19,771 Comments

1. Jennifer on April 23, 2016 at 7:57 pm

   Dear Dr. Sher,

   Thanks for maintaining this site, I know we all really appreciate it. I had my egg retrieval yesterday. They collected 15 eggs, 11 mature, and 9 fertilized with ICSI. My concern is that the day I triggered (HCG) my e2 had pretty much plateaued, only rising to 1585 from 1560 the day prior. Does this indicate poor egg quality?

   Thanks in advance!

   Jennifer

   • Dr. Geoffrey Sher on April 23, 2016 at 7:59 pm

     Not necessarily Jenifer. With premature luteinization, the E2 will often drop >20% in 24 hrs. So all could still be fine.

     Good luck!

     Geoff Sher

2. Sarah on April 23, 2016 at 7:32 am

   What’s the average live birth rate for 1 hatching blast vs 2 at 36-37 years old?

   • Dr. Geoffrey Sher on April 23, 2016 at 4:06 pm

     Probably about 25-30%.

     Good luck!

     Geoff sher

3. Bernie on April 23, 2016 at 1:34 am

   Hi dr Sher

   I am 45 years old and had egg vitrification 2 years ago, 6 mature eggs and 2 immature.
   1) What are the chances of I having twins or triplets? as I would love to have a multiple birth and I dont want to have children any later than 47.
   2)I am definitely going to go you to have IVF and do you think it is high risk to have twins or triplets at this age. I am in very good health

   Looking forward to hearing from you.

   • Dr. Geoffrey Sher on April 23, 2016 at 5:06 am

     Hi Bernie,

     The chance of twins is very, very small given your age and the effect of age on egg quality.

     Good luck!

     Geoff Sher

4. Kathrine on April 22, 2016 at 9:16 pm

   Background: My understanding is that egg quality is most affected in the 90-70 days prior to conception. Until recent recommendations from national organizations, I thought infrequent wine consumption was safe – I had taken my REs advice to have a few glasses of red wine per week DURING and before stimulation. I drank wine lightly in December, and more recently in March (about half of those times included exposure to second hand smoke.) Question: how can I calculate a time for stimulation safely past the seventy day and preceding twenty days crucial to optimal egg health? Thank you, K PS I have jus spoken to your concierge – I can’t imagine greater comfort or help.

   • Dr. Geoffrey Sher on April 23, 2016 at 5:12 am

     Frankly, in my opinion, I do not think there is much effect prior to conception. Bear in mind that eggs that are in play in a given cycle have been in body all the woman’s life.

     Geoff Sher

5. Claire on April 22, 2016 at 8:22 pm

   Hello! I was hoping you may be able to help? So, we started IVF in January 2015, I have no medical conditions however I previously had an ectopic pregnancy 18 years ago and lost 3/4 of my right tube, I was also told at the time that my left tube had adessions and therefore I may have an ectopic again. When we started IVF I was told that before any transfer I would need both tubes even the 1/4 clipped or removed before I had any embryos transferred as they wanted to give me the best chance of success. I had one collection and only got 1 viable and surviving egg which was then frozen, for this cycle I was given all meds but was told they made no difference so my next cycle would be a natural one. I had my 2nd collection and they retrieved 3 eggs but none survived. At this point we decided to go for a donor to give us a better chance of success providing our 1 frozen egg didn’t work. I had a hysteroscopy which came back clear and both my tubes were clipped. My FE was transferred resulting in no pregnancy on a natural cycle. We then found a donor who was 32 years old (I was 40 and now 41) she has created 3 families and had a son of her own. We took 7 eggs from her and 5 fertilised. In November last year we had a FET of 2 on crinone, clexane, cyclogest, aspirin, progynova, eastrogen patches, utrogesten this resulted in pregnancy but upon the 6 week scan the sac was detaching and I miss carried. We again had 2 more thawed but one did not survive so we had to use the 1 remain frozen as we wanted 2 transferred. I had the same meds except the cyclogest was changed to lentogest injections – this resulted in no pregnancy. Now we have no more donor eggs left and have had to get more from another donor, this donor is a lot younger she is 21 at the time of donation and we have 13 eggs I was wanting to know if this is too young and what is a balance? We need to get this right as this is going to be our last batch of eggs so I want to be sure I have the right age match. Thank you – Claire

   • Dr. Geoffrey Sher on April 22, 2016 at 9:08 pm

     Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
     It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
     1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
     2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
     We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
     3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
     4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
     a.A“ thin uterine lining”
     b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
     c.Immunologic implantation dysfunction (IID)
     d.Endocrine/molecular endometrial receptivity issues
     Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).

     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)
     •IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
     •Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
     •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)
     •Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
     •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.
     •IVF Egg Donation: A Comprehensive Overview

     I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:

     Email: Julied@sherivf.com

     OR
     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