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 have 1 child and then had 3 miscarriages all in the first trimester. We seeked help after trying 8 months after our last loss with no success of getting pregnant again. We were diagnosed with partial dq matching. After multiple rounds of intralipids we still had no success of getting pregnant. Doctor suggested IVF but we declined due to cost. It has been almost 2 years since we have attempted to get pregnant, so with that being said, is there a chance to get pregnant on our own, or would we have to go back to seeing our specialist for intralipids and or further assistance? Do NK cells go dormant over time, since its been almost 2 years? Will my body still attack the embryo even if we get lucky and it doesn’t match since its a 50/50 chance?
If you have DQa partial matching without associated NK cell activation, the DQ a match would have no immediate implications. There is in my opinion no therapeutic benefit in using Intralipid in such cases. But if you do have NKa (by the K-562 target cell test , then the combined NKa + DQa (partial) match has significant implications that in my opinion would require IVF with Intralipid + steroid therapy and single blastocyst transfers. I earnestly suggest that we talk.
I strongly recommend that you visit http://www.DrGeoffreySherIVF.com. Then go to my Blog and access the “search bar”. 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
•The Role of 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
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report
•Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
?800-780-7437
Geoff Sher
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.
Dear Dr Sher
When looking at a 3 day embryo photo of mine. I realised that one cell from the 6 cells that made up the embryo had a tiny opening along its wall. It is a small gap but most embryo picture I have seen have nothing like that as all have ring like outer walls that haven’t the slightest gap. I wondered if having a gap along the wall ring of one cell indicates anything?
I doubt this has implications with regard to overall egg/embryo competency.
Geoff Sher
Hi Dr Sher, I just completed by 2nd round of IVF and got a positive test. I am now 6w 2d and I had and ultrasound done 4 days ago after some slight spotting. The ultrasound looked good – not eptopic so we were relieved. I”m still on 3 progesterone tablets/day. Today I noticed that occasionally when I go to the bathroom there is light blood that is closer to red than pink – no clots, very light and no cramping. Do i have a reason to worry about this? It’s hard not to panic when you see blood after going through everything to get this far.
As long as the amount of bleeding does not increase and is pain free, you will hopefully be fine. But have a confirming ultrasound done this week.
Good luck!
Geoff Sher
Hello Dr. Sher,
I completed my 2nd round Of IVF. I had to do a Ct-scan and found out I have swollen lymph nodes in the back of my abdomen. I took blood test and everything came normal. My organs in the act- scan came normal. I can only think it’s from the hormones I took that made my lymph nodes react. Any chance that can be a possibility ? Tomorrow I have to do a cut- scan in my chest area and then I’m going to see a oncologist to rule it out. I might do a biopsy to be safe.
Does this sound familiar to you?
Also I had weight gain and stomach bloating during taking the meds.
Also how long does it take to get the hormones out of your system?
I’m going to detox soon with juice for 7 days.
Thank you!
Hi Dr. Sher, thank you for all the great blogs you post! I have gone through 3 unsuccessful IVF cycles and I have DOR (AMH .9). I recently went through an IVF cycle (Estrogen priming with 2 vials Menopur morning and 300 units gonal-f at night, also daily chlomid and Saizen). In this cycle, I had 14 follicles, 10 above 18mm and the others were very close in size. They were only able to retrieve 6 eggs, 3 mature and only 2 fertilized. It was my worst cycle to date. After reading your article I was convinced I had empty follicle syndrome and it was caused by the trigger shot. I had a combo of Lupron and 5000 pregnyl. My RE insists that’s not the cause because my bloodwork prior to ER was right where it should be (Estrogen 3600, LH 200, Progesterone 5.1 and HCG 100). What do you think?
Hi Gretchen,
I would require a great deal more information to provide an authoritative opinion.
I strongly recommend that you visit http://www.DrGeoffreySherIVF.com. Then go to my Blog and access the “search bar”. 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 Aproach
•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)
•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
•Why did my IVF Fail
•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.
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
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.
Dear Dr Sher,
I am 31 years old and my husband has been diagnosed with severe oligozoospermia. His karyotype is normal (no Y chromosome microdeletion). On my side no issues where found, my AMH is high. We have now just had our 1st failed IVF ICSI cycle.
I have read your article on empty follicles and would welcome your input on our situation:
Out of 15 follicles only 3 oocytes where retrieved, all others were empty. 2 oocytes fertilized and made it to grade 1 blastocysts on day 5 with no fragmentation.
The gynecologist assured me that the follicles were empty and not immature, I spoke to a different specialist who suggested they were most likely immature and not empty and that this was due to the protocol being too short and the trigger shot being given too soon.
Here was our protocol:
Birth Control Pill for 1 month
Follitropin beta 200IU for 8 days (combined with Orgalutran on the last 2 days)
2 x Ovitrelle injection on day 9
I would welcome your opinion on my protocol and on the possibility of the follicles being immature instead of empty.
Many thanks for your time,
I really think this could be a stimulation protocol issue.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.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 Aproach
•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)
•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
•Why did my IVF Fail:
•The Role of 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
•Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
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