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’m 4 weeks pregnant with an hcg level of 557 is that a good thing or bad .. Plz help first pregnancy
That is quite good.
Geoff Sher
Hello Dr. Sher
I was on BCP for approximately 3 months, after that I started the DR stimulation protocol, lupron with the last 4 PCB pills, then after 13 injection of lupron I started with puregon 50 IU (because I usually high responded and there is a risk of OHSS) for three days, after that I took 3 days Menupor 75IU today I had my first ultrasound appointment they found that I didnt respond at all, there is many small follicles 3mm only, this is my 7th IVF cycle, every time I have a lot of follicles even when I took very small dose (37.5 IU). what are the possible reasons for this to not respond , my DR want to continue with medications another 4 days and we will see , what do you think doctor?
In my opinion, the length of time on Lupron before starting the stimulation, can desensitize the antral follicles from responding to response to FSH . However, if you continue the stimulation for another few days, the follicles will likely start developing without prejudice. I agree with your RE, continue with the stimulation.
Please let me know in 3-4 days from whether the follicle growth has taken off again.
Geoff Sher
I recently did a Frozen transfer with a PGS normal embryo and “am 5 weeks pregnant” but my hcg is on the low side for the average numbers at this time (118 at 9 days past 5 day transfer, 407 on 12 days past, and most recently at 1318 at 17 days past transfer. My progesterone level also dropped from over 60 to 45 in 5 days time. I am currently on Progesterone in Oil shots.
I am assuming this will not be a viable pregnancy with this trend….so my question is-If assuming this is an implantation issue (since its unlikely a choromsome issue) would assisted hatching and lovenox/prednisone be a solution to help the next PGS normal embryo stick and become implanted correctly? I have had a child naturally 5 years ago and carried her with no issue, but always suspected Endometriosis of the bowel/colon area from my symptoms…not sure if this would affect implanatation? I’ve Been tested for blood clotting anitbodies and all came back normal. I’ve read your articles, thank you for your thoughts always.
Thanks!
I respectfully disagree. In my opinion this pregnancy is doing OK.
Be a little patient. An US in about 7-10 days will be definitive.
Good luck!
Geoff Sher
I know we shouldn’t put much stock in hCG numbers, but I can’t help but over analyze. I know for a FACT I ovulated on cycle day 14 and I have 28 day cycles like clockwork. I got a positive digital home pregnancy test at 7DPO. On 8DPO I had blood drawn and hCG levels were 58. On 10DPO they were 175. Time drawn was exactly 48 hours in between. I’m extremely concerned about a molar pregnancy. I had a set of MoMo twins that I lost around 12 weeks and even my hCG levels with them were not like this. Should I be concerned? I’m only 13DPO currently so not far enough along to get an ultrasound to ease my worries, but I will as soon as I can.
No reason for concern in my opinion. Just be a little patient. Hopefully all will work out fine.
Geoff Sher
Dear dr sher,
In older patients where bcp overlapped with Lupron seems to suppress them should estrogen priming be considered as an alternative protocol
The bcp overlap protocol seemed to have oversupressed me leading to fewer follicles compared to a pure antogonist ( short protocol) with certitude which yielded more eggs .
I do not agree! If used correctly the BCP overlapped with Lupron does not suppress folliculogenesis! I personally reserve estrogen priming for VERY resistant patients wth basal AMH levels <0.3ng/ml.
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.
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•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?
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.