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 not sure if you missed my question or it got lost in translation…. anyhow just cut and paste it again. 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 and they are never even in growth – but sometimes will get 4 or 5 mature eggs. 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 2 or 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 and Thanks again 🙂
Dear Dr Sher,
My tnfalpha was high before I started my Ivf cycle. After two intralipid infusions it lowered to 26 and I started Ivf.
I am planning to have another intralipid infusion 7 days before ET. However my egg collection has been bought forward so I will be having intralipid on egg retrieval day. As I am hoping for a 5 day transfer, ET will now take place 6 days after intralipid. Is this timing likely to significantly reduce my success rates or is 6 days before ET still affective? I responded well to intralipid before.
Thank you
In my opinion, the timing of the infusion of IL should ideally be 10-14 days prior to ET, but not less than 1 week before…
I would remind you that to be effective, there are 2 important considerations. The 1st is to differentiate between autoimmune and alloimmune (DQ alpha/HLA matching) cause of NK cell activation ( NKa). Second, bear in mind that while a raised TNFa is highly suggestive of NKa, it is not confirmatory.. You need your blood tested by the KK-562 target cell test. I recommend Reproductive Immunology Associates (RIA) in Van Nuys, CA to do this test..look them up on Google. Third and finally, IL therapy must be combined with steroid therapy to be optimally effective and this should be continued until 10th week of pregnancy.
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
•Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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
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 am a 43 year old female. I have 2 healthy kids and have had no problems, or miscarriages. We want to have a third baby now, but with PGS and IVF to abviate any risk of defects. I have tried one cycle of IVF with recombinant FSH and orgulatron protocol starting day 2 of cycle with HCG trigger. 7 eggs were retriwved out of which only two were viable and were used for ICSI. Following which only one embryo was viable and used for PGS but turned out to be aneuploid.
Atmy age with lowAMH(<0.3) but normal FSH, LH, estreogen etc, what would be the best IVF stimulation protocol for best quality embryos.
thanks
regards
ABBY
Truthfully Abby, at 43y of age with very low ovarian reserve (AMH=0.3MIU/ml) I would recommend you consider IVF with egg donation as being the best option for you. If you reject this, then I suggest that your 2nd best choice would be IVF using a very robust modified long pituitary down-regulation protocol Agonist/antagonist conversion protocol-A/ACP) with estrogen priming and augmentation with human growth hormone (HGH). I would also favor the banking of PGS-selected embryos to try and 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.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•Why did my IVF Fail?
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,
As a poor responder, AMH 0.9, using the antagonist protocol with cetrotide did not work greatly for me. My estrogen wasnt rising properly, very low, I only ended up with 5 eggs, only 2 of them were fertilized using ICSI. Still waiting to see if they’ll continue growing. If this cycle failed, which protocol would suggest to a poor reaponder.
Thank you Dr Sher!
We have ordered metanx through BDH,they have left the medicine in our mailbox.Temperatures on that day around -5 F.The suggested temperature on the medicine is from 50 F to 77 F.Please suggest whether I can use these capsules or disregard them.Thank you!
I think they should be fine!
Good luck!
Geoff Sher