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,
I had my FET this week on Monday 19th Sept. I was given 1500U Pregnyl immediately after transfer. I have my QBHCG blood test scheduled for Thursday 29th Sept. Will those 10 days in between be long enough for the HCG from the Pregnyl to have left my system and therefore deliver an unbiased result??
Probably so but only if the hCG level doubles within 48h thereof.
Geoff Sher
Would you test one embroyo Pgs if the couple no longer want to cycle with that clinic and that cycle has only one embroyo developing on point ? Or transfer singleton day three or day five blast. Note we no longer want to cycle with that clinic
Couple older age.
Provided the PGS was not indicated to rule out a specific genetic disorder or was required for medically indicated gender selection, I would transfer the embryo without testing.
Geoff Sher
Hi, I am 43 years old, scan on day 12 of my cycle (equals day 9 of my IVF antagonist protocol with Gonal-f 450 and Cetrotide starting day 5 of fsh) showed two large follicules (20-21) on the right and 3 small ones (11-12) on the left. Blood test from the morning of the scan showed low LH (I was told 7) so I was told to trigger not the same night but the following night (tonight) at 9pm. Egg collection is scheduled for 8.30am the day after tomorrow. I am afraid of ovulating the two large eggs so I was testing LH urine with strips every 2-3 hours and so far it was negative (single line) but I just checked again 2 hours after the trigger (with 10k gonasi ) and I can see a faint line.. Should I be worried and ask if they can prepone egg collection? What should I do ? Thanks
You can iform your RE, but frankly, at this stage there is nothing that can/should be done.
Good luck!
Geoff Sher
I’m supposed to start a cycle, but I haven’t gotten my period/withdrawal bleed after stopping birth control pill 4 days ago. RE said as long as lining is thin and follicles are small it’s OK to start before/without having a period/withdrawal bleed. Is this true? Should I post pone things?
In my opinion. if your lining is <5mm you should be good to go.
But discuss with your RE first.
Geoff Sher
Hi I am 32, my partner 28. We are having to under go IVF with a surrogate as I had hysterectomy due to cancer- my ovaries remain. I have one child pre cancer my partner has no children.
Our first IVF cycle my surrogate had a mmc at 6 weeks we had nothing to freeze from this cycle.
Second IVF ended in chemical pregnancy, we have 3 frozen embryos from this cycle.
We are having upcoming FET next week our clinic have added Clexane & 5mg of prednisalone. If this cycle fails can you advice us some next steps? I feel very upset with the highs of positive test then over night it changes.
My surrogate has 3 children of her own with no issues.
Thanks
J x
If this does not work, we should talk.
Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
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.