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. Is there such thing as a lining that is too thick for transfer? My lining has been at least 12 mm for three of my cycles at trigger. Was just wondering if this could be a sign of adenomyosis or inflammation? I do have immune issues and had a lap done that discovered stage 2-3 endo. I have also had two blighted ovums on two of my four transfers, another transfer just resulted in a chemical a few months ago. I am a patient of Dr. T’s at Sher NY.
No, in the absence of endometrial pathology there is no such thing as a “too thick” lining, in my opinion. ! By the way. 12mm is good….no excessive.
Geoff Sher
Hello Dr. Sher. I have read your article lupron therapy and IVF. It states you overlap lupron with the BCP for 2-4 days. My questions are below
1. How do you decide how many days of overlap you prescribe to the patient?
2. Does using synarel nasal spray instead of lupron alter the number of overlapping days?
3. Does someone with LOR require less or more overlap?
Many thanks!
1. How do you decide how many days of overlap you prescribe to the patient?
A: It does not vary from patient to patient on BCPO. 3 days woirks well and there is no reason to alter.
2. Does using synarel nasal spray instead of lupron alter the number of overlapping days?
A: No
3. Does someone with LOR require less or more overlap?
A: No
Good luck!
Geoff sher
I suffered a missed miscarriage in March, karotyping of the products of conception revealed the embryo was chromosomally normal
I underwent a battery of investigations, including :
– SHG & hysteroscopy to assess the uterine environment
– thyroid function
– level 1 immunes tests (anticardiolipin antibodies (IgG and IgM), antithrombin 111, factor V Leiden, factor II prothrombin gene, PAIP polymorphism, activated protein C resistance, Protein C/Protein S, lupus anticoagulant, MTHFR, autoimmune antibodies ( inc. anti-nuclear antibodies, thyroid peroxidase and anti-mitochondrial antibodies).
– level 2 immunes tests (Immunophenotyping of peripheral blood lymphocytes, NK cell cytotoxicity assay, Th1/Th2 cytokine ratio assay)
– infection testing (ureaplasma & mycoplasma)
All were broadly normal – my NK cells were ever so slightly elevated, however this was very marginal.
None of the tests showed anything major: our best guess is that the cause of the miscarriage was the quality of the endometrium. It was only 7.2mm on the day of hCG trigger – at egg retrieval it had regressed to 5.5mm. 4 days later oestrogen and progesterone had taken this to 8.5mm and we elected to proceed to transfer. 7.2mm was evidently suboptimal, so this seems to be the most likely cause
We did PGS (next generation sequencing) with our next round and obtained 6 euploid blastocysts
The quality and thickness of the endometrium is our core focus for a FET – I’ve had two FET cancelled because my endometrium didn’t get above 7mm and wasn’t triple line. I didn’t respond sufficiently well to transdermal, vaginal or oral oestrogen, nor did my endometrium thicken up with natural oestrogen produced by ovulation induction with low dose Gonal-F
In my May freeze-all cycle my lining reached 11mm without any additional intervention – so it seems that my lining only responds in the presence of high levels of endogenous oestrogen. We are therefore trying ovulation induction with a higher dose of Gonal-F (and will collect the eggs, as I have 15+ mature follicles) and so far my lining appears to be responding well.
I am taking vaginal viagra, additional oestrogen tablets and we’ve done a G-CSF uterine wash – I’m currently at 8.5mm and don’t trigger for another 2 days.
My protocol also includes both progesterone pessaries and injections, prednisolone, intralipids, clexane and aspirin
Given all we are doing to optimise the uterine environment, and that my endometrium appears to be on track this time, how many blastocysts would you recommend we transfer?
We have always assumed we’d do eSET – if the uterine environment is good then it’s v possible both would take, if it’s not then neither will and we’ve wasted two embryos
Would be very grateful for your thoughts!
Kindest regards
Katy
Sorry – missing a crucial word in the above!
should be “how many *euploid* blastocysts would you recommend we transfer?” (we are only transferring PGS tested embryos)
A lining of <9.0 mm is suboptimal. 8-9mm is intermediate and <8mm is poor. If th relining is less than optimal in spite of estradiol levels being adequate it points towards a potential anatomical or endometrial receptivity issue that Viagra may or may not help reverse. it often has to do with the protocol used for ovarian stimulation or hormone replacement therapy for FET. This can be identified and addressed in most cases...We would need to talk!
lastly, I am not convinced that your NK assay results (K-562 target cell test) are indeed normal. If/when we talk, I would need to review these thoroughly as a misdiagnosis here could cost you dearly, in my opinion.
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
•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?.
•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.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•PGS in IVF: Are Some Chromosomally abnormal Embryos Capable of Resulting in Normal Babies and Being Wrongly Discarded?
•PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
•IVF Failure and Implantation Dysfunction:
•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!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
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 reading your information online for the past few months, I decided to get tested with Dr. Coulam here in Chicago for NKa. We have been trying to conceive for the past 2 years and have had unsuccessful (1) IUI and (2) IVF. I tested negative for NKa but positive for Phosphatidic Acid and borderline for Cardiolipin. The recommended treatment was IVIG. I have been trying to research this online and have not been able to find out very much information on these antibodies and unsuccessful pregnancies, although the Doctor told me that it functions to inhibit the embryo from implanting. Do you have any information regarding this and do you suggest the IVIG? It is very expensive and I am wondering if the Intralipid therapy would help. Thank you very much in advance, Amanda
I think that the NKa testing (K-562 target cell test) done at Milenova, is an abbreviated version where only a few results are reported. It is good lab but if i am correct and was asked to comment, then I would have the NKa test repeated elsewhere. I use Reproductive Immunology Associates in Van Nuys, CA. Loomk them up in Google.
In my opinion, IVIG can be supplanted by Intrali9pid and steroid therapy which is much less expensive, fewer side effects and equally successful.
Geoff Sher
800-780-7437
I just found out a few days ago I’m pregnant. My lmp was August 1st I had a positive ovulation test on the 16th and 17th. Had grown spotting on the 26th that must have been implantation bleedinf. Positive home test on the 28th. Went for blood work yesterday and Dr said my hcg levels were 25.2 and would have expected them to be double that. Going to get levels checked again tomorrow and praying for it to have doubled. Can a viable pregnancy have low hcg levels??
Absolutely it can! Good luck with the next beta hCG…hopefully it will double (or so) per 48h as it should do
Geoff Sher