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 hope you can answer a few questions for me.
What are your thoughts on the Bravelle recall – if the drug has potency issues do you think this could have had a neagative impact on a cycle – we responded very poorly – worst response out of al the cycles we did by far.
How bad is amh of 1.7 for a 38 yr old? Does this drop quickly – ie over the next year or even few months?
Can a single embryo break into 2 after implantation – if so what’s the likelihood?
Thank you for your help.
Jones
The recall of Bravelle has to do with its lower biopotency and probably a batch to batch variation in its biological effect. I have suspected this for years and have never prescribed the product. However, the recall was voluntary by Ferring and there appears to be no suggestion of teratogenicity.
An AMH of 1.7 is still OK but it should serve as a warning that you could be on the brink of DOR and that you need to be proactive now and proceed with planned treatment before things get worse.
Fewer than 1: 100 embryos split to form identical multiples.
Please visit my new Blog on this very site, http://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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site 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 have a two part question for you. I have unexplained infertility with all thyroid, AMH, hormone levels and lining thickness levels normal. I am 30 yrs old and a runner, but have a healthy body weight. I had a DVT in my calf 3 years ago, so I take a daily baby aspirin. My husband has no male factor issues. So far, we have had 3 failed IUIs with letrozole, 1 failed IUI with follistim and 2 failed IVF cycles. The first IVF cycle we used follisitim and had 7 eggs retrieved, 6 fertilize and 2 transferred on day 3 due to the growth slowing down. No eggs made it to freezing stage. The second IVF cycle we added Menopur to the mix and had 9 mature eggs retrieved, 7 fertilize with ICSI and transferred 1 high quality embryo on day 5, but none made it to freezing stage. My doctor thinks egg quality is an issue, but the Menopur was successful with helping the quality.
1. Are there over the counter supplements I should be taking to assist with egg quality? I already take a daily multi vitamin.
2. I am interested in this article I found linking poor blood circulation to unexplained infertility: http://www.bellaonline.com/articles/art173281.asp
Is this diagnostic test for uterine blood flow impairment a normal protocol at infertility clinics? I don’t think I’ve had this testing, even though I do have poor circulation. Should I see my hematologist for this testing?
Thank you!
If you are able to produce a uterine lining of >8mm at the time of the hCG trigger, you do not have a uterine blodd flow issue.
Unfortunately there is no way to improve egg qualitb with supplements. I would strongly discourage the use of DEA. Besides, I do not believe at age 30Y that you have an intrinsic egg problem. This wouldbe exceedingly unlikely. What is more likely in my opinion, is that you need a review of the protoc0l used for ovarian stimulation because it is there that most egg quality issues reside (see below).
In addition, I would strongly recommend that you be evaluated for an immunologic implantation dysfunction. Your blood should be tested for NK cell activation by the K-562 target cell test and if +ve, further evaluation would be needed to better define whether this is due to an autoimmune (most likely) or an alloimmune cause.
Please visit my new Blog on this very site, http://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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•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 Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•Why did my IVF Fail?
•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
•The Role of Nutritional Supplements in Preparing for IVF
this site 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. I have a mood disorder and have had problems with anxiety and depression in the past. I have been stable for 7 plus years and have a full time job. My husband have a consult in April and are thinking we will do ivf in May. The nurse practitioner that prescribes my pscyh meds wants me to get off my klonopin. I am on 1.5 mg. I had tapered down to .75 mg, but could not handle it. I was even thinking of going to the hospital last night. My mood was all over the place and anxious thoughts that I hadn’t had for years were coming back. My husband convinced me to go back to my regular dose of 1.5 mg, which I did. I am worried that I will be denied getting ivf because of the klonopin. My husband and I am aware of the risks, but I need to be in a stable place mentally, so I am going to remain on the klonopin. My question is-will they not let me do ivf on klonopin? Do they deny people ivf because of certain meds? Please respond as soon as you can and thanks in advance
Stephanie
Ultimately, the decision as to use medications that have the potential to cause developmental problems is up to the patient. This is especially with Drugs like Klonopin that have a “possible” fetal developmental impact.
More than likely you will be required to sign some sort of release before they proceed.
Geoff Sher
Dear Dr Sher,
1) On my last IVF cycles I took 2 x 400mg progesterone pessaries plus 1 x 25mg Prolutex (progesterone) injections into the stomach under the skin. The reason I got so much is because I spotted from 9 days post 5 day transfer. My Dr believes in not doing a blood test until 14 days post 5 day transfer.
In your opinion, is the dose of progesterone I am taking too high? Can such a high progesterone actually hinder implantation?
2) On a previous cycle I took 2 x 400mg progesterone pessaries only (no Prolutex then). I did a progesterone test on 14dp5dy as again I had spotting before test date and my progesterone levels were about 170. Are these levels too high?
3) And finally why do I spot 9 days post transfer even though my progesterone levels seem to be quite high with all the progesterone I am taking?
1.In your opinion, is the dose of progesterone I am taking too high? Can such a high progesterone actually hinder implantation?
A: It is a high dosage but I do not think it will cause a problem with implantation.
2) On a previous cycle I took 2 x 400mg progesterone pessaries only (no Prolutex then). I did a progesterone test on 14dp5dy as again I had spotting before test date and my progesterone levels were about 170. Are these levels too high?
A: Again..high but wont cause a problem in my opinion.
3) And finally why do I spot 9 days post transfer even though my progesterone levels seem to be quite high with all the progesterone I am taking?
A: Hard to say. It could be local cervical irritation or it could be failing implantation.
Good luck!
Geoff Sher
Hi Dr Sher. I am now 40 years old. I had 3 IVF cycles in 2012 and was successful on the third one. Originally, the only issue was male factor – no sperm so using donor. I have always responded very well to medications. First two cycles was thw wrong protocol. Third cycle had a son and 4 blasts frozen. Have since transferred all 4 and had 2 chemicals and 2 BFN. Did a full immune work up with Alan Beers after the failures and found to have low LADS ( t cell, B were fine) and only borderline elevated NK cells. My lining has always only gotten to the 7s for transfer. I did a 4th IVF a few months ago with pgs. Out of 5 blasts, one was normal, 2 were not and 2 were “no result”. I did IVIG 4 days before the transfer of the normal one but still got a BFN. What is going on? I have the two no result blasts frozen. What would cause a “no result” and how often are they normal? The normal blast was frozen on day 6, but was transferred on day 5, would this make a difference. My instinct has always been that it is not immune related, but after a failure with a normal one I am not sure what to think. Of note, I also had two unplanned natural pregnancies in my 20s and had no issue getting pregnent.
Frankly, it does sound as if you might have an immune issue…but of course I could be wrong. If you do have an immunologic implantation dysfunction, I would not be surprised if it turned out to be the rarer form, i.e. alloimmune (rather than autoimmune) implantation dysfunction (see below). I do however feel that the protocol used for ovarian stimulation should be critical revied.
As for the issue of “non-tested embryos”. That simply means that for technical reasons the Genetics lab could not arrive at a definitive diagnosis. What is important to know is that such embryos are no more and no less likely to propagate a viable pregnancy that embryos that were never ever subjected to PGS.
Please visit my new Blog on this very site, http://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
•Why did my IVF Fail?
•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
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site 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