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,
I have a first ultrasound on 13th August today after frozen embryo transfer on July 15th. They were able to see Flickr for heartbeat but not able to hear any sound.They mentioned it’s 6 week 6 days today but gastetinoal sac is little behind and size measure 6 week 2 days.
Is this normal? Will it result in normal pregnancy?
I would not worry now. It is still too early. Do another US in a week. By then you should have a definitive answer!
Good luck and G-d bless!
Geoff Sher
Dear Dr Sher,
I am 39 and easily conceived naturally age 36 and have a 3 year old.
When trying to conceive a 2nd child after 6 months I went for hormone tests:
My progesterone was normal but LH and FSH was abnormally high at around 15. My AMH was 5.7. AFC 8
I have now had 3 round of ivf as follows:
Short protocol 300 menopur 150 gonal f. Resulting in 4 eggs but only 1 normal egg, arrested before blast.
Second round long protocol, down regulation then 300 menpopur cancelled as only 2 follicles growing.
Third round short protocol (same drug doses as previous short). Cancelled as only 1 follicle growing.
Fourth round protocol: 225 memopur 5mg letrozole (cd3-8). Only two follicles growing.
My AFC has always been 8 but this round it has dropped to 4.
I’m wondering if these are the right protocols for me or whether I need to try something different.
Respectfully Mekayla,
You have significantly diminished ovarian reserve (DOR) and in my opinion, your protocl for ovarian stimulation needs careful review and revision.
Women who (regardless of age) have diminished ovarian reserve (DOR) have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production, and/or biological activity, of LH. This can result in excessive ovarian male hormone (predominantly testosterone) production. This in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, 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 women 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 new Blog on this very site, www. SherIVF.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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Geoff Sher
Hello Dr. Sher,
I had an embryo transfer on 7/8 – two 5 day blastocysts (donated)
7/18 – HCG 10
7/20 – HCG 10
7/23 – HCG 81
7/26 – HCG 161
7/27 – HCG 219; us done but no sac
7/31 – HCG 656; us done but no sac; ridge more defined
8/4 – HCG 2017; 5 mm sac seen but nothing else
8/11 – HCG 9317; 10 mm sac seen but nothing else
The next us is scheduled for 8/20; the doctor has been very pessimistic since the second HCG of 10 and basically gives almost no chance of this being okay. Is it possible an embryo implanted late or is just slow to develop and will show up soon?
Thank you for anything you can share.
I am afraid…I concur with your RE’s opinion!
It looks like a “blighted ovum.
I would prepare for the worst while hoping for the best. Your next US will be definitive!
Geoff Sher
Hello,
I have an odd situation. I had a miscarriage on June 11th. It was very early & HCG was followed down to zero. After one cycle, we tried again. My lmp was on July 13th and jokingly, I took a pregnancy test and was shocked to see a faint line. This was on July 31st. 2 weeks & 4 days after my period. I obviously was concerned so kept testing with first response. The next day, the line got darker and then on 8/4,8/5, and 8/6 began to almost completely fade away. I chalked it up as chemical and waited for the miscarriage to happen. Took another test on 8/9 and to my surprise it was darker. Took a test again on 8/11 and it was very dark. Got betas on 8/11 and they’re at 132. Go back tomorrow to draw again….
Any idea why this might have happened? I’m currently only 1 day past my missed period so betas are within range, just not within range obviously of my first positive test. Is there any chance I might have ovulated twice?
One egg sped down & didn’t implant correctly? The other is sticking? Kind of like vanishing twin. I’m also worried about ectopic. I seen where you mentioned recovering implantation. Would that be possible in this situation?
I’m so anxious and ready to know what’s going on. Any thoughts is so appreciated.
Only time will tell. Ultimately an US in about 2 weeks time will be definitive.
Good luck!
Geoff Sher
Hi Dr.Sher,
Can you please help to give me your opinion on my below HCG and Progesterone levels? I am very pessimistic that this pregnancy will be viable, however the nurse I’ve spoken to continues to be optimistic and my doctor wishes to continue with my 7-week US visit next week (Aug 19th). I have been unable to find any similar stories that lead me to believe there is any chance this pregnancy could be viable.
HCG Levels
July 31: 98.93 (Progesterone 18.51)
August 3: 143.7 (Progesterone 15.37)
August 5: 209 (Progesterone 14.74)
Aug 12: 2516 (Progesterone 13.13)
Many thanks!
The pregnancy is clearly in jeopardy. I have however see such cases culminate in viable pregnancies. The US should be definitive.
Good luck!
Geoff Sher
Hi Dr Sher,
Thanks for all your write ups, which is helpful.
I will like to check my fallopian tubes, uterus , ovaries etc but with minimal invasion & little or no chemical. Which is the best scan / procedure for this? Also, I’m thinking about trying clomid/ femera to help ovulation however i have hypothyroism with DOR, is this a good idea?
Look forward to your response.
Thanks,
Ade