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.
Dear Dr Sher,
Please could you help me, I am abit confused. I am currently doing a frozen donated embryo cycle. I am doing a short medicated protocol. On day 2 I started 3 X 2mg progynova daily and injected cetrotide for 7 days. I had a scan on day 11 and my lining was 7.5mm. My nurse said this was good and that my transfer would be approx 6 days later after taking progesterone for 6 days (I have 2 blastos). However another nurse reviewed my scan and said I had to take oestrogen for another week and that transfer would be in about 13 days. They do not do not take any bloods (I’m im England). My questions are:
My normal menstrual cycle is only 23 days. For a frozen transfer, does it need to happen around when I would normally ovulate? Or is there no correlation?
2. I am worried that my lining might be too thick by the time of transfer?
Thankyou so much for your help
My greater concern is that it might not get to >8mm which is the minimum thickness I would accept to do an ET.
In 1989, I first demonstrated that in both normal and “hormonally stimulated” cycles, preovulatory endometrial thickness as assessed by ultrasound examination, is partially predictive of embryo implantation (pregnancy) potential following IVF. Ideally the endometrium should measure at least 8.0mm in thickness, (but preferably >9mm).
A “poor” endometrial lining is most commonly due to: 1) inflammation of the uterine lining (endometritis) that usually occurs as a result of endometritis (inflammation of the uterine lining that can follow a septic delivery, partial retention of the placenta following delivery, abortion or miscarriage, 2) severe adenomyosis (gross invasion of the uterine muscle by endometrial glandular tissue), 3) multiple fibroid tumors of the uterine wall) 4) prenatal exposure to the synthetic hormone, diethylstilbestrol (DES) and, 5) following >3, consecutive, back to back cycles of clomiphene citrate ovulation induction.
Treatment with vaginal Sildenafil (Viagra): Hitherto, attempts to augment endometrial growth in women with poor endometrial linings by bolstering circulating estrogen blood levels (through the administration of increased doses of fertility drugs, aspirin administration and with supplementary estrogen therapy) have yielded disappointing results.
In the mid-90’s I first reported on the finding that thee vaginal administration of Viagra for several days prior to the “hCG trigger “ or progesterone administration enhances
Geoff Sher
Hi Dr Sher,
Little Background – I has my 5 day transfer on 9/14/16 (4BA embryo) .
I have a positive beta at 10dp5dt HCG 160, Progesterone 22.7, Estrogen 408 , 17dp5dt HCG 1378, Progesterone 18.6, Estrogen 248, TSH 1.38 (taking Armour Thyroid 60mg this year – will continue), 20dp5dt HCG 3,868, Estrogen 282, progesteron 14.8. RE stated that I should continue same dosage Estrodial 6mg daily, 1cc progesterone in oil, continue same dosage in thyroid meds. I am nervous – my progesterone is dropping. He wants to see me on 10/13/16. Should I get another blood test to ensure that all is well?
I suggest you follow the directions given by your RE.
Good luck!
Geoff Sher
Hi Dr. Sher,
I was unable to get a refill of injectable Estradiol Valerate, seems to be on back order with no dates of availability. I have read that you prefer this form over others. I am having my FET (donor) on Monday and am worried about the consequences of having to switch to another form. I’d appreciate any insight from you. How are you advising your patients? Thank you very much for your time!
Hi mary,
that surprises me because we are not experiencing any such shortage.
I suggest that if possible you use skin patch estrogen rather than oral estrogen to replace the intramuscular estradiol valerate.
Geoff Sher
sir,how to deal with growth of multiple medium sized follicles in a iui cycle of a 24 yr old patient with primary infertility.BCP was given in previous cycle,basal scan was suggestive of polycystic ovaries but hormonal levels on d2 within normal range.
Hi Anamika,
Itwould be by an individualized approach to choosing the protocol for ovarian stimulation. To select such a protocol would require a great deal of information regarding ovarian reserve, details regarding prior protocols used and specific responses.
I strongly recommend that you visit http://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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•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
•Optimizing Response to Ovarian Stimulation in Women who Have Compromised Ovarian Response to Ovarian Stimulation in Women who Have Compromised Ovarian Reserve: A Personal Approach.
•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
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
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.
Dr. Sher,
My wife and I were a patient of yours here in Las Vegas last year. We were told we were a complete dq alpha match with highly activated NKA cells and surrogate/sperm donor was recommended. We have just found out today that we are 5 weeks pregnant, naturally. Ultra sound confirmed that things look normal as of today. What can we do at this point to prevent and or limit the alloimmune reaction to occur in the uterus? How can we best protect the embryo root system from being compromised? We have never had a successful implantation before. Please advise as we really need your help.
Sincerely,
Congratulations Matt. You have certainly beaten the odds. I am very, very happy for you.
My suggestion is that you try and arrange to have a 20% intralipid infusion in 500cc of Saline done ASAP and then repeat this evedry 2-4 vweeksn until 24 weeks of pregnancy. If you get beyond 12 weeks, you should have a good chance of holding the pregnancy.
Pleased keep in the loop as this is not a ver common occurrence.
G-d bless and good luck!