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 did a natural cycle IVF, follicle was 17mm 2 days before the trigger and 19-20mm on egg collection day and it was mature and it DID fertilise.
I did a second natural cycle, the follicle was 15.4mm 2 days before trigger, it was about 19-20mm on trigger day and it was mature but did NOT fertilise. Estrogen was higher on the second try.
My question is: did the smaller size of the follicle on my second try 2 days before trigger (and presumably therefore a smaller follicle size on trigger day), (although with a higher estrogen level than on my first try) indicate that the follicle wasn’t mature enough to get fertilised that second time round compared to the first time round?
I really fail to understand why patients ever do natural cycle (NC) IVF (or even mini-IVF). The only cost factor that differentiates conventional IVF from the latter options is the cost of the med. And with the latter you get more eggs/embryos, the success rate is MUCH higher and in the proper hands it is no more risky. Besides NC IVF is in my opinion contraindicated in older women and women with diminishing ovarian reserve.
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?
•Micro-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
Dear Dr Sher,
When doing am antagonist protocol, would you suggest to start cetrotide / ganirelix on a specific day? Is it dependent on follicle size?
Is it correct that adding the antagonist slows down follicle growth?
And finally, will cetrotide hinder egg maturation?
No the antagonist will dot adversely impact on egg maturation if used appropriately. I use Ganirelix/Cetrotide in the agonist/antagonist conversion protocol (A/ACP) arrangement where the antagonist is commenced on the 1st day of gonadotropin stimulation…see below.
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
•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?
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•A personalized, stepwise approach to 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, is it possible to get pregnant naturally straight after IVF/embryo banking cycles? My accupuncturist said it can take 2 months at least for your Ovaries to heal and your body’s hormones to get back to normality making it difficult to get pregnant naturally. I always assumed it was possible to get pregnant after an IVF cycle. Do you know many patients who have done so?
Respectfully…. It is possible to get pregnant straight after an IVF cycle.
Geoff Sher
Hi Dr Sher, I have been really interested to read your opinion that protocol can impact DNA especially for older women and those with PCOS. Please could you explain how egg DNA can be impacted by the protocol? I have talked to many clinics about this but they seem to believe the protocol does not impact on the DNA of the eggs.
Very respectfully, I strongly disagree with this opinion. Egg chromosomal integrity is defined in the 36 hours (or so) after the trigger. It is then that the egg is driven into meiosis (reproductive division) when the number of chromosomes is reduced. The objective is that the trigger will halve the chromosome number from 46 to 23. A mature egg that does not have precisely 23 chromosomes is “incompetent” and cannot propagate a healthy embryo (with 46 chromosomes…euploid) upon fertilization and it is the predominantly the egg (rather than the sperm) that is responsible for embryo chromosomal “competency”. Events preceding the “trigger” shot profoundly impact the ability of the egg to complete meiosis with 23 chromosomes. While age is the most important variable in this regard, second on the list is the ovarian environment in which the egg develops prior to entering meiosis and this is profoundly influenced by the protocol used for ovarian simulation, especially in older women and women with diminished ovarian reserve.
Geoff Sher
Geoff Sher
Dr Sher,
I have normal AFC and AMH but had premature luteinization and 50% immaturity last cycle. Would you suggest low dose HCG instead of menopur? Thank you for your invaluable advice, it is so appreciated!!
I would suggest neither.n my opinion, you need a modified long pituitary down-regulation protocol the A/ACP) with a full 10,000U hCG trigger (see below).
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
Hi I’m not sure if my previous comments have gone to the right Web site? Sorry if you have received this more than once.
I had ivf with donor eggs 20 days ago. The donor is 30 and I am 39. I have a son through ivf with my own eggs but decided donor eggs were safer.
My problem is, 8 days after transfer I had a small bleed but my home pregnancy tests were positive. The bleeding stopped but returned again a week later and I still have brown spotting since 6 days. I have had two blood tests the first one showed 4000 48 hours later the repeat test showed 9100. The Dr was happy with this but I’m still spotting. I’m so worried. Does this look like a miscarriage? I had two 5 day blasts put back one B and one C. Any advice would be much appreciated.
Thank you
Kate