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,
I am 22 years old and have pcos on both ovaries. They gave me clomid 50 mg to help me ovulate but it did not work. My concern is that they never did blood work to see if I was truly ovulating on my own before giving me the medication. Can clomid damage my cycle if I was really ovulating? And also my period are 36 days long and I have been ttc with my husband of 3 years.
Thank you!
I take it that the diagnosis of PCOS has been confirmed and the variety is known (primarily pituitary-ovarian or adrenal). This needs to be done to define the best treatment modality. And yers, in my opinion, if the wrong approach to stimulation is taken, it can compromise ovulation.
I think you need to be stimulated (very cautiously because of the risk of hyperstimulation) using gonadotropins.
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): Selecting the ideal protocol
•Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•Induction of Ovulation With Clomiphene Citrate: Mode of Action, Indications, Benefits, Limitations and Contraindications for its ue
•Clomiphene Induction of Ovulation: Its Use and Misuse!
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•Traveling for IVF from Out of State/Country–
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!
•Micro-IVF: Often Preferable to Ovarian Stimulation with or Without IUI
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,
I am writing to you because i am facing a big dilemma. I am 39-40 years ol. Last years, I tried 3 IVF, Antagonist protocols, with basically BCP for 3 weeks before, testosterone patch and Fostipur 300IU, the first 2 days while afterwards Menopur 300IU , and finally Centrodite till the trigger. This protocol has been decided from my doctor that with FSH 12,12 and LH 1.14 believes i have DOS. I had one chemical pregnancy, and one miscarriage in 6,5 weeks (biopsy showed trisomy on Chromosome 20). My doctor pushed me in ovodonation since the second try. Said that this is the best solution for me since she doesn´t believe i have good quality eggs. The eggs i produces in every IVF where 6-9, and always all mature, about 5 every time always fertilised and both of them were transfered at day 3.
So I convinced that i am not able to use my DNA, and i went for an egg donation in a clinic in overseas. But the doctor that saw me, said that my case its not so severe for move on egg donation. She saw my ovaries healthy and also AFC about 10 eggs while i had just ovulated. He saw my uterus and etc, and he conclude that i should do a mild IVF, without downregulation with BPC and without testosterone patch! No need to stress ovaries to produce numbers of eggs that we dont need. I was surprised! It was the first time that somebody was talking nice about my ovaries and my eggs as he mention that protocols can affect the quality of eggs and number its not always an issue in your age. He said that we change Menopur, and we introduce pure FSH 225UI Altermon , with 75IU FSH:LH Merional ( i understand that he reduce the LH in the dosis of 300IU) .
Since i was ready to give up tries, i am confused.
– Can finally protocols affect egg quality and destoy eggs? My ex doctor never told me that, only keep saying that all my eggs are old and bad quality. Could be that even its existing one good maybe will be affected by a wrong protocol?
– Its true that a different portion of FSH / LH can affect outcome?
– Can testosterone patch jeopardize my eggs instead of help? Do you think that the testosterone protocol with mild down regulation push my ovaries too hard? (just to mention that the first IVF was without down regulation and my eggs grow very fast and and we trigger in 7 days of stimulation , while in the next two with BCP, took them 14 days till trigger) ..
– Should i try other protocols, and if yes, what in general you suggest?
I am really looking forward for your reply ,
Geo
Respectfully, in my opinion, aside from advancing age (which directly affects egg “competency”), the protocol used for ovarian stimulation also can profoundly affect egg quality.. I also do not support the use of approaches that profoundly increase exposure of the ovaries to male hormones such as testosterone (whether induced by LH or directly through exposure to excessive administration of such hormones), especially when it comes to older women and those who have DOR…see below! I also do not believe in lowering the stimulation protocol when ovarian resistance is increased due to DOR.
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
Is it normal to have a delay in the 2nd period after fet? I had a failed fet. Got my period a few days after stopping crinone gel. Now my period is 3 days late and I am always regular, like clockwork, never late. We have MFI (azoospermia) so natural pregnancy is out of the question. Any ideas? Suggestions?
That can and does happen because the HRT for the FET can temporarily disrupt cyclicity.
I have been charting my BBT for three month now and using the clearblue fertility monitor for two months. My chart has showed I ovulate on the 18th day by my BBT calculations but my monitor only has shown lows or highs. Then this cycle on the 25th day I got a peak reading on the monitor. Today is day 29 and no period. Is the Peak reading a possible positive pregnancy reading?
No! There is no cross-reactivity between LH (the surge at ovulation) and hCG. Thus a positive ovulation test in no way implies a positive pregnancy test.
Geoff Sher
Hello Dr. Sher,
I am a 38 year-old woman who has never been pregnant, with one distal blockage in the left fallopian tube and on the right side the dye sprayed upwards on the HSG. I was diagnosed with probable endometriosis based on this and other symptoms. My day 3 test results were FSH 7.41 mIU/mL, LH 13.07 mIU/mL and 17-Beta Estradiol 65.63 pg/mL, although my estradiol level made my RE suspect that it was actually later than day 3. My prolactin was 19.75 ng/mL, TSH 1.54 uIU/mL, Testosterone 0.3 ng/mL. My AMH was 2.21 ng/mL which my RE said did not match the other levels. She told me it was taken with the older system and there is a high margin of error. She counted 5 antral follicles on my right ovary and 3 on my left.
For my first and only IVF cycle, we did 150 IU of Gonal F and 150 IU of Menopur starting from day 3. On the first ultrasound on day 7 I had about 7 follicles visible on the right ovary, several of which were already at 13 and 14mm. There were fewer on the left, and they were smaller. I started Cetrotide 0.25 mg that day, and also took it on day 8. On the day 9 ultrasound I had 8 mature follicles ranging from 18 to 21 mm, and some smaller ones that were about 13 mm and 14 mm. I was advised to trigger that night (Ovitrelle 250 mcg). We did the egg retrieval on day 11. I understand that’s pretty early. Afterwards, they told me the bigger follicles were “empty” and they had only been able to retrieve 4 eggs. Apparently the zona pellucida was hard and since there was a slight male factor they didn’t want to take the chance that they wouldn’t fertilize normally, so they used ICSI. The next morning they called to say they had to discard 3 eggs which were not mature and 1 had fertilized. They did a day 3 transfer.
My question is, do you think the reason my follicles grew so rapidly and the zona pellucida was quite hard could have anything to do with the protocol, or is it simply connected with my age? If I were to attend your practice, given these results would you have me try a different protocol, or do you think what I did the first time round was the best option for me?
Thank you very much for your help.
Hi Allison,
Very respectfully, and recognizing that there are differences of opinion when it comes to protocols of stimulation and their implementation. In my opinion, the protocol used in your case should be revised. I would not use a late antagonist protocol and I would trigger with 10,000U of hCG or 500mcg of Ovidrel rather than 250mcg. It is in my opinion very possible that your “empty follicles” could be linked to the stimulation…see below! Also, in my opinion, your basal FSH/LH/E2 and AMH and the fact that aside from 10 larger follicles there were also numerous smaller ones that did not evolve on stimulation, indicates that you have normal (rather than reduced) ovarian reserve.
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?
•Blastocyst Embryo Transfers Should be the Standard of Care in IVF
•Why did my IVF Fail
•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
•Endometriosis and Infertily
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•Fertility Preservation (FP) Through Freezing/Banking Human Eggs
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