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,
I watched your video on endometriosis and it was great! I learnt a lot that I didn’t know before! I was wondering if I could possibly get some advice…I was diagnosed with endometriosis in 2014. Since then my symptoms have just gotten worse, I’m in excruciating pain, throwing up and a few other symptoms. I have tried many different types of pills but my body doesn’t seem to tolerate them and now my doctors are trying to push a mirena coil on me and I really don’t want one. I recently saw my doctor and asked if I could have surgery again to see if there is any more endometriosis and was told that is a stupid option as surgery is more for diagnosis and I already have a diagnosis. I’m feeling really confused and feeling pressured to have a coil. They have tried to insert the coil 3 times before but it was too painful (apparently I have a sensitive cervix) and they want me to go under general anaesthesia and I’m not really comfortable going under general for something that simple. Is there maybe any advice that you can give me? I would really appreciate it!
Many Thanks,
Sheireen
Hi Sheireen,
I wish I could help, but alas, unless you were here and my patient, there is not much I can do. You need to weigh your reproductive aspirations with the severity of the condition and its symptoms. If childbearing is a priority then treatment would differ. In such a case, you would need to be as proactive in reaching that goal as possible and not procrastinate while the endometriosis gets worse. If you are not that intent upon having a baby, you should consider definitive surgery to rid you of the condition and enhance your quality oflife. And even if you proceed aggressively to conceive, once having had the baby, you might revert to the definitive surgical option.
Good luck!
Geoff sher
Dr. Sher,
Yesterday I asked you a question and I greatly appreciate your thoughtful answer. I have one more question about the same issue, if you don’t mind! This was the original question :
Hello,
I just had IVF #3 cancelled due to a 22mm functional cyst producing estrogen on my ovary found at my baseline appointment. I have been on a low dose BCP in the month leading up to the cycle. My first IVF cycle was cancelled at baseline due to the same circumstance, 22mm cyst found on the same ovary. My second IVF cycle was cancelled during stimulation because of dominant follicle issues on the same ovary that has the history of cysts. My doctors say that cysts are random but how could this be, I’ve been cancelled twice due to the exact same cyst issue. All cycles have been 3 months apart with no break, all using BCP leading up to the baseline. I have Endometriosis and my fallopian tubes were removed. Could the BCP somehow be causing the cysts rather than preventing them? Is there anything I can do differently going into a cycle to prevent the cyst from forming and getting my IVF cancelled? Will it negatively impact an IVF cycle to go ahead with it and do stimulation meds with a cyst in place? Will that ovary with the cyst produce less viable follicles? Thank you so much for your help!
In your answer you said the clinic should aspirate the cyst at my baseline appointment as long as it’s not an endometriotic cyst, and the cycle should be okay. My concern is that my clinic has already said they will not aspirate the cyst, they will just have my cycle with the cyst in place and monitor my estradiol levels. They said they don’t aspirate because the cyst will just fill up again, are they giving me good advice? Also, they decided it was a functional cyst based on an ultrasound, and the fact that my estradiol is very low, so they don’t think the cyst is producing estradiol but I’m not sure how they ruled out endometriotic cysts. Is there a link between Endometriosis and higher rate of cysts of various kinds? Thank you so much for your help and consideration!
Very respectfully, I do not agree with the position taken not to aspirate the cysts…provided they are cysts and not cystic tumours or endometriomas. Alas, I cannot advise you on how to deal with that attitude.
Sorry!
Geoff Sher
Hi Dr. Sher I’m 6 weeks 1 day pregnant and had a ultasound today and we saw a heartbeat of 113 is this low or normal?
It is on the lowish side. Repeat the US in a week or 2 to see if it picks up.
Geoff Sher
Hi Dr. Sher I had my first ultrasound today at 6 weeks 1 day pregnant and we saw a heartbeat it was 113 is this low or normal? thanks
It could be a little slow but it will hopefully pick up by the next US.
Good luck!
Geoff Sher
Good afternoon, Dr. Sher.
I am a 34 year old female who has undergone a total of 4, failed, IVF cycles. In 2010, we had 3 failed cycles. Our most recent failure was this spring. After completing auto-immune testing (blood work) it was determined that my TH1 and Th2 were somewhat elevated. My RE is recommending taking Humira for a month. My insurance company has denied the medication, which costs, out of pocket, $9,000. Do you have any recommendations/ treatment recommendations to help treat this issue? I know that IVIG is a possible alternative. Will I be able to get pregnant with the Th1 and TH2 levels being higher than normal?
Much thanks,
Joanna
Hi Joanna,
Respectfully, my preference would have been to confirm that you have an IID by doing blood tests on you for antopihospholipid antibodies, antithyroid antibodies, an immunophenotype and NK cell activation (the K-562 target cell test). Then if you tested NK active, I would add blood tests on both you and your husband for DQ alpha and HLA matching.
Respectfully I do not use Humira for reasons you will find in the relevant article(s) 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
•Why did my IVF Fail
•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–
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.