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.
They do have a chance but 6 cells or better do best!
Geoff Sher
Hello Dr,
I have a history of 3 ectopic pregnancy. My tubes are tied and salpingectomy one side.I did 4 ivf where I got 2 embryo in long protocol overlapping with bcp .2 nd I got 3 embryo antagonist protocol. 3rd NC ivf 1 embryo. 4 the 2 day 3 8 cell embryo. All failed.my amh is 1.19 ng.I did 3 further cycle and got 1 day 4 morula I used HGH in this cycle.and it was frozen. I did 2 more cycle and have 3 and 3 embryo .for the last FET Dr.gave Lupride depot 3.75 mg 15 days before the cycle and day 9 in transfer cycle i did endometrial scratch on transfer cycle.
I got my period on Nov 25 but transfer was on Dec 23.I don’t have problems in endometrial growth. I think it was a medicated fet.do you think prolonged transfer cycle might have caused failure.?
Next I am planning for NC FET.do you think it will help?
I took Prednisone, lmwh,aspirin, with progesterone and estrogen supplement.
Estrogen was 12 mg per day.is it the right dosage.
Will NC FET with intralupids will help?.plz reply
My preference is a well conducted hormonal cycle for FET. In my opinion, it is much easier to accurately pin point the window of implantation in such cases.
Good luck!
Geoff Sher
Hello Dr. Sher. My wife is on her first antagonist IVF cycle (MFI), and she appears to be a slow responder.
She is 34 with baseline (day 3) AMH 3.6, FSH 10.7 and Estradiol 66.
Here are here stats from the IVF cycle
Stims Day 3 – Estradiol 22
Stims Day 5 – Estradiol 110 (13 follicles seen but small)
Stims Day 8 – Estradiol 500 (13 follicles in 6-8 mm range)
Stims Day 10 – Estradiol 960 (13 follicles in 8-11 mm range – a few smaller 6mm follicles).
The docs think things are progressing appropriately though slowly. Would you concur? At this point it looks like she’ll stim for a total of 14-15 days. I’ve heard this happens, but is there anything to be concerned about?
I do not think she will stimulate that long and yes, I concur with your RE’s opinion here.
Good luck!
Geoff Sher
Hello Dr.
How long does it take for ovulation to occur after trigger injection?
Usually 37-42 hours.
Geoff Sher
Hello Dr. Sher,
I’m 39 years old and we have a 2 year old daughter which we conceived through IVF. My AMH level is 1.29 and we now wanted to have second baby for family balancing. We have had 2 retrieval cycles and done the PGD testing unfortunately none of our embryos were normal. In our first cycle, we had 6 eggs, 3 fertilized and 2 were sent for PGD testing both came abnormal. The second cycle, we had 8 eggs, 5 fertilized and 3 were sent for PGD testing and none came normal again. What are our chances?
Is there anything that I can do to increase the number of eggs and also influence so we have some normal embryos?
It could well have go do with the protocol used for ovarian stimulation which must be carefully planned and individualized, especially in older women and those with DOR.
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