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, I would like to ask if Lupron depot 3.75 mg injections are helpful to do for women with endometriosis before IVF cycle. And if yes for how long. Thank you
Also can you provide me price list for consultation and IVF .
Thanks so much.
No! It totally suppresses estrogen production for several months, which in my opinion can impair subsequent endometrial response to estrogen with the transfer.
Geoff Sher
Happy New Year. I stumbled across this site on exactly the right day. I’m undergoing a FET next Thursday. I’m feeling rather deflated. I have a day 6 below average blastocyst (last one from when I did harvest 3 years ago). Couple months ago I did a transfer with day 6 above average blastocyst. It failed. Beginning of 2018 I had two transfers of good blastocysts both failed. Am I wasting my time transferring this blastocyst?
I do not believe you would be wasting your time Lyndsey. I wish you luck with your FET.
Geoff Sher
Hi, Dr. Sher. Happy New Year. My clinic told me today I have a better chance of success of transferring 1 pgs normal day 5 embryo at age 42 than at age 43. They said at 43 there was a drop off of success even with pgs normal embryos. Is this true? Thanks for the time.
In my opinion, it all depends on your age when the egg retrieval and generation of blastocysts occurred, not your age at the time of ET. Against this background, blastocysts resulting for eggs harvested at 42y will be more likely to be viable than when harvested at 43y.
Good luck!
Geoff Sher
Hi dr Sher, I’m 40 with AMH 1.98 and FSH (end luteal messured) 6.3 I contacted you at the end off October after my first IVF cycle long protocol (gonapeptyl 0,1 and menopur 225, triggershot pregnyl 5000 iu) Had 18 nice looking follicles, pick up went terribly wrong, each follicle flushed 4 times, and only 2 eggs, of which one was mature, ICSI fertilized, PSG tested as a blastocyst and had a monosomy. My doctor (professor) had never experienced this (1 mature egg out of 18 follicles) in 17 years of practice. You suggested that the dosage of pregnyl 5000 IU, was to low for proper meiosis to happen, and thus no mature eggs could be collected. My second cycle: long protocol (suprefact nasal spray 0.1 6 puffs a day, puregon 225 and the triggershot PREGNYL was TRIPPLED to 15000 IU) 14 follicles, flushed once, 13 mature eggs. 10 fertilized ICSI, Day 3: 7 embryos morning of day 6: 7 blastocysts (6 looking excellent, one ok) they would be PSG tested Late afternoon, my doctor rang me up to tell me that all 7 (nice looking embryos to that point) stopped growing at the same time and thus couldn’t be tested. He said that it is unusual for all of them stopping together, and that he thinks maybe te culture medium that the lab uses didn’t suffice for my embryos? What in your experience could have caused this? Is there a way to prevent this from happening again? Many thanks in advance,
Kiki
Hi dr Sher,
I’m 40 with AMH 1.98 and FSH (end luteal messured) 6.3
I contacted you at the end off October after my first IVF cycle long protocol (gonapeptyl 0,1 and menopur 225, triggershot pregnyl 5000 iu)
Had 18 nice looking follicles, pick up went terribly wrong, each follicle flushed 4 times, and only 2 eggs, of which one was mature, ICSI fertilized, PSG tested as a blastocyst and had a monosomy.
My doctor (professor) had never experienced this (1 mature egg out of 18 follicles) in 17 years of practice.
You suggested that the dosage of pregnyl 5000 IU, was to low for proper meiosis to happen, and thus no mature eggs could be collected.
My second cycle: long protocol (suprefact nasal spray 0.1 6 puffs a day, puregon 225 and the triggershot PREGNYL was TRIPPLED to 15000 IU)
14 follicles, flushed once, 13 mature eggs.
10 fertilized ICSI,
Day 3: 7 embryos
morning of day 6: 7 blastocysts (6 looking excellent, one ok) they would be PSG tested
Late afternoon, my doctor rang me up to tell me that all 7 (nice looking embryos to that point) stopped growing at the same time and thus couldn’t be tested.
He said that it is unusual for all of them stopping together, and that he thinks maybe te culture medium that the lab uses didn’t suffice for my embryos?
What in your experience could have caused this?
Is there a way to prevent this from happening again?
Many thanks in advance,
Kiki
Again, and very respectfully, I doubt this was a laboratory issue. While certainly, at age 40, a smaller percentage o your eggs are likely go be chromosomally normal, given your normal ovarian reserve, you shad have had a significant number of biopsiable blastocysts by day-6 post fertilization. I suspect that this is still a medically induced egg competency issue, perhaps linked to the protocol used for ovarian stimulation and/or its implementation. The use of a BCP to launch the cycle, an overlap with an imjectible agonist (Lupron or Buserelin/Superfact) rather than a nasal agonist, the dosage and composition of the gonadotropin medications, perhaps the addition of human growth hormone to try and augment egg development and finally, the timing of a 10,00U hCHG (or 500mcg Ovidrel) “trigger” are all very important considerations, in my opinion.
Here is the protocol I advise for women who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur—no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit http://www.SherIVF.com. Then go to my Blog and access the “search bar”. Type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
• The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
• Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
• IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation (COS)
• The Fundamental Requirements For Achieving Optimal IVF Success
• Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
• Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
• Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
• A personalized, stepwise approach to IVF
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
If you are interested in my advice or medical services, I urge you to contact my patient concierge, ASAP to set up a Skype or an in-person consultation with me. You can also set this up by emailing concierge@sherivf.com or by calling 702-533-2691 and/or 800-780-743. You can also enroll for a consultation with me, online at http://www.SherIVF.com.
Also, my book, “In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com .
Geoffrey Sher MD