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.
Dear Dr Sher
Thank you for taking the time to reply.
I’m currently 9 weeks pregnant from a day 2 fresh transfer, and have an unusually high level of uterine natural killer cell (75th percentile) and partial DQ alpha gene match with my husband. I finally fell pregnant after 5 rounds of Ivf with nothing to freeze as I’m 41 and egg quality is an issue.
Since the start of this Ivf cycle, I have been on 1.0mg of Dexamethasone, (4.5mg) low dose Naltraxone, Clexane and Intralipids and was instructed to continue till Week 14, then wean off Dex.
However, I asked my specialist if I should continue will Week 26 because of the possibility that my body may reject the baby after I wean off the meds, he said since I’m 41, and been through a long IVF journey and this may be the only one chance I’ve got, there’s more good than harm continuing the protocol till Week 26. However, I’m concerned about the effects of these drugs, esp Dex on my bub.
Am I overly concerned about the effects (possibility of cleft lip) of dex on the unborn baby? Or should I just request to change dex to prednisolone since I heard the latter doesn’t penetrate the placenta? Lastly am I being too paranoid in requesting I should continue the drugs till week 26?
Thank you so much. Your insight is much appreciated.
Regards
Esther
Thank you! 🙂
Congratulations!
By the way, you clearly have an insightful and smart RE!The treatment he put you on for your alloimmune implantation dysfunction, is likely the main reason for your successful treatment.
The risk of cleft palate is 1%. However, in my opinion, it is averted by stopping the steroids completely bt the 10th week. . Prednisone also crosses the placental barrier, just as readily. Since this is an alloimmune implantation dysfunction, I would stop doing IL infusions by the 29th week..but that decision is between you and your RE.
Please go to my SFS website (www.sherivf.com). When you get to the “home page”…near the top of this page you will see an invitation to participate in a Skype consultation with me. Click on this and you will be taken to an enrollment form. Fill in your name and telephone number and submit it (Do not be concerned that this will bind you to having that consultation…it does not). It will usher you to a page where you will find an invitation to down-load (free of charge) a copy of my 50 page E=book Do so and then read it. It will address all your questions comprehensively. This book is only obtainable through the SFS website.
Good luck and G-d bless!
Geoff Sher
Geoff sher
Hello there,
My husband and I are a complete dq alpha gene match. We had 7 Ivf cycles, with no immunosuppressants- they all failed. We moved to a different doctor and we had many tests, many drugs, including steroids, clexaine, intralipid and were successful on the first round using this protocol.
In attempts to have a second child, we were lucky enough to be gifted with my younger sisters eggs. We have had two unsuccessful transfers.
We are wondering what our chances are in having a second baby? I read that he more exposure your uterus has to these embryos, the more aggressive the natural killer cells get – is this true?
Looking forward to hearing from you.
Kind regards,
Erika Vlasic
You likely conceived of your baby in spite of a “total DQ alpha match” because at the time you probably did NOT have natural Killer cell activation. The match is not problematic unless NK cell activity coexists. However, by now, you likely do have NK cell activity. To make sure, I would have your blood sent to Reprosource Reproductive Immunology Reference Laboratory in Boston, MA for a K-562 target cell test to determine if this is the case.
If you now, in addition to the total DQa match also have NK cell activation (NKa), then using donated embryos, you would again need IL/steroid therapy. However, if you use an egg donor with your husband’s sperm, you will not be successful, unless. You would need a gestational carrier. You could however, break the match by using donor sperm (However, I doubt this would interest you), and in such a case would again require IL/steroid therapy.
Please go to my SFS website (www.sherivf.com). When you get to the “home page”…near the top of this page you will see an invitation to participate in a Skype consultation with me. Click on this and you will be taken to an enrollment form. Fill in your name and telephone number and submit it (Do not be concerned that this will bind you to having that consultation…it does not). It will usher you to a page where you will find an invitation to down-load (free of charge) a copy of my 50 page E=book Do so and then read it. It will address all your questions. This book is only obtainable through the SFS website.
Good luck!
Geoff Sher
Dear Dr. Sher, I have a low AMH and one through five IVF sessions for banking. We implanted to untested embryos in June. At my six week ultrasound, the embryo measured two days behind with a heart rate of 129. At my eight week ultrasound (8w5d), which was yesterday, the embryo was still 2 days behind, and heart rate was 181-182. Is that last heart rate too fast? Is there a higher heart rate indicative of a problem, or maybe if a chromosomal problem? Or should I not worry?
It is looking good to me. You should ignore the few day lag and the heart rate is OK too!
Good luck!
Geoff Sher
Hi, I would love some feedback about my current situation. My husband and I were diagnosed with unexplained infertility and underwent an egg retrieval I was 29 and he was 31 after years of trying. We opted for ICIS-IVF and ultimately we had 6 five day embryos with our best graded as A/B. We had our first transfer that same year that resulted in a healthy baby boy. Two years later we transferred our second highest graded embryo that resulted in a blighted ovum. After that failed attempted we obtained to perform PGT-A (PGS) testing on the remaining four embryos. Out of those, one was abnormal and the other three were normal. This summer (the following year) we have now done two separate transfers- each failing. We have one embryo left. Before each transfer we have completed all the appropriate pre op testing and had following the instructions of our clinic with no success. To my knowledge, the most common reason for failed IVF is embryo abnormalities. Since our last three embryos were deemed normal by the PGT-A testing I am left wondering if there could be some other explanation. Does this sound like a case of IID to you? How are we tested for IID and if that does show to be the causing factor what are the treatments? Can you provide any more insight on what to do to improve my last IVF attempt?
Frankly Jillian, although healthy births are reported following the transfer of secondarily PGS-tested embryos, it is in my opinion not a good idea to do this. Consider that the embryos that were frozen need to be thawed, biopsied, refrozen and then re-thawed for ET. In my opinion this could be excessively stressful on the embryos. Besides, the testing does not enhance embryo competency . It merely helps select euploid embryos. So why not transfer them without subjecting them to such undue stress.
Good luck!
Geoff Sher
Hello.
I’m sorry for a duplicate question but I am unable to find my previous post.
I had an FET completed with a 5 day blastocyst and after 9 days my hcg value was 37.9.
The clinic looks for 50 or above, should I be concerned? We will be repeating the test in two days.
Thank you
As I stated, to me this is in no way a discouraging level.
Good luck!
Geoff Sher