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,
I will be doing IVF in next month (I am 34 years old female) and my doctor prescribed BC pills, and here is protocol:
1 pill per day for 7 days
2 pills per day for next 8-9 days
now my concern is: is it safe to take 2 pills in a day? (one in morning and another one in night)
looking forward to your guidance.
Hi Srimonti, while mI do not use thisapproach with the BCP, I cannot comment further, ecept to say that you should follow the avive of your chosen RE.
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.
•The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
•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.
•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
•Optimizing Response to Ovarian Stimulation in Women with Compromised Ovarian Response to Ovarian Stimulation: A Personal Approach.
•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?
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.
Dear Dr. Sher, I am one of the IVF consultant with over 18 years of experience in IVF and Andrology from UK. Currently I am in UAE for the last 2 months and am facing so many women who have been through multiple cycles of IVF in the past with extremely low ovarian reserve and poor response. WE didn’t have this much problem in UK. These Arab women have tried different protocols with different combination of drugs without any positive outcome. I did extensive search as to how to help these women and came across your AACEP/AACP protocol. Would it be possible to send me this protocol so that i can use it for my patients and help them achieve a pregnancy. I feel very sad because these lovely women are ready to try anything. I really want to make a difference in their lives. If you want I can send you the data for all these patients that i use this protocol for. I have put my email and will be grateful if you could help me. . Many thanks. Yasmin
Hi Dr,
Might I suggest that you have your assistant contact my assistant, Belinda McGregor at 702-308-6969 and set up a phone discussion on this matter with me…for starters!
Geoff Sher
Dear Dr. Sher,
I think I posted it but it disappeared. I am 39 yo, one living child 22 mo old via IVF. I have a problem with thin lining, please recommend the next step.
Summary:
endometritis, IVF with fresh transfer at age 37 – 2 day 5 embryos of poor quality were transferred but both took, one of them died at 8.5 weeks and one survived. No embryos survived to be frozen. Endometrial thickness at the time of retrieval was 12 mm.
Age 39 – normal AMH. Did IVF fresh cycle, resulted in many embryos. transferred one good quality embryo > miscarriage at 7 wks, retained products after misoprostol -> D and C, biopsy from surgery showed chronic endometritis, doxycycline x 7 days -> repeat biopsy negative.
Next cycle – medicated FET, one good quality embryo at 5 days, lining was at most 6.8 despite high dose vaginal estrogen (3 mg bid)-> negative hCG.
Next cycle – natural FET with definite natural LF surge on blood test, but lining only got to 4.9 mm, 5 days good quality embryo got transferred -> chemical pregnancy.
Hysteroscopy after this – normal. ANA – trace, anticardiolipin negative, B-glycoprotein negative, lupus negative. TSH is 2.0 on 50 mcg levothyroxine. On u/s one small fibroid 1 cm on the outside.
Please suggest why my lining is thin and what is the next step. I have several frozen embryos including some good quality ones. Also I am a physician, was trying to find publications on lining thickness in natural cycle but most literature really is on medicated cycle. Can you recommend specific sources for lining in natural cycle please. Thank you so much!
I hope you have a great vacation, and thank you for your help!
In my opinion, it is very likely that your thin lining is due to a post-abortal endometritis that has damaged your basal (germinal) endometrium from which the lining develops each month. This is sometimes VERY difficult to correct. It is worthntrying compounded vaginal Viagra + estrogen and baby aspirin. It might not work , in which case a long course of Trenatal (pentoxifilin) might be worth trying. If this fails, and you lining annot get up to at least 8mm, in my opinion, you will require a gestational carrier.
In 1989, I first demonstrated that in both normal and “hormonally stimulated” cycles, preovulatory endometrial thickness as assessed by ultrasound examination, is partially predictive of embryo implantation (pregnancy) potential following IVF. Ideally the endometrium should measure at least 8.0mm in thickness, (but preferably >9mm).
A “poor” endometrial lining is most commonly due to: 1) inflammation of the uterine lining (endometritis) that usually occurs as a result of endometritis (inflammation of the uterine lining that can follow a septic delivery, partial retention of the placenta following delivery, abortion or miscarriage, 2) severe adenomyosis (gross invasion of the uterine muscle by endometrial glandular tissue), 3) multiple fibroid tumors of the uterine wall) 4) prenatal exposure to the synthetic hormone, diethylstilbestrol (DES) and, 5) following >3, consecutive, back to back cycles of clomiphene citrate ovulation induction.
Treatment with vaginal Sildenafil (Viagra): Hitherto, attempts to augment endometrial growth in women with poor endometrial linings by bolstering circulating estrogen blood levels (through the administration of increased doses of fertility drugs, aspirin administration and with supplementary estrogen therapy) have yielded disappointing results.
In the mid-90’s I first reported on the finding that thee vaginal administration of Viagra for several days prior to the “hCG trigger “ or progesterone administration enhances uterine blood flow and estrogen delivery to the uterine lining and so improves endometrial thickening. Then In October 2002, I reported on the administration of vaginal Viagra to 105 women with repeated IVF failure due to persistently thin endometrial linings. All of the women had experienced at least two (2) prior IVF failures attributed to intractably thin uterine linings. About 70% of these women responded to treatment with Viagra suppositories with a marked improvement in endometrial thickness and 45% of these women achieved live IVF- births following a single cycle of treatment with Viagra. Nine percent (9%) miscarried. None of the women who had failed to achieve an improvement in endometrial thickness following Viagra therapy, subsequently and who underwent embryo transfers achieved viable pregnancies.
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.
•The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
•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.
•IVF Failure and Implantation Dysfunction:
•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.
Hello Dr. Sher. I have a question that has stumped even my RE! I just had my third (ugh) failed cycle. Only 5 eggs retrieved and all 5 were immature. I’m 36, borderline dor, (fsh between 9-12, amh 2) + MFI. This cycle was antagonist and my estrogen reached only about 2300. Though I don’t get a lot of eggs and have had an issue with getting mature eggs, I was able to get some mature eggs during cycles 1 and 2, with estrogen numbers about the same as this last cycle. Any insight as to why all eggs were immature and what protocol you would use for next cycle? First was antagonist (9 retrieved, 4 mature, 2 fertilized with icsi), second was antagonist with estrogen priming and microdose lupron (8 retrieved, 3 mature, 1 fertilized with icsi). All of my other numbers are normal aside from fsh. Thanks in advance!
In my opinion, it is highly likely that this is a stimulation protocol issue and that an urgent review/revision of such is needed.
In my opinion, the protocol used for ovarian stimulation, against the backdrop of age, and ovarian reserve are the drivers of egg quality and egg quality is the most important factor affecting embryo “competency”.
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.
•
Hello Dr. Geoffrey,
I am 37 years old an 2 years in fertlity treatments. 4 AI with one pregnancy ended in MC 6 weeks. All studies showed infertility as unknown cause. Chromosomal analysis also normal, only my housband with a 46, XYqh-. Apparenntly, should not affect.
1st IVF Gonal F 150+ merapur 150 ; 10 days. 7 eggs retrieved; 7 fertlized; 3 reached blastocyst stage. 2 of them apparently good quality. This cycle ended in chemical pregnancy.
2nd cycle (change in protocol).
Lupron 7 days prior to my next period 0.1 mg/day. Gonal F 100ui+ merapur 150 and lupron 0.05mg 2nd day after my period begins. This cycle was cancelled only 2 follicles at 5 days stimulation
3rd IVF cycle.
Lupron 0.1mg first 2 days after my period
Gonal F 100 ui + merapur 225
5 eggs retrieved; 2 fertilized; none made it to blastocyst. TRANSFER CANCELLED
My doctor is recommending to repeat first protocol not using lupron Or go directly to ovodonation
I am confused if my two MC are related to my poor egg quality and I should go to ovodonation or try once more
I appreciate your opinion