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, Thank you for your help and advice in the past! I have a question regarding starting a cycle of IVF with the OCP. I have been told to take Microdiol from CD1 – CD6 (6 days of the pill) and then wait 5 days before starting stims,.. So I would be starting Stims on day 11 of my cycle. I have never heard of this type of protocol, but they said it’s to help make the follicles even in size (I always have a dominant follicle) and then having the 5 days break before starting stimulation will give the ovaries a chance to start back up. Why would they be doing this? Sorry, but they are overseas and the cycle is free as part of a trial (nothing to do with this IVF cycle) so I don’t feel comfortable questioning the protocol…
Very respectfully Simone, I may be missing something here, but I am unfamiliar with this approach also. One often hears the expressed opinion that the BCP suppresses response to ovarian stimulation. This is not the case, provided that the BCP is overlapped with administration of an agonist (e.g. Lupron, Buserelin, Superfact) for several days leading up to the start of menstruation and the initiation of ovarian stimulation cycle with gonadotropin drugs. If the latter precaution is not taken, and the cycle of stimulation is initiated coming directly off the BCP the response will often be blunted and subsequent egg quality could be adversely affected.
The explanation for this is that in natural (unstimulated) as well as in cycles stimulated with fertility drugs, the ability of follicles to properly respond to FSH stimulation is dependent on their having developed FSH-responsive receptors . Pre-antral follicles (PAF) do not have such primed FSH receptors and thus cannot respond properly to FSH stimulation with gonadotropins. The acquisition of FSH receptor responsivity requires that the pre-antral follicles be exposed to FSH, for a number of days (5-7) during which time they attain “FSH-responsivity” and are now known as antral follicles (AF). These AF’s are now able to respond properly to stimulation with administered FSH-gonadotropins. In regular menstrual cycles, the rising FSH output from the pituitary gland insures that PAPs convert tor AF’s. The BCP (as well as prolonged administration of estrogen/progesterone) suppresses FSH. This suppression needs to be countered by artificially causing blood FSH levels to rise in order to cause PAF to AF conversion prior to COS commencing, otherwise pre-antral-to –antral follicle conversion will not take place in an orderly fashion and the follicles will not readily respond to gonadotropins (FSH) , thereby delaying follicle development by up to 7 days and compromising egg quality. GnRH agonists (e.g. Lupron, Buserelin, Superfact) , cause an immediate surge in release of FSH by the pituitary gland thus causing conversion from PAF to SAF. This is why, women who take a BCP to launch a cycle of COS need to have an overlap of the BCP with an agonist.
By overlapping the BCP with an agonist for a few days prior to menstruation the early recruited follicles are able to complete their developmental drive to the AF stage and as such, be ready to respond appropriately to optimal ovarian stimulation. Using this approach, the timing of the initiation of the IVF treatment cycle can readily and safely be regulated and controlled by varying the length of time that the woman is on the BCP.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
•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
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
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.
Geoff Sher
Thank you for your comprehensive answer! Just wondering if perhaps with only 6 days of the pill that would not be enough to really suppress the ovaries? Then also the 5 day lag before stimulation is to allow natural FSH/LH to build up so that the antral follicles can be converted into active follicles? I am so worried, as it seems really unusual to me and I am travelling a long way (24 hours!) to have the treatment so I want to be sure there is a chance it could work to suppress dominant follicle and not suppress egg growth altogether!
Dear Dr.Sher,
I am currently taking treatment at one of SIRM offices.My AMH recently dropped below 1 recently.My RE suggested to take ova boost and dhea. I heard resveratrol supplements are good for egg quality.Please suggest which one to take for good egg quality.Thanks much for your help!
Hi Jenny,
All I can say is that while these supplements probably do no harm, they do not have any proven benefit either.
It is important to nurture and take care of yourself mentally and physically when preparing and going through your IVF journey. This starts with trying to have a positive attitude about what you are about to go through, creating a stress support system for yourself by using tools such as visualization, acupuncture and meditation, eating the right foods taking a few supplements (see below) and balancing exercise with sufficient rest. . Not only will it help your experience but it may also help to increase your chances for IVF success
This article will focus on the role of nutritional supplements in preparing for IVF. You’ve probably wondered whether commercially available fertility supplements could help you achieve your goal. The answer is complex.
Here is my take: Nutrition is indeed a vital prerequisite for optimal reproductive function. However, a well-balanced diet that meets food preferences, coupled with modest vitamin, mineral and antioxidant supplementation (as can be found in many prenatal vitamin preparations) should suffice.
This having been said, conceiving is a delicate process, and eating the right foods is essential to optimize reproductive potential. Indeed, a balanced diet (i.e. a lot of organic and brightly colored foods) will provide most of the nutrients you need. But the truth is that most people do not have a balanced diet and are unwittingly often deficient in important nutrients.
A balanced diet is one that is rich in good quality protein, low in sugar, salt, caffeine and industrially created trans-fats (trans-fatty acids or partially hydrogenated oils) and soy, uncontaminated by heavy metals, free of nicotine, alcohol and recreational drugs. This is why routine supplementation with the following nutrients could enhance preconception readiness:
•Folic acid (400 micrograms daily)
•Vitamins A (2565 IU daily); B6 (6mg -10 mg daily); B12 (12-20 mcg per day); C- (2,000 mg a day for both men and women); E (both sexes should get 150-200U daily), Vitamin D3 1000U daily
•Co-enzyme Q10 (600mg daily )
•Amino acids such as L-Carnitine (3 grams daily) and L-arginine (1 gram per day )
•Omega 3 fatty acids (2,000mg per day)
•Minerals, mainly zinc (15mg per day); selenium (70-100mcg per day); iron (up to 20mg per day ); magnesium (400mg per day )
There are likely to be significant reproductive health benefits (including enhanced fertility and intrauterine development) associated with the use of nutritional supplements. However there are also certain potential pitfalls associated with their use. Some supplements are not as safe as they would seem. For example, excessive intake of fat-soluble vitamins (A, D, E and K) can even be dangerous to your health and may be associated with fetal malformations.
Additionally, numerous supplements have been found to contain contaminants such as toxic plant materials, heavy metals and even prescription medications that can compromise fetal development. Prior to the passage of the Dietary Supplement Health and Education Act of 1994, supplements (vitamins, minerals, amino acids, and botanicals) were required to demonstrate safety. However, since passage of “the Act”, they are now presumed to be safe until shown otherwise, thus establishing a rather hazardous situation where a typical prenatal vitamin that will provide sufficient vitamins and minerals for a healthy early pregnancy and potentially dangerous supplements can and are being sold in the same store without product liability.
In summary, maximizing reproductive performance and optimizing outcome following fertility treatment requires a combined strategy involving a balanced diet (rich in protein, low in sugars, soy and trans-fats), modest nutritional supplementation, limiting/avoiding foods and contaminants that can compromise reproductive potential, and adopting disciplined lifestyle modification such as not smoking, reducing stress, minimizing alcohol intake, avoiding nicotine and recreational drug consumption, and getting down to a healthy weight through diet and exercise.
Geoff Sher
Dear Dr.Sher,
I am currently taking treatment at one of SIRM offices.My AMH recently dropped below 1.My RE suggested me to take ova boost and Shea supplements.Please let me know whether I can use them.Also,I came to know resveratrol supplements are good for egg quality.Please suggest which one to take for good egg quality.Thanks much for your help!
Unfortunately none of these will help any, in my opinion. It all boils down to having to carefully and strategically develop an optimal protocol for ovarian stimulation. This becomes even more essential in women who have DOR such as you do.
In my opinion, “microdose” (“flare”) Lupron protocols, the use of clomiphene or Letrozole, high dosage Menopur protocols and even late antagonist protocols, are best avoided in women with DOR (see below). It surges LH and with it ovarian testosterone as the stimulation begins and this can have a deleterious effect on egg quality/competency…especially in older women and also in women such as yourself who have DOR. You need a modified, robust, long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing)-normal blastocysts, to make hay while the sun still shines.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•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?
•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 Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it Happens and how it can be Prevented.
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
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.
Geoff Sher
Hello Dr. Sher,
I just came across study showing Intralipid therapy not being beneficial for women 40-42.
I am curious what is your experience?
I know there is a lot of evidence of success for younger women with RPL or RIF.
But have you seen as much success with patients more advanced in age?
I am 44 with many years of unsuccessful attempts (I think repeated implantation failure).
Next attempt will be with donor eggs.
I just received the below results from ReproSource … and have no idea how to interpret this – is my NK activity elevated?
Would you advise Intralipid?
NK Activity Assay Cell Viability 99.5%
Cell Viability (whole blood) 98.6%
E:T 50:1 Native State 8.1%
E:T 25:1 Native State 4.0%
E:T 12.5:1 Native State 2.9%
E:T 25:1+IL-2stimulation 6.7%
% increased 66.3 >15% Stimulation
E:T 25:1+Intralipid 3.8%
% reduced 4.0
E:T 25:1+12.5mg/dl IgG 1.7%
% reduced 58.5 >15% suppression
E:T 25:1+6.25mg/dl IgG 3.2%
% reduced 19.5 >15% suppression
Thank you so very much,
Zuza
You do not have NK cell activation based upon these results. So, age is irrelevant. This having been said, IL therapy (provided it is used correctly and combined with corticosteroids is equally effective in regulating the immunologic receptivity of the uterus..,regardless of the woman’s age. What such treatment caannot compensate for is the profoundly adverse effect of age on egg/embryo competency.
Geoff Sher
Dear Dr Sher,
Hubby (34) and I (31), all blood test, sperm test, sono hsg (both sides open), normal ovarian reserve, showed us have no problem of conceiving naturally. However, we have been trying for 1 year with 2 failed IUIs. We insisted our RE to do an IVF.
One failed IVF in March 2016:
Drugs: 300 menopur only, antagonist protocol
Stimming: start drugs on cycle day 4, add orgalutran 5 days, stimming total 8 days. Trigger shot with HCG10000
ER+ET: total 6 eggs, 3 eggs did IVF (fertilized but embryos didn’t development at all, stop at day 1); other 3 eggs did ICSI (all fertilized, until day 3 is good, but slow development, no blast on day 5, nothing to freeze on day 6), transfer one embryo on day 5 (none blast), BFN.
My concerns:
1.Stimming only 8 days, is it too quick? Fast cook eggs, hurt quality?
2.I think I’m with PCOS, but my RE said I might on the edge of PCOS, he believes I don’t have it. Should I ask him to do hormone testing again?
3.After read online, I found out menopur may not good for me, it has too much LH. I’m not sure if I need that much…
4.From failed IVF, what do you think? it’s more egg problem or sperm problem? RE said sperm fragmentation is not in our case.
5.DEHA or HGH could help me with egg quality? We both taking supplements.
6.Should I do a day 3 transfer over day 5? embryo slow development after day 3
7.RE takes first IVF as trial…I believe drugs he used was easy on me. I didn’t ask him why he uses Menopur at first place, but he mentioned menopur is good for egg quality. I know maybe it is hard for RE to treat patient like us – unexplained infertility. It’s like taking chances.
8.My RE said he is going to change drugs with FSH, then use Menopur 375-450 (I’m worried about LH), his goal is to have 16 eggs, ICSI only. (Should I question him, what should I ask him?)
9.We both overweight, hubby BMI is 40, my BMI is 30. Is it a problem? We’re planning to do a second IVF about 4 months later. We both start weight lose, if I lose 20lb is it a good for IVF?
10.We haven’t done Chromosome analysis or immunity test, my RE thinks we get good embryos first then, if other problems arise he will deal with it since me never pregnant before. Other suggestions on testing, drugs, and protocol?
Thank you so much for your time, it’s a long question list, I still couldn’t believe we failed. Need hope.
1. Stimming only 8 days, is it too quick? Fast cook eggs, hurt quality?
A: Not necessarily too quick:
2. I think I’m with PCOS, but my RE said I might on the edge of PCOS, he believes I don’t have it. Should I ask him to do hormone testing again?
A: I doubt , given that your response, that you have true PCOS…but if in doubt, have the testing done.
3. After read online, I found out menopur may not good for me, it has too much LH. I’m not sure if I need that much…
A: >75U Menopur a day is in my opinion not ideal.
4. From failed IVF, what do you think? it’s more egg problem or sperm problem? RE said sperm fragmentation is not in our case.
A: Usually an egg issue.
5. DEHA or HGH could help me with egg quality? We both taking supplements.
A: I am against the use of DHEA (see below) and additional hCG only adds more of an LH-like effect which in my opinion is detrimental to egg quality.
6. Should I do a day 3 transfer over day 5? embryo slow development after day 3
A: Embryos not surviving to day 6-6 are almost always chromosomally abnormal and incompetent. Transferring on day 3 has no merrit in my opinion.
7. RE takes first IVF as trial…I believe drugs he used was easy on me. I didn’t ask him why he uses Menopur at first place, but he mentioned menopur is good for egg quality. I know maybe it is hard for RE to treat patient like us – unexplained infertility. It’s like taking chances.
A: Some LH-like activity is needed for egg development but >75U per day (1 vial of Menopur) can be harmful in my opinion.
8. My RE said he is going to change drugs with FSH, then use Menopur 375-450 (I’m worried about LH), his goal is to have 16 eggs, ICSI only. (Should I question him, what should I ask him?)
A: Respectfully, in my opinion, that is far too much Menopur.
9. We both overweight, hubby BMI is 40, my BMI is 30. Is it a problem? We’re planning to do a second IVF about 4 months later. We both start weight lose, if I lose 20lb is it a good for IVF?
A: Not a bad idea to lose the weight ASAP.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•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?
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•Why did my IVF Fail
•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
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!
•Micro-IVF: Often Preferable to Ovarian Stimulation with or Without IUI
•The Role of Gender Selection in IVF.
•Infertility Caused by Pelvic Tuberculosis: An Easily Missed Diagnosis
•Being Overweight with a high BMI: How Does it Affect Fertility and IVF Outcome?
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
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.
Geoff Sher