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.
Hello Dr Sher and thanks for answering my question.
I have severely diminished ovarian reserve with high fsh, AMH 0.20pmol/l. and an AFC of 3. I am 40 years old.
I was supposed to do an estrogen priming protocol with clomid and medium stimulation(150fsh, 75HMG)
However a few days before my period came i had very high estrogen levels. Day 2 i got good results.
FSH is 9.82(lab range 3.50-12.50)
LH is 11.39(lab range 2.40-12.60)
E2 175 pmol/l
So my dr suggested to skip priming and to start the cycle. So on day 2 i started clomid(1oomg)
Due to him being out of town i had to have a scan today-day 3-and unfortunately he discovered a 3 cm cyst and he is thinking to cancel me!
I know you probably do not agree with this protocol but given the tough situation i am in right now:
1) is there anything that can be done to save this cycle? And if yes would you go ahead to cycle with LH 11.39 without priming?
2) Given that i have a cyst, i took clomid for one night, and that my day 2 fsh is not high, can i do estrogen priming after i ovulate and cycle the next month?
I am very short on time given my dismal AMH and high FSH and want to get going. Even though my numbers are tragic i managed to get a blastocyst 2 months ago-so i am not ready to give up just yet.
Thank you for your answer.
1) is there anything that can be done to save this cycle? And if yes would you go ahead to cycle with LH 11.39 without priming?
A: In my opinion, based upon the sparse information provided, this cycle is unlikely to yield success Christina.
2) Given that i have a cyst, i took clomid for one night, and that my day 2 fsh is not high, can i do estrogen priming after i ovulate and cycle the next month?
A: Would wait one full cycle on no treatment before proceeding to another treatmennt.
Geoff Sher
Hello Dr. Sher,
I recently was tested for the NK cells at your St. Louis location and they found out I have it. I was told about the treatment for it and I guess I pretty much understand it…. Some stuff i googled. I am doing a FET mid June. So I already have my first treatment scheduled. I take it this is the first of many treatments if I actually get pregnant. When i was looking up the NK stuff I noticed people talking about DQalpha. I have no clue what that is. Can you fill me in on the DQalpha? I also have PCOS.
I am taking metformin for it…. Im not really sure its helping. I was going to take cinnamon pills because it helped me in the past but read that it causes miscarriages. Will PCOS hurt my chances of becoming pregnant?
You will be in excellent hands in SL. As for information on immunologic implantation dysfunction (IID)…including alloimmune (DQa) matching…please refer to the articles listed below. I am also referencing a blog article on PCOS, FYI.
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
•IVF Failure and Implantation Dysfunction:
•The Role of 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)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report
•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!
•”
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
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
Dr. Sher,
After multiple failed IVF’s, we found you, and you had us tested for immune disorders, etc. You found I have an immune disorder (elevated NK), and my husband and I are a partial DQalpha match. We had our first IVF cycle with you March 2012 where we had our embryos sent out for testing (check the chromosomes – I forgot the name of it). The test determined we only had one normal embryo which was implanted at day 6 and resulted in a little boy born in December 2012 – our Miracle.
So my question. With all of that, is it possible we may be able to get pregnant with IUI this time rather than IVF, or not likely? We are wanting to try for another little one, but financially IVF is not an option at this point in time. Also, you had me on Intralipid IVF’s until I was 24 weeks.
Thank you very much!
Hi Tammy,
Thank you for sharing.
While it is possible to conceive with IUI, it is not very likely. Remember, with IUI we cannot do PGS .
Give baby a kiss from Grampa Geoff!!
G-d bless!
Geoff Sher
Hello Dr Sher,
1) why do some women get activated NK cells with pathologies such as endo or Hashimoto’s while others don’t? What determines this activation?
2) also, I’ve heard of cases where the NK cells activate for a few years and then deactivate, making the woman fertile again. Why is there that on-off switch phenomenon with NK cells?
2) when using low molecular weight heparin for thrombophilias during a FET, which cycle day should it be started on?
Thank you
1) why do some women get activated NK cells with pathologies such as endo or Hashimoto’s while others don’t? What determines this activation?
A: No one knows…but it is linked to an underlying autoimmune process.
2) also, I’ve heard of cases where the NK cells activate for a few years and then deactivate, making the woman fertile again. Why is there that on-off switch phenomenon with NK cells?
A: In my experience, once activated they remain activated…but I guess anything is possible.
2) when using low molecular weight heparin for thrombophilias during a FET, which cycle day should it be started on?
A: With a +ve blood pregnancy test
Geoff Sher
Dr sher,
What are your thoughts on metformin for egg quality for high responders that do not necessarily have PCOS?
In the absence of insulin resistance, I do not believe it has merit.
Geoff Sher