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.
Dr. Sher,
Thank you for this post and for your great efforts.
I have a long infertility journey that was successful when I tried the immune treatments,
I am given IViG every 4 weeks now, my Cytokines levels continue to increase as I go further into my pregnancy.
I am now 17 weeks and my levels were rocking high, the highest number I ever had.
I don’t know if I have a match, but according to your valuable experience, if I want to extremely cautious when do you recommend stopping the treatments, I read some studies suggest until 32 weeks, what do you think?
Thank you so much
Thank you for connecting! I am updating my entire blog, so kindly-go to http://goo.gl/4hvjoP and re-post your question/comment there, and I will respond promptly. Henceforth I will be responding on that site.
Thank you.
Geoff She
I am currently 5 weeks pregnant from a 3dat FET. MY LEVELS 6 days ago were hcg 300, p4 11.1 and estrogen 1700. I have been on endometrin 3x a day since 3 days before transfer and estrace 1/2 tab 2x a day. My first blood work 6 days ago was taken in the morning. I had my levels rechecked today my hcg was 6,000 and estrogen dropped to 215. I also had an u/s and my gestational sac measured 5 weeks exactly. Does this look bad?
No it looks good!
Good luck!
Geoff Sher
Hello Dr. Sher,
I am a 39 year-old with Asian ethnic background who has been trying to conceive for the last 16 months, first 10 months trying on our own and for the last 6 months we have been working with an RE. So far we have not been able to get pregnant, not even a chemical.
I have a very low AMH (0.15) and my FSH has ranged from 20 to 7 within the last 6 months. HSG showed my fallopian tubes open. I am taking Synthroid to address slightly low thyroid function. I have been taking 75mg DHEA and 300mg ubiquinol daily for 6 months.
Since starting to work with our RE we have tried 3 cycles without success:
1) IUI cycle on 150IU Bravelle and after 9 days we had 2 follicles growing and while everything (follicle size and lining) looked good IUI did not work.
2) Estrogen suppression followed by 300IU Follistim and 150IU Menopur with Omnitrope. After 13 days of stimulation we only had two follicles growing and had to convert to IUI.
3) Mini IVF with Clomid and 150IU Menopur without estrogen suppression hoping to get better quality eggs since we didn’t get a good response with injectables anyway. After 10 days we only had one follicle growing and had to convert to IUI again.
We are very discouraged by the low response we keep getting and want to ask you what protocol you would recommend based on my response to previous protocols. We really would like to at least be able to retrieve eggs and go further on the IVF process.
I have read your articles about Lupron microflare protocol and was wondering if that would be an option although my follicles stopped growing when Ganirelix was used to hold off ovulation in previous cycles.
We really appreciate your generosity in sharing your expertise to help people dealing with infertility.
HLB
Very respectfully…you cannot waste time on IUI’s and mini-IVF with your severely diminished ovarian reserve. Th chance of success with IUI in your situation is probably <3% per cycle and with clomiphene/gonadotropin mini-IVF...<10%.
You have such severe DOR that the best advice would be to go to egg donation. BUT if this is something you are not ready to do then it is all about using an aggressive , Robust, modified long pituitary down-regulation protocol (agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation , in my opinion. You should also seriously consider embryo banking pf PGS-normal blastocysts to make hay while the sun still shines....and you need to get going immediately before you run out of eggs. The protocol I am suggesting will give you the best chance of good eggs/embryos.
Also, you slightly low thyroid function could be linked to autoimmune thyroid dysfunction (Hashimoto's disease) which in 50% of cases will be associated with activated uterine natural killer cells that can thwart implantation (see below).
Finally i would respectfully advise against using DHEA. In my opinion it can harm egg development, especially in women with DOR.
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?
•Frozen Embryo Transfer (FET): What Does it Involve?
•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 Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•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
•The Role of Nutritional Supplements in Preparing for 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
Dr. Sher, appreciate your earlier response. However, I was specifically seeking your thoughts on IVM v. IVF. Do you think this is a worthwhile/effective procedure for someone with such high AMH/extreme PCOS?
Dear Doctor Sher, I am 45 and my husband is 61 with a low sperm count and decreased libido due to enlarged prostate. We already have one son born in 2007 but desperate for another baby. Is there any hope or is it too late?