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
Please advise me, if it’s risky to put any of my 3 genetically tested embryos in.
Embryo 1) Trisomy 21, Monosomy 22
Embryo 2) Monosomy X
Embryo 3) Trisomy 7, Trisomy 19, Low level mosaicism for monosomy 15
Any advice would be so appreciated
In my opinion…no! #’s 1 &2…definitely not and #3…..possibly! Discuss with your RE.
Geoff Sher
Dear Dr Sher, Im 10 weeks pregnant, baby size and heart is normal. Day 5 transfer PGTA embryo normal. Sonograms look good. My doctor has recommended adding an extra dose of intralipids, part of his standard immune treatment. My doctor doesnt test for HLA match. I already had an intralipid after + pregnancy and at 7weeks. After my first daughter, I had 2 miscarriages (6weeks and 8 weeks), in both cases growth was slow and heart was irregular (during early scans). This is my second pregnancy. My Dr said that if we do intralipids we have to postpone T21 test. In your opinion, which one is more important, Intralipids or T21?
I ordinarily only give 2 X IL therapy. The 1st is 10-14 days prior to ET and the 2nd is with the positive beta hCG test.
Good luck!
Geoff Sher
Dear Dr Sher
I have 3 embryos.
Embryo 1) Trisomy 21 and Monosomy 22
Embryo 2) Monosomy X
Embryo 3) Trisomy 7, Trisomy 19, Low level mosaicism for monosomy 15
Please advise me.
In my opinion, none should be transferred…but discuss with your personal RE!
Geoff Sher
Hi Dr.Sher,
I recently did a natural FET of a 5d blast in Japan and tested positive for pregnancy. I am back in US.My RE from Japan gave me progesterone supp (Crinone gel 8%) for 4 weeks (from day of ovulation) and said I can either continue or stop as it was a natural cycle. I have got an appointment of my OBGYN next week. Question is do I need to continue progesterone till 10th week of pregnancy or its ok to stop.
Thanks,
SG
Not sure it is necessary but it is probably safer to continue!Besides it will do no harm to do so!
Geoff Sher
I took Dhea and my testosterone went through the roof. how long before it returns to normal and should one wait a further 3 mths for ER in case follicles were damaged?
It will return to normal in a few days. No need to delay stimulation!
Dehydroepiandrosterone (DHEA), is steroid hormone produced by the adrenal glands and ovary. It is involved in producing the male hormones, androstenedione testosterone and also estrogen. DHEA blood levels tend to decline naturally with age.
Under the effect if luteinizing hormone (LH), DHEA is metabolized to testosterone in ovarian connective tissue (theca/stroma). Thereupon the testosterone is transported to the granulosa cells that form the innermost layer of the ovarian follicles where, under the influence of follicle stimulating hormone (FSH)-induced desmolase and aromatase enzymatic activity the testosterone is converted to estradiol. As this happens, granulosa cells multiply, follicle fluid volume increases along with estrogen output and egg development is promoted.
It is recognition of the essential/indispensable role that male hormones (mainly testosterone) play in follicle and egg development that prompted the belief that by giving DHEA and boosting ovarian testosterone production might benefit follicle/egg development. This belief was given some credence by an Israeli study that in 2010 reported on improved fertility when a group of infertile women were given the administration of 75mg of oral DHEA for 5 months. However, this study was seriously flawed by the fact that it did not separate out women who had diminished ovarian reserve, older women and those with PCOS, all of whom have increased LH-induced production of testosterone. In fact, we recently completed a study (currently being processed for publication) where we conclusively showed that when follicular fluid testosterone levels exceeded a certain threshold, egg quality was seriously prejudiced as evidenced by a marked increase in the incidence of egg chromosomal defects (aneuploidy).
Consider the following: Ovarian testosterone is needed for follicular development. However, the amount required is small. Too much ovarian testosterone spills over into the follicular fluid and has a deleterious effect on egg/follicle development. Some women (women with diminished ovarian reserve –DOR, older women and those with polycystic ovarian syndrome-PCOS) who tend to have increased LH biological activity, already over-produce testosterone. To such women, the administration of DHEA to such women, by “adding fuel to the fire” can be decidedly prejudicial, in my opinion. Young women with normal ovarian reserve do not over produce LH-induced ovarian testosterone, and are thus probably not at significant risk from DHEA supplementation. It is noteworthy that to date, none of the studies that suggest a benefit from DHEA therapy have differentiated between young healthy normal women with normal ovarian reserve on the one hand and older women, those with DOR and women with PCOS on the other hand.
In Some countries DHEA treatment requires a medical prescription and medical supervision. Not so in the U.S.A where it can be bought over the counter. Since DHEA is involved in sex hormone production, including testosterone and estrogen, individuals with malignant conditions that may be hormone dependent (certain types of breast cancer or testicular cancer) should not receive DHEA supplementation. Also, if overdosed with DHEA some “sensitive women” might so increase their blood concentrations of testosterone that they develop increased aggressive tendencies or male characteristics such as hirsuites (increased hair growth) and a deepening voice. DHEA can also interact other medications, such as barbiturates, corticosteroids, insulin and with other oral diabetic medications.
BUT the strongest argument against the use of routine DHEA supplementation is the potential risk of compromising egg quality in certain categories of women and since there is presently no convincing evidence of any benefit, why take the risk in using it on anyone.
Finally, for those who in spite of the above, still feel compelled to take DHEA, the best advice I can give is to consult their health care providers before starting the process.
Addendum: One potential advantage of DHEA therapy if used appropriately came from a study conducted by Washington University School of Medicine in St. Louis, MI and reported in the November 2004 issue of the “Journal of the American Medical Association” which showed that judicious (selective) administration of 50mg DHEA daily for 6 months resulted in a significant reduction of abdominal fat and blood insulin in elderly women.
Geoff Sher
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