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,
Thank you so much for opportunity to ask you few questions:
1. I contacted both laboratories that you mentioned before, RIA and ReproSource. Only ReproSource takes insurance, which is important with all that we already had to spent for IVFs … However, they said they do NK Activity w/Suppression but they don’t test using K-562 target cell test. Can you advise if NK testing by ReproSource is also reliable?
2. Is it possible to have TH1/TH2 ratio not good while not having NK activity elevated. I thought that not, but a friend has this situation and we were wondering that maybe lab (not specialized) that performed testing didn’t do a good job…
3. Would you advice taking birth control pills in cycle before FET only for scheduling purposes? (I have to travel to Europe). Could this possibly have any negative influence on the process? If not for how long should I take them and what type?
Thank you very much again!
Zuza
Dear Dr. Sher,
Good morning. I am eagerly looking for your advice in this regard.
40 year old from India, never conceived for 3 years , clock work like cycles of 28 days.
Recently diagnosed with immune issues, high tnf alpha. Doctors treated me with 2 rounds of intralipids and now the immune issues are under control as per the latest results and they declared so.
My confusion is that after the immune treatment started and finished, my cycles have been becoming slightly shorter by a day or two, bleeding is bright red and heavy on days 1-2, wheareas earlier it was scanty , light colored blood lasting just for 1.5 days.
This time the cycle ended at 23 days as against the usual 28-30 days , again heavy dark red blood and lots of clots.
I am not sure whether this is a good sign or bad sign.
I am unable to leave it as a one off occurrence because the pattern seems to have gradually changed over the last 3 months after completion of the immune treatment.
Pls. Share your valuable views on the same.
Regards
Divya
Hi Divya,
I really do not know of any cause and effect relationship here. Separately, I do not understand why you are on protracted treatment for an immunologic issue. Treatment should be linked to IVF treatment and not be continued over time. Also, have you been evaluated fully for NK cell activation (NKa) by doing the K-562-target cell blod test and if so, where was this done (which laboratory) and what was the result. Bear in mind that while increased endometrial cytokine activity is suggestive of NKa, it is not diagnostic thereof. Finally, have you been evaluated for an Alloimmune implantation dysfunction (DQ alpha/HLA matching) because if you are indeed NKa+ and the cause is alloimmune, treatment would differ (se below).
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.
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 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
Sir,
I have undergone frozen embryo transfer on 7th February 2016 .3 grade 1 A embryos ( 7 cell) were transfered.on the day of transfer they gave me progesterone shot and inj.fertygyn 5000 iu s/c .Then I was advised to take T.progynova 2mg 2 tid, T.duphastone 10 mg 1 tid ,folic acid, Argine plus protein powder hs, crinone 8% vaginal gel hs for 14 days. On 10th February 2016 to take inj.decapeptyl 0.2 mg s/c and on 15 the February 2016 inj.fertigyn 5000 iu s/c. They advised to me test for serum beta hcg on 19 th February. For my eagerness I have HPT today and it is positive. My doubt is it due to hcg inj on 15 th .can I hope for best. Kindly advise on this
Thanking you
This protocol in unfamiliar to me. And yes, I agre that having taken hCG on the 15th, negates the value of doing an hCG test on the 19th as there will be residual hCG remaining in your sstem by then. You need to wait at least 12-14 days post the last hCH administration before doing the 1st hCG test in my opinion.
Good luck!
Geoff Sher
Dear Dr Sher, I am undergoing intralipid treatment for autoimmune implantation dysfunction. I had the first infusion 9 days prior to projected embryo transfer. I see you advise the second infusion to be given with a rising beta. When do you check betas (post 5 day fresh transfer) and what timing do you employ? I will have a beta 11 days post 5 day transfer- if positive should I then have another to confirm rising before having intralipid? Thanks so much, Mel
11 days post-day 5 ET is fine and then waiting 2 days to confirm doubling before doing the infusion is also also OK. We tend to do the 1st and second beta’s a few days earlier but as far as there being any disadvantage in waiting a few days longer…I think not!
Geoff Sher
Good afternoon/evening Dr Sher:
I am a 31 year old that is freezing my embryos since I am about to get on medication for my rheumatoid arthritis that I might hurt my eggs. We are currently watching after 5 embryos that are at day 3. 4 out of the 5 of them made it to day 3 and are good quality. the 5th one is a little slower. My question is how many embryos that make it to the blastocyst phase make it through the defrosting process? I want to make sure we have enough to fulfill our dreams of having a family. any information you can give us to put us at ease will make me feel better. Thanks so much.
-Julia: Westchester County, NY
More than 85% of vitrified blastocysts should at your age, survive the thaw.
Good luck!
Geoff Sher