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.
So I just got my estrogen back and I am at 1,129 5 days before transfer.. I am currently on 4 minivivelle patches and 2mgs of estradiol done twice a day vaginally. I am stopping the vaginal suppositories after tomorrow.. My questions is this a good estrogen level to have 5 days before transfer? and once I stop the suppositories and go down to two patches the 19th my transfer is on the 20th my estrogen should still be at a good level right?
Ideal is an E2 of 500-1000pg/ml in my opinion, but 1,100pg/mls close enough and fine.
Geoff Sher
Hi Dr. Sher,
I had a five day fet on October 12th, 2016 with two pgs normal embryos. They were a grade AB before pgs testing.
From the pictures that people posted online – most people’s embryos were already hatching on the day of fet and they definitely had some structure to it. Mine just looked like a clump of cells along the outer edge.
Also almost everyone who received a bfp started having implantation cramping on day 1 or day 2 after transfer. Last time with my bfp I had implantation cramping as well but unfortunately I lost the baby after the first ultrasound.
My question is..
1. Does the embryo have a better chance if it looks a certain way before fet and is already hatching on the day of transfer?
2. Is it bad sign that I’m not feeling any implantation cramping or any symptom that implantation is happening even at three days post 5day transfer?
Thanks Doctor 🙂
1. Does the embryo have a better chance if it looks a certain way before fet and is already hatching on the day of transfer?
A: After PGS biopsy, the blastocysts are frozen and then they are thawed prior to FET. The apearance of the embryos is affected by how soon prior to FET, they were thawed. If the thawing took place >12 hours prior, they will have had the chance to re-expand and they will usually look good. If they were thawed within a few hours of the transfer they might not have re-expanded and look less attractive due to not having fully expanded.
2. Is it bad sign that I’m not feeling any implantation cramping or any symptom that implantation is happening even at three days post 5day transfer?
A: Absolutely not! Such symptoms are subjective, erratic and meaningless in my opinion.
Good luck!
Geoff Sher
Hey I am 5 days before transfer and my lining is 9.7 is that good?
Pretty good!
Good luck!
Geoff Sher
Dear Dr Sher,
I have just read your book – thanks for writing such a comprehensive guide on all things IVF. Today I’ve also received my immune tests results. I’m waiting for a consultation to have them explained, but from my limited understanding, I think that things are not looking good.
With my DQ at 0102, 0505/0511 and my husband’s at 0501, 0505, I think that we have a 4.1 complete match?
Also, I’ve got NK cells 50:1 at 24.5 (down to 12.6 with IVIG 12.5mg/ml) and in-range CD values except for CD56 at 14.2.
My TNF-a are high with 41.6, IFN-g at 23.6.
My LAD panel shows IgM of 20.5 (t) and 8.2 (B) and igG of just 1 for both t and b-cells.
I’m also positive for Leiden 5 and MTHFR (both heterozygous).
Anticardiolipin, anti-histone and antinuclear antibodies are all in range (and low). I haven’t had K-562 test done yet.
I fear from reading your book that this is not a very good combination of results, likely to result in poor outcomes. However I’ve got hope in the fact that I’ve been pregnant once for just 11 weeks (conception happened at very first try aged 39, after having used condoms previously so no exposure to sperm), and only have had 1 IVF (failed, 3 months ago – but with good response, fertilisation rates, 2 high-grade blastocysts and healthy lining).
I’m not sure whether given that we’ve been trying ‘only’ for 18 months, there might be a chance to get my NL and LAD results in range, and keep them in range while undergoing another round of IVF?
Also, I don’t recall you mentioning LIT therapy, which I would have thought might help in our case? It would be available to me here in London UK.
Lastly, if we were to use donor sperm, am I right thinking that I would first still need treatment to get my NK/LAD values in range before IVF?
I would be very grateful for your opinion. Many thanks, Julie
“get my NL and LAD in range” – meant NK and LAD. Julie
Alas, your understanding is correct. With a total DQa match and NKa+ your chance of a successful pregnancy, although not zero, is very much reduced in my opinion and no IL/IVIG/LIT therapy will change that. Again, in steroid . In my view, the only realiable way to achieve your goal would be through Gestational surrogacy or using non-DQa matching sperm. You are correct, even if you use DS, you will need IL/steroids to down-regulate your NKa+.
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.
•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!
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•IVF-Gestational Surrogacy: An 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.
Hello Dr sher,
I have just read your topic on unexplained infertility, to which I have been told I have for the last 22 year’s, since reading this i now think that I should have been diagnosed and looked at properly and because I haven’t had a doctor investigate me I therefore have never been able to get pregnant, I have had numerous failed iui and 3 failed ivf treatments and not one pregnancy, I am currently on another round of iui treatment as the NHS here in northern Ireland will only fund that for me cause I’m 42 if this does not work I must pay for my ivf treatments next.
If a doctor had of examined me many years ago with your knowledge i probably would have had kids running round my feet but unfortunately it is not the case please can you reply to my question.
Kind regards
Lisa Taylor
Unfortunately, the best recourse for women of your age seeking to have a baby is IVF….NOT IUI, where the chance of success would be <2% per treatment cycle. More important is that in my opinion, you do not have the time to waste on IUI.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
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
•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.
•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?
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.•
. 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
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.
Geoff Sher