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 Doctor, I wrote you last week but still have some questions and Im not receiving answers in Germany. I was a low responder (only one egg retrieved, first Ivf) I’m 29 years old and an AMH of 1.93.
Should I also get a third day FSH exam?
Should I also get Antral follicle count?
My only egg fertilized and was transferred on day 3, it had 4 cells and I think it was fragmented, do I have a chance?
I would like to know your opinion because I don’t want to invest more money and emotions if things are unlikely to go well for me. With such a poor response I feel hopeless, I haven’t seen anywhere of someone with just one egg retrieved.
If you were to be my doctor would you continue trying?
Frankly, I doubt that doing any more such testing will be of benefit. As I stated before, women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
Please visit my new Blog on this very site, https://www.drgeoffreysherivf.com, 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
• 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 Approach
• 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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
• 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?
• Blastocyst Embryo Transfers Should be the Standard of Care in IVF
• 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.
• 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
• 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
• Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
• Empty Follicle syndrome.
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
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.
Hi Dr. Sher,
What are your thoughts on the endometrial receptivity assay and endometrial scratching. It was suggested by our RE as we have only a few frozen blasts, although they are high quality. This would be the first time attempting to transfer and we want to do everything to make it a success, but also going through more painful and possibly unnecessary testing is not appealing. Thanks!
Hi Daisy,
Very respectfully, In my opinion, neither of these techniques have any merit. I do not use them on my patients.
Geoff Sher
G
Hello Doctor,
My Wife undergone IVF treatment and 5 day embryo got transferred on 20th July after 14 days HCG level came up to 73 and two day later it went up to 107 and again after 2 day it went up to 120 after 2 days it came down to 80 and again it went up to 90 (such a roller coaster), Yesterday she undergone Ultra Sound where they found very unclear SAC and they confirmed no ectopic pregnancy and our Dr asked my wife to be on Progesterone 2ml twice per day for one more week to check whether any improvement is there on HCG level . Do you think that there is any chance to become a viable pregnancy and does it make any sense to be on progesterone.
Thank You!
Zen
Frankly it does not sound promising but “while there is life there is still hope”!
Good luck!
Geoff Sher
Dear Dr.Sher,
I’m very happy to find your website and reviewed many of patients questions and your answers. I’m also facing very difficult situation, lot of confuse and lack of confidence. I’m 39 years old, 5’4″, 128 lb. My husband and I we all like sports, we run 1-3 times a week, around 5-15 miles. We married 3 years, we really look forward a baby, but due to my problem I can’t get pregnant naturally. I have premature ovarian failure, high FSH 32.8 and low AMH 0.03. I have another issue is pituitary tumors, I did MRI on 2014 Oct, the tumor is very small, (I can’t remember exactly, it should be something like 3 mm.), I already had Bromocriptin around 3 years, half per day.My period is very abnormal these years, the new period didn’t come yet since last year Oct. My doctor suggest me to do donate egg if we really want a baby. Recently I’m start to looking for donor. Although donor egg is the way we can try, actually it might be the only we if we still want to have a baby, I don’t have other choices. But I am not sure how much possibility I will be successful if by donate egg IVF based on my situation? And what aspects I need to pay attention and concern? I really need help and advice to know what I should do? Can you kindly give me some help and advise? Look forward to hearing from you. Thanks!
Shirly,
You are indeed a candidate for egg donation IVF. Your pituitary tumor is not likely to pose a problem (but discuss this with your endocrinologist).
I would be happy to discuss the oportunity with you but to do so we would need to connect.
Name: (F) Michelle Bleier Age: 41
Partner: Scott Bleier Age 38
Email Address: SUMROF75@YAHOO.COM; scottebleier@yahoo.com
Contact Phone # 602) 999-7596
Dear Michelle,
I really enjoyed meeting and interacting with you. Thank you kindly for your interest in my opinion and in my services.
Below, please find a summary of our consultation for your records. Also, please know that you will be contacted by an office administrator to help you understand the financial options, as well as by a clinical coordinator who will discuss clinical aspects of treatment with me in Las Vegas.
I typically schedule my IVF cycles 6 months in advance, for specific dates. The cycles last about two weeks, and I do limit the number of cases in each batch in order to make sure I can personally monitor the cycles, and dedicate special attention to each patient. Given my very busy schedule, it is always advisable for you to schedule possible treatment for the earliest convenient date. Both, the financial and clinical coordinators will help you work out logistic issues, and assist you in finalizing the ideal dates for your treatment. We require that all patients make a modest non-refundable deposit to secure the date. This deposit is deducted from the cost of the cycle of treatment.
We recognize that regardless of the nature of your reproductive issue both partners have a stake in the process and its outcome. Accordingly both would usually wish to be present throughout most of the 7-14 days of management. From a practical standpoint however, this might not always be possible (or even necessary). In such cases, we would be able to provide the male partner at least 3 days advance notice of when he would be to be present in Las Vegas for one day. In cases where frozen embryo transfers (FETs) are being done, the male partner will not even be required to be present in Las Vegas. Moreover, selectively when sperm is required from a fertile male partner, we can even arrange for frozen semen sample to be shipped timely for the fertilization process.
There is rarely a need for women undergoing controlled ovarian stimulation (COS) for IVF to begin serial monitoring by ultrasound and/or blood testing prior to the 7th day of stimulation. As such, the female partner is not needed to arrive in Las Vegas prior to the 7th day of fertility drug administration, All preliminary preparatory testing can thus be done at your home setting by your primary GP or OB/GYN, including (if needed) bloodwork and a baseline ultrasound examination with the start of the menstrual period that launches the cycle of ovarian stimulation. After treatment is completed, you can return home. We will follow up with you and/or your partner by phone or Skype communication. We will also interact as needed with your primary care OB/GYN to supervise post-treatment and early-pregnancy management.
While this process might at first glance seem somewhat complex, in reality with a dedicated Clinical Coordinator assisting you, we have developed over the past 30 years of providing infertility treatment to more than 70,000 patients a very easy, convenient, safe and effective method for treating local patients as well as those traveling to Las Vegas from out of state or from abroad.
I provide my cell phone number and email address (702) 281-7437 to all my patients and as such I invite you to call me if you have any questions or issues that need to be addressed. If I am not immediately available, leave your name and phone number and I will get back to you promptly.
Thank you again for your interest
–
CONSULTATION SUMMARY:
Date of Consultation: August 11th, 2016
Nature of The Reproductive Dysfunction:
Age: 41y
•G P M E G4 P0 M4 (10/2014-3/2016) all early
•Duration of infertility: 2Y
•Menstruation: Regular/normal flow/not very painful.
•Pain with deep penetration during intercourse: no
•Pain with ovulation: yes
•PAP Smears (10/2015)..: normal
•Previous pelvic inflammatory disease: no
•Prior abdominal-pelvic surgeries: no
•Systemic History: hypothyroid disease/heterozygous MTHFR mutation
•Current Medications: Levothyroxine 250mcg daily/Labetalol 400mg BID
•Allergic to: none
•Substances:
oSmoking: no
oAlcohol: no
oSubstance abuse no
•Family History: Diabetes/hypertension
•Ovarian reserve: DOR…AMH=0.23ng/ml/basal FSH=11MIU/ml
•Prior immune tests for IID: No ATA done…aPS-+ve…no NK cell assessment or alloimmune profile done
•Previous hysterosalpingogram: no
•Previous hysterosonogram (HSN): no
•Male partner” ` normal sperm parameters
oInitiated pregnancies in the past 4 with partner
•Previous infertility treatments: #X3 IVF with one (1) FET with two (2) PGS-normal blastocysts : last fresh cycle was in April 20116. Launched off BCP and then Lupron (?flare)…….? Dosage gonadotropins…3 follicles observed…2 eggs harvested …2 transferred on day 3
SUMMATION: Age 41Y…RPL….DOR (AMH=0.23ng/ml), 3 X failed IVF/ WANTS IVF WITH OD…Probably done at a distance.. Probably has an IID. We need to evaluate for this. (autoimmune vs alloimmune).
PLAN:
•Immune tests: ATA/NKa/APA/RIP/DQa/HLA
•HSN
•BCP
•IVF with OD …I have referred them to FTF…aim for ER on OD in October cycle. Will need to get a specimen of husband’s sperm frozen here.
•CC/F consultation
¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬____________________________________
ADDITIONAL INFORMATION!
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
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies
•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
•How Many Embryos should be transferred: A Critical Decision in IVF.
•The Role of Nutritional Supplements in Preparing for IVF
•IVF with egg donation
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, does too much ivf drugs (eg LH for older women) and the wrong protocol impact on the quality of all eggs or just the eggs that grow in that particular cycle? Many thanks!
Onlt those developing in the cycle of treatment.
Geoff Sher