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’m writing to discuss my case and see if anything sticks out to you. I am 27 years old and I’ve tried my best to summarize my treatment history here:
Initial diagnosis: PCOS, Hashimotos
Metformin (1500 mg), Levothyroxine (25 mcg)
Three IUIs with letrozole- #1 and 2 were unsuccessful, #3 cancelled for poor response
IVF freeze all cycle
BCPs; Stim: follistem, menapour; ganirelix
Retrieval- 32 eggs, 13 fertilized (7 on their own, 6 with ICSI), 10 made to day 5 blasts
Hysteroscopy to remove one cervical and one uterine polyp.
FET #1- transferred one blast (unsuccessful)
BCPs, lupron, estrace, PIO, endometrin, baby aspirin, doxycycline, HCG, medrol, anaprox
FET #2- transferred two blasts (chemical pregnancy)
estrace, PIO, endometrin, baby aspirin, doxycycline, HCG, medrol, anaprox
Break for immune workup, PGS, and ERA-
All embryos came back normal
ERA was performed on a natural cycle, results were non-receptive
Immune workup- positive ANAs, AOAs
NK cell count was low, lupus anticoagulant was negative
Suggested low dose prednisone and aspirin
FET #3- transferred one PGS blast (unsuccessful)
BCPs, lupron, estrace, PIO, endometrin, baby aspirin, doxycycline, HCG, prednisone (10mg started with estrace), lovenox (40mg started with progesterone)
Break for another ERA, this time with medication
estrace, PIO, endometrin, baby aspirin, doxycycline, prednisone (10mg started with progesterone), lovenox (40mg started with progesterone) *HCG removed from the protocol*
Result- Receptive (day 6)
FET #4- transferred two PGS hatching blasts (unsuccessful)
estrace, PIO, endometrin, baby aspirin, doxycycline, prednisone (10mg started with progesterone), lovenox (40mg started with progesterone) *HCG removed from the protocol*
We are at a complete loss and feel like we’ve covered all bases. These transfers seemed flawless- good lining, good estrogen/ progesterone levels, healthy embryos, proper placement and smooth transfer. Are there any suggestions for RIF beyond what we’ve tried? We have four embryos left and are considering surrogacy as our best option.
Thank you for your time,
-Kelsey Ibach
In my opinion, you almost certainly have an anatomical (lining thickness) and/or an immunologic implantation dysfunction (IID). You need to know that NK cell concentration is irrelevant. In fact the higher the concentration, the better. Rather, it is NK cell activity as measured by the K-562 target cell test, that matters.
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
•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
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•“Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
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 forgot to mention- I am 27 years old.
And adding to my other post I have been taking Famera which gives me at least 3 follicles every cycle and all my cycles are 30 days long and regular
Hi! I have been dealing with infertility for almost year and half I just turned 30 and my FSH level is 11.8 I have scheduled IVF in November but want to get pregnant naturally what are my chances?? I have been going through acupuncture once a week with Chinese herbal medication everyday. Does that help?? I have been desperately trying to conceive please and suggestion anything would help
Thank you
Hi Krupa,
You are certainly young enough to try on your own, provided you do not have diminished ovarian reserve (DOR). I say this because if your basal FSH is >9 MIU/ml, this could meant that you might have premature DOR, in which case time could be an issue and you might need IVF. Have your blood AMH measured. If it is normal (>2ng/ml or >15pmol/L) then you are fine. If it is much lower, there could be a serious problem…I hope not!
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.
•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
•Optimizing Response to Ovarian Stimulation in Women who Have Compromised Ovarian Response to Ovarian Stimulation in Women who Have Compromised Ovarian Reserve: A Personal Approach.
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.
Hi Dr. Sher
I am a 35 yo old woman who has a healthy 4 year old son who was conceived naturally. fast forward to today and I’ve had one miscarriage, one ectopic and one D&E after finding out the baby had triple x syndrome. Throughout the process of testing the baby’s chromosomes I also found out i am low level mosaic for turner’s (6%).
I was referred to a RE and told to do IVF with PGS. When tested my amh level was 2.33, baseline estrogen was 21 and FSH level was 6.7. I do not know what my AFC was but i do remember seeing some on both ovaries when the u/s was performed.
I was put on a protocol of birth control for a month, and started injectibles of 150iu menopur and 300 gonal-f. On day 3, it was increased to 300 menopur and 300 gonal-f and cetrotide was started on day 6. I stimmed for 11 days and was triggered with hcg thereafter with only 4 follicles on my right ovary, the left one never responded and i have no history or surgery etc which was surprising to my dr.
4 eggs were retrived, and all 4 fertilized and made it to day 3. between day 3 and 5 we were left with 2 of which one was watched until day 7 to biopsy which i believe was due to it not growing as fast. It was rated HEBB and the pgs result was abnormal, it was missing a chromosome 16.
Is there anything with my protocol that sticks out to you of having caused my poor response? My RE has no answer as to why i responded poorly given my hormone levels and reserve seemed fine when tested?
I would need much more information to critique the protocol used for ovarian stimulation. I would need to carefully review your records to offer a man authoritative opinion . Additionally, I do agree that PGS is needed.
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
•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?
•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
•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.