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.
I just currently finished under going IVF stimulation using the drugs Menopur and Follistim. I was under careful observation. I saw my follicles on Sunday 6/5/16 on the vaginal ultrasound. I had two follicles to mature to the correct size. I gave myself the trigger shot 35 hours before follicle retrieval Monday morning at 12:30am. I arrived at the clinic this pass Tuesday at 12:30 pm. When the doctor went in to retrieve my follicles they were gone. When I woke up an hour later I was told by my husband no follicles were retrieved. How could this have happened?
Hi rosalinda,
You clearly must have ovulated. This is sometimes unavoidable, but in other cases it has to do with the type of protocol used for stimulation and the timing/type of “trigger” shot used. Often there is an underlying element of diminished ovarian reserve which can predispose you to premature luteinization of your follicles and premature ovulation.
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?
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
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.
Hi Dr. Sher: I have just undergone my 1st IVF in May 2016. I had 2 embryos transferred at day 5 (blastocysts). My hubby and I are 33 y.o. and we have “unexplained infertility”. My 1st beta (5/30/16) – 125; My 2nd beta (6/1/16) – 314; My 3rd beta (6/8/16) – 1246 (following my 1st pregnancy scan wherein RE couldn’t locate embryos in uterus or anywhere else).
I should be 6 weeks and 2 days today. I went in for my 1st pregnancy ultrasound to check on my embryos yesterday. The NP couldn’t locate any sac in my uterus. She then called the staff doctor to double check. He, too, couldn’t locate either embryo anywhere! This was a transvaginal ultrasound. More staff came in the room and they all looked perplexed. They believe this “could” be either ectopic or early miscarriage, but don’t know for sure.
They said my options are: (1) Manual Uterine Aspiration and maybe Methotexate if the MUA doesn’t reduce my pregnancy levels. Or (2) Straight Methotrexate.
The advantage of option 1 is I’d be able to rule out if I had a miscarriage vs. ectopic pregnancy. I don’t want to do 2 differ. treatments if I can avoid it. My question is, were my beta’s any indication of potential issues my RE didn’t see? Also, which option is advisable given your expertise. Thanks in advance!
Note – I have had the usual pregnancy symptoms (hunger, gassy, fatigued), but 2 nights ago I had strong cramping on my left lower abdomen, left leg pain, shoulder pain, and light bleeding of what looks like old brown blood. I was lightheaded as well. On duty doc at clinic advised I not go ER and wait for my ultrasound on 6/8 (following day.) I feel fine as of now, but have nagging feeling I have an ectopic pregnancy though scan showed nothing.
Alas, if there is definitely no sac in the uterus, this is almost certainly a tubal (ectopic) pregnancy. I agree that you would/should not do both treatments. Methotrexate alone would suffice in my opinion. However, this needs to be discussed with your RE.
Good luck and G-d bless!
Geoff Sher
Hi Dr. Sher,
I am wondering if you would share your opinion on what our next steps would be.
We recently did 2 cycles of IVF due to my husband having severe male factor infertility. I had the full workup of tests done (HSG, blood, etc) and all came up fine. I have controlled hypothyroidism. Very regular periods. Never been pregnant before.
I am a 36 (37 in a few months) and my husband is 39.
Our second round of IVF worked, but I recently had a D&C at what would have been 12wks 3 days due to no fetal heartbeat. The fetus seemed to have stopped growing around 10.5 weeks. We are awaiting genetic testing from that to find out the cause.
We did two back-to-back fresh cycles back in Feb and March this year. A quick breakdown:
IVF#1 – fresh cycle, 15 retrieved, 10 fertilized, 3 transferred on day 3, nothing made it to freeze
IVF #2 – fresh cycle, 14 retrieved, 9 fertilized, 3 early blasts transferred on day 5.There was one other that blast we hoped would go to day 6 and freeze, but no go. Singleton pregnancy ending in MC.
For IVF #3, I’m inclined to go with Freeze-all cycles and PGS to help avoid miscarriage and also hopefully bank some embryos for potentially more than one pregnancy. However, I’m concerned about the fact we previously never had anything make it to freeze. And also how long it will take to get enough to bank for multiple FETs.
I know a lot of factors come into play, but do you believe my history warrants PGS? Do you think the risk of losing embryos due to PGS or freezing outweigh the risks of doing just a fresh cycle and potentially miscarrying again? I obviously want to get pregnant as soon as I can, but I also do want to think about a couple years down the road and what my chances of pregnancy will be if I’m 38 or 39 years old.
Thank you!
First, you need to know that given your age, I would recommend Staggered IVF with PGS (next generation gene sequencing-NGS) embryo selection for frozen transfer later when the results of the embryo karyotyping are known. You might even seriously wish to consider Embryo banking (see below). However UI do not believe that this explains your repeated failures after numerous “good looking” embryos were transferred. I believe that there is a strong possibility that you have an immunologic implantation dysfunction. this is likely autommune in norigin (but it could be alloimmune –see below). I say autoimmune because you have hypothyroidism and most hypothyroidism in women is autoimmmune in origin.
Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or Intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
Selection of the protocl to be used for ovarian stimulation is very important. The protocoil should in my opinion be a modified, 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.
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 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 IVF
•Why did my IVF Fail
•Blastocyst Embryo Transfers Done 5-6 Days Following Fertilization are Fast Replacing Earlier day 2-3 Transfers of Cleaved Embryos.
•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?
•PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
•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!
•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.
I should also add – the ones we have are not PGS tested…does this change what your advice would be.
It might do!
We would need to talk!
Geoff Sher
PH: 702-533-2691
Hello Doctor,
My wife had a Frozen Embryo Transfer on May 24. Her betas on 06/03 was 399(10dp5dt), 06/06 1459(13dp5dt). According to the RE it’s looking good. In your personal opinion, what are the chances of having successful pregnancy and is it possible for her to have chemical or ectopic pregnancies based on these numbers. This is our first IVF and transfer too. Any information and/or suggestions would be helpful.
Thanks in advance,
Ian
Yes it is possible to lose the pregnancy but thus far, I would agree with your RE that things are looking up!
Good luck!
Geoff Sher