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,
Your blog has been very helpful to me so far. I would like to clarify my beta hcg results with you. My initial hcg count 11 days after 5 day transfer was 354 and exactly 47 hrs later it was 642. It had not quite double but 83% increase. My coordinator asked me to repeat it in another 48 hrs as it is not the number they expected, it should have been 710. I’m worried and concerned. I have mild nausea, morning sickness and cramping throughout the day and no other symptoms . Is there something with my estrogen or progestrone dose ? Should they be increased usually after implantation? What could I do to make this proceed in a successful way. Thank you
Priya,
I am relatively optimistic that everything will turn out fine. Wait about 10 mdays and do an ultrasound for confirmation.
Geoff Sher
Hello Dr. Sher, My ivf dr. just did a embryo transfer. PGD was done on day 5th results came out 18th chromosome missing but grade level A. He did the transfer anyways we had no other embryo to transfer but he said it could autocorrect itself? Is this true or what if it didn’t will it show 100% tests done at 9weeks? Pls advice…thx in advance Dr.Sher
Yes, it could be “mosaicism” and indeed, CVS done aT 9 weeks or an amniocentesis done in the 2nd trimester would be able to make a definitive diagnosis.
Good luck!
Geoff Sher
Hi,
Hoping you can help. I have recently undergone IVF on the NHS in the wales and unfortunately our result wasn’t expected. 11 eggs at grade 3’s and 4’s, transfer at day 3 and unfortunately never received a positive test, due to the grading the embryos had to be discarded of.
I haven’t been diognosed of any fertility problem other than low ovarian reserve and low AMH which is at 1.7… due to being in an unfair world the NHS will only investigate if I have more than three
Miscarriages… can you advise anything or any further tests?
Thank you!!! By the way this is absolutely great what your doing!
Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (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 Approach
•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.
•Hereditary Clotting Defects (Thrombophilia)
•Blastocyst Embryo Transfers Done 5-6 Days Following Fertilization are Fast Replacing Earlier day 2-3 Transfers of Cleaved Embryos.
•Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
•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
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
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.
My wife had used IVF with CGH in 2014 to get pregnant with our now 2 year old daughter. At the time 10 eggs were retrieved but only one embryo came back CGH tested normal. We transferred that embryo as a 5 day blastocyst. Fortunately, that embryo ultimately resulted in our daughter.My wife is now 34 years old and we just finished a cycle of IVF for Baby #2. Five eggs were retrieved and like last time we transferred one normal CGH tested embryo as a 5 day blastocyst this past Sunday. I know that no one can predict the future but is there a good chance for success a second time IVF and with CGH testing?
There is every reason for cautious optimism.
Good luck and G-d bless!
Geoff Sher
Good Afternoon Dr Sher,
My wife (age 26) just went in for her baseline ultrasound for FET cycle. We had a retrieval in October and followed up that retrieval with 21 days of birth control pills. She started 10 units lupron on the 16th day of taking the birth control pills. She stopped birth control pills on 11/17 and we had the baseline today.
She is young and healthy. The retrieval process went smooth for us. The problem is with my count and quality of sperm. She did a blood test and found out Estrogen is 147 and Progesterone is a little over 2. The nurse said she may have ovulated to some degree while on birth control pills. The nurse said to continue taking Lupron 10 units until Monday and she will test again to see if those levels have come down. She is 5’2” 120 pounds. If the numbers aren’t down by Monday we have to cancel this cycle and go into January.
Is 10 units of Lupron appropriate? Is there anything else we can be doing? It was my understanding that most protocals call for 20 units from the start but for some reason we started at 10.
Sincerely,
Ken
That is appropriate and what I prescribe too!
Good luck!
Geoff Sher