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.
Hi, Dr.Sher. I’m 21 years old, married, and childless. I have had 3 molar pregnancies, 2 complete, 1 partial. Do you have any advice on what’s wrong or what I should do? My doctor can’t give me answers on why this is happening. I really need some advice as my husband and I have been wanting a baby. Thank you!
Like normal pregnancies the complete mole has 46 chromosomes (two sets of 23), i.e. it is diploid.. However unlike with normal fertilization where one set of chromosomes comes from the mother and the other set from the father, with a complete molar pregnancy both sets of chromosomes come from the father. This is the result from duplication of a sperm’s chromosomes after it has fertilized an “inactive egg”. Since an embryo that has a YY karyotype is not viable, the chromosome gender of the molar pregnancy is invariably XX (female). Accordingly, if with IVF, one avoids transferring an embryo that by preimplantation genetic diagnosis (PGD) is found to be female (XX) and selectively transfers only male (XY) embryos the possibility of a complete molar pregnancy can be virtually eliminated. A complete molar pregnancy can result from fertilization of an “inactive egg” by 2 separate spermatozoa. Injection of a single sperm by ICSI avoids the latter from occurring altogether. In <10% of cases a complete Hydatidform molar pregnancy can be inherited due to a mutation (not yet clearly identified) involving chromosome 19. In such cases molar pregnancies can occur repetitively and the mole can have an XX or an XY chromosomal configuration. It should be borne in mind however, that not all repetitive molar pregnancies are due to this mutation. Complete molar pregnancies can also run in families (e.g. in sisters). The true incidence of this genetic mutation is still unknown. This situation cannot be identified by PGS.
I hope this helps!
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)
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
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.
Hi Dr Sher,
I’m 41 (42 next month). Until very recently, I knew nothing about IVF, and I now find myself in a scramble to optimize my chances with it.
Despite a lifelong dream of having a healthy baby and happy family, it has taken me this long to find a great man/dad I can believe in for my unborn kids, so prior, I always used protection and never tried to get pregnant. Since my mom got pregnant naturally at 40, I grew up thinking that was normal-or at least normal for my family. And, I thought if I did have a problem, IVF was supposed to be FOR older women-even into their late forties. I also never got to try with my partner because as soon as we committed and were ready to start, he was diagnosed w cancer. Within a couple weeks we had his sperm frozen and we set off to focus on his 6 months of chemo (completed), followed by a stem cell transplant (next month). We fit my first IVF appointment into this window.
Although I asked for guidance when we had the sperm frozen, no one told me to rush based on my age. I spent the time trying to take care of him and research his cancer so we could make the best choices for his treatment. So I’m only finding out all the ins and outs of IVF now, and my initial appointment was a total shock! What I thought would be informational and the beginning of a process that was made for me has suddenly turned into a desperate race for a finish line that I may have already missed.
I just finished my initial testing. I don’t think I have the official labeling for all markers like the rest of the people here, but I will try. My IVF doctor described my follicles as being good/adequate. The number I think was 3-4 in each ovary which met his minimum of what he likes to see. My AMH was .87. My FSH was described over the phone as “good” but I was told my estrogen was high at 107, therefore my FSH was unreliable. I was then told I’d be doing the Micro Flare Lupron protocol. My appointment to get all the details is tmrw.
To find out more, I got online and that is where I found you and read these articles about NOT doing the micro flare specifically for people of advanced reproductive age (even though it’s described elsewhere as something to do exactly for that).
As it is now, I’m just at the cut-off for fitting in a cycle before the winter break. If I have to wait to start until January-February, I’ll have lost another 4-5 months in this race.
In your opinion, is my doctor wrong? If so, how should I challenge him and still have a good relationship and have us both feel confident? If he doesn’t agree to a new plan such as what you describe, should I look for someone else, even at the expense of waiting until next year? Is there a way to approach another doctor with all my results and have this discussion to see if they can start me in this upcoming cycle on the kind of protocol you suggest?
Also, do you have a list of foods and nutritional supplements to use or avoid during the IVF process? The plan is to do an all freeze cycle, then PGS, then transfer in 6 mos, after my partner has recovered from his transplant.
Thank you so much!
Hi Nora,
Your story is so very, very heart-rendering and I really would like to be of assistance to you without being intrusive. It simply would not be right for me to inject myself into your treatment plan as you are under treated by another physician. However, I would like you to know that in spite of your advanced “biological clock” (age (42y) and diminished ovarian reserve-DOR ( AMH=0.87ng/ml) there is in my opinion, still a modest window of opportunity for you to have a baby using your own eggs. However to be successful you cannot afford to spin your wheels. You need to be proactive and strategic and engage ASAP.
I cannot provide you with specific directives and would not be so presumptuous as to tell you how to approach your treating physician, I am prepared to provide you with an insight into how I deal with such cases and as to why I take this approach. This having been said, you should know that what follows represents my personal opinion which is not shared by all in the field.
So here goes……You see, 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
If following completion of the treatment you are now receiving, you wish to have a Skype or an in-person consultation with me to discuss your case in detail. please contact Julie Dahan, my patient concierge at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
May 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,
I had a miscarriage on June 18, 2016 and found out I’m pregnant again October 3, 2016, which was the 28th day in my cycle. My last period was 9/6 and I ovulated on 9/10.. I ovulate pretty quick after my periods. On 10/3 my hcg level was 1,174.2 (3 weeks 6 days, based on my last period) and exactly 48 hours later, on 10/5 my hcg level was 3,180. It almost tripled! Twins run in my family (I was supposed to be a twin, my siblings are twins, plus grandma’s and aunts and tons of people on my mom’s side have had twins). Do you think I’m having twins? Or would you guess it’s more likely that I’m just further along because I ovulate sooner than most people after my periods? I am dying waiting for my 1st appointment on the 28th, and I’m curious to get your opinion.
It could well be a multiple pregnancy.
Good luck!
Geoff Sher
Hi Dr. Sher,
I had a FET with one chromosomally normal embryo last Wednesday. Yesterday morning (5dp5dt) got a positive home pregnant test and that evening i saw brown discharge and a tiny bit of bright red spotting (less than the size of a dime). There was nothing more after that and I went in to get my beta and hormone levels checked this morning and found out the beta is 28, progesterone is 55 and estrogen is 121. Now tonight I got the same exact drop of bright red spotting and that was it. I checked inside by my cervix and no more blood… I’m so nervous that I’m already miscarrying… I’m on PIO, estrace patches and pills, prednisone and baby aspirin. Any advice and insight as to why I’m bleeding (albeit very light)?? And the chance I’m miscarrying already?? Thank you more than I can say…I know for now I just need to wait and see that my betas are rising appropriately on Thursday but I’m a wreck…
Stefanie,
The spotting is probably nothing. Repeat the beta 2 days from the last one to see if it doubled.
Good luck!
Geoff Sher
Dear Dr Sher,
I am 40, have an amh of 0.9, an Antral follicle count of 14, an fsh of 6.8iu and an lh of 6.7iu. I am doing an antagonist cycle.
Would you suggest to do estrogen priming with an antagonist cycle?
Does taking estrogen priming suppress the natural LH (or just the FSH)?
Will taking estrogen as part of priming delay the period and why?