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 – what dosage of intralipids do you give normally? I am planning to do an fet, with steroids 25mg intralipids and aspiran and progesterone shots. Is it ok to start as soon as I get my cycle after egg collection or should I wait for a few months. Thanks.
I use 100cc, 20% IL dissolved in 500cc normal saline and infuse this 10-14 days prior to ET. Throughout this time I combine IL therapy with oral steroids (usually 0.75mg Dexamethasone daily. The second infusion of IL is made with the +ve beta hCG result and I start to tail down the Dexamethasone at the eigth week of pregnancy and stop by the 10th week. This applies to autoimmune implantation dysfunction (by far the commonest form). With alloimmune implantation dysfunction treatment is different. I do NOT use aspirin at all.
Geoff Sher
Dear Dr. Sher,
I have a question about where to go from here as regards treatment. I’m 42 yrs old with a diagnosis of stage 4 endometriosis. At ages 39-40, I had 5 day 5 embryos transferred (1 frozen and 2 x 2 fresh – the fresh were early blastocysts and morulae), which 1 fresh cycle with intralipids due to high uterine NK cells. All had a negative outcome. A new clinic diagnosed bilateral hydrosalinx, which were then removed, and we were advised to go to donor eggs due to my age. All level 1 immune tests came back negative. My husband was diagnosed with high sperm DNA fragmentation (41%) by SpermComet test so we used ICSI. For our donor cycle, we got 8 frozen blastocysts from 14 fertilized eggs from a 24 yr old donor with proven fertility. We have, over two single transfers, put back 2 x 5aa blastocysts on x 2 frozen cycles that were EEVA high predictors. Both have failed. The protocol for the first cycle involved an endometrial scratch, intralipids x 2 days prior to transfer, prednisolone 15 mg, progynova x 6 mg, and cyclogest x 3 daily. The protocol for the second one was the same with added clexane (I have a family history of DVT, but we all show up negative on thrombophilia screen) and aspirin 75 mg and intralipids 7 days post transfer.
My questions are: (a) are we just unlucky and should we go ahead with the same protocol again for our next transfer – which will be an EEVA medium predictor, a 4aa blastocyst or (b) should we be looking at doing some more tests? Having never had a positive pregnancy test, I can’t help but feel there is something wrong with my uterine lining and am wondering whether the endometrial receptivity array test may be worthwhile?
Many thanks for your response
Marie
Of course age and the biological clock are issues when it comes to using your own eggs. However you do seem to be a good responder so, in my opinion you are still a candidate for own eggs (although no doubt egg donation is more likely to be successful). However to do so the protocol you use must be reviewed and revised . I would use an agonist/antagonist conversion protocol (A/ACP with human growth hormone (HGH) supplementation. I would combine this with Staggered IVF (St-IVF) and embryo banking of PGS selected embryos…see below.
VERY important is that in my opinion, receiving an infusion of intralipid 2 days before ET is too late. It needs to be done 10-14 days prior to ET and be combined with daily steroid therapy to be effective. I believe that there is little, if any benefit using IL 2days prior to ET.
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?
•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 Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•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
•IVF Egg Donation: A Comprehensive Overview
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
I was curious to see if you could answer a question that I can’t seem to find any valid information on…
What would cause estrogen levels to dramatically decrease in early pregnancy. Pregnancy was a FET that was controlled by estrace and endometrin. What does this mean if the u/s shows a gestational sac measuring on track and also hcg is more than doubling every 24 hours? Would it mean anything for the pregnancy if this level increases with an added dose of estrace? Or does the decline mean that the pregnancy is failing?
estrogen went from 1,700 at 4 weeks to 251 at 5 weeks to 1837 at 5 weeks 3 days with in increase of 1/2 estrace tab. Could this still mean that the extra estrogen from the estrace is just putting off the inevitable?
A decline in estrogen level is not good. It is only after 8 weeks that the placenta takes over and delivers the hormones necessary to sustain pregnancy. Until then falling estradiol levels could mean insufficient absorption or cross-reaction with other medications. Either way you do need to supplement estradiol if need be.
GeoffSher
Hi Dr. Sher,
I am 33 my husband is 35, we are currently diagnosed as unexplained with a short luteal phase. My progesterone is very low. We conducted 6 unsuccessful IUI. We just conducted our first IVF. Using Menopur and Follistim I produced 16 eggs, 9 were fertilized with ICSI, 6 made it to day 3 and 4 made it to day 5. PGD testing was conducted and all 4 were abnormal due to chromosomes. Due to our age our doctor said this was just a case of bad luck. They have recommended another cycle with a different drug protocol. Before we go through this process again do you have any suggestions regarding additional tests or considerations we should conduct? It was devastating to have no good embryos considering my age. We would really like to avoid a second round with the same results. Thank you!
No other tests…but I would respectfully suggest that the protocol used for ovarian stimulation be carefully reviewed and if need be…be revised. At 33Y,provided your partner has adequate sperm, some of your eggs/embryos should have been normal and aside from age it is the ovarian protocol for stimulation that plays a central role.
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
Dear Dr Sher,
I have had 2 failed ICSI cycles, our problem is male factor infertility.
Both my husband and I are in our 20s
We also did the “Chicago Test” in London which is an immunes test which came back normal except:
Cytokine Ratio:
TNF-a IL10 33.5 (13.2-30.6)
NK Assay Panel
12.5:1 23.8 (3-20%)
I also have had low neutrophils my whole life, it hasn’t caused me any known problems.
my most recent level was 1.47 and the normal range is 2.0-7.5
This is usually my level.
My questions are:
Could the low neutrophil level be causing my failed attempts with ICSI?
Is there a treatment? I read that Neupogen injections can raise my levels?
And are intrauterine or under the skin better?
If yes, what are the doses and how often?
Thank you so much
These immune test results are NOT normal in my opinion. To me they strongly suggest an immunologic implantation dysfunction liked to activated NK cells. Respectfully, unless the chance that you will be successful is markedly diminished (see the articles on immunologic implantation dysfunction below).
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
•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
•IVF Egg Donation: A Comprehensive Overview
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