19,771 Comments

1. Jules on February 16, 2016 at 9:27 pm

   Hi Dr Sher,
   Apologies for repeating this question- I feel I may have confused the issues as to what I was asking. My main concern right now is lining. Have you experienced lining ‘going backwards’ after a woman starts progesterone? On a HRT cycle I was taking 12mg progynova plus estraderm patches. My lining was 6.8, I started progesterone 900mg, and 5 days later my lining was 4mm.

   I have some immune issues high anti-thyroid peroxidase antibodies, high ANA, have moderate NK56 & borderline NK57 (as per my reproductive immunologist), I also appear to have raynauds (diagnosed purely by my description of symptoms in my hands & feet). Have had other immunology testing done which has been clear. My RI is treating the immune issues with prednisolone, intrallipids, clexane.

   During my stim cycles we discovered my lining is too thin. Never getting past 6mm prior to egg retrieval. Even with 10mg progynova daily, estraderm patches X 2, and aspirin daily.

   My transfer has now been cancelled.

   My question to you is- have you seen this happen before? If so, why does this happen? I had NO bleeding- so how can the lining lessen???

   The nurses at my clinic seemed perplexed and said they’ve never seen a lining go backwards. How is this possible?? Do you have any suggestions on why this happened and how to treat it? I’m so worried this can’t be fixed.

   • Dr. Geoffrey Sher on February 16, 2016 at 11:10 pm

     Without much more information, I really cannot advise authoritatively. What I can tell you is that a “poor” endometrial lining is most commonly due to: 1) inflammation of the uterine lining (endometritis) that usually occurs as a result of endometritis (inflammation of the uterine lining that can follow a septic delivery, partial retention of the placenta following delivery, abortion or miscarriage, 2) severe adenomyosis (gross invasion of the uterine muscle by endometrial glandular tissue), 3) multiple fibroid tumors of the uterine wall) 4) prenatal exposure to the synthetic hormone, diethylstilbestrol (DES) and, 5) following >3, consecutive, back to back cycles of clomiphene citrate ovulation induction.

     Treatment with vaginal Sildenafil (Viagra): Hitherto, attempts to augment endometrial growth in women with poor endometrial linings by bolstering circulating estrogen blood levels (through the administration of increased doses of fertility drugs, aspirin administration and with supplementary estrogen therapy) have yielded disappointing results.

     In the mid-90’s I first reported on the finding that thee vaginal administration of Viagra for several days prior to the “hCG trigger “ or progesterone administration enhances uterine blood flow and estrogen delivery to the uterine lining and so improves endometrial thickening. Then In October 2002, I reported on the administration of vaginal Viagra to 105 women with repeated IVF failure due to persistently thin endometrial linings. All of the women had experienced at least two (2) prior IVF failures attributed to intractably thin uterine linings. About 70% of these women responded to treatment with Viagra suppositories with a marked improvement in endometrial thickness and 45% of these women achieved live IVF- births following a single cycle of treatment with Viagra. Nine percent (9%) miscarried. None of the women who had failed to achieve an improvement in endometrial thickness following Viagra therapy, subsequently and who underwent embryo transfers achieved viable pregnancies.

     Good luck!

     Geoff Sher

2. Ben on February 16, 2016 at 4:36 pm

   Doctor,

   Wondering why eggs from tiny follicles are removed in retrievals – they do it in our clinic. Is this just to improve numbers for the clinic and for it to sound better for the patient on retrieval – won’t they always be immature when follicles are very small – i.e below 10mm.

   Thank you

   • Ben on February 16, 2016 at 4:38 pm

     Doctor,

     Also, do you recommend DNA sperm test for men with MFI? Is it a reliable test to see sperm quality?

     Thanks

   • Dr. Geoffrey Sher on February 16, 2016 at 7:52 pm

     Because some will still harbor mature and competent eggs at times.

     Geoff Sher

3. Julie on February 16, 2016 at 2:08 pm

   Just wanted to add, in June 2015 I did have a laparoscopy, hysteroscopy & D&C which came back as all clear- I was advised everything was as it should be. I have an AMH of 24.7m/mol (Australian measurement), which is considered very high here. At EPU’s I had 13 eggs & 15 eggs retrieved at both cycles. Then 6 embryos & 7 embryos resulted.. But this reduced to us ending up with 1st cycle X 1 PGD normal hatching blast & 2nd cycle, X 3 hatching blasts, 2 tested abnormal & the 3rd couldn’t be tested due to the ICM hatching- embryologist didn’t want to risk damaging it. I realise this may be due to my age (40.5yrs & 41yrs at times of EPU), and also my partners poor sperm issues. Im very nervous therefore about transferring our one PGD embryo- it may be our only chance of a biological child. My lining issues are no a huge concern.

   • Dr. Geoffrey Sher on February 16, 2016 at 2:53 pm

     Julie,

     You are correct, age is a factor because at age 41Y only 1:8 eggs are likely to be normal. If it were up to me I would not transfer the one blastocyst now. Rather I would first to bank more PGS-normal embryos and (so to say) try to “make hay while the sun still shines”.

     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.
     •Traveling for IVF from Out of State/Country–
     •A personalized, stepwise approach to IVF
     •The Role of Nutritional Supplements in Preparing for IVF
     •Measuring and Interpreting Blood hCG to Assess Pregnancy Viability Following ART Treatments.
     •Male Factor Infertility
     •The Sperm Chromatin Structure Assay (SCSA): A Measure of the Potential of Sperm to Help Propagate a Viable Pregnancy
     •IVF for Women Who Have Previously Conceived (Secondary Infertility).
     •Endometriosis and Infertily
     •Treating Ovarian Endometriomas with Sclerotherapy.
     •Implications of “Empty Follicle Syndrome and “Premature Luteinization”
     •Fertility Preservation (FP) Through Freezing/Banking Human Eggs
     •Selective Banking of Genetically Tested Donor Eggs:
     •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

4. simone on February 16, 2016 at 10:29 am

   Hi Dr Sher,
   Thank you so much for this wonderful forum and for answering our questions!! I wonder how you deal with women with DOR who always get a dominant follicle during IVF? I am now 37 but started doing IVF at 35 after 3 chemical pregnancies conceived naturally. I was on BCP for 21 days and 14 days before 2 cycles and each time was oversupressed and didn’t have many follicles grow. I also did your antagonist/agonist conversion protocol (overlapped synarel from luteal phase with the antagonist- orgalutran) and I did the initial high doses of FSH (think 600IU from memory) and this didn’t work well either. Most cycles I have done antagonist protocol with 225IU to 300IU FSH. We also added a little menopur after day 5 or 6 of stims (75IU). My last cycle I did 4mg of oestrogen priming each day for last 7 days of luteal phase of cycle prior to try to avoid the dominant follicle, but it happened again! I usually have AFC of about 8-10 follicles, but I only ever get 5 or 6 if they grow evenly, but most often they don’t. I have an AMH of 10.1 at last check a year ago (Australian measurement) and my FSH varies from 8-11 on day 3. I am wondering what you do for ladies like me? I am about to do another cycle next month and am on day 5 of the menstrual cycle before. Just wondering should I have been on oestrogen longer or higher doses – why did I still get a dominant follicle?

   1. Would you suggest micro-dose lupron in the luteal phase as well?

   I know you aren’t a fan of testosterone for older women, but my testosterone is below the ideal range.
   2. Do you think low testosterone could be an issue as I know testosterone is needed also for egg development.

   3. Do you believe that day 3 transfers are better than day 5 for older women (my embryos have only ever made blast once, and only one of them, out of 4 cycles!)
   4. What do you think of low dose HCG during stims (as an LH supplement)?
   5. What do you think of HGH (low dose through the cycle before and then again during stims in higher doses) to help with egg quality?

   Any help much appreciated!!!!

5. Emily on February 16, 2016 at 8:38 am

   Thanks so much dr.sher my ivf journey is so much more informative with you to answer my questions. Can I ask you why you do not use aspirin, does it have a negative effect. I forgot to mention I will be on clexane also. Thanks again… wish I lived in Las vegas