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 doctor,
I am seeking your knowledge about Ivig. I am wondering whether it acts in a “modulatory” way to the immune system (in reference to allo immune matching) or is it “suppressive ”. I ask because I want to know if by adding this in prematurely (along with prednisone and Intralipids etc) is it possible to “over surprise” the immune system ? I’ve read it acts like a shield to the embryo? So I can’t see it being “bad” to add in as I have a partial dq alpha match and natural killer cell activation.
With the introduction of Intralipid, I no longer administer IVIG to my patients. They are both effective in regulating cytokine activity by “activated” NK cells but probably have a limited effect CTL cytokine production. Hence the addition of steroids to the mix. The fact is that IL appears to be equally effective and cost about 20 times less than IVIG. Also it is not a blood product and its administration is far less likely to result in serious side effects or cause risk to the patient.
While the precise mode of action of both IVIG and IL is not known, what is clear is that they need to be has to be infused >1 week (preferably >10 days) prior to the embryo reaching the uterus in order to adequately down-regulate NK cell activity. It is possible that these agents act on NK cell progenitors to modulate the activity of the NK cells they propagate…..and this takes time to effect. As such, I do not believe that either IVIG or IL can shield the embryo from the NKa-induced TH-1 cytokine onslaught. They act by down-regulating activated NK cells.
Sorry, that is the best I can offer in response to your inquiry.
Geoff Sher
Dear Dr. Sher,
2 clarification questions please on protocol. Thank you for your time.
1) On all your protocols, you say that gonadotropins stop on day of trigger. Are you saying last gonadotropin stimulation shot (ie. Gonal-F, Menopur, etc.) to be injected day before trigger, or last shot should also be injected same day as trigger? My RE has me take last gonadotropins shot on same day of trigger.
2) It looks like you recommend to take BCP at least 10 days before start of cycle. I didn’t take any BCP on my first cycle, and took BCP after my first egg retrieval prior to 2nd cycle. I am going to take a break after 2nd cycle to give my ovaries a rest, but how would I know precisely to start taking BCP again after skipping a cycle? I am thinking probably taking it after ovulation on next cycle to prepare for next retrieval cycle. However, how would I know exactly when ovulation takes place?
1) On all your protocols, you say that gonadotropins stop on day of trigger. Are you saying last gonadotropin stimulation shot (ie. Gonal-F, Menopur, etc.) to be injected day before trigger, or last shot should also be injected same day as trigger? My RE has me take last gonadotropins shot on same day of trigger.
A: The day of!
2) It looks like you recommend to take BCP at least 10 days before start of cycle. I didn’t take any BCP on my first cycle, and took BCP after my first egg retrieval prior to 2nd cycle. I am going to take a break after 2nd cycle to give my ovaries a rest, but how would I know precisely to start taking BCP again after skipping a cycle? I am thinking probably taking it after ovulation on next cycle to prepare for next retrieval cycle. However, how would I know exactly when ovulation takes place?
A: I do not agree with starting after ovulation. My recommendation is to start soon after the preceding period commences.
Geoff Sher
Hey! I just wanted a little piece of mind. We’ve been TTC for over a year now, with pcos and endometriosis. This past cycle I did clomid and fermara with metformin.
I did my labs at 4w3d and it was 33 I repeated two days later at 4w5d and it’s was 92 I then repeated again at 5w3d and it was 822.
My doctor says it’s normal and it’s fine and I have a ultrasound next week but i wanted another opinion if that was indeed a good increase. I dig my self in a rabbit hole bc everyone’s seems so high.
I am guardedly optimistic for you Shelby!
Good luck and G-d bless!
Geoff Sher
Hi Dr. Sher,
I will stop breastfeeding a month before starting injections before FET (3 weeks of injections).
Does this sound alright?
Thanks
hi sir, i got my positive pregnancy result after first ivf… my 13 day post 5 day embryo transfer was 1116
i was on progesterone IM once a day and vaginal suppository 400 mg BD until positive test, now am prescribed only progesterone suppository BD and was asked to stop oil injections.. i just wanted to know if this wont affect my pregnancy..i am currently 5 weeks
i am also on dehydrogesterone thrice daily
I think you are fine with this approach!
Good luck!
Geoff Sher
Hello Dr Sher,
Hope all is well. I have been recently diagnosed with Hypothyroidism ( My TSH level was 4.53). My doctor started me on Levothyroxine 25mcg daily 1 tablet and it has been a week. After a week we repeated the bloodwork and below are the test results. I was unable to understand why my TSH level got increased in a week( 4.53 to 5.49). Please suggest and provide your inputs. Also, I will be doing my egg retreival end of september 2020. Is it safe to go for egg retreival haviing these levels of Thyroid along with taking the Levothyroxine? Will this impact the quality of eggs or embryo formation? Please suggest if you would like me to wait until my levels are completely normal before going for egg retreival?
1)Thyroxine (T4) Free, Direct, S – 1.02 ng/dL
2)TSH- 5.490 uIU/mL
3)Thyroid Perioxidase (TPO) Ab- <9 IU/mL
4)Antithyroglobulin Ab (Thyroglobulin Antibody)- <1.0 IU/mL
The throxine dosage needs to be increased. However, I do not think the TSH level will affect egg quality and Since you do not seem to have an autoimmune cause for your raised TSH, I doubt you have related autoimmune implantation dysfunction.
Geoff Sher