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.
Conceived naturally in 2017 at 30 years old which ended in an early missed miscarriage at 8 weeks. During this time, my husband and I found out we were carriers of ARPKD (polycystic kidney disease) and that we had a 25% chance of passing on the gene. We decided to move forward with IVF with PGT-A and PGT-M to ensure the health of our future children. The first stim cycle went well and we sent 6 embryos to testing with 3 coming back as normal, non affected and/or carrier. First 5AA FET resulted in my now 3 year old son.
Fast forward to 2020, we had two consecutive FET transfers – first was a biochemical where we had low betas and second achieved pregnancy however we had a missed miscarriage at 9 weeks.
My RE suggested a laparoscopy post these losses and discovered and successfully removed stage 3 endometriosis. Before the laparascopy we did two stim cycles. First stim cycle we retrieved 15 eggs, 10 mature, 8 fertilized with ICSI ( which we had not done previously) and we ended with no embryos. The difference this cycle was the ICSI and the use of lupron/hcg combo trigger. RE said the lupron did not mature the eggs enough and resulted in poor quality.
Did another stim cycle following, which we used a long lupron protocol and 10,000 HCG as a trigger instead and we retrieved 18 eggs, 12 mature 10 fertilized and 3 were sent for testing. We only had 1 normal 5ba embryo to transfer.
Two months post the laparoscopy and removal of visible endo, we did the transfer and it resulted in a chemical pregnancy.
With this being now the 3rd consecutive loss, what steps can we now take or tests we can do to find out why I am experiencing loss after carrying a successful pregnancy to term? I am unsure how to proceed as we do want 1 more child for our family and I don’t want to go through this process yet again for more failed transfers.
Hi Dr Sher!
Am really quite worried, I had my frozen transfer 2 days ago, during a natural cycle, 1 day before transfer I took 3 lots of pessaries and my progesterone levels on day of transfer was 111, now 2 days post transfer it’s 57.. which appears to a significant decrease, the Nurse couldn’t tell me much other than it can drop after transfer and it’s still early. I’m now going to pick up some Lubion (to help increase progesterone level) and an anti-inflammatory steroid.. is the progesterone level something to be concerned about / should I just hope that embryo hasn’t tried to implant yet?
Sorry for the additional questions!!
I really appreciate your help, so much!!
Kindest regards,
Cassidy
Frankly Cassidy, Take the supplementation, but I would not be overly concerned. The level is still adequate, in my opinion.
Geoff Sher
HI Dr. Sher,
Do Woman over 40 with high AMH require DHEA or is it more so for woman with DOR?
I’m 42 with an AMH of 18 and not sure if I need to take DHEA.
Thank you for your input on this one.
Sarah
Dehydroepiandrosterone (DHEA), is steroid hormone produced by the adrenal glands and ovary. It is involved in producing the male hormones, androstenedione testosterone and also estrogen. DHEA blood levels tend to decline naturally with age.
Under the effect if luteinizing hormone (LH), DHEA is metabolized to testosterone in ovarian connective tissue (theca/stroma). Thereupon the testosterone is transported to the granulosa cells that form the innermost layer of the ovarian follicles where, under the influence of follicle stimulating hormone (FSH)-induced desmolase and aromatase enzymatic activity the testosterone is converted to estradiol. As this happens, granulosa cells multiply, follicle fluid volume increases along with estrogen output and egg development is promoted.
It is recognition of the essential/indispensable role that male hormones (mainly testosterone) play in follicle and egg development that prompted the belief that by giving DHEA and boosting ovarian testosterone production might benefit follicle/egg development. This belief was given some credence by an Israeli study that in 2010 reported on improved fertility when a group of infertile women were given the administration of 75mg of oral DHEA for 5 months. However, this study was seriously flawed by the fact that it did not separate out women who had diminished ovarian reserve, older women and those with PCOS, all of whom have increased LH-induced production of testosterone. In fact, we recently completed a study (currently being processed for publication) where we conclusively showed that when follicular fluid testosterone levels exceeded a certain threshold, egg quality was seriously prejudiced as evidenced by a marked increase in the incidence of egg chromosomal defects (aneuploidy).
Consider the following: Ovarian testosterone is needed for follicular development. However, the amount required is small. Too much ovarian testosterone spills over into the follicular fluid and has a deleterious effect on egg/follicle development. Some women (women with diminished ovarian reserve –DOR, older women and those with polycystic ovarian syndrome-PCOS) who tend to have increased LH biological activity, already over-produce testosterone. To such women, the administration of DHEA to such women, by “adding fuel to the fire” can be decidedly prejudicial, in my opinion. Young women with normal ovarian reserve do not over produce LH-induced ovarian testosterone, and are thus probably not at significant risk from DHEA supplementation. It is noteworthy that to date, none of the studies that suggest a benefit from DHEA therapy have differentiated between young healthy normal women with normal ovarian reserve on the one hand and older women, those with DOR and women with PCOS on the other hand.
In Some countries DHEA treatment requires a medical prescription and medical supervision. Not so in the U.S.A where it can be bought over the counter. Since DHEA is involved in sex hormone production, including testosterone and estrogen, individuals with malignant conditions that may be hormone dependent (certain types of breast cancer or testicular cancer) should not receive DHEA supplementation. Also, if overdosed with DHEA some “sensitive women” might so increase their blood concentrations of testosterone that they develop increased aggressive tendencies or male characteristics such as hirsuites (increased hair growth) and a deepening voice. DHEA can also interact other medications, such as barbiturates, corticosteroids, insulin and with other oral diabetic medications.
BUT the strongest argument against the use of routine DHEA supplementation is the potential risk of compromising egg quality in certain categories of women and since there is presently no convincing evidence of any benefit, why take the risk in using it on anyone.
Finally, for those who in spite of the above, still feel compelled to take DHEA, the best advice I can give is to consult their health care providers before starting the process.
Addendum: One potential advantage of DHEA therapy if used appropriately came from a study conducted by Washington University School of Medicine in St. Louis, MI and reported in the November 2004 issue of the “Journal of the American Medical Association” which showed that judicious (selective) administration of 50mg DHEA daily for 6 months resulted in a significant reduction of abdominal fat and blood insulin in elderly women.
Geoff Sher
Hello Dr
Below is my history
1. FIrst FET – 2 embryos transferred resulted in right fallopian ectopic tube removed
2. Second FET – 2 embryos transferred- miscarriage at 6 weeks
3. Third FET- 2 embryos transferred- negative results
4. Fourth FET- 1 embryo transferred- left Fallopian tube ectopic-removed left tube
5.fifth FET- 1 embryo transferred- miscarriage at 6 weeks
Retrieved and PGT tested 4 embryos all came as normal
6.sixth FET – 1 PGT tested 6ab embryo transferred- negative
So I have 3 PGT tested embryos what additional tests I need to do to have a successful pregnancy?
Hi Dr.
Just an update. My 1st hcg reading was 49, 2nd 48 hours later was 115. My 3rd and 46 hours later was only 185 (approximately a 60 % increase). Is there a chance my levels can double again? Or is this highly unlikely? I have my next blood test tomorrow (Wednesday) but am preparing for the worst, I suppose.
There is a modest chance!
Good luck!
Geoff Sher