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.
Hello dr Sher,
I have watched your video about egg quality where you speak about trigger being given at 5000u rather than 10000u not allowing the eggs to reach adequate maturation. I have just had 10 eggs collected all mature using 5000u hcg trigger and I’m worried they won’t gone through proper meiosis and divided enough to be of good quality. If they were mature at collection does that mean they divided enough to be ok?
No! Maturation as evidenced by the presence of a detectable polar body (PB1), only tells you that the eggs have gone into meiosis. It does not tell you if the process was orderly or if the eggs are truly competent (chromosomally normal).
Geoff Sher
Hi Doctor Sher,
I know you encourage embryo banking to take advantage of age and ovarian reserve. Unfortunately my partner & I have separated so it’s just me. I have begun banking my eggs but don’t have access to testing them for abnormalities before freezing. At age 37 how many eggs should I aim to have frozen to account for possible loss during thawing, and what percentage of my eggs could I expect to be chromosomally normal?
About 1 in 3-4 of your mature eggs should be chromosomally normal.Taking into account the posible adverse effect of freezing on the eggs, I would suggest that you freeze >12. Give me a call to discuss if you are interested (800-780-7437).
Good luck!
Geoff Sher
Goodmorning. I am 42 with DOR at 0.5. I was on the flare protocol. 7 follicles were seen with 3 good sized one.
However 1 egg retrieved, 1 broke. Could I have been on a too stronger protocol . I have been conceiving first time with my 2 natural pregnancies, last one in July 15 ended in fallopian ectopic. Your advice will be kindly appreciated.
Hello Dr Sher, thank you for your previous advice, it helped me to convince my RE to adjust my 6th and final cycle. I am 41, AMH 10.3, Inhibin B 64. I completed a long down regulation (21 days BCP) and my bloods at Day 3 of BCP were FSH 11.4, LH 3.3 and E2 142. I am now on Day 6 of stims. I’m on 300 Menopur and 300 gonal-f. I’m also taking melatonin, DHEA, thyroxine (slightly elevated TSH), coQ10, and a pre-preg supplement. The DHEA/thyroxine is very recent. My bloodwork today was a little concerning: my LH 1.6 and E2 1962, progesterone 1.5 (FSH untested). I’m concerned my ovaries have not “woken up” from the down reg – is this possible? My endocrinologist suggested it is (she also praised your work on DHEA, but that’s another story!). Should I talk to my RE about adjusting my stims doses based on these results? I don’t want runaway follicles again (although I’m on nafarelin 2x daily). Do my numbers look OK to you? I’ve read all your papers on DOR, poor responders, COS etc and I’m concerned my RE is still putting me on Menopur at such a high dose but with low LH numbers does it look safe? I have a scan in two days but any reassurance or alarms bells you could sound would again be much appreciated.
Thanks you do much.
I really cannot inject myself into your treatment by another RE. That would not be right. However, here is my take:
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
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
•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 Approach
•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
•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
•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.
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Testing (PGS) in IVF: It Should be Used Selectively and NOT be Routine.
•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
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•IVF Egg Donation: A Comprehensive Overview
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
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 40 years old. What are the chances for a day 5 blastocyst to be PGS normal at my age?
Also, on a recent natural ICSI cycle (we also have male factor infertility), I had my one egg fertilised. It was 10 cells on day 3. On day 5 it was a compacting morula. On day 6 it was an early blastocyst grade 2BB and frozen. We couldn’t do PGS as it was not expanded enough. What are the chances of this day 6 blastocyst to be normal considering its slowing down of growth?
Also, i understand that 10 cells on day 3 is a little fast. But only being an early blast on day 6 is slow. Does this point to an issue with egg or sperm (we used MACS)?
Hi Fran,
At 40Y in my opinion. about 1:4 expanded blastocysts should be chromosomally normal.
Good luck!
Geoff Sher