or biological activity, of LH. This can result in excessive ovarian male hormone (predominantly testosterone) production. This 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,
Appreciate you taking the time to answer our questions. My wife (35) and I (36) went through three failed IUIs, after trying to conceive for 6 months. We did some tests after trying and it was determined that my sperm has low motility and poor morphology. My wife has healthy eggs, yet a lower amount for the average person at her age. My wife went through one IVF stim cycle this past April and we were able to come away with 2 viable embryos from 7 retrieved eggs (8-11 estimated follicles). We elected to do another round of stimulation again before implanting to increase our chances of multiple children. The second stimulation did not work and the retrieval was canceled. We then tried again, and we are now in the same situation. It appears the stimulation medication is having no effect on creating more follicles (it’s as if she is having a natural cycle) and our clinic is recommending to cancel again. For the three IUI’s and the first round of IVF she had responded well to the medication. My question: is this common? To have stimulation fail two times after working well? Can her egg supply drop in 2 months?Is it possible that the retrieval process from the first cycle “damaged” something?
Thanks