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 doing an IUI …..and have 1 lead follicle (14mm) and several smaller ( including a 9 mm and a 7 mm). I’m on Lupron 5, follistim 300 and 1 vial menopur. Today, the NP (not my RE) increased (my menopur to 2 vials, but I’m afraid it’ll just make the lead follicle take off and the others not catch up. They said once the lead is 20 mm I have to trigger. Is increasing the menopur a bad idea?
Berna,
I recommend that you follow directions. The additional Menopur should not do harm.
Good luck!
Geoff sSher
So went for my first ultrasound and bloodwork today for my FET.. No cysts on my ovaries (I am excited our first FET that ended in a chemical I had a small cyst on my left ovary) I got my estrogen level back it was 16.. Is that okay? I start the estrogen patches this Monday.. My next Dr appointment is October 10th should I expect to see a significant rise is in estrogen once starting the patches? Also Can I put the patches anywhere on my abdomen? The nurse was not 100% clear with where to put the patches?
Having a low baseline E2 is good. I do expect a progressive rise in this level with the start of administration.
Geoff Sher
Dear Dr Sher
I am 40 yr and last month went through the IVF-ICSI process. I had 13 eggs collected, 7 were mature and 4 fertilized. Only one got to day 6 blastocyst stage and the embryologist was unable to PGS. I was of course devastated. Do you believe that this embryo will be viable?
How can I best prepare for the next IVF cycle?
Is it worth doing the IVF-ICSI with HA?
It is hard to say whether the one blastocyst will or will not be “competent”. Bear in mind that the older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, 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
•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 Approach
•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
•Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•Blastocyst Embryo Transfers Should be the Standard of Care in IVF
•Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Testing (PGS) in IVF: It Should be Used Selectively and NOT be Routine.
•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?
•PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•Traveling for IVF from Out of State/Country–
•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
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•IVF Egg Donation: A Comprehensive Overview
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
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.
My irregular period that started this year made me go to a gynea in AugustStarted trying in April .The doc said I had PCOS after a scan and I wasn’t ovulating cuz the follicles weren’t maturing he placed me on HMG injections immediately and HCG to rupture after I had 2 matured follicles 20mm & 18mm . I had sex b4 and after I ovulated buh didn’t conceive. He placed me on clomid&Metformin the next month thank God I had four mature follicles 21mm was the biggest and had to take HCG to rupture them. Had sex b4 and after I confirmed ovulation. Period showed up again today the hormonal test I did showed I had high prolactin & oestrogen buh he said it wasn’t a problem since I ovulated m so confused cuz I v gotten preg b4 for hubby buh didn’t keep it last year. My prolactin was 19.8 ny/m it was done on day 8 of my cycle. Should I continue the clomid or lower my hormones
Hi Emmanuela,
Unfortunately, I would need much more information about your condition to advise authoritatively.
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
Age 29. Stage 3/4 endometriosis and lamp brush zona.
Day 13 serum hcg is 56. Post frozen blastocyte single transfer. What does this mean? I am scheduled for another hcg level in 48hrs.
Thanks
A single hCG is not enough to confirm pregnancy viability. The repeat hCG done 2 days later should double to provide some confidence.An if it does then an US done 2 weeks later should be definitive.
Good luck!
Geoff ZSher