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, does PCOS disappear as you age? I had very irregular periods when I was younger but they are more regular now. Would I still be considered as having PCOS for IVF protocol purposes or is that no longer relevant now that my symptoms have gone. Many thanks.
I am 40 years old with regular menstrual cycles now, I had irregular cycles in most part of my life. I and my husband have normal karyotypes. My husband has kruger 0% in spermogram.
In January and February ( I was 39 yrs.) I did 2 IVFs on a short stimulation protocol. I was given 300 units of Menopur for 7 days in my first IVF and 300 units for 8 days in my second IVF.
First IVF: 17 eggs were retrieved, 14 mature, 11 fertilized. We did a PGD test in e 8 embryos in Day 3, 4 embryos grew to blastocyst. All embryos were abnormal.
Second IVF: 18 eggs were retrieved, 13 mature, 9 fertilized. We did a PGD test in 3 embryos in Day 5. All embryos were abnormal again.
What to do?
At 40 years of age only about 1:6-8 egg will be normal and about 1:5 blastocysts would be normal. However, the type of protocol used for stimulation would in my opinion also play an important role.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
•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?
•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 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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
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.
Geoff Sher
Hi Dr Sher,
I had my first beta yesterday at 12 days past (2) 5day AA frozen embryo. My hcg was 1244 it just seems that number is so high and progesterone is 15 which dr prescribed prometrium. I do go for another beta on Wednesday. I’m 42 years old and just stressing about everything. Thanks in advance. Kris
So far so good Kris.
Good luck!
Geoff Sher
Good Morning! So I did some research on Implantation dysfunction and I don’t think that applies to me or rather I think they would have found it already because they have tested my thyroid already and it is normal as well as I am on Metformin for insulin resistance. So I am honestly chalking our chemical pregnancy to beginners luck.. However what are the chances that all 6 of our frozen embryos that are left (they are day 3 freezes) are all chromosomally abnormal?
I respect and defer to your opinion/assessment that there is no implantation dysfunction but I would point out that the fact that you have normal thyroid function and take Metformin does not discount the possibility of an IID.
It is possible but not likely that they are all frozen embryos abnormal…but possible.
Good luck and G-d bless!
Geoff Sher
Hi Dr Sher, I had methotrexate 3 months ago to deal with an ectopic. I know it depletes folic acid so I had a red blood cell folate test, vitamin b12 and full blood count just to check things are ok before a further embryo transfer. The blood count and b12 were normal but the rbc folate is higher than the reference range (200-650 ug/l) at 1089 ug/l. I have been supplementing with higher dose 5mg folic acid in order to get my levels back up to normal. Could this be the reason for the increased levels or could it be an indication of something else wrong?
Would you recommend anymore tests based on this?
Do you think it would be OK to have an embryo transfer with these levels?
I think that this could well be the reason for the elevated folate. If it stays high, consult with your internist about this to look for other possible causes.
Good luck!
Geoff Sher