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,
If natural LH surge occurs and the exact time is known but retreival is done 42hrs after the natural LH surge, does it affect the egg if the egg is still retrieved?
Thank you for this wonderful forum.
That is too late! Either ovulation will have occurred or egg quality will be compromised.
Geoff Sher
Hi Dr. Sher,
I just found out on Monday that I’m pregnant from my first FET. I’m unclear about how much exercise is safe at this point. I’ve been a marathon runner for many years, and I also strength train with moderate weights several times a week. At my transfer, my doctor instructed a few days of bed rest and then only walking, no more than an hour (3 miles). I have only seen the nurse since, and when I asked if I can do a little more, she suggested that I do even less, 30 min walks max, until we hear a heartbeat in a couple of weeks. I’ve read a lot about the importance of exercise during pregnancy, and how seasoned athletes can continue with their exercise routine, albeit with a few modifications. How much exercise is too much at this point? I don’t want to risk losing the pregnancy by overdoing it, but I also don’t want to sit around all day. I’m a teacher, so I don’t even have work right now! Your thoughts are appreciated.
Anything that requires over-exertion is not a good idea.
Geoff Sher
Hello, Dr. Sher.
My RE wants to do a 30 day prime with hgh, however I do not want to spend that much money, out-of-pocket, for a medication that does not appear to have much evidence based research to prove it’s efficacy. We are contemplating a 7-10 day prime instead. What are your thoughts on the human growth hormone?? I am apprehensive about it at this point.
Much thanks.
A woman’s reproductive potential is very much influenced affected by her “biological clock” which comprises two components:
1.Age: Advancing age is inevitably accompanied by a progressive reduction in the number of eggs in the ovaries (“ovarian reserve”). As a diminution in ovarian reserve (DOR) ultimately passes a theoretical “threshold” the woman becomes progressively more resistant to stimulation with fertility drugs. This is accompanied by a fall in blood AMH levels and a rise in basal blood FSH. After several years of progressive DOR, the ovarian reserve is ultimately depleted, and ovulation as well as cyclical menstruation ceases (menopause).
2.“Egg Competency” The second component of the biological clock is an inevitable age-related decline in egg competency (the ability of an egg, upon fertilization, to propagate a healthy embryo) . The most important manifestation of this age-related occurrence is an inevitable and rapid increase in the percentage of eggs that have numerical chromosome irregularities (aneuploidy). By way of example, at age 30Y, about one out of every two human eggs will be aneuploid while at 45Y more than nine out of ten are so afflicted. Aneuploid eggs cannot propagate healthy babies. Most will not even fertilize and those that do, will usually be lost as early miscarriages or go on to produce a birth defect such as Down syndrome.
It is important to understand is that e the two components of the biological clock (i.e. ovarian reserve and age) represent variables which while they are often interrelated and inter-dependent can often exist independently. By way of example, some older women in their mid-forties have excellent ovarian reserve while some young women in their thirties have DOR. Yet while they produce fewer eggs, the potential competency of the eggs they produce is largely tied to their age. However, the ovarian hormonal environment brought about by DOR and the protocol used for ovarian stimulation, is readily affected by the protocol used for ovarian stimulation. Selection of the wrong stimulation protocol can adversely influence egg competency. Conversely, an individualized and optimal protocol for ovarian stimulation by favorably regulating the ovarian hormonal environment, can improve the potential for optimal follicle and egg development thereby minimizing the risk of egg aneuploidy. The problem is that it becomes progressively more difficult to optimally regulate the intra-ovarian hormonal environment in older women, and in those with DOR, and it is here that the use of human growth hormone can play a valuable role.
Several researchers have shown that the administration of human growth hormone (HGH), as an adjunct to ovarian stimulation, enhances follicle response in older women and those with DOR and so can help optimize egg quality. It is thought that HGH hormone by increasing the production of insulin-like growth factor 1 (IGF-1), improves follicle development, estrogen hormone production and egg maturation. Two basic mechanisms have been proposed: 1) improving the response to gonadotropin therapy by up-regulating the FSH receptors on the granulosa cells that form the inner lining of follicles and, 2) through a direct enhancing effect of HGH on the egg’s mitochondrial activity. While human eggs do have HGH receptors, those retrieved from older women show decreased expression of such receptors (as well as a reduction in the number of functional mitochondria) as compared with those derived from younger women. In fact, it has recently been shown that older women treated with HGH showed a marked increase in functional mitochondria in their eggs along with improved egg quality.
My own experience in selectively prescribing HGH as an adjuvant to women with DOR, older women and those with unexplained egg quality deficits, is that if used in combination with individualized protocols of ovarian stimulation it does indeed enhance egg quality and ovarian response, culminating in improved IVF outcome.
Hope this helps!
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.
Please i need your advice on my Ivf process,
I am 45years, had an Ivf process this month using a donor egg, 8 eggs were fertilised,7 embryos were gotten, 5 were of grade A and 2 grade B.
5 of grade A were transefered but went for pregnancy test as scheduled but it was negative and have not seen my period or any blood. Today is my 19th day of plantation. Though I was ask to come back for another test on day 20 which is tomorrow 30th of June.
Please help me, I don’t know what the problem is.
Thanks
Hi Funmi,
I would like to help but to do so authoritatively,. I would need much more information.
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,
You may remember me. We had a consultation by Skype in 2015.
In April 2016, following your advice on treatment with heparin, dexamethasone and intralipids, I have become pregnant through a frozen donor egg cycle in Prague.
I am 11 weeks 3 days and so far all going well. I have tapered off dexamethasone and duphaston but Dr Gorgy here wants me to continue until week 12. It is a bit concerning to me to continue as you had adviced to start tapering off dexamethasone from week 8-10. I have thrombophilia, high NK cells, PAI-1 gene mutation and protein S deficiency.
My next scan is planned July 8th but my work requires me to fly to the Netherlands early next week just in the 12th week. Due to my thrombophilia, I am very worried about flying but I cannot change the dates or commitment. What would your advice be knowing the flight is short less than 1 hour. Is it safe to fly if I take heparin and aspirin before the flight? Can flying in week 12 cause a miscarriage? I am very thankful for your thoughts as I have got that far and the little one’s heartbeat is good and I would not want to take a risk. Many thanks indeed for all your help in getting js there!
Firstly, congratulations to you and to your treating RE in Prague. I do nt think that going an extra 2 weeks on the dexamethasone will do any harm. Nor would the trip to Holland be harmful at all.
Good luck!
Geoff Sher