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,
I recently found out we are expecting! Yet I can’t shake the worry of miscarriage.
We had a blighted ovum 4 years ago. Then got pregnant with our son 3.5 years ago naturally. Healthy pregnancy and healthy son. Got pregnant again 2 years ago and miscarried around 6 weeks. Tried to get pregnancy without success for about 9 months then sought out a fertility doctor. I was diagnosed with diminished ovarian reserve. My AMH was between 3-6 pmol (Canada).
First IVF failed. Second was a success (3 day fresh embryo). This is where we’re at right now. I’m approx 5 weeks pregnant.
My first fertility doctor told me (after the failed ivf) that i would never get pregnant with my own eggs and if I did I’d miscarry. My current fertility dr wasn’t as concerned and was confident it’d work.
So far my beta levels are as follows: 134, 401, 989, 2694, 6016. Each 48 hrs apart.
I’m just so worried about miscarrying.
Does my low AMH determine that I have poor egg quality and at a greater risk of miscarriage?
Thank you for your time.
Sara
To me you look in good shape. Now that you are pregnant, the AMH level is not really relevant.
Geoff Sher
I apologise, I forgot to add that I am 33 years old and my husband is 35 with low sperm count and low morphology.
Both in good health. Thanks
Unerstood, but that is unlikely to be the real problem.
Geoff Sher
Hi there,
I have recently undergone two cycles of ICSI and both have been unsuccessful. I have an AMH of 5.6 (UK measurement) and was put on the short protocol. I took norethisterone tablets for 10 days and then after a period I went for a prostrap injection. I then took Gonal F (210 iu daily) for 5 days and on day 6, after a scan, I was told I was ready for egg retrieval. I then took my ovitrelle trigger shot and went in two days later for retrieval. This was exactly the same for both cycle 1 and 2. Cycle 1 I had 13 eggs, 12 mature, 4 fertilised and one poor quality cavitating morula on day 5. Cycle 2 I had 6 eggs, 5 mature, 4 fertilised and day 3 transfer with a 6 and 7 cell badly fragmented eggs. One more egg made it to blastocyst on day 5 but it was too low quality for freezing.
My clinic want to keep me on exactly the same protocol for cycle 3 but I am worried that my eggs developed so fast (ready on day 6 of Gonal f) so this is the reason the quality was compromised. Any advise about my protocol would be much appreciated as I am nervous about attempting yet another cycle with exactly the same mediation.
Many thanks
Hi Anna Marie,
Very respectfully, I do not agree with the use of “short agonist protocols” in women with diminished ovarian reserve. Also, if Ovitrelle is used, the dosage should be 500mcg in my opinion.
In my opinion, against the backdrop of age and diminished ovarian reserve (DOR), the protocol used for ovarian stimulation is one of the most important drivers of egg “competence” (quality) and the number, yielded.
Women 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 of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
Please visit my new Blog on this very site, https://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
I had a scan at 8.3 am this morning and had the following folicles, 20.3, 17.7, 14.4, 19.4, 17, 14.3, 20, 17.4, 21.8. I have done my stims medication this morning. My doctor advised I don’t do any injections in the morning tomorrow and then trigger tomorrow evening. I am on long lupron protocol (take 5ml daily). What do you suggest I do in the morning? I am worried about premature ovulation and also my folicles getting to big. Please can you let me no if you would advise a lupron injection and if I should add any stims. Thanks
If these measurements are accurate I probably would have triggered you today. I personally would trigger with 10,000U hCG or Ovidrel 500mcg…not Lupron.
Good luck!
Geoff Sher
Hi Dr. Sher!
I appreciate all the information you share on your site.
We have one normal embryo and one with Mono X and Mono 13. With Mosaic for 35%. Would that something you would implant?