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,
I’ll make this as short as possible.
At 6 am on September 7th I took my last birth control pill (was on them for 9 days.) I was expecting my Menses around day 3 of stopping the pill. AF actually showed the next night around 5 pm on September 8th. I immediately emailed my coordinator at my IVF Clinic because i thought i needed to have baseline on day 3 and start my Estrogen meds on day 4. She said to stick to the calendar. So on Day 5 of my cycle I had baseline. The ultrasound tech saw 6 follicles on each ovary that were 14mm. My lining was at 5mm, but my blood work came back perfect and the gave me the green light to start meds the next day (CD6). I am on 2mg of estrace 3x oral daily, and Delestrogen ever 3rd day .4mls. EVERYTHING i read online and my previous RE said that estrogen must be started between day 1-3 of Menses to prevent ovulation. Is this true? I am so so worried that i will ovulate through the Estrace and delestrogen. Please ease my nerves.
I do not think you will ovulate through, but I do personally prefer to start the stimulation as early as possible following menses.
Geoff Sher
Sent this too quick! I am 36 years old with a high AMH but no PCOS and have had 3 ICSI cycles- my first resulted in a TFMR at 16 weeks due to our angel girl having Turners and oedema, a FET a few months later resulted in a chemical pregnancy and a third fresh cycle resulted in a blighted ovum. We have MF infertility (high DNA fragmentation) which we are trying to overcome with high antioxidants in his diet and extra vitamins. We are going to use pgs testing on our next cycle. Would we have better success with donor eggs? We are awaiting genetic feedback on our conception producto from the blighted ovum.
Thank you!
No need for DE. Just focus on an optimal stimulation protocol (that, to me is pivotal) and then do PGS testing with FET.
ASHEPARD120509@YAHOO.COM
Dear Dr Shaw, I have read your book and have started your modified long agonist/antagonist conversion protocol with estrogen priming due to my older age and DOR. This was launched off the BCP of 15 days, overlapping BCP with an agonist for 3 days (synarel nasal spray). Menses started 3 days after stopping BCP and my estradiol was measured at 337 pg/ml and LH 2.2 at that time. I continued the agonist and retested 4 days later and E2 was 242 of/ml and LH 4. My fertility specialists wants me to continue the agonist for another 6 days to try to suppress E2 further (to under 70pg/ml). This means I will have been on the agonist for 17 days in total (and for 11 days post period). As I also plan to estrogen prime for 7 days, it will be at least 18 days post period before I start stimulation. Should I continue the agonist until E2 suppresses further or just move on to the next stage of antagonist and E2 priming without further delay? I have 2 ovarian cysts which my Specialist won’s aspirate. I am also on 3mg daily of human growth hormone which I started together with the agonist. At the rate I am going this could be a very long protocol, should I reduce my dosage or take it every second day instead? Thank you very much for your time.
You probably have a functional cyst causing the high E2. I personally would favor draining the cyst stat through vaginal aspiration under local anesthesia. There after the E2 should drop withing 1-2 days.
Good luck!
Geoff Sher
Hi Dr Sher! I love that you are able to give your wonderful knowledge to us all, it is so helpful so thank you! Quick question, I have suspected immune implantation dysfunction. I have had all the ‘standard’ immune bloods done which shows everything in range so now I have be told to do the ‘deeper’ immune bloods. The NK Assay (NK562) was suggested. My question is, would this be the only test needed to give a full overview of my immune issues? I have read about the TH1/TH2 test, the DQ Alpha test, the LAD test etc. Would you suggest any of these tests for a full work up or is the NK562 sufficient? Thank you! 🙂
I would do an NKa test. If it is negative, done at a reliable reproductive immunology reference laboratory (I use Reproductive Immunology Associates in Van Nuys, CA), there is no need for further testing. If +ve then I would follow up with antiphospho;lipid antibody panel/antithyroid antibody panel/reproductive immunophenotype (RIP) and ANA …all on your blood and do a DQ alpha/HLA match-up on both your and and your partner’s by blood.
Geoff Sher
Hi Dr Sher!
Could you please tell me, once an embryo has been ‘thawed’, how soon should it be put back into the woman’s body?
That depends. If the embryo has not yet reached the blastocyst stage, it can in my opinion be thawed and held in culture to the expanded blastocyst stage, provided that that is attained by day day 6, post-fertilization. Expanded blastocysts should be thawed and transferred within 24 hours, preferably even sooner. In our program we thaw expanded blastocysts and transfer within <6 hours. Programs that plan on transferring embryos in the cleaved state should also transfer within hours of thawing them.
Good luck!
Geoff Sher