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.
At 5 weeks 4 days my hcg was 7090 and progesterone was 72. 48 hours later my hcg was only 7026 but progesterone was 178. I read that after 6000 the rate slows and should double every 4 days not two. I am confused. I feel like it’s not progressing but progesterone quite high?
Sorry it went up to 7926 from 7090
At this stage, an ultrasound is needed to assess fetal viability!
Geoff Sher
Hello Dr.,
I am 5wks and had one day of spotting 6 days ago. Ultrasound showed uterine lining thickening but not much else. 5 days ago my HGC tested at 425 then 48 hours later tested at 473.
The prognosis is not good but have there been successful pregnancies with these numbers?
Thank you for your time!
Sadly, this does not look promising for a viable pregnancy!
Sorry!
Geoff Sher
Hi Dr. Sher,
I had my last period on August 8th. On the night of August 24th I got a positive OPK and had intercourse that night a few hours later (like 1 or 2 am on August 25th). I am now pregnant.
On September 9th, my betas were 49 IU/ML and two days later, yesterday on September 11th they were 115 IU/ML. My question is do these numbers seem low if I go by my LMP which would mean that these tests were taken at 4w5d and 5ws? However, since I tested positive on my OPK on day 17/ 18 this means that I likely ovulated later than day 18. And going my ovulation, I could in fact be earlier in my pregnancy than I thought? What are your thoughts on this? Is the LMP or DPO more accurate in this case? Also are these beta numbers very low for either (if we go by LMP or DPO)?
You could be earlier but it is hard to say. However, a repeat test in 2 days will be more relevant. It should double.
Good luck!
Geoff Sher
Hi Dr Sher,
First of all, thank you for having this informative blog! I’ve learned a lot from it.
I just completed my first IVF Freeze-All cycle and ended up with 2 PGT-a normal embryos. We are planning to have 2 kids, so I have decided to do another IVF Freeze-All cycle. Before I proceed, I would like your opinion on my previous cycle to see if anything could be improved upon. I’m listing all the details below. Thanks ahead for your time!
I am 35 years old. Overall very healthy except for asymptomatic hypothyroidism. I’ve been taking Levothyroxine 75mcg for a few years.
6/18 – Diagnostic on day 2 of period.
TSH: 2.62 uIU/ml, AMH: 5.01 ng/mL, FSH 6.58 mIU/ml, E2: 26.08 pg/ml
11 Follicles through Ultrasound: (Left)6,6,5,5,5, (Right) 8,7,7,6,5,4
HSG exam came back normal.
Comprehensive Carrier Screening (302 Genes) came back all negative.
My husband’s semen analysis came back normal as well.
7/16 – Menstrual period started
7/18 – 15 Follicles through Ultrasound: (Left)6,6,6,6,6,6,6,5,4, (Right) 7,6,5,4,4,4.
E2: 14.54 pg/ml, FSH: 5.18 mIU/ml, Endo thickness: 5.99.
Started taking Desogen at noon everyday for 17 days.
8/4 – Stopped Desogen.
15 Follicles through Ultrasound: (Left) 4,4,4,3,3,3, (Right) 5,5,4,4,4,4,4,4,3.
E2: <5.00 pg/ml.
8/7~8/10 – Injections: Gonal-F 250 IU + Menopur 75 IU injections at 8pm.
8/11 – 18 Follicles through Ultrasound: (Left) 11,11,10,10,10,9,8,7, (Right) 11,10,10,10,9,9,9,8,7,7.
E2: 939.7 pg/ml, LH: 3.87 mIU/ml, Endo thickness: 6.93.
TSH came back high at 6.83 uIU/ml. Increased daily Levothyroxine dosage to 100mcg.
Injections: Gonal-F 250 IU + Menopur 75 IU injections at 8pm.
8/12 – Injections: Gonal-F 250 IU + Menopur 75 IU injections at 8pm.
8/13 – 19 Follicles through Ultrasound: (Left) 13,13,12,12,11,11,7,6 (Right) 14,12,12,11,9,9,8,6,6,5,5.
E2: 1632 pg/ml, LH 6.34 mIU/ml, Endo thickness: 10.03.
Injections: Cetrotide 0.25mg at 11am (right after ultrasound). Gonal-F to 200IU (decreased) + Menopur to 150 IU (increased) at 8pm.
8/14~8/15 – Injections: Cetrotide at 8am, Gonal-F to 200 IU + Menopur to 150 IU at 8pm.
8/16 – 19 Follicles through Ultrasound: (Left) 20,20,19,19,16,15,13,11,11, (Right) 19,18,18,17,17, 16,13,12,12,8,8,7,6.
E2: 2365 pg/ml, LH: 0.885 mIU/ml, Endo thickness: 12.74.
Injections: Cetrotide at 8am + Menopur to 150 IU at 8pm (no more Gonal-F).
Trigger injections: Pregnyl 5000 IU + Lupron 80 IU at 10:30pm.
8/17 – E2: 2776 pg/ml, LH: 77.15 mIU/ml, HCG BETA: 127.2 mIU/ml, PROGESTERONE13.88 ng/ml.
Injections: Pregnyl 5000 IU + Lupron 80 IU at 10:30am.
8/18 – Egg retrieval at 9:30am. 11 Eggs retrieved.
8/19 – 9 eggs were mature and fertilized. 5 were 2PNs, 2 were 0PNs, 2 were discarded.
8/23 – 4 Day-5 blastocysts were biopsied and sent for PGT-a testing.
8/24 – 1 Day-6 blastocysts were biopsied and sent for PGT-a testing.
9/6 – 2 embryos tested normal. One is 3AA and the other is 4BB (it was previously 0PN). The other 3 were -13, -21, and complex abnormal.
Additionally, this week I had another blood test for TSH and the number came back too low (0.220 uIU/ml). So now we’ve decreased my daily Levothyroxine dosage to 88mcg.
Overall the cycle seems normal. But I am concerned with the lower number of eggs retrieved (we were able to observe 19 follicles but only retrieved 11 eggs). The fertilization and blastocyst rates also seem to be on the low side. I would like to get your thoughts on it. Any input is appreciated!
In my opinion, your protocol could adjusted to your benefit, but that is something we would need to discuss. I suggest you set up an online consultation with me to do so.
There is another issue and that relates to the fact that hypothyroidism in women is often autoimmune in origin and if so, in 50% of cases there will likely be an immunologic implantation dysfunction.
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!!
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Geoff Sher
Hi Doc I had my first HCG test on Sept 8th evening and it was 500 and the second one on Sept 10 morning and it was 488 and I am 5weeks pregnant. is this normal? should I be worried? I’ve been asked to do another in 2days and this is my first pregnancy and I am so worried because the nurse said it might mean I’m losing it and she said it could also be a lab error. I’m so worried
It does not look promising but if in the next 2 days, the levels go above 1000, it could still be OK. perhaps you started with 2 and reduced to 1.
Good luck!
Geoff Sher