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 Dr. Sher,
I am doing Natural IVF due to very low AMH, but recently have to do hysteroscopy to remove calcified Endometrium (Cycle day 5) before my Egg retrieval (usually around cycle day 14). Is it okay to do egg retrieval in the same cycle as hysterscopy. Does Anesthesia has any effect on this?
Also, recently I have had low Estrogen and get night sweats? Why do I have such a low estrogen? Does low estrogen affects the egg quality?
My DHEA-sulphate level is 221 ug/dl, I have normal testosterone levels (Total 24ng/dl and free 1.4 pg/ml) and DHEA 561ng/DL. Do you think I should supplement with DHEA?
Thank you so much in advance!
It is not advisable in my opinion to do a hysteroscopy in the same cycle as an ER. Also, I am NOT a fan of mini-IVF or Natural cycle IVF. Success rates are dismal!
Good luck!
Geoff Sher
Hi Dr.
I had 5d embryo transfer on 13 july. My hcg results below:
22 jul hcg 87.5
24 jul hcg 65
26 jul hcg 50
29 jul hcg 80
What do think about my results?
I’m taking these since started the cycle:
progynova (3 tablets a day) and utrogestan 200mg (3 times a day).
I was advised to stops the medication, but i thought since the hcg rises, i wanted to give a little more time, thus I continue the meds. I will have another blood test on Friday.
Thank you in advance.
Sadly Sevia, this doers not look very promising. Have your Dr track your hCG levels but I am afraid this is not likely a viable pregnancy.
So sorry!
Geoff Sher
Hello Dr. Sher
I have had my frozen embryo transfer (5-day blastocyst) on May 6th with egg donor (24 yrs old) and sperm donor (32 yrs old). I am a single 50 years old and went through menopause 4 years ago. I also was on HRT for 2.5 years prior IVF treatment.
I am currently 14 weeks pregnant. This time was my 4th attempts (1 fresh embryo, 3 FET). My 1st and 2nd transfer was unsuccessful and on the 3rd one, I had chemical pregnancy and HCG dropped within 10 days.
I live in USA but I had my treatment in IVF clinic abroad (Ukraine). All treatments and preparation prior transfers were with the help of my OB/Gyn here in USA and guidance/protocols from IVF clinic.
After the 3rd unsuccessful attempt, I went to Ukraine for some tests like NK tests (CD56, CD138) and Thrombophilia. The NK test was negative.
On my 4th attempt that I am currently pregnant, like the previous attempts, I have been prescribed for: Estradiol 2 mg (4 times a day, which it started before my transfer), Progesterone vaginal 200mg (3 times a day) and only this time for injecting Clexane (Lovenox) 20mg (once a day).
The IVF clinic in Ukraine recommended me to have this prescription protocol till at least 18-20 weeks and after that decrease it like 1 pill every week, then stop it. About Lovenox, I have been told that I need to have Thrombophilia test and based on result to know if I should stop it.
However, my OB/Gyn says that right now the placenta makes more estrogen and progesterone than I am taking by medicines. So, he recommends that I need to stop all hormones also not taking Lovenox anymore.
Can you please let me know, what your opinion is and what I should do now?
Thanks for your time!
Morgan
Congratulations and well done.
In my opinion, there is really little merit in continuing estrogen and progesterone supplementation beyond 10 weeks. Otherwise I am in agreement with your Ukranian doctor.
Good luck!
Geoff Sher
Dr Sher,
I’m 43. My 3day fsh is 4.8, LH is 3.0.
Last cycle retreived 19 eggs, 14 of which were mature, only 5 fertilized… Still waiting on embryo development. My bmi is 35.
We did lupron 10cc going into cycle, 450 gonal, 150 menopur for 10 days , HCG 10000 trigger. Also did omnitrope.
Cycle before this one, got two blasts, both complex abnormal.
I know I’m old. I’m not sure if I should be doing testosterone or inositol, if my dosages are too high and ruining my eggs.
Maybe I’m delusional but it just seemd with such great FSH and lots of follicles and making blasts every cycle, that this just has to work. Any suggestions on tweaking this I would be grateful for.
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. So it is that older women the more reduced is the 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 age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can 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 older women , 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 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, 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
•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
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ADDENDUM: PLEASE READ!!
INTRODUCING SHER FERTILITY SOLUTIONS (SFS)
Hitherto I have personally performed IVF- treatment and related procedures on patients who, elected to travel to Las Vegas to be managed by me. However, with the launching of Sher-Fertility Solutions (SFS) in April 2019, I have taken on a new and expanded role. Now, rather than having hands-on involvement I confine my services to providing hour-long online Skype consultations to an ever-growing number of patients (emanating from >40 countries), with complex Reproductive problems, who seek access to my input, advice and guidance. All Skype consultations are followed by a detailed written report that meticulously describes and explains my recommendations for treatment. All patients are encouraged to share this report with their personal treating doctor(s), with whom [subject to consent and a request from their doctor] I will, gladly discuss their case with the “treating Physician”.
Through SFS I am now able to conveniently provide those who because of geography, convenience and cost, prefer to be treated at home or elsewhere by their chosen Infertility Physician.
“I wish to emphasize to all patients with whom I consult, that in the final analyses, when it comes to management, strategy, protocol and implementation of treatment, my advice and recommendations are always superseded by that of the hands-on treating Physician”.
Anyone wishing to schedule a Skype consultation with me, can do so by: Calling my concierge (Patti Converse) at 1-800-780-7437 (in the U.S.A or Canada) or 702-533-2691, for an appointment. Patients can also enroll online on my website, http://www.SherIVF.com, or email Patti at concierge@SherIVF.com .
I was very recently greatly honored in receiving an award by the prestigious; International Association of Top Professionals (IAOTP). For more information, go to the press release on my website, http://www.sherIVF.com .
PLEASE HELP SPREAD THE WORD ABOUT SFS!
Geoff Sher
What do you think of duostim? Proponents say that luteal phase stimulation had better egg quality because less LH is present?
I absolutely do not agree!
Geoff Sher