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,
Can I have your opinions on day 7 blastocysts? I know data shows they have lower chances of working but if they grade out well, are they still worth using later?
On that note, would you prefer to use a day 5 blastocyst 4BA over a day 7 blastocyst 4AA ?
In my opinion, it is virtually always an exercise in futility. I do not advocate it.
Geoff Sher
Hello Dr. Sher,
I am very excited that I found your blog! I currently am taking a Femara to try to conceive. However, prior my husband and I have tried naturally for 2 years with no success (we do not have any children and we’re both 37). Recent tests disclosed my AMH is low. Do you think that taking Femara is worth it or should we try IVF?
If you have diminished ovarian reserve (DOR)you should, in my opinion not be using clomiphene or Femara. You need IVF ASAP to avoid wasting valuable time.
Women who (regardless of age) have diminished ovarian reserve (DOR) have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production, and/or biological activity, of LH. This can result in excessive ovarian male hormone (predominantly testosterone) production. This in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole/Femara), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.
I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
Please visit my new Blog on this very site, www. SherIVF.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
•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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the “Conventional” Antagonist Approach
•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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
•Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Blastocyst Embryo Transfers Should be the Standard of Care in IVF
•Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•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 Testing (PGS) in IVF: It Should be Used Selectively and NOT be Routine.
•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?
•PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•How Many Embryos should be transferred: A Critical Decision in IVF.
•The Role of Nutritional Supplements in Preparing for IVF
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•IVF Egg Donation: A Comprehensive Overview
___________________________________________________
ADDENDUM: PLEASE READ!!
INTRODUCING SHER FERTILITY SOLUTIONS (SFS)
Founded in April 2019, Sher Fertility Solutions (SFS) offers online (Skype/FaceTime) consultations to patients from > 40 different countries. All consultations are followed by a detailed written report presenting my personal recommendations for treatment of what often constitute complex Reproductive Issues.
Patients are encouraged to share the information I provide, with their treating Physicians and/or to avail themselves of my personal hands-on services, provided through batched IVF cycles that I conduct every 3 months at Los Angeles IVF (LAIVF) Clinic, Century City, Los Angeles, CA.
If you wish to schedule an online consultation with me, please contact my assistant (Patti Converse) by phone (800-780-7437/702-533-2691), email (concierge@SherIVF.com) or, enroll online on then home-page of my website (www.SherIVF.com).
PLEASE SPREAD THE WORD ABOUT SFS!
Geoff Sher
I started my period Nov 30, 2019, and ended on Dec 4th. My ovulation test showed positive Dec 17. and we tried the 16th and 17th. On Dec 29th, i had pink spotting just once during the day. The next two days I had brown spotting. I tested on Jan 1st and had a very faint line, so I took a digital test and it showed position. My doctor tested my HCG levels and it was 20 on Jan 2. On the 4th she retested and it showed 26 , i also had pink spotting just in the morning when i wiped, never any tissue. On Jan 6th, I had an ultrasound to check for an ectopic pregnancy. The ultrasound showed no sac in the uterus, the ultrasound tech said she didn’t see a sac in my left tube, but is assuming that it may be there because of the vascular color changes she saw. My doctor decided to draw a CBC and BMP and another beta to assure it was safe to take Methotrexate. She called me later and said she wanted to wait since my HCG came back at 46. What are your thoughts? Are my hcg too low, and could this still be ectopic? Thank you!
It would be very surprising if you have abn ectopic with such a low hCG level. It would also be almost unheard of to see a Gestational sac with such a low hCG.
Good luck!
Geoff Sher
Hello Dr Sher,
I am a healthy 36-year old with 2 children of my own. I am currently a gestational surrogate for a dear friend going through cancer treatment. We transferred a 5 day frozen embryo which also happened to be mosaic. My betas have been consistently low, however they are continuing to rise (10dt 10; 12dt 28; 14dt 91; 16dt 225) – based on our calculations this would put me at 5 weeks gestation. I will go for another beta at day 19 and am hoping to see a number in the 600-range. My question: I developed a reaction to the commonly prescribed progesterone suppositories (200mg 3 times/day) and have now switched to endometrium suppositories (200mg 3 times/day) — could my low betas be explained by the possible low absorption of the progesterone suppositories? How many more betas would you want to see if I were your patient? At what point would you suggest a viability ultrasound? The concern here is that the embryo was mosaic and the very last one for this couple, with no chance of producing anymore. Your opinion would be greatly appreciated!
A few items to clarify: my lining 5 days prior to transfer was 10mm and there were no concerns. The allergic reaction I had was to the waxy outer coating of the standard progesterone suppository and experienced a significant amount of discharge – which is why I’m concerned about lack of absorption and it’s possible effect on low betas. Since switching to the endometrium effervescent suppository I have had little to no discharge.
I do not think there is a problem. To, me , while the beta’s rose slowly at first, they seem to be picking up. I doubt absorption of progesterone is a factor here.
Good luck!
Geoff Sher
Hi Dr. Sher,
I wrote to you a couple weeks ago about my HCG levels. At this point I am 7 weeks 2 days. My HCG has still been increasing but not as quickly as it should. At my ultrasound today, my doctor didn’t find a heart beat and said she doesn’t think the pregnancy will progress. The crazy part is after that, my doctor noticed another sac, yolk sac, and fetal pole that wasn’t there last time. Now she wants me to stay on meds and check back in a week to see if that pregnancy progresses. She was extremely shocked. Have you ever seen anything like this? What do you think the chances are that this could progress normally? Feeling a little bit like an alien right now! Would be happy to send pics if it would be helpful. Thank you in advance! I so appreciate your generosity in creating this forum.
The first sac was likely missed with the 1st US. It is hard to say. At 7 weeks there should have been a HB. However, only time will tell the result!
Give it 1 more week and repeat the US.
Good luck!
Geoff Sher