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.
Hi, I’m 32yrs old. Hx of Ectopic pregnancy with total right tubal removal. And hx of PCOS. I’m currently taking Metformin 1500mg po qd. I’ve done 1 unsuccessful round of Clomid. I recently had another U/S of my ovaries, and they’re way worse than that of 7 years ago. (They look like popcorn) Anywho, my husband and I have been trying to conceive for the past 5 years. I’ve done pretty much every otc method I can possibly think of. I’ve done so much research and have tried so many things. I’m completely desperate. I’m so scared of surgery, and to have IVF. Plus the cost is daunting. Is there anything that I can do? Anything you recommend? I feel that I’m not thinking outside the box enough. I have 1 tube, and 2 cystic ovaries. I’m slowly gaining weight, and it won’t come off despite my rigorous activities and dieting. I fear that gaining weight greatly reduces my chances for conceiving. Please advise. Thank you Dr!
It sounds as if aside from IVF you have tried everything else. I would be happy to talk to you about your problem in a Skype consultation if you wish.
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
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•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
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•“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
Dr. Sher
I apologize if I missed this answer, but in your article about implantation dysfunction, you say the reason was that there were killer cells present… I missed what the treatment was? All I saw was IVF… was there a particular medication or pro?
I am weeks away from being 34 and no pregnancies yet. I have had all testing done to find that I am completely healthy. I have a great donor who is genetically awesome and I think this is my first time of having conception take place but no implantation. Going into the next cycle, I’m looking for anything I can do to promote implantation.
Thanks.
Hi Athena,
Treatment depends on the type of immunologic implantation. It is not the same in all cases (see below).
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
•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?
•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
•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
Dr. Sher,
I asked a question a while back talking about how I’m a 31-year-old, healthy weight, naturally muscular build, generally active female with a 29-year-old, healthy very active husband. My general labs always come back normal. As a teenager I had heavy periods and a few cysts and was subsequently diagnosed with PCOS. I was simply placed on birth control to control it. None of my doctors since have labeled me as having PCOS. I never had acne, weight issues or glucose issues.
Here are some labs taken back in Nov of 2015: My AMH 3.22 ng/mL, FSH 17.1 mIU/mL, LH 68.3 mIU/mL, TSH 1.540 uIU/mL, estradiol 257.2 pg/mL (although in another more recent estradiol test it was 16 pg/mL … I have no true understanding of these numbers other than that they change throughout cycles), progesterone 0.3 ng/mL, serum testosterone 14 ng/dL, free testosterone 1pg/mL, and I also had normal glucose test. Just last month we also tested my OH-17-progesterone and my DHEA-S. Both came back low although I’m not sure of exact numbers. My vitamin D came back low too at 29.5 ng/mL. I do have high platelets at 480. I tend to take after my father and have low/normal blood pressure.
After being on birth control pills follows by gonal-f, menopur, and certitude, I had two egg retrievals. In both we had more follicles than the number of eggs we got (15 follicles with only 6 eggs retrieved for the first and 11 follicles with only 7 retrieved for the second). The first retrieval only saw one fair/poor blast make it to freeze. During our most recent retrieval (last month) we had 2 make it to blast for freeze. They were graded fair/fair.
Earlier this month we started estrogen pills and then added progesterone shots in preparation for the frozen embryo transfer. The FET took place yesterday. Doctor said everything went well, so fingers crossed for achieving pregnancy.
I’ve been on metagenics prenatals, vitamin D3, CoQ10, baby aspirin, and Bromocriptine (for a prolactinoma) throughout ivf treatment. Since the reason for my poor egg response has not been apparent and pretty much stumped my doctor, she asked colleagues for their opinions. With that feedback she told me after the FET yesterday to start taking 50mg DHEA 3 times daily. This makes me feel she and her colleagues may see me as having some adrenal fatigue (although that was not directly stated). However, from what I’ve read generally DHEA (sometimes in addition to CoQ10 or another supplement) is prescribed for ivf patients a few months prior to starting an ivf cycle to help improve egg quality and quantity.
Have you heard of doctors recommending or would you yourself ever recommend patients start DHEA after a frozen embryo transfer as mine has?
Thank you.
One of vthe most importand indications of hypothalamic/pituitary PCPOS (the most common variety, is the basal (day 3) FSH:LH ratio. In your case the measurements done were NOT basal . I know this because your E2 was >70pg/ml at the time. Thus you were already into the cycle when the tests were done. Respectfully, it is not possible to assess this ration unless the FSH/LH/E2 was measured at the right time . Also, it is important to know what your DHEAS and 17-OH progesterone level was at the same time. Elevation of the latter could pont to an adrenal cause of PCOS.
I do not ever prescribe DHA therapy in woman suspected of PCOS. It converts to testosterone in the ovaries and in my opinion, the last thing such women need is additional ovarian male hormone production.
In my opinion, it is very possible that your egg/embryo quality issue (and the numerous “empty follicles) you get, could be associated with the protocol(s) used for ovarian stimulation and/or the metod and dosage of the “trigger”….please review the relevant articles below, carefully.
By the way, even if DHEA is used, I franlkly do not see a reason to use it in embryo recipient cycles (e.g.FET).
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
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•IVF Egg Donation: A Comprehensive Overview
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•“Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
•: What are the Implications when it comes to Pregnancy?
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, Is there any difference between blastocysts that reach blastocysts stage at day 5 compared to day 6? Many thanks.
Probably so Sheeena,
In my opinion, day 5 blastocysts have the edge when it comes to “competency” (i.e.the ability to propagate a viable pregnancy).
Geoff Sher
Hi Dr Sher, I have previously asked you about PCOS. I’m 44y, AMH 17.6, FSH 9.1. In 2009 I tested for PCOS but the tests were inconclusive (although there were some symptoms of PCOS). The only symptoms I have now is irregular periods (although it has become more regular). I am not overweight (I am slim), no facial hair. In the past I did get a little bit of acne on occasion but that was several years ago.
Is there anything I can do to check for PCOS or higher testosterone? Should my protocol still be modified as if I do have PCOS?
I have done 2 IVF cycles and banked 9 blastocysts (7 to day 5 and 2 to day 6).
Thanks so much for all your help!
You could have your day 2-4 blood tested for FSH/LH/testosterone/DHEAS/androstenedione/17-OH progesterone/insulin and nHB A1C. Perhaps you have already done so? If so , if you post these I would be happy to comment.At 44y (and especially if you have PCOS) however, you will likely have >90% of your eggs/embryos chromosomally abnormal (aneuploid). Two things are important to try and contain this. The first is to select a very strategic and individualized approach to ovarian stimulation (see below) and the second is to try (through PGS testing) to identify those embryos that are euploid (chromosomally, numerically normal) and thus more likely to be “competent” to propagate viable pregnancies.
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.
•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
•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
•The Basic Infertility Work-Up
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•“Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
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.