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 there dr sher!
I have tried a to post a few times but I’m not sure they have been working? sorry if I’ve doubed up somewhere.
Heres our story,
We are 38 with 2 children ages 7 and 9, we have had periods of infertility and miscarriages and would love another child!
We tried for our first child for 5yrs then went on to miscarry. We then conceived our daughter 9months later and conceived our son when daughter was 15months old. We have had 2 miscarriages after our son, the last one being 2.5years ago.
With each miscarriage we get to 8.5wks plus, see heartbeat and baby is growing well at each scan then for some reason heart stops and i go on to miscarry?
We have both had lots of tests done and they have never found anything wrong with either my husband or myself, he has a good sperm count and my amh is 18.
We are trying to decide where to from here? We have been given two different lots of advise and I would love your advise to help make our decision.
Specialists suspect I have endometriosis because of painful,heavy periods and infertility.
So do I have a laparoscopy to remove endo and have a d&c done and then try to conceive naturally if not successful go on to have ivf? or go straight to ivf?
I can get the laparoscopy etc public but will have to pay ourselves for ivf. Before ivf they are recommending a hysteroscopy while Im awake to check uterus, but if i have laparoscopy they will do hysteroscopy and d&c at same time.
I tried chlomiphine for 9 months, have been told there is another drug similar to that starting with an L? that I could possibly try after laparoscopy. I will be eligible to receive funded ivf and go on the waiting list when i am 40.
Basically I would like to know if you think laparoscopy before ivf would be beneficial? and a good idea?
I really appreciate your help,
Thanks soo much!
Blessings Ange
No! I respectfully suggest that unless you have an ovarian endometriotic cyst that needs removal, there is no benefit (as far as your fertility is concerned) in doing a laparoscopy. I suspect that you might have developed an implantation dysfunction, possibly related to uterine NK cell activation. ..please read below as well as the articles referenced here.
I strongly recommend that you visit my NEW personal website at http://www.DrGeoffreySherIVF.com and when you reach the home page, go to my new Blog find the “search bar” and 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•The BCP: Does Launching a Cycle of Controlled Ovarian
•Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies?
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
•The Role of Nutritional Supplements in Preparing for IVF
•IVF for Women Who Have Previously Conceived (Secondary Infertility).
•Endometriosis and Infertily
•Treating Ovarian Endometriomas with Sclerotherapy.
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•IVF for Same Sex Couples
•Confronting the Financial and Emotional Costs Associated with Doing IVF
I invite you to call 702-699-7437 or 800-780-7437 and set up a one hour Skype consultation with me to discuss your case in detail.
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
Dear Dr Sher
I just thought I would follow up on some very kind advice you gave me a few months back:
http://haveababy.com/fertility-information/ivf-authority/ask-dr-sher-open-forum/comment-page-1975#comments
In Oct 2010, at the age of 28, I was diagnosed with lean PCOS (3/3 of the Rotterdam criteria), with AMH 28 pmol/l, FSH 3.1, and an AFC of 42
In July 2015, at the age of 33, it was found that I fulfiled 0/3 of the Rotterdam criteria and have DOR: my July bloods showed AMH 1.5 pmol/l, FSH 17.6 and an AFC of just 5
You advised me (quite understandably, given these horrendous results) that I was likely heading towards an early menopause, and my chances of success were remote
Well, I thought you might appreciate an update, as apparently bloods may not tell the entire story
In Oct 2015 I underwent my first round of IVF, on a high stims antagonist protocol – retrieving 7 eggs (6 mature) – however due to issues with obtaining a fresh sample on the day (my husband was v unwell on the day – brilliant timing!!!), the 6 mature eggs went straight into the freezer unfertilised
In Jan 2016, I underwent my second round of IVF, again on a high stims antagonist protocol, aiming to get more eggs to batch with those retrieved the first time around.
At my baseline scan, my AFC had doubled to 10.
Before trigger, I had 15 good sized follicles.
At retrieval on Mon 18th Jan, we retrieved 17 eggs, all mature
Meaning we had a total of 23 mature eggs from two cycles. Not bad for a woman with severe DOR supposedly in peri menopause!
16 fertilised, and currently at day 3 we are on track to go to blastocyst – with 11 top quality embryos, 2 good quality, and 3 laggards on a go-slow.
We are expecting a significant drop off between day 3 and 5 -but considering we expected to get a very small number of eggs to begin with, I am over the moon with 13 decent quality embryos at day 3
Obviously none of this guarantees we will have any good quality blastocysts to transfer in 2 days time, nor indeed that any of these embryos will become a baby
But for someone that the NHS had written off as a lost cause, and many clinics would have given the donor eggs speech, I feel that it really is a case of ‘you don’t know until you try’!!
I very much hope this cycle results in a successful outcome. However even if it doesn’t, I am feeling encouraged that despite my apparent severe DOR, 23 eggs from 2 round of IVF doesn’t feel too shabby!
V best regards
Katy
Two different embryologists asked me if the AMH could have been a lab error – I told them it had been repeated three times, and each time it came back at 1.5 pmol/l (which I believe is < 0.16 ng/ml or thereabouts? anyway – rubbish!!)
Needless to say, I am very pleased that someone with undetectable AMH has managed to produce 17 mature eggs in one go, of which 12 fertilised beautifully, and 10 are excellent quality embryos at day 3. Any idea how this might be?
I am delighted for you . I wish you well and I thank you for this input. Clearly, the AMH measurement done most recently was incorrect. I believe if you were to repeat it now, it would likely be much higher and you probably do NOT have severe DOR.
Good luck!
Geoff Sher
Hi Dr. Sher,
My husband and I are trying to get pregnant, and are seeing one specialist who is prescribing various courses of treatment, but without elaborating much on her reasoning.
I had a very regular cycle for about 13 years, then (due I think to weight loss) I stopped menstruating. It’s been 20 months now. I tried a cycle of 50mg x 5 days clomiphene, but developed 7 large follicles. I didn’t naturally ovulate from that cycle, so had to take progesterone in order to induce a bleed. The next cycle was unmedicated, but I only managed to develop a few follicles to about 10mm, with a reasonable endometrium thickness. Once again I didn’t ovulate, and had to take progesterone to induce the bleed.
Now I am on FSH, I have taken 25IU for 8 days, and only have a couple of 8-10mm follicles with a thin (5mm) endometrium. My doctor has recommended increasing the dose to 50 for a few days and checking again.
I have gained back the weight I lost and am at a weight where I would normally get regular periods.
Do you have any thoughts, comments or guidance? What are the chances of successful timed intercourse if FSH stimulation goes on for more than 10 days? Is my cycle likely to start up on its own again? Why did I over respond to the clomid, but underrespond to the FSH? Would you also recommend FSH stimulation in my case?
Hi Melanie,
The good news is that given your response to a very low dosage of FSH stimulation means that you are not in ovarian failure. It now becomes important to determine the cause of your anovulation…before proceeding any further. I would recommend that your blood be tested forAMH/basal FSH, LH, E2/Testosterone/DHEAS/androstenedione and 17-OH progesterone. Also, can you tell me whether you started the stimulation after a hormone withdrawal bleed was effected, what the peak estradiol level was/is and what the thickness of your uterine lining reached.
I strongly recommend that you visit my new Blog on this website find the “search bar” and 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): Selecting the ideal protocol
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!
•Micro-IVF: Often Preferable to Ovarian Stimulation with or Without IUI
I invite you to call 702-699-7437 or 800-780-7437 and set up a one hour Skype consultation with me to discuss your case in detail.
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
Hello, Dr. Sher,
Not long ago I was diagnosed with endometrioma in my left ovary which is about 4 cm in size. I am 38 and planning to start trying to conceive in about a year. Is it possible to perform a sclerotherapy procedure in your clinic to get rid of the cyst. I really don’t want to undergo a laparoscopic surgery as it is done under general anaesthesia and i would loose a part of my healthy ovary tissue. I am so concerned about that as I already had this kind of surgery on my right ovary 13 years ago and now the ovary is smaller than it used to be. I don’t want to reduce my chances of getting pregnant even more. Thank you.
In the era of assisted reproductive technology (ART), there are two reasons for the treatment of endometriosis. The first is to alleviate symptoms of pain. The second is in preparation for In Vitro Fertilization (IVF). Conventional surgical treatment of ovarian endometriosis involves either an abdominal incision or laparoscopic drainage of the cyst contents with subsequent removal of the cyst wall. Unfortunately, in many cases, normal ovarian tissue is inadvertently removed along with the cyst wall, which may decrease the number of available oocytes for subsequent fertility treatment. A large percentage of such women have advanced stage disease and have had multiple previous surgeries. In the presence of pelvic adhesions, visualization of anatomic structures may be inadequate, leading to inadequate surgical removal with frequent cyst recurrence, which could further diminish the potential response to ovarian stimulation with gonadotropins. In addition, most women with advanced endometriosis (ie; those who are also more likely to have endometriomas) are likely to have developed pelvic adhesions and accordingly are at increased risk of surgical complications. Many patients with recurrent ovarian endometriomas are uncomfortable with the prospect of repeat surgery and its avoidance is often a factor in the decision to proceed with IVF. There have been several reports on the use of sclerotherapy in the treatment of recurrent ovarian endometriomas. We have experience with the use of sclerotherapy in many women with endometriomas, who were preparing for treatment with IVF.
Sclerotherapy for ovarian endometriomas involves; needle aspiration of the liquid content of the endometriotic cyst, followed by the injection of 4-5% tetracycline into the cyst cavity. Treatment results in disappearance of the lesion within 6-8 weeks, in more than 75% of cases so treated. Ovarian sclerotherapy can be performed under local anesthesia or under general anesthesia. It has the advantage of being an ambulatory office- based procedure, at low cost, with a low incidence of significant post-procedural pain or complications and the avoidance of the need for laparoscopy or laparotomy.
Sclerotherapy is a safe and effective alternative to surgery for definitive treatment of recurrent ovarian endometriomas in a select group of patients planning to undergo IVF. Since the procedure is associated with a small, but yet realistic possibility of adhesion formation; it should only be used in cases where IVF is the only treatment available to the patient. Women who intend to try and conceive through fertilization in their fallopian tubes (e.g; following natural conception or intrauterine insemination) will be better off undergoing laparotomy or laparoscopy for the treatment of endometriomas.
I strongly recommend that you visit my NEW personal website at http://www.DrGeoffreySherIVF.com and when you reach the home page, go to my new Blog find the “search bar” and 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Measuring and Interpreting Blood hCG to Assess Pregnancy Viability Following ART Treatments.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
•The Role of Nutritional Supplements in Preparing for IVF
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?.
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•The Sperm Chromatin Structure Assay (SCSA): A Measure of the Potential of Sperm to Help Propagate a Viable Pregnancy
•IVF for Women Who Have Previously Conceived (Secondary Infertility).
•Endometriosis and Infertily
I invite you to call 702-699-7437 or 800-780-7437 and set up a one hour Skype consultation with me to discuss your case in detail.
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 asked a question at your other website, and you redirected me here and offered to review my immune testing results. I tested negative for Anti-thyroglobulin antibodies, anti-microsomal antibodies, anti-phospholipid antibodies. I had an NK Assay done and everything came back zero. In addition TH1/TH2 intracellular cytokines tested normal. We are totally stumped and very scared about our second FET!
Hi daisy,
I was hoping you would post the exact results pertaining to the K-562 target cell test done for assessing NK cell activation. Remember, the concentration of NK cells is totally irrelevant. It is the % killing of target cells that matters (i.e. NK cell activity). Also i would like to know your and your partner’s Dq alpha and HLA genotypes . Also please post the exact TNF alpha and Interferon (cytokine values too.
Finally, please note that there are VERY FEW Reproductive Immunology reference laboratories in the world that can evaluate these parameters with sufficient sensitivity and specificity.
The reason I am dwelling on all this is that your situation sounds so much like an immunologic implantation dysfunction that I find it hard to believe that proper testing will not confirm this. Also, it is important to differentiate between alloimmune and autoimmune implantation dysfunction because IL alone cannot be used as a shotgun approach. If the treatment is not individualized you will be wasting your time.
I strongly recommend that you go to my Blog on this site and 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.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•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
I invite you to call 702-699-7437 and set up a one hour Skype consultation with me to discuss your case in detail.
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