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 doctor, this is update from my previous thread , i am 32 and 14 eggs retrieved 7 feetilized without icsi 7 made it to day 3 and only 3 made it to day 6. they said day 6 and not day 5. today is day 6 and they have sent all 3 embryos for biopsy PGS. My question is what is survival rate of embryos in % being normal for a women under 35 with unexplained infertility . I hope at least 2 make it . I am worried and tensed and i know it all depends on my luck and also on how embryo survive refreeze and thaw rate.. But your answers baswd on your experience would be helpful for me.thanks
In my program about 90% can be expected to survive the freeze-thaw.
Geoff Sher
Dear Dr. Sher,
I am 37 years and on 75 Menopur and 150 Gonal F. My FSH and LH have been low to start and generally within range. After down regualting and taking 75iu Menopur and 150 Gonal F, my LH spiked to 16. I have never had such a huge LH level on 7 day on Stims. My E2 is 30. I have 3 follicles around 8mm. Would this have compromised the eggs already or is there anything that can save such a cycle?
It can sometimes self-correct but in my opinion, the high LH is not a good thing.
Geoff Sher
Stats:
Maternal Age: 38
IVF Cycle #1
AMH: 2.4
# of eggs retrieved: 22
# of eggs fertilized: 14
# of embryos that made it to 5-day transfer/freeze: 8 (1 blastocyst transferred, 7 frozen)
Embryos were graded on a clinic-specific scale of 1-8 (expansion), letter A-D for each of inner cell mass and trophectoderm. PGS was not done. The blastocyst transferred was 7Ab, and I don’t know the grades of the remaining 7. Criteria for freezing was 4 or better and an A or B on at least one of the criteria.
Beta hCG to be done on 9/6/16.
Please help me think through my understanding of my chancing at successful implementation/live birth? While these are clearly results on the high side of normal, it’s not clear to me what that actually means when trying to understand it in relation to all of the information that is out there. Moreover, I’m not sure that I understand what the distribution of grading is for embryos. Do they tend to lump around the middle (4/5B/C) with fewer high quality ones, and fewer low quality ones, or do they skew in one direction or another depending on age?
My embryologist said that based on the high quality of my “cohort” of eggs, they suspected that maternal age would not be as much of a factor for me as it might be for some women; I might have “young” eggs. Based on this, they recommended SET, which was fine for us, but now I wonder how this calculation is made. Any illumination on the thought process around this would be helpful.
Thanks.
I respectfully disagree with your embryologist. While embryos of poor morphology are much more likely to be aneuploid (numerically chromosomally abnormal) and the protocol of stimulation used is critical when it comes to egg development (the most important determinant of embryo competency), embryos (even those of the best morphologic grading) have an age-determined inherent risk of aneuploidy.
There are numerous morphologic grading systems of blastocysts so it is not easy to assess a randomly provided grade, for embryo competency.
At 38Y even a perfect (untested) single blastocyst will have about a 20% chance of propagating a viable pregnancy.
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)
•Blastocyst Embryo Transfers Done 5-6 Days Following Fertilization are Fast Replacing Earlier day 2-3 Transfers of Cleaved Embryos.
•Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
•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.
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
Hello Dr. Sher,
I recently had a FET of a PGS tested hatching AA blast that resulted in a chemical pregnancy. My protocol was identical to what you have described in your “Frozen Embryo Transfer (FET): What Does it Involve?” article. After only 2 IM estradiol valerate injections (administered 3 days apart) my lining was 9 mm, triple stripe and my E2 was 767 pg/mL. As I had to travel to my clinic, my transfer never took place until 17 days later. Do you feel that a prolonged period of estradiol exposure after a sufficient thickness and E2 had already been attained could have negatively affected endometrial receptivity? Would you advise starting progesterone as soon as sufficient thickness and E2 are reached? Thank you so much for your insight.
Did it really take 17 days to get your estradiol above 500pg/ml and the endometrium to >8mm? If not then I do nut understand why you waited that long.
Geoff Sher
Hello doctor,
I am undergoing IVF process, today I had my egg retrieval. There were 3follicles seen til Saturday.
Saturday night I took all my posting injection at 11:00p.m IST. And today at 10 was my pick up. Unfortunately after pick up there were no eggs seen in the follicles.. I am totally broken into pieces listening to it.. I have only one ovary and my AMH is quite low.. I have been advised to repeat the process after two months.. Can u pleas e advise me??
Thank you,
Regards,
Kumuda
Frequently, when following vigorous and often repeated flushing of follicles at egg retrieval they fail to yield eggs, it is ascribed to “Empty Follicle Syndrome.” This is a gross misnomer, because all follicles contain eggs. So why were no eggs retrieved from the follicles? Most likely it was because they would/could not yield the eggs they harbored.
This situation is most commonly seen in older women, women who have severely diminished ovarian reserve, and in women with polycystic ovarian syndrome (PCOS). In my opinion it is often preventable when an optimal, individualized and strategic protocol for controlled ovarian stimulation (COS) is employed and the correct timing and dosage is applied to the “hCG trigger shot.”
Normally, following optimal ovarian stimulation, the hCG “trigger shot” is given for the purpose of it triggering meiosis (reproductive division) that is intended to halve the number of chromosomes from 46 to 23 within 32-36 hours. The hCG trigger also enables the egg to signal the “cumulus cells” that bind it firmly to the inner wall of the follicle (through enzymatic activity), to loosen or disperse, so that the egg can detach and readily be captured at egg retrieval (ER).
Ordinarily, normal eggs (and even those with only one or two chromosomal irregularities) will readily detach and be captured with the very first attempt to empty a follicle. Eggs that have several chromosomal numerical abnormalities (i.e., are “complex aneuploid”) are often unable to facilitate this process. This explains why when the egg is complex aneuploid, its follicle will not yield an egg…and why, when it requires repeated flushing of a follicle to harvest an egg, it is highly suggestive of it being aneuploid and thus “incompetent” (i.e., incapable of subsequently propagating a normal embryo).
Older women, women with diminished ovarian reserve, and those with polycystic ovarian syndrome, tend to have more biologically active LH in circulation. LH causes production of male hormone (androgens, predominantly testosterone), by ovarian connective tissue (stroma/theca). A little testosterone is needed for optimal follicle development and for FSH-induced ovogenesis (egg development). Too much LH activity compromises the latter, and eggs so affected are far more likely to be aneuploid following meiosis.
Women with the above conditions have increased LH activity and are thus more likely to produce excessive ovarian testosterone. It follows that sustained, premature elevations in LH or premature luteinization (often referred to as a “premature LH surge”) will prejudice egg development. Such compromised eggs are much more likely to end up being complex aneuploid following the administration of the hCG trigger, leading to fruitless attempts at retrieval and the so called “empty follicle syndrome.”
The developing eggs of women who have increased LH activity (older women, women with diminished ovarian reserve, and those with PCOS) are inordinately vulnerable to the effects of protracted exposure to LH-induced ovarian testosterone. Because of this, the administration of medications that provoke further pituitary LH release (e.g., clomiphene and Letrozole), drugs that contain LH or hCG (e.g., Menopur), or protocols of ovarian stimulation that provoke increased exposure to the woman’s own pituitary LH (e.g., “flare-agonist protocols”) and the use of “late pituitary blockade” (antagonist) protocols can be prejudicial.
The importance of individualizing COS protocol selection, precision with regard to the dosage and type of hCG trigger used, and the timing of its administration in such cases cannot be overstated. The ideal dosage of urinary-derived hCG (hCG-u) such as Novarel, Pregnyl and Profasi is 10,000U. When recombinant DNA-derived hCG (hCG-r) such as Ovidrel is used, the optimal dosage is 500mcg. A lower dosage of hCG can, by compromising meiosis, increase the risk of egg aneuploidy, and thus of IVF outcome.
There is in my opinion no such condition as “Empty Follicle Syndrome.” All follicles contain eggs. Failure to access those eggs at ER can often be a result of the protocol used for controlled ovarian stimulation.
Good luck!
today. But if this gives the same result again, we should talk because in my opinion, this is potentially avoidable by altering the basic protocol for ovarian stimulation.
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.
•Optimizing Response to Ovarian Stimulation in Women who Have Compromised Ovarian Response to Ovarian Stimulation in Women who Have Compromised Ovarian Reserve: A Personal Approach.
•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
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.