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 Doctor,
I’m 42, 12 weeks 4 days. Conceived with IVF. After going off progesterone shots a few days before 12 weeks my level dropped from 46 to 18. My IVF doctor prescribed 10 days of vaginal progesterone, 100 mg 2x/day. He said my OB should handle it from here. My OB feels the placenta will take over and doesn’t see a need to even retest the level.
I’m concerned because I don’t want to have a miscarriage, since this was our only viable embryo. We had PGT and it tested normal.
I’m thinking we should retest a few days after the 10 day course of meds. If it’s still low, would it be harmful to remain on vaginal progesterone for maybe the whole time, just to b on the safe side? Do some women just not produce it well? Is it age related? The heartbeat is strong and all of my other labs and bloodwork are really good. I’m also a smaller person, I don’t know if that’s a factor. I’m 5’4 and was about 110 when we had the transfer and I’m about 118 now.
Thank you for your time!
I do not think supplemental progesterone after the 19th week does much good. And frankly, it sounds to me like everything is still well on track! I am optimistic!
Good luck and be safe!
Geoff Sher
Hi Dr. Sher,
My husband (45) and I (just turned 37 this week) have gone through 8 mini IVF cycles over the last year. My FSH tends to run high, ranging from 9-17.8 on day 2/3. AMH was recorded at 1.25 (a year ago, so it is probably lower now). My antral follicle count is around 8. My husband has low volume and 2% normal morphology.
We have been at a clinic now for a year doing mini IVF. We decided to go this route for several reasons: 1) At the time we didn’t want to overproduce embryos for ethical reasons (we plan to use anything we create, though at this point we are not too worried of overproducing embryos, since after a year we only have 5 embryos, with only one assigned a high grading). 2) We had read there was a chance the embryos might be better quality with less meds 3) We had been told people with diminished ovarian reserve tend not to respond any better with more meds. For my second cryopreservation cycle, we did our clinic’s full version of IVF, which they call ‘Optimal IVF’ (though still a similar protocol, just increased dosage of meds), and I still only ended up with 4 eggs. At this point we aren’t planning on doing any more cycles and were just going to implant what we have, but would be open to suggestions/ideas. It just doesn’t seem worth it to keep trying, since for the last 2 cycles we have failed to produce any viable embryos. Clearly what we are doing isn’t working! Originally we had hoped to have 3-4 children, but that dream seems less and less likely with every cycle.
When we first began a year ago, I was able to get 4 mature eggs each time for the first 2 cycles. We haven’t fertilized those eggs yet, so are unsure of the quality. I took a 2 month break, but since then it has been a struggle to get my body to produce even 4 mature eggs. For every cycle except the first 2, we have done ICSI and have mostly produced poor quality embryos (if at all). We have (1) 4AA, but do not know if it is chromosomally normal (we declined PGS testing, since, for ethical reasons, decided we would use any embryos we create and not discard anything with even a slight chance of success…we have read that occasionally mosaic embryos turn into healthy babies, so we will give every embryo a chance). As I mentioned, the last two cycles I have failed to produce any embryos. Is it possible my system is just worn out? Every time I take a 1-2 month break, the next cycle produces even worse results. I know quality/quantity decreases with time, but there is such a marked difference between now and the first IVF cycle a year ago. It just seems like my body is responding less and less effectively to the treatment protocol. They change the dosage up and the frequency of injections every time, but nothing seems to improve the results. Are there other factors that might be at play here? We’d love to know your thoughts.
Drug protocol: In general, I start with 50mg of Clomid (sometimes only 25mg if my FSH is above 15) and use Gonal F (sometimes every day, sometimes every other, usually at 75iu but other times at 150iu). Usually the follicles aren’t growing very quickly, so I either get switched to Menopur, or it gets added in half way through the cycle. The last cycle I only used Menopur (and ended up with 2 mature eggs that arrested during the embryo development phase). The retrieval tends to be around cycle day 13-15.
Here is a breakdown of the 8 cycles we have done:
Cycle 1: May 2019
– 4 mature eggs (banked for future use)
Cycle 2: June 2019
– 4 mature eggs (banked for future use)
Cycle 3: September 2019
– 3 eggs retrieved (1 mature, 2 immature – stage GV and stage MI)
– 1 frozen embryos (4CB)
Cycle 4: October 2019
– 5 eggs retrieved (3 mature – 2 fertilized, 1 ZP Free – fertilized and arrested on day 6, 1 degenerated)
– 2 frozen embryos (4AA, 4CC)
Cycle 5: November 2019
– follicles were growing very slowly (largest follicle was 13mm on day 14), increased meds, all follicles shrank in size except the 13mm follicle. After 5 more days of increased meds, it still was only 13mm. We cancelled the cycle. I had taken birth control after the retrieval the cycle before and had read on your blog a few months ago that this can suppress follicle recruitment…I wonder if that could have been a factor here?
Cycle 6: January 2020
– 4 eggs retrieved (3 mature – 2 fertilized, 1 damaged and discarded)
– 2 frozen embryos (4CB, 4CB)
Cycle 7: February 2020
– 4 eggs retrieved (1 mature – abnormally fertilized, 2 stage GV, 1 non-viable)
– 0 frozen embryos
Cycle 8: March 2020
– 2 eggs retrieved (both mature, 1 fertilized and arrested before/at day 5)
– 0 frozen embryos
We also did the ERA test in March. It came back as ‘Late Receptive’. I don’t know how much stock to put in this test. The clinic plans to adjust my transfer based on these results. We have such few embryos that I don’t want anything to jeopardize their potential success in any way. Have you found this test to be useful? The clinic wrote: “the personalized embryo transfer of your blastocyst should be performed with 111 +/-3 hours of progesterone administration. The administration of progesterone can be delayed by 12 hours relative to the timing used in the protocol for this endometrial biopsy”
I’m not sure if it matters, but they started me on progesterone when my largest follicle was only 12mm. My lining was 8.6, so maybe that is the only thing that matters? My LH had been running higher than normal (usually under 9 at this point, but it was 14 in this cycle). My LH was at 18 the day before they started me on progesterone). I don’t think it was actually starting to surge. Could this affect the test results in any way? They performed the ERA on Day 18 (after 6 days of Endometrin 100mg).
We’ve tried our best to research all our options along the way, but we are feeling lost and would appreciate your thoughts on any of this!
Sincerely,
Jenni
Very respectfully Jenni,
I do NOT agree with the approach to ovarian stimulation and in opinion, a “mini-stimulation” with clomiphene is not a good approach. You have diminishing ovarian reserve (DOR) and such protocols are not ideal. You need a modified long pituitary down-regulation protocol. I would use a robust agonist/antagonist conversion protocol (A/ACP). I would also not freeze eggs. They do not do nearly as well as blastocysts. In my opinion, even with DOR, the most likely explanation for your disappointing results, relates to the protocol used for ovarian stimulation. I do NOT believe that given yur age and circumstances, this is attributable to an intrinsic egg issue.
I really think we should talk. Might I suggest that you call my assistant, Patti Converse and set up an online consultation with me to discuss your case in detail.
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 15y 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
e.Ureaplasma Urealyticum (UU) Infection of cervical mucous and the endometrial lining of the uterus, can sometimes present as unexplained early pregnancy loss or unexplained failure following intrauterine insemination or IVF. The infection can also occur in the man, (prostatitis) and thus can go back and forth between partners, with sexual intercourse. This is the reason why both partners must be tested and if positive, should be treated contemporaneously.
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).
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.
•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.
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•IVF: How Many Attempts should be considered before Stopping?
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•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)
•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!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•A personalized, stepwise approach to IVF
•How Many Embryos should be transferred: A Critical Decision in 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.
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
We are trying to time a FET transfer. Can you please advise if taking birth control for 9 days is sufficient to shed lining and start estrogen? Or is 9 days too little?
Also, the protocol the dr has provided is 2mg of estrogen pills for 14 days, and then 5 days of 1.5 units of progesterone shots. My partner normally ovulates very long cycles (50 – 60 days). Given that, do you think that this protocol to transfer day 5 blasts is ok?
Also, we are debating transferring 1 vs 2 non pgt tested 4aas. we would be ok with twins, but understand there are risks. Ultimately we want healthy babies. Would you suggest transferring 1 or 2?
Thank you
I would do a full cycle on the BCP. Here is my approach to preparing for FET:
Until less than a decade ago, most women undergoing IVF would have embryos transferred to the uterus in the same cycle that the egg retrieval was performed (“Fresh” Embryo Transfer). This was because embryo cryopreservation (freezing) was a hazardous undertaking. In fact, it resulted in about 30% not surviving the freezing process and those that did, having about one half the potential of “fresh embryos to implant and propagate a viable pregnancy. The main reason for the high attrition rate associated with embryo cryopreservation is that the “conventional” freezing” process that was done slowly and this resulted in ice forming within the embryo’s cells, damaging or destroying them. The introduction of an ultra-rapid cryopreservation process (vitrification) freezes the embryos so rapidly as to avoid ice crystals from developing. As a result, >90% survive the freeze/thaw process in as good a condition as they were prior to being frozen and thus without being compromised in their ability to propagate a viable pregnancy.
Recently, there have been several articles that have appeared in the literature suggest that an altered hormonal environment may be the reason for this effect. There have also been reports showing that when singletons (pregnancy with one baby) conceived naturally are compared to singletons conceived through a “fresh” embryo transfers they tend to have a greater chance of low birth weight/prematurity. This difference was not observed in babies born following FET. Hence, there is a suspicion that the altered hormonal environment during the fresh cycle may be the causative factor.
Available evidence suggests that FET (of pre-vitrified blastocysts) is at least as successful as is the transfer of “fresh” embryos and might even have the edge. The reason for this is certainly unlikely to have anything to do with the freezing process itself. It more than likely has to do with two factors:
a)An ever increasing percentage of FET’s involve the transfer of PGS-tested, fully karyotyped, euploid blastocysts that have a greater potential to propagate viable pregnancies, than is the case with “fresh” ET’s where the embryos have rarely undergone prior PGS selection for “competency”…and,
b) With targeted hormone replacement therapy for FET, one is far better able to better to optimally prepare the endometrium for healthy implantation than is the case where embryos are transferre3d following ovarian stimulation with fertility drugs.
There are additional factors other than method used for embryo cryopreservation that influence outcome following FET. These include
•An emerging trend towards selective transferring only advanced (day 5-6) embryos (blastocysts).
• (PGS) to allow for the selective transfer of genetic competent (euploid) embryos
•Addressing underlying causes of implantation dysfunction (anatomical and immunologic uterine factors) and
• Exclusive use of ultrasound guidance for delivery of embryos transferred to the uterus.
Against this background, the use of FET has several decided advantages:
•The ability to cryostore surplus embryos left over after fresh embryo transfer
•The ability to safely hold embryos over for subsequent transfer in a later frozen embryo transfer (FET) cycle (i.e. Staggered IVF) in cases where:
1.Additional time is needed to perform preimplantation Genetic testing for embryo competency.
2.In cases where ovarian hyperstimulation increases the risk of life-endangering complications associated with critically severe ovarian hyperstimulation syndrome (OHSS).
3.To bank (stockpile) embryos for selective transfer of karyotypically normal embryos in older women or those who are diminished ovarian reserve
4.The ability to store embryos in cases of IVF with third party parenting (Egg Donation; Gestational Surrogacy and Embryo donation) and so improve convenience for those couples seeking such services.
Preimplantation Genetic Sampling with FET:
The introduction of preimplantation genetic sampling (PGS) to karyotyping of embryos for selective transfer of the most “competent” embryos, requires in most cases that the tested blastocysts be vitribanked while awaiting test results and then transferred to the uterus at a later date. Many IVF programs have advocated the routine use of PGS in IVF purported to improve IVF outcome. But PGS should in my opinion should only be used selectively. I do not believe that it is needed for all women undergoing IVF. First there is the significant additional cost involved and second it will not benefit everyone undergoing IVF, in my opinion.
While PGS is a good approach for older women and those with diminished ovarian reserve (DOR) and also for woman who experience recurrent pregnancy loss (RPL) or “unexplained” recurrent IVF failure recent data suggests that it will not improve IVF success rates in women under 36Y who have normal ovarian reserve, who represent the majority of women seeking IVF treatment. Nor is it needed in women (regardless of their age) undergoing IVF with eggs donated by a younger donor. This is because in such women about 1:2/3 of their eggs/embryos are usually chromosomally normal, and in most cases will upon fertilization produce multiple blastocysts per IVF attempt, anyway. Thus in such cases the transfer of 2 blastocysts will likely yield the same outcome regardless of whether the embryos had been subjected to PGS or not. The routine use of
It is another matter when it comes to women who have diminished ovarian reserve and/or DOR contemplating embryo banking and for women with unexplained recurrent IVF failure, recurrent pregnancy loss and women with alloimmune implantation dysfunction who regardless of their age or ovarian reserve require PGS for diagnostic reasons.
Embryo Banking: Some IVF centers are doing embryo banking cycles with Preimplantation Genetic Screening (PGS). With Embryo Banking” several IVF cycles are performed sequentially (usually about 2 months apart), up to the egg retrieval stage. The eggs are fertilized and the resulting advanced embryos are biopsied. The biopsy specimens are held over until enough 4-8 blastocysts have been vitribanked, thus providing a reasonable likelihood that one or more will turn out to be PGS-normal. At this point the biopsy specimens (derived all banking cycles) are sent for PGS testing at one time (a significant cost-saver), the chromosomally normal blastocysts are identified and the women are scheduled for timed FET procedures….. with a good prospect of a markedly improved chance of success as well as a reduced risk of miscarriage.
Standard (proposed) Regimen for preparing the uterus for frozen embryo transfer FET) is as follows:
The recipient’s cycle is initiated with an oral contraceptive-OC (e.g. Marvelon/Lo-Estrin; Lo-Ovral etc) for at least 10 days. This is later overlapped with 0.5 mg. (10 units) Lupron/Lucrin (or Superfact/Buserelin) daily for 3 days. Thereupon the OC is withdrawn and daily 0.25 mg (5 units) of Lupron/Lucrin/Superfact injections are continued. Menstruation will usually ensue within 1 week. At this point, an ultrasound examination is performed to exclude ovarian cyst(s) and a blood estradiol measurement is taken (it needs to be <70pg/ml) until daily progesterone administration is initiated some time later. The daily Lupron/Lucrin/Superfact is continued until the initiation of progesterone therapy (see below).
Four milligram (4mg) Estradiol valerate (Delestrogen) IM is injected SC, twice weekly (on Tuesday and Friday), commencing within a few days of Lupron/Lucrin/Superfact-induced menstruation. Blood is drawn on Monday and Thursday for measurement of blood [E2]. This allows for planned adjustment of the E2V dosage scheduled for the next day. The objective is to achieve a plasma E2 concentration of 500-1,000pg/ml and an endometrial lining of >8mm, as assessed by ultrasound examination done after 10 days of estrogen exposure i.e. a day after the 3rd dosage of Delestrogen.. The twice weekly, final (adjusted) dosage of E2V is continued until pregnancy is discounted by blood testing or an ultrasound examination. Dexamethasone 0.75 mg is taken orally, daily with the start of the Lupron/Lucrin/Superfact. Oral folic acid (1 mg) is taken daily commencing with the first E2V injection and is continued throughout gestation. Patients also receive Ciprofloxin 500mg BID orally starting with the initiation of Progesterone therapy and continuing for 10 days. Luteal support commences 6 days prior to the ET, with intramuscular progesterone in oil (PIO) at an initial dose of 50 mg (P4-Day 1). Starting on progesterone administration-Day 2, PIO is increased to 100 mg daily continuing until the 10th week of pregnancy, or until a blood pregnancy test/negative ultrasound (after the 6-7th gestational week), discounts a viable pregnancy.
Also, commencing on the day following the ET, the patient inserts one (1) vaginal progesterone suppository (100 mg) in the morning + 2mg E2V vaginal suppository (in the evening) and this is continued until the 10th week of pregnancy or until pregnancy is discounted by blood testing or by an ultrasound examination after the 6-7th gestational week. Dexamethasone o.75mg is continued to the 10th week of pregnancy (tailed off from the 8th to 10th week) or as soon as pregnancy is ruled out. With the obvious exception of the fact that embryo recipients do not receive an hCG injections, luteal phase and early pregnancy hormonal support and immuno-suppression is otherwise the same as for conventional IVF patients. Blood pregnancy tests are performed 13 days and 15 days after the first P4 injection was given.
Note: One (1) vaginal application of Crinone 8% is administered on the 1st day (referred to as luteal phase day 0 – LPO). On LP Day 1, they will commence the administration of Crinone 8% twice daily (AM and PM) until the day of embryo transfer. Withhold Crinone on the morning of the embryo transfer and resume Crinone administration in the PM. Crinone twice daily is resumed from the day after embryo transfer. Contingent upon positive blood pregnancy tests, and subsequently upon the ultrasound confirmation of a viable pregnancy, administration of Crinone twice daily are continued until the 10th week of pregnancy.
Regime for Thawing and Transferring Cryopreserved Embryos/Morulae/Blastocysts:
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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 Doc,
I am 7w4d according to LMP, but I had my first scan today.it shows fetus of 6w2d with Some flickering.and my Bhcg is 2726. Am really afraid because I had a miscarriage 4mnths back. Can I have a hope for good outcome this time.?!
Is there anything I can do (any life style changes ,am a vegan) to keep them fetus viable and healthy.
Just have a balanced diet, adequate rest and exercise and try not to stress out!
Good luck!
Geoff Sher
Hi Dr Sher
What is your experience with CA 125 and Endometriosis? I have had a few months worth of raised CA 125 levels (level of around 39 – 70 depending on the month). Haven’t had a laparoscopy to investigate as yet as I have no symptoms of endometriosis and wondering whether solely based on CA 125 and around 9 months of failing to conceive is worth investigating further?
Thanks!
I would investigate further!
Geoff Sher