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.
Thank you Dr Sher
I have followed your blog throughout our ongoing treatment and I am very grateful for all the information that you share with people & the queries you answer (for many people who are not even your patients although they wish they were)
I am intrigued by this statement due to what happened on our treatment to date – The key is to trigger with no less than 10,000U of hCGu (Profasi/Novarel/Pregnyl) and if hCGr (Ovidrel) is used, to make sure that 500mcg (rather than 250mcg) is administered. In my opinion, any lesser dosage will reduce the efficiency of meiosis, and increase the risk of the eggs being chromosomally abnormal.
Our treatments:
Treatments with trigger of 250 Ovidrel – no normal embryos
Treatment with trigger of 10000 pregnly – normal embryo – To be used
Treatment with trigger of 5000 Pregnly – no normal embryos
We are looking for answers and our re has none – basically unexplained – hard to accept that when we have major doubts about the protocols chosen and the impact of the trigger shot?
Question – In a situation where there are no reversible factors – If the RE gets the trigger dosage wrong – can this ruin the whole cycle? If so I find this absolutely mind boggling. In our last treatment I queried with the nurse as to why it was only 5000 and she just said the Re decides on a case by case basis.
Thank you,
Thank you for your kind words. They are very much appreciated.
In my opinion, based upon 34y doing this, the dosage of hCG used is a very important factor. However, not everyone agrees with this.
Geoff Sher
Thank you
I have a feeling we will meet someday in rather unfortunate circumstances that will turn out good..
Hello Dr. Sher,
I am currently in the process of doing a FET. My embryos were frozen 5.5 years ago on day 3 using vitricication. I have 5 frozen day 3 embryos (two 8-cell, two 7-cell and one 6-cell).
I froze these embryos for fertility preservation when I was 33 years old (with donor sperm) as I have a family history of premature menopause (both my mom and maternal grandmother). I’ve now just turned 39 and have decided to use them but I have never been diagnosed with a fertility issue and all my testing has come back normal even now.
I have a few questions that I’m hoping you can help me with;
1. My clinic asked me whether I would like them to do assisted hatching on the embryos prior to transfer but they haven’t given guidance on the pros and cons and whether or not it’s recommended and why. What would your suggestion be and why?
2.My clinic has asked if I’d like to take Medrol for 4 days prior to the transfer. They said it can be done with or without it and it was my choice. They said it could help prevent the body from rejecting the embryo. What are your thoughts on this?
3.They have prescribed both progesterone suppositories (200mg 3 times a day) plus a daily progesterone injection starting feb. 16th (with the transfer tentatively scheduled for feb. 22nd). Why are both the suppository and injection needed? Is it possible to use just one or the other?
Thank you very much!
1.My clinic asked me whether I would like them to do assisted hatching on the embryos prior to transfer but they haven’t given guidance on the pros and cons and whether or not it’s recommended and why. What would your suggestion be and why?
A: In my opinion AH wont really help. I would however ask that the embryos be grown to blastocyst before being transferred. Those that dont make it ould not make a baby anywy!
2. My clinic has asked if I’d like to take Medrol for 4 days prior to the transfer. They said it can be done with or without it and it was my choice. They said it could help prevent the body from rejecting the embryo. What are your thoughts on this?
A: In my opinion, use of steroids improves implantation potential. However, instead of Medrol, I prescribe 0.75mg dexamethasone daily from the onset of the cycle to the 10th week of pregnancy to ALL my patients.
3. They have prescribed both progesterone suppositories (200mg 3 times a day) plus a daily progesterone injection starting feb. 16th (with the transfer tentatively scheduled for feb. 22nd). Why are both the suppository and injection needed? Is it possible to use just one or the other?
A: That is a high dosage. I would use intramuscular progesterone + vaginal progesterone once daily on my patients.
Good luck!
Geoff Sher
Dear Dr. Sher,
Is Cetrotide the same as Ganerelix. I react well to Ganerelix and want to know if Cetrotide is exactly the same thing. Thanks
They are identical products.
Geoff Sher
Dear Dr. Sher,
I am flying from Canada to Europe and need to take my IVF medicines with me including Ganerelix, Menopur, Pregnyl and Progestrone. I have to put these in the luggage. Will they be ok or will they get spoilt due to temperature in the plane luggage. I can’t carry them all by hand. Thanks
In my opinion they will be fine.
Geoff Sher
Dear Dr. Sher,
We had an IVF with 5-day-blastocyst transfer and a positive pregnancy with a bHCG of upto 1575 iu/mL at 15 days after. But my wife has been spotting on and off since last week (started 13 days after transfer) Neither our doctor nor “Dr.Google” has a definitive answer on why this is happening. Can it still be implantation when the embryo is getting bigger and putting more roots, is it still tender uterus/cervix bleeding because of the progesterone injection and estrogen pill?
What is the way to differentiate? And before the ultrasound, when one get worried on this spotting? Even then, is there anything to do then rest and get the progesterone injection?
How is in your experience for percentages of woman that had IVF and positive bHCG but spotting? And how many could go to a health heartbeat and a baby after all?
As long as the bleeding remains mild, does not increase and is not associated with increasing pain/cramping it is usually benign and not of concern. Besides there is nothing you can do about it. An US in about one week should be definitive.
This type of spotting can be caused by local cervical irritation brought about by the insertion of suppositories or by intercourse.
Good luck!
Geoff Sher