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
I would like to thank you for your guidance and valuable advices for my case.. I have PCOS .. young 31 years old…and I had empty follicle for several cycles…your advice was to apply long down regulation protocol.. I discussed that with RE and we put the next plan:
1. taking monophasic birth control pill (BCP) for 42 days.
2. The last 4 days on the BCP is accompanied by the addition of decapeptyl 0.1mg.
3. Thereupon the BCP is stopped and decapeptyl therapy is continued.
4. After 3-7 days menstruation usually ensues, low dosage FSHr (Gonal-F 75 IU) -dominant ovarian stimulation is commenced. Lupron and gonadotropins are then continued together.
5. the gonal-F is stopped and Seventy five (75) units of LH/hCG Menopur is added from the 3rd day of gonadotropin stimulation.
6. we continue according to the number of follicles and their development.
7. pregnyl 10000 IU or ovidrel 500 mcg as a trigger shot 36 hours before Egg retrieval.
I want to ask you if you agree with the plan .. and your reply will be very grateful
Sounds good to me!
Good luck!
Geoff Sher
I am 52 yrs old, and I am post menopause. I have only been pregnant twice, one miscarriage 20 yrs ago, and one live birth 25 yrs ago . I do not want to carry a child/get pregnant my self. I would like to if it is possible have a child via a surrogate using my eggs (if there are any good ones left), and my husbands sperm. This is his first marriage and he does not have any kids of his own. Is this option possible or would we have to do a surrogate using donor eggs. (he is 53 yrs old)…
Hi Regina, using your own eggs at 52Y is not an option….in my opinion.
Geoff Sher
Hello, Dr. Sher:
I am a 32 years old woman who had never been pregnant before. Due to abnormal uterine bleeding with endometrial polyps I had hysteroscopic resection of endometrial polyps and endometrial curettage procedure in Sept. 2015. And it was a success.
In March 2016 I had HSG done with the results: unable to successfully visualize bilateral fallopian tubes and unusually angulated endocervical canal with retroverted uterus. The doctor considered total occlusion bilaterally; however, he was not able to completely exclude tubal spasm.
I had AFC counted as 8 (Feb. 2016 around Day 10), 11 (April 2016 on Day 3), 5 (June 2016 Day 3) and 1 (Day 2 July 2016). My RE thinks the sudden number drop is caused by stress. My numbers are:
FSH 12.9; LH: 8.6; Estradiol 33.4 (March 2015 Day 3);
FSH 10.7; LH: 7.2; Estradiol 33.0 (May 2015 Day 3);
FSH: 10.8; LH: 5.8; Estradiol 28.9; Progesterone 0.7 (April 2016 Day 3);
FSH: 10.1; LH: 7.2; Estradiol 29.2; Progesterone 0.6 (June 2016 Day 3);
Starting from Feb 2016 I have been taking wheatgrass, royal jelly, coQ10, Vitamin C, Vitamin D, and Levothyroxine (this is to improve my TSH level). I also took DHEA about 3 months from March 2016 to June 2016 because my first RE told me DHEA can be taken for no more than 3 months to increase AFH counts. In April 2016 I changed my RE. I stopped taking DHEA after June 2016 Day 3 since I saw a sudden decrease in AFC count. But what makes me confused is my July 2016 result.
FSH: 25.3; LH: 11.9; Estradiol 16.7; Progesterone 0.4 (July 2016 Day 2).
I have not got a chance to talk to my RE. But I am worried about this sudden FSH spike. Dr. Sher, have you seen any patient experiencing similar situation? And if so, what could be possible reasons? Stopping taking DHEA is the only thing happened that I can recall between last month’s AFC count and this month’s AFC count. I understand small fluctuation of AFC and FSH; but do not know why sudden spike happened.
Thank you very much for your help.
Hello, Dr. Sher.
I am sorry that I forgot to mention my AMH is 1.53.
Thank you very much.
Clearly you have a rapidly declining ovarian reserve. While the rise in FSH strongly suggests this, your AMH confirms it. I also respectfully recommend against using DHEA (see below) and can tell you that in my opinion you need a vedry individualized and strategically implemented protocol for ovarian stimulation (see below).
Women 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.
•Nutritional supplements in IVF
•DHEA
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. My husband and I started trying for a family in 2008. After months of nothing happening, we went in for evaluations. Nothing came up on my end but my husband was diagnosed as a carrier of cystic fibrosis and no vas deferens. We were told that IVF would be our only chance of biological children but we couldn’t afford it at the time. Finally in 2015, my husband went in for a PESA which was successful and we were told that it was good enough to proceed with IVF/ICSI. My Doctor at the time (we’re military so physicians are rotated and I don’t consistently see the same person), said I was developing OHSS during stim (Lupron, Menopur, and Gonal-F, standard trigger) so I knew we’d have to freeze whatever emrbyos we ended up with in October. They collected 34 eggs from me, 32 were mature, 19 fertilized but over the course of 5 days, we only ended up with 2 embryos for cryo. March of 2016, we transferred the 2 embryos. By day 9, I was told that I was pregnant with HCG of 81. 48 hours later, that number had dropped in half and ended in a chemical pregnancy. In June we decided to try again and this time I got to see the same Doctor for the entire cycle. He put me on Ganorelix, Menopur, and Gonal-F but triggered with Lupron (co-trigger after retrieval with a small dose of HCG). I didn’t end up getting sick this time and while they were able to retrieve 25 eggs, 24 were mature and the numbers didn’t drop so significantly/rapidly this time. Because I didn’t develop OHSS, I was able to do the fresh transfer so we used two embryos again and froze the other 3 we had. I didn’t feel at all like I did last time and before my beta, I could tell it hadn’t worked. The beta was negative. I just don’t understand why this isn’t working. We’ve been made aware of the the impact MFI could be having on our outcome but I have some other concerns. During my initial uterine exam, I was told about an endometrioma on my left ovary. It wasn’t producing hormones and during both cycles, it didn’t really do much. I never even knew it was there but it’s of moderate size. Before we started our last cycle, my new Doctor did give us the option of removing the cyst and seeing if there was anything else going on but he said he felt comfortable proceeding if we did, so we did. Should this be addressed? When we reviewed our first cycle, I did notice a small remark from the embryologist about some of my eggs having hard shells but no one ever mentioned it to me. Could this be IID? We have three embryos left and I had to proceed with another FET if there’s an underlying issue that’s causing an issue with implantation. We’re supposed to meet with our Doctor next week for another cycle review and after reading your blog, I’d like to ask him what he thinks about IID. I’m an active, healthy person and I eat well but my new Doctor did notice a slight iron deficiency on my first blood panel before we started cycle #2 and he put me on an iron supplement. The only other supplements I took were prenatal and DHA. I just don’t understand why this isn’t working for us and I’m hoping for a different approach if we proceed with the few embryos we have left. IID? Surgery to remove the endometrioma? Would assisted hatching have made a difference? Endo scratch? Thank you!
By the way, I’m currently 32 and my husband is 33. My Grandfather had a form of lupus and my oldest sister has systemic lupus. I included this family history in my chart but no one has ever thought it to be relevant. I’m not sure what my current physician thinks about IID but it does make me very curious.
There are 3 issues here. The 1st is that yourv protocol for ovarian stimulation needs to be reviewed and probably modified in my opinion (see below) because this is the most likely factor that cann affect egg quality/competency. Second is the endometriosis that in and of itself can be a problem with regard to being associated with an immunologic implantation dysfunction in 1/3 of cases. The third is your tendency to overstimulate and the risk of OHSS (see below).
Whenever a patient fails to achieve a viable 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
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).
My answer to patients who ask me when is the time to stop undergoing IVF is ….Aside from the weight of the financial burden, the time to stop is when in spite of thorough and comprehensive evaluation, there is no remediable and treatable explanation for repeated failure.
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.
•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
•Blastocyst Embryo Transfers Done 5-6 Days Following Fertilization are Fast Replacing Earlier day 2-3 Transfers of Cleaved Embryos.
•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.
•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!
•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
•Endometriosis and Infertily
•Endometriosis and Infertility: Why IVF Rather than IUI or Surgery Should be the Treatment of Choice.
•Treating Ovarian Endometriomas with Sclerotherapy.
•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.
Hello doctor . We have been trying for pregnancy since February after a Myomectomy in November and noting since . I had a miscarriage at 19 weeks last July and was told preterm labor . The baby was chromosome normal . I had no infection . Lupus anticoagulant was normal . I suspect cervix insufficient not preterm labour . We tried prior to this pregnant for three years . IUI with menupor January failed , Femara natural cycle failed and natural conception by March with miscarriage my July . Okay so we did the Myomectomy . I notice my cycle days fluctuations 22-26 days I wonder if in perimenopausal . Progesterone 7 after ovulation was 5, fsh 12.91, testosterone 0.13, dhea 48. I suspect DOR . I’m 33 this August and have no children .
There are 2 issues . The 1st is probable cervical incompetence and the second that yo might have diminished ovarian reserve.
The diagnosis of cervical incompetence is usually strongly suspected on the basis of the following history:
•Recurrent second trimester miscarriages or premature births, in which both bleeding and painful contractions are minimal and the process is completed rapidly
•Few prior warning symptoms or signs
•Where the bag of bulging membranes often breaks followed by a sudden gush of water per vagina that heralds the onset of miscarriage or premature birth.
•A physician inadvertently detects a partially dilated and shortened cervix with routine pelvic examination performed in the mid-trimester of pregnancy.
Once, the diagnosis of cervical incompetence is suspected, it can and indeed should be confirmed on the basis of one or more of the following:
1.A hysterosalpingogram (HSG-dye x-ray test) to evaluate for a well demarcated anatomical transition from endocervical canal to the uterine cavity (without evidence of “funneling”) and to detect a deformity (congenital or acquired) of the uterus, that can also lead to mid- trimester miscarriage and premature birth.
2.A vaginal ultrasound examination to measure the length of the cervical canal (it should measure more than 2.5 cm) and to exclude pathology of uterine wall(e.g.; fibroids)
3.A diagnostic hysteroscopy to carefully evaluate uterine scarring, fibroid tumors protruding into or distorting the uterine cavity and for the congenital deformities such as a uterine septum.
Treatment:
Cervical incompetence is routinely treated by the placement of a temporary circumferential non-absorbable tape or suture around the neck of the cervix at the 12th-14th week of pregnancy per vagina (“McDonald cerclage”. The advantage of this approach is that the cerclage can readily be removed a week or two before delivery, thereby allowing a subsequent spontaneous vaginal birth to take place The disadvantage of placing a McDonald cerclage” is the ever present risk of puncturing the fetal membranes while inserting the stitch. This sometimes prompts the overcautious OB/GYN to place the stitch well below the cervical-uterine junction, thereby increasing the likelihood that it will slip or tear and thus fail to prevent cervical shortening and dilatation.
After undergoing a preliminary assessment to confirm the diagnosis of cervical incompetence, non-pregnant women in whom a McDonald cerclage has failed, should be considered for the elective placement of a permanent, non-absorbable cerclage “Shirodkar suture”(, prior to undertaking another pregnancy. In fact we believe that this should be considered as the primary (initial) approach. The reason is that in the absence of a pregnancy, it is possible, through careful surgical dissection, to ensure the correct placement of the suture (usually a double strand of #2 nylon is used), and in so doing, maximize its effectiveness. The one relative disadvantage to this approach is that the completely buried Shirodkar suture, is sometimes not amenable to removable before delivery. Accordingly, such women would require delivery by Cesarean section. Notwithstanding this, we hold that a Cesarean delivery, is a relatively small price for a woman who has usually experienced recurrent pregnancy loss, and/or repeated premature deliveries, to pay to have a healthy baby.
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.
• 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
•Why did my IVF Fail
•Secondary Infertility: Addressing the Root Causes
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies
•Blastocyst Embryo Transfers Done 5-6 Days Following Fertilization are Fast Replacing Earlier day 2-3 Transfers of Cleaved Embryos.
•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.
•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
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.