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.
i was suggested t by doctor for beta HCG test 0n 26 october 2020 and the result was 10071. i again got it tested on 02 november and the result is 11332. what does it mean
Hello Dr Sher,
I have a question that I hope you can answer and quell my anxiety. Does a heartbeat take precedence over HCG levels not doubling?
Here are my numbers –
23 days post 5 day transfer – 19149
26 days post 5 day transfer – 28160 (we saw a heart beat on this day)
This also began as a twin pregnancy and now there is just one. Does this look OK even though it’s not doubling?
Thank you so much
Every time, US evidence of viability trumps the rate of hCG rise.
Geoff Sher
I’m 37 y/o on my second IVF cycle. Similar to last time, I started on BC, then Lupron 20 units but Lupron did not suppress. Last time, neither 10 units nor 20 units Lupron suppressed, with 4-6 cysts observed. So, again, I am back on BC and will start stimulation with Follistim and Menopur, also taking omnitrope. Last IVF cycle, 6 eggs were retrieved with 1 abnormal and 1 low mosaic -17. Is it a concern that Lupron does not work with me? I find very little information on non-responders to Lupron.
WE need to talk. I need much more information to be able to comment authoritatively.
______________________________________________________
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
Hello,
Question regarding fresh donor egg treatment protocol please.
Is the recipient (me) protocol appropriate?
Is a bleed needed between stopping OC and starting estrogen? In the past this has been delayed or not happened so I am considering simply starting estrogen at the end of the pill adding 4 days to ensure coordination with the donor. Your thoughts greatly appreciated.
Day 1 start contraceptive pill (Oct 4)
Day 30 stop pill
Wait for a bleed usually 4 days later
On first day of bleed start 6mg estrogen
Day 13 scan to check lining (I usually respond well to estrogen)
Start progesterone when lining reaches +8mm and coordinated with donor egg collection and to allow for 5 days or progesterone (Sub cutaneous)
Transfer blastocyst only on day 5 of progesterone
Medication
OC pill (28 days or so)
Estrogen progynova tablets oral 6mg daily
Lubion/Prolutex subcutaneous 25 daily for 5 days to transfer
Prednisilone 5mg daily before transfer as hashitmoto suspected and thyroid always within normal range but high for fertility (3.5). On 50 eltroxin to bring it down to just above 2.
Doxycycline antibiotic before transfer with the preds and progesterone
No decaceptly in previous cycle this time as I did not do well on this and it stopped periods fully for 3 months (hence day 1 happened to be day of surgery and only noticed the night before) He was happy to proceed though as D&C needed anyway.
Other Info:
On Day 1 of cycle October 4 had a laproscopy and hysteroscopy. Lap found grade 1 endometriosis on left tube and behind uterus. Dermoid cyst removed on left ovary. Nothing abnormal in the uterine cavity. Hysteroscopy all clear. Guided D&C done.
One year ago had spontaneous pregnancy resulting in blind D&C at 10 weeks
Have had 4 failed donor egg transfers since October 2019 mostly chemical pregnancies
One successful pregnancy with donor egg that child is almost 2 and half
There are many different approaches to preparing the uterus for transfer of fresh embryos derived from donor eggs. Regardless of the medications used and their administration, it is my opinion, always advisable to start the estrogen after a bleed.
A bigger issue is to determine the reason for the failures you experienced.,… See below:
Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about 15y ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
e.Ureaplasma Urealyticum (UU) Infection of cervical mucous and the endometrial lining of the uterus, can sometimes present as unexplained early pregnancy loss or unexplained failure following intrauterine insemination or IVF. The infection can also occur in the man, (prostatitis) and thus can go back and forth between partners, with sexual intercourse. This is the reason why both partners must be tested and if positive, should be treated contemporaneously.
Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
I strongly recommend that you visit http://www.DrGeoffreySherIVF.com. Then go to my Blog and access the “search bar”. 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.
•The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
•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
•Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•IVF: How Many Attempts should be considered before Stopping?
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•IVF Failure and Implantation Dysfunction:
•The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 1-Background
•Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 2- Making a Diagnosis
•Immunologic Dysfunction (IID) & Infertility (IID): PART 3-Treatment
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management 🙁 Case Report)
•Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
•Intralipid (IL) Administration in IVF: It’s Composition; how it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•A personalized, stepwise approach to IVF
•How Many Embryos should be transferred: A Critical Decision in IVF?
______________________________________________________
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 Sher,
My wife had a consult with you last week. Thank you so much for your recommendations. She did mention she has your cell phone but did not feel it was emergent to call, we will be following up with you in two weeks. We had been reading your suggested readings and you mentioned removal of any submucosal fibroids. My question is, an Mri last year showed my wife’s uterus has 13 fibroids, primarily subserosal and intramural, there was one submucosal fibroid measuring .8mm but it has never been visualized on saline sonograms In the cavity. What further testing would you do to rule out fibroid involvement or surgery? My wife is 37 and we fear the time delay and healing/risks of surgery if not warranted. Thanks in advance
The important consideration is to have the submucosal fibroid removed hysteroscopically before ET. As for the other fibroids, the need for their removal would depend on their sizes and locations.
I look forward to our consultation coming up soon.
Geoff Sher