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.
Hello Dr.,
I am 39years old female. Did immunology tests
– NK: Normal
– APA: Indeterminate on Anticardiolipin IgG GPL, Negative on rest
– Th1/Th2:
TFN-a/IL-10 is 39.9,
IFNg:IL-10 is 6,
IFNg % is 11.2,
rest normal range
And genetic testing
MTHFR: Tested positive for 2 copies (C677T/A1298C) of the mutation for MTHFR
History – I had 1 early (within 8 wks) miscarriage (no heartbeat found) with natural pregnancy during my 9 years of trying to conceive on my own.
Now, am due for an embryo transfer, could you please let us know your treatment recommendations as per the tests above.
This is confusing: 1st, I do not know whether the NK assay done was the right one. Remember, the concentration of NK cells is not relevant. It is the activation as measured by the K-562 target cell test. The latter is only performed by a handful of clinics. Second. I do not know where these test were done. Once again, only a handful of centers can do them reliably and finally, I do not know whether the cytokine test was done on your blood or on an endometrial sample obtained through biopsy. {blood cytokine analyses are not very reliable)
Thus, I cannot advise you authoritatively
Sorry
Geoff Sher
Hello Dr Sher. Thank you for this blog. However my question will be a bit different from others on here but given that you performed thousands of egg retrievals I am hoping you can help. In July I had an egg retireval of a single follicle, an ovarian clear cyst aspirated plus a peritoneal psuedocyst aspirated. All were on the right. Three days after the egg retrieval I got pain on my right side that is going on until today. I find it hard to press on my right side and scream in pain if i do. Even a light touch causes pain . I cant lie on the right. The right lower pelvis feels swollen without being visible. And it is ongoing pain even without pressing. But pressing makes it worse. It feels like I have both localized pain and visceral pain. It has stopped all my IVF efforts and have no idea what to do. MRI and transvaginal scans are clear. What could be causing this? Is it possible to hit a nerve during aspirations and what is the treatment? Can bleeding into the cul de sac create adhesions? Or is it something else? Anything? Please I have no clue what to do. I went from trying for a baby to living in pain and no baby.
Hi Courtney,
I know you are trying to hang on to a glimmer of hope, but frankly,I do not see this pregnancy with potential viability. I think it is an abnormal implantation. I really hope I am wrong though!
Good luck!
Geoff Sher
Hi Dr. Sher,
Just wanted to get some input. FET on 2/19. 2/25 HCG was 8, 2/27 32, 3/3 159 and today 3/5 only went up to 232. Should I be concerned that this number did not double? Going in for additional beta on 3/9.
I guess only time will 5tell. The most important will be an ultrasound done about 10 days from now.
Good luck!
Geoff Sher
Dear Dr. Sher,
First, I want to thank you so much for your blog. Fertility treatments can be so confusing and I have found the information you provide to be incredibly helpful. I have read several of your responses regarding IVF protocols for women over 40 but I am still feeling a bit confused. I am 41 and conceived easily at 36 (now have a 4 year old son). We have done two unsuccessful cycles of IVF and are willing to try once more but it feels like something in the protocol needs to change. Both cycles I produced a good amount of eggs (7 and 12) and they all fertilized but in the first cycle I ended up with 4 blasts that were abnormal and in the latest cycle 3 abnormal blasts. My doc has been doing the protocol of Follistim, HGH, and Menopur for 10 days with Ganirelix starting on the 5th day of stimulation. Pregynl for the trigger. Might the stimulation meds be harming the quality of my eggs thus leading to abnormal embryos?? thank you so much in advance. also, do you have a clinic on the west coast?
Best,
Meg
I do my IVF in Los Angeles, while consulting online prior to the treatment cycles.
There is little doubt in my mind that the protocol used for ovarian stimulation needs to be individualized/customized in IVF conducted in older women and/or women (of any age) who have diminished ovarian reserve (DOR).
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can 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 older women and those 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 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 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 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
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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
Hello, my daughters have premature ovarian failure due to the gardasil vaccine. They are now 25 & 26. We are desperately trying to create eggs. Have you had any patients with POF and if so any success? Thank you.
Joen E Meylor
608.444.1768
Hi Joen,
Sadly this is not a promising alternative. They will need egg donation-IVF!
Geoff Sher