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.
the doctor said my three eggs were empty are all my eggs empty. what can I do to improve I am 39
In my opinion, this could be an ovarian stimulation issue.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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, with an AMH of 36 and after 3 failed transfers with PGD tested embryos, what are your thoughts on pursuing IVM?
Whenever a patient fails to achieve a pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
5.The cause of the infertility: Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa)
Patients often ask me the question…”When should I stop doing IVF” or “when should I move on to egg donation and/or gestational surrogacy?”. The answer does not lie solely in the number of prior attempts made. Rather it is “when in spite of thorough evaluation” there is no “remediable/treatable cause” for failure that can be identified.
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)
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Why did my IVF Fail??
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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,
How long does intralipid take to work? Is 2-3 days prior to transfer sufficient time?
Thank you for helping me (and so many other women out there).
Best regards, Mel
At least 7 days prior to transferring embryos, but ideally 10-14 days prior to embryo transfer.
Good luck!
Geoff Sher
Hi Dr. Sher, I am a Year 12 student and I am conducting a research project on ‘Should there be a cut off age as to when you are viable to get an IVF’. I would like to know your opinion on the matter.
Madeline Kelly
Hi Madeline,
I am not sure I understand your question so I decided to post an article I wrote a while ago on age an IVF outcome. If this does not address your question, please restate it and I will take another stab once I understand precisely what you are asking:
There is currently a lively media debate raging on whether a woman’s age, sexual orientation, marital status or economic strength should influence her eligibility to undergo advanced fertility treatments such as IVF. Perhaps not surprisingly, the most vociferous opposition has come from those who already have children of their own, from women who in spite of (often repeated attempts at) fertility treatments have failed to conceive and from those who for whatever reason have chosen not to have children.
Discrimination on the basis of the woman’s age:
Those who speak out against older women (over the age of 50 years) embarking on a quest for parenthood usually parents use two arguments to support their position. The first is that pregnancy carries with it such significant, incremental age-related medical risks to both mother and baby that it is inordinately dangerous for older women to conceive and accordingly that any medical interventions aimed at propagating conception would verges on being morally and ethically reprehensible.
The second argument relates to parenting risks. The argument advanced is that with progressive aging, older women will lack the physical ability to share in the common formative physical activities with their offspring, and that the emerging generation gap would ultimately become so wide as to compromise child rearing and finally, that there would be a greater risk of the child being orphaned at an early age without having fully benefited from parenting.
1. Age-related medical risks: It is indeed indisputable that in general, pregnancy in older women is associated with increased risk to both mother and baby. Pregnancy-induced complications (e.g. preeclampsia, gestational diabetes, intrauterine growth retardation, premature separation of the placenta, preterm delivery, low birth weight, dysfunctional labor and caesarean section) are all far more likely to occur in older women. However, this risk can be mitigated by in advance identifying those older women who are most predisposed to developing such complications.
The following assessments in advance of pregnancy would allow for screening out those women who for medical reasons should not undergo fertility treatments:
Tests of cardiovascular status include physical examination, effort EKG , blood lipid-profiling and Chest X-ray
Predicting the risk of gestational diabetes through glucose tolerance testing and blood insulin levels
Assessing the risk of preeclampsia by testing liver enzymes, blood BUN, electrolytes and creatinine and through advance evaluation for hereditary blood clotting; tendencies (thrombophilia)
Evaluation of the integrity of the woman’s reproductive apparatus through physical and pelvic ultrasound examinations
Tests for blood diseases such as severe anemia, lymphoma and leukemia include a complete blood and platelet count, measurement of the blood sedimentation rate, iron and folic acid levels as well as selective evaluation of women of African extraction for Sickle Cell disease and those of Asian and Mediterranean extraction for Thalassemia
Psychological screening
When women so deemed to be at risk are selectively precluded from proceeding, the physical risk of age-related complications can be minimized.
2. Parenting risks: The common argument made is that the mother might either not live long enough or because of age-related maladies, might not be able to afford her child all the benefits of parenting. I would argue that less than 5 decades ago the average lifespan of women was in the mid-70. Today through women commonly live into their eighties. While it is true that advancing age might well compromise the ability to fully participate in some physical activities with their children, other advantages that age brings to child rearing such as enhanced wisdom, and a greater likelihood of financial and marital stability as well as preservation of the nuclear family, would in my opinion more than offset any disadvantages. Rather such age-related benefits might better prepare children for the real challenges of life in the 21st century. But surely the same parenting concerns should apply to men becoming fathers at an older age. Singling out women in this regard represents a double standard and is somewhat sexist, in my opinion.
Good luck!
Geoff Sher
Dear Dr.Sher,
Is Cetrotide the same as Ganerelix. I react well to Ganerelix and want to know if Cetrotide is exactly the same thing. Thanks
It is identical Tiarra!
Please visit my new Blog at http://goo.gl/4hvjoP , 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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