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.
Dear Dr Sher. I am 8 weeks 4 days pregnant with twins from ICSI. At 5 weeks and 5 days I had a large bleed and went to A&E. I have a subchorionic hematoma which was large but is now about 10mm (twins are about 20mm). I am still bleeding a little everyday, but not much and it is brown. There is also a third sac but nothing is happening there and the others are now outgrowing it. My biggest problem is that since not long after the large bleed by bowels have been a mess. I have IBS but have that under control and am not eating any of my usual trigger foods. I also have endometriosis. My stools are loose (occasionally explosive or liquid), get worse as the day goes on and are rather urgent not long after eating. I’m going 3-5 times a day. Is this normal please? My clinic hasn’t really given me a helpful answer and I am rather concerned for the pregnancy (this is round 4 – I miscarried in round one at 8 weeks and the other rounds have failed). I am drinking as much water as I can but still feel horrific so don’t know if it is the pregnancy or the bowels causing it! I am taking prednisolone 10mg (steroid) and progesterone injections (100ml). My progesterone levels are 733. I have also had 3 rounds of IVIG. I very much appreciate your help.
Hi Anna,
I am not sure why you are having these bowel symptoms. Frankly, unless you are reacting to some of the medications you are taking, the pregnancy and the bowel dysfunction might not even be causally linked. I suggest that you see a Gastroenterologist.
Geoff Sher
Hi Dr Sher, Please would it be possible to ask your opinion on my embryo banking protocol. I’m 44 with AMH 17.1 and FSH 9.1. I have had 2 cycles so far. I started with AFC of 23 and 27 in the 2nd cycle. In the 1st cycle I collected 8 embryos (9 eggs) to day 3 of top quality. The 2nd cycle I so far have 5 fertilised embryos (8 eggs collected).
I started meds on day 3 (Merional 150, Fositmon 225). This increased on day 6 to 225iu each (up until and including day 13). Days 3, 5, 7, 9, 11 I had Zomacton 4mg. I started cetrotide 0.25 on day 9-13, along with Dexamethasone 2 tablets (o.5mg each). Doxycycline days 7-14. Trigger shot was on day 13. Pregnyl first time and Gonassi 10,000iu the 2nd cycle. Egg collection day 15.
The first and second cycles were similar with the exception that on the 2nd cycle I was on Norethisterone from days 5-25 due to a cyst being found. The 1st cycle was shorter and Triggered on day 12 (with no Merional, Fostimon taken on day 12). The eggs grew a lot faster on the 1st cycle (I started on a lower dose Merional 150, Fostimon 187.5 but this also increased to 450iu – more gradually than the 2nd cycle).
Do you have any advice on how I can improve my protocol to achieve better quality eggs and more chromosomally normal embryos. Also, the number of eggs collected compared to AFC seems low – is there anyway to improve this. In the 2nd cycle a number of the smaller follicles which were originally 5mm and under did start to grow to 8mm on day 12 (but not large enough for collection). There were 8 follicles that had grown to 8mm.
The IVF scans did not show that I have PCOS. But back in 2009 I did tests which showed borderline POCS but it was not conclusive. My Chinese herb doctor thinks I have PCOS. Is this what is causing the low AFC to egg conversion?
Is there any advice at all you can offer in terms of what I can do differently or better (in relation to protocol or anything else)? This is my last chance due to my age … so thank you so so much for your help. We are so very grateful for your blog!
In older women I favori 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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
•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 IVF
•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
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•Fertility Preservation (FP) Through Freezing/Banking Human Eggs
•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
Hello Dr. Sher,
First of all thank you for making such an effort to educate us through your webinars, blog and responses to questions! It has been invaluable in understanding what IVF is all about.
I am about to turn 40 and have just completed the first round of embryo banking. For the stims I was on Orgalutran (From the beginning), 375 Gonal-f, 1 vial of Menopur and HGH for the first 6 days. On trigger day we saw 8 follicles >15mm and 3 of them were 19mm (some smaller ones were visible too but it was clear those were not going to make it) and I was triggered with 10,000 Pregnyl.
On egg retrieval day only 5 were retrieved (4 were mature, which then luckily all 4 fertilised and were frozen on Day 3, giving us 3x 8-cells with zero fragmentation and 1x 12-cell with zero fragmentation). The rest were “empty”. Now we will wait for 2 months before we do the next round. My questions to you are:
1) on your webinar you mention that you only use half a vial of Menopur. My Day 3 LH is at 11. Is it possible that using one vial instead of half vial was enough LH to ruin some of the eggs?
2) surprisingly the “empty” follicles were the biggest three (the ones that were 19mm on trigger day). Should the hCG trigger have been a day earlier?
Thank you in advance!
oh, I forgot to mention in case it is relevant, my E2 on trigger day was 2650
1) on your webinar you mention that you only use half a vial of Menopur. My Day 3 LH is at 11. Is it possible that using one vial instead of half vial was enough LH to ruin some of the eggs?
A: I do not believe so. Up to 1 vial (75U) is fine.
2) surprisingly the “empty” follicles were the biggest three (the ones that were 19mm on trigger day). Should the hCG trigger have been a day earlier?
A: Without full access the entire stimulation and your response, I really cannot answer this authoritatively.
I 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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
•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 IVF
•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
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•Fertility Preservation (FP) Through Freezing/Banking Human Eggs
•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
Thank you in advance!
Hi Dr Sher,
For an IVF pregnancy, that uses intralipids due to high natural killer cells and cytokines. When the skin develops allergies during the pregnancy such as red, blistered and itchy skin that is currently being a bit controlled with emollients. From an immunological point of view, is it better to take an oral antihistamine daily to calm it down such as Zyrtec or is it best to try to tolerate it? Do allergies raise the level of TNFa and Cytokines? Whats the best treatment?
Your help is always appreciated!
Soory I forgot to mention that the allergy is suspected to be due to Nickel. And a dermatologist diagnosed it as pompholyx eczema.
No Shay, the allergies won’t increase NK cell activity or put the preganncy at risk. However, if you need oral antihistamines…you should discuss with your OB and then subject oo his/her agreement, use these!
Good luck!
Geoff Sher
Dear Dr. Sher,
How much longer after a successful FET do you recommend a patient stay on the estrogen patches? My doctor plans to keep me on crinone and lovenox until week 13 of the pregnancy, but wants me to give up the patches on week 7.
Thanks!
Respectfully, I continue both progesterone and estrogen therapy until the 10th week of pregnancy.
Geoff Sher