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, you asked me to write you on this blog instead.
I’m 32, live in Canada, was pregnant (by accident w/boyfriend at the time) at age 25, terminated at 7 weeks, no complications.
At age 29 got pregnant with husband after trying for 9 months- MMC @12w, embryo age was 9w. Was immediately pregnant again after MC, but MMC again @15w, embryo age was 14w. Both MC the heartbeat just stopped. A year after the 2nd MC we were still not pregnant again despite actively trying so we followed all your advice and got tested for everything through your clinic and clinic here: normal karyotype, no alloimune issues, no blood clotting factors other than mild protein C deficiency , no structural issues, excellent FSH ans AMH, no ATA but TSH at 4 so on Synthroid ever since, no apparent autoimmune factors BUT activated NK cells 14% (you thought on Skype appointment it may be due to mild endometriosis- the only symptom I possibly have is mildly painful ovulation).
We just did IVF with 0.75mg dex and IL, had 2 excellent quality embryos transferred but it failed. We have 1 embryo left over which we will transfer next month. We’re just not sure why it didn’t work, the “soil” was taken care of with the dex and IL and the “seeds” were good too. We were told heparin wasn’t necessary. Was this just bad luck that it did not work?
I’m baffled and afraid that upcoming FET will fail too. My questions are:
1) if no alloimune issues why was it relatively easy getting pregnant naturally at first, twice, but now I can’t?
2) is it possible that my very first pregnancy (terminated) at age 25 may have caused issues in that partner at the time may have had a DQHLA match with me and as a result fired up my NK cells? Would this cause issues with subsequent pregnancies even with current partner with whom I don’t have a match?
3) why did IVF fail if I followed all the indicated treatments?
I guess I’m just trying to figure out what could possibly have gone wrong and why it didn’t work out if theoretically it should have. We are saving to come see you in Vegas this May for IVF #2. Until then we’d love to understand what’s going on and what needs to be done differently. Thank you.
Hi Laura,
Thanks for posting here, as requested.
Clearly you have an autoimmune implantation dysfunction. Since you really have only had one go at IVF with immunotherapy, I strongly believe that you were unlucky this time. What you need in my opinion is the same type of immunotherapy (see below) but next time I would suggest that you do Staggered IVF (see below) with PGS (next generation gene sequencing-NGS) to insure that the embryos transferred are chromosomally competent next time round (see below).
I strongly recommend that you visit my new Blog on this site, 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
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•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?
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies?
•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 800-780-7437 and set up an 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
Thank you for the information. To be sure I understand, it is recommended that I use lupron or other agonist for the last 5-7 days of bcp use. Followed by a baseline sonogram and initiation of stims a few days later (they plan on using menopur and follistim). Then ganirelix up until the hcg trigger. This protocol would be ok for DOR?
Sounds like it is OK !
Good luck!
Geoff Sher
Testing to confirm that this comment goes directly 🙂
Dr Sher,
I know normally you prescribe folgard to patients but what about the studies saying folate is the better option? I’ve read that people with mthfr issues can’t break down folic acid so folate is better for everyone.
In my opinion, you can go either way and it will likely not make a difference.
Geoff Sher
Hey Dr. Sher,
I posted in your other forums in prep for my first FET cycle. Have a follow up question in regards to MTHFR.
I just did my 23andme/genetic genie analysis and found out I’m heterozygous for both MTHFR C677T and MTHFR A1298C.
Is this something I should be concerned about and prep for prior to my March 1 transfer? I’ve read conflicting info as to whether heterozygous is a problem– or if it’s just homozygous that can lead to problems with fertility/miscarriages.
Since this will be my first FET and transfer, I can’t speak from experience, but I’d much rather be proactive about it, if there’s a chance this could cause problems.
What’s your understanding of MTHFR? If one of your patients was heterozygous for both alleles, what precautions (if any) would you recommend?
Thank-you so much for your time.
I strongly recommend that you visit my NEW Blog on this site, find the “search bar” and type in ” Hereditary Clotting Defects (Thrombophilia)”. “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.
I invite you to call 702-699-7437 or 800-780-7437 and set up an 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
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