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,
What are your thoughts on the chance to increase implantation success by the use of acupuncture? I cannot afford to have it done twice weekly as Chinese practitioners recommend, however I have read many reports on the apparent success rate increase after having had an acupuncture session both immediately before and after embryo transfer. What are your thoughts and experience on this? Is it worth a try?
Acupuncture involves the insertion of thin needles into the skin along so-called meridians (energy channels). It has been used in China for centuries to regulate and treat many health disorders including ailments involving the female reproductive system.
When I visited China in 1987, I actually witnessed a Cesarean birth being performed without sedation, pain killers or anesthesia… using only acupuncture. The mother lay there relaxed, conversing with the surgeon and nurses while the surgery was being performed. It was truly quite amazing. So I need no convincing that this complimentary treatment actually works when used for the right indications.
The last twenty years have witnessed a virtual explosion in fascination with, and interest in, acupuncture (as well as in traditional Chinese Herbal Medicine) in Western societies. The growing fascination and interest in the “mystical” power of acupuncture to enhance fertility potential and its incorporation into the IVF arena should come as no surprise, given the desperation of many infertile couples to have a baby. As a consequence, interest in acupuncture has grown by leaps and bounds in the field of Assisted Reproduction in the last 10 to 15 years.
So…does acupuncture actually improve IVF outcome? Well, those who support its use as a complementary treatment for IVF claim that it works by improving blood flow to the woman’s reproductive organs and thereby improving follicle development, egg quality and implantation. But what are the true facts in this regard? Does acupuncture actually enhance reproductive blood flow as has been asserted, and if so, does treatment actually improve results?
Well, what we do know, based on ultrasound studies, is that acupuncture can indeed enhance uterine blood flow. But convincing evidence that it improves ovarian blood flow is lacking. A few years ago, a Sher Institute doctor reported on the fact that acupuncture administered around the time of embryo transfer improves embryo implantation potential and thus IVF success. Its use during stimulation with fertility drugs has as yet not been shown to improve ovarian follicle growth, egg quality or endometrial thickening.
In fairness… acupuncture is not harmful and most of those so treated swear by it. For the nay-sayers, what can be said with certainty is that at the very least acupuncture has a “feel good” aspect to it and in most, evokes a psychological benefit that should not be discounted.
In conclusion…..I offer my patients access to in-house acupuncture. But I only recommend that it be administered surrounding the time of embryo transfer, preferably on the day that the embryos are placed in the uterus. However, I caution them intensively not to have exaggerated expectations regarding the role that this complementary therapy might play in enhancing IVF outcome.
Hope this helps!
Geoff Sher
This is my second round of IVF…this time from a frozen embryo. We had a successful pregnancy on the last one but my numbers never doubled. Got first blood test result today and transfer day was 8/24 and it was a 5.4. This seems very low we were told its low….have u seen them this low and still end up as a pregnancy?
Yes I have…but not frequently.
Good luck!
Geoff Sher
Dear Dr Sher,
When a cycle is stopped due to over suppression and stimulation not working, will ovulation take place or will medicines have to be taken for ovulation? What can be done to start up an ovary that has been over suppressed?
Thank you for helping so many people.
Pamela
Probably not…but the response will differ depending on individual circumstances.
How to address the problem, would depend on what led to it happening in the 1st place.
Geoff Sher
Is it important to check e2 and p2 levels at transfer and before beta?
Not at all!…In my opinion.
Geoff Sher
Dear Dr Sher,
1-Does continuous high LH (above 16) prevent E2 increase and therefore follicle growth?
2- what is the reason for high FSH and LH at 32yrs?
In my opinion, the reason is usually diminished ovarian reserve + the use of a non-strategically individualized protocol for ovarian stimulation.
Premature luteinization (“premature LH surge”) occurs when prior to the planned initiation of the hCG trigger, a progressive rise in LH, irreversibly compromises follicle and egg development and maturation. It is not a sporadic isolated event. It comes as a culmination of a series ovarian events, occurring mostly in susceptible women (i.e. usually older women and those with diminished ovarian reserve. It is more likely to occur when the protocol used for ovarian stimulation has failed to maintain LH activity at a low level prior to and throughout the ovarian stimulation process. Once it occurs in any given stimulation cycle it cannot be switched off by changing the stimulation in progress or by administering GnRH antagonists (e.g. Ganirelix/Cetrotide/Orgalutron) midway in the cycle in the hope that this could rescue the eggs under development. It is my opinion, once premature luteinization commences, the cycle is doomed and outcome is doomed to fail. The condition increases the likelihood of premature ovulation, failed release of eggs during needle-guided egg retrieval (so called “empty follicle syndrome” and the incidence of egg/embryo “incompetence” (chromosomal aneuploidy).
This situation is most commonly seen in older women and in women who have severely diminished ovarian reserve. In many cases its effect can be prevented through implementation of strategic and individualized protocols for controlled ovarian stimulation (COS) coupled with optimizing the type, timing and dosage of the “hCG trigger shot.”
Normally, following optimal ovarian stimulation, the “trigger shot” is given for the purpose of it initiating 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).
Older women, and women with diminished ovarian reserve, 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 mentioned conditions often 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, and women with diminished ovarian reserve) 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 or Ovidrel can, by compromising meiosis, increase the risk of egg aneuploidy, and thus of IVF outcome.
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 IVF.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
•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
•Why did my IVF Fail
•“
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.