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 am 40 years old and just underwent my 4th try at IVF, but my second transfer. It was a 3day 8 cell, grade A, no fragmentation embryo, even started compaction. This was a frozen transfer because progesterone level was too high for fresh. I have Hashimotos and my TPO antibodies are close to 500. My TSH was 2.0 day of transfer, it was 3.1 four days prior, but drs changed my levothyroxine dose to bring it down. My TSH can bounce around sometimes but we constantly check it before an IVF round. I’m just trying to get a second opinion, my drs say the antibodies don’t affect IVF, but other things I read says it can affect implantation rates. I’m just trying to get clarification as to if this could be a reason for multiple failures.
50% of women who have thyroid auto-antibodies have also activated NK cells which unless addressed will in my opinion explain your situation.
Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.
I strongly recommend that you visit http://www.DrGeoffreySherIVF.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.
•The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 1-Background
•Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 2- Making a Diagnosis
•Immunologic Dysfunction (IID) & Infertility (IID): PART 3-Treatment
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management 🙁 Case Report)
•Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
•Intralipid (IL) Administration in IVF: It’s Composition; how it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
My final IVF cycle at SIRM-LV commences on March 19th and concludes on April 2nd. If you are interested in undergoing a fresh IVF treatment cycle with me or if you have embryos cryopreserved at SIRM-LV and wish to undergo a Frozen Embryo Transfer (FET) prior to my departure, please contact me immediately….. My March cycle is likely to be very much in demand…….So, time is of the essence!
Following my departure from SIRM in mid-April, 2019, I will continue to provide comprehensive consultations to those of you that wish to have my guidance. Upon scheduling a SKYPE consultation with me, you will promptly receive a detailed questionnaire, along with a request that you submit available medical records for my review prior to our consultation. Additional tests and records can/will be requisitioned later, as needed. Your +/- 1 hour comprehensive SKYPE consultation will be followed by a detailed written report which you can also share with your personal Fertility Physician.
I will soon be posting a list of internationally regarded Fertility Specialists whom I endorse and who will have expressed a willingness to implement my suggested approaches, at their discretion. It is to one of these doctors that I would selectively refer you…upon request.
CONTACT INFORMATION:
•Online: Go to sherivf.com and Schedule a Skype Consultation. Upon doing so, you will be able to download a free copy of my new eBook ” Recurrent Pregnancy Loss (RPL) and Unexplained IVF Failure: The Immunologic Link”
•Phone
oIf you live in the USA or Canada: Please call 1-800-780-7437 or 702-533-2691
oIf you reside elsewhere Abroad: Please call 702-533-2691
oEmail: concierge@SherIVF.com
Please monitor this website for future announcements on further developments.
Geoff Sher
I just did my first ivf cycle and a bit confused with my results and what I should do.
Discuss with your personal RE.
My final IVF cycle at SIRM-LV commences on March 19th and concludes on April 2nd. If you are interested in undergoing a fresh IVF treatment cycle with me or if you have embryos cryopreserved at SIRM-LV and wish to undergo a Frozen Embryo Transfer (FET) prior to my departure, please contact me immediately….. My March cycle is likely to be very much in demand…….So, time is of the essence!
Following my departure from SIRM in mid-April, 2019, I will continue to provide comprehensive consultations to those of you that wish to have my guidance. Upon scheduling a SKYPE consultation with me, you will promptly receive a detailed questionnaire, along with a request that you submit available medical records for my review prior to our consultation. Additional tests and records can/will be requisitioned later, as needed. Your +/- 1 hour comprehensive SKYPE consultation will be followed by a detailed written report which you can also share with your personal Fertility Physician.
I will soon be posting a list of internationally regarded Fertility Specialists whom I endorse and who will have expressed a willingness to implement my suggested approaches, at their discretion. It is to one of these doctors that I would selectively refer you…upon request.
CONTACT INFORMATION:
Online: Go to sherivf.com and Schedule a Skype Consultation. Upon doing so, you will be able to download a free copy of my new eBook ” Recurrent Pregnancy Loss (RPL) and Unexplained IVF Failure: The Immunologic Link”
Phone
If you live in the USA or Canada: Please call 1-800-780-7437 or 702-533-2691
If you reside elsewhere Abroad: Please call 702-533-269
Email: concierge@SherIVF.com
Please monitor this website for future announcements on further developments.
Hi, Dr. Sher. We were successful on our first ivf try. So thinking about going back for a FET, is there a season that results in more positive pregnancy tests than any other? I’ve read a few articles on why spring/summer conceiving is best but not sure how true this is with FET. What are your thoughts? Thank you!!
No Katie there is in my opinion no seasonal effect whatsoever.
Geoff Sher
hi dr sher
after 6 1/2 month abortion my bleeding didnt stoped for 20 days. dr had me started cyclo-progynova. when i went to doctor on cd3, u/s showed i had cysts in both ovaries 5cm and 3cm. I am 43 years old and for 2 years, I have been taking femeras, ivf medicines, fet medicines.. but for the first time i have folicule cysts and they didnt go away by my period. besides that my most concern my fsh was always below 8 and estradiol was between 40-60 but this time on my cd 2, estradiol 28 fsh 8,5.. and i never thought take a blood test again next day on cd 3 but this time i had another blood test and estradiol 29 fsh 12,25 it freaked me out. my doctor said it is normal because one day past. could these cysts and high fsh be because of abortion and long bleeding and cyclo-progynova???
and other question: my doctor gave me birth control pill for these cysts just for 10days. after 10 days the menstruation bleeding will start then second day of bleeding again fsh estradiol test will be taken and ultrason check for cysts. if everything is ok my doctor starts medicines for ivf. are these egs after just 10day birth control pill new eggs or are these eggs same ones when fsh high and there were cysts. are they able to be have high quality and number.. is it okay to start ivf or wait next month with normal hormomes values
I am concerned that your bleeding might have to do with an incomplete abortion and retained products of conception. I suggest you discuss this with your doctor. Also, I would wait for at least one regular menstrual cycle before trying again.
Geoff Sher
I posted a question earlier but did not see it so will try posting again…
I found out I was pregnant a week ago and have had the following test results:
-1/7 @ 10:30 am:
HCG: 79
Progesterone: 33
-1/9 @ 8:00 am
HCG: 118
-1/10 @ 11:30 am
HCG: 167
-1/12 @ 5:00 pm
HCG 326
Between my first and second HCG results, my doctor expressed concern that they were not rising appropriately. It appears that they are now rising faster, though not exactly every 48 hours. Because we could not yet see anything on an ultrasound, I am still very concerned about the viability of this pregnancy and the possibility of an Ectopic pregnancy. Do you think the results look alright?
You will need to wait this out. Repeat the hCG level every 2-4 days and then when it is >2,000, do an US for confirmation. I think there is still hope but be sure to have your doctor also watch for an ectopic pregnancy. Report any sudden pain, light-headedness/fainting spells etc…to him/her.
Good luck!
Geoff Sher