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.
My husband and I have been through 3 IUI which failed. He was diagnosed with low motility. After failing 3 times we moved on to IVF. First egg retrieval we got 6 eggs. 5 made it to Day 5 and all good quality. We transferred two. It was unsuccessful. We decided to do a FET. We transferred 2 and I was pregnant with one embryo. We lost the baby at 8 weeks from Turner’s. It came from the male sperm. We were told to try PGS testing. We didn’t need PGD because we weren’t carriers for the same thing. They wanted more eggs this time so they raised my medication. Ended up with 13 eggs, 7 embryos made it to day 5 for PGS testing. When the results came back we only had one healthy embryo. I’m now 30 years old. Every embryo had a different issue. It would be missing a chromosome, have an extra, or have a damaged one. The genetic counselor said it may just be bad luck. The majority of them were my eggs. I tried to ask if my health history could be a factor. I received 6 months of chemotherapy for Hodgkin Lymphoma. My ovarian reserve is great though. No one can directly tell me if this is a factor though. I even contacted an oncologist fertility specialist. I have crohns and receive remicade every 8 weeks for this. Because of my crohns I do not take the baby aspirin my office recommends. I’m not to take anything with ibuprofen with it because it could make my intestine bleed. I’m starting to think if I should take that risk. I also have allergies and asthma and receive allergy shots. I have had melanoma and have no gall bladder. My tubes are clear because I had that test done. I had the one embryo transferred and it failed. I will start over with another egg retrieval. Do you have any recommendations for me or any other tests I should do before I proceed. Thank you.
It is quite possible that the chemotherapy affected your eggs qualitatively. However, the fact that you have produced at least one PGS-normal blastocyst suggests that you are able to potentially to have a baby with own eggs.
I suggest that you also be evaluated to exclude an anatomical or immunologic implantation dysfunction before transferring that embryo.
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.
•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.
•IVF: Selecting the Best Quality Embryos to Transfer
•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
•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
•CASE REPORT: A woman in her Early 40’s who has Diminished Ovarian Reserve Requiring IVF with Embryo Banking and PGS.
•Induction of Ovulation With Clomiphene Citrate: Mode of Action, Indications, Benefits, Limitations and Contraindications for its ue
•Clomiphene Induction of Ovulation: Its Use and Misuse!
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.
Dr. Sher, I was wondering if you can do an embryo donation to save the baby from an ectopic pregnancy.
Yes, it might reduce the risk of an ectopic, but in my opinion it is a drastic step to take for this reason alone!
Geoff Sher
I’m about to do my fourth transfer and I’m having a huge problem with cramps during my cycles. They are there at the start of the estrogen (doing fet) but really kick in once the progesterone is started. I cramp on transfer day and when he touches my cervix. Is there anything I can take to stop the cramps? I don’t want to mask them with pain meds I actually want to stop them.
This is unusual. Unless the Dr is using a tenaculum attached to the cervix and eliciting traction, it is in my opinion, possibly related to technique of ET.
The procedure requires a very gentle but yet assertive and planned approach.
Good luck!
Geoff Sher
Dear Dr Sher
The result from my recent cervical screening came back with a result of ‘suspected non-cervical glandular neoplasia’. My cervical cells were normal, but there is suspicion of an endometrial or ovarian abnormality (from what I’ve read, it is “suggestive of adenocarcinoma arising from endometrial, ovarian or metastatic lesions from beyond the genital tract”)
I have been referred to my NHS (UK) gynae-oncology clinic, and am seeing my fertility gynaecologist next week.
The cytology report said ’suggest D&C’ – however I have had one D&C and two hysteroscopies in the last 9 months, and histology from all three procedures was normal (albeit confirmed retained products of conception)
Over the last 6 months during the course of my fertility treatment, I have had multitude of medications to manage thin endometrium: oestrogen pills, patches, vaginal viagra, tamoxifen, pentoxifylline and a copper IUD following the removal of small filmy intrauterine adhesions in my most recent hysteroscopy in Oct. My endometrium reached 8.5mm this month and we have successfully restored menstruation.
Could any of the medications affect the glandular cells leading to my abnormal result? Or is it more likely that two normal endometrial biopsies and hysteroscopies in the last 6 months have missed cancerous cells that have only now been detected in a cervical smear?
I realise only further investigations can confirm either way, but I’d be very grateful for any thoughts on any possible impact of the various interventions on the smear result
Wishing you happy Chanukah and an enjoyable festive season
Kind regards
Katy
Hi Katy,
I think your suspicious endocervical/endometrial cells are unrelated in any way to ther treatment yopu have been receiving. Identifying and addressing this must take priority. Perhaps a D&C and endocervical biopsy is needed…perhaps even conization of the cervix if the origin is deemed to be endocervical.
As for your lining issue. The only concern I have is that the detection of uterine synecheae is not pointing to a damaged basal endometrium. Also, please bear in mind that viagra must be administered in a “compounded form”, via the vaginal route to be effective. Oral Viagra or the insertion of Viagra tablets in the vagina wont help.
Perhaps we should talk?
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)
•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.
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.
Hi Dr. Sher,
I’m 43, turning 44 in March, single and have had all fertility tests done. They’re all great. My AMH is 4.19. I’m aware that statistically speaking, 90% of my eggs are chromosonally abnormal. Does my AMH affect the outcome of an IVF cycle with donor sperm? Do the statistics stay the same? I don’t know if it’s relevant, but when I was 36, I get pregnant immediately after deciding to try with my ex. My mother had her last child at 35. I have limited funds, so I’ll be going abroad for treatment. I just don’t know if it’s a waste of time and money to do one ivf cycle with my own eggs or go directly to donor egg/sperm.
What are your thoughts?
At 44y, >90% of your eggs will be abnormal and the chance of IVF using your own eggs is remote. My advice is to go directly to egg donor-IVF. This having been said, the fact that you are single, needing donor sperm makes this decision a VERY difficult one. So it would not surprise me if you decide to go with own eggs. In such an event, consider the following:
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”.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
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 Aproach
•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.
•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?
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
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.
Geoff Sher