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.
Hello Dr Sher
I am currently 2 days past 5 day transfer. During my IVF I had 21 follicles, 12 eggs retrieved and 7 fertilised. Out of that 7 only two made it to day 5 blastocysts. They were grade 2 and I only transferred one. Can you tell me why did my numbers drop so low and should I be worried about the fact that they are grade 2? Testing was not available for the blastocysts.
I am 30 years old and the sperm used in our cycle was from tese procedure that had been frozen.
Hi Tracey,
To answer that question I would need to know a lot more about your cases and particularly specific details about the protocol used for ovarian stimulation, its implementation and how/when you were triggered at the end. The protocol used is the most important consideration.
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.
• 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
•Why did my IVF Fail
•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
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
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I’m wanting to know what things increase fertility besides eating right and losing weight. It’s so hard to lose weight with PCOS I have lost weight before but I am also at my heaviest as well. Anything would be appreciated.
Hi Mary,
I would need a great deal more information about your situation to be able to advise authoritatively.
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 am 34 and recently failed my second fresh IVF cycle. The first cycle resulted in 3 good day-5 embryos, which resulted in 1 chemical pregnancy, 1 miscarriage at 8 weeks, and one live birth. I am still breastfeeding and my dr suggested that I do another fresh cycle because my AMH has been drifting down (currently at 1.06). We did the second cycle almost identically to the first but added clomid to the protocol. So the only things that were different the second time around were the clomid, the breastfeeding (i pumped and dumped during the stimulation), and the fact that I was one year older. The results were 15 eggs, 9 mature, 7 fertilized, 1 ok embryo at day 5, and by day 6 it had arrested. So my question is do you have any theories why the results were so poor this time around? The breastfeeding, the clomid, or just horrible egg quality? I’m trying to figure out if it is worth trying another fresh cycle at some point or if it’s time to move on to other options. Thanks very much.
I should add that the intent of this latest cycle was to freeze whatever embryos we got, not to move on to the implantation stage.
Hi Stacey,
In a young woman like you are, the most common reason for por egg quality i sthe porotocol used for ovarian stimulation. In my opinion, clomiphene should not be used in women with DOR.Women 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”.
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?
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•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.
Geoff Sher
Dear Dr. Sher
Thank you so much for your response the other day.
Im still not sure what protocol I should suggest to my doctor since he seem to prefer a short protocol with more stims.
I had two failed IVF –
First one 225 gonal f – At the ultrasounds I had 8 follicles, 5 follicles and at retrieval 4 follicles but only one egg,
Second one 350 gonal f – Only two follicles at every ultrasound but only one at retrieval and again only one egg.
The doctor said my eggs looked good, fertilized well and cleaved nicely. But no pregnancy.
I have endometriosis which has caused an elevated FSH (14,9) and a low AMH (2,9 p/mol).
Which protocol would you suggest? Maybe the long lupron?
Im also afraid its my endometrium that is hostile since the eggs dont attach. I have a 3 year old child so im not sure whether I should worry about that? He did attach and I had a good pregnancy (He was made with IUI in a non stimulated cycle and in attempt two).
Hope you can give me some advice.
Quite honestly, I am not comfortable in telling your RE how to stimulate your ovaries. That would be too intrusive and presumptive. I can just say that if I were treating you, I would 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”.
Good luck!
Geoff Sher
I have had repeated egg donor failure. 8 embryos transferred of good quality from young donors. I tested positive for natural killer cels and cytokines (?) and therefore had intrapalid treatment. Is there anything else i should consider before moving to surrogacy? I feel surrogacy may be the only option left for us. We never tested husbands karyotype – could this be an issue? thank you
It is important to have your and your partner’s blood tested for DQ alpha and HLA genetic matching to see whether you might have an alloimmune cause for the NKa…because treatment of this differs as does outcome. The best lab for doing such testing is in my experience, Reproductive Immunology Associates (RIA) in Van Nuys, Ca.
Good luck!
Geoff Sher