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.
Dear Dr. Sher,
My husband had a vasectomy during his first marriage and has no children. We married in February, and I also have no children. He had his vasectomy reversed in September ’15 prior to proposing. We learned his reversal was suboptimal in March and began pursuing IVF in April. He had a redo reversal with a different doctor in late July, and we don’t know if that was more successful yet. My husband is 41, and I just turned 39. My day three labs back in April all came back good. I don’t remember all of the numbers, but I know that my AMH was over 4, my estrogen was in the 40s, and my AFC was 14. My RE put me on birth control leading up to my first IVF cycle attempt in July and also Lupron overlapping before stopping BCP. My estrogen came back in the 200s. I had been taking 10 units of Lupron daily, so he increased my dose to 40 units daily and checked again. My estrogen had only gone down to about 180, so he canceled the cycle.
We just tried again with the BCP, the overlapping Lupron, and then stopping the BCP. This time we used 40 units of Lupron daily for eleven days. My labs came back on Friday with my estrogen at 181. My RE thinks I’m having an atypical reaction to Lupron, and it’s actually stimulating my ovaries to make estrogen rather than suppressing them. I have had no cysts in either sets of ultrasounds.
The nurse called with the results, and I’m going to get to talk to my RE on Monday. The nurse said that my only options are to cancel IVF or to go back on BCP and try with the ganerilex protocol instead. My estrogen will still need to come back low enough somehow in the next set of labs in order to start. I started the BCP on Friday night.
Have you ever seen something like this happen? What did you do? What would be causing this high estrogen?
Thank you so much for your help. IVF is a lonely journey.
Indeed it can and does happen.
You need to have your protocol for ovarian stimulation reviewed and completely revised.
Also your husband should be checked for anti-sperm antibodies.
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.
•The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IV
•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
•Antisperm Antibodies, Infertility and the Role of IVF with Intracytoplasmic Sperm Injection (ICSI)
•Testicular Sperm Extraction (TESE) and Testicular Sperm Aspiration (TESA): Surgical Approaches for Accessing Sperm from men who have no sperm in their ejaculates (Azoospermia)
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. After recurrent chemical pregnancies i went through thousands of dollars of testings for genetics, clotting, immunology etc with my RE as well as a RI in NY. All was in normal range except KIR AA, homo HLA-g, and slightly elevated TNF aIL. I was dx with stage 3 endometriosis during a lap, asymptomatic pcos, hashimotos, and chronic endomtritis (took 14 days of AbX). I decided to do PGS thinking it could eliminate aneuploidy caused my pcos… Well this last transfer with a PGS normal embryo failed while on lovenox, neupogen,prednisone, and baby asa. Do you believe in hidden infection causing implantion failure or recurrent early loss? Also. 6day past transfer i had sore throat, do you believe this was a sign of immune rejection?? Thanks!
Your elevated TNfa suggests that you likely have an immunologic implantation dysfunction linked to activation of uterine natural killer cells (NKa+). This occurs in 1/3 of women who have endometriosis, regardless of its severity. This will require treatment with Intralipid/steroids.
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.
•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?
•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!
•Endometriosis and Infertily
•Endometriosis and Infertility: Why IVF Rather than IUI or Surgery Should be the Treatment of Choice.
•Endometriosis and Infertility: The Influence of Age and Severity on Treatment Options
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.
Good evening Dr Sher! I’d like to ask, what is the purpose of human growth hormone being included in a stimulation cycle? My doctor has suggested it for next cycle but not explained what the benefit would be and why I would need it. I’ve never used it before and have responded well to stimulation and had good egg numbers. Can you shed some light on why it would be added to a cycle? Thanks in advance!
A woman’s reproductive potential is very much influenced affected by her “biological clock” which comprises two components:
1.Age: Advancing age is inevitably accompanied by a progressive reduction in the number of eggs in the ovaries (“ovarian reserve”). As a diminution in ovarian reserve (DOR) ultimately passes a theoretical “threshold” the woman becomes progressively more resistant to stimulation with fertility drugs. This is accompanied by a fall in blood AMH levels and a rise in basal blood FSH. After several years of progressive DOR, the ovarian reserve is ultimately depleted, and ovulation as well as cyclical menstruation ceases (menopause).
2.“Egg Competency” The second component of the biological clock is an inevitable age-related decline in egg competency (the ability of an egg, upon fertilization, to propagate a healthy embryo) . The most important manifestation of this age-related occurrence is an inevitable and rapid increase in the percentage of eggs that have numerical chromosome irregularities (aneuploidy). By way of example, at age 30Y, about one out of every two human eggs will be aneuploid while at 45Y more than nine out of ten are so afflicted. Aneuploid eggs cannot propagate healthy babies. Most will not even fertilize and those that do, will usually be lost as early miscarriages or go on to produce a birth defect such as Down syndrome.
It is important to understand is that e the two components of the biological clock (i.e. ovarian reserve and age) represent variables which while they are often interrelated and inter-dependent can often exist independently. By way of example, some older women in their mid-forties have excellent ovarian reserve while some young women in their thirties have DOR. Yet while they produce fewer eggs, the potential competency of the eggs they produce is largely tied to their age. However, the ovarian hormonal environment brought about by DOR and the protocol used for ovarian stimulation, is readily affected by the protocol used for ovarian stimulation. Selection of the wrong stimulation protocol can adversely influence egg competency. Conversely, an individualized and optimal protocol for ovarian stimulation by favorably regulating the ovarian hormonal environment, can improve the potential for optimal follicle and egg development thereby minimizing the risk of egg aneuploidy. The problem is that it becomes progressively more difficult to optimally regulate the intra-ovarian hormonal environment in older women, and in those with DOR, and it is here that the use of human growth hormone can play a valuable role.
Several researchers have shown that the administration of human growth hormone (HGH), as an adjunct to ovarian stimulation, enhances follicle response in older women and those with DOR and so can help optimize egg quality. It is thought that HGH hormone by increasing the production of insulin-like growth factor 1 (IGF-1), improves follicle development, estrogen hormone production and egg maturation. Two basic mechanisms have been proposed: 1) improving the response to gonadotropin therapy by up-regulating the FSH receptors on the granulosa cells that form the inner lining of follicles and, 2) through a direct enhancing effect of HGH on the egg’s mitochondrial activity. While human eggs do have HGH receptors, those retrieved from older women show decreased expression of such receptors (as well as a reduction in the number of functional mitochondria) as compared with those derived from younger women. In fact, it has recently been shown that older women treated with HGH showed a marked increase in functional mitochondria in their eggs along with improved egg quality.
My own experience in selectively prescribing HGH as an adjuvant to women with DOR, older women and those with unexplained egg quality deficits, is that if used in combination with individualized protocols of ovarian stimulation it does indeed enhance egg quality and ovarian response, culminating in improved IVF outcome.
Hope this helps!
Geoff Sher
PH: 800-780-7437
I had Icsi and went for a scan at 7 weeks a heart beat could not be detected I was re scanned 2 days later and they found a good stong heartbeat the baby was measuring at 6 weeks 5.7 MM. I then went for a scan at 11 weeks and the baby had no heart beat and was smaller measuring only 4mm I have not had any bleeding or bad cramps yet please can you tell me why it got smaller? I thought when it stopped growing it would stop and not get smaller ? This was my 6th ivf cycle and my first pregnancy all other cycles have been failed and one chemical I am under 35. Please help
Does having been on the oral contraceptive pill long term affect your ovarian reserve? I was on the pill from age 14 to 33 (a long time) due to being diagnosed with polycystic ovaries with bad acne all my life and given the pill to cure it which it did. I was of the impression that when you are on the pill you don’t ovulate which would mean to me that you then don’t waste all those years of eggs? Shouldn’t that mean they are still there unused then?? Now in my late 30s and stopped the pill 4 years ago & I have very low AMH (and now incidentally, I no longer have polycystic ovaries according to ultrasound but I am mildly insulin resistant which I control with diet & exercise.) What causes low AMH/DOR?
No Sammie, it does not…in my opinion.
Geoff Sher
Hay dr sher i had ivf with no bcp using angonist with 225 menpor and 225 gonal f in day 7 start again full dose cetrotide all these med. untill day 13 i retrevied 4 2 fertilized no one made it to day 5 , my new doctor will start bcp with lupron flare im confused need an advice pls , my amh .5 LH 8
Very respectfully Eva, while opinions do differ, I personally would not use either the antagonist protocol or a “Lupron flare” in high responders such as yourself.
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)
•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?
•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?
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.