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.
Hi Dr. Sher,
I have had one successful pregnancy (with help of clomid) and 2 subsequent chemical pregnancies (one at 5 weeks and another around 6). I am pregnant again and my betas have been the following:
9 DPO: 9.7
10 DPO: 31.8
11 DPO: 50 (progesterone 19)
12 DPO: 84
13 DPO: 141.4
What are your thoughts on the viability of this pregnancy? Do you find the progesterone to be in acceptable range?
Thank you so much,
Emily
The progesterone is fine but that hCG rise is sluggish. You will need to have an Us at 6-7 weeks to get a definitive answer.
Good luck!
Geoff Sher
Dear Dr. Sher,
I had a 3 day frozen embryo transfer (FET) and I became pregnant with a HCG of about 275 that doubled. I used up four progesterone in oil (PIO) vials and, at 5 weeks pregnant, I opened a sealed PIO vial and gave myself my daily morning 2 ml intramuscular injection. That evening, before going to bed, I noticed that the PIO vial that I used that morning was 2 years expired and was from a previous FET and I had accidentally mixed this old vial with the other four new (not expired) vials that I had used up. I couldn’t get a new vial until the morning which would mean that I technically missed a progesterone shot if the old expired PIO vial was no longer effective and did not provide me with any progesterone. For this FET, I did not take any other sources of progesterone besides my daily morning 2 ml PIO intramuscular shot. I never had any bleeding but I ended up with a blighted ovum (11 week empty sac with no yolk sac or fetal pole) and had to have a D&C. Could the one “missed” progesterone shot have caused the blighted ovum? My HCG was doubling normally and I thought that HCG will not double with a blighted ovum. The FET embryos were obtained when I was 40 years old with my own eggs. The four vials that I took previous to this expired fifth vial were all new and not expired and my progesterone level was tested and was determined to be high. I’m in such emotional agony thinking that I caused the blighted ovum by missing a progesterone in oil dose in a FET at 5 weeks pregnant. Thank you.
I doubt that this single episode contributed to the blighted ovum.
Geoff Sher
Hello Dr Sher, I have hypothyroidism (stable on Synthroid) and repeated pregnancy losses before 12 weeks. My doctor agreed to give me lovenox and prednisone before my next FET and until heart beat id detected. Do you think its worth a try?
Thanks
Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.
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.
•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) Why did my IVF Fail
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies
•Genetically Testing Embryos for IVF
•Staggered IVF
•Staggered IVF with PGS- Selection of “Competent” Embryos Greatly Enhances the Utility & Efficiency of IVF.
•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.
•IVF: Selecting the Best Quality Embryos to Transfer
•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?
•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!
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
•Should IVF Treatment Cycles be provided uninterrupted or be Conducted in several Pre-scheduled “Batches” per Year
•A personalized, stepwise approach to IVF
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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
Hi Dr. Sher,
I am 11w2d pregnant via FET. I stopped the prescribed meds (estrace 3 mg BID and PIO 1mL) at 10 weeks and was released to by OB. My HCG, estradiol, and progesterone were drawn at 11 weeks. HCG level was 87,335 IU/L, estradiol level 1,570 pg/mL, however my progesterone level was 15.98 ng/mL. I am very concerned with how low this level is. My OB is not concerned with this and said the level is ok for where I am at in my pregnancy. I am wondering if supplementing with PIO or crinone should be considered. Thank you.
Hi Samantha,
I agree with your OB!
Geoff Sher
I concur with your OB!
Geoff Sher
Thank you! Would you say the first one has a higher chance than the second one, or similar likelihood for both? And would you implant both at the same time? Both are day 5.
– 1BB, +19, 55%
– 2BB, -22, 65%
In would transfer both….if there are no serious contraindications to you carrying twins (a very small likelihood).
Geoff Sher
Probably similar!
Geoff Sher