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.
Dr. Sher,
I’m 35 y.o. with slight DOR and got pregnant 5 m. ago via IVF with ICSI. Only had three eggs, did a Day 3 transfer of 2 good looking 8 cell embryos, both took, and the third embryo arrested before becoming a blast. Both heartbeats started but then stopped at 7 1/2 weeks and I had a double miscarriage. Testing of the POC showed that both had Trisomy 15, which is odd since they were fraternal twins. Karyotyping of me and husband came back normal. Moved on and did another round of IVF, but did a Day 5 transfer of two early blasts this time. Wanted to do PGS but did not because only had the two early blasts on morning of Day 5 and embryologist said there was a chance that neither would be extended blasts by morning of Day 6 to do biopsies.
I just got my betas and am pregnant again. My question is this: is it less likely that these embryos are chromosomally abnormal since they made it to early blast on the morning of Day 5, compared to the Day 3 8-cell embryos I used last time? Also, in that first cycle if we had waited until Day 5, would those Day 3 8-cell embryos with Trisomy 15 likely have arrested in the lab prior to making in to blast, sparing me the trauma of a double miscarriage? Or since they made it to 7 + weeks inside of me, does that mean that they likely would have made it to blast in the lab.
Thanks, Michelle
Hi Michelle,
No it is not less likely that the embryos transferred were normal because they made it to blastocyst. I say this because the 2 that propageated an earlier pregnancy in spite of being transferred on day 3 obviously also reached blastocyst in your uterus. However, at 35y of age, about 2:5 embryos that reach blastocysts should be normal so you do have a good shot here.
Good luck and G-d bless!
Geoff Sher
Dear Dr. Sher,
thank you for haing this forum for us to ask questions about IVF. i have just finished my 1st cycle of IVF in the middle east. I did a cycle of IUI in Canada after i was only able to produce 1 follicle. Ive been told I have a low ovarian reserve and poor quality- i am 38 years old and i am not sure what my real chances are. This cycle i was on 15 days of 450 mg of Gonalf and 2 mg of centriole for 3 days (including booster shot) – i had 3 follicles but one 1 collapsed and 1 was too small. They extracted the one at 18 mm but it contained no egg *or so they said. The cycle is canceled and i have to start again.
I am not sure what to do? Do i have a chance ? For the last 4 months i have been taking supplements like DHEA and CQ10 but still no luck.
Can you provide a medical explanation for why intralipid therapy and prednisone are discontinued at 24 weeks for alloimmune issues and not continued longer? Is there any evidence that this puts the baby at risk and are there treatment outcome studies that show 24 weeks is optimal? I’m currently a patient through the Peoria office and getting nervous as I end these treatments. Thank you!
In my opinion, it is because the conceptus is protected from immunologic onslaught by the fully developed placenta. It is probably not necessary to go beyond the 12th week. Going to 24 weeks is simply precautionary.
Geoff Sher
Is a progesterone level of 4.2 two days after ovulation concerning? I know that’s low, but if it’s two days after ovulation, is it possible it’s on the way up and therefore may be an ok level for luteal phase? It was tested 1.5 days or so after ovulation to confirm ovulation, but it’s 4.2.
No . That is too early for it to be of concern.
Geoff Sher
I read your articles on the immune protocols. I was just wondering when do you exactly give your intralipids? When do the steroids start, dose and for how long? thanks.
The 1st IL infusion is given 10-14 days prior to ET and the steroids are commenced at the initiation of gonadotropins.
Geoff Sher