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 recently underwent a hysteroscopy and the doctor found some moderate inflammation which he called endometritis. I am currently on Flagyl and Doxycycline for 21 days for this condition. He did not take a biopsy while I was undergoing the hysteroscopy because I was in a lot of pain. They said they do not know what causes endometritis or why I have it. I have yet to undergo any IVF treatments as we are still early in the process but should I undergo IVF then they will do a biopsy before transferring the embryo. My question is this: Is this condition (endometritis) a major factor in my ability to get pregnant? I am 36 yrs old with normal range AMH, 10 antral folicle count on CD 4, but I only have 1 fallopian tube due to fibroid removal surgery.
Thanks!
Respectfully,
With the rare exception of uterine (endometrial) tuberculosis, I do not believe in the existence of chronic endometritis.
Geoff Sher
Hi Dr Sher,
I am 34 years old and just undergone a failed ivf cycle in th UK. I have a diagnosis of unexplained infertility, although my amh is on the lower end at 6.7pmol. My partner’s sperm is good except for morphology at 5%.
My failed cycle was a short protocol with 300iu of merional from day 2, introduction of cetrotide on day 5 of stimulation and ovidrel trigger. I responded poorly to stimulation, with one dominant follicle, another a bit behind and several smaller ones. On the day of trigger they were 24.5mm, 23mm, 13mm, 12mm & 10mm.
We retrieved 2 eggs both of which fertilized and looked “perfect” on day 3 but by day 5 neither was quite a blastocyst. We transferred a “nice looking” morula and the other did not make it to freeze.
My question is around the protocol and the fact that the clinic based everything on the low amh result. I had a saliva hormone panel done 2 years ago which showed I have high testosterone (although never been diagnosed with pcos, I have regular ovulation & periods and no cysts on my ovaries) and also suggested a high progesterone to estaridol ratio – my total estaridol was just within normal bounds but low on individual days throughout the cycle. Are you able to advise, with this type of hormone profile, what a better approach would be? Am I correct in thinking that too much LH from the Merional during stimulation phase would further increase my testosterone and compromise egg quality?
Many thanks for any pointers you can give me.
Women 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 effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, 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 women 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 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
hello! Feeling helpless…
I am 33, unexplained fertility, Crohn’s disease since age 13…. Was on BCP for years but after stopping, periods never returned and I do not ovulate on my own. I became pregnant through IUI in 2015 (Menopur and Ovidrel)… Carried to term 🙂 … My RE suggested IVF for baby #2 because I had an incredible response during the IUI stim and we were at risk for multiples. Just completed my first failed IVF cycle (menopur 150, Gonal 100-300, Cetrotide 7 days, and HCG trigger on day 16 of stim cycle). 13 eggs retrieved, 12 fertilized normally, but at day 3, we were down to 5 embryos (2- 8cell, 1- 6cell, 1-5cell, and 1-4cell … All grade 2&3). Waited until day 5, and all had arrested so no transfer. Devastated and so confused. Was there something wrong with the protocol?? Do you feel a different protocol can change the quality of the embryos?? Is a day 3 transfer a better approach??? Is A second IVF attempt a good idea, or do we resort back to a risky IUI??? I don’t ovulate, so I’m also wondering if Cetrotide was necessary??? Any advice you may have is greatly appreciated!!!!
I would need a lot more information to answer authoritatively but I can tell you that in most cases this is due to egg/embryo incompetency (chromosomal aneuploidy) and in my opinion, in most cases the protocol selected for ovarian stimulation and its implementation plays an important role.
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.
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
Hi Dr Sher, I wrote you awhile back. I’ve had 5 miscarriages, you mentioned the Nk cell testing. I went to one of your clinics in Peoria and discussed my case with her. Because if my 5 miscarriages she said that she is worried about my egg quality since 50 percent of losses are related to genetic abnormalities. She said that it was potential I could be nearing premature ovarian failure. This has really concerned me. Since my hysteroscopic septoplasty in December followed by d and c in April I have had light menses. Though I miscarried in August and September my cycle this round is now virtually nothing, appears to
Be brown spotting. not sure if this is just related to the procedures or do you feel this could be an indication of pof? Thanks in advance for your response.
Very respectfully, I do not believe your miscarriages to be due to DOR or impending POF. While almost 80% of SPORADIC miscarriages are due to egg/embryo chromosomal issues, recurrent miscarriages (as with you) are not. They are far more likely to be due to implantation dysfunction ….. in my opinion.
Geoff Sher
800-780-7437
A little embarrassed to ask, for obvious reasons, is it safe to take glycerin suppositories after a successful FET? Just found out I’m pregnant, probably 3 weeks, and severely constipated. Is it safe???
Yes! However, I would advise against vaginal sexual penetration until a healthy pregnancy has been established through US.
Good luck!
Geoff Sher