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 am 31 with one ovary . Diagnosed with b/l hydrosalpinx , which they believe is from scar tissue from prior surgeries . I had 14 eggs from the first IVF cycle and 2 embryos frozen. How should I proceed with transfer. Do I need to undergo another surgery to remove my tubes ? I am told laparoscopic surgery will be tough given scar from prior surgeries
If you have hydrosalpinges, it is advisable to have the tubes clipped (wherfe they leave the uterus) or removed.
Damage to the Fallopian tubes as a result of prior pelvic inflammation is one of the most common female causes of infertility. Commonly (as was the case with RL), this results in blockage of the tubes at their ends, while leaving them open and connected to the uterine cavity. In such cases, the Fallopian tubes often progressively fill with fluid (hydrosalpinx) that contains dead cells and other noxious products…potentially toxic to embryos.
Leakage of such fluid backwards into the uterus can severely compromise implantation of transferred embryos. This is why women with hydrosalpinges are strongly advised to have the diseased tubes removed or ligated (at the point that they emerge from the uterine wall), prior to undergoing embryo transfer. Admittedly, it is often hard for patients to accept that their tubes will be gone, as it means that future conception will require IVF. This is where it is necessary to explain that such tubes are non-functioning, and that even if they could be opened through surgery, the likelihood of pregnancy would be remote.
Good luck!
Geoff Sher
I am 42 yrs old with a surprise wanted pregnancy. This is my 8th pregnancy, 2 miscarriages, 2 births, followed by 3 miscarriages, followed by this pregnancy. All miscarriages were in the first trimester. The first day of my period was feb 1st. I have a typical 28 day cycle and found out I was preg at 11dpo. 11 dpo beta was 136 and prog was 16.1. At 13 dpo beta was 240 and prog was 17.4. I am on lovenox for lupus anticoagulant and started taking prednisone 10mg for antibodies on dsdna and hashimoto’s. I also take levothyroxine
I am not under the care of a high risk dr yet, and my nurse practitioner from my reg obgyn office thinks my numbers are low and I dont need prednisone and didnt want me starting lovenox so soon( my hematologist started me on it as soon as I called him at 11dpo)
My husband and I tried for years and while this is so exciting, the NP really got me nervous. I been having light brown spotting randomly throughout the day since I found out I was pregnant.
What do you think of the numbers and the medication protocol im on?
Age is definitely a factor that impacts egg/embryo compe3tency but since you have Hashimoto’s disease, I think you shoul know that immunologic factors can and often do affect implantation in such cases.
Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.
•The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
•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
•Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
•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) Why did my IVF Fail
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my PregnanciesGenetically Testing Embryos for IVF
•Staggered IVF
•Staggered IVF with PGS- Selection of “Competent” Embryos Greatly Enhances the Utility & Efficiency of IVF.
•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.
•IVF: Selecting the Best Quality Embryos to Transfer
•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?
•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)
•Intralipid (IL) Administration in IVF: It’s Composition; how it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
•Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
•A personalized, stepwise approach to IVF
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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).
PLEASE SPREAD THE WORD ABOUT SFS!
Geoff Sher
I am in a delimma after 2 failed fets, we are choosing the route to use donor eggs; Now my fertility clinic has a frozen egg bank but then I am also looking into egg bank, is it better to go with fertility egg bank, outside agency, or egg bank (Fairfax egg bank/ort world egg bank) I am very new to all of this as time is of the essence due to my age (40)
Hi Mia,
I much prefer using fresh donor eggs rather than banked eggs. The success is significantly better, the cost is the same and you own all the eggs.
Geoff Sher
Hello Dr sher,
I had my ivf medications last month (frozen cycle), I retrieved 12 eggs, 7 mature and resulted in one (5 day) good quality blastocyst. I had 7.9mm ET. (Same day of egg retrieval) hysteroscopy where they did scratching that took ET upto 5.4 mm. Since then for 15 days i had 0.625 premarin (3 times a day) and norethisterone 10mg (once a day). My Et went upto 8.8mm on 10th day. After stopping medicines, i got period on 3rd day.
My problem is, the day i started my period. It was super light and i had some suction pain on both ovaries (as if i cannot pass my gas and it is causing me pain). Other day… Pain was much reduced. But my flow is still light (almost 1/3rd of my regular flow).
Pls let me know, if this is something wrong. Will this affect my chances of pregnancy with this one blasto. How can i improve??
Fyi.. since two years i m experiencing reduced flow from 3 days to 2 days.
But this flow after ivf is more lighter than normally i get this days.
The amount of flow is irrelevant. It should not affect your prospects for success.
Good luck!
Geoff Sher
Past excerpt: Endometriosis stage 3 and husband has a DFI of 51%. We’ve had a successful natural pregnancy, then successful IVF FET: gave birth to a boy after transferring two PGS normal boys (6AA, 6BC), so not sure which one he is. Our last embryo is a PGS normal 5AA but had an elevated Mitograde level. Our RE doesn’t test for this anymore but I still am discouraged. What are your thoughts on Mitograde? Are they less likely to implant? I can’t find any studies besides inconclusive ones.
I do not believe in its value and do not order it!
Good luck!
Geoff sher