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.
Dr. Sher,
I am 32 with DOR. I’m wondering if there is anything that we can do to adjust my next cycle to collect more eggs. Or, since we created one high quality blastocyst on my first cycle, is this the right path forward?
7 follicles initially, 5 responded but in varying sizes. Upon retrieval two were 23-25mm, two were 18-20mm, and one was 13mm. We retrieved two mature eggs. One fertilized and became a high quality blastocyst (thankfully). Estrogen levels seemed a little lower than expected on day three blood test, but bumped up to 450 the next day. Started ganerilex on day 4 of injections. Used 300 follistim and 2 menopours each day. Also used Omnitrope, aspirin, and dhea. Estrogen levels were a little low again the day before the trigger at 1350, even with two follicles at 22-24mm. Waited a day to trigger Lupron. Upon trigger day, estrogen was 1750. Is there anything we can do to make the follicles grow more even or collect more eggs next time?
Respectfully, I would review and adjust the stimulation protocol (see below) and avoid Lupron-triggrer. This in my opinion can adversely affect egg maturation.I would also stay away fro DHEA.
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.
•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 Aproach
•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.
•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
•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
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
Please call or email Julie Dahan, my patient concierge. She will guide you on how to set up an in-person or Skype consultation with me. You can reach Julie at on her cell phone or via email at any time:
Julie Dahan
•Email: Julied@sherivf.com
•Phone: 702-533-2691
?800-780-7437
Geoff Sher
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Thank you so much Doctor 🙂
You are very welcome BD.
Geoff Sher
Hi dear Sher, what is the success rate for the transfer of an acgh tested normal healthy embryo? No known problems with uterus / lining and recent hysteroscopy all clear.
it would probably range from 40-55% depending on age of the egg provider uterine receptivity and skill in the performance of embryo transfer.
Geoff Sher
Dear Doctor, It’s been 6 days since the embryo transfer but I have no symptoms yet. Is it alarming? Also , do you think Fertilaid and Ovaboost by Fairhaven can harm implantation ? Regards
Symptoms are very subjective, you will know definitively in a few days. Try to be patient. And no! These supplements should not prejudice outcome in any way.
Geoff Sher
Dr Sher,
I have recently completed my first cycle of IVF. I’m wondering if there is anything we can do in the protocol to increase the number of eggs that we can retrieve in the next cycle.
I am 32 and have diminished ovarian reserve. AMH 0.36 and FSH 13.9. I had 4 follicles in my initial ultrasound but after taking DHEA for 1.5 weeks, I started the first IVF cycle with 7 follicles in total. 5 out of the 7 grew. They reached 25, 23, 20, 18, and 13mm upon retrieval. Unfortunately, we were only able to retrieve 2 eggs. Both were mature, one fertilized, and one did not. Thankfully, the fertilized egg grew to a healthy blastocyst today. My estrogen level was 1760 upon the lupron trigger. The day before, it was 1350, which they thought was low. So, they kept me on the meds for one more day before triggering. My estrogen level was also lower than expected the first day of monitoring. However, there was a nice bump upon the next blood test. I was on 300 follistim and 2 vials of menopour per day. I also took 50cc of omnitrope every other day for 6 days. Ganrelix was started the 4th day of injections. Asprin and DHEA were taken each day.
What do you think is more indicative of mature eggs – estrogen level or follicle size? My doctor said that I may have had some empty follicles that never grew eggs. She suspects that the eggs may have come from the 20 and 18mm follicles and that the larger 23 and 25mm were empty because of my lower estrogen level. I’m still a little confused how my estrogen level could have been at 1760 but I only produced 2 eggs? I thought each egg produced 200 of estrogen. I’m so thankful for my one blastocyst so far, but I was concerned that we only retrieved 2 eggs from 5 grown follicles. I’m just not sure if this is to be expected, or if the protocol should be revised.
Thanks very much in advance for your help.
Very respectfully, while I have do not doubt that your RE will feel not agree, but I would definitely use a different approach to stimulation and would not use a Lupron trigger (for reasons outlined in specific articles below. I would favor the use of use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH) and I would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach would in my opinion, optimize the chance your getting moreand better quality eggs/embryos as well as a viable pregnancy per embryo transfer procedure. Moreover, it would provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
Please visit my new 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 Aproach
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•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
•Why did my IVF Fail
•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 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?
•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
•IVF Egg Donation: A Comprehensive Overview
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher