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 had a 2 day transfer of, what I was told, were excellent embryos. I was told my remaining 7 were of good quality. However, only 2 of those remained at day 5. What is the chance that the 2 that were transferred will make it to implantation
Pretty good!
Good luck
Geoff Sher
I Dr, Sher, I have had 2 second trimester miscarriages and I have had all the test run but nothing shows up abnormal besides high thyroid antibodies. Would intralipid therapy help with this and if so what are the success rates? Thank you
Immune factors are rarely associated with 2nd trimester miscarriages. these are most commonly due to anatomical uterine factors such as an incompetent cervix, a congenital uterine abnormality or uterine pathology.
Call us at 800-780-7437 if you wish to talk.
Geoff Sher
HI, I just wanted to clarify that I lost both pregnancies when the baby was measuring 10 week 3 days and my doctor said these were second trimester. I’m also wondering if taking thyroid medication would help my chances even though I am euthyroid. Thanks
Hello.. We have had two chemical pregnancies both with Frozen 3 day embryos is there any chance that all 8 of our frozen embryos are chromsomally abnormal?
It is less likely if you are well under 40Y and the embryos are advanced (blastocysts)…but yes, it is possible.
Geoff Sher
Hello Dr Sher,
I have been trying IVF for the past year. Below is a summary of my journey so far. I have also been using donor sperm. On all my failed cycles cysts have showed up on both my ovaries. I have been told that these are not serious cysts but that they could be affecting my cycle.
I have never had an iui which I am considering now, what have I got to lose. My consultant says that he would not change anything with my protocol. I don’t understand this as obviously what he is doing is not working. Donor eggs have been suggested but I feel that not everything has been tried first to use my own eggs. Also my right fallopian tube has been removed during op for Ectopic pregnancy. Since then my right ovary has been very quiet. This was the ovary that most of my eggs was collected from on my own successful cycle. I got a second opinion from another clinic and all they suggested was going on the pill prior to starting another ivf cycle.
Dr. Sher I welcome any advice you could offer to me at this stage. I really feel that there is more that can be done.
AMH 1.2 pmol/L (11/02/2015), Repeat 1.5 pmol/L (15/10/2016)
D3 Hormone profile (03/04/2015)
FSH
12.12 mIU/ml
Prolactin
241.46 mIU/ml
LH
4.20 mIU/ml
E2
147 pmol/L
IVF DONOR Cycle Oct 2015
Anatagonist
Drugs
Menopur 450, orgalutron 0.25
D3 profile
E2 536, FSH 5.21
Outcome
Cycle cancelled poor response
IVF DONOR Cycle Nov 2015
Anatagonist
Drugs
Puregon 450, Luveris 75, Cetrotide
D2 profile
E2 150, FSH 11.57
Outcome
6 eggs collected, 6 fert.
2 xDay5 Blastocysts transferred (grade 4AA, 4BB)
2x Blastocsyts cryopreserved.
Ectopic pregnancy: Right salpingectomy
IVF DONOR Cycle April 2016
Anatagonist
Drugs
Puregon 450, Luveris 75,
D2 profile
E2 74, FSH 12.44
Outcome
Cycle cancelled no reponse
FER Cycle June 2016
HRT
Drugs
Syneral, Femetab
2 Blastocysts thawed, 1 survived and transferred
Outcome
Not pregnant
IVF DONOR Cycle Sept 2016
Long protocol
Drugs
Down reg Syneral. Puregon 450, Luveris 75,
BL profile
E2 155
Outcome
Cycle cancelled. Poor response
Kind regards,
Pauline
Sorry Dr. Sher I forgot to mention that I am 35 years old.
While still young (35y), you do have severely diminished ovarian reserve and time is of the essence. In my opinion, , given your age and the fact that you still by and large do respond, you still do have a chance using own eggs, provided that a revised approach involving a different protocol for ovarian stimulation is used , embryo banking is immediately started and PGS is used for embryo selection.
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
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. Just wondering if you know what the stats are regarding risk of having twins if you transfer 2 Day 3 embryos with highest grading? Thanks!
It depends on their quality and your age. Under 35Y it is probably about 20%.
Geoff Sher