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.
Btw, these were the blood panel tests they had me do that all came back normal. Also, in terms of quality of my embryos, they were all Excellent-Good quality (no Fair/Poor). Majority were Excellent with A/B’s.
ICD 10 Code: N96
1. TSH
2. Thyroid Peroxidase Antibody
3. Hemoglobin A1C
4. Anticardiolipin Antibody IgG
5. Anticardiolipin Antibody IgM
6. Lupus Anticoagulant
7. Anti Beta 2 Glycoprotein IgG
8. Anti Beta 2 Glycoprotein Igm
Are there any other blood tests in your mind I should be looking into? Also, my blood type is A- and the donor blood type is AB+…and they gave me the shot (can’t remember what it’s called) to neutralize given the two blood types.
Thanks so much again,
-KAZ
You need to have your blood tested fo natural killer cell activity (NKa) using the K-562 target cell test, a full antiphospholipid antibody panel. antithyroglobulin and antimicrosomal antibodies and an immunophenotype. If the NKa comes back +ve then your and your partner’s blood should be matched for DQalpha and HLA genetic similarities. These tests can only be performed adequately in a hand full of Reproductive Immunology Reference Laboratories. I use Reproductive Immunology Associates in Van Nyuys, CA. You can look them up on Google.
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.
Hello Dr. Sher:
I am writing today as I just received terrible news that my pregnancy test came back negative again and I have been told I have “unexplained infertility”. I know there has to be an answer…and I’m looking for any advice/protocol possible. Here is my story:
-Current age: 39.5 yrs old
-Lining has always been 10.5 for every FET
-Did 2 egg retrievals at 37.5 yrs old, 1 retrieval at 39.5yrs old
-Retrieval #1: 22 eggs, 16 mature, 9 fert w donor sperm/ICSI, 6 blasts, 4 PGS normal
-Retrieval #2: 26 eggs, 20 mature, 19 fert w donor sperm/ICSI, 10 blasts, 5 PGS normal
-Retrieval #3: 26 eggs, 25 mature, 23 fert w donor sperm/ICSI, 12 blasts, 3 PGS normal
FET’s
-#1 (Sept ’15): FET PGS tested normal embryo: natural (no meds): NO PREGNANCY
-#2 (Nov ’15): FET PGS tested normal embryo: medicated: NO PREGNANCY
-Dec ’15: Trying to find answers as to why 2 PGS tested had not taken. Doc did procedure and found polyp and had removed
-#3 (Feb ’16): FET PGS tested normal embryo: medicated: PREGNANCY – miscarried at 7 weeks
-March ’16: Had blood panel done for thyroid, diabetes, autoimmune (not sure of all they tested for here) = results all normal
-#4 (April ’16): FET PGS tested normal embryo: NO PREGNANCY
We (and the docs) are baffled and have NO idea why I’m not able to carry, despite getting a positive pregnancy (1st blood test was 254, then 500+, then for 3rd and 4th blood test only increased by ~55% vs doubling.
Would love any and all thoughts…we are heartbroken and don’t know if I’ll ever be able to carry. This was the whole reason we’ve done PGS on all of my embryos. We are at UCSF in San Francisco.
Thank you,
KAZ
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.
Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
My answer to patients who ask me when is the time to stop undergoing IVF is ….Aside from the weight of the financial burden, the time to stop is when in spite of thorough and comprehensive evaluation, there is no remediable and treatable explanation for repeated failure.
•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
•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 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?
• IVF Failure and Implantation Dysfunction:
•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
•How Many Embryos should be transferred: A Critical Decision in IVF.
•The Role of Nutritional Supplements in Preparing for IVF
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•Advancing Age of the Woman and IVF: How Old is too old?
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
Dear Dr Sher,
Please help I think I am having my 5th chemical pregnancy in 3 years of TTC.
Here is what happened:
7,8,9 DPO spotting – already taking 400mg progesterone pessaries at night
10dpo: negative HCG blood test.
11DPO: faint line on HPT, upped to 2 x 400mg pessaries
12DPO: Faint line on HPT, Blood test: 12HCG, Progesterone 20 Pmol/L, Took 5000IU booster to help get progesterone up quickly.
14DPO: 156HCG, Progesterone 47 pmol/L (booster would be reducing, so took this as a good number!)
16DPO: 162HCG, Progesterone 42 Pmol/L (booster almost gone) Started taking PIO progesterone…
18DPO: 206 HCG, progesterone 105, Estrogen 362 Pmol/L, TSH 3.2IU
21DPO: 76 HCG, Progesterone 153, TSH 3.8, Estrogen 308 pmol/L
I have moderate endometriosis, but had a lap a year ago and removed it, my recent lap showed only mild endo and it wasn’t removed (was Lap for something else).
Do you think the TSH could be contributing to my miscarriages? It is normally between 1.5-2.5 when not pregnant, but obviously starts skyrocketing when pregnant. I have never had thyroid auto-antibodies detected previously.
Do you think my oestrogen levels are too low? Would supplementing with oestrogen in future be helpful if they are this low?
Is it inevitable I have lost this pregnancy? I started on Thyroxine 50mcg to try to bring down my TSH today, but I am guessing I am too late.
I did 30 grams of IVIG on 17DPO and have been on 30mg of prednisone since 12dpo since I do have some raised cytokines from previous immune testing. I did find that my progesterone does tend to plummet after 8 or 9 DPO in a normal monthly menstrual cycle, so it appears normal at day 21 testing but then drastically reduces… not sure if this can also contribute to recurrent chemicals? Sorry to repost this, but my question disappeared off forum for some reason… Thanks in Advance!
I already addressed this post…earlier today!
WE should talk. 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
Geoff Sher
I have a question I had a d&c on April 5,2016. I still haven’t gotten a period yet. im in a 3:1 shared donor recipient program and everyone is waiting on me so my re wants me to take provera to bring on my period. What do you think about this should I take provera or should I wait for it to come on its own. I would really hate to do anything that might affect a fresh embryo transfer in a negative way.
I would take the Provera!
Good luck!
Geoff Sher
Hello Dr. Sher,
I had posted a question to you a few weeks ago, but i think it was on your older blog, so I believe it got lost in the shuffle. Hopefully this post gets to you. I came across your site as I was doing research on my fertility case. I’m finding it very hard to get any encouraging information about my situation. I did however find some that you posted so thank you for that. I am 34 years old. Up until last month had no known fertility issues. What brought us to choose IVF was a male factor. My husband has low count, motility and morphology. I started my cycle with 2 weeks of birth control pills and then started stimulation for about a week and a half before retrieval (Gonal F, Ganirelix, pregnyl and HCG). My doctor said i responded perfectly to the stimulation medication. I had 10 follicles, majority measuring 18mm and over. My numbers were so called “great” and my egg retrieval was scheduled. My egg retrieval resulted in 10 eggs retrieved BUT all 10 of them were immature. Of course I was devastated and my RE said he was “baffled” by it since it is very rare. Through my research, the rarity is confirmed. I don’t know where to turn. I since sought out a second RE and will be trying a different protocol in a few weeks but I feel very unsettled because no one seems very optimistic. I just want to reach out to you and ask you if you ever had any cases similar to mine go on to have a successful pregnancy or a similar case like mine to go on and have a much better outcome with an egg retrieval resulting in mature eggs??? I am so disheartened by everything and just wish there a clear cut answer as to why. I am currently taking CoQ10, myo inositol, and royal jelly. Not sure if these will have any effect but I will try anything. My dr. has recommended me not going on the pill this round because maybe is decompressed me too much. He wants me to use my natural cycle with LH. I am nervous about this approach. Is it possible that i just don’t produce mature eggs. Desperately looking for some encouraging information. Thank you so much for your time! I look forward to hearing from you
If I understand correctly, you went from the BCP directly to stimulation. In my opinion that is less than ideal. Ideally you need to verlap the BCP with an agonist (Lupron/Buserelin)/. I respectfully differ with your RE. In my oipinion launching off a BCP is ideal, provided rthat the BCP is overlapped with an agonist. Failure to do so will result in poor antral follicle functionality and suboptimal egg development.
the ability of follicles to properly respond to FSH stimulation is dependent on their having developed FSH-responsive receptors . Pre-antral follicles (PAF) do not have such primed FSH receptors and thus cannot respond properly to FSH stimulation with gonadotropins. The acquisition of FSH receptor responsivity requires that the pre-antral follicles be exposed to FSH, for a number of days (5-7) during which time they attain “FSH-responsivity” and are now known as antral follicles (AF). These AF’s are now able to respond properly to stimulation with administered FSH-gonadotropins. In regular menstrual cycles, the rising FSH output from the pituitary gland insures that PAPs convert tor AF’s. The BCP (as well as prolonged administration of estrogen/progesterone) suppresses FSH. This suppression needs to be countered by artificially causing blood FSH levels to rise in order to cause PAF to AF conversion prior to COS commencing, otherwise pre-antral-to –antral follicle conversion will not take place in an orderly fashion and the follicles will not readily respond to gonadotropins (FSH) , thereby delaying follicle development by up to 7 days and compromising egg quality. GnRH agonists (e.g. Lupron, Buserelin, Superfact) , cause an immediate surge in release of FSH by the pituitary gland thus causing conversion from PAF to SAF. This is why, women who take a BCP to launch a cycle of COS need to have an overlap of the BCP with an agonist.
By overlapping the BCP with an agonist for a few days prior to menstruation the early recruited follicles are able to complete their developmental drive to the AF stage and as such, be ready to respond appropriately to optimal ovarian stimulation. Using this approach, the timing of the initiation of the IVF treatment cycle can readily and safely be regulated and controlled by varying the length of time that the woman is on the BCP.
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)
•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
•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.
•The Role of Nutritional Supplements in Preparing for 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
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.