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. Sher,
Ten months ago, I did my baseline fertility testing. I was 39 years and 5months of age. I had an amh of 2.09 and an afc count of 19. My fsh and estradiol were within normal range. Today, ten months later, I just refinished my first IVF cycle. I was on Apri birth control for 13 days before I started the cycle. During the first few days of my period, I went in for blood work. I had 14 afc’s and my estrogen was normal. Unfortunately, my stimulation cycle was only 7 days long because I had one lead follicle (20 mm) that was growing way ahead of the others. I had a smaller, more consistent cohort of follicles (four) that measured 15-17 mm and two more around 10mm. I was on 150 IU menopur and 150 IU gonal F for those 7 days. I triggered with 2500 hcg and 80 units of Lupron. On day of retrieval, they only got 5 eggs. I am currently a little over 40. I am awaiting the results of the 5 eggs in terms of fertilization, etc
My questions are:
1) Is this a sign of poor egg quality?
2) Is there something wrong or that can be changed in my stimulation protocol so that I can produce more eggs?
3) Does the birth control suppress some follicles into not showing up during stimulation
4) Generally, is there hope?
1) Is this a sign of poor egg quality?
A: Not necessarily
2) Is there something wrong or that can be changed in my stimulation protocol so that I can produce more eggs?
A: We would need to talk.
3) Does the birth control suppress some follicles into not showing up during stimulation
A: Not if used correctly
4) Generally, is there hope?
A: Yes, I believe there is but we need to talk.
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. 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 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.
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
Hi Dr,
I had a FET on 7/22. Beta HCG came back positive on 7/31 with 97.8. Repeated the Beta HCG on 8/3 – 202.4 and 8/5 – 303.6. Waiting for ultrasound during week 6. I wanted to reach out to you to understand if you think the pregnancy could still be viable?
I think the US will be definitive!
Geoff Sher
Hi Dr. Sher,
My friend had a 5day embryotransfer. 14 days post embryotransfer her hcg was 419.
Does this sound promising or is it way too low?
Thanks
It could be fine if the levels double every 2 days!
Geoff Sher
Hello dr, I am 6 weeks 5 days according to last menstrual period, but US shoed 5-5.5 days, Gsac and yolk sac were formed , fetal pole and heart beat not visualized,my Hcg levels at 6 weeks 3 days were 8100(36 hours earlier they were 7300). I had misccarriage 6 months back at 7 weeks as babys heart beat was not detected. Doctor suggested a scan after 2 weeks saying I might have ovulated late. Is this might be the case? or should i prepare mentally for another miscarriage.Kindly help doctor
I would repeat the US in 1 week. If there is no viable pregnancy seen then, I am afraid all bets would be off!
Good luck!
Geoff Sher
My daughter in law had her first 5 day fresh transfer on 7-23-20. Hcg so far:
7-31-20. 98. (3 weeks)
8-3-20. 220. (4 weeks)
8-5-20. 355 (4 weeks 4days)
Nurse says may be chemical pregnancy because the numbers aren’t doubling. Do believe these numbers are a sign of impending miscarriage?
I forgot to mention that the nurse said if her numbers were not up to 1200 by 8-10-20 that they wouldn’t do an ultrasound as it most likely would be a miscarriage. Unless the numbers start going down, what would it hurt to do the ultrasound just be certain?
This does not look encouraging. It could be a failing implantation.
Sorry!
Geoff Sher