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.
Dear Dr Sher,
We have just had one low mosaic embryo transferred (-7). How hopeful should we allow ourselves to be?
It has a chance…that is dependent on your age.
Geoff Sher
Hi. What is the best ivf protocol for me. I am 39 years old and clomid menopur do not work well for me. Just had ivf with Gonal f and menopur and I had premature ovulation. Please let me know what would be the best ivf protocol for me. Many thanks
You probably have diminished ovarian reserve. Depending on the measure of your ovarian reserve you probably have premature luteinization and would benefit from a robust agonist/antagonist conversion protocol.
Background Information: Bear in mind that the main reason for using antagonist suppression is to avoid the “Premature LH Surge”. This is a condition where high ovarian LH activity propagates androgen-induced “follicular exhaustion” and egg dysmaturity. The term “premature LH surge” is a misnomer since it does not involve a sudden “surge” or sporadic rise in LH. In actuality it occurs as a steady rise in LH activity (a “staircase effect”) which elicits a progressive increase in ovarian stromal androgens that ultimately exhausts follicle development and compromises egg “competency”. A more accurate term might be “premature luteinization.” Such poorly developed eggs will often respond to the hCG trigger by becoming aneuploid (a numerical chromosomal abnormality Thus, trying to avoid “premature luteinization” by administering GnRH antagonist 6-8 days into the COS cycle, is like” shutting the gate after the horse has already left the stable”.
GnRH antagonists (e.g. Ganirelix, Cetrotide, and Orgalutron) are currently used with many controlled ovarian stimulation (COS) protocols. The conventional approach is to administer 250mcg antagonist, daily starting from the 6th-8th day after commencing ovarian stimulation with gonadotropins. This traditional approach is in my opinion, best suited to younger patients who have normal ovarian reserve (AMH>2.0ng/ml or 15pmol/L) and are “good responders” to COS, provided that the stimulation cycle is launched with a spontaneous menstrual cycle and is not launched coming off a birth control pill (BCP) or following prolonged premenstrual hormonal suppression (see Use of BCP in IVF”, elsewhere on this blog). However, this approach can in my opinion be decidedly disadvantageous when used in older women (>39y), women with diminished ovarian reserve (DOR) or women with polycystic ovarian syndrome (PCOS) who all tend to have increased LH bioactivity.
The A/ACP, involves using a GnRH antagonist (Ganirelix, Cetrotide, and Orgalutron) is administered by daily injection from the onset of COS. The A/ACP COS-cycle is launched with the woman coming off a monophasic birth control pill that was administered starting in the 1st 5 days of the preceding cycle and continued for at least 10 days. The BCP is then overlapped with an agonist (e.g. Lupron/buserelin) for three days, whereupon the BCP is stopped and the agonist (Lupron/buserelin) is continued until the onset of menstruation. At or around this point, the agonist (Lupron/Buserelin) is supplanted by an antagonist (Cetrotide/Ganirelix/Orgalutron) and concurrently COS is initiated using an FSH-dominant bias (mainly Follistim/Gonal-F/ Puregon + a small dosage of a menotropins such as Menopur). The combined antagonist/gonadotropin therapy is continued until the hCG trigger. For the reasons cited above, I prescribe some form of the A/ACP for my older IVF patients and those with DOR.
We should talk!
Geoff Sher
702-533-2691
Hello doctor
After I have a freeze all cycle, would going on birth control right after retrieval in preparations for a frozen transfer be ok or would this be detrimental for uterine lining? Or should I have a bleed then start the birth control? If I do wait for a period can I start the birth control cycle day one? Or wait until the period is over then start the birth control?
I would have a period then start the BCP in the 1st 3-4 days of the bleed.
Good luck!
Geoff Sher
Hi.
I had a single frozen embryo on July 15th and after 12 days did the first beta hcg test.result is hcg 1924. Is this beta hcg good? Are there any chances of twins
Promising!
Yes , it could be twins from a split embryo but I do not think so!
Good luck!
Geoff Sher
Hello Dr Sher. I have 28 frozen eggs which I saved at the age of 39. I am now 45 and want to fertilise and transfer the possible embryos. I have the option of using a known donor to me who is 51 years old. He did not do any sperm testing yet but I would like your opinion on whether this is a good idea or not. Does the sperm over 50 reduce ivf success? And is it more possible to create children with autism, schizophrenia, cancer etc? The research seems confusing. What has been your experience?
There is in my opinion, no significant reason to preclude using donated sperm from a 51 year old based upon a very small risk of autism, schizophrenia, etc.
Geoff Sher