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 am having question for PCOS. As I have learned and seen that always PCOS patients are having irregular menstrual and AMH Level is high.
As I understand when ovulation doesn’t happen menstrual will not happen and number of follicles increase in ovary.
When cyst increase in ovary we say that patient is having PCOS.
When menstrual will be irregular weight gain also might be happen Iike after menopause women’s use to gain weight.
Now, if menstrual will become regular which means ovulation is happening and due to menstrual cycle amount of folicle will reduce and along with it AMH Level becoming normal.
If things happen like this can I say that PCOS is cure? As menstrual become normal, AMH become normal and patient start losing weight.
Can you please reply.
No, unfortunately you cannot make this assumption.
Geoff Sher
Dear Doctor, I’m 23 weeks pregnant, is it safe to do a sea salt water flush?
I would not douche during pregnancy! Discuss with your OB.
Geoff Sher
Dear Dr. Sher,
All the genetic studies related to thrombophilia are focused in the women. I am wondering What is the risk in the embryo and placenta if the male carries a thrombophilia related mutation but not the mother. To be more clear, I am going to explain my case. My husband (42) is heterozygous for prothrombin G20210A and MTHFR C677T, he is normal for Leiden V factor. I (36) am not carrier any of these mutation. We did 5 ICSI embryos (2 each time) transfer without success, the doctors couldn’t find any explanation, because all the other studies are fine. Now we are checking the M2/ANXA5 factor, because it has been shown that is involved in the embryonic anticoagulation. But my question is if prothrombin and MTHFR male mutation could affect the embryonic anticoagulation? In case of a positive answer, what kind of treatment do you suggest?
In my opinion, male thrombophilia has no relevance when it comes to an ensuing pregnancy.
Geoff Sher
Hi Dr Sher! I hope you are keeping well. I have a question about NK testing that has me so confused! Please can you tell me the difference between the NK Assay Panel, the NK562 test and the NK Activation with IVIG/Intralipid Suppression? I am trying to arrange the right test as I have endometriosis and suspected implantation dysfunction but each lab I contact in America has a different name for the test. I look forward to hearing from you. Thank you kindly, Sharon
In my opinion, NK cell activity testing should be done using the K-562 target cell test. This blood tests measures activity in the “native state and against various dilutions of IVIG and intralipid. The concentration of NK cells in the blood is irrelevant….the higher, the better. Another test that can be used is the uterine cytokine assessment but in my opinion this is less consistently reliable than the K-562 test. There are only a handful of Reproductive Immunology Reference Laboratories in the United States that can do this test reliably. I use Reproductive Immunology Associates (RIA) in Simi Valley, CA). Blood can be sent overnight to this and similarly equipped laboratories from virtually anywhere in the the world.
Good luck!
Geoff Sher
Hi Dr. Sher,
I am a 35 year old female with no known fertility issues. My husband has low morphology (1%) and motility but very good count. I have been TTC for 3 years with two failed IVF cycles (fresh). Essentially no implantation with 2 good quality Day 3 embryos (approx 10 mature eggs but only an avg of 2-3 fertilised in both rounds). We changed the clinic for our third IVF where the Dr. put me on higher doses of Gona F, Human Growth Hormone and couple of other changes. Had a very good response with ~20 eggs and 18 fertilised with 12 blastocysts frozen (combination of good and average) Hubby and I did genetic testing of chromosomes – all was normal. My NK cells were borderline so my Doc prescribed steroids and aspirin + lipid therapy which I underwent 1 week and 1 day before the FET (2 blastocysts). I was also given IV medication to ensure no uterine contraction. I am in the 2WW. No history of infertility in the family and my AMH is 22 but hubby’s family has some issues. We did IMSI this round to improve fertilization which I believe helped. Doc also did a check of my uterus and only found small polyps (no cysts) which was removed last month and did some endo scratching. Lining thickness was ~12 before FET. I do have a retroverted uterus. I had one chemical pregnancy – only 1 week – during a previous IUI session. If this round fails, what would you recommend I should change?
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).
My answer to patients who ask me when is the time to stop undergoing IVF is ….Aside from the weight of the financial burden, the time to stop is when in spite of thorough and comprehensive evaluation, there is no remediable and treatable explanation for repeated failure.
I strongly recommend that you visit https://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
• IVF: How Many Tries Should be Considered before Stopping?
• Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
• IVF Failure and Implantation Dysfunction:
• The Role of 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
• Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
• Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
• Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
• Endometrial Thickness, Uterine Pathology and Immunologic Factors
• Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
• A personalized, stepwise approach to IVF
• How Many Embryos should be transferred: A Critical Decision in IVF.
• The Role of Nutritional Supplements in Preparing for IVF
• IVF Egg Donation: A Comprehensive Overview
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.