Dr. Geoffrey Sher on January 17, 2017 at 3:00 pm

I virtually no longer use IVIG. Intralipid is far less expensive, in my opinion is just as effective and virtually devoid of the serious side effects associated with IVIG. Both need to be used in association with a steroid to be maximally effective.

There is an ever growing realization, recognition, and acceptance of the fact that uterine immunologic dysfunction can lead to immunologic implantation dysfunction (IID) with “unexplained” infertility, IVF failure, and recurrent pregnancy loss (RPL). Although there are many factors that contribute to such implantation dysfunction, in the final analysis it is activated, “functional” uterine natural killer cells (NKa) in association with cytotoxic-T cells (CTL), which, through the production of cytotoxic cytokines (see below), damage the “root system” (trophoblast) of the embryo, causing the pregnancy either to be immediately rejected or so compromising placentation that early pregnancy loss occurs. Both immunoglobulin-G (IVIG) and intralipid (IL) therapy given in combination with corticosteroids (e.g. dexamethasone, prednisone, and prednisolone) are used to effectively reduce/down-regulate activated NK cells.
NK cells reach the uterus from the woman’s bone marrow, early in the menstrual cycle, as so called “parental” or “progenitor” cells. There, these early NK cells proliferate under the effect of estrogen. Only upon being exposed to progesterone do they begin to propagate “functional” NK cells that release cytokines and promote implantation. The concentration of functional NK cells in the endometrium is maximal about 7 days after exposure to natural(endogenous), or synthetic (exogenous) progesterone ….i.e. corresponding to the time the time when the embryo implants into the uterine lining (endometrium).
Functional uterine natural killer (NK) cells as well as T-helper cells are immune cells that frequent the uterine lining. They produce growth factors known as cytokines that regulate orderly implantation of the embryo and facilitate placentation (development of a functional placenta, the baby’s life line).There are two varieties of uterine cytokines: a) TH-2 (humoral) cytokines that promote permeation of the uterine wall by the embryo’s trophoblast (“root system and, b) TH-1 (cellular) cytokines that oppose trophoblastic proliferation and permeation of the uterine wall by culling interstitial trophoblastic cells. Orderly implantation and formation of a functional placenta (lifeline of the baby) requires that TH-1 and TH2 activity be in equilibrium
There are two categories of immunologic implantation dysfunction (IID) linked to NK cell activation (NKa).
•Autoimmune IID. Here, there is often a personal or family history of autoimmune conditions such as Rheumatoid arthritis, Lupus Erythematosus, and thyroid autoimmune activity (e.g. Hashimoto’s hypothyroidism) etc. Autoimmune IID also occurs in about one third of cases of endometriosis, regardless of severity.
•Alloimmune IID. Here uterine NK cell activation results from uterine exposure to an embryo derived through fertilization of an egg by a spermatozoon which shares certain genetic (HLA/DQ alpha)characteristics with that of the mother or embryo recipient.
In both autoimmune and alloimmune IID, the end point is an excessive NKa/CTL, TH-1 release that damages the embryos trophoblast, resulting in failed implantation or early pregnancy loss.
It is important to bear in mind that measurement of the concentration of blood NK cells has little or no relevance when it comes to assessing NK cell activation (NKa). Rather, it is the degree of NK cell activation (cytotoxicity) that matters. In fact, there are certain conditions (such as with endometriosis) in which the NK cell blood concentration is normal or well below normal and NK cell activation is markedly increased.
There are several methods by which NK cell activation (cytotoxicity) can be assessed in the laboratory. Methods such as immunohistochemical assessment of uterine NK cells and/or TH-1 and TH-2 cytokines have been used with some success. However, use of the K-562 target cell test remains the gold standard. With this test, NK cells are isolated from the woman’s blood using Flow Cytometry and are incubated in the presence of specific “target cells”. These are then incubated together. The percentage (%) of “target cells” killed through exposure to NKa/CTL-TH1 cytokines is then quantified.
Currently, there are less than a half dozen Reproductive Immunology Reference Laboratories in the U.S.A that are capable of performing the K-562 target cell test reliably. I have for 20 + years been working with Reproductive Immunology Associates (RIA) in Van Nuys, CA and preferentially recommend them to my patients.
There exists a pervasive but blatant misconception on the part of many, that the addition of IL/IVIG can have an immediate down-regulatory effect on NK cell activity. This has established a demand that Reproductive Immunology Reference Laboratories report on NK cell activity before and following exposure to IVIG and/or IL. However, the fact is that activated “functional” NK cells (NKa) cannot be deactivated in the laboratory. Effective down-regulation of activated NK cells can only be adequately accomplished if their activated “progenitor/parental” NK cells are first down-regulated. Thereupon once these down-regulated “precursor” NK cells are exposed to progesterone, they will begin spawning normal and functional NK cells, which takes about 10-14 days. It follows that to assess for a therapeutic response to IVIG/IL therapy would require that the patient first be treated (10-14 days prior to embryo transfer) and thereupon, about 2 weeks later, be retested. While at 1st glance this might seem to be a reasonable approach, in reality it would be of little clinical benefit because even if blood were to be drawn 10 -14 days after IL/IVIG treatment it would require an additional 10 days to receive results from the laboratory, by which time it would be far too late to be of practical advantage.
Neither IVIG nor IL is capable of significantly suppressing already activated “functional NK cells”. For this to happen, the IL/IVIG would have to down-regulate progenitor (parent) NK cell” activity. Thus, it should be infused several days prior to ovulation or progesterone administration so that the down-regulated “progenitor/precursor” NK cells” can propagate a sufficient number of normally regulated “functional NK cell” to be present at the implantation site 7 days later.
It is very regrettable that so many patients are being denied the ability to go from “infertility to family” simply because (for whatever reason) so many reproductive specialists refuse to embrace the role of immunologic factors in the genesis of intractable reproductive dysfunction. Hopefully this will change, and the sooner the better.

IL is a solution of small lipid droplets suspended in water. When administered intravenously, IL provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid. It is made up of 20% soybean oil/fatty acids (comprising linoleic acid, oleic acid, palmitic acid, linolenic acid and stearic acid), 1.2% egg yolk phospholipids (1.2%), glycerin (2.25%) and water (76.5%).
Possible Mode of Action:
It is thought that fatty acids within the emulsion serve as ligands to activate peroxisome proliferator-activated receptors (PPARs) expressed by the NK cells. This is believed to decrease NK cytotoxic activity, and thereby enhance implantation A growing number of IVF programs, including ours, perform egg retrieval under conscious sedation using Propofol, a short acting hypnotic agent. Interestingly, similar to Intralipid 1% Propofol also contains the same concentration of soybean oil, and purified egg phospholipid, with glycerin. Perhaps its use offers a fringe benefit in cases of immunologic implantation dysfunction.
Whatever the exact mechanism of action might be, IL exerts a modulating effect on certain immune cellular mechanisms largely by down-regulating cytotoxic /activated natural killer cells (NKa). This effect is enhanced through the concomitant administration of corticosteroids such as dexamethasone, prednisolone and prednisone which in my opinion do so by immune modulation of T cells . The combined effect of IL + steroid therapy is thought to suppresses pro-inflammatory cellular (Type-1) cytokines such as interferon gamma and TNF-alpha, produced in excess by activated NK cells and cytotoxic T cells.
IL will in about 80% of cases, successfully down-regulats activated natural killer cells (NKa) within 2-3 weeks. In this regard it is likely to be just as effective as IVIg but at a fraction of the cost and with a far lower incidence of side-effects. Its effect lasts for 4-9 weeks when administered in early pregnancy.
Can in-vitro (laboratory) tests assess for an immediate benefit of IL on Nka?
Since the down-regulation of NKa through IL (or IVIg) therapy can take several weeks to become detectable, it follows that there is really no benefit in trying to assess the potential efficacy of such treatment by retesting NKa in the laboratory after adding IL (or IVIg) to the cells being tested.
Treatment of NKa Using IL:
•Autoimmune Implantation Dysfunction: When it comes to NKa in IVF cases complicated by autoimmune implantation dysfunction, the combination of daily oral dexamethasone commencing with the onset of ovarian stimulation and continuing until the 10th week of pregnancy, combined with an initial infusion of IL (100ml, 20% Il dissolved in 500cc of saline solution, 10-14 days prior to embryo transfer and repeated once more (only), as soon as the blood pregnancy test is positive), the anticipated chance of a viable pregnancy occurring within 2 completed IVF attempts (including fresh + frozen ET’s) in women under 39Y (who have normal ovarian reserve) is approximately 80%.
•Alloimmune Implantation Dysfunction
oPartial DQ alpha match: IVF patients who have NKa associated with a partial alloimmune implantation dysfunction (DQ alpha match between partners) we use the same IL, infusion as with autoimmune-NKa, only here we prescribe oral prednisone rather than dexamethasone until the 10th week of pregnancy and IL infusions are repeated every 2-4 weeks following the chemical diagnosis of pregnancy until the 24th week. Additionally, (as alluded to elsewhere) in such cases we transfer only a single embryo at a time. This is because in such cases, the likelihood is that one out of two embryos will “match” and we are fearful that if we transfer >1 embryo, and one transferred embryos “matches” it could cause further activation of uterine NK cells and so prejudice the implantation of all transferred embryos. Since we presently have no way of determining which embryo carries the matching paternal DQ alpha gene and thus would transfer only one embryo at a time, it follows that the anticipated viable pregnancy rate per cycle will be much lower than with autoimmune implantation dysfunction. It also follows the only way to improve success with a single embryo being transferred would be to perform PGS on the embryos in advance of ET and then selectively transfer a “chromosomally normal-euploid (“competent”) embryos.
oTotal (complete) DQ alpha Match: In cases where the partners have a total alloimmune (DQ alpha) match with accompanying NKa the chance of a viable pregnancy occurring or (if it does) resulting in a live birth at term, is so small as to be an indication for using a non-matching sperm donor or resorting to gestational surrogacy would in our opinion be preferable by far.
Contra-Indications and Cautions with Intralipid Infusion:
IL is only contraindicated in conditions associated with severely disordered fat metabolism (e.g. severe liver damage, acute myocardial infarction and shock,
Rarely, hypersensitivity has been observed in patients allergic to soybean protein, egg yolk and egg whites and where fat metabolism may be disturbed (e.g. renal insufficiency, uncontrolled diabetes, certain metabolic disorders and in cases oif severe infection (sepsis) sepsis
Adverse Reactions During Infusions of IL (rare):
Adverse reactions (rare) reported to occur during and/or following infusion of Intralipid include: transient fever, chills, nausea, vomiting, headache, back or chest pain with dyspnea and cyanosis.
In cases of verified or suspected liver insufficiency, liver function must be closely followed. If increased levels of transaminases, alkaline phosphatases or bilirubin appear, infusion of Intralipid should be withheld or postponed, until normalization is achieved.

Very rare cases of hypersensitivity have been observed in patients allergic to soybean protein, egg yolk and egg whites.

Fat metabolism may be disturbed in conditions such as renal insufficiency, uncompensated diabetes, certain forms of liver insufficiency, metabolic disorders and sepsis.

Administration:
The drip rate is adjusted to 500 ml of a 20% solution should be infused over about 3 hours. The infusion should be started at half the infusion rate during the first 30 minutes, under supervision.

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 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
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!

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

19,771 Comments

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Kimberley on January 17, 2017 at 8:17 pm

Hello Dr Sher,
I am 40 years old and my fsh and lh are normal. A long protocol doesn’t and didnt work for me. My clinic doesn’t offer the agonist/antagonist conversion protocol.

My question is this: On a short antagonist protocol with Gonal F only, do you think adding in an LH drug like Menopur at the very end is essential? Or would be helpful for egg maturation?
- Dr. Geoffrey Sher on January 17, 2017 at 9:05 pm
  
  I think a small amount of LH (present in Luveris) or LH/hCG (present in Menopur) is needed.
  
  Geoff Sher
Jackie on January 17, 2017 at 6:55 pm

Dr. Sher,

I am on long Lupron protocol with 225 Gonal F and 75 menopur. I’m on day 3 of stims and my E2 levels was only 60. Should I be concerned? For reference, my last cycle on Ganirelix resulted in premature luteinization and my E2 level on day 3 was also 60. Should I increase my dose of Gonal F? Thank you so much!
- Dr. Geoffrey Sher on January 17, 2017 at 9:04 pm
  
  Hi Jackie,
  
  This is really something you need to ask your RE. I cannot interfere!
  
  Sorry!
  
  G-d bless!
  
  Geoff Sher
Dorothy on January 17, 2017 at 12:53 pm

Hi Dr. Sher,
Im 41y/o and did my first IVF last Jan.2 with 3 frozen embryo-blastocyst transfer.
Jan.9 (just 7 days post as per my doctor’s advise) my first Beta HCG count is 32.5 then on Jan.11 is 76.7
Doctor didn’t ask for followup blood test after this and they schedule my ultrasound on Feb.2
Even not advised, I did urine test on Jan.14 but the second line is not clear.
Im taking Cyclogest, Metformin and Progyluton 3x a day.
I had a light bleeding on Jan. 10 but didn’t happen again, still feeling light cramps from time to time too.
Im really puzzle if Im on the right track…. do you think Im pregnant?
Is the treatment successful or do I need to wait for my scan?
Please enlighten me.
- Dr. Geoffrey Sher on January 17, 2017 at 2:56 pm
  
  The beta hCG increase looks encouraging. You need to wait for the ultrasound to confirm.
  
  Good luck!
  
  Geoff Sher
Lorena on January 17, 2017 at 11:26 am

Hello Dr. Sher –
I’m struggling with IVIG vs Intralipid… i have elevated NK cells, 3 failed ivf… the cost is so different – I am just wondering if i have missed the LATEST information regarding any difference between the two.. thank you!
- Dr. Geoffrey Sher on January 17, 2017 at 3:00 pm
  
  I virtually no longer use IVIG. Intralipid is far less expensive, in my opinion is just as effective and virtually devoid of the serious side effects associated with IVIG. Both need to be used in association with a steroid to be maximally effective.
  
  There is an ever growing realization, recognition, and acceptance of the fact that uterine immunologic dysfunction can lead to immunologic implantation dysfunction (IID) with “unexplained” infertility, IVF failure, and recurrent pregnancy loss (RPL). Although there are many factors that contribute to such implantation dysfunction, in the final analysis it is activated, “functional” uterine natural killer cells (NKa) in association with cytotoxic-T cells (CTL), which, through the production of cytotoxic cytokines (see below), damage the “root system” (trophoblast) of the embryo, causing the pregnancy either to be immediately rejected or so compromising placentation that early pregnancy loss occurs. Both immunoglobulin-G (IVIG) and intralipid (IL) therapy given in combination with corticosteroids (e.g. dexamethasone, prednisone, and prednisolone) are used to effectively reduce/down-regulate activated NK cells.
  NK cells reach the uterus from the woman’s bone marrow, early in the menstrual cycle, as so called “parental” or “progenitor” cells. There, these early NK cells proliferate under the effect of estrogen. Only upon being exposed to progesterone do they begin to propagate “functional” NK cells that release cytokines and promote implantation. The concentration of functional NK cells in the endometrium is maximal about 7 days after exposure to natural(endogenous), or synthetic (exogenous) progesterone ….i.e. corresponding to the time the time when the embryo implants into the uterine lining (endometrium).
  Functional uterine natural killer (NK) cells as well as T-helper cells are immune cells that frequent the uterine lining. They produce growth factors known as cytokines that regulate orderly implantation of the embryo and facilitate placentation (development of a functional placenta, the baby’s life line).There are two varieties of uterine cytokines: a) TH-2 (humoral) cytokines that promote permeation of the uterine wall by the embryo’s trophoblast (“root system and, b) TH-1 (cellular) cytokines that oppose trophoblastic proliferation and permeation of the uterine wall by culling interstitial trophoblastic cells. Orderly implantation and formation of a functional placenta (lifeline of the baby) requires that TH-1 and TH2 activity be in equilibrium
  There are two categories of immunologic implantation dysfunction (IID) linked to NK cell activation (NKa).
  •Autoimmune IID. Here, there is often a personal or family history of autoimmune conditions such as Rheumatoid arthritis, Lupus Erythematosus, and thyroid autoimmune activity (e.g. Hashimoto’s hypothyroidism) etc. Autoimmune IID also occurs in about one third of cases of endometriosis, regardless of severity.
  •Alloimmune IID. Here uterine NK cell activation results from uterine exposure to an embryo derived through fertilization of an egg by a spermatozoon which shares certain genetic (HLA/DQ alpha)characteristics with that of the mother or embryo recipient.
  In both autoimmune and alloimmune IID, the end point is an excessive NKa/CTL, TH-1 release that damages the embryos trophoblast, resulting in failed implantation or early pregnancy loss.
  It is important to bear in mind that measurement of the concentration of blood NK cells has little or no relevance when it comes to assessing NK cell activation (NKa). Rather, it is the degree of NK cell activation (cytotoxicity) that matters. In fact, there are certain conditions (such as with endometriosis) in which the NK cell blood concentration is normal or well below normal and NK cell activation is markedly increased.
  There are several methods by which NK cell activation (cytotoxicity) can be assessed in the laboratory. Methods such as immunohistochemical assessment of uterine NK cells and/or TH-1 and TH-2 cytokines have been used with some success. However, use of the K-562 target cell test remains the gold standard. With this test, NK cells are isolated from the woman’s blood using Flow Cytometry and are incubated in the presence of specific “target cells”. These are then incubated together. The percentage (%) of “target cells” killed through exposure to NKa/CTL-TH1 cytokines is then quantified.
  Currently, there are less than a half dozen Reproductive Immunology Reference Laboratories in the U.S.A that are capable of performing the K-562 target cell test reliably. I have for 20 + years been working with Reproductive Immunology Associates (RIA) in Van Nuys, CA and preferentially recommend them to my patients.
  There exists a pervasive but blatant misconception on the part of many, that the addition of IL/IVIG can have an immediate down-regulatory effect on NK cell activity. This has established a demand that Reproductive Immunology Reference Laboratories report on NK cell activity before and following exposure to IVIG and/or IL. However, the fact is that activated “functional” NK cells (NKa) cannot be deactivated in the laboratory. Effective down-regulation of activated NK cells can only be adequately accomplished if their activated “progenitor/parental” NK cells are first down-regulated. Thereupon once these down-regulated “precursor” NK cells are exposed to progesterone, they will begin spawning normal and functional NK cells, which takes about 10-14 days. It follows that to assess for a therapeutic response to IVIG/IL therapy would require that the patient first be treated (10-14 days prior to embryo transfer) and thereupon, about 2 weeks later, be retested. While at 1st glance this might seem to be a reasonable approach, in reality it would be of little clinical benefit because even if blood were to be drawn 10 -14 days after IL/IVIG treatment it would require an additional 10 days to receive results from the laboratory, by which time it would be far too late to be of practical advantage.
  Neither IVIG nor IL is capable of significantly suppressing already activated “functional NK cells”. For this to happen, the IL/IVIG would have to down-regulate progenitor (parent) NK cell” activity. Thus, it should be infused several days prior to ovulation or progesterone administration so that the down-regulated “progenitor/precursor” NK cells” can propagate a sufficient number of normally regulated “functional NK cell” to be present at the implantation site 7 days later.
  It is very regrettable that so many patients are being denied the ability to go from “infertility to family” simply because (for whatever reason) so many reproductive specialists refuse to embrace the role of immunologic factors in the genesis of intractable reproductive dysfunction. Hopefully this will change, and the sooner the better.
  
  IL is a solution of small lipid droplets suspended in water. When administered intravenously, IL provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid. It is made up of 20% soybean oil/fatty acids (comprising linoleic acid, oleic acid, palmitic acid, linolenic acid and stearic acid), 1.2% egg yolk phospholipids (1.2%), glycerin (2.25%) and water (76.5%).
  Possible Mode of Action:
  It is thought that fatty acids within the emulsion serve as ligands to activate peroxisome proliferator-activated receptors (PPARs) expressed by the NK cells. This is believed to decrease NK cytotoxic activity, and thereby enhance implantation A growing number of IVF programs, including ours, perform egg retrieval under conscious sedation using Propofol, a short acting hypnotic agent. Interestingly, similar to Intralipid 1% Propofol also contains the same concentration of soybean oil, and purified egg phospholipid, with glycerin. Perhaps its use offers a fringe benefit in cases of immunologic implantation dysfunction.
  Whatever the exact mechanism of action might be, IL exerts a modulating effect on certain immune cellular mechanisms largely by down-regulating cytotoxic /activated natural killer cells (NKa). This effect is enhanced through the concomitant administration of corticosteroids such as dexamethasone, prednisolone and prednisone which in my opinion do so by immune modulation of T cells . The combined effect of IL + steroid therapy is thought to suppresses pro-inflammatory cellular (Type-1) cytokines such as interferon gamma and TNF-alpha, produced in excess by activated NK cells and cytotoxic T cells.
  IL will in about 80% of cases, successfully down-regulats activated natural killer cells (NKa) within 2-3 weeks. In this regard it is likely to be just as effective as IVIg but at a fraction of the cost and with a far lower incidence of side-effects. Its effect lasts for 4-9 weeks when administered in early pregnancy.
  Can in-vitro (laboratory) tests assess for an immediate benefit of IL on Nka?
  Since the down-regulation of NKa through IL (or IVIg) therapy can take several weeks to become detectable, it follows that there is really no benefit in trying to assess the potential efficacy of such treatment by retesting NKa in the laboratory after adding IL (or IVIg) to the cells being tested.
  Treatment of NKa Using IL:
  •Autoimmune Implantation Dysfunction: When it comes to NKa in IVF cases complicated by autoimmune implantation dysfunction, the combination of daily oral dexamethasone commencing with the onset of ovarian stimulation and continuing until the 10th week of pregnancy, combined with an initial infusion of IL (100ml, 20% Il dissolved in 500cc of saline solution, 10-14 days prior to embryo transfer and repeated once more (only), as soon as the blood pregnancy test is positive), the anticipated chance of a viable pregnancy occurring within 2 completed IVF attempts (including fresh + frozen ET’s) in women under 39Y (who have normal ovarian reserve) is approximately 80%.
  •Alloimmune Implantation Dysfunction
  oPartial DQ alpha match: IVF patients who have NKa associated with a partial alloimmune implantation dysfunction (DQ alpha match between partners) we use the same IL, infusion as with autoimmune-NKa, only here we prescribe oral prednisone rather than dexamethasone until the 10th week of pregnancy and IL infusions are repeated every 2-4 weeks following the chemical diagnosis of pregnancy until the 24th week. Additionally, (as alluded to elsewhere) in such cases we transfer only a single embryo at a time. This is because in such cases, the likelihood is that one out of two embryos will “match” and we are fearful that if we transfer >1 embryo, and one transferred embryos “matches” it could cause further activation of uterine NK cells and so prejudice the implantation of all transferred embryos. Since we presently have no way of determining which embryo carries the matching paternal DQ alpha gene and thus would transfer only one embryo at a time, it follows that the anticipated viable pregnancy rate per cycle will be much lower than with autoimmune implantation dysfunction. It also follows the only way to improve success with a single embryo being transferred would be to perform PGS on the embryos in advance of ET and then selectively transfer a “chromosomally normal-euploid (“competent”) embryos.
  oTotal (complete) DQ alpha Match: In cases where the partners have a total alloimmune (DQ alpha) match with accompanying NKa the chance of a viable pregnancy occurring or (if it does) resulting in a live birth at term, is so small as to be an indication for using a non-matching sperm donor or resorting to gestational surrogacy would in our opinion be preferable by far.
  Contra-Indications and Cautions with Intralipid Infusion:
  IL is only contraindicated in conditions associated with severely disordered fat metabolism (e.g. severe liver damage, acute myocardial infarction and shock,
  Rarely, hypersensitivity has been observed in patients allergic to soybean protein, egg yolk and egg whites and where fat metabolism may be disturbed (e.g. renal insufficiency, uncontrolled diabetes, certain metabolic disorders and in cases oif severe infection (sepsis) sepsis
  Adverse Reactions During Infusions of IL (rare):
  Adverse reactions (rare) reported to occur during and/or following infusion of Intralipid include: transient fever, chills, nausea, vomiting, headache, back or chest pain with dyspnea and cyanosis.
  In cases of verified or suspected liver insufficiency, liver function must be closely followed. If increased levels of transaminases, alkaline phosphatases or bilirubin appear, infusion of Intralipid should be withheld or postponed, until normalization is achieved.
  
  Very rare cases of hypersensitivity have been observed in patients allergic to soybean protein, egg yolk and egg whites.
  
  Fat metabolism may be disturbed in conditions such as renal insufficiency, uncompensated diabetes, certain forms of liver insufficiency, metabolic disorders and sepsis.
  
  Administration:
  The drip rate is adjusted to 500 ml of a 20% solution should be infused over about 3 hours. The infusion should be started at half the infusion rate during the first 30 minutes, under supervision.
  
  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 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
  •Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
  
  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
Mamuti on January 17, 2017 at 8:43 am

Hello doctor.
I’ve got a result of two sperm analysis tests and would appreciate if you could tell me are these numbers good enough for natural conceiving.
1st test:
volume: 2ml
sperm concentration: 45mil / ml
motility: A+B 40% (A=8, B=30, C=2%, immotile 58%)
2nd test:
volume: 2ml
sperm concentration: 30mil / ml
motility: A+B 40% (A=12, B=28, C=0%, immotile 60%)
all other parameters are normal except no data on morphology.
Thank you very much
- Dr. Geoffrey Sher on January 17, 2017 at 3:12 pm
  
  The motility is borderline normal and the morphology (1st test) is slightly below normal but …it is possible to conceive naturally.
  
  Good luck!
  
  Geoff Sher

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