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 am a 37yr old woman with DOR and low AMH score yet good consistent FSH and good Antral follicle count. My FS finds it quite contradictory. I did an egg freeze cycle at age 35 and retrieved 16 mature eggs. I have also had 2 natural pregnancies at age 36, one which miscarried. This year I did an ICSI cycle (different protocol) and got 6 mature eggs, 4 fertilised and 1 day 5 blastocyst which I have frozen. I am now separated and want advice on freezing eggs for future use to become pregnant. Last month I did another egg freeze cycle and got 10 mature eggs using the original protocol which got the 16 eggs. My main question is, what is the ideal number of eggs to retrieve to freeze for later use? I am willing to do as many rounds of egg retrieval as possible but I am wondering if you can go too far and have many eggs but that they are essentially useless or poor quality due to my age, or is it just better to have as many eggs to work with as possible and get them out of my ovaries and frozen before they run out? I am a good responder to stimulation on short protocols of around 10/11 days of FSH shots before trigger. Is this called a short antagonist cycle?
As of now I have 26 eggs frozen, 16 from age 35 and 10 from age 37. My FS has estimated that of the first 16 eggs, I would be lucky to potentially get 3 blastocysts at best.
Also, I am concerned about the possible loss of some eggs during the thaw process, as I know that eggs are much more fragile and susceptible to perishing than thawing embryos. I froze my eggs as soon as it was available to mainstream in Australia & no longer considered experimental (2014). Do I need as many as possible to accounts for the possible loss of some during eventual thaw for fertilisation at some stage in the future?
Your advice on how to proceed from here would be very valued.
Best regards,
Anne
FYI, while significant enhancements in technology have brought about much improved success rates following freezing (cryopreservation) of embryos, results following egg freezing have been very relatively disappointing.
And there is a lot of misinformation out there. It is not uncommon to see advertisements of a 30-40% birth rate per transfer procedure using embryos derived from previously frozen eggs.. But this statistic is “misleading” because it does not tell the whole story. It fails to address the fact that in the final analysis each egg being frozen and banked will have no more than a 7% chance that it will survive the thaw, be successfully fertilized, and upon being transferred to a recipient uterus will result in a live birth. It also does not reveal that because (even in young women) at best one out of two mature eggs (M2s) eggs are chromosomal abnormal (aneuploid) and “incompetent”; i.e., are incapable of propagating a normal pregnancy (this incidence increases progressively with advancing age). Thus the vast majority of eggs being frozen/banked are in actuality, “incompetent”. This is why most Egg Banks require a commitment on the part of patients, to bank least 15-20 eggs before stopping. It should therefore come as no surprise that recent data shows that the pregnancy rate when eggs used with egg donation are derived from currently operating frozen egg banks, the pregnancy rate following embryo transfer is significantly lower than when fresh (non-frozen) donor eggs are used. That is why our following our governing body, the American Society for Reproductive Medicine (ASRM), currently, still regards egg freezing and banking as being an “experimental approach”.
But all this could be about to change dramatically. We published on the fact that if eggs are selectively frozen, based upon them being chromosomally normal, and such eggs are subsequently used for fertilization and embryo transfer, the pregnancy and birth rate per embryo is several fold higher. In 2007 we were the first to report (RBM-online) on a study where, using metaphase CGH, we were able to selectively freeze (vitrify) and bank only chromosomally normal eggs. We reported on how, upon thawing such pre-vitrified eggs , 90% would survive and that upon fertilization (using ICSI) and then transferring up to two (2) resulting blastocysts), the baby rate baby rate per frozen egg was six times higher and the birth rate per embryo transfer procedure was 60%. To date we have had about 40 babies born using this approach.
So…. the process of selectively vitrifying (freezing) and then banking ONLY “competent” (CGH-normal) represents a real break-through and will likely soon allow women to safely postpone having babies, without fear that the inevitable decline in egg quality which accompanies aging, will deny them having a family they are ready…”Fertility Preservation”. This would also benefit women with existing medical conditions (such as breast cancer, leukemia, lymphoma etc.) which preclude initiation of pregnancy until cured. In such cases treatment (e.g. by radiotherapy or chemotherapy) would otherwise often render these women permanently infertile. The successful cryopreservation and storage of their eggs could avoid denying such women the opportunity of parenthood with their own eggs. Finally, it could lead to genetically competent donor eggs being banked for subsequent purchase (at a comparatively low cost) by women with failing or failed ovaries who wish to have babies.
Truth be known, there are few (if any) IVF labs that presently offer egg chromosomal testing. At 37y, freezing your eggs without this advantage probably means that you should freeze no less than 15 mature (M2) eggs.
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. Thanks alot for this opportunity.
Mu case is the following:
I was diagnosed with low ovarian reserve (.5 ng/ml) 2 years ago so i did an ivf cycle with icsi .. 4 eggs grade 3 retrieved , 2 of which were fertilized which led to my first pregnancy.
Last April and this mobth also i went for another 2 rounds .. fewer eggs retrieved and i transferred 2 grade A embryos on day 2 but no pregnancy in both times.. my eggs were grade 4 which i think is the main issue.
All my cycles were short protocol and eggs were retrieved on CD 11
Any suggestions for improving egg quality? Supplements? Food?
Should they change my protocol?
Hello Dr. Sher, I just had my blood results back and I notice that my Total NK cells were elevated to 350, although they are at 13%. Can that be a reason for infertility? Also my TSH is varying between 2.50 and 3.20. Thank you
Hi Diana,
The total NK cell concentration is irrelevant. It is NK cell “activation” (NKa) 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
•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!
•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.
I am 32 yrs with diagnosis of grade 4 endometriosis a year back. Since then I have had 3 ivf cycles 2 with short and one with long protocol. .I have jus 2 blastocyst frozen. My left tube is blocked with low ovarian reserve. Eggs retrieved per cycle is 5 to 6 only. Most of day 3 embryos are 5 or 6 cell and degenerate at morula stage. Should I go for lap adhesiolysis or further ivf cycles? ?
Unless hyou have one or more ovarian endometriotic cysts (endometriomas), I would not do surery. It won’t in my opinion solve your problem. What is important is to be tested for an immunologic implantation dysfunction (IID) that occures in about 1/3 of endometriosis cases.
Endometriosis is a condition that occurs when the uterine lining (endometrium) grows not only in the interior of the uterus but in other areas, such as the fallopian tubes, ovaries and the bowel. Endometriosis is a complex condition where, the lack or relative absence of an overt anatomical barrier to fertility often belies the true extent of reproductive problem(s).
All too often the view is expounded that the severity of endometriosis-related infertility is inevitably directly proportionate to the anatomical severity of the disease itself, thereby implying that endometriosis causes infertility primarily by virtue of creating anatomical barriers to fertilization. This over-simplistic and erroneous view is often used to support the performance of many unnecessary surgeries for the removal of small innocuous endometriotic lesions, on the basis of such “treatment” evoking an improvement in subsequent fertility.
It is indisputable that even the mildest form of endometriosis can compromise fertility. It is equally true that, mild to moderate endometriosis is by no means a cause of absolute “sterility”.
Rather, when compared with normally ovulating women of a similar age who do not have endometriosis, women with mild to moderate endometriosis are about four to six times less likely to have a successful pregnancy.
Endometriosis often goes unnoticed for many years. Such patients are frequently, erroneously labeled as having “unexplained infertility”, until the diagnosis is finally clinched through direct visualization of the lesions at the time of laparoscopy or laparoscopy. Not surprisingly, many patients with so called “unexplained” infertility, if followed for a number of years, will ultimately reveal endometriosis.
Women who have endometriosis are much more likely to be infertile. There are several reasons for this:
•First-Ovulation Dysfunction: In about 25 – 30% of cases, endometriosis is associated with ovulation dysfunction. Treatment requires controlled ovarian stimulation (COS). The problem is that the toxic pelvic environment markedly reduces the likelihood that anything other than IVF will enhance pregnancy potential.
•Second- Toxic Pelvic environment that compromises Fertilization Endometriosis is associated with the presence of toxins in peritoneal secretions while it is tempting to assert that normally ovulating women with mild to moderate endometriosis would have no difficulty in conceiving if their anatomical disease is addressed surgically or that endometriosis-related infertility is confined to cases with more severe anatomical disease…nothing could be further from the truth. The natural conception rate for healthy ovulating women in their early 30’s (who are free of endometriosis) is about 15% per month of trying and 70% per year of actively attempting to conceive. Conversely, the conception rate for women of a comparable age who have mild or moderate pelvic endometriosis (absent or limited anatomical disease) is about 5-6% per month and 40% after 3 years of trying. As sperm and egg(s) travel towards the fallopian tubes they are exposed to these toxins which compromise the fertilization process. In fact it has been estimated that there is a 5-6 fold reduction in fertilization potential because of these toxins which cannot be eradicated. Frankly, it really does not matter whether an attempt is made to remove endometriosis deposits surgically as this will not improve pregnancy potential. The reason is that for every deposit observed, there are numerous others that are in the process of developing and are not visible to the naked eye and whether visible or not, such translucent deposits still produce toxins. This also explains why surgery to remove visible endometriosis deposits, controlled ovarian stimulation with or without intrauterine insemination will usually not improve pregnancy potential. Only IVF, through removing eggs before they are exposed to the toxic pelvic environment, fertilizing them in-vitro and then transferring the embryos to the uterus represents the only way to enhance pregnancy potential.
•Third-Pelvic adhesions and Scarring: In its most severe form, endometriosis is associated with scarring and adhesions in the pelvis, resulting in damage to, obstruction or fixation of the fallopian tubes to surrounding structures, thereby preventing the union of sperm and eggs.
•Fourth-Ovarian Endometriomas, Advanced endometriosis is often associated with ovarian cysts (endometriomas/chocolate cysts) that are filled with altered blood and can be large and multiple. When these are sizable (>1cm) they can activate surrounding ovarian connective tissue causing production of excessive male hormones (androgens) such as testosterone and androstenedione. Excessive ovarian androgens can compromise egg development in the affected ovary (ies) resulting in an increased likelihood of numerical chromosomal abnormalities (aneuploidy) and reduced egg/embryo competency”. In my opinion large ovarian endometriomas need to be removed surgically or rough sclerotherapy before embarking on IVF.
•Fifth- Immunologic Implantation Dysfunction (IID). Endometriosis, regardless of its severity is associated with immunologic implantation dysfunction linked to activation of uterine natural killer cells (NKa) and cytotoxic uterine lymphocytes (CTL) in about 30 of cases. This is diagnosed by testing the woman’s blood for NKa using the K-562 target cell test or by endometrial biopsy for cytokine analysis, and, for CTL by doing a blood immunophenotype. These NKa attack the invading trophoblast cells (developing “root system” of the embryo/early conceptus) as soon as it tries to gain attachment to the uterine wall. In most cases, this results in death of the embryo even before the pregnancy is diagnosed and sometimes, in a chemical pregnancy or even an early miscarriage. . As such, many women with endometriosis, rather than being infertile, in the strict sense of the word, often actually experience repeated undetected “mini-miscarriages”.
Advanced Endometriosis: In its most advanced stage, anatomical disfiguration is causally linked to the infertility. In such cases, inspection at laparoscopy or laparoscopy will usually reveal severe pelvic adhesions, scarring and “chocolate cysts”. However, the quality of life of patients with advanced endometriosis is usually so severely compromised by pain and discomfort, that having a baby is often low on the priority list. Accordingly, such patients are usually often more interested in relatively radical medical and surgical treatment options (might preclude a subsequent pregnancy), such as removal of ovaries, fallopian pubis and even the uterus, as a means of alleviating suffering.
Moderately Severe Endometriosis. These patients have a modest amount of scarring/ adhesions and endometriotic deposits which are usually detected on the ovaries, fallopian tubes, bladder surface and low in the pelvis, behind the uterus. In such cases, the fallopian tubes are usually opened and functional.
Mild Endometriosis: These patients who at laparoscopy or laparotomy are found to have no significant distortion of pelvic anatomy are often erroneously labeled as having “unexplained” infertility. To hold that the there can only infertility can only be attributed to endometriosis if significant anatomical disease can be identified, is to ignore the fact that, biochemical, hormonal and immunological factors profoundly impact fertility. Failure to recognize this salient fact continues to play havoc with the hopes and dreams of many infertile endometriosis patients.
TREATMENT:
The following basic concepts apply to management of endometriosis-related infertility:
1.Controlled Ovulation stimulation (COS) with/without intrauterine insemination (IUI): Toxins in the peritoneal secretions of women with endometriosis exert a negative effect on fertilization potential regardless of how sperm reaches the fallopian tubes. This helps explain why COS with or without IUI will usually not improve the chances of pregnancy (over no treatment at all) in women with endometriosis. IVF is the only way by which to bypass this problem.
2.Laparoscopy orLaparotomy Surgery aimed at restoring the anatomical integrity of the fallopian tubes does not counter the negative influence of toxic peritoneal factors that inherently reduce the chances of conception in women with endometriosis four to six fold. Nor does it address the immunologic implantation dysfunction (IID) commonly associated with this condition. Pelvic surgery is relatively contraindicated for the treatment of infertility associated with endometriosis, when the woman is more than 35 years of age. With the pre-menopause approaching, such women do not have the time to waste on such less efficacious alternatives. In contrast, younger women who have time on their side might consider surgery as a viable option. Approximately 30 -40 percent of women under 35 years of age with endometriosis will conceive with in two to three years following corrective pelvic surgery.
3.Sclerotherapy for ovarian endometriomas.: About 10 years ago I introduced “sclerotherapy”, a relatively non-invasive, safe and effective outpatient method to permanently eliminate endometriomas without surgery being required. Sclerotherapy for ovarian endometriomas involves needle aspiration of the liquid content of the endometriotic cyst, followed by the injection of 5% tetracycline into the cyst cavity. Treatment results in disappearance of the lesion within 6-8 weeks, in more than 75% of cases so treated. Ovarian sclerotherapy can be performed under local anesthesia or under general anesthesia. It has the advantage of being an ambulatory office- based procedure, at low cost, with a low incidence of significant post-procedural pain or complications and the avoidance of the need for laparoscopy or laparotomy
4.The role of selective immunotherapy Women with antiphospholipid antibodies (APA’s) experience improved IVF birth rates when heparinoids (Clexane/Lovenox) is administered from the onset of ovarian stimulation with gonadotropins until the 10th week of pregnancy.
a.About Intralipid (IL) and steroid therapy: Intralipid (IL) is a solution of small lipid droplets suspended in water. When administered intravenously, IL provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid.IL is made up of 20% soybean oil/fatty acids (comprising linoleic acid, oleic acid, palmitic acid, linolenic acid and stearic acid) , 1.2% egg yolk phospholipids (1.2%), glycerin (2.25%) and water (76.5%).IL exerts a modulating effect on certain immune cellular mechanisms largely by down-regulating activated natural killer cells (NKa). This effect is enhanced through the concomitant administration of corticosteroids such as dexamethasone, prednisone, and prednisolone which enhance the therapeutic effect by suppressing cytotoxic/activated T-lymphocytes (CTL). This effect of IL might is likely due to its ability to
5. In vitro fertilization is the treatment of choice for women with endometriosis. This is especially true for women more than 35 years of age or where surgery and treatment with fertility agents has proven to be unsuccessful. We anticipate that approximately 75 percent of such women will achieve the birth of one or more babies within three IVF attempts performed.
6.
?suppresses pro-inflammatory cellular (Type-1) cytokines such as interferon gamma and TNF-alpha. In-vitro testing has shown that IL successfully and completely down-regulates activated natural killer cells (NKa) within 2-3 weeks in 78% of women experiencing immunologic implantation dysfunction. In this regard it is just as effective as Intravenous Gamma globulin (IVIg) but at a fraction of the cost and with a far lower incidence of side-effects. Its effect lasts for 4-9 weeks when administered in early pregnancy.
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.
•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
•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.
Hello Dr. Sher,
We had four unsuccessful IVF cycles with donor eggs. I am 44 now and we are running out of options, money and most importantly out of time… so I am looking for your advise before we transfer two last blastocysts we have frozen. We never did pgd testing so I do not know if the problem was with the embryos or with me.
I did check NK activity in March with ReproSource and the results seemed to be below normal range:
NK Activity Assay – 99.5
Cell Viability – 98.6%
——————————————-
E:T 50:1 Native State – 8.1 (normal range 12.1-37.4)
E:T 25:1 Native State – 4 (normal range 6.6-30.6)
E:T 12.5:1 Native State – 2.9 (normal range 3.4-23.5)
——————————————-
E:T 25:1 +IL-2 stimulation – 6.7 (normal range 10.8-33.2)
% increased 66.3 >15% Stimulation
——————————————-
E:T 25:1+Intralipid – 3.8 (normal range 7.0-34.5)
% reduced 4.0
——————————————-
E:T 25:1+12.5mg/dl IgG – 1.7 (normal range 2.7-29.2)
% reduced 58.5 >15% suppression
E:T 25:1+6.25mg/dl IgG – 3.2 (normal range 4.9-28.3)
% reduced 19.5 >15% suppression
1. What those below range results mean – is it a problem?
2. My Dr said that I have increased NK and therefore I needed Dexamethasone. But from those results it doesn’t seem that NK activity is increased – does it? If this is the case, is it OK to take Dexamethasone for the next FET?
3. Should I take also Intralipids?
4. What is your opinion on ERA testing and e-tegrity testing?
5. Any other tests you would advise?
6. Because of my MTHFR C677T mutation, starting few weeks before transfer I was taking baby aspirin twice a day and 40 mg Clexane staring one day before transfer- would you agree with this dosage?
7. And the last question: we want to transfer two remaining embryos: 5day 1BB and 6day3BC
Can it disturb the implantation process if one is at a different development stage than the other and would potentially start implantation earlier?
Thank you so very much,
Zuza
These NK assay test results are NORMAL, but this is contingent upon the reliability of the assay and this depends on where the tests were done (there are only about 5 reproductive immunology reference laboratories in the USA that can do the test reliably). Thus based on this, your problem could be unrelated to an immunologic implantation dysfunction (IID). We need to talk in order to flush out where your problem lies.
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
•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
•Why did my IVF Fail
•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.
•IVF Egg Donation: A Comprehensive Overview
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.
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