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 a former patient of SIRM NY, and have one healthy child thanks to them. I have always been told I have an egg quality issue, it took me three cycles to have my son- he was the result of an FET due to a freeze all cycle for high progesterone. Over 2 cycles at SIRM I had 6 grade 2 blasts, transferred 2 in a natural cycle FET, negative result. Transferred 2 in a medicated FET, had my son. The remaining 2 were thawed and did not look good so were not transferred.
I moved out of town and went to a large reputable clinic near my home. Opted to do PGS testing this round so as to not keep transferring incompetent embryos. Did 2 cycles there- first cycle no blasts. Second cycle was a new protocol and got 3 blasts, 2 tested PGS normal. Clinic used vitrification. Transferred one PGS normal hatching blast, negative result. My question is, do you think this was a fluke and the embryo was still in other ways incompetent, or do I actually have an implantation issue? Would you recommend additional testing? Is it possible to develop an implantation issue after a successful pregnancy (my son is less than 2). I had an HSG before this most recent transfer. Thank you for your time.
Hi Erosen,
It is possible that you might have an implantation issue. However if it is immunologic, then it probably wont be autoimmune. It would be alloimune (a DQ alpha/HLA match)….see below. It is also possible that the PGS test was erroneous. I my opinion that is more likely to happen when array CGH is used than when PGS is done by next generation gene sequencing.
Geoffrey Sher MD
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
The most common causes of implantation dysfunction are:
a)A “thin uterine lining”
b)A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c)Immunologic implantation dysfunction (IID)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women.
Please visit my new Blog on this very site, 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)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•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?
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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
Hi Dr Sher, isn’t possible to develop implantation distinction after a successful pregnancy? I have a 2 year old who took three IVF cycles to become pregnant with, and I became pregnant via FET. I was a patient at SIRM-NY. I moved so went to a local clinic for number 2- and opted to do pgs testing since it always appeared I had egg quality issues. Just went through the another FET, transferring a pgs normal hatching blastocyst. Negative result. Lining and hormone levels were good and normal. Is there further testing I should do or was this just a fluke?
It could be a secondary immunologic implantation dysfunction that is sometimes due to alloimmune implantation dysfunction (DQ alpha/KLA matching)….see below.
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
The most common causes of implantation dysfunction are:
a)A “thin uterine lining”
b)A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c)Immunologic implantation dysfunction (IID)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women.
Please visit my new Blog on this very site, 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 Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF FailureImmunologic 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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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.Shear,
Congratulations on your very informative website.
I have been battling infertility for 8 years. I am now 39 years old. Diagnosed with endometriosis back in 2012. Pelvic adhesions and 1cm endometriomas in each overy. Had laparoscopic treatment. AMH following treatment 1.9. AFC 5&4. Following that I had 3 fail IVF cycles. First IVF, a short protocol of Menupur (high dose) and growth hormone was abandoned due to poor ovarian response at Day 7. Devastation. Two natural cycles followed, one with no collection of follicle and the other in an abnormally fertilised one. All the above with national health system (NHS) in London. Moved to private clinic for a final more customised try. Had immune tests resulting in high Cytokine Ratio of 50 which after two rounds of Humira (my cycles were radically effected following treatment), and a round of intralipids is now reduced to 30. Following that I was expecting to cycle but it was postponed due to high FSH of 19. I cannot stop but thinking that I have been at the mercy of endless protocols without any actual results. What will your advise be?
Hi Sophia,
It sounds as if you have several issue.
1.The first is your severely diminished ovarian reserve (FSH=19MIU/ml) which may or may not respond to stimulation and might mean the need for egg donation/IVF. If however you decide that you want to at least try with own eggs, you would in my opinion be advised to use a robust modified long pituitary down-regulation protocol (agonist/antagonist convesion protocol -A/ACP) with human growth hormone supplementation with embryo banking of PGS selected blastocysts (see below).
2. The second issue is u=your endometriosis with likely immunologic implantation dysfunction. While cytokine analysis would seem to suggest this…the best confirmatory test is the K-562 target cell blood test done at one of a few specialized reproductive immunology reference laboratories. I use Reproductive Immunology Associates in Van Nuys, CA.(look them up on Google). I note that you used Humera and Intralipid. Humera is in my opinion not the best approach because it blocks THI-cytokine activity because some THI-cytokine activity is needed in the early stage of implantation. Intralipid in combination with steroid therapy is best, in my opinion.
Please visit my new Blog on this very site, 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)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•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
•Unexplained IVF Failure
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies?
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
•Endometriosis and Infertily
•Treating Ovarian Endometriomas with Sclerotherapy.
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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
Hi there Dr Sher
I am 38 and have been trying to get pregnant for 6 years. I have had one unsuccessful round of IVF and one IUI. This cycle, on day 28, I began having pains down my legs and arms, followed by intermittent but constant contractions, like period pain but not exactly the same. This has continued for 6 days now. On day 3 my period arrived late but the cramps just continued on. I usually have a very regular 28 day cycle and wondered whether this month I may have had an auto immune issue?
Many thanks for your help
Emma
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
The most common causes of implantation dysfunction are:
a)A “thin uterine lining”
b)A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c)Immunologic implantation dysfunction (IID)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women.
Having said the above, I have a hunch that these symptoms are due to underlying endometriosis (see below)
Please visit my new Blog on this very site, 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.
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
•Endometriosis and Infertily
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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,
I am a 33 year old mother of a 2 year old little boy. Combining all the time spent actively trying for a child (with previous marriages and my current one), I have spent a total of 15 years trying to conceive; 12 years before I became pregnant with my son. Before my son’t pregnancy I had never been pregnant before and have had no miscarriages. John is a Clomid/Metformin baby – I ordered the Clomid from the Internet and was on the Met for weight loss. We started trying again 4 months after my son was born since it took so long the first time. This time I have infertility medical coverage for everything except IUI/IVF. We have been trying for 2 consecutive years this month. We’ve been through Clomid, Femara, Soy Isoflavones, Metformin, and have charted my BBT, and so far we’ve STILL not been able to conceive. I began seeing an RE and last cycle was my 1st round of injectables; I stimmed for 9 days on 150 mg of Follistim and administered a 250 mg Ovidrel trigger shot on the 9th day. I had a mild case of OHSS, as I had 6-7 fully matured follies at the time I triggered, with 5 more coming up right behind it. I began 200 mg Prometrium daily on 3 DPO. I had what appeared to be the faintest + test on 3 different tests on 10 DPO, but my period began 4 days early on 11 DPO – I have never had a 10 day luteal phase in my life! My LP runs between 14-16 days every cycle. I went in today (CD 4) for my baseline scan to check my ovaries and I have a leftover 15 mm follicle on in my right ovary, so my RE wants to put me on BCPs for 2 weeks. Since my husband is a soldier and will be leaving for a month in a few days, I’m considering to take it for the entire cycle so the follicle/cyst will shrink. My questions are these: Is there an egg inside the 15 mm follicle, or is it a fluid filled cyst? My RE didn’t call it a cyst, but that’s what I’m finding on the Internet. If there IS an egg in it, will it eventually release on it’s own? My RE said that one explanation of why my luteal phase could’ve been so short is that we may have had a fertilized embryo begin the implantation process but fail to complete it, and when it failed my body may have immediately shed it’s lining to prevent any further embryos from implanting. Does this sound feasible? Do you have ANY other explanation why it could’ve been so short? With the progesterone supplementation my LP should’ve been EXTENDED, if anything! I’m sorry for the novel, I just have a boatload of questions! I’m blogging my journey, and I don’t want to put out any misinformation!
Hi Linda,
Sorry to hear of your long standing problem .
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
The most common causes of implantation dysfunction are:
a) A “thin uterine lining”
b) A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c) Immunologic implantation dysfunction (IID)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women.
Please visit my new Blog on this very site, 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.
• 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)
• Traveling for IVF from Out of State/Country–
• A personalized, stepwise approach to IVF
• The Role of Nutritional Supplements in Preparing for IVF
• Endometriosis and Infertily
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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