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.
Hello Dr Sher,
I am writing from Melbourne Australia where my wife and I have previously been seeing Dr Nick Lolatgis in regards to our fertility issues. I will try and be as brief as possible. my wife suffered an ectopic pregnancy just before we were about to start treatment with Chlomid, it ruptured and therefore she had to have her right tube removed. she suffers from type 2, pcos and is also a celiac.
After recovering and several other attempts we decided to see Dr Nick and move forward with IVF.
This went on rather unsuccessfully ( 0 zero pregnancies achieved from any of our transfers )and therefore he decided to run further and more detailed tests.
We unfortunately received the bad news that we are a 100% DQ Alpha gene match and she also has high NK cells. we continued to harvest and fertilise our eggs and my wife began immunosuppressant treatment.
Dr Nick began LIT therapy, unfortunately none of our eggs had made it to day 5 for genetic testing.
we collected once more and were lucky enough to get 3 genetically tested good embryos back.
during this time we had discussions around surrogacy as we weren’t at all confident that anything was working. During our first appointment this year with Dr Nick back in march we had a very frank conversation where Nick basically told us that he thought that because we now had a viable surrogate here in Melbourne that we best move in that direction and not waste any further embryos with my wife, we reluctantly agreed and organised an appointment for my wife and surrogate to meet with Nick. My wife then immediately stopped all treatment ( clexane, dexamethasone etc )
several weeks later my wife was late and did the very last pregnancy test we had, low and behold there was two lines…. to cut a long story short she was most definitely pregnant. Dr Nick immediately out her back on to all the medications and also fortnightly intralipid.
she is now close to 21 weeks pregnant and every scan has shown that the baby looks perfectly healthy.
Nick has also started her on Melatonin. We are of the understanding that there is currently no other pregnancy that has come this far with the 100% DQ match ( or at least here in Melbourne )
Nick has struggled to give us any statistics etc as to whether all these treatments will have a detrimental effect on the baby.
you may or may not already be aware of our case as we believe Dr Nick was going to contact you regarding this.
Any light you can shine on our case would be greatly appreciated, as you can imagine now that we have come this far we are extremely happy yet also very nervous as to what the outcome will be. Dr Nick has suggested that hed like to stop her treatment at week 24, this also has us worried as to what will happen after that, would our match cause her body to try and reject the baby even at wk24??
I look forward to hearing from you
regards
Leon & Jade
I agree that with a total DQa match + NK cell activation, the chance of a viable pregnancy is low…but not impossible. It is possible that you have an absolute DQ alpha match but I need to be convinced that you have an actual NK cell activation. And unless there is NKa, the total match would be irrelevant.
Bear in mind also that if your doctor was going by the NK cell concentration the conclusion would not be applicable. It is NK cell activation as measured by the K-562 target cell test that is important and frankly, I am not aware of any Reproductive Immunology Reference Laboratories in Australasia that can perform this assay reliably. I have many patients from Australia and I have there blood sent to Reproductive Immunology Associates (RIA) in van Nuys, CA (PH: 805-578-7002) for testing. Contact them and resend your a blood for NKa testing and both your blood’s for DQa/HLA rematching. Mention my name when you call them. I really urge you to be retested.
Good luck!
Geoff Sher
Hi Dr. Sher,
I am a 33 y/o female with a history of RPL as well as autoimmune disorders (Sjogrens Syndrome & Hypothyroidism). After 2 chemical pregnancies through IVF, our RE sent a RPL blood panel to Chicago and showed APA (my number was double what is considered normal). For our third cycle, we tried 40mg of Lovenox 1x day. This got us further in our pregnancy than we had been before. However, when we went in at 7 weeks there was no heartbeat and the baby stopped growing at 6 weeks. We tested the baby when the D&C was completed and the results came back normal.
My question to you is do you think this is Autoimmune or Alloimmune related? The RPL blood test did not test positive for NK cells. Do you think maybe 40 mg of Lovenox wasn’t enough and maybe we should double it while adding steroids? Our RE isn’t sure why we lost this pregnancy but does suspect it is autoimmune related.
Thank you!
If there is no NK cell activation, it is neither…but I suspect that either the wrong NK assessment was done (it is not the concentration of NK cells that matters. Rather, it is NK cell activity as measured by the K-562 target cell test ad there are only a handful of labs that can do this test reliably)
If in fact you actually do have an immune issue, as I suspect (in spite of your representation that your NK activity was normal),it is likely to be autoimmune but it could be alloimmune. You would then need a detailed evaluation to determine!….see 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
•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–
•A personalized, stepwise approach to 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.
Do you ever recommended using Lovenox 40mg 2x daily?
I just wanted to say thanks….The women ob FB have a lot of questions so I may periodically ask you…thanks for your help..Lynn I’m going to have a day during the week called ” Dr Sher answers”
Thank you Lyn…I appreciate it!
Geoff Sher
A question from Nikki:
4 years of failed IVF some where PGS tested embryos, endo stage 3 removed no tubes sperm DNA fragmentation and auto immune issues, I have a good AMH at 27.7 low FSH at 4 respond well but end up with bad numbers at the end of it all. And then can not seem to hold onto anything after ET, we get nice embryos on day 3 then they all seem to slow down, also seem to get some multinucleated embryos on day 2 it seems so unfair we have so much against us. Do you know why the embryos may do this?
In my opinion, there are 2 main considerations here. The first is the need to review and revise your protocol(s) because this can impact egg/embryo quality profoundly, and the other is the possibility of an endometriosis-related immunological implantation dysfunction (IID)…see 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?
•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–
•A personalized, stepwise approach to IVF
•Endometriosis and Infertily
•Endometriosis and Infertility: Why IVF Rather than IUI or Surgery Should be the Treatment of Choice.
•Endometriosis and Infertility: The Influence of Age and Severity on Treatment Options
•Treating Ovarian Endometriomas with Sclerotherapy.
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.
Dr Sher, Do you see that AMH fluctuates between cycles? I had an AMH of 2.7 and another time 9.0?
thanks lynn
It does fluctuate within a relatively narrow range.
Geoff Sher