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 so much for taking the time answer questions in this open forum. I have been reading more or less all your replies and they have been vey helpful!
My Husband and I have just had our first IVF/ICSI. My husband has Azoospermia and we have used PESA.
I had 12 eggs taken out and 11 were mature enough. However they were at first only able to find 3 sperms in my husbands testicle, they went back with a much thicker needle and founds some more sperms, but they are seemingly of very poor quality, and only 2 of my eggs were fertilized. Only one survived to the second day and was in very poor quality. Our Doctor decided to transfer the egg on the second day to give it a better chance. That was now 4 days ago.
6 years ago we started an IVF treatment in another country. We only got to the stage where my husbands azoospermia was investigated. However we have 7 ‘stocks’ of sperm frozen down. At the time, there seemed to have been ‘plenty’ of sperms to retrieve, and the Doctor was very positive.
Our current Doctor suggested that we have that ‘sperm stock’ transferred to them, hoping that we might have better luck with theses sperms. But off course he can’t be sure that theses sperms are of better quality or has even survived the freezing.
Do you have any advice to give here? We are both 34, and not ‘old’ by IVF standards. Could it be that my husband had more/better sperms when he was younger? Or were we just lucky at that time and/or really unlucky this time?
Our Doctor said that there was nothing we could do to improve my husband’s sperm quality or amount.
We are off course not sure if this IVF round will be successful or not, but he advised us to start arranging this transfer as it can take quite some time. We will be transferring sperms from a EU Country to a European Non-EU Country and there is a lot of paperwork to be done.
I can also add that I have PCOS and was slightly over stimulated, hence had sever pain before, during and after the egg retrieval… and still do.
Thank you for your time!
Regards,
Matilda
Hi Matilda,
I might be able to offer constructive advice to you, but I need much more information to render an authoritative opinion.
The PCOS is another matter altogether (see below)!
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)
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•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?
•Male Factor Infertility
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!
•The Fundamental Requirements For Achieving Optimal IVF Success
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
Greetings sir..
My wife (aged 30 ,my age 32)suffered three ectopic pregnancy ( natural conception) and both tubes are removed. Then we went for a ART clinic , my blood, semen results and her blood ,scan results are normal and they had done karyotyping and result was
46 ,XY,15ps+ ,normal variant(for me)
46,XX, 13ps+ ,normal variant (for her).
Last week her aspiration was done,18 follicle retrieved, 8 embroyos in day2 and in day 3; we got 3 good embryos and clinic freezed three good embryos.
My doubt is if the good looking embryo had this ps+ variant,will they survive ?
Can i directly go for embryo transfer or wait for another stimulation cycle for my wife to get more embryos for doing PGS ?
My wife was very tired after taking stimulation medicines..kindly advice me whether i should try my luck with this embryos or wait..?
I would go for the transfer and if pregnant undergo chorionic villus sampling or amniocentesis to confirm normalcy of the pregnancy. However, before taking this recommendation to heart, please discuss with a medical genetecist.
Geoff Sher
Hello Dr. Sher,
I am a 27 years old woman with already two molar pregnancies plus two miscarriages. I do not have children. What are the changes for me to have a healthy natural pregnancy? Please advise,
Elizabeth
Hi Elizabeth.
I really would need much more information to respond authoritatively.
Molar pregnancy or hydatidiform mole — is a benign tumor that occurs in the uterus. It starts when an egg is fertilized, but instead developing into a normal, conceptus + placental tissue, the placenta tissue develops into a mass of small cysts. Here, the root system (trophoblast) of the embryo which under normal conditions develops into the placenta that connects the baby to the mother. With molar pregnancy, the roots of the trophoblast (chorionic villi) undergo cystic degeneration and when the woman bleeds, these cystic structures are passed in dark blood, giving rise to the common description of “white currants floating in red currant jelly”.
The condition usually presents with one or more of the following:
•Vaginal bleeding in the first trimester
•Very high beta hCG levels early on in pregnancy
•Exaggerated pregnancy symptoms and pernicious intractable vomiting (hyperemesis gravidarum)
•Rapid (often painful) enlargement of the early pregnant uterus
•Ultrasound evidence of a typical “snow storm pattern)
A molar pregnancy can have serious complications. It can become invasive (an invasive mole or chorioadenoma destruens) and permeate the uterine wall or it can (albeit rarely) develop into a rare form of cancer known as choriocarcinoma.
Molar pregnancies are rare (about 1:2000 pregnancies) and having occurred.it infrequently (<1:1000) recurs in the same woman. It is at least twice as common among Asian women. On rare occasions (1%) a twin pregnancy will comprise of a normal baby and a mole. In about 20%-40% of cases the healthy baby will survive to delivery.
There are two types of molar pregnancies: a) the complete molar pregnancy: Here there's no embryo or normal placental tissue is present. b) . A partial molar pregnancy, there is a developing embryo present but it is abnormal and non-viable, but there can be some “normal” placental tissue present as well.
“Complete Hydatidiform Molar Pregnancies” occur when an egg that has no chromosomal material (anuclear) is fertilized by a sperm and thereupon divides in two and propagates haphazard tissue growth. Like normal pregnancies, the complete mole has 46 chromosomes (two sets of 23), i.e., it is diploid. However, unlike with normal fertilization, where one set of chromosomes comes from the mother and the other set from the father, both sets of chromosomes come from the father in the case of a complete molar pregnancy. This results from duplication of a sperm’s chromosomes after it has fertilized an “inactive” egg. Since an embryo that has a YY karyotype is not viable, the chromosome gender of the complete molar pregnancy is invariably XX (female). Accordingly, with IVF, if one selectively only transfers only male (XY) embryos, the possibility of a complete molar pregnancy can be virtually eliminated.
A “Partial Molar Pregnancy” on the other hand, most often results from an egg being fertilized by 2 separate sperm, such that instead of the resulting embryo comprising 46 chromosomes (23 from the egg + 23 from the sperm), it instead has 69 chromosomes (23 from the egg + 46 from 2 separate sperm). However, it can also happen where one sperm fertilizes an egg, but one group of 23 chromosomes duplicates …again resulting in 3 groups of 23 chromosomes (triploidy)…..for a total of 69 chromosomes. Thus with partial moles, the sex chromosome configuration will be XXY or XYY. Partial moles can thus be avoided through selectively fertilizing an egg by intracytoplasmic sperm injection (ICSI), where a single sperm is injected, and thereupon performing PGD on the embryo(s) to exclude triploidy.
Persistent trophoblastic disease refers to the situation where following treatment to remove a molar pregnancy some molar tissue is retained and starts to grow again. It occurs in 8-10% of molar pregnancies. In such cases the woman will usually need to undergo chemotherapy
Treatment involves complete emptying of the uterus as soon as the diagnosis is made – even in cases where a spontaneous passage of the molar tissue appears to be complete. The reason is to avoid the development of an invasive mole (where the uterine wall is permeated by remaining tissue), and to limit the development of choriocarcinoma a very malignant tumor that invades the uterus and can spread rapidly via the blood system to bone, lungs, brain and other sites. Fortunately this cancer does respond well to hysterectomy, removal of ovaries plus aggressive chemotherapy.
In the vast majority of properly managed cases however, outcome after treatment is usually excellent. In cases where the beta hCG level fails to drop appropriately following evacuation of the uterus, chemotherapy will usually be curative. Close follow-up with serial quantitative blood hCG testing, ultrasound and/or Magnetic Resonance Imaging (MRI) is essential. After successful treatment, the woman must use very effective contraception for at least 6 to 12 months, so as to avoid pregnancy in order to allow for proper follow-up.
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
Hello Dr Sher,
Thanks for answering our questions and thus helping us out.
I am 40 with severely diminished ovarian reserve(high fsh, low amh, afc usually 3).
My doctor wants to try an estrogen priming protocol this time. He suggested i start to use estrogen patches one week after ovulation is confirmed. However he said we can skip estrogen priming if my day 2 results are good and we can start the protocol right away.
I just got my day 2 results back.
FSH is 9.83 (lab range 3.5-12.5)
LH is 11.39 (lab range 2.4-12.6)
E2 is 175.40pmol
Do you think i can start the protocol right away with these numbers or should i skip cycling right now and start estrogen priming a week after ovulation is confirmed?
I am bit worried about LH being high already.( i had a day 1 test as well where fsh was 7.8 and LH 9.08 so for some weird reason LH decided to rise from day 1 to day 2)
Thank you very much in advance.
You omitted giving me your AMH result. That is far more reliable than basal FSH/E2. BUT if we assume that you do have DOR, then (somewhat contingent upon your AMH), you might not need estrogen priming and yes!, I would not delay going in to IVF .
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
Hello Dr. Sher, Thanks in advance for your time! My husband and I are using a surrogate and an egg donor, and we’ve had one failed round of IVF. Our donor is an anonymous healthy 23yo and our surro is a healthy active 40 yo who has two healthy children of her own (11 & 14yo) who were conceived naturally. She said she conceived very quickly and her pregnancies were uneventful. We did ICSI and PGS and ended up with 3 healthy blastocysts. We did a 5 day FET and found out 9 days later that the implantion failed. After reading your articles, it sounds like it could be IID. However, that was not an issue with her previous pregnancies. Which specific tests should be run before doing another transfer? Are there other precautions we can take to prevent another failure? We only have 2 more embryos to work with. Do you recommend transferring one at a time? Thank you very much.
IID is an outside possibility but not necessarily the consideration here your situation and not top of the list. There are other factors to consider including the performance of ET, other non immunologic implantation issues, non-chromosomal genetic or metabolomic embryo factors or…simply bad luck!
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)
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF..
•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
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Why did my IVF Fail
•Secondary Infertility: Addressing the Root Causes
•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)
•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.
•The Role of Nutritional Supplements in Preparing for IVF
•Progesterone-Estrogen Hormonal supplementation in IVF: How Does it Work and What is its Value?
•IVF Egg Donation: A Comprehensive Overview
•IVF-Gestational Surrogacy: An Overview
•The Fundamental Requirements For Achieving Optimal IVF Success
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