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, how much is it for a fertility test. Am 25 and I want to know if I can or can’t have baby’s. I have try in the pass and never got pregnant and now soon am getting married and I will like to know before I take that step if I can be.
Adriana, the cost will depend on where the evaluation is done and what tests are required.
After 1 year of unsuccessfully trying to have a baby, it is time to have a basic infertility evaluation. And the urgency increases the older the woman is.
A: Preparatory Tests done on the woman:
•Tests for Ovarian Reserve: On the third day of spontaneous or progesterone withdrawal menstruation, blood is drawn to test for ovarian reserve. This requires testing for blood concentrations of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH) and for anti-Mullerian hormone (AMH).
•A hysterosalpingogram (HSG): This is performed within a week of the cessation of menstruation. This out-patient procedure involves injection of a radio-opaque dye which outlines the Fallopian tubes allowing the diagnosis of tubal blockage. To a lesser degree, it permits the detection of surface lesions inside the uterine cavity.
•Hysterosonogram (HSN) : When IVF is planned this procedure is done early in the menstrual cycle. It involves instilling a sterile saline solution into th uterus, followed by a pelvic ultrasound to map the contour of the uterine cavity.
•Laparoscopy: This is a procedure that is sometimes needed. It is usually performed under general anesthesia in an ambulatory surgical center. Here, a telescope like instrument is passed into the abdominal cavity to allow thorough inspection of pelvic structures. It is usually confined to cases where symptoms and signs backed up by pelvic ultrasound findings, suggest significant underlying organic pelvic pathology (e.g. advanced endometriosis/fibroids, tubal disease and pelvic adhesions
•Hysteroscopy: Women suspected on the basis of symptoms and/or signs, (usually following ultrasound assessment or HSN) of having intrauterine pathology (fibroids/polyps/scar tissue) that might interfere with embryo implantation are sometimes required to undergo a hysteroscopy. This involves introducing a thin telescope-like instrument via the vagina and cervix into the uterus in order to allow visualization of the uterine cavity and surgical repair. It can be performed under local anesthesia with sedation in an ambulatory center orin-office. In some cases general anesthesia is needed.
•Testing the urine LH surge…for impending ovulation: Commencing at least 17 days before the expected menstrual period (i.e.; usually about 10 days following the initiation of menstruation), urine should be collected twice daily and tested for the onset of the spontaneous luteinizing hormone (LH) surge. The initiation of the LH surge usually precedes ovulation by 8 to 36 hours. In order to detect the onset of the LH surge accurately, an early morning urine specimen is needed. Ideally, the bladder should be emptied first thing in the morning, upon awakening. About one half-hour later urine is collected (only a very small amount is required) and tested using an over-the-counter LH – kit (obtainable over the counter, at a drug store). At the earliest sign of a color change the woman should present at her treating physician’s office for:
The 1st In-Office Assessment where the following is carried out::
1.A pelvic ultrasound examination to assess for a dominant follicle or for evidence of recent ovulation and for the thickness and pattern of her uterine lining to be assessed (ideally it should measure >8mm with a triple “line” (trilaminar) appearance
2.Blood should be tested for measurement of estradiol (E2) l level.
A 2nd In-Office Assessment is arranged for three (3) days after the first office assessment. At this visit, a vaginal ultrasound exam is performed to check (or to confirm) that ovulation has occurred (i.e. whether the egg has been released). The presence of small amount of fluid collecting in the lowermost region of the pelvis, or a change in the shape of the follicle is suggestive of ovulation.
A 3rd In-Office Assessment takes place five (5) days after the 2nd visit. At this visit, blood is drawn for the measurement of progesterone (P4) and estradiol (E2)
•Assessment for an Immunologic Implantation Dysfunction (IID) This is selectively done at one of about six Reproductive Immunology Reference Laboratories in the United States (I preferentially use Reproductive Immunology Associates (RIA) in Van Nuys, CA). Testing is indicated when:
1.Autoimmune assessment; In my opinion, this is indicated when here is a personal or family history of autoimmune diseases (e.g. Lupus Erythematosus, Hypothyroidism, Rheumatoid Arthritis etc.), symptoms or signs of endometriosis (e.g. prior surgical visualization of lesions in the pelvis, heavy painful periods and pain during intercourse and/or ovulation) which is associated with immunologic implantation dysfunction (IID) in about 1/3 of cases. Also, when there is a past history of repeated “unexplained” IVF failure. Here, blood is drawn (at any time) from the female partner and sent to a reliable Reproductive Immunology Reference Laboratory for testing of antiphospholipid antibodies (APA), antithyroid antibodies (ATA) and the K-562 Target cell test, otherwise known as a natural killer cell activity test (NKa) test. In some cases, a uterine biopsy is done to test for endometrial cytokines.
2.Alloimmune assessment: In select cases (especially where there is a history of Recurrent Pregnancy Loss (RPL), or “unexplained” secondary infertility” or where Natural Killer cell activation (NKa) is diagnosed without there being an underlying autoimmune cause., both partners should be tested for alloimmune genetic similarities (DQ alpha and HLA genetic matching).
•A semen analysis is required for accurate measurement of sperm motility and count. Sperm morphology is assessed employing “strict (Kruger) criteria.”
•Sperm Antibody Test: Selectively we also test the man and/or the woman’s blood for anti-sperm antibodies (ASA) using the indirect Immunobead test (IBT). This is particularly important in cases of “unexplained” infertility (where the blood of both partners should ideally be tested) in men when there is a history of a prior vasectomy or sperm microscopy reveals significant sperm-to-sperm attachment (agglutination).
•Sperm Chromatin Structure Assay (SCSA): In selected cases, semen should also be sent for a Sperm Chromatin Structure Assay (SCSA) to assess the DNA Fragmentation Index (DFI) which ideally should be <15%, but 15%-30%
•Hormonal assessment of the man: in an ambulatory surgical center, performed In men where a semen analysis reveals a low count/motility/morphology, blood id collected from the man for FSH, LH, TSH, testosterone and prolactin measurement
•Male Urology Visit: In selected cases (the man is referred to an Urologist for further testing or testicular biopsy.
Good luck!
Geoff Sher
I am an Indian woman 36 years of age, overweight (obese), used to smoke and drink occassionally until recently. In 2011, I conceived naturally and miscarried at 10 weeks (missed abortion stimulated by meds) because there was no fetal heart beat at 8 weeks and then subsequently at 10 weeks (doctor administered HCG and progesterone supplements in the meantime while i rested at home). Post miscarriage investigation yeilded I had undetected hypothyroidism. Throughtout the pregnancy my HCG count was very low and I has lower abdominal cramps and occassional spotting…the placenta was low in the uterus and smaller than expected size in every scan. The miscarriage was extremely painful and i had to be admitted to hospital to scan for left over tissues which were not found. I broke my tail bone during the contractions and didn’t even realize that thanks to the pain.
The experience left me emotionally scarred for a while, however, my husband and I started trying once again after a year…nothing happened. Between 2012 and 1015, we went to various famous doctors who treated me for things starting from prolonged urine infection to vaginal rush to PCOD. My ovulation cycles were monitored, i was put on susten-duphaston-follic acid, etc. ….everytime the result at the end of the cycle was negative. Finally, a doctor suggested going for hysteroscopy follwed by laprascopic surgery…that done, it was found that I’ve abdominal adhesions (subsequently removed except for some that bound my left ovary in a pouch kinda thing but the ovary is healthy), a stunted fimbria, partial blockage in tubes (the ink used for testing got out the other end on pressing), a lone fibriod in lower uterus which my doctor tells me will not affect implantation and PCOD (the polyps were removed at the time)…the procedure happened in 2016 January. In October I consulted an IVF specialist. I underwent a lot of tests to check if I ever had any PID, TB or any other infection or condition. Except for what I’ve already mentioned, nothing was found. I got my periods early at the age of 9, used talcum powder as a child after bathing in and around my vaginal area, am obsessed about hygeine and clean myself quite frequently, have extremely painful 5 day periods (1st 3 days heavy with chunks sometimes), eat healthy food and exercise moderately, reduced my weight by about 10kgs in 1 year only to gain most of it back in another year. I underwent a cycle of IVF treatment this last month – 14 eggs were collected, 10 fertilized of which 3 blastocysts (1 A grade and 2 B grade) were transffered on day 5. I started spotting 7 days later 10 days later, I’ve an HCG level of 11.6. Am due for another blood test to check if the levels rise in 2 days. I don’t really have abdominal cramps. However, I have a lot of pain in my legs…am getting night sweats, a prickly pain around my ovary areas and a dull ache in lower abdomen that lasted for a couple of minutes twice in the last 2 days. I don’t understand what’s happening to my body but am guessing, most likely, the implantation didn’t work. My doctor asked to continue with my meds (crinone gel, susten 100mg shots, duphaston, metformin, eltroxin, folic acid, ecospin) until results of next test arrives. I want to understand what’s wrong with me…if all reports are fine, why isn’t it working for me.
Hopefully this cycle of IVF was successful. I suggest you have a repeat hCG blood test done 2 days following the 1st one. If it doubles (or better), then have an US examination about 2 weeks later to confirm the result. In the meantime follow the advice of you doctor who seems to be doing fine with you.
Good luck!
Geoff Sher
Hi I am a 36 year old female with 2 children 1 of which is from my current partner, who is 37, and he also has 2 children from a previous partner. With my partner I have also had a chemical pregnancy, a bighted ovum and an ectopic pregnancy as I was only born with one fallopian tube I now need IVF as I had to have my only tube removed in that ectopic pregnancy. I have done 2 rounds of ivf the first I got 4 eggs and all 4 fertilised and I lost one at day 2 and the other 3 went to blast by day 5 I had one put in at a time and all three failed two didn’t implant and one was a chemical pregnancy pretty much straight away. The second cycle I got 4 eggs I did ICSI (as was recommended due to low egg retrieval) and 3 fertilised and I lost one at day 2 and the other two I put in at day three (one was an eight cell and one was a seven cell) again they did not implant. I have hashimotos disease which is under control using medication but I know I have high antithyroid antibodies. My issue is my husband has told me I can only do one more cycle so I need this one to work and I don’t know what I should do. I am currently in Lebanon and they do not have the same type of treatment as in my home country of Australia so I am unsure what should be my next step, could you please give me some idea on what I should try next?
Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.
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.
•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.
•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
•IVF: How Many Attempts should be considered before Stopping?
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•IVF Failure and Implantation Dysfunction:
•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.
Hello there
Could you please help me – I have regular cycles – 26 days. We have only been pregnant naturally twice. My ovulation is around 15 days (checked with an ultrasound scan last month) – then I get to day 18/19 and I can feel my period is starting – or at least my body is preparing for this – bloating/abdominal pain (similar to PMT) but 6 days early. Things then calm down and I have terrible PMT on day 25 and then my period starts. What’s happening here? Is this a leutal phase defect? There doesn’t seem to be enough of a window for successful implantation as the period (part 1) comes too early. What can I do – is progesterone supplements enough after ovulation? Do I need clomid as well as I seem to be ovulating normally and fertilising successfully. Under IVF my embryos were tested and seemed normal so doesn’t seem to be this. Please help as I know you always have such good advice.
Hi Fiona,
You absolutely need a thorough basic infertility evaluation before trying anything specific.
After 1 year of unsuccessfully trying to have a baby, it is time to have a basic infertility evaluation. And the urgency increases the older the woman is.
A: Preparatory Tests done on the woman:
•Tests for Ovarian Reserve: On the third day of spontaneous or progesterone withdrawal menstruation, blood is drawn to test for ovarian reserve. This requires testing for blood concentrations of estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH) and for anti-Mullerian hormone (AMH).
•A hysterosalpingogram (HSG): This is performed within a week of the cessation of menstruation. This out-patient procedure involves injection of a radio-opaque dye which outlines the Fallopian tubes allowing the diagnosis of tubal blockage. To a lesser degree, it permits the detection of surface lesions inside the uterine cavity.
•Hysterosonogram (HSN) : When IVF is planned this procedure is done early in the menstrual cycle. It involves instilling a sterile saline solution into th uterus, followed by a pelvic ultrasound to map the contour of the uterine cavity.
•Laparoscopy: This is a procedure that is sometimes needed. It is usually performed under general anesthesia in an ambulatory surgical center. Here, a telescope like instrument is passed into the abdominal cavity to allow thorough inspection of pelvic structures. It is usually confined to cases where symptoms and signs backed up by pelvic ultrasound findings, suggest significant underlying organic pelvic pathology (e.g. advanced endometriosis/fibroids, tubal disease and pelvic adhesions
•Hysteroscopy: Women suspected on the basis of symptoms and/or signs, (usually following ultrasound assessment or HSN) of having intrauterine pathology (fibroids/polyps/scar tissue) that might interfere with embryo implantation are sometimes required to undergo a hysteroscopy. This involves introducing a thin telescope-like instrument via the vagina and cervix into the uterus in order to allow visualization of the uterine cavity and surgical repair. It can be performed under local anesthesia with sedation in an ambulatory center orin-office. In some cases general anesthesia is needed.
•Testing the urine LH surge…for impending ovulation: Commencing at least 17 days before the expected menstrual period (i.e.; usually about 10 days following the initiation of menstruation), urine should be collected twice daily and tested for the onset of the spontaneous luteinizing hormone (LH) surge. The initiation of the LH surge usually precedes ovulation by 8 to 36 hours. In order to detect the onset of the LH surge accurately, an early morning urine specimen is needed. Ideally, the bladder should be emptied first thing in the morning, upon awakening. About one half-hour later urine is collected (only a very small amount is required) and tested using an over-the-counter LH – kit (obtainable over the counter, at a drug store). At the earliest sign of a color change the woman should present at her treating physician’s office for:
The 1st In-Office Assessment where the following is carried out::
1.A pelvic ultrasound examination to assess for a dominant follicle or for evidence of recent ovulation and for the thickness and pattern of her uterine lining to be assessed (ideally it should measure >8mm with a triple “line” (trilaminar) appearance
2.Blood should be tested for measurement of estradiol (E2) l level.
A 2nd In-Office Assessment is arranged for three (3) days after the first office assessment. At this visit, a vaginal ultrasound exam is performed to check (or to confirm) that ovulation has occurred (i.e. whether the egg has been released). The presence of small amount of fluid collecting in the lowermost region of the pelvis, or a change in the shape of the follicle is suggestive of ovulation.
A 3rd In-Office Assessment takes place five (5) days after the 2nd visit. At this visit, blood is drawn for the measurement of progesterone (P4) and estradiol (E2)
•Assessment for an Immunologic Implantation Dysfunction (IID) This is selectively done at one of about six Reproductive Immunology Reference Laboratories in the United States (I preferentially use Reproductive Immunology Associates (RIA) in Van Nuys, CA). Testing is indicated when:
1.Autoimmune assessment; In my opinion, this is indicated when here is a personal or family history of autoimmune diseases (e.g. Lupus Erythematosus, Hypothyroidism, Rheumatoid Arthritis etc.), symptoms or signs of endometriosis (e.g. prior surgical visualization of lesions in the pelvis, heavy painful periods and pain during intercourse and/or ovulation) which is associated with immunologic implantation dysfunction (IID) in about 1/3 of cases. Also, when there is a past history of repeated “unexplained” IVF failure. Here, blood is drawn (at any time) from the female partner and sent to a reliable Reproductive Immunology Reference Laboratory for testing of antiphospholipid antibodies (APA), antithyroid antibodies (ATA) and the K-562 Target cell test, otherwise known as a natural killer cell activity test (NKa) test. In some cases, a uterine biopsy is done to test for endometrial cytokines.
2.Alloimmune assessment: In select cases (especially where there is a history of Recurrent Pregnancy Loss (RPL), or “unexplained” secondary infertility” or where Natural Killer cell activation (NKa) is diagnosed without there being an underlying autoimmune cause., both partners should be tested for alloimmune genetic similarities (DQ alpha and HLA genetic matching).
•A semen analysis is required for accurate measurement of sperm motility and count. Sperm morphology is assessed employing “strict (Kruger) criteria.”
•Sperm Antibody Test: Selectively we also test the man and/or the woman’s blood for anti-sperm antibodies (ASA) using the indirect Immunobead test (IBT). This is particularly important in cases of “unexplained” infertility (where the blood of both partners should ideally be tested) in men when there is a history of a prior vasectomy or sperm microscopy reveals significant sperm-to-sperm attachment (agglutination).
•Sperm Chromatin Structure Assay (SCSA): In selected cases, semen should also be sent for a Sperm Chromatin Structure Assay (SCSA) to assess the DNA Fragmentation Index (DFI) which ideally should be <15%, but 15%-30%
•Hormonal assessment of the man: in an ambulatory surgical center, performed In men where a semen analysis reveals a low count/motility/morphology, blood id collected from the man for FSH, LH, TSH, testosterone and prolactin measurement
•Male Urology Visit: In selected cases (the man is referred to an Urologist for further testing or testicular biopsy.
Geoff Sher
Hi Dr. Sher. I’ve been reading about a single embryo transfer becoming identical twins. What is the percentage of this happening? Does icsi + pgs increase the odds of a single embryo splitting? Thank you so much for the time! Be safe and have a grand time!!
The odds are <1:100 BUT yes indeed, ICSI, PGS biopsy and assisted hatching (AH) do marginally increase the risk of an embryo splitting and resulting in uniovular multiples.
Geoff Sher