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.
I am 38years old asian. And my husband is 66year old Canadian diabetes for 5 years. We wish to have a baby. Anyway we can make it?
I suggest you call my assistant, Patti at 800-780-7437 and set up a Skype/FaceTime consultation with me.
Geoff Sher
Hi Dr. Sher,
We have gotten back the PGT-A results for 3 embryos. Our donor was 23 years old so we were shocked at the aneuploidy level of eggs and embryos, (lost 15 out of 18 mostly at cleavage stage). Only one female was normal. 1. Would you transfer the other two listed below? 2. Should I trust the PGT-A results on these? I’m not sure how accurate this is when only the trophectoderm is biopsied. This will be our only shot at IVF. This has been beyond stressful for us. Thank you in advance for your suggestions.
1. Male/ Trophectoderm/ Complex Abnormal: +7, -9, +15, +16, +21
2. Female/ Trophectoderm/ Complex Abnormal: -1, -4, -21
Btw these were biopsied on day 6 Size 5, BB, starting to hatch embryos.
1. Would you transfer the other two listed below?
A: No I would not transfer these
2. Should I trust the PGT-A results on these?
A: Yes! I would trust these results.
Sorry!
Geoff Sher
You talk about embryo banking for older women with DOR. However is response to stimulation in back to back cycles reduced?
Yes! In my opinion you need a one cycle complete break between stimulations.
Geoff Sher
My fresh cycle worked when my blastocyst was transferred on the 6th day of progesterone but my clinic now want to give me one less day of progesterone for my frozen cycle. Is there a reason for this i.e frozen embryos implant later?
Can you therefore advise on what is the optimum window for initiating progesterone administration to maximise chances in a frozen cycle? Do you administer progesterone for five days (transferring blastocyst on the 6th day of progesterone) or for 4 days, transferring blastocyst on the 5th day of progesterone as standard?
Thank you
Here is what we do:
Blastocysts frozen on day 5 post-ER:Thaw in PM of day 5 and transfer on the AM of day 6
Blastocysts frozen on day 6,post-ER: Thaw in AM of day 6 and transfer on the PM of day 6
Geoff Sher
Dear Dr. Sher,
for 2 years your blog was a constant guide in tackling with our infertility problems – thanks a lot for this open format! Since we are about to conduct our 3rd round of IVF I would appreciate your opinion on our case. My wife now is 36 (I am 37, both normal weight do some sports, both from Europe) and we started our journey 2 years ago with 6 IUIs that were suggested due to an AMH that was determined at 0.6 at that time (ignoring an AFC of 14 at that time). It turned out that labs were not really reliable – 6 months later it was at 1.8 without any intervention. Long story short we scheduled our first IVF and got on a ‘standard’ protocol (starting out from BCP on CD1 FSH 225 IU in the morning and 75 IU Menopur plus Omnitrop in the evening) until follicles reached a size of 18 mm – we then triggered using Lupron and 5000 IU hCGu. We got 15 follicles, 11 fertilized, 3 ‘ok’ d3 and 2 low quality d5 blastocysts. The second attempt was using the same protocol except my wife took DHEA as a supplement for 2 months prior initiation of the cycle. This time we got 18 follicles, 15 fertilized (we were really happy) but NO blastocyst was present on day 5. Considering DHEA being a precursor of steroids and her always having significant pain during menstruation we suspect that she might have endometriosis that lead to a localized oversaturation with androgen hormones (in order to not cause more harm than doing any good we refrained from laparoscopy for now). Hence – and inspired by your blog – we tried to inform ourselves about proper treatment methods for low quality embryos caused by endometriosis and – except surgical intervention – came across the ultra long pituitary gland downregulation protocol using leuprolide acetate (I found a good number of clinical publications that support this procedure and find statistically significant improvement over other protocols for endometriosis patients).
As of now she already had her second injection of a depot (and will have her 3rd early December) and so far (also because of nonexisting menstruation) is doing far better except for the side-effects this drug is causing. Now the question: How would the suitable COH protocol look like? Our clinic is suggesting the injection of lupron 6 days before the initiation of FSH/Menopur stimulation (that may be supplemented with Omnitrop) until ovulation is being triggered using hCGu (5000IU) and Lupron. I know that according to your opinion a single trigger consisting of 10000 IU of hCGu without the administration of Lupron would be preferred – and I hope I will be able to convince our RE to follow this procedure. Any other valuable advice that you could provide?