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.
Doctor, My BPT was positive today but the HCG level is very low 11. Can something be done to increase it? Any injections? My RE will do a second test on Saturday.I am on progesterone suppositories 3 times a day, estradiol 2mg tab once a day , prenatal vitamins and Fertilaid. Regards
I am afraid that at this stage, there is nothing to be done, other than to take a wait and see approach.
Geoff Sher
Hi Dr Sher,
I am 37 and my husband and I have been TTC for three years. My history to date is:
2013 Initial investigations returned AMH of 6 and investigative laparoscopy found omental adhesions (possibly from prior appendix removal via laparoscopy also) but no endometriosis.
2014 Lap and dye finds right tube is blocked
April/May 2015 Long protocol Gonal F 187.5 Only one egg retrieved. Day two embryo transferred. No pregnancy.
September 2015 Second ivf, long protocol Menopur 375, three eggs retreived, two transferred on day three, positive pregnancy result however it became a pregnancy of unknown location and had to be treated with methatrexate when hcg levels got to 4000.
So now I am due to start another ivf cycle in July, this ivf doctor has suggested an antagonist short protocol due to my previous poor responses. My amh is still 6.34 and my fsh is 10. Today I received prolactin results of 790. This was a repeat blood test as the previous one was 960. My local doctor now is referring me to an endocrinologist and for an mri. This is unlikely to happen before I start the ivf cycle in July and I’m just wondering if it would be better to postpone the treatment or how likely is it that the high prolactin level will affect ivf?
Any other thoughts on my situation would be greatly appreciated. Thank you so much for taking the time to read this.
QAs far as your prolactin is concerned, what was the normal range and in what units did they measure it. I would need to know that before recommending that you postpone your IVF cycle. be sure to again provide your prolactin level in your re-post.
I am not certain as to whether your AMH was measured in ng/ml ot pmol/L. Given your resistance to stimulation, I suspect it was the latter. If so, you have DOR and you would need a completely different approach to stimulation and would need to consider embryo banking. I am anti the use of pure Menopur for IVF in general and for women with DOR, in specific. If so, you would, in my opinion, do best on a modified, robust, FSHr-dominant long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing)-normal blastocysts, to make hay while the sun still shines.
Please visit my new Blog at o to http://goo.gl/4hvjoP , 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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?
•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.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•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
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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,
Does gonal f reduce basal LH? For example I have a day 3 LH level of 8. But when we checked LH levels on day 8 of taking Gonal f (before administering cetrotide), then the LH was only 3. So it looks like it reduced itself somehow?
Also, can basal LH levels fluctuate from month to month?
Do you consider a day 3 LH of 8 high?
Basal LH does fluctuate and no, it is not likely that Gonal-F will lower your blood LH significantly, in my opinion.
Geoff Sher
Hi Dr. Sher, My husband and I are trying to conceive for over 6 years now, I am now 36 and he is 43. We are undergoing IVF for the past 2 years and I am now preparing for my 6th IVF transfer after already transferring 9 grade AA blastocysts resulting in an ectopic pregnancy, 2 chemical pregnancies and 2 negative cycles. We always produce “beautiful” embryos and have even done PGS testing which showed 90% of our embryos to be normal. We originally needed IVF as my husband has a very low sperm count (6 million). I have no known issues and have spent the past 6 years undergoing test after test which shows no issues at all. We are so lucky to have 10 PGS genetically normal frozen blastocysts waiting for us. My lining has always been an issue as I have had 3 cycles cancelled due to my lining not getting over 6mm and for all of my transfers my lining was between 7mm – 8.5mm when measured on the day of the transfer so I believe this is my main problem. As I don’t respond well to estrogen tablets/pills etc, I was put on a low dose stim along with Viagra, vitamin E, etc and this worked a little better, however from having 3 fresh rounds and 2 cancelled cycles last year I ended up with 3 cysts on my ovaries so for our next FET I will be back on estrogen with Viagra. I have had the cysts checked by MRI and they are just regular cysts so hopefully they will be gone soon. All the reasons you list that cause a thin lining does not apply to me so I don’t know why it is thin, I have had biopsies to check for infections, laparoscopies etc and everything is “perfect”. My only issue is I have the single gene mutation MTHFR C667T which I take Cleaxane for. I must add I have been on low dose steroids for all of my transfer and for the last transfer I was also on Intralipids as a precaution.
I have had all the standard immune bloods done and everything came back perfect, also I had an endometrial biopsy with SIMS clinic which showed no major immune issues, however the test is only in its trial stages so I still can’t be 100% sure there is no immune issues as I haven’t done the Chicago bloods yet. There are a few autoimmune issues in my immediate family, I had psoriasis for a few years as a teenager but haven’t had it since, my mother has psoriasis and hyperthyroid and both parents have IBS. I also have hayfever and a cat hair allergy.
I am seeing a herbalist who trained under Trevor Wing from the UK, she has me on raw herbs to help build up my lining and I have seen a big difference in my periods since starting them, my pre-menstrual spotting has gone from 4-5 days to just 1-2 days which is great. She suggested I take Mesima mushrooms or else Coriolous between now and my next transfer in 11 weeks time just as a precaution. Please can you tell me, do you think its likely our main issue is my thinner lining or could there be an underlying immune issue also? I am due to be on intralipids for my next transfer but not steroids this time. I would really love to hear your opinion and thank you so much for taking the time to read my email. Best wishes, Ciara
Hi clara,
I strongly suspect that you do indeed have implantation dysfunction which is either immunologic or anatomical (lining)-related…I suspect the former. I would urge you not to transfer any more of your embryos until this is definitively addressed. Please know that in my opinion, there are no more than a half dozen (or so) labs that can do the immune testing comprehensively and reliably. I use Reproductive Immunology Associates in Van Nuys, CA preferentially for testing my patients. The most important tests you will need are the K-562 target cell teest for NK cell activity on your blood and a DQ alpha/HLA match on your and your partner’s blood. Finally, a single MTHFR mutation will not explain your issue.
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.
•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
•How Many Embryos should be transferred: A Critical Decision in IVF.
•The Role of Nutritional Supplements in Preparing for 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.
Hello,
So I am loving your blog. It has mounds of information.
I am on cd 25 and 7 dpo. I moved and just met my new doctor. Going over my medical history she was concerned with my galactorreah. I am currently 30 and have dealt with it since I was 19. I have had my prolactin checked yearly. I had it checked with my old doctor 11/2015 and it was 15 ng/ml. From yesterday’s blood work it came back at 39 ng/ml. Although I did not fast and I was 6 dpo. I have heard that the prolactin should be checked before ovulation. So I am unsure if being past ovulation and not fasting could show the elevated prolactin. She has ordered a MRI.
The last time I had elevated prolactin of 39 ng/ml was in 7/2012 and those doctors had me diet and exercise and return for a retest in 11/2012 which came back at 14 ng/ml. I have also had blood with intercourse lately and she believes that I might have a uterine fibroid. She has ordered an ultrasound.
I have gone to an endocrinologist in the past and have had my tsh/tr thyroid check. Plus various of other hormones. They all returned within normal ranges in 2014. My new doctor did order new bloodwork for some hormones, but I haven’t received those yet. So I am wondering if my elevated prolactin and potential uterine fibroid will interfere with fertility.
My S/O and I have been actively trying for a year next month. We are just beginning with exploring more options and discussing him having a SA. I have temped my bbt for the last 15 months and do show a clear shift of temperatures and have a 32-35 day cycle.
Thank you in advance for your help. Any thoughts would be helpful.
I doubt your prolactin at the levels you describe is the cause of your galactorrhea. Be sure to get checked for a local breast condition.
I think you need a full fertility work-up but you seem to be on the righttrack!
Good luck!
Geoff Sher