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 recently received PGT-A results. I have one embryo that is 30% mosaic, missing an X chromosome. As I live in Canada, where they don’t release gender, it’s unclear if this is an XO situation or OX situation. What are your thoughts on transferring this embryo? From reading your blog I see that most monosomies would self abort as they are not compatible with life. However Turner syndrome is, of course, viable. I take this to mean that if the missing X is on my side, so the embryo is OX, the mid would not be viable (assuming no “self correction”). However if the embryo is XO, this would be viable with a risk of turners syndrome (if no self correction). Is that correct? What would your advice be for XO or OX? I believe my doctor will request the gender in this case as there are “health reasons” to request same.
Many thanks,
A
Thanks
I would not transfer a sex chromosome monosomic embryothis embryo.
Geoff Sher
Hi Dr. Sher,
I am 39 years old and I just completed my first IVF cycle; the result was 7 eggs, 4 of which were mature, 2 made it to day-6 blastocysts and are currently out for PGS. I am looking to start a second round to bank more embryos before attempting a transfer and I am wondering if the approach should be adjusted. A bit of background: I have DOR, my AMH is .48 and my FSH is 12. My thyroid is somewhat low: TSH is 4. I was recently diagnosed with endometriosis, my tubes are fine but there are some adhesions on my ovaries. I also had a myomectomy in the fall to remove two fibroids, and was all clear when I started IVF but during COS a polyp was discovered.
The protocol I previously used was Lupron microflare:
BCP for 2.5 weeks
Lupron (20 units)
Day 3 added Gonal F (300 IU) and Menopur (150 IU)
HCG (10,000) was the trigger used
I have also been taking Synthroid (50 mg) to help with my thyroid level, as well as COQ10 (250 mg) and DHEA (75 mg) to help with egg quality. We are beginning to discuss the next cycle and the options that were presented were to either stick with the same protocol or switch to an estrogen priming protocol that would utilize estrogen patches. In either case HGH will be added.
Despite understanding that I have DOR, I felt disappointed in only having 2 embryos, and worried about the outcome of PGS. I am wondering if this is a good result for my circumstances or if a different approach may improve my result?
Thank you!
I have my transfer scheduled for thurs what should I be eating pineapple core before and after transfer
It really does not make a difference if you do orv dont!
Good luck!
Geoff Sher
hi dr sher first off all thank you
my question is about triggers. i know you think taht one ovitrell 250mg is not enough.. my doctor offer me duo trigger one ovitrell and one gonapeptyl 0.1mg
which way is better as trigger shot : 2 ovitrelles or 1 ovitrelle +1gonapeptyl
I would choose the former!
Good luck!
Geoff Sher
Hello Dr. Sher
I am considering using human growth hormone in my next ivf cycle. I am 36 and will be stock piling my blastocyst to have 3 more children. I already got 4 blastocysts when using your protocol. I’m hesitant to use the human growth hormone because it’s expensive and there is nothing in the literature that I have found that suggests it’s helpful in IVF at all. Then I saw one clinic suggest that using it during the cycle is too late for it to have any positive results and you should use it at least 6-8 weeks before IVF cycle starts so it can influence the follicles while they are still small. Can you please share your take on this? I know you didn’t believe it in the past but see now you selectively recommend it for some. I appreciate science and medicine is always evolving so I would really love to know what made you change your mind. Can you share how this helps in your opinion and experience? Thank you so much.
Best regards
In my opinion there is no benefit in starting HGH so long before the cycle. I usually start ity about 1 week before stimulation. I prescribe 0.4mg Omnitrope daily until the hCG “trigger”.
Older women and those who have diminished ovarian reserve (DOR) have greater difficulty in conceiving naturally or through assisted reproductive technology (ART). This is largely due to an inevitable increase in egg aneuploidy (numerical chromosome irregularity). However, although less significant than the rising increase in egg aneuploidy, advancing age and DOR are both also associated with non-chromosomal egg deterioration involving a decline in mitochondrial activity as well as a progressive reduction in the ability of the granulosa cells that line the inside of the follicle to respond to FSH stimulation.
Getting older women and those with DOR to respond optimally to ovarian stimulation often represents a serious challenge. Many will fail to respond adequately to standard ovarian stimulation regimens, requiring any individualized and strategic approach to ovarian stimulation…. one that regulates and limits exposure of ovarian follicles and eggs to LH-induced local male hormones (predominantly testosterone). This, in my opinion is best addressed by using a modified long pituitary down regulation protocol with an agonist (e.g. Lupron/Buserelin/Superfact) coming off a birth control pill. Thereupon, as soon as the period starts, the agonist is supplanted by an antagonist (e.g. Cetrotide/Orgalutron/Ganirelix) and stimulation with recombinant FSH (Follistim/Gonal-F/Puregon) along with a small amount of menotropin (e.g. Menopur) until t optimal follicle development prompts initiation of the hCG trigger. More than 15 years ago, I reported on the observation that in some women with severe DOR, the addition of intramuscular administration of estradiol valerate (i.e. Delestrogen) prior to and during gonadotropin stimulation (i.e. “estrogen priming”) is capable of further enhancing follicle growth .
More recently, researchers have shown that the administration of human growth hormone (HGH), as an adjunct to ovarian stimulation, can enhance follicle response in older women and those with DOR. Two basic mechanisms have been proposed: a) enhanced response to FSH by up-regulating the FSH receptors on follicular granulosa cells and, b) through a direct effect of HGH on the egg itself whereby mitochondrial activity is enhanced. Human eggs do have receptors to HGH but eggs retrieved from older women show decreased expression of such receptors (as well as a reduced amount of functional mitochondria. It was recently observed that some such women treated with HGH, show a marked increase in egg functional mitochondria along with improved egg quality.
Geoff Sher
PH”: 702-533-2691