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 did my 2nd icsi now days embryo transfere was 1/19 /2015
2 grade A4 embryos and today i did qualitative beta hcg which gave me negative result and i did home pregnancy test (urine ) today also which was negstive is it sure or i have to do the quantitative to confirm ??? thanks in advance
Hi Lucie!
Thanks for posting here!
Alas this does not look good. However you should do the second hCG test because the urine test is much less sensitive than the blood test also sometimes the implantation can be delayed slightly.
G-d bless!
If it turns out to be negative again, consider booking online for a Skype consultation with me or call 800-780-7437 and set up a skype consultation so we can discuss your case in detail.
Geoff Sher
Geoff Sher
Hello Dr. Sher, I am 33 with low ovarian reserve and poor egg quality. My husband and I have completed 2 IVF retrievals and had no fertilization success; the first time multiple sperm fertilized the eggs and the second time we used Injection of sperm into the egg with no fertilization. Additionally upon retrieval some of the eggs were cracked. The RE told me that my egg quality was poor and that I would be throwing money away if I continued to do IVF with my own eggs. She recommended that I use donor eggs. I would really like to use my own eggs though so I was wondering, is there is anything that can be done to improve my egg quality? or tests to understand why I have this problem? I was told I have unexplained infertility.
Hi Rachel!
Thank you for posting here.
Rachel, very respectfully, I do not agree with this opinion. Yes, it is possible that you have inherently poor quality eggs…this acan happens BUT it is extremely rare that a woman as young as you are would have this problem. In most cases it has to do with the protocol used for ovarian stimulation and would be potentially reversible through using a more individualized and strategic protocol for ovarian stimulation. Given your DOR, you in my opinion probably need a modified, robust, long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing)-normal blastocysts, to make hay while the sun still shines.
Please go to my Blog on this web site, 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 further questions or comments with the full expectation that I will (as always) respond promptly.
•Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 and set up an one hour Skype consultation with me to discuss your case in detail.
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
Dear Dr. Sher,
Congratulations on your new blog. It looks great! My question is that I am having nausea after my egg retrieval. I had 3 eggs from 3 follicles that did not fertilise and I am a low responder. I have very low AMH and I have never had nausea before from any retrievals. What could cause this? What can I do to recover from it?
The nausea is probably related to the anesthesia. As for your DOR and the resulting poor response to ovarian stimulation, in my opinion, this likely has a great deal to do with the protocol used for ovarian stimulation and can be addressed through using a more individualized and strategic protocol for ovarian stimulation. I think you probably need a modified, robust, long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing)-normal blastocysts, to make hay while the sun still shines.
Please go to my Blog on this web site, 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 further questions or comments with the full expectation that I will (as always) respond promptly.
• Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
• Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
• Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
• IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
• 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)
• Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
• Frozen Embryo Transfer (FET): What Does it Involve?
• Hereditary Clotting Defects (Thrombophilia)
• Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
• PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
• Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
• Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
• IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
• Traveling for IVF from Out of State/Country–
• A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
• The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 and set up an one hour Skype consultation with me to discuss your case in detail. You can also set this up online on this blog. 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
Hi Dr Sher,
Thanks for the detailed information on aneuploidy on your web site.
My reproductive history in brief is: one 3 year old daughter conceived naturally and easily at 37 years old.
Since trying for a second child I have had 2 early miscarriages due to trisomy.
Due to my advancing age we decided to use IVF with pre-implantation genetic screening(PGS).
My ovarian reserve was found to be good for my age and all other lab work and ultrasounds were NAD.
I am in Australia so some of the drug names are slightly different so I will try and use active ingredients as well.
A brief summery of my IVF results and the drug regimes on each cycle are as follows:
I have had 2 stimulation cycles the first was with Gonal F (follitropin alfa) 300 iu from day 3 then Orgalutran (ganirelix 250 ug) plus Gonal F once lead follicle reached 1.4cm till trigger injection, this cycle resulted in 6 oocytes, of which 2 were mature, one fertilised and genetic testing determined that embryo to have normal chromosome numbers.
The second cycle used a different drug regime – 3 weeks on the pill(OCP) then 3 days after stopping OCP, I was started on lucrin (Leuprorelin) 4iu for 3 days with Gonal F 450 iu and Luveris (lutropin alfa) 75 iu daily started on the final(3rd) day of lucrin until lead follicle reached 1.4cm then Gonal F, Luveris and Orgalutran 250 ug till trigger injections. This cycle resulted in 14 follicles 11 of which were retrieved, 10 fertilised and 4 survived till blastocyst stage and were tested by PGS – all were found to be aneuploid.
I am soon to start a third round of IVF and I would sincerely appreciate your opinion on the Drug regime, I am particularly interested in your opinion of the use of Luveris as it is my understanding that LH early in the stimulation phase can be detrimental to oocyte quality.
Yours sincerely
Tania
Tania,
Thank you for posting here!
Firstly let me say that age is by far the most common cause of egg/embryo aneuploidy and of course this cannot be reversed. However, aside from age, the protocol used for ovarian stimulation is the next in line as far as relevance is concerned and here is where I belive that with a few changes made, it might be possible to improve matters. Given your age and DOR, you in my opinion probably need a modified, robust, long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing)-normal blastocysts, to make hay while the sun still shines.
Please find my blog on this site . Go to 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 further questions or comments with the full expectation that I will (as always) respond promptly.
• Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
• Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
• Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
• IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
• 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)
• Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
• Frozen Embryo Transfer (FET): What Does it Involve?
• Hereditary Clotting Defects (Thrombophilia)
• Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
• PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
• Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
• Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
• IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
• Traveling for IVF from Out of State/Country–
• A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
• The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up an one hour Skype consultation with me to discuss your case in detail.
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,
– [ ] Dear Dr Sher,
– [ ] We are in a real quandry as to what to do no next, feeling our resources of time and money are now running low. I have included a comprehensive history of our fertility treatment to date below – this shows our specific problems of low ovarian reserve and poor response to IVF. But in a nutshell, we have had 2 failed cycles of IVF, and our most recent cycle which we changed from the long protocol to the short has had to be cancelled as we only got two lead follicles at 16mms. Rachael did get pregnant naturally in between our first and second cycles with a foetal heartbeat detected at 6 weeks, but sadly she suffered a missed miscarriage at 12 weeks with the embryo failing to grow after 7 weeks.
– [ ] In addition to the information below, we also had tests for NK cells and these were found to be elevated. It was found that their effect would be halved by using IVIg infusions. We had decided to do this until our third cycle was cancelled.
– [ ] We are not sure whether we should just continue on the same path, or try something different. Our plan was to do a third cycle using the long protocal again and also to do the immunotherapy treatment using IVIg infusions. But we have also read about the Augment treatment from Ovoascience and we are debating whether we should try this? We also were wondering if we should try ICSI this time, even though there have been no problems with fertilising any eggs produced.
– [ ] Any thoughts would be hugely appreciated as to what should be our next step
– [ ] Many thanks,
– [ ] Amit and Rachael Mehta
– [ ] We have been having our fertility treatment at the Lister Clinic in London.
– [ ] Couple’s History ?Wife’s Date of Birth: _05/28/1977
– [ ] Husband’s Date of Birth: _03/31/1981?Female BMI: __19.43, Male BMI: _24.49
– [ ] How long have you been actively trying to get pregnant? ___3 years_________________?How long have you been trying to conceive with the help of a doctor? ______1 ½ years______________?Number of years not using contraception? 3?Do either of you have children from a previous marriage? No
– [ ] Any known reasons for infertility??Poor Quality Eggs ?? Low # of Eggs?One tube possibly Blocked/Damaged
– [ ] Wife’s Medical History
– [ ] Obstetrical History?Number of pregnancies: __1___________________?Number of full-term pregnancies: _______0_______?Number of miscarried pregnancies: _____1_______?Number of ectopic pregnancies: ___0____________?Number of twin pregnancies: _____0__________?Number of triplet pregnancies: ______0_________?
– [ ] Were any babies stillborn or did any babies die after birth? No
– [ ] Menstrual & Sexual History?Date of your last menstrual period _14/1/16____________________?At what age did you have your first menstrual period? ____13_________________?Are your periods regular? Yes No?(every 25-32 days) Every ___28-34______ days?How many days do you bleed? __4__________________?Describe the amount of menstrual flow: Light ____________________?Do you experience excessive menstrual pain during cycles? No?Do you bleed/spot between cycles? No?Do you bleed after intercourse? No?How many times on average do you have sexual intercourse per month? _______8_____________?Frequency of intercourse around ovulation: _____4________________?Do you have problems with intercourse? No
– [ ] Gynecological History?Date of your last Pap Smear _____september 2015_______________?Was it normal? Yes?History of abnormal Pap smears? No?Are you using contraception now? No?Previous contraception? Yes?Type and date of last use: _____Cilest, last used in 2013
– [x] Previous Tests?AMH Level 15/9/14 3.23 pmol/L TSH Jannary 2016 – normal________________?FSH level 15/9/14 13 iu/L T4 January 2016 – Normal?LH 15/9/14 6.7 iu/L ?Progesterone 04/06/14 93.8nmol
– [ ] ?Dilatation and Curettage (D & C) Yes If yes, when? June 2015________________?
– [ ] Social History?Do you currently smoke??No?Do you drink alcohol??No?Do you drink caffeinated beverages? If so, how many servings per day? No?_________________
– [ ] ?Pregnancy? Yes?Baby? No Have you had In-Vitro Fertilization (IVF) or IVF-ICSI? Yes If so, please provide details below:??- 28/01/16 – Short protocol with Menopur 375, Cetretide, 2 follicles at 16mm – cancelled cycle.
– [ ] – 28/08/15 Long Protocol 13 days Fostimon 300iu and Merionol 150iu, Pregnyl 10,000 8 follicles, 4 eggs, 3 fertilised, 1 transferred at day 6 blastocyst – Not pregnant?- 10/11/14 Long Protocol 17 days Fostimon 300iu and Merionol 75iu, Pregnyl 10,000 8 follicles, 2 eggs, 1 transferred, 1 transferred on day 2 – Not pregnant
– [ ] Husband’s details:
– [ ] Previous Tests?Semen Analysis Sperm Count ______108 10*6/mL_____________?Date: ____6/10/14__________________ Sperm Motility ____85______________%?Sperm Morphology ____________7______%?
– [ ] Family History?Have you fathered children with your wife? No?Does he have a history of Infertility? No?Any hormonal disorders in the family? No
– [ ] History of Fertility Therapy?Treated for Infertility Before? No?Drugs Taken for Infertility? No
?
Clearly, you have 2 issues. The first is your immunologic implantation dysfunction (IID) and the second is that with your DOR you do not have a great deal of time. Treatment of the IID first requires that it be determined whether this is due to an autoimmune (the commonest) cause or whether it is alloimmune in origin. While the NKa points squarely at an IID, it does not make this distinction. To do so you and your partner will need to be teated for DQ alpha and HLA genetic matching (see below). Treatment of the IID will differ depending on the cause. The second issue is your DOR and its impact on your response to stimulation. Here, in my opinion the protocol used for ovarian stimulation needs to be carefully reviewed and probably changed. In my opinion you might be best served through a modified, robust, long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing)-normal blastocysts, to make hay while the sun still shines.
Please go to my Blog on this site, 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or to go online here, and set up an one hour Skype consultation with me to discuss your case in detail.
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