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,
Thank you so much for offering your time and expertise on this forum. I’m 49 years old and have no children. After 4+ years of IUI and IVF cycles with my own eggs without much success (2 early miscarriages and chemical pregnancies), my husband and I decided to move onto donor eggs. In the first donor cycle, we purchased 8 frozen eggs, with only 2 making it to day 3. The 2 were transferred (6-cell and 8-cell with slight fragmentation) and the pregnancy test was negative. We moved onto our second donor who produced 18 mature eggs (we received half) and all 9 fertilized normally. We froze all of the embryos on day 1, and did an FET with 2 of the embryos (6-cell and 8-cell with little to no fragmentation). I convinced my doctor to give me prednisone for this cycle due to previous positive testing for high NK cells. I took 16mg of prednisone for 4 days, starting two days before transfer. Once again, the pregnancy test was negative. After doing some extensive research and reading your articles on implantation failure and immunology issues, I wanted to ask you for your opinion. Would you recommend further immunology testing and a different protocol or dosage of prednisone in my next FET cycle? I have also done saline drips in a few previous IUI/IVF cycles with no success. In addition, I have hypothyroidism (taking 50-75mcg of levothyroxine). My TSH has been all over the map during cycles. It’s well controlled in between cycles, but once I start estrogen patches, my TSH goes up, so I’ve been also trying to keep that under control (currently my TSH is 1.6). I would be extremely grateful for any advice you can provide. We have 7 embryos left and I want to make sure we pull out all of the stops in hopes to have success this next round.
Thank You,
LRD
Hi – I have been reading through your posts where you responded to people about their HCG. I’m having a very difficult weekend bc my beta was doubling every 48 hours on the first 2 tests and then only doubling every 72 hours on the next test. Do you think I have any hope of a viable pregnancy? I go in for a repeat test on Monday and an u/s. Thank you!
Day 12 post ovulation: 56.5
Day 14 post ovulation: 110
Day 17 post ovulation: 329.7
Day 21 post ovulation: 769
Only time will tell. I suggest you have an ultrasound examination in 7-19 days for a definitive answer.
Good luck!
Geoff Sher
Would you mind explaining what could have caused this sudden slowdown in rising that would still allow the possibility of viability? Grateful for your time and expertise.
Hi Dr Scher
I am currently 6.2w pregnant after being treated for high NK cell activity and an ANA of 1:1280. I believe this was the cause of my previous miscarriage at 7.3w and another 2 chemicals I suffered thereafter.
I am in South Africa and had a major struggle to find any doctor that acknowledges autoimmunity as a complication, but finally came across an Immunologist who does. He treated me with 15mg of prednisone (upped to 20mg on positive pregnancy test), as well as suggesting 0.4 enoxaparin daily.
Last month I had a repeat blood test which showed my NK activity had reduced to be in normal limits and my ANA had dropped to 1:80. Shortly thereafter, I discovered I was pregnant.
My APA, LAC, clotting panel and inherited thrombophilia tests are all completely negative.
The immunologist wants me to begin weaning of the prednisone as of 9w to be completely off by 12w. The enoxaparin is also supposed to stop at 12w.
I have read so many forum discussions of other ladies on this treatment who only begin to wean off prednisone at 12w to be completely off by around 15/16w. And most seem to continue with the blood thinner almost until delivery.
I understand that after 12w the killer cells should no longer be able to affect the pregnancy but I’m worried about the ANA flaring and causing complications later. I’ve read horror stories about iugr and still birth due to inflammation of the placenta caused by ANA.
Please can you let me know your thoughts on this? Should I be retesting the ANA to keep an eye on it? And should I be pushing to stay on prednisone till 12w and the blood thinner for longer?
I am terrified of losing this baby by not managing the treatment of my antibodies.
Please can you give me as much information or advice as possible so I can try to persuade my doctors?
I have also had intralipids. One just after positive pregnancy test and another 2 weeks later. My immunologist has recommended keeping that up every 2-3 weeks for the first trimester. It’s that long enough? Would it be worth doing throughout?
I am looking forward to hearing from you. Thanking you in advance.
Regards
Lauren
It sounds optimistic to me. I wean my patients off steroids starting at 8 weeks and completing the process by the endo of the 10th week. No need to go any further.
I am happy for you! So far so good.
G-d bless!
Please keep me in the loop!
Geoff Sher
Hi Dr. Sher, thank you for having this board! I underwent IVF w FET. I am currently on week 9, day 5. Last week I had an ultrasound that showed a heartbeat of 181. My progesterone level then was 65.9 and estradiol was 1324. My doctor had me decrease the progesterone in oil from 1.5 to to 0.5, my Endometrin from 4 to 3, and my delestrogen injections from 0.2 to 0.1. My progesterone and estradiol levels were checked yesterday and were much lower compared to last week! Progesterone went down to 23.4 (that’s only a third of what it was last week!) and estradiol to 912. Does this mean that I am having a miscarriage??? Or is this purely from decreasing the amount of injections and suppositories and is normal? I am really freaking out.
Not at all! It is possible due to the lowered hormone dosages.
Geoff Sher
Dr. Sher –
I am about to embark on my 3rd round of IVF, after two failed rounds, in an attempt to conceive our first child. We started our IVF journey due to low sperm count in my husband (~2 million due to a botched surgery when he was young for torsion). At the onset, I had no diagnosis other than irregular cycles.
During round #1, I responded poorly to stims, retrieved 5 eggs, and transferred my only Day 5 blastocyst. This ended in a biochemical pregnancy.
Round #2, stimulation meds were increased and 6 eggs were retrieved. My RE was unable to reach any follicles on my left ovary due to its position. I ended up with 2 Day 5 blastocysts and transferred one. The pregnancy survived until about 7.5 weeks when I miscarried. The fetus was genetically tested and came back as chromosomally normal.
At this point, my RE ran a RPL panel to see what else was going on. We discovered I had compound heterozygous MTHFR mutation. I also tested positive for ANA with 1:320 homogeneous titer. No other autoimmune diseases were detected (Factor V, Lupus, etc.).
I just completed an FET with my remaining embryo from round #2. I was put on Lovenox and low dose aspirin to help sustain the pregnancy. The cycle ended in a biochemical pregnancy. At this time, my RE is recommended completing an ERA, a 3rd round of IVF with PGS testing before transferring back a normal embryo. Does this recommendation seem like the correct course of action?
Thank you!