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.
What are your thoughts on the Autoimmune Protocol Diet? Particularly for someone over 35, with Hashimoto’s and having problems trying to conceive? Thanks!
Diet will in my opinion not alter anything as far as NKa-induced implantation dysfunction is concerned.
Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.
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
•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
•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.
Dear Dr Sher,
I am age 38 with PCOS, BMI 31. I have had 2 failed ICSI cycles. 1st cycle short protocol produced 5 eggs with 150u gonal f (increased to 225u) and cetrotide, 250 mcg ovitrelle trigger. Only 1x 3 day embryo survived. On 2nd cycle did flare protocol with 0.05ml buserelin, 225u gonal f, 250 mcg ovitrelle trigger. Produced 11 eggs, of which 7 mature and all fertilised but only 2 x 5 day blastocysts to transfer (medium quality). After this cycle failed my doctor recommended DHEA to improve egg quality due to my age as my ovaries do not respond like PCOS ovaries should and thinks I have high number of abnormal eggs. I am reluctant to take DHEA due to the side effects and PCOS indication but wondered if the dose of trigger shot (250 mcg) has been too low to properly mature my eggs? Also, as my BMI is higher will this have an effect? Thank you for your help
Hi Charlie,
Very respectfully, there is little about the protocols and recommendations that I would agree with. First, in my opinion, the “flare protocol” is less than Optimal in women with PCOS who already tend to have increased LH biological activity (see below); Second, I do not recommend DHEA in general but most particularly not to women with an increased androgen (male hormone) ovarian environment which is common in women with PCOS; Third, in my opinion,250mcg of Ovidrel is too low a “trigger” dosage. It should be double that in order to effect optimal egg maturation (meiosis)…see below.
I would use a low dosage, FSHr-dominant long pituitary down-regulation protocol coming off a BCP …in readiness for “prolonged coasting” to prevent OHSS..see below.
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
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•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?
•Micro-IVF: Often Preferable to Ovarian Stimulation with or Without IUI
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.
Dear Dr Sher,
Thank you so much for the opportunity to ask you questions.
A brief history, my wife and I have tried to conceive for several years without success, went to see fertility Drs who diagnosed me with male factor infertility and after multiple rounds of failed ICSI cycles, and further investigations my wife was diagnosed with hypothyroidism and high natural killer cells and high cytokines. After more failed ICSI cycles, we found out we had partial DQ alpha match. We asked our Dr if we could follow Dr Sher’s approach with prednisolone, clexane and biweekly intralipid infusions until 24 weeks and he agreed and thankfully this cycle worked. We hit a few bumps in the road with subchorionic hematoma bleeding in the first trimester, a low lying placenta and recently gestational diabetes and high amniotic fluid levels.
Since before we started this cycle, my wife was reading a lot about immunity issues in regards to her high NK and cytokines, and she came across some information that diary and gluten are the most common food intolerances in the world. So she decided to completely cut both out of her diet just in case they raised the NK and cytokine levels more if she was intolerant. She doesn’t know for a fact that she is intolerant, she used to get bloated and have gas when she had dairy, so she is just taking her precautions during this pregnancy as it was a very tough road to get here.
After her recent gestational diabetes diagnoses, they gave her the standard diet given to most women which includes all the food groups as well dairy and bread, she is nervous to have dairy and gluten again so we thought we would ask you for your opinion.
So our question is, do you believe if my wife is in fact intolerant to dairy and gluten and she reintroduced both into her diet again at 24 weeks, it could harm the pregnancy? If so in what way, is there a risk of God forbid still birth?
Would a food allergy like that raise her NK and cytokine levels again?
Considering she finished her last intralipid infusion this week.
We thank you for your valuable time and help.
Best regards,
Mark
No! I do not think this would harm the pregnancy.
My congratulations to you and your treating RE.
Geoff Sher
So had my blood drawn today my progesterone is 10.4 so they will NOT prescribe me provera.. They said I must have ovulated last month and I just have to wait for my period to start.. Question I have is if my progesterone is 10.4 can you give me any idea of how many days till my period may start?
Sorry Meghan, that is not possible.
Geoff Sher
Dear Dr. Sher,
my last period was 17/7. I had natural conception and the urine test was positive on 17/8. I made blood test on 18/8 and my first beta was 1317, second beta (two days later) was 2337 and I did one more on 22/8 and it was just 3555. I had a surgery 2011 (endometriosis on my left ovary). On February 2015 I had blighted ovum (also natural conception) and curettage and I have passed through 4 IVF (one was biochemical pregnancy). Yesterday I went to see my doctor and he made an ultrasound. He believes he saw a gestational and yolk sack ( uterus AVF 76×51 mm , endometrium is rich- 20mm, gestational sac 4mm, Douglas is normal, on right ovary which is 27x17mm is a yolk sack of 15mm, left ovary is 21x13mm ) but everything is very small so I will have another ultrasound on 29/8. Currently I am 5 weeks and 3 days pregnant.
I know my beta is not doubling well but is there still a chance for the normal pregnancy? Thank you very much!
You need to give it another week or two and then have an ultrasound to determine.
Geoff Sher