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.
I had 2 frozen embroys implanted. HCG was over 1200 on day 14 – increased again to 2600 on day 16. Started bleeding but not bad on day 19 – numbers dropped – bleeding stopped and numbers dropped again and I am back to 1200. What does this mean.
You might have started with >1 baby and now spontaneously reduced to 1. You need to have an US to see. Hopefully this is what happened and all will be well.
Good luck!
Geoff Sher
I am writing to find out if it is possible to do genetic testing on frozen embryos. When we did our first round of retrieval, I was under 35 and was not offered genetic testing before the embryos were frozen. Our first transfer was success and we had twin boys (fraternal). But, there is absolutely no way I’m willing to transfer 2 embryos at this stage, and I’d very much like to reduce the number of cycles. If we do it soon, I’ll be 36-37 at the time of transfer. What are your thoughts on genetic testing of frozen embryos?
Yes you can do so but in my opinion this will reduce viability of the thawed-biopsies-refroze-thawed again for FET. perhaps it would be better to simply transfer one at a time by FET. Granted it might take longer to achieve the desired result but it is probably less stressful for the embryos and cumulative outcome would be the same.
Good luck and G-d bless!
Geoff Sher
Dear Dr. Sher,
I am undergoing estrogen priming protocol (2x 2mg), my baseline scan on cycle day 2 shows 2 follicles (5mm) and the estradiol is 235 pg/mL, however the endometrial lining is 9mm thick. Should I proceed with the IVF cycle or wait for the next IVF cycle when the lining is thinner?
Looking forward to hear from you.
Kindest Regards.
That depends on your age and whether the optimal stimulation protocol was used.
Women who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH
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
•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)
•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?
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
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.
Geoff Sher
Hi Dr Sher,
What are your thoughts on compacted morulas on day 5?
What sort of success rate do they have?
What stage should an embryo be on day 5? Is expanded blast ok?
I would give it until day 6 (if possible) and transfer expanded blastocysts then. Embryos that do not reach the expanded stage by then are usually “incompetent” and not worthy of transfer.
Good luck!
Geoff Sher
So would it be out of line for me to ask my DR to do a ultrasound after my hysteroscopy tomorrow if he does not find any polyps in my uterus? Because I started birth control to do another FET and I have so much ovary pain I want to rip them out… I am thinking I may have a cyst.
I think that is a wise idea!
Geoff Sher