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.
How many eggs on average will usually be needed to get one 5 day blastocyst? For example if you get 13 mature eggs from a 36yr old, how many blastocysts could you expect to get front those 15? On average of course! I know it is hard to generalise, so I am just asking as a rough estimate from your experience.
Thank you Dr Sher!
On average at 36Y of age …about 4.
Good luck!
Geoff Sher
Hi Dr Sher, my question is – Can doing many rounds of IVF deplete your ovaries of follicles/eggs? In comparison, would a woman who never did IVF still have the same amount of eggs left as she would if she had done say 6 rounds of IVF in her life? Does it deplete or alter your egg numbers/reserve, and make you run out faster by stimulating the ovaries?? It is an unnatural process after all… which begs the question!!
No Tamara, it will not. You would have recruited and used up the same # even if you were ovulating normally on your own. The fertility drugs rescue many that would have been lost ordinarily..that is all.
Geoff Sher
Hi Dr Sher,
I am doing a long down reg cycle next month. I am on the pill from CD2- CD22 (21 days), on CD 17 I start Synarel nasal spray (agonist) and continue on it throughout the cycle (so while I am on stimms). Is this the norm, to continue on the agonist throughout? i.e. no antagonist? Does this affect egg quality or quantity compared with an antagonist protocol (coming off my own menstrual cycle, with no pre-treatment). I usually only get 6-7 eggs at a time grow to full mature size on the antagonist, but they always struggle to make it to blast and are slow growing, so I want to try something different… Do I need to be on the pill for a full 21 days, or can you do a bit less. I am really worried I will be oversupressed since I am DOR. Thanks for your wonderful advice to date and this very helpful site 🙂
This could work OK. I personally do not prescribe the nasal agonist, preferring the injectable kind for my patients because it absorbs more evenly.
As long as the agonist is overlapped with the BCP, it will not over-suppress your ovaries.
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
•The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for 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?
If interested, 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.
“40 years old, no children yet. I must note that we did receive a positive blood test in 2014, but then a week later, we lost it. The OBGYN advised that it was my body naturally expelling an unhealthy pregnancy. Our family (paternal & maternal) had ovarian, breast & colon cancer. My husband is 60 years old, had & received treatment for colon cancer (now no cancer cells). I had Amenorrhea (received treatment & was cleared by fertlility specialist & gynecologist). My husband & I have both been tested by fertility specialist to find out why we haven’t gotten pregnant. The doctor said, my body is like a 20 year old & my husband’s sperm is extremely healthy.
We received IUI treatment in 2015 went home & relaxed per doctor’s orders. That following week we went on our annual vacation to South Carolina. We rented a small car, that I had to get in & out of rather awkwardly, I experienced some pain later that day while walking & had to take a golf cart back to our hotel because I couldn’t walk anymore. When we got back (because I was ovulating), but the insertion was unsuccessful, which I believe I caused due to not rescheduling our vacation.
Moreover, my husband has had several children before we were married, but it was inconclusive to determine “why” we weren’t pregnant yet. Gynecologist tests are also normal. I just don’t know why after trying for several years, why we haven’t become pregnant.”
Consider the fact that between 40 and 43 of age, the success rate per cycle of treatment with injectible fertility drugs alone, with or without intrauterine insemination (IUI) is 2- 3%. Since it is 6-8 times higher with “conventional” With “conventional IVF” it follows that for such infertile for whom the biological clock is “ticking” IVF is the treatment of choice.
In most cases, an embryo’s “competence” (its potential to propagate a normal pregnancy) is determined by the chromosomal integrity (ploidy) of the egg, rather than the sperm that fertilizes it. Age progressively increases the incidence of abnormal numerical chromosomal egg integrity (aneuploidy) from about 50% in the early 30’s to >80% by the time the woman reaches her 40’s. To make matters worse, most women ages over 40 years of age develop diminishing ovarian reserve (DOR) as evidenced by rising basal FSH and declining blood AMH levels. This results from the decline in ovarian egg population, which once it drops below a certain threshold level and accompanied by an increased incidence in dysfunctional ovulation, a progressive resistance to fertility drugs , , a lower yield of eggs/follicles in response to fertility drugs and growing vulnerability to “suboptimal” protocols for ovarian stimulation. Simply stated, unless the protocol used for ovarian stimulation is carefully individualized, women over 40Y and those who (regardless of age) have DOR, will be more likely to propagate chromosomally normal (euploid) eggs that upon fertilization are capable of implanting and propagating normal offspring. To add to the problem, there is nothing that can be done to mitigate this age-related decline.
Thus, the only way to increase the overall likelihood of successful IVF in older women is to:
1.Individualize (“customize”) the ovarian stimulation protocol so as to meet individual needs avoiding a “same size fits all” approach,
2.Improve availability of and access to of embryos available by cryobanking or stockpiling “competent” embryos, selected through preimplantation genetic screening (PGS), using reliable testing such as next generation gene sequencing (NGS), over several cycles and then selectively transferring one or two at a time to the uterus in later cycles (i.e. “staggered IVF”).
Unfortunately many infertile women in their 40’s, make the mistake of deliberately deferring the decision to do IVF until they have tried less expensive alternatives such as ovarian stimulation with or without IUI. In the process they often ignore the fact that the differential does not lie in the cost of a procedure. Rather it is lies in the cost of having a baby and it comes in the form of emotional as well as financial currency. The unfortunate reality is that once on the move the biological clock can unfortunately not be reset. Thus in my opinion infertile women of 40-43 years of age (and especially those who have never had a baby before) should consider doing IVF preferentially….from the get-go.
For women over 43 years, where fewer than one in ten of their eggs are likely to be euploid, IVF with egg donation is in my opinion, the treatment of choice.
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
•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.
•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.
•The Role of Nutritional Supplements in Preparing for 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.
In 6the week pregenancy i had abdominal ultrasound and found CRL 0.598cm and heartbeat was 124bpm . I went yesterday that means 8 weeks 4 days for transvaginal ultrasound and doctor said she is not able to see heartbeat of foetus . She gave us another appointment on 16Sep 2016 for NT Scan . Will my baby in safe mode . I am in tense mode i am taking reularly heparin 25 injection
I am so sorry for you. Sadly this does not look good.
G-d bless!
Geoff Sher