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 35 but peri-menopausal. My cycles have been irregular the last two years and I have not started a cycle in four months. We have a donor egg frozen embryo we want to transfer. History of endometriosis but HSG and Saline sono were fine as per my doctor. Before the transfer, In your opinion should I try to bring on my period with BC pills etc first or should I just ensure my lining is thick with estrogen/progesterone? Thanks.
Yes I do so believe. However, please also consider the possible effect of endometriosis on implantation dysfunction before proceeding.
“More than half of women who have endometriosis harbor antiphospholipid antibodies (APA) that can compromise development of the embryo’s root system (trophoblast). In addition and far more serious, is the fact that in about one third of cases endometriosis, regardless of its severity is associated with NKa and cytotoxic uterine lymphocytes (CTL) which can seriously jeopardize implantation. This immunologic implantation dysfunction (IID) is diagnosed by testing the woman’s blood for APA, for NKa (using the K-562 target cell test or by endometrial biopsy for cytokine activity) and, for CTL (by a blood immunophenotype). Activated NK cells attack the invading trophoblast cells (developing “root system” of the embryo/early conceptus) as soon as it tries to gain attachment to the uterine wall. In most cases, this results in rejection of the embryo even before the pregnancy is diagnosed and sometimes, in a chemical pregnancy or an early miscarriage. As such, many women with endometriosis, rather than being infertile, in the strict sense of the word, often actually experience repeated undetected “mini-miscarriages”.
Women who harbor APA’s often experience improved IVF birth rates when heparinoids (Clexane/Lovenox) are administered from the onset of ovarian stimulation with gonadotropins until the 10th week of pregnancy. NKa is treated with a combination of Intralipid (IL) and steroid therapy: Intralipid (IL) is a solution of small lipid droplets suspended in water. When administered intravenously, IL provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid.IL is made up of 20% soybean oil/fatty acids (comprising linoleic acid, oleic acid, palmitic acid, linolenic acid and stearic acid) , 1.2% egg yolk phospholipids (1.2%), glycerin (2.25%) and water (76.5%).IL exerts a modulating effect on certain immune cellular mechanisms largely by down-regulating NKa.
The therapeutic effect of IL/steroid therapy is likely due to an ability to suppress pro-inflammatory cellular (Type-1) cytokines such as interferon gamma and TNF-alpha. IL/steroids down-regulates NKa within 2-3 weeks of treatment the vast majority of women experiencing immunologic implantation dysfunction. In this regard IL is just as effective as Intravenous Gamma globulin (IVIg) but at a fraction of the cost and with a far lower incidence of side-effects. Its effect lasts for 4-9 weeks when administered in early pregnancy.
The toxic pelvic environment caused by endometriosis, profoundly reduces natural fertilization potential. As a result normally ovulating infertile women with endometriosis and patent Fallopian tubes are much less likely to conceive naturally, or by using fertility agents alone (with or without intrauterine (IUI) insemination. The only effective way to bypass this adverse pelvic environment is through IVF. I am not suggesting here that all women who have endometriosis require IVF! Rather, I am saying that in cases where the condition is further compromised by an IID associated with NKa and/or for older women(over 35y) who have diminished ovarian reserve (DOR) where time is of the essence, it is my opinion that IVF is the treatment of choice”.
I strongly recommend that you visit http://www.SherIVF.com . Then go to my Blog and access the “search bar”. 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.
•The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
•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
•Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF:
•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)
•Intralipid (IL) Administration in IVF: It’s Composition; how it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
•Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
•A personalized, stepwise approach to IVF
•How Many Embryos should be transferred: A Critical Decision in IVF?
•Endometriosis and Immunologic Implantation Dysfunction (IID) and IVF
•Endometriosis and Infertility: Why IVF Rather than IUI or Surgery Should be the Treatment of Choice.
•Endometriosis and Infertility: The Influence of Age and Severity on Treatment Options
•Early -Endometriosis-related Infertility: Ovulation Induction (with or without Intrauterine Insemination-IUI) and Reproductive Surgery Versus IVF
•Treating Ovarian Endometriomas with Sclerotherapy.
•Effect of Advanced Endometriosis with Endometriotic cysts (Endometriomas) on IVF Outcome & Treatment Options.
•Deciding Between Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF).
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s &
•Induction of Ovulation with Clomiphene Citrate: Mode of Action, Indications, Benefits, Limitations and Contraindications for its use
•Clomiphene Induction of Ovulation: Its Use and Misuse!
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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
Hi Dr. Sher,
I had 8 eggs(unfertilized)frozen from previous IVF. I had them thawed, fertilized. 2 out of 8 reached early blastocyst on Day 5 and both were transferred on day 5. Unfortunately, they failed to attach.
I would greatly appreciate your thoughts on the following questions.
1.What are the chances of transferring early stage blastocysts?
I was on a medicated cycle and my lining was good.
2. In such situations, is it better to transfer it on Day 5 even it hasn’t expanded , with the intention of not to miss the window of implantation or is WOI the same on Day 5 and 6, as long you are taking progesterone and estrogen medications?
Thank you.
I transfer early or expanded blastocysts on 6 of progesterone.
Geoff Sher
I just completed my second IVF cycle (the first resulted in my 2.5 year old son). I got the call on Monday (10 days post transfer of frozen 5 day embryo) that i was pregnant and my HCG was at 171. Unfortunately today, I got another call from the nurse that my HCG is now only 114, 48 hours later. She indicated that this can happen and sometimes still result in viable pregnancy but everything I have heard points to miscarriage. Any thoughts? I am getting re-tested on Friday but the wait is killing me.
Only time will tell. Prepare for the worst while hoping for the best.
Good luck!
Geoff Sher
If my daughter donated her eggs to help me get pregnant, would it create any difficulties for her when trying to get pregnant herself in the future?
It should not!
Here is a copy of a recent case I had:
“The case involves D.R, a recently remarried, premenopausal woman in her late 40’s, who had a daughter (N.R.) some >33Y ago, in a prior marriage. D.R. inquired whether I would be willing to do IVF on her daughter, fertilize the eggs with her husband’s sperm and then transfer e embryos to her (D,R’s) uterus. Needless to say, it was recognized that if successful, and D.R. were to give birth to a baby born from NR’s eggs, she would be giving birth to her own genetic grandchild who would be her daughter’s sister.
I emphasized to D.R. that it was imperative that there be no pressure put on her daughter to do this and that it had to be by her own free will. I advised professional counseling and to think carefully on the implications of any decision reached.
I scheduled and then had a separate meeting with S.R, in order to satisfy myself that she was not being coerced to proceed and discussed the process involved, with all parties. I assured N.R that ovarian stimulation and egg retrieval (done properly) would be very unlikely to compromise her subsequent fertility, that since she had never been pregnant before, she should recognize this possibili.
Fully cognizant of all implications, we all agreed to proceed. I implemented a modest protocol for ovarian stimulation. N.R produced 12 follicles and 11 eggs, Eight of the eleven eggs were mature (MII’s) and were fertilized with husband’s (her stepfather’s) sperm using intracytoplasmic sperm injection (ICSI). This resulted in 4 good quality blastocysts. I transferred 2 blastocysts to D.R’s uterus and cryobanked the leftovers for subsequent dispensation.
D.R. conceived with twins and subsequently gave birth to twins (a boy and a girl). I attended their christenings and had the opportunity to once again meet and confer with the genetic mother and the biological parents who were all elated. I hope and pray that it will remain so.
Conclusion: While it is not unusual for the son of an infertile man to provide sperm to impregnate his stepmother, this was the first case that I had encountered in a 35 year IVF practice, where the reverse has occurred, i.e., that a daughter donated eggs to her mother so that she could procreate using her step father’s sperm. However, when one thinks carefully on, you cannot escape the fact that refusal to provide such a service while being willing to do so when it comes to donated sperm, would be sexist. I do recognize that there’s a far greater commitment and physical investment when it comes to a woman undergoing ovarian stimulation and egg retrieval than there is for a man providing sperm for insemination or IVF and that albeit minimal, there is always a risk that complications could arise in the process of stimulating a woman and performing egg retrieval, that might compromise her future fertility.
I guess, “all is well that ends well” and I have no regrets whatsoever. The children are both healthy, loved/wanted, beautiful and the parents are happy and the egg provider (N.R) is nothing short of proud and elated at her ability to contribute towards the expansion of her family tree”.
___________________________________________________________
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
We fell naturally pregnant this month of course when we weren’t tracking or trying so makes knowing dates hard but here’s what I have, I’m very worried. I have had several early miscarriages and 2 ectopic pregnancies in the past.
Got a positive hpt Aug 29th
1st beta Sept 3rd : 171
2nd beta Sept 5th: 355
3rd beta Sept 7th: 712
4th beta Sept 10th: 1791 (didn’t quite double in 48hrs but 56ish hour doubling time)
Had early scan yesterday (Sept 10th) couldn’t see anything but she thought maybe a sac like structure (when she measured it measured 5w2d which is about what I think I am) but in her report to doctor though the sac like was actually a polyp. Any advice? Should we have see something yesterday with a beta of 1791… repeating beta tomorrow but worries it started to plateau.
Thanks
Give it another 10-14 days and repeat the US. It is too soon!
Good luck!
Geoff Sher