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.
I’m turning 33 in August and have unexplained infertility.
My first fresh IVF cycle (1.5 yrs ago) started with a Day 3 antral follicle count of 21. I started out taking 75 Menopure and 225 Follistim. I was a slow responder, but after bumping Follistim up to 300, the cycle resulted in 7 eggs retrieved, and 5 were mature. We fertilized 2, froze the rest of the eggs, and have a baby boy!
Now I’m on my second fresh IVF cycle 1.5 years later, with a Day 3 follicle count of 10. I’m taking 150 Menopure and 300 Gonal F – my doctor says it’s the max dose. I’m concerned that I’m starting out with 50% fewer follicles than first time. If I get the same percentage of mature eggs, I’ll end up with only 2. I asked my doctor about this, and she said it’s still an acceptable number of follicles and reminded me that I’m getting older, so my follicles will continue to decline.
Looking for a second opinion. Was my original cycle normal in the percentage of mature eggs retrieved compared to the number of follicles? Am I wrong to think this new cycle looks disappointing? Should I continue or start over?
The 1st cycle showed a real drop off from AFC to response and eggs harvested. I personally think that tghe protocol used for ovarian stimulation should be reviewed and possibly be revised (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.
•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
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 Doctor,
I am 29 yrs old and my husband is 33 yrs we having been trying to conceive past 4 yrs. We tried one year naturally with no results. Then we tried number of medicated cycle as follows
1.We did 3 months of Letrzole of 2.5 mg with no success.My periods have always been like a clockwork and i ovulated with my progesterone being 13 to 14
2.Then we were referred to RE where we did an hsg and MRI and found out i have left Unicorn Uterus.Where i have 2 ovaries and 2 tubes and 2 kidney but my right is not connected to the uterus.
3. Then we did 2 iui one with only letrzole and the 2nd with letrzole and follistism which was also a fail.
4.Then we did ivf where in we retrieved 16 eggs out of those 14 were mature and 11 were fertilized with ISCI. 7 made it to the blastocyst stage we transferred 1 and 6 were frozen on day 6.My first ivf resulted in a miscarriage at 6 weeks were there was no heartbeat and my RE said that was due to my Uterus.
5.Then we did a Frozen Transfer and transferred 4 BB cell embryo which again resulted in a chemical pregnancy.My doctor this time said it was due to my uterus and very les chance given my age wuld be due to the embryo.
6.Recently did another Frozen and again transferred 1 and this time my beta was negative.
My lining has always looked great and there is no problem with my husband.
My RE wants me to start thinking about Surrogacy as she blames it on my Uterus.My question is can i ever get pregnant.I have still 4 embryos left and have decided to transfer 2 in my next cycle i am not ready to give up with the fact that expect for unicorn uterus and hypothyroidism (which i have been on synthroid past 5 yrs) i dont have any issue my AMH is 3.4 and i have an healthy living style.
Please help me Doctor
Thanks
I responded to this post yesterday Preeti.
Geoff Sher
Dear Dr Geoffrey,
Thanks for the opportunity to talk to you.
I am 35 years old presently.
Background problem: Low AMH (1.2 ), Autoimmune thyroiditis with subclinical hypothyroidism and elevated TPO Ab in the past.
I have undergone total of 4 IVF cycles till now.
1) In 2015, with my first fresh embryo transfer (donor cycle), I had one biochemical pregnancy.
2) Frozen embryo transfer (donor cycle) : Implantation failure.
3) Fresh embryo transfer (self cycle): Implantation failure.
After the third failure, we underwent pooling of embryos. Doctors pooled 9, grade 1 embryos which were frozen at day3 and later thawed to yield 6 blastocysts.
I underwent endometrial array before my 4th IVF cycle ( FET) to assess receptivity status.
The reports were receptive.
4) I recently had 2 FET( blastocysts) and this cycle also failed.
I do not know what to do next to succeed.. All other possible tests fr repeated implantation failure have been done till now and are normal. ( I ve not done NK cell test yet).
I still have 4 blastocysts , but scared with the thought of loosing these precious ones.
Could my case be a immunological mediated cause /IID causing repeated implantational failures?
What investigations will exclude this cause?
Kindly advice.
thanks and regards,
Shravani.
There is in my opinion a great possibility that this is due to an implantation dysfunction and more than likely immunologic. Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.
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
•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
•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
•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)
•Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•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
•IVF Egg Donation: A Comprehensive Overview
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.
Dear Dr. Sher
Thank you for your prompt and incredible explanation. I just wanted to be clear that we didn’t even have any embryos make it to day 5 in the lab- they all ceased growing after day 3 – so we never had any to implant (on both occasions) But perhaps you are talking about this too – my thyroid was a little high about a year ago but I’ve never had any issues with it otherwise.
good morning Doctor. my name is Soraya and I write from Colombia South America. I have 43 years old , I have two teenagers and children with my second husband I have not been able to have a baby. I have had recurring losses. Last Wednesday July 6 I became blastocyst transfer 5 days with donated egg but the beta was negative. Previous my endometrium had 4mm thick and I take Viagra to help me and climbed to 9 mm to 14 day cycle . After this date will not again review the endometrium. Was the use of Viagra by the vagina. Please help me . I’m deseperanzada . we have two frozen to transfer blastocysts. I want you to help me to sber if I use Viagra through the vagina and as I should , on what days of the cycle. Here in Colombia there are only Viagra pills not in ovules . Thank you very much
I am not sure that your problem is being addressed. You see, at 44Y of age, even if your eggs produce blastocysts, these will in the vast majority of cases be chromosomally abnormal because of the effect of age on egg quality. You really need an egg donor. As for your thin uterine lining. This does not seem to be responding to Viagra. The cause needs to be carefully assessed and then if possible, addressed optimally. In my experience, a lining of <8mm at the time of the hCG trigger or progesterone supplementation (in recipient cycles) is whofully inadequate and is highly unlikely to support a visible implantation.
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.
•IVF Failure and Implantation Dysfunction:
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•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
•IVF Egg Donation: A Comprehensive Overview
•IVF-Gestational Surrogacy: An Overview
•Advancing Age of the Woman and IVF: How Old is too old?
•IVF pregnancies: Why They Carry a Greater Risk?
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 how do you decide if a patient need dexamethasone over prednisone? I have positive tpo and nka… so I will be taking intralipids but my question is why dexamethasone over prednisone for high tpo levels? Thanks
I prescribe them somewhat interchangably. However, I favour using dexamethasone in routine IVF and dexamethasone + Intralipid with autoimmune implantation dysfunction and prednisone with alloimmune implantation dysfunction (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.
•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
•IVF Failure and Implantation Dysfunction:
•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)
•Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•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.