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 have a question regarding ongoing immunologic treatment into the 2nd and 3rd trimesters. I just entered my 3rd trimester and have been advised to continue receiving intralipid treatments and take 20 mg prednisone/daily for the following results:
%CD19 18
%CD19+cells.CD5+ 2
TNF-a:IL-10(CD3+CD4+). 52
For background my history is: 4 early (8w) miscarriages, followed by a successful pregnancy with IVIG at confirmation and 1 Intralipid at 16w and a 2nd pregnancy with IVIG at confirmation and 2 subsequent intralipid treatments, the last at 18 weeks (APA+, ANA+, ATA+, hypothyroid, MTHFR; taking baby aspirin, lovenox, metanx for all successful pregnancies).
With this pregnancy I have been receiving intralipids every 3 weeks. While I am fine continuing the intralipid treatments until the end I am not okay with the use of prednisone and am wondering if you think that the above tests results warrant the risk of taking prednisone this late in the pregnancy. My Dr. is either unable or unwilling to explain to me the reason other than the numbers are up and must be decreased. In your experience do those raised number pose a significant threat to my child, or am I past the danger point now that I have hit 28 weeks?
TIA!
Respectfully, I do not think it necessary to take IL beyond the 2d dosage (i.e. taken once the pregnancy test is +ve). As far as steroid therapy is concerned, my patients start weaning of it at 8 weeks and discontinue at 10 weeks gestation.
Geoff Sher
I have gone through my first IUI today on day 15th of my cycle. My monthly cycle comes every 36th day. When should I test for pregnancy through the home pregnancy test kit?
In about 2 weeks.
Good luck!
Geoff Sher
I’m a 21 year old female trying to conceive. I have been of the contraceptive injection since May 2014. I am ovulating as normal. However I was involved in a seriouse RTC in May 2013 and as a result sustained seriouse internal/external bruising to the abdoman and surrounding areas. I haven’t been to see a doctor yet but I am getting very concerned. Could this be affecting me he thong pregnant??
I really doubt it but definitely get checked up.
Geoff Sher
Hi. I feel like I maybe a very complicated case and may need to move to donor eggs. By husband and I are turning 31 this year and have had 2 failed rounds of IVF (April & June) this year. I have MRKH (Congenital absence of a cervix and uterus) all of our blood tests and his semen analysis including Dna defragment all came back great for both of us. I am ovulating normally as well.
IVF #1 puregon +orgalutran +5000 hcg trigger
– Mild OHSS (1L of fluid)
– 32 retrieved – 8 post mature, 8 mature, 16 immature. 5 fertilized ICSI only 2 of good quality on day 3 and frozen.
– 1 failed 3 day transfer to our surrogate
IVF #2 puregon (lower dose. 100 daily) + metaformin +orgalutran + lupron only trigger
– 22 eggs retrevied. 11 ICSI /11 IVF
– ICSI batch = 4 mature, 1 fertilized
– IVF batch = 6 fertilized
– 7 embryos still growing on day 5 but never reaching blastocysts on day 6. Failed cycle.
Should we try a 3rd round and if so switch clinics? Should we move to donor eggs now?
Many thanks in advance for you advice!
Katie
I am very familiar with MRKH and have treated several patients with this condition over the years. Indeed you would need a gestational carrier, that is a given! However, MRKH does NOT affect egg quality and at your young age, your inability to propagate viable embryos has nothing to do with MRKH. It much more likely has likely to do with the protocol used for ovarian stimulation and that being a high responder you are at risk of egg developmental problems during stimulation and which need of an individualized and much more customized protocol (see below).
I strongly recommend that you visit https://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.
• 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
• How Many Embryos should be transferred: A Critical Decision in IVF.
• The Role of Nutritional Supplements in Preparing for IVF
• 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?
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 have seen that you have recommended to several women with PCOS or possible PCOS that they NOT do an A/ACP protocol, but instead do a Lupron only long down-regulation protocol. Is this to prevent any of the woman’s own LH at all from entering the blood? Isn’t a little LH a good thing? Is it then added in the stimulation medicine? Also, for women whose LH is higher than their FSH (mine is 13 while the FSH is 7) but who have no other symptoms of PCOS (I have regular periods, no hirsutism, I am thin, have low cholesterol and triglycerides and a normal glucose challenge result), would you still advocate the Lupron only cycle just to be sure, just in case, or would the A/ACP protocol be better? I am 38 years old with an AMH of over 2.
PCOS is often associated with ovarian hyperstimulation syndrome and this in my opinion requires “prolonged Coasting (PC)” to treat optimally. PC requires that you be able to correlate respose to stimulation accurately by measuring serial blood estradiol levels so as to know whne to initiate and stop the “coasting” (see below). PC is a novel approach that protects egg quality while preventing the development of OHSSS and has established itself as a “standard of care”. It involves withholding gonadotropin therapy while continuing the administration of the GnRHa and waiting until the plasma estradiol concentration drops below 2,500 pg/ml. Thereupon hCG is administered. In such cases, regardless of the number of developed follicles or the number of eggs retrieved, these women rarely, if ever develop OHSS. It has been reported that while PC virtually eliminates the risk of life-endangering complications associated with OHSS, there are reports in the literature that “the price to pay with PC” is often a poorer fertilization rate and reduced embryo implantation potential, compromising the pregnancy”. It is the author’s opinion an experience in the development of PC that egg/embryo quality deficit likely has little to do with the process of PC, itself and can be explained as follows: When PC is initiated too early, follicle growth and development may cease (as evidenced by the estradiol level plateauing or falling immediately, rather than showing an initial continued increase), and when PC is started too late, the follicles will often become cystic, measuring >21mm by the time the estradiol level falls below the safe threshold of 250000pg/ml, and so harbor dysmorphic eggs. Thus precise timing of the initiation of PC is critical. It should in pact be initiated preemptively in all cases when there are more than 25 follicles and the plasma estradiol reaches or exceeds 2,500pg/ml in association, provided that at least 50% of the follicles measuring 14-16mm in mean diameter. Not a day sooner or a day later. If PC is initiated with precise timing, it will usually be followed by a further progressive rise in the estradiol concentration. After a few days, the estradiol level will plateau and then it will start to fall (often rapidly). The temptation to trigger with hCG before the estradiol level falls below 3000picogtrams per milliliter must be resisted …even if the level falls below 1,000pg/ml by the time hCG is given.
I strongly recommend that you visit https://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.
• 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
• How Many Embryos should be transferred: A Critical Decision in IVF.
• The Role of Nutritional Supplements in Preparing for IVF
• 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?
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.