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.
Doctor Sher your blog is amazing! Thank you so much! My question is-
What lifestyle factors contribute to egg quality? apart from the obvious factors such as advanced maternal age (wear & tear) cigarette smoking, illegal drug use etc. How much does prescription drug use such as antidepressants & anti anxiety medications (short term use only) social alcohol use, diet, stress, genetics ect have a marked impact on the quality & deterioration off egg supply and quality? Any input is very valued! Many thanks.
The most important factor aside from age/ovarian reserve anc narcotic abuse is genetics. There is no evidence that anxiety medications and antidepressants taken appropriately will harm egg quality.
Thanks for your kind sentiments.
Geoff Sher
How do you know if your eggs are either good or ‘poor quality’? If you get a good number of mature eggs retrieved, how do you then know if they are of good or bad quality? Is it only upon attempting fertilisation and growing them that the lab can tell the quality off the eggs?
Other than morphologic (microscopic) assessment, preimplantation genetic sampling (PGS) is the only way we have to assess egg/embryo competency.
About 12 years ago, Levent Keskintepe PhD and I introduced Comparative Genomic Hybridization (CGH) into the clinical IVF arena, as a preimplantation genetic sampling (PGS) method that enables full karyotyping (numerically chromosomal analysis) of all 23 pairs of an embryo’s chromosomes so mas to determine its subsequent ability to propagate a viable pregnancy (i.e. its “competence”). Since then we have, over a period of a decade, authored many articles on the clinical utility and advantages associated with the selective performance of embryo PGS and with it have witnessed embryo karyotyping emerge as a valuable efficiency tool in the IVF arena. Several alternatives to CGH have since emerged and while none are perfect, they have all enhanced our ability to better select the most “competent embryos for transfer to the uterus, thereby improving the efficiency of IVF, and reducing the risk of chromosomal miscarriages and birth defects. One recently introduced method known as “Next Generation Gene Sequencing (NGS)” bears special mention since its improved accuracy and reliability over previously used methodologies, has established it as a method of choice when it comes to embryo karyotyping..
Gene Sequencing is a method that determines the precise order of nucleotides within a DNA molecule. The method/ technology determines the order of the four bases—adenine, guanine, cytosine, and thymine—in a strand of DNA. A new generation of sequencing technologies known as NGS now provides unprecedented opportunities for high-throughput functional genomic research. NGS is currently being applied to identify the karyotype of the human embryo and in my opinion is more reliable than other available PGS methodologies.
NGS can be conducted reliably on single blastomeres (derived from day 2-3, cleaved embryos) as well as on pooled cell samples biopsied from a blastocyst. When performed individually on several cells derived from a blastocyst NGS can help differentiate between meiotic and mitotic (mosaic) aneuploidy. Done selectively, this could have potential advantages because unlike meiotic aneuploidy which is permanent and often lethal to the embryo, mitotic aneuploidy (mosaicism) is often self-correcting with further embryo development.
Optimal timing of embryo PGS biopsy is very important. You often hear told that embryo biopsy is more reliable if conducted on a blastocyst, rather than on an early (day 3) cleaved embryo. I disagree for 2 reasons. The first is that the earlier in embryo development that the biopsy is done for PGS, the more likely it is that a numerical chromosomal irregularity (aneuploidy) originated during egg (and rarely sperm) meiosis and accordingly is irreversible. In contrast, the later in embryonic development that the biopsy is done, the more likely it becomes that the aneuploidy occurred post-fertilization, affecting only some of the embryo’s cells during mitosis and is thus potentially autocorrectable over time. Thus, it is in my opinion preferable to perform embryo biopsies for PGS on day 3 rather than on day 5-6. The second reason that I prefer doing day 3 biopsies is to give the embryo time (over the ensuing 2-3 days that it develops into a blastocyst) to recover before being vitrified (ultrarapidly frozen). In my experience embryos that are biopsied earlier tend to survive the subsequent freeze/thaw in a much better condition than when they are biopsied as blastocysts whereupon thy are immediately frozen.
Based upon available data, it is my opinion that the time has arrived to recommend that NGS be used as the preferred method for PGS in 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’m just trying to find answers with what me and my husband are currently going through. Any insight would be appreciated. This is a bit long but here is our story.
First, we conceived my son and had a healthy pregnancy 3 years ago. I was 24 and my husband was 35 at the time of conception. We have now been trying for baby #2 for at least 6 months, initially tracking ovulation and such. Keep in mind I’ve not been on BC since my son was born and we’ve not made any efforts to prevent pregnancy since that time. Since I had my son I’ve had irregular cycles. I first chalked it up to breastfeeding but it’s never regulate itself. My first cycle was 8 months postpartum, and then my next wasn’t until 12 months postpartum and after time has gone on I have a cycle about very 8-10 weeks. In. December I started having extremely painful cycles out of no where and its continued until this last cycle in July. I went to my OBGYN who did a ultrasound, a biopsy of my uterus, and the a saline infused sonogram which ruled out any reasons for the pain other than a nabothian cyst on my cervix. Then she decided that Clomid was a good first step in conceiving since I don’t ovulate regularly. Ive done two cycles and we still aren’t pregnant. During the Clomid a friend suggested we have my husbands sperm checked. That was 2 months ago and we finally got the results back today. The urologist told him that he has a sperm count of 140 million. That the majority of his sperm has crazy morphology of double heads, tails etc, but he does has some normal sperm. The doc also said he does not produce enough fluid which is effecting motility. The doc told my husband you only have a “slim” chance of conceiving. He had bariatric surgery in August 2014 and the doc says there is a link between the surgery and infertility and his age. We are now 27 and 38. Please tell me this “slim” chance is more than just slim. I need hope. Our game plan is at my next cycle I will start BC to try and regulate my cycles for 3 months. In that time we will work on boosting his sperm health with supplements and anything else we can find. From what I’m reading, the morphology described isn’t uncommon and that 90% of sperm is misshapen anyways. I’ve already read that motility can be improved. I’m just hoping we have a chance if I get my cycles regulated and we can improve his sperm health. If not, we have no other choices. We can not afford IVF and our insurance doesn’t cover it. Thanks for reading.
With painful periods (especially if you also have pain with intercourse, you could have endometriosis and if so, this will make getting pregnant mopre difficult, even if you use fertility drugs with or without IUI (see below). The only way to make that diagnosis is by laparoscopy.
It is possible that the male factor is playing a role here, but I doubt it because you did achieve a pregnancy together. I do not believe the bariatric surgery has anything to do with this. It would not do any harm for your husband to see an Urologist to determine whether he might have a varicocele (see below)
Your irregular periods point to dysfunctional or absent ovulation. The next step is to try IUI with gonadotropin stimulation for 3 cycles (each cycle interspersed by at least 1 resting cycle.
I have done an IVF and today is 9th day after embryo transfer. (1 embryo) Today I did HCG test and it comes out as law as 3. My dr asked to continue my medication and come to HCG test again on 30th August . Is there any chance I m pregnant .
There is a chance but it is small! I agree with the advice your RE gave you.
Geoff Sher
i had an IVF/Embryo transfer on 24/7/16, did a pg test and it was positive but on 25/8/16, i started bleeding.i did a scan on 26/8/16 and wel defined and regular outlined GS of 1.1 cm with no obvious evidence of fetal pole and no obvious fluid collection in POD. the bleeding continued till 27/8/16.
I suggest you wait a week or so and repeat the ultrasound.
Geoff Sher