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,
I would greatly appreciate your opinion on how many attempts of IUI are appropriate in my situation. I am 29 years old and using IUI with donor sperm because I am single, not because of any evidence of infertility. I have never tried to conceive naturally but have no known medical / reproductive problems.
I have so far had 4 failed IUI attempts. I have regular cycles and clear evidence of ovulation every month. I have had one or two mature follicles each attempt. I have used no drugs for cycles 1-3 and then HCG ‘trigger shot’ with Pregnyl for the fourth cycle. (I am trying to avoid stimulation drugs because I have suffered severe depression from the oral contraceptive pill in the past [no other history of depression] and am extremely wary of the potential for mood-altering side effects of fertility drugs, hence my strong preference not to progress to IVF).
My fertility specialist recommended progressing to IVF after 3 failed IUI attempts. However, I have read academic evidence in the ‘Human Reproduction’ journal that only 44% of healthy women under 37 years are pregnant after 3 IUI attempts, then 61% at 6 months and 83% at 12 months (Botchan et al., 2001). Therefore, in my situation where I am only using reproductive technologies because I lack a male partner (and not because of ‘infertility’), wouldn’t it be appropriate to continue with further IUI attempts? Or, does an absence of a pregnancy after 4 failed IUI attempts indicate a likelihood that I now have a ‘problem’ too?
Also, what is your opinion on ‘natural IVF’ in my situation? (as I feel this is the only IVF option I would be comfortable with). Would you recommending progressing to this now or continuing with IUI?
Thanks so much for offering this opportunity to ask yo questions.
Kind regards.
Even though you started this journey with no expectation of being infertile, in my opinion, you now need a full infertility work-up asif you have “unexplained infertility”……..before you embark on further treatment.
While I fully understand that you are averse (for a variety of reasons) to using fertility drugs and some women do conceive with natural cycle IUI and natural cycle IVF, I am convinced that these are far less likely to be succssful than are medicated cycles using ovulation induction.
Discuss with your RE!
Good luck!
Geoff Sher
Hello Dr. Sher,
Are intralipids ever prescribed when Natural Killer Cell Activity has not been tested (too expensive to test or can’t find a provider to test)? History of autoimmune conditions (hashimoto’s, and celiac) suggest an immune system problem. Also, conceived naturally, but recurrent (3) miscarriages.
Thank you for any advice you can offer.
Yes…some do! However, I am against this because unless you have a diagnosis to start with you cannot assess the value of treatment. Also, it is important to differentiate between autoimmune and alloimmune implantation dysfunction because treatment differs substantially (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
•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!
•Treatment to Help Thicken a Thin Uterine Lining
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
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
Dear Dr Sher,
Is Ganirelix and Cetrotide made with the exact same chemical compounds? I am asking because I have had better luck controlling my LH with Ganirelix compared to Cetrotide.
They are “me too” products. …Virtually identical and interchaneable!
Geoff Sher
Dear Dr Sher,
After a Clomid cycle my eggs grow very fast from one day to the other. This has caused a big problem for me to get the eggs out at the correct size. One day they are 15 and the next day they are 21 and when my eggs are retrieved at over 20, I have not had much luck with them fertilising. Best size for me has been 18/19. How can I stop this fast growth? Before taking Clomid my eggs grew 2mm per day.
Clomiphene is not the best fform of ovarian stimulation…especially not for IVF.
Geoff Sher
Dear Dr Sher,
If E2 drops during the two week wait, what would that indicate and can it be rectified?
Not sure I understand the question.
Geoff Sher