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.
Hello, I am a 32 year old female with PCOS and Hashimotos. During our first egg retrieval at age 30 I was stimulated with Gonal-F, Menopur, and Cetrotide. We retrieved 15 eggs, 9 fertilized naturally, and we did a fresh transfer with 1 Day-3 EEVA-low embryo. We froze 6 untested blasts. I did not get pregnant. Additionally, despite being euthyroid right before stimulation and uterine priming, I became very HYPERthyroid immediately after this cycle. My endocrinologist lowered my Synthroid dosage, and I was once again euthyroid for 6 months. We then went through a medicated FET and transferred 1 day 5 untested blast. I got pregnant but miscarried at 5 weeks. The same day I miscarried my face and eyes swelled shut. The D&C showed the embryo was aneuploid so we elected to do PGS testing on our remaining embryos. Again, immediately after the FET I became hyperthyroid. Once my levels were corrected again, we did a second medicated FET this time with a single PGS-tested euploid blast. This cycle did not result in pregnancy, and once again I became hyperthyroid. We underwent a second retrieval on the same protocol as before but on much lower doses of stims, and I started taking coenzyme Q10 and acupuncture. This time 40 eggs were retrieved, 32 fertilized naturally, 19 made it to blast with 9 euploid and 3 no-result. We still have one euploid from our first retrieval for a total of 10 euploid and 3 no-result. My concern going into another FET is the affect estrogen seems to have on my thyroid which is the opposite of most Hashimoto’s patients (I am become hyper rather than hypo). Additionally, my TPO antibodies measured at close to 4,000 and have always been elevated. We have discussed adding prednisolone 5 mg to my protocol, but is that enough to help with implantation and prevent miscarriage? Would an unmedicated/natural FET be more suitable for my thyroid? What about selenium supplementation? Any insight is appreciated.
I should note that my lining has always looked good, and I’ve had two hysteroscopies. Both revealed a healthy looking lining and normal uterus with the exception of a few small polyps which were removed. We’ve also done the “endometrial scratch” technique.
I suspect that you might have an immunologic implantation dysfunction linked to your autoimmune thyroid condition (Hashimoto’s disease).
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
•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 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
•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
•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
•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.
Hi. I just came across this website and was wondering if you can give me any input. I have had 2 cycles of ivf. First around of ivf, I had grade 2 embryos. Transferred 2 through fet and ended up ectopic pregnancy. 2nd round, had grade 4, 3, and 2 embryos. Conceived one child and 2 failed fet. i have one remaining grade 2 embryo. Do you think I should do another round of fet or start the whole cycle again?
There are may factors that should influence your decision. The first is your age because the older you get the more likely it is that your eggs will become incompetent. The second is your ovarian reserve (how many eggs you have left. Together these two components comprise the biological clock. If that is running down, then you might wish to do a fresh cycle, accumulate more embryos for future use so as to “make hay while the show still shines”. Then there is the emotional and financial investment needed to do yet another cycle.
Good luck!
Geoff Sher
Hi Dr Sher, I previously mentioned to you that I had 9 good quality embryos but none were chromosomally normal (all with complex aneuploid of between 3-12 missing chromosomes). Is 3-12 missing chromosomes considered very severe? Can DNA fragmentation tests help assess whether this is coming from the sperm? Thanks so much!
It is serious and in my opinion, SCSA wont help prevent this from happening.
Geoff Sher
I have so many questions but my main question for now is the following. I have experienced bleeding twice now. It doesnt last but it does scare me! I usually feel when i am going to bleed because i start to feel a lot of pain in my lower belly it hurts badly. When the bleeding happens its mainly blood clots and then it stops out of no where. Both times i have seen my IVF doc about it and the babies are great and the only pain i feel after the bleeding is soreness as if i had been doing crunches or sit ups. Its troubling beceause my doctor says that there is no real answer as to why im bleeding that as long as the babies are fine everything will be ok. Please tell tell me if this is common at all? I should mention that im 32 yrs old and im 6.4 weeks pregnant and there is already 2 heart beats also I have my tubes tide and that is the only reason that we decided on IVF.
First Trimester Bleeding: How serious is it?
Good luck!
Geoff Sher
I have so many questions but my main question for now is the following. I have experienced bleeding twice now. It doesnt last but it does scare me! I usually feel when i am going to bleed because i start to feel a lot of pain in my lower belly it hurts badly. When the bleeding happens its mainly blood clots and then it stops out of no where. Both times i have seen my IVF doc about it and the babies are great and the only pain i feel after the bleeding is soreness as if i had been doing crunches or sit ups. Its troubling beceause my doctor says that there is no real answer as to why im bleeding that as long as the babies are fine everything will be ok. Please tell tell me if this is common at all?