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 – I have a question about HCG levels. I did an FET on 8/12 of 2 blasts. Here are my betas – 8/24 42.3; 8/26 it was 99; 8/29 435; 9/2 1642; 9/6 6477 and today 9/9 only 8054. I’ve had 3 ultra sounds and saw the heart beat today. I am measuring about 5-6 days behind based on my transfer date. Should I be concerned that my beta only rose to 8054 from Tuesday’s number? My office said they would have liked it higher but they did see the pregnancy today so they were happy about that. Just looking for another opinion.
I think it is fine. The hCG levels do not usually increase at the same rate after the hCG reaches 6000U
Geoff Sher
Dear Sir,
Greetings from India, 32 years old female.
I’m asking you with great hope.
I have gone through my first cycle of IVF (ovum pick up) and I have received a notification from the hospital
15 eggs retrieved
9 mature
4 fertilised
So i would like to understand that what has happened to the immature 6 eggs (i.e 15-9)? Or i have to wait till 5 days till the 6 eggs also reaches maturity stage
And also what about the 5 eggs that have not fertilised (9 mature – 4 fertilised). Will the mature eggs fertilise in future?
I am a bit worried and awaiting for your response.
Most immature eggs will not propagate viable embryos so you can only rely on the mature ones.
Geoff Sher
Dr. Sher,
I am a 36 year old female, G1P1, who conceived naturally 6 years ago. However, I now have diminished ovarian reserve with low antral follicle counts (3-5 per ovary at best but follicles very small, 2-3mm) on US and day 3 labs indicating AMH of 0.43, FSH 8.9, estradiol 43. I have been through 3 IUI’s ( 1 natural cycle, 2 IUI’s with clomid + metformin) and attempted a micro-flare IVF but developed a dominant follicle. The provider used Menopur and Gonal-F for stimulation, but only 3 follicles were growing in only one ovary prior to one follicle becoming dominant. I have read your articles and information regarding excessive LH exposure negatively affecting follicular development and I wonder if this scenario might have occurred in my cycle. The provider did not convert this cycle with the dominant follicle to IUI; instead, he felt I had ‘follicular exhaustion’ due to dropping estradiol levels and endometrial contraction. The follicle never ruptured has now become a functional cyst. I was referred by the local provider to another infertility practice who suggested a trial of a Mini-Stimulation IVF cycle with Femara and Gonal-F. However, I have reading about your Agonist/Antagonist Conversion with estrogen priming and wonder if that would be a better approach. I would like your opinion on the best approach to take regarding a trial of a Mini-Stim or conventional LEAP protocol used in some of the infertility practices. I have been in contact with your office and am unsure about the logistics of traveling out of town for IVF. We are trying to decide the next best step to take in this IVF journey and I would appreciate your advice. I am in the process of setting up a Skype consult with you as well.
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 further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
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
Two weeks and two days after double Embryo transfer, hCG level is 17. Nurse seems very pessimistic about this and says it is not good news. Is it not more correct to say that this could still be a positive pregnancy test but that second test is required in a few days?
Sadly,
I concur!
Geoff Sher
Hi Dr Sher, firstly I want to thank for your pioneering work and dedication and commitment to helping couples all over the worl become pregnant. My clinic used your poor responder protocol recommendations and I am thrilled to say that we have gotten further than we’ve ever gotten before and I’m pregnant. We are very much not out of the woods yet though – we transferred two top quality day 5 blasts and our beta at 12dp5dt was only 75, rising to only 118 at 14dp5dt. At this stage we thought we were out (but were so grateful to get that far as we never got to transfer in our first cycle), however unbelievably it went to 265 16dp5dt and now 544 at 18dp5dt. While great to see them double, we are realistic and understand these numbers are very low for this stage of pregnancy. I was wondering if you’ve ever seen such low numbers result in a successful outcome? Either way, sincere thanks for giving us a little bit of hope that we might become parents after years of heartbreak, and thank you for all that you do. In the event that this does not work out, we hope to schedule a Skype consultation if that’s okay.
Yes I have seen such cases as yours continue successfully and I wish you luck!
Geoff Sher