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 will try to be as brief as possible to explain our situation but I don’t think that is possible. We have been undergoing infertility treatments for 3 years. A timeline:
-Miscarriage after a 3-month natural pregnancy which was deemed a “chemical” pregnancy (ie it likely miscarried very early but her body didn’t “realize” for 3 months).
-Due to low sperm count we underwent IVF ending up with 3 embryos of ok quality (around 2AB range).
-First embryo was successful but miscarried with fetal heart failure around 6 weeks.
-Second and third embryo were unsuccessful.
-At a new clinic underwent all sorts of immunological testing. Results came back as my wife having elevated NK cells (around 43ish).
-Underwent IVF again, having 5 embryos which were sent for pre genetic screening. 4 Came back euploid. These embryos were excellent quality (4AB, 5AB, etc).
-Intralipids did not work, and actually raised her NK count to 46ish.
-Used Humira to drop her NK count just under 30.
-First embryo did not implant.
-Used Humira again but this time her NK dropped to around 14.
-Second embryo did not implant even though everything was lined up “perfectly” as our doctor put it – NK was down plenty far enough, lining was great, and hormone levels were excellent.
-Tested NK right after the false pregnancy test and her NK count was back up to about 32.
At this point we found your blog post about DQa matching which sounded pretty much exactly like our situation so had ourselves tested through our fertility doctor:
She: 0102/0303
He: 0501/0501
As I understand it that means it is not DQa causing the issue, but I have also read somewhere that our HLAs could match which is the same problem. Our tests did not report any HLA numbers, just DQa.
Our question is do we need to have our HLA numbers tested as well, or does the HLA only matter if you have a DQa match?
We are searching for answers as there is no reason for having 5 transfer failures, 2 of which were using excellent embryos in near-ideal transfers.
Hi Travis,
So sorry to hear all you have been through. I understand that you have NKa+, unrelated to an alloimmune cause, and that you received IL therapy. But unless the dosage was correct, it was administered at the right dosage and at the right time (10-14 days prior to ET), was combined with steroids and possibly also Lovenox/Clexane, it would likely not have been effective. Also, bear in mind that implantation dysfunction is not always due to immunologic factors. It can occur due to other factors as well. In your case, given the circumstances surrounding your 1st pregnancy loss, it is very possible that your uteus was compromized. perhaps yu have a thin lining ((<8mm) at the time of the hCG trigger or at the initiation of progesterone therapy. Alternatively, your uterus might have internal scarring.
I would very much enjoy going over the details of yourcase along with reviewing your records carefully.
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
•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
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, I 6w pregnant today, and had light bleeding/sp0tting of pink/red blood over the weekend (not enough to fill a pad or leak through my underwear). At my ultrasound yesterday, my doctor found a small bleed above the gestational sac of one of my twins. He said it was small, less than 10%, but ordered me on bedrest for the next week. I have not had a big ‘bleed’ or really spotted or bled in two days. I am incredibly nervous as my first pregnancy of twins last summer ended in miscarriage after a horrible series of bleeds. Is it possible for this bleed to heal and not affect my pregnancy? Thank you, Laura
Yes!,
It hopefully will heal.
Good luck!
Geoff sher
Hi dr. Sher,
I had my FET last May 25, 3 embryos all were a blastocyst. 6dpt I noticed some brownish red spotting, I called my doctor’s office to let them know, cuz it feels like I’m about to start my period, they said to continue my meds and it’s ok to have some spotting, my blood test is scheduled this Friday. Should I be worried about this spotting?
Painless spotting is usually innocuous.
Good luck!
Geoff Sher
Dear Dr Sher,
My doctor doesn’t measure e2 during stimulation, they just measure the follicles to determine the maturity. They take two sides and calculate the average size. I noticed that next to the size the approximate volume is given. Is the size of a follicle a better measure if an egg is mature or the volume or is it equal (assuming the volume is calculated by using the 2 side measures)? What is the minimum volume for an egg to he considered mature?
I am aware of the fact that many doctors take this approach with which I personally do not agree. The rise in E2 (especially the trend) is an added and valuable parameter that helps assess follicle and egg development, in my opinion.
Geoff Sher
Dear Dr Sher: I read your article about controlling LH level today and have a urgent question, I’m 39 years old and my day 3 LH was 8, now I am day 6 of stimulation and my LH is 12! Is that too high? Does that mean the eggs will not conceive and will have high chance of chromosomal irregularity? Thank you so much for your reply!
The level is high in my opinion and to me this would be of concern to me. However, I cannot with certainty conclude that this this would inevitably preclude adequate egg development in each individual case.
Geoff Sher