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 doctor and thank you for your help.
My wife of 33 has bad quality eggs and a low AMH of 1.5. first IVF failed with all 7 eggs having to be really bad quality. Now we are scheduled to do a second IVF different doctor and we are on same protocol. Follistim lupron and menopur.
Im concerned that the protocol we are on is just a standard IVF practice and we are not been treated as a low responder and bad quality.
What are your thoughts on this.
Thank you again!
I fully understand! 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, https://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,
I wrote to you earlier about VTS. I was diagnosed with VTS at 10 week scan (one of the babies stopped growing after 9 wks. I started spotting bright red and then brown over thanksgiving weekend which stopped in 4 days. I was 12 weeks at that point. Had a NT scan on 12wks3 days and everything with the baby looked fine. VT was still there but the dr said was getting reabsorbed and spotting could have been due to that, however i started spotting again since Saturday 03 Dec (dark brown) and still going on. I wanted to know what could be the reason and how long is this going to go. I am 13wks4days today and my next appointment is not until the 13th Dec. Should i go in to get a ultrasound for the peace of mind or do you think things are okay. I am trying very hard not to stress about this but everytime i see that brown spot on toilet paper it freaks me out.
Please help and thank you so much for taking the time out to read and respond. Much appreciated!
Sorry for multiple message, one more question, should i be on pelvic/bed rest due to this spotting. Can i go to work, do household work like, cooking, going up and down the stairs etc.
Thank you once again!
Anki,
When there is brown spotting it is NOT active bleeding. Rather it is old blood that had pooled in the upper vagina, become altered and now is being passe3d. In the absence of heavy and increasing passage of red blood, the condition is in all probability stabilized. I think all will be well. However, by all means have another US for your peace of mind.
Good luck and G-d bless!
Geoff Sher
Hi Dr Sher, hoping you might be able to help explain what happened. No one has an answer for me and I have seen many specialists. About 2 months ago a Fertility Specialist put me on decapeptyl and oestrogen 4mg four days after ovulation. I stayed on decapeptyl for 12 days and then my menstrual cycle started. On day 5 of menstrual cycle, i was put on 600IU puregon (for 14 days) and 75IU luveris (for 6 days). My LH was <1.4 IU/ml every day they checked it, so on day 7 of stims i was asked to take 150 IU luveris (2 x 75 IU). However, my LH never went above 1.4 IU/ml at any point throughout the cycle and they tested it every day. I was on oestrogen 4mg all the way up until egg retrieval. I was also on 3mg growth hormone for 14 days while i stimmed. My trigger was 2 x decapeptyl followed by 250 ovidrel followed by 10,000 pregnyl. My oestrogen the day of trigger was 1518 pg/ml, but it dropped to 861 pg/ml the following day. At egg retrieval, they only collected 3 eggs. 2 were mature and 1 was immature. They said they had "seen worse eggs", which tells me my eggs weren't the best, but they weren't the worst. Suffice to say they didn't make it to day 5.
My fertility specialist says I am old (I'm 38 years old with am AMH of 1.1 and day 3 FSH of 9 and day 3 LH of 4) and I need to consider donor eggs. However, after reading your articles, it seems that he expunged my system completely of progesterone, LH and oestrogen that I feel like the eggs could not properly develop. Some LH induced testosterone is required for egg development, but the role of decapeptyl was to completely expunge my system of LH, so how could egg development occur if there were hardly any hormones there to help develop the follicles/eggs?? My progesterone throughout the fresh cycle barely got over 0.7… Is it common practice to put someone who is borderline DOR on such a protocol? I have read your agonist/antagonist conversion protocol, but I have about 12 antral follicles and previously produced 9 eggs on a long protocol using lupron for 7 days before I got my menstrual period. I feel like putting me on decapeptyl for 12 days prior to the start of my menstrual period was overkill.
I would consider donor eggs, but this is my second cycle and in my first cycle, I got 12 follicles and 9 eggs. I feel like this protocol was too much and caused over suppression. What do you think went wrong here? The triple trigger was to overcome empty follicles on the last cycle. Do you think I am just old or do you think the protocol was problematic and damaged my eggs in the process? I'm going mad!
In my opinion, it could well be a protocol issue. I am not in favor of agonist-induced triggers. Also the addition of Luveris is probably not what I would have preferred.
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, https://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. This is the most typical question to ask you.Please help me out of this. My husband has a doubt. I feel so bad for this. But please suggest and give me a good reply. The doubt is that ” I had sex with X Boyfriend. He used condoms. We had it nearly 5 minutes only. Whether my X boyfriend’s DNA would affect my future baby of my husband ? Will the DNA gets mixed with my husband’s DNA and come for my baby? Please sir. Reply me as soon as possible.. I hope that this would surely crack the misunderstanding between us please.
In no way should this affect the baby, unless he has transmitted a sexually transmittable infection to you.
Geoff Sher
Hi Dr.Sher! I was your patient 4 years ago and had a successful IVF after intralipids due to NKs. We had an embryo transfer in the spring which was negative, by a complete miracle I just got a positive pregnancy test today! Should I try to get an intralipid infusion? Thanks so much! Anything else I can do to help not miscarry? ( I had two miscarriages 5 years ago) thanks so much!! Hope you are well!!
I would do so immediately. Hopefully it will be in time.
Good luck and G-d bless!
Geoff Sher