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 am a 29 year old woman and my husband is 30 years old, and we are trying to get pregnant with our third child. I conceived naturally and quickly with my first two children and since then, I have had 5 losses. Both of my children were carried to full term without any prenatal or delivery complications, both delivered vaginally. Since then, I had one 5 week loss that I miscarried naturally at home. One ruptured ectopic, that resulted in the removal of my left fallopian tube. One 13 week loss that required a D&C – a baby boy that was later determined to have trisomy 13. After this loss, we consulted a reproductive endocrinologist and tried 6 rounds of clomid + IUI with no success. We switched doctors to an REI specialist, had an HSG performed – which was determined to be normal, so he recommended giving clomid and timed intercourse a few more tries before moving on to IVF. We got pregnant with our first round but it was determined to be another ectopic pregnancy and was treated early with methotrexate. Our REI doctor recommended moving on to IVF after this loss. So we did a month of birth control, and then 10 days of monitored stimulation + a trigger shot. I was on 225 Gonal F plus 75 menopur for three days, then 225 Gonal F and 150 menopur for the next 7 days. And 250 of Ganerelix was added during the last 5 days of stimulation. We did our ovidrel shot at 8pm on the 11th day and had our egg retrieval at 7am on day 13. A total of 16 eggs were removed – 11 of which were determined to be mature and fertilized. 6 of those made it to Day 5/6 blastocysts and were sent for PGS testing. 3 were determined to be abnormal, 2 were determined to be normal, and one had an unknown result. We opted to transfer the two best embryos but on the day of the transfer, received a call that both embryos did not survive the thaw. The lab has a 99% thaw success rate so we were told this was a rare result and probably had to do with the embryo quality (despite the genetically normal results we had previously received). We opted to transfer the last remaining embryo that had an unknown genetic result. We got pregnant and used crinone gel and estradiol for uterine lining support through week 10. All of our scans to this point had been normal and baby was growing on schedule. We had our 13 week nuchal translucency scan and everything looked “perfect”. No abnormalities detected, baby’s growth on track, great heart beat and movement. We did the non invasive cfDNA testing as well where they look for 13/18/21 and aneuploidy abnormalities and that was later determined to be normal. We had our first OB appointment 4 days later and baby was determined to have no heart beat on doppler and confirmed twice on ultrasound, once at the office that day, and once before my D&C procedure at the end of the week. We opted to send some tissue off to have the baby further tested for abnormalities so we will know those results in a couple of weeks. But needless to say, we are very disappointed after having invested nearly $30,000 between our out of pocket expenses for IVF and medications and meeting our healthcare deductible for the year.
I’m just trying to search for some answers. I have been told that our only problem is anatomical due to my issues with my fallopian tubes. I do have thyroid nodules and am on 50 micrograms of levothyroxine per day as a preventative measure, but I have never had abnormal thyroid labs. None of my other blood work was abnormal either, aside from having thyroid antibodies and my vitamin D level being on the lower side of normal. But again, my thyroid is well controlled with medication and I am on prenatal vitamins and a vitamin D supplement. (Some of the other labs that were drawn and found to be normal – AMH, CBC with Diff platelet count, CHEM 24 SMAC, chromosome karyotype). I am a carrier for D-bifunctional protein deficiency but my husband is not so we were told this would not be an issue for us.
Is there any other testing that you would have me do? Do you think doing another round of IVF would be worth a shot for us? Is there anything you would have done differently or would recommend doing differently to help maximize our chances of having success with IVF?
Thank you for your time and insight.
Thank you for connecting with me. Your issue sounds like a possible secondary implantation dysfunction. However, I would need much more information to be authoritative and more specific in my response.
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
•Why did my IVF Fail
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies?
•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?
• IVF Failure and Implantation Dysfunction:
•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)
•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)
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
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.
Dear Dr. Sher
A patient has tried to give us a semen sample for along time but unfortunately he has not been able to prepare a sample. He was given a viagra but it didn’t work either. Are there any specific recommendations in such circumstances since I don’t want to rush to TESE or other surgical procedures.
regards
Soheil
II am not certain I understand the question fully. If you are saying he cannot ejaculate through masturbation…is he able to do so with intercourse because if so, a condom which is free if spermicide can be used for collection. If he is able to reach climax but nothing passes outward, he may be experiencing retrograde (backward) ejaculation and his urine can be alkalinized through medication in advance and then collected post ejaclation, from which his sperm can be separated. Alternatively his bladder could be catheterized immediately post-ejaculation, irrigated and and his sperm could be so retrieved. If he is not able to ejaculate on his own at all, this might be able to be accomplished through trans-rectal electrical stimulation (electro-ejaculation. Finally, if all else fails, testicular sperm aspiration might be needed.
Good luck!
Geoff Sher
Hi, I just turned 43. Had natural pregnancy/9 week miscarriage March 2015. Started ivf oct 2015. First low dose round, only 1 follicle day 5 so didn’t progress. Rounds 2 and 3, 7 then 5 follicles got me 4 frozen eggs. Round 4, same higher dose(350 foisting twice a day plus low dose hcg 20 twice a day) got 5 retrieved, 2 mature and fertilized but didn’t survive first 24 hours. Round 5, 10 flicked but ot 4 eggs, 2 mature 1 fertilized but arrested before day 5. We can only afford 1 more round. Last round we did 450 Follistim twice a day so max dose. Any suggestions? The discrepancy between u les and eggs on last round surprised me as hadn’t been seen before. Are we simply too late to move forward with my own eggs? Not sure I’m mentally able to do egg donation.
Hi Helena. The age factor + probable severely diminished ovarian reserve make your case a real challenge. Clearly IVF with egg donation is likely to be the best solution but if you insist on using own eggs, even with the low follicle yield, I suggest that a completely different approach be taken to ovarian stimulation. Ordinarily I would recommend several cycles to bank PGS-tested embryos but since this will be your last attempt, that would not be justified.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH).
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
•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
Hi Dr. Sher,
For the IVF protocol for ladies with DOR, you recommend us to use a modified IVF protocol with robust long pituitary down-regulation using an agonist/antagonist conversion protocol with human growth hormone augmentation. Can you kindly elaborate what you mean by “conversion protocol” with human growth hormone augmentation? Can Omintrope be used as the human growth hormone?
Many thanks for your advise.
for this information, please visit http://www.DrGeoffreySherIVF.com. Then go to my Blog and access the “search bar”. Type in the titles of the articles listed below, one by one. “Click” and you will immediately be taken to those you select.
•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
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.
I am writing because I do have a question that I want to ask.
Background: I was going to be a patient of Dr. Sher’s in 2011, and was all set to do an invitro cycle in January 2011, but found out that prior to that (in November), I was already pregnant with twins:)
Fast forward 5 years to Present: I have a set of twins (boy/girl) that are happy, healthy and thriving. I had them at age 41. I am now 46, and the twins are wanting to be a big brother and sister. However, since I had complications at their birth and had to have my uterus removed (bled out and emergency partial hysterectomy), I can’t have anymore children because I don’t have a uterus. I still have ovaries though and have not gone through menopause, so the possibility is there. I am still producing eggs.
I would need a gestational carrier to have any other children, but do believe that I could use my own eggs…or at least it wouldn’t hurt to see what I have. I can’t find any invitro clinic in the vicinity where I live (Minneapolis, MN) that will even consider using my own eggs (they want me to use donor eggs) due to my age of 46; 45 is their strict cut off point.
I am wondering if the Sher institute has an age limit on use of own eggs…or how old is too old? I firmly believe that I do have good eggs, seeing that I had my twins naturally, without fertility intervention, at age 41, and if I hadn’t lost my uterus, I would still be able to get pregnant.
Please advise/let me know and thanks. I really appreciate it. I am looking at my options to see if use of my own eggs at this point is even still an option, and wondering the cost of using my own eggs with invitro/gestational carrier. Also wondering about uterus transplantation or if that is an option still, too.
Please let me know and Thanks:)
Of course I would be willing to try with your eggs, however, I would first need to make you fully aware that it is not very likely to work and that by any parameter, IVF using an egg donor would be highly preferential. You need to know that age adversely affects egg competency so that at 46y, <5% of your eggs will be chromosomally normal. If you are willing to go for such a long shot, that is something I would not reject out ofhand, provided that testing reveals you to still have enough ovarian reserve to yield enough eggs to make this feasible.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and 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
. Gestational surrogacy
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