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 Dr Sher,
I am 37 and was diagnosed with PCOS 15 years ago and miraculously fell pregnant unexpectedly nearly 7 years ago while taking the BCP. Successful pregnancy and straight forward delivery. Fast forward 5 years and after over 2 years of ttc, got sent off for tests to find that in addition to the pcos, both tubes are fully blocked. Laparascopy was done to attempt to unblock and it was unsuccessful but significant adhesions within the pelvis were found and cleared but no evidence of endometriosis and no history of any infection.
Just attempted our first cycle of ICSI – due to cycles regularly being in excess of 3-5 months, 10 days of provera was used to induce the cycle. 150 Gonal F was commenced on Day 2, and 250 orgalutran commenced on Day 6. Heavy bleeding continued until Day 10 at which time some small follicles had begun to respond on my left ovary but the right ovary was extremely difficult to locate on ultrasound. Gonal F was increased to 225. U/S every few days until there was 1 dominant (21mm) follicle on left with 4x 14mm, and 2 dominant on right with 5 x 14mm and an e2 level of 5000. Hcg (ovidrel) trigger and EPU 36 hours later, with only 3 eggs being collected from my left ovary and none from my right as they were unable to access it. None of the eggs fertilised and the cycle was cancelled but I then went on to develop moderate OHSS with severe pain and swelling and some shortness of breath.
What kind of protocol would you recommend in my situation if we attempt another cycle?
Many thanks,
Sharyn
In my opinion the protocol used for ovarian stimulation is singularly the most important determinant of egg/embryo quality (and thus IVF outcome), particularly when it comes to older women, women with DOR and women with PCOS who tend already to over-produce ovarian male hormones (especially testosterone) which if present in excess will adversely affect egg/embryo development (see below). Also, I am not in favor of triggering with an agonist such as Lupron/Buserelin/Superfact..(see below). Also, if Ovidrel is used for the trigger, the dosage should in my opinion be 500mcg rather than 250mcg (see below).
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
•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?
•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
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 found out that I was pregnant about 2 weeks ago, I went to see my OB-Gyn, scheduled for an U/S. Well they saw a gestational sac measuring approx. 6w, but we didn’t see a baby (sac was empty). My dr said it may too early to see the baby. So he took my blood to check hCG and pregosterone. hCG was 59,929; Pregosterone was 10.4, 2 days later my blood was taken again and the hCG was 67,950. So I am extremely worried! Can you please give me some answers? Is there still a possibility that the pregnancy is going to be normal without miscarriage?
It is too early. Give it a week and repeat the US.
Good luck!
Geoff Sher
Hello. I had my first HCG test on July 1st which would be 8 dpt and it was 201. I had another on the 3rd and it was 368. My clinic wants me to go in for another one tomorrow. She said it was a 83% increase. Should i be concerned?
It is a little on the slow side, but I think it will be OK.
Let me know how it turns out.
Good luck!
Geoff Sher
Hi I sent a post earlier about cysts. Mine seem to have been resolved, I went in for a scan today . . The doctor however said my egg measured small mid cycle and everything seemed a bit quiet. Meaning I may not ovulate this month. I don’t know if this is due to the just resolved cyst or not. What does small measuring egg 12 mm mean? I am 41 . Do I need to. Do all to check my baselines again next cycle from day 1-3 . I recently did one in feb which looked okay. I don’t know if all this is due to recent ivf and fet ? Anyway thoughts would be welcome
I do not think he was refderring to egg size…rather follicle size and I would not be concerned. I would not necessarily repeat the baseline hormone tests if these have already been done in the last year,.
Good luck!
Geoff Sher
Dear Dr. Sher
After my 5 chemical pregnancies, I was willing to start taking Intralipid before starting IVF, but I have just found out that I am pregnant today! Should I take it immediately or what should I do?
And, is it safe to continue taking inositol 1ts during pregnancy?
If tests previously showed activation of NK cells then yes. But if not, I would defer to your treating physician as to whether you should do so or not. I probably would not!
Geoff Sher