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 Doctor,
My 1st Ivf failed . Doctor said because of poor quality egg and having so much of fragmentation and embryo grading was ‘B’. Well, my concern is during my 1st IVF cycle we did sperm DNA fragmentation test . Index was >49 . , poor DNA integrity . We did IVF with ICSI , but my question is does DNA Fragmentation index will going to be affect and plays important role in embryo development?? This was the reason behind occurred fragmentation . if yes do we need to make test again on sperm DNA fragmentation if we want to go for second IVF Cycle .
In about 40% of infertility cases, male factor is the sole cause. In approximately another 40% it is solely a female factor and in the remainder (20%) both male and female factors are involved. In more than 80% of cases, performance of a semen analysis (sperm concentration, motility, and morphology) will be sufficient to diagnose male factor, while
There is growing evidence to indicate that DNA damage is prevalent in many cases of male infertility and that this can impact fertility, even in the presence of a normal semen analysis. The latter occurs in 10% of cases when sperm parameters are normal. What remains unclear is at how the DNA damage should be measured, at exactly what level it would impact fertility and precisely, precisely what should be done when there is evidence of such damage and how effective treatment will be.
While assessing male factor by semen analysis (whether using conventional manual assessment or computer measurement is reliable in about 95% of cases, it tends to be more accurate when it comes to diagnosing normal male fertility, in about 20%-25% of cases where it diagnoses poor sperm parameters it is inaccurate.
A variety of conditions can cause sperm DNA damage. They include, malignant disease, irradiation, chemotherapy, varicoceles (a collection of surrounding varicose veins in scrotum), white blood cells in the sperm (leucocytospermia) ,cigarette smoking and even cryopreservation (freezing) of sperm.
Sperm chromatin structure Assay (SCSA).
Sperm chromatin has a highly specialized and compact structure that is essential for protection and subsequent transmission of the paternal genome.
The SCSA evaluate for Sperm DNA damage, expressing it as the percentage of sperm DNA fragmentation –(DFI-small breaks in the sperm chromosomes). A DFI of <15% is considered normal while a value of >30% is regarded as abnormal. Fifteen percent (15%)-30% is “intermediate”. Couples where the man has sperm that registers a DFI of >30% reportedly have a four-fold reduction in term pregnancies and a doubling in the miscarriage rate.
What is true is that the SCSA is measure of sperm DNA damage and does predict male sub/infertility and poor reproductive performance. The SCSA/SDIA measures the degree of abnormalities in the genetic material of the sperm, expressing it numerically as the DNA Fragmentation Index (DFI).
This having been said, it is important to reemphasize that SCSA data will not always correlate well with standard sperm parameters (count, motility and morphology).
It is true that varying degrees of DNA damage may be present in sperm from both fertile and infertile men. However a quantitative expression of the DFI often will reveal a hidden abnormality of sperm DNA and as such unveils infertility in cases where prior standard sperm parameters failed to reveal underlying male infertility. Optimal sperm chromatin packaging seems necessary for full expression of male fertility potential. SCSA emerge as predictors of the probability to conceive and carry the pregnancy to viability
Current information on the clinical role of the SCSA testing in patients undergoing IVF suggests the following:
•The IVF birth rate could be as much as 1.5-2 times lower in women under 33yrs of age, whose husbands have patently abnormal SCSA assays (with a DFI of >30%). Results seem to become progressively worse with advancing maternal age such that at 35y+, the viable pregnancy rate could be as much as 2-3 times lower.
•It is possible for abnormal SCSA results to spontaneously revert back to normal, this occurs infrequently. One study reported that even without treatment, 37% of patients with an abnormal result on first SCSA (DFI >30%) were subsequently found to have normal result (DFI < 30%) on a second SCSA test. •Although abnormal SCSA results are detected in men with apparently normal semen analyses, abnormal results are more commonly seen in cases of men who have abnormal sperm parameters (abnormal sperm count, motility and/or morphology) •Abnormal SCSA augers poorly for the outcome of fertility treatments in general and for IVF/ICSI in specific. In the latter cases, fertilization and pregnancy rates are reduced and the chance of early pregnancy loss appears to be increased. However it is important to stress that an abnormal SCSA result does not preclude a successful pregnancy. In fact we have seen many IVF pregnancies occur in spite of abnormal SCSA results….even when the DFI was > 60%
•The likelihood of a successful outcome with IVF/ICSI in cases where the SCSA is abnormal worsens progressively as the age of the egg provider advances beyond 35yrs.
•While abnormal SCSA results rarely revert spontaneously to normal this can and does happen on occasion, especially following surgical or interventional radiological treatment of varicoceles (a collection of distended veins surrounding one or both testicles in the scrotum). In addition, there is some suggestion that the use antioxidant/vitamin male fertility blends such as “Proxeed or, Proceptin if taken for 2-3 months can improve the SCSA. In fact, in a relatively recent study, 38 men with an increased percentage of DNA fragmented sperm who received antioxidants, were followed for 2 months after one failed ICSI attempt. A second ICSI cycle was then performed which demonstrated a marked improvement of clinical pregnancy rates (48.2% vs. 6.9%) when compared with pretreatment ICSI outcomes.[
While the SCSA is not a measure of the sperm’s ability to fertilize an egg, results tend to correlate well with the potential of the fertilized egg, to develop into “competent” embryos (i.e. ones that are capable of propagating live births). As such the introduction of SCSA in the diagnostic armamentarium represents an important advance
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?
•Why did my IVF Fail.
•Male Factor Infertility
•Antisperm Antibodies, Infertility and the Role of IVF with Intracytoplasmic Sperm Injection?
•Varicocele and Male Infertility: When and how should it be treated.
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
Hi Dr Sher,
I really need your help!
I am 39 years old and have had 3 children naturally only trying once all three times with ovulation kit. They are aged 6, 12, 13 years.
However, I have remarried and we both want a child. Because of my age – I didn’t want to risk it – so went to Cyprus to do IVF with pgd to ensure no defects.
First cycle, last November 450iu menopur and cetrotide days 6 – 10 and then Ovidrell 250. Had 17 follicles – only 6 eggs. 1 immature, 4 died during fertilization up to day 4 and also chromosomal defects. 1 blastocyst transferred. Negative pregnancy!
From January, after research I started taking dhea 25mg x 3 per day, Coq10 600mg, Red gelatinised maca and royal jelly.
Second cycle, Early March. Exactly same as above but with Letrozole 2.5mg x 2 per day added days 2 – 6 of menstrual cycle. 11 follicles and 10 eggs retrieved. Only one mature and no defects to blastocyst. 2 others were put under lab and matured but had chromosomal deficiencies. Embryo frozen as my progesterone levels had risen to 2.5.
Now the Dr is suggesting another cycle but very different. Gonal F 200 11 day protocol. Cetrotide added from day 5 – 11 with Ovidrelle trigger 250.
I am worried now that with a low dose, are my follicles going to grow and will there again be immature eggs? Dr is saying that there is little hope and we should consider donor eggs – but I don’t wish to do that – I want my own eggs!
I have since decided to add myo inositol 4g, melatonin 3mg.
My blood tests done last September in the UK on day 3 of my menstrual showed -amh 10, fsh 8.3, tsh 0.86, LH 3.6, prolactin 1.43, Estradial 1.59.
I am overwhelmed by your praises on fertility forums. Please can you advise what protocol you would put me on.
Thank you
I do not necessarily agree that you need an egg donor. I think thi scould well be due to the protocol used for ovarian stimulation in general and the triggering method in specific.
Ideal egg development sets the scene for optimal egg maturation that occurs 36-42h prior to ovulation or egg retrieval. Without prior optimal egg development (ovogenesis), egg maturation will be dysfunctional and most eggs will be rendered “incompetent” and unable upon fertilization to propagate viable embryos. In IVF, optimal ovogenesis requires the selection and implementation of an individualized approach to controlled ovaria stimulation (COS). Thereupon, at the ideal time, maturational division of the egg’s chromosomes (i.e. meiosis) is “triggered” through the administration of hCG or an agonist such as Lupron, which induces an LH surge. The, dosage and timing of the “trigger shot” profoundly affects the efficiency of meiosis, the potential to yield “competent (euploid) mature (M2) eggs, and as such represents a rate limiting step in the IVF process .
“Triggering meiosis with Urine-derived hCG (Pregnyl/Profasi/Novarel) versus recombinant hCG (Ovidrel): Until quite recently, the standard method used to “trigger” egg maturation was through the administration of 10,000 units of hCGu. Subsequently,, a DNA recombinant form of hCGr (Ovidrel)was introduced and marketed in 250 mcg doses. But clinical experience strongly suggests that 250 mcg of Ovidrel is most likely not equivalent in biological potency to 10,000 units of hCG. It probably only has 50%-70%of the potency of a 10,000U dose of hCGu and as such might not be sufficient to fully promote meiosis, especially in cases where the woman has numerous follicles. For this reason, I firmly believe that when hCGr is selected as the “trigger shot” the dosage should best be doubled to 500 mcg at which dosage it will probably have an equivalent effect on promoting meiosis as would 10,000 units of hCGu. Failure to “trigger” with 10,000U hCGu or 500mcg hCGr, will in my opinion increase the likelihood of disorderly meiosis, “incompetent (aneuploid) eggs” and the risk of follicles not yielding eggs at egg retrieval (“empty follicles”). Having said this, it is my personal opinion that it is unnecessary to supplant hCGu with hCGr since the latter is considerably more expensive and is probably no more biopotent than the latter.
Some clinicians, when faced with a risk of OHSS developing will deliberately elect to reduce the dosage of hCG administered as a trigger in the hope that by doing so the risk of critical OHSS developing will be lowered. It is my opinion, that such an approach is not optimal because a low dose of hCG (e.g., 5000 units, hCGu or 25omcg hCGr) is likely inadequate to optimize the efficiency of meiosis particularly when it comes to cases such as this where there are numerous follicles. It has been suggested that the preferential use of an “agonist (Lupron) trigger” in women at risk of developing severe ovarian hyperstimulation syndrome could potentially reduce the risk of the condition becoming critical and thereby placing the woman at risk of developing life-endangering complications. It is with this in mind that many RE’s prefer to trigger meiosis by way of an “agonist (Lupron) trigger rather than through the use of hCG. The agonist promptly causes the woman’s pituitary gland to expunge a large amount of LH over a short period of time and it is this LH “surge” that triggers meiosis. The problem with using this approach, in my opinion, is that it is hard to predict how much LH will be released in by the pituitary gland. For this reason, I personally prefer to use hCGu for the trigger, even in cases of ovarian hyperstimulation hyperstimulated, with one important proviso…that being that is she underwent “prolonged coasting” in order to reduce the risk of critical OHSS, prior to the 10,000 unit hCGu “ trigger”.
The timing of the “trigger shot “to initiate meiosis: This should coincide with the majority of ovarian follicles being >15 mm in mean diameter with several follicles having reached 18-22 mm. Follicles of larger than 22 mm will usually harbor overdeveloped eggs which in turn will usually fail to produce good quality eggs. Conversely, follicles less than 15 mm will usually harbor underdeveloped eggs that are more likely to be aneuploid and incompetent following the “trigger”.
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?
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
•IVF Egg Donation: A Comprehensive Overview
•IVF-Gestational Surrogacy: An Overview
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
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
Hi Dr Sher
Many thanks for your reply to the following email I sent you on 23rd April.
Bernie – April 23, 2016 reply
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.
Disappointing that my chances are very, very low to conceive twins however some celebrities in their late 40’s had multiple births with their own frozen eggs, so I am a little confused as to why I cannot do the same. Please excuse my ignorance of knowledge about same.
Looking forward to hearing from you.
Thank you so much for your time.
Hi again Dr Sher
I have just sent you a message and may have confused you as I copied and pasted my question that I sent to you on 23rd onto the last message.
Your reply stated that I have very very low chances of having a multiple birth because of my age.
I am aged 45. My question is as follows:
Celebrities in their late 40’s have had multiple births with their own frozen eggs. so I am a little confused as to why there is little hope for me to have a multiple birth.
I appreciate your time and advise and looking forward to hearing from you
As I previously indicated…eggs harvested at 43y of age are >90% likely to be chromosomally abnormal (aneuploid). Because of the fact that aneuploid eggs will not propagate a healthy pregnancy and because the older the woman, the more likely it is that any given egg will be aneuploid, the chance of twins with IVF is very much reduced. In addition,egg freezing does not yield as good results as good potential for success as does embryo freezing. Thus, the likelihood of a successful IVF using your frozen eggs is very low. I am not suggesting that you abandon your eggs that are already frozen. Of cors you should try to use them . All I ma saying is that you be realistic about the small chance of a successful outcome.
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
•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
•Advancing Age of the Woman and IVF: How Old is too old?
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.
Good luck and G-d bless!
Geoff Sher
Thank you for your reply. I will be in touch to arrange a skype consultation
Doctor I’m 45yrs old with low AMH I want to do IVF with my own eggs what is the protocol for someone my age?
Ginger,
Doing IVF with own eggs after age 43y , especially when there is also DOR is really not a good idea. The chance of success is so low as to render egg donor-IVF by far the best option. However, when in spite the decision to use own eggs is absolutely then I would say that again, 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 because they all result in increased LH-like activity. This in turn results in increased ovarian testosterone and and this can have a deleterious effect on egg quality/competency and this is particularly the case in older women and in women of any age who have DOR. You would in my opinion 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.
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
Hi Dr Sher,
I am 38 trying to conceive for 4 years. I have 1 child 5 years old conceived naturally no issues. I got pregnant for a second time and had a blighted ovum. Since then i have not been able to get pregnant not even once, no miscarriages nothing! My amh now is undetectable and fsh is 50. I’ve had to 4 failed iui’s and recently in the last 4 months 2 failed ivf’s. I did not get embryos tested but all 3 have gone 5 day aa blasts and one 6 cell three day. I know that egg quality is most likely the problem but can’t help but wonder if there is anything else I should test. I have never had a hysteroscopy and wondering if I should have that done before next transfer? I did have a endometrial biopsy and that came back negative. Just wondering if there are other things I should test before doing my next transfer? Do you think that I should get hysteroscopy? also my lining is in the thinner side between 8-9mm. Is there any way to get it thicker? Just trying to make sure I done everything I can to make this work? Any recommendations on other tests I should take?
Thank you kindly.
In my opinion, you absolutely should move to IVF with egg donation.
Doing IVF with own eggs with such severe DOR is really not a good idea. The chance of success is so low as to render egg donor-IVF by far the best option. However, when in spite the decision to use own eggs is absolutely then I would say that again, 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 because they all result in increased LH-like activity. This in turn results in increased ovarian testosterone and and this can have a deleterious effect on egg quality/competency and this is particularly the case in older women and in women of any age who have DOR. You would in my opinion 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?
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•IVF Egg Donation: A Comprehensive Overview
•The Fundamental Requirements For Achieving Optimal IVF Success
•Advancing Age of the Woman and IVF: How Old is too old?
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