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 a 37 years old and had a successful pregnancy 2 years ago which ended in stillbirth at 38 weeks. The baby died due to an umbilical cord accident. My husband and I have been trying to conceive for 12 months with no luck and have recently visited a fertility clinic. We are currently considering our options to proceed given the following results:
-My fallopian tube test was normal.
-Sperm count was normal.
-Lower antral follicle count at 11.6
-I was prescribed synthroid (the hormone level was low but was not diagnosed with hypothyroidism)
-No other problems were detected
Our doctor has recommended to proceed directly with IVF but we thought that perhaps we would start with IUI for 2 months first. I would greatly appreciate your thoughts on this matter.
Best regards,
Catherine Morris
Clearly, at 38Y of age you need to be proactive in trying to determine the cause of your unexplained failure to conceive again. I think this should include an immunologic assessment for natural killer cells. If this is normal and all other tests are also normal, then I agree, it is worthwhile trying IUI with gonadotropin stimulation before moving to IVF. If the NK cell activity test (the K-562 target test is abnormal further immune tests will be required before going forward.
Geoff Sher
Is steroid & intralipids the correct method to surpress CD56 & CD57 natural killer cells? Is CD56 difficult type to surpress as I’ve read it is.
Yes it is!
Geoff Sher
Dear Dr. Sher,
Thank you so much for taking the time and writing this response. I appreciate it and I think what you do here is great.
Hi Dr Sher,
I am going out on a limb here, wanting your opinion. First IVF of 2 – 5 day blast resulted in chemical pregnancy (1st beta HCG 14 days post transfer was 22, dropped to 5 – 2 days later). We had 2 frozen embryos (the other 10 did not meet criteria for freezing). Had frozen transfer od 2 embryos (4bb and 4BA) on 5/25. My beta HCG 14 days post transfer was a 2101 and 2 days later (16 days post transfer) was 4902. They scheduled me for an ultrasound next week, 6/21 (they are dating me 6 weeks and 4 days for that ultrasound). Considering 4 years of unexplained infertility, 6 failed IUIs, and a failed IVF (and this is our LAST CHANCE) I’m terrified we won’t see a heartbeat or something will be wrong. Any opinions on Beta HCG levels of 2101 and then 4902 as a predictive measure for pregnancy success to delivery???
I should also add that having very light, scant light brown/pink discharge that they said was normal, as I’m on vaginal progesterone suppositories 3-4x/day, doing I’M progesterone in oil every other day). And this freaks me out a lot.
Hi Andi!
The numbers look good!
Good Luck!
Geoff Sher
Hi Dr Sher.I just turned 30, never pregnant.I had endometriosis and one ovary and some of the other removed, 2 fibriods were removed retroperineal, there was also signs of cervical stenosis.My AMH came out to be 0.5 at the time of IVF.My first IVF yielded only 2 mature eggs with 1 vial of menopur,225 gonalf and 5units of lupron with a trigger of Ovidrel.The cycle was cancelled. I have spoken with several doctors who all have different protocols and it has thrown me in a frenzy because of the responses.One doc said there is no reason to have a low amh with only one ovary left, which confuses me.What will you say is an ideal protocol given my age and amh level. Thank you
Hi Taylor,
You definitely have diminished ovarian reserve and in my opinion you need a different approach if you are to succeed with using your own eggs. 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.
• 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
Hi Dr Sher, there was a Polyps found during my last scan. The IVF consultant said it needs to be removed before embryo transfer. Will this interfere with pregnancy if I get pregnant naturally? Or does it need to be removed with or without IVF? Many thanks!
It needs to be removed!
Geoff Sher