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 unfortunately got the unpleasant news today that none of the 3 embryos made it to blastocyst. This is my 2nd ivf cycle attempt and I had 11 eggs, 10 mature, 3 fertilised but none made it. During the previous 1st attempt, the same thing happened again with the difference I had 13 eggs,
I am 40, turning 41 in Jan and I am devastated. I broke down in the middle of my grade today and I could not hold back my emotions. This cycle I increased ny CoQ10, I was taking Omega, Vit E, D, prenatal, acupuncture, hyperbaric sessions, eating organic and all my efforts have failed. My doctor had me on growth hormones, melatonin, trying different things but it hasn’t improved anything this cycle. I cut out coffee, alcohol now since Feb, no processed foods and
I really just need guidance as I’m thinking of giving up. I really don’t know what else to do and what I am doing wrong?
Could I ask please ask for your help?
Warm regards
M
Hi Mary,
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those 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 age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can 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 older women and those 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 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
Dr. Sher- do you recommend natural or medicated FET? I understand the differences in medication and scheduling between the two. My doctor says success rates are identical at their clinic. It seems like the research says varying things. What are your thoughts?
Thank you in advance!
You must go the direction that you are advised, but I only do medicated FET’s because in this way it is much easier to fix on the ideal time for implantation and in my opinion, success rates are better than non-medicated cycles.
Geoff Sher
Good Morning Dr Geoffrey Sher,
Firstly I’d like to thank you for your ongoing support and advise with your live videos.
They are a great help to me and I’m sure many others
Secondly could yourself or any of your followers/members please shed some light on the following….
I am 37 years of age perfect BMI with pcos. I have never ovulated without medication and I have had one round of IVF in 2012 with my estranged husdand which resulted in a miscarriage at 9 weeks.
Now suddenly after blood work confirmation I have ovulated with no medication.
I have been looking into as to why, and discovered this is quite common for us pcos ladies to become more fertile in later life and go on to conceive
What is professional opinion on this please?
If im ovulating can I now get pregnant as any ‘normal’ women would or is egg quality still a factor?
Have any women here or any one know of any women conceive naturally in her later 30’s?
What advice if any do you have for me?
All feedback greatly appreciated
Xx
Yes I agree……Some PCOS cases do revert to spontaneous ovulation on their own and when this happens, pregnancy can occur. The problem is that may PCOS women who start ovulating on their own have “dysfunctional ovulation”. Thus the first thing is to have the ovulation cycle carefully evaluated and if there is dysfunctional ovulation, the use fertility agents to try and correct this. If this is not done, chance of pregnancy is reduced and the risk of miscarriage will be increased.
Good luck!
Geoff Sher
Hello, I had a question…my wife had an iui, no hormones because it was to late doctor said, and surprisingly she (kind of got pregnant). Yes…here is our confusing first HCG was done 14 days level 24, 2 days later 40, another 2 days 52…we are being cautiously optimistic. I know they want it to double but is it possible she is “slow-to-rise?” Thank you
POssible…but unlikely. I am afraid, this does not look very promising.
Sorry!
Geoff Sher
I also forgot to ask how I can get tested for Immunologic Implantation Dysfunction. My HSG’s have came back normal, no hormonal imbalance, and I have been taking medication to better my lining before all of the IUI’s followed my progesterone. My periods are really light and each time they tell me my lining is around 7mm prior to the IUI being performed which is why they give me the medication to thicken it. Could I have Immunologic Implantation Dysfunction?
There are only a handful of Reproductive Immunology reference laboratories that can do the tests required reliably. I suggest you call Julie Dahan at 702-533-2691 to get the required information.
Geoff Sher