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 ,
I did transfer 2 days ago on Monday and saw in the protocol that I should take for 4 nights 16 milligram of medrol starting on Friday evening (3 days prior the FET) , and instead I did mistake and took only 1 pill every night of 4 milligram , I want to ask you if do you think it is can affect the result of getting pregnant ? Beside I’m taking everything else correct 2 mg of Estrace 2 times a day and also progesterone injection every night and 81 aspirin and multivitamin , is it that bed that I didn’t take the 16 mg medrol ? Shoul I stop all my medications and start all over again new FET , I did it with egg donor , thank you dr sher
The use of steroids such as dexamethasone/medrol/prednisone, are beneficial but unless there is an underlying immunologic implantation dysfunction…not critical. In my practice my patients receive dexamethasone 0.75mg orally daily from the begininbg of the treatment cycle to the 10th week of pregnancy.
Geoff Sher
Dear Dr. Sher
2.5 years ago (at age 36) I checked my fertility and my results were as follows on cycle day 3: AMH: 1.4, E2: 30, FSH: 7.3 LH: 7.6 (I no longer have my Total and Free Testosterone results, but throughout the years Total Testosterone has been either at the maximum normal value or a bit above it, and Free Testosterone has been within the normal range.)
I decided to freeze some eggs as the AMH seemed to be low. I was given Menopur (5 powders + 3 liquids) for 10 days, Orgalutran starting on day 6 for 7 days and on the last day was given Pregnyl (2 powders +1 liquid). 36 hours later we did the egg retrieval and I had 18 follicles but only 4 eggs and out of those only 3 frozen. They tested my hCG and it was at 120mU/mL, so I was told I have empty follicle syndrome.
I didn’t try again, and last week (age 39) I re-did the day 3 tests with the following results: AMH: 1.6, E2: 26, FSH: 7.8, LH: 10.8, Total Testo: 41.0, Free Testo: 0.34.
My question is given these numbers, my age and that I won’t be trying for a baby for 1-2 years, is it worth it to do another egg freezing cycle (with a different protocol?), or should I wait for when I am ready to start trying and go for fresh cycle IVF? I would really like to avoid egg donation when it is time for a baby.
Thank you!
I absolutely suggest that you do freeze eggs again. However, my suggestion is that the protocol be drastically revised. I would use a modified robust long-pituitary down-regulation protocol (an agonist/antagonist conversion protocol -A/ACP with human growth hormone supplementation).
Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, find the “search bar” and 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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.
Dear Dr. Sher,
I am 5w4d pregrant after a donor egg cycle. Today we saw 2 gestational sacs with yolks and one with fetal pole. My doctor is still keeping me on 12mg of estrace, 1 injection 100mg progesterone + 2x200mg cyclogest. I am also taking clexane as well as eutirox. I have never heard of anyone being on such high doses of estrace. Does the therapy i am on seem ok to you?
Thank you
Lili
I do not see a real problem. I would go with your RE’s advice!
Good luck!
Geoff Sher
Good morning Dr Sher, Quick question for you. My RE is giving me mixed advice about my weight and FET. I’m currently 5’8″ and weigh in between 123-125#. At first he told me to gain weight. I have a very small frame, eat healthy and do an hour of cardio about 4-5 times a week. Now he is telling me I don’t need to gain weight. My embryos were frozen when I was age 34, but I only have three and of course want the best outcome. What are your thoughts on BMI and FET? Thank you, I’m feeling rather confused right now.
Morgan
There is little doubt that the prevalence of obesity in Western society is increasing and that this is having a significant influence on the reproductive performance of women who are trying to have a baby. Recent evidence indicates that excessive weight in women of reproductive age is associated with decreased birth rates, increased miscarriage rates, higher rates of premature delivery and a marked increase in pregnancy complications.
While being overweight clearly has an adverse affect on overall reproductive performance, the situation is less clear when it comes to its influence on women undergoing In Vitro Fertilization (IVF). Several studies have been conducted and while the results vary and in some cases conflict, the general trend is in the direction of women who are moderately overweight (BMI>25-30) and those who are obese (BMI>30) having poorer IVF outcomes than do controls with a BMI of less than 25. It would appear that in general, moderately overweight women, and more particularly those who are obese, exhibit a poorer ovarian response to fertility drugs (impaired follicle and embryo development with fewer blastocysts becoming available for transfer). They also might have a reduced ability to implant transferred embryos into their uterine linings (perhaps due to reduced endometrial receptivity).
It is of interest that many women with Polycystic Ovarian Syndrome (PCOS) are also overweight. In such women, the hormonal environment in the ovaries is known to adversely affect follicle and egg development. Given that there is often no clear-cut distinction between PCOS and overweight women, it is possible that many of the factors that are believed to affect egg/embryo quality in PCOS might similarly affect egg development and endometrial receptivity in overweight women. Such factors could include increased production of luteinizing hormone (LH), hyperinsulinemia and increased production of ovarian male hormones (androgens such as testosterone). The link between increased LH and resulting increased production of ovarian androgens (mainly testosterone) and poor follicle and egg development is well established. It is also well known that such hormonal changes can be transmitted to the adjacent uterus, thereby adversely affecting endometrial development.
Clearly the question arises as to whether the negative effect of an elevated BMI (>25) on general fertility potential and IVF outcome is due to compromised egg development, endometrial receptivity to the implanting embryo, or both. In my opinion, while a direct ovarian influence probably predominates, there is also likely to be an adverse influence on endometrial development. This endometrial affect is commonly seen in PCOS women who, when they develop severe ovarian hyperstimulation on fertility drugs, often have a very thin (< 8mm) endometrium. Finally, it is important to emphasize that overweight women are at far greater risk during pregnancy than are women of normal body weight. As previously mentioned, the miscarriage rate is much higher. So is the incidence of diabetes, high blood pressure, preeclampsia, premature labor, surgically assisted deliveries, stillbirth and neonatal death. Maternal complications that occur after birth of the baby (i.e., infection, uterine post partum hemorrhage, etc.) are also much more common. Babies born to such mothers are also at great risk of developing respiratory distress syndrome (RDS). This condition, which ordinarily only occurs in preterm babies, can also occur in the absence of prematurity in such cases. RDS is the most common reason for the newborn having to be admitted to a neonatal intensive care unit, and also the most common cause of death in the first week of life. The clinical significance of a growing population of overweight women is enormous because not only can this compromise their overall reproductive performance, but it also compounds the risk of chronic medical conditions such as diabetes, and coronary/cerebral/peripheral vascular disease, and thus compromises life expectancy as well as the quality of life. As such, being overweight represents an overall life hazard that should be addressed by the medical profession as well as by society as a whole. The answer is surely not a simple one, but the solution does not lie in dieting alone (which rarely is of sustained benefit). Instead it requires an overall modification in lifestyle. Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, find the “search bar” and 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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
•The Role of Nutritional Supplements in Preparing for IVF
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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.
Geoff Sher
Dear Dr. Sher,
My wife had an IVF on January 26. On 15th day after 5 day blastocyst transfer, 4th bHCG value was 1500 and it has doubled and tripled every other day. She has been taking progesterone and estrogen supplements.
Until this morning, she had sore breasts and some nausea and tiredness but now she says they are gone overnight. Even last night, she was complaining about these symptoms. There’s no bleeding or pain. We are very nervous, first we planned for a ultrasound today but then read it may be not so good for the embryo (since we have one planned 3 days from today on) to have multiple ultrasounds in first trisemester and cancelled that.
Do you see that it’s normal for symptoms to cease that quickly? Can it be translated as a miscarriage?
What do you think of ultrasounds in early pregnancy? Can it be harmful to the embryo?