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.
I have done one fresh and one FET cycles: 13 total eggs fertilized and 9 made to day 5. $ were transferred right away – got pregnant but lost the baby at 9 week. Had FET transfer of 5, 5-day blasts – BFN.
Im 40 years old; all tests are good and very good ovarian reserve (for my age, so i was told).
I have started 2nd round of IVF but worry that my egg quality is so poor that it wont happen. Any opinion on that? Is it worth continue trying
I agree!
For you, what kit is mostly about in my opinion, is the need to select an optimal and strategic stimulation protocol and I would also consider embryo banking of PGS-normal embryos to make hay while the sun still shines.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•A personalized, stepwise approach to IVF
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Human Growth Hormone (HGH) Administration in IVF: Does it Enhance Egg/Embryo Quality and Outcome?
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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
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Hi Dr Sher, would a higher than normal progesterone level on day of hcg trigger after implantation of an embryo? What level of progesterone would be considered ok on trigger day?
An elevated progesterone on the day of hCG is not good. Anything above 2-3ng/ml could suggest premature luteinization and have a deleterious effect of egg quality as well as on embryo implantation. In my opinion, this suggests the need to carefully review and revise the protocol used for ovarian stimulation.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•A personalized, stepwise approach to IVF
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Human Growth Hormone (HGH) Administration in IVF: Does it Enhance Egg/Embryo Quality and Outcome?
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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
I did an ivf cycle with sirm and had the interlipid treatment done as well. There is no Dq match. We did one before egg retrieval and one after I got a positive pregency test. We found the heart beat at 6 wks and then lost the baby at 7 wks. I wanted to k ow if I should do another ivf cycle or not because the treatment did not work. If I should what should be different?Also I just had a d and c done recently and how long to start another ivf cycle
You probably lost the pregnancy because of an embryo defect and not a failure to address the immunologic problem adequately.
Next time round, i suggest you do PGS embryo testing.
Geoff Sher
We did the testing and it was a healthy embryo
Hello Dr Sher. I am attaching alongwith my treatment summary. Please opine on what can be done for better results. Thanking in anticipation
TREATMENT SUMMARY
I have underwent 4 cycles of IVF, have had embryo transfer done thrice (1st time, three D-3 A1 grade embryos, 2nd time, two D-5 blastocysts and 3rd time frozen embryo transfer)
Female partner : Age : 34
Male partner : Age : 36
Married since 7 years, 3 months
Trying to conceive since 3 and 1/2 years.
Relevant history and investigations in chronological order –
MAY 2013 :
Follicular monitoring and planned relations done.
Semen analysis : 44 million/ml spermatozoa, 70% A+B motility
JULY 2013 :
TSH : 7.02, started on Tab Thyronorm since then. And TSH quite well in range now. Latest being 1.52 (Dated : 8-8-2015) on Thyronorm, 25 mcg/day
LH, FSH, Prolactin, E2, DHEA : Normal
MARCH 2014 :
HSG : T shaped cavity, Right tubal spasm ?
USG pelvis + MRI pelvis : Endometriotic nodule along posterosuperior wall of urinary bladder, few small hemorrhagic cysts in left ovary.
APRIL 2014 :
AMH : 3.2 – Repeated in MAY 2015 : 0.91
LH : 8.94
FSH : 6.78
LH/FSH ratio : 1.32
CA 125 : 60.3
Prolactin : 16.75
MAY 2014 :
Laparoscopic adhesiolysis with fulguration of endometriotic implants with hysteroscopic septal and b/l metroplasty and cystoscopy done on 29-5-2014
Positive Findings :
?Left tubal delayed spill
?Right tube normal
?Right ovary : e/o superficial endometriotic spots, fulgurated
?Left ovarian adhesions released and cyst drained
?Endometriotic implants over bowel, terminal ileum and peritoneum and baldder surface – fulgurated
?T-shaped cavity
?Septal and b/l metroplasty done
JUNE + JULY 2014 :
GnRH analogues
Husband : Semen analysis – normal
AUGUST 2014 :
1st IVF cycle : (Antagonist protocol)
?Preceeded by Oral contraceptive pills.
?Drugs used : FSH, Follitropin alpha, Cetrorelix
Dose : 300/ 75 * 5 days, 300/ 150 * 1 day, 300/ 225 * 3 days
?Produced 6 follicles
E2 : 2755
Endometrial thickness >10 mm, 3 layered.
?Trigger on D-10 (of stimulation) with Ovidrel
?No. of eggs collected : 5, all immature, next day 4 matured, ICSI done, 3 fertilised
?All 3 : Grade A1, 4-6 celled (Pictures following)
?All 3 transferred on D-3
?Outcome : BHCG : 23 (Biochemical pregnancy) on D-14
APRIL 2015 :
2nd IVF cycle : (Antagonist protocol)
?Not preceeded by OCPs,
?Ovarian cyst aspiration done before ovarian stimulation.
?Drugs used : Follitropin, Menopur, Cetrotide
Dose : 300/ 300 * 5 days, 300/ 450 * 4 days, 150/150 IU * 1 day
?Produced 6 follicles
E2 : around 1900
Endometrial thickness >10 mm, 3 layered.
?Trigger on D-11(of stimulation) with Ovidrel
?No. of eggs collected : 3, Mature : 2, Immature : 1, ICSI done to 2 eggs, 1 fertilised
?Grade A2 (?) (Picture following) : D2 2-celled embryo
?Embryo frozen, no transfer
JUNE 2015 :
3rd IVF cycle : (Short Protocol)
?Drugs used : Menotrophin (Ferring pharma), Leuprolide
Dose : Leuprolide : 500 mcg * 9 days
Menogon – 450 * 5 days, 375 * 1 day, 300 IU * 2 days
?Produced 5 follicles
E2 : 1393
Endometrial thickness >10 mm, 3 layered.
?Trigger on D-9 (of stimulation) with Koragon
?No. of eggs collected : 4, Mature : 2, Immature : 2 (matured next day) ICSI done to 4 eggs, 2 fertilised
?Grade : D3 1 embryo (8 celled), D2 1 embryo (4-6 celled with fragmentation)
?Embryo frozen, no transfer
JULY 2015 :
4th IVF cycle : (Short Protocol)
?Drugs used : Menogon (Ferring pharma), Leuprolide
Dose : Leuprolide : 500 mcg * 9 days
Menogon – 450 * 8 days, 375 * 1 day
?Produced 9-10 large follicles, 4-5 small follicles
E2 : 3759
Endometrial thickness >10 mm, 3 layered.
?Trigger on D-10 (of stimulation) with Koragon
?No. of eggs collected : 14, Mature : 6, Immature : 8 (matured next day) ICSI done to 14 eggs, 8 (2+6) fertilised
?2 Embryo (Blastocyst stage – D-5) transferred, Rest frozen (D4 6 embryos : Compacted (2), 6-8 celled (1), 6 celled (1), 4-6 celled with slight fragmentation (1)
?Outcome : BHCG on D-10 <1.2 IU/ml
SEPTEMBER & OCTOBER 2015 :
Endometrial preparation (for frozen embryo transfer) tried with hormonal supplements in the form of Tab Progynova and Inj Gestone in one cycle and Tab Progynova and Progesterone suppository in the other, but endometrium thinned out after starting progesterone.
NOVEMBER 2015 :
Natural cycle frozen embryo transfer
Total 9 frozen embryos –
D2 2 embryos : 2-celled (1), 4-6 celled with fragmentation (1)
D3 1 embryo : 8 celled
D4 6 embryos : Compacted (2), 6-8 celled (1), 6 celled (1), 4-6 celled with slight fragmentation (1)
?23-11 : Dominant follicle rupture, Endometrium : 0.73, Started on Progesterone suppositories
?27-11 : Planned FET : 2 compacted embryos thawed, but did not grow.
?28-11 : Planned FET : All the remaining frozen embryos thawed, 3 of them progressed and all 3 transferred.
?Outcome : BHCG on D-14, <1.2 IU/ml
DECEMBER 2015, JANUARY 2016 AAND FEBRUARY 2016 :
IUI trials
?2 cycles – Follicle ruptured before IUI could be done
?1 cycle – IUI done – unsuccessful.
With anTSH of 7, its is likely that you have underlying insipient hypothyroidism which in women is almost always autoimmune and in 50% of cases is associated with an immunologic implantation dysfunction linked to NK cell activation. In nthe same way, 1/3 of women with endometriosis also have NK cell activation. Given these odds, I would be surprised if this is not the root of your problem….please read the aricles listed below on my blog.
Separately, in my opinion, your stimulation protocols also need to be carefully reviewed and revised.
Whenever a patient fails to achieve a 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).
My answer to patients who ask me when is the time to stop undergoing IVF is ….Aside from the weight of the financial burden, the time to stop is when in spite of thorough and comprehensive evaluation, there is no remediable and treatable explanation for repeated failure.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•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 Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•PGS in IVF: Are Some Chromosomally abnormal Embryos IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
•Endometriosis and Infertily
•Treating Ovarian Endometriomas with Sclerotherapy.
•Adenomyosis-Related Infertility: A Therapeutic Challenge!
•Human Growth Hormone (HGH) Administration in IVF: Does it Enhance Egg/Embryo Quality and Outcome?
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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
Hello.
I am 27 and my case is very odd. History of a ruptured appendix and lung infection when I was 18 and had to take TB meds for 18 months to get rid of infection. I have gotten pregnant once but sadly ended in ectopic due to all the scarring from appendix. I then lost that tube (right). Next month I did an HSG and was told I had hydrospinx so I got that tube surgically removed so we could move on to IVF. All normal labs. AMH 4.81, FSH 5.7. Husband has excellent semen analysis. First cycle was antagonist. We got 21 eggs, 18 mature, 14 fertilized with ICSI. Day 3 we were told we were down to 9. On day 5 we only had 2 “early blasts” we transferred on day 5 and got a negative beta. Nothing left to freeze. We then started taking COQ10 Ulbiqinol both of us. We took these for 5 months before moving on to second cycle.
2nd cycle antagonists: Follistim, menopur, ganirelex and 10,000 hcg trigger
We got 10 eggs, 9 mature, 8 fertilized with icsi. On day 3 we were told we had 5 growing. 3 of them were 8 cell, 1 6 cell and 1 5 cell. ON day 5 we were left with 2 “early blasts” again. We transferred on day 5 and got a negative beta. I am so devastated. I am only 27 years old. Do I have poor egg quality?? What protocol will I benefit from? Please tell me. Thanks.
I forgot to mention I am 5’4 and weigh 136 lbs.
Cindy,
It is very rare for a woman of your age to have eggs with inherently poor quality. The most likely problem in my opinion probably has to do with selection of an optimal protocol for ovarian stimulation. However, please also read the following:
Whenever a patient fails to achieve a 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).
My answer to patients who ask me when is the time to stop undergoing IVF is ….Aside from the weight of the financial burden, the time to stop is when in spite of thorough and comprehensive evaluation, there is no remediable and treatable explanation for repeated failure.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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.
•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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