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.
Dear Dr Sher
Wondered what your opinion was on G-CSF uterine wash for thin endometrium?
We have 6 euploid blasts frozen but are dealing with stubborn endometrium – my Dr will not proceed to embryo transfer unless he is happy with the endometrial thickness, and is looking for a minimum of at least 8mm+ with a trilaminar appearance
My lining has failed to respond to a medicated FET (oral and vaginal oestrogen, oestrogen patches) and an ovulation induction cycle (75iu Gonal-F – got 4 mature follicles but endometrium only got to just below 7mm and not triple line)
In my most recent fresh IVF cycle (freeze-all so we could do PGS) my lining did grow to 11mm, so seems to respond in the presence of high levels of endogenous oestrogen
My uterine blood flow is terrific: I would ideally try vaginal viagra, however it seems impossible to get these in the UK, and no US pharmacy will accept a prescription from an overseas Dr, as they say scripts can only be issued by a physician licensed in the US with a DEA number. I have tried oral viagra, high dose L-arginine & vitamin E – none of these worked, however my issue seems to be related to oestrogen receptors (as evidenced by the fact I got to 11mm when I had 28 follicles)
It is looking like our next step will be another hysteroscopy to check the uterine environment for adhesions (hysteroscopy in Apr showed no scarring in the endometrium, but my consultant wants to thoroughly evaluate for any structural issues), and then a stimulated IVF cycle to stimulate my lining with higher levels of endogenous oestrogen, transferring one of our frozen PGS tested blasts on day 5
We are trying a G-CSF uterine wash to see if this makes any difference, however I just wondered what your experience was of this treatment? We aren’t expecting miracles but decided it couldn’t hurt to try…
Would be very interested in your thoughts
Kind regards and many thanks in advance
Katy
I do not believe that a G-CSF wash will have any benefit. Also, oral Viagra is not helpful. If you cannot obtain compounded vaginal viagra suppositories, it would be preferable (although not ideal) to insert the pills directly high up into the vagina.
Finally, if a sonohysterogram reveals your uterine cavity’s contour to be normal, I do not see the need for a hysteroscopy.
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
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•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
•Blastocyst Embryo Transfers Done 5-6 Days Following Fertilization are Fast Replacing Earlier day 2-3 Transfers of Cleaved Embryos.
•Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•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.
If compounded Via
Hi
What do you think of the following protocol
Gonapeptyl Depot 3.75 mg taken on 21 day as a down reg followed by letrozole on start of period for five days ovetlappwd with menopur from day 3. Menopur 375iu.
imam slighly pcos towards pcos with lh of 11 but recently lh has gone to 5.5 and normalised somewhat, fsh 8.15
Any advice much appreciated particularly whether the down reg drug is okay and protocol potential
Hi Elizabeth,
Letrozole works by causing the release of pituitary FSH, but the agonist (Gonapeptyl depletes pituitary FSH…so inn my opinion the follicle response might be suppressed or blunted. I personaqlly do not use this approach.
Geoff Sher
My husband had a visectomy about 7 years ago and now we would like to have a baby. What would be the best way to go?
Men with no sperm in their ejaculates (azoospermia) whether due to non-obstructive or obstructive (usually post-vasectomy) causes, can have their sperm accessed surgically and still propagate pregnancies. There are 2 methods by which this can be achieved. : 1) TESE (testicular sperm extraction), where a biopsy of the testis is done or, 2) TESA (testicular sperm aspiration), which involves introducing a needle into the testis and aspirating fluid and tissue. Both methods can be conducted under local anesthesia and both will provide sperm-containing tissue and fluid for immediate processing and fertilization (using ICSI) or cryostorage for future use. However, the question is: Which method yields better results. An Israeli study performed on men with non-obstructive azoospermia, conducted about a decade ago, compared the results of TESE with those from TESA in the same patients and found TESE to be the preferred approach.
TSE/TESA is the preferred method for accessing sperm in men with azoospermia. By far the commonest indication for using this approach is post-vasectomy obstructive azoospermia where the use of TESE/TESA is far more successful and uncomplicated than is the alternative of having the man undergo surgical reversal. In fact, TESE/TESA yields a comparable IVF birth rate as for controls where normal sperm derived through masturbation is used. The approach is simple, relatively low-cost, and safe. In most cases, it is relatively painless and has a low complication rate. Moreover, in post-vasectomy men, it avoids the need for riskier and painful surgery designed to reconnect sperm ducts (vasa deferentia) while enabling the man to retain his chosen method of contraception after having propagated another pregnancy. In addition surgical vasectomy often fails to successfully reestablished duct patency and even when successful it often results in the subsequent reocclusion of the sperm ducts due to scar tissue formation. Moreover, in a large percentage of cases where vasectomy reversal was performed > 5 years after the vasectomy antisperm antibodies develop and this will almost always preclude subsequent natural conception even in cases where surgery had reestablished duct patency.
While in some cases of non-obstructive azoospermia, TESA/TESE will yield sperm capable of achieving fertilization through ICSI and also subsequent viable pregnancies, success rates are low. However, in such cases, this approach yields the only possibility of the male partner participating genetically in propagating pregnancy.
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
•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
•Male Factor Infertility
•Routine Fertilization by Intracytoplasmic Sperm Injection (ICSI): An Argument in FavorHormonal Treatment of Male Infertility
•Antisperm Antibodies, Infertility and the Role of IVF with Intracytoplasmic Sperm Injection (ICSI)
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.
I am having bicornuate uterus and also unexplained infertility. Did iui today. The follicle was at the right ovary but my doctor inserted semen to the left uterus. Is there any chance of getting pregnant this time?
Yes indeed there likely is. A bicornuate uterus does NOT cause infertility.
Geoff Sher
Thank you dr sher for you reply it’s been a shock we did I’ve over male fertility issue and was no expecting this I had 7 eggs collected 4 fertilised only two made 3 day transfer a five cell grade 1 and a 6 cell grade 2 but because I had my son with no help I thought it would be ok but my doctor said when eggs was collected they was not good quality but all my bloods and scans was good but I no unless you see the eggs you can’t tell I’m 31 years old I’ll try one more time my doc thinks it won’t work and suggested donor egg but could my next cycle be good eggs could it be meds or bad batch thank you for your help
Understood! You are welcome!
Geoff Sher