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, I am 43 years old and am trying to have one more baby via IVF with my own eggs. My fertility issues are no tubes and now age. I had a daughter naturally 24 years ago and a son via IVF 8 years ago. At 39yrs old I started trying to have another baby via IVF and was unsuccessful 3 times. Each time I produced 4 to 5 eggs that seemingly looked great at day 3 but ended up in a BFN.. With that being said I started researching any and everything that could possibly help me succeed with a viable pregnancy at my age and I came across Ovarian PRP. Mind you my numbers are as expected at my age.. AMH less than .02 and FSH varied from 10 to 20.. My question is, in your professional opinion, how do you feel this new upcoming procedure, Ovarian PRP, is actually helping older women succeed in having successful pregnancies with their own eggs? Do you feel I have any chance? I did the procedure 10/22/2020 so I have yet to check my numbers to see what, if any has improved.
Quite honestly, with an AMH of 0.02 and at your age, I believe that only IVF with egg donation has merit for consideration.
I do not in any way believe that ovarian rejuvenation procedures have any proven benefit. The PRP procedure which involves injecting platelet-rich plasma (PRP) directly into the ovaries in the hope that this will stimulate existing stem cells into transforming into new, healthy eggs, is without scientific foundation or proof.
However, if in spite of this advice, you choose to go ahead and use own eggs, then please consider the following.
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. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). 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
Is there anything that can be done to prevent chemical pregnancies? I am currently a GC and have had two chemicals (two different sets of IPs so it’s not just an embryo issue). I had an ERA done that came back as pre-receptive so I will be starting progesterone a day later this cycle. They have also added intralipid infusions and a neupogen wash this cycle as well. Other than that my med protocol has stayed the same. Is there anything else I can do to prevent another early loss? Or anything I can ask my clinic about that might help as well?
Thank you, that’s how I feel. I just worry about getting too far in a pregnancy that is not viable. Would it be worth it to use my own eggs for ivf as they can be preselected to weed out the genetically mutated ones?
Perhaps we should talk!
Please call my assistant, Patti to set up an online consultation with me.
Geoff Sher
Hi Dr Sher,
I have DOR and have had 3 egg retrievals to get 5 normal embryos. We did an ERA that showed I was receptive and had 2 cancelled FETs due to wonky hormones before I was able transfer. We transferred a hatching 5BA embryo with a perfect lining and no success. Now I’ve moved on to FET attempt 2 and just had an endometrial scratch. I also have 3 intramural fibroids that have been examined via SIS. Should I be concerned and ask for more testing?
Thanks
I think that if this FET is unsuccessful, you and I should talk.
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.
Patients are encouraged to share the information I provide, with their treating Physicians and/or to avail themselves of my personal hands-on services, provided through batched IVF cycles that I conduct every 3 months at Los Angeles IVF (LAIVF) Clinic, Century City, Los Angeles, CA.
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 beta at 14dpo was only 18.94 (I may have been 12/13dpo though). Four days later it was 92.54. The doctor said that progression is fine, but I’m worried the numbers are low. Does it seem like a viable pregnancy? I am going in for repeat betas tomorrow.
Only time will tell if this is a viable pregnancy. Do serial hCG tests 2 days apart to make sure the level rises appropriately and then do an US at 6-7 weeks for confirmation.
Good luck!
Geoff Sher