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.
I’m 34, husband is 35. We’ve had 3 8 week missed miscarriages and a stillbirth at 23 weeks dues to trisomy 18. The last miscarriage was monosomy X. Pregnant naturally in 2-3 cycles. We’ve done the RPL panel and karyotyping on us. No male factor. My AMH is 1.7, FSH 7.9. I’m heterozygous for MTHFR. Nothing seen as abnormal in our karyotype. Pursued IVF, the clinic only does ICSI. Round 1 resulted in 8 eggs retrieved, 6 mature, and only 1 fertilized. Sent for PGS and it was trisomy 20. 2nd round with testosterone priming resulted in 10 retrieved, 8 mature, only 2 fertilized and arrested. E2 was 1111 at trigger 1st round, but 869 the day of trigger the 2nd round. The doctor is thinking fragile X. Just wondering if this makes sense? I’m a scientist and have read a few papers that indicate this is a stretch, but I’m willing to do the test just in case. Thoughts?
Hi Dr. Sher,
We just went through our first ivf cycle – I’m 35 and husband 37. We had a transfer of a 5aa embryo on December 18th. Blood test came back showing I was pregnant on Dec 27th. I’ve had two ultrasounds since. The ultrasounds show that the single embryo that was transferred has split, resulting in twins. Ultrasounds registered heartbeats for both, although too early to measure them. My fertility doctor is sending me to a perinatal specialist because she said that the likelihood of the pregnancy continuing is very low. She wants me to consider a selective reduction of one, or termination of both of the fetuses. She said there may also be a chance that one of them stops growing and gets absorbed by my body, but that we will likely not be able to continue with both. She also insinuated that even if one of them ceases to continue, the other will likely not be strong enough to continue or be “normal” because it split when “it wasn’t supposed to”.
I have two questions for you:
1. Is a selective reduction of one twin harmful to the remaining fetus?
2. Is a SET that splits once implanted incompatible with a healthy baby should one continue even though it “wasn’t supposed to split”? Is there going to be developmental issues with the one baby because it was a result of an SET split?
We see the perinatal specialist in a few days, but very curious to hear your take on this.
Thanks!
1. Is a selective reduction of one twin harmful to the remaining fetus?
A: In my opinion it is contraindicated in monozygous twins where the blood supply is shared as it will often kill both.
2. Is a SET that splits once implanted incompatible with a healthy baby should one continue even though it “wasn’t supposed to split”? Is there going to be developmental issues with the one baby because it was a result of an SET split?
A: Respectfully, In my opinion, the pregnancy should not be interfered with, unless there is another reason to do so. I would not terminate this pregnancy. While the risk of twin to twin transfusion is increase, many (most) such monozygotic twins will survive to term.
Geoff Sher
Dear Dr. Geoffrey Sher.
With almost undetectable AMH is there any chance to get eggs during IVF? If yes, which IVF protocol to use?
Thanks in advance,
Katarina
We would need to talk. I need much more information.
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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).
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Geoff Sher
Hi Dr. Sher,
Day 10 of my stim and my estrogen level is 5100 and progesterone level is 1.7, I have abt 18 follicles but they’re around 16-10mm. I don’t know why my doctor wants me to trigger, aren’t they still small?
Also my doctor wants to trigger with 1 ovidrel instead of 2. I insisted of 2 because I read on your blog, 1 is not enough to mature all the eggs. Do you think I’m at risk at OHSS? Any advice?
Thank you
Very respectfully, I disagree on both counts, but you need to follow the advice if your RE. What can I say!
Perhaps we should talk after this cycle!
Geoff Sher
I am currently 8 weeks and 2 days pregnant following IVF and FET. Beginning prior to FET, I have been taking Estrace 2mg x 3x/day, Prometrium inserts 200 mg x 2x/day and PIO 1 ml per day. US shows appropriate size and HR for gestational age. E2/P4 levels were done and were 1400 and 50. My doctor advised me to stop PIO shot, continue inserts as above and reduce estrace to 1x/day for 1 week, then cease all medications. From reading your articles and other sources, it seems supplemental hormones are usually continued a bit longer. Do my levels support the timing of removing medications? Since reducing meds I have had no cramping or spotting, but have noticed a decrease in some of my pregnancy symptoms, namely fatigue and nausea. I am nervous about decreasing the support to the pregnancy and increasing risk for miscarriage. Thank you for your time.
There are differing opinions with regard to the ideal time for stopping meds with FET’s. It probably wont make much of a difference in the final analysis. However, I prefer to wait a few weeks longer for placentation to be established before stopping. You need to discuss with your RE who is in charge of your management.
Geoff Sher