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.
After first transfer of IVF with egg donor 21 years old , and PGS testing , of 2 Blast A embryos it’s failed .
My doctor told me he is in shock , and offer me before my second transfer , to do scratching and to have in the day of transfer right after Intralipids iv treatment , he said he think it will help me succeed .
I want to ask you if you recommend to do blood check first for natural killers cells ? And if one test or two test !
Because he said its expensive to do this blood check and that only one time it’s not indicate and better to do again because sometimes the first results showing normal results and second showing not normal results !
Please tell me your opinion !
And also I know that this cells supposed to fight against tumors and cancers , so I afraid that the Intralipids iv treatments can damage the health !
Please tell me your suggestion!
Thank you very much !
My second transfer is on 02/15/2016
If I will do the test I will receive results on time do you think ?
And how much it’s supposed to cost ?
Thank you sooooooo much Dr
ABSOLUTELY, the fact that PGS-normal embryos failed to propagate a viable pregnancy suggests that there is likely to be an underlying implantation dysfunction …possibly immunologic in origin. It would in my opinion be a travesty not to evaluate this thoroughly before going to ET.
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
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)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. 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.
Please visit my new Blog on this very site, 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:
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF FailureImmunologic 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
•IVF Egg Donation: A Comprehensive Overview
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
Hi Niki,
ABSOLUTELY! I think it would be a serious omission not to test for an immunologic implantation dysfunction here. Obviously this should be considered when PGS-normal embryos fail to propagate a viable pregnancy.
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
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)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. 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.
Please visit my new Blog on this very site, 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
•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.
•Frozen Embryo Transfer (FET): What Does it Involve?
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies?
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
•IVF Egg Donation: A Comprehensive Overview
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
Please can you tell me about my test! If i can conceive naturally
Thank you
Physical characters:
Appearance Normal
Volume 2 ml
pH 8
Viscosity Normal
Liquefaction 30 min
Sperm quantitification:
Sperm Count / ml 47000000 Sperm
Total Sperm Count / ejaculate 94000000
Motility assessement : (After liquefaction)
Motility 70 %
Progressive (PR) 20 %
None Progressive (NP) 50 %
Immotile 30 %
Microscopic Examination:
Leucocytes 500000 cell /ml
RBCs: 0 – 1 H.P.F
Spermatogenic Cells 2 – 4 H.P.F
Agglutination Absent
Sperm Morphology :
Normal forms 60 %
Abnormal heads 20 %
Yes Aziz,
this count is compatible with normal fertility. However, if you are having problems, see an andro-urologist to have other parameters evaluated as well. Or call 800-780-7437 and set up a consultation with me via Skype.
Geoff Sher
Dear Dr Sher,
Congrats on the new website.
I have a question regarding stimulation protocol.
My husband and I are young and have been trying to conciece naturally for a few years, we found out my husband has male factor infertility (low count, motility and morphology). We did 2 cycles of ICSI which the first failed and the second was a chemical pregnancy. Our embryos growth slows down after day 3.
After reading your blog I started wondering if the protocol was wrong.
Both cycles I was on Gonal F alone for stimulation, do you think I should have been on another stimulating drug as well? Does Gonal F alone lead to poor egg quality/and or chromosome issues within the egg.
Your valueble input would be very much appreciated, as we are financially struggling and I want to ensure the 3rd cycle is done correctly.
Thank you!
Hello Maya,
thanks for posting here!
It is possible that the protocol for stimulation could be a problem. Also, your husband needs to be evaluated carefully to see whether he has a reversible cause for male infertility.
Please visit my new Blog on this very site, 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
•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)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Unexplained IVF Failure
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•The Role of Nutritional Supplements in Preparing for IVF
•Measuring and Interpreting Blood hCG to Assess Pregnancy Viability Following ART Treatments.
•Male Factor Infertility
•The Sperm Chromatin Structure Assay (SCSA): A Measure of the Potential of Sperm to Help Propagate a Viable Pregnancy
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!
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
Good day Dr.
I always go to your blog as support for the IVF journey and today I feel compelled to write. This is our 2nd IVF attempt, first ended with a MC slow risinh Beta and failed FET. We transfered two grade AA expanding blasts with no PGD and got our first Beta today which is 8dp5dt and it was 33. We were supposed to do the test tomorrow but had some red blood spotting last night and Dr. told us to come in a day sooner for blood. They have upped the endometrium dosage to 2 am and 2 pm from 1 am and 2 pm. With all this do you feel 33 at 8dp5dt is a good number or should we be worried?
Thanks again for all you do!
Thank you for your kind words and for visiting this site!
When confronted with “unexplained” IVF failures where morphologically good embryos were transferred, the question arises as to whether the problem is due to inherent egg/embryo “incompetence” (which usually equates with an irregular chromosomal configuration [aneuploidy]) or whether it is due to an implantation dysfunction. The younger the woman and the higher the quality of available embryos (preferably blastocysts), the less likely it is that the fault lies with embryo “incompetence” and the greater is the likelihood that it is due to underlying implantation dysfunction.
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)
Implantation dysfunction (anatomical or immunologic) is a common cause of repeated “unexplained” IVF failure with good embryos. 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.
Please visit my new Blog on this very site, 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
•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)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
•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 Capable of Resulting in Normal Babies and Being Wrongly Discarded?
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•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
Thanks for taking the time to read these Dr. Sher! My husband was diagnosed with a form of muscular dystrophy this month. Needless to say my world has been turned upside down, and we now must turn to IVF with PGD. I just made an appointment with one of your doctors for a consult. I am having so much anxiety over the appointment though, because even though my age is okay and I believe I ovulate normally (get my period regularly, and tracking my cervical fluid/temp) I have a very high BMI. I’ve been reading some IVF clinics won’t even see patients with higher BMIs and I’m distraught thinking I’m going to be treated badly/differently than other patients (mainly because I’ve experienced this from other doctors in the past). Does your practice turn away patients due to BMI, or will they make me try to lose weight first (currently trying of course). Thanks for addressing my concerns, I really appreciate it.
There should be no concern that you would in any way be treated differently or be the target of ANY discrimination because of having a high BMI. Notwithstanding. it is important for you to keep the following in mind:
Recent evidence indicates that excessive weight in women of reproductive age is associated with decreased birth rates, increased miscarriage rates, higher rates of premature delivery and a marked increase in pregnancy complications.While being overweight clearly has an adverse affect on overall reproductive performance, the situation is less clear when it comes to its influence on women undergoing In Vitro Fertilization (IVF). Several studies have been conducted and while the results vary and in some cases conflict, the general trend is in the direction of women who are moderately overweight (BMI>25-30) and those who are obese (BMI>30) having poorer IVF outcomes than do controls with a BMI of less than 25. It would appear that in general, moderately overweight women, and more particularly those who are obese, exhibit a poorer ovarian response to fertility drugs (impaired follicle and embryo development with fewer blastocysts becoming available for transfer). They also might have a reduced ability to implant transferred embryos into their uterine linings (perhaps due to reduced endometrial receptivity).
It is of interest that many women with Polycystic Ovarian Syndrome (PCOS) are also overweight. In such women, the hormonal environment in the ovaries is known to adversely affect follicle and egg development. Given that there is often no clear-cut distinction between PCOS and overweight women, it is possible that many of the factors that are believed to affect egg/embryo quality in PCOS might similarly affect egg development and endometrial receptivity in overweight women. Such factors could include increased production of luteinizing hormone (LH), hyperinsulinemia and increased production of ovarian male hormones (androgens such as testosterone). The link between increased LH and resulting increased production of ovarian androgens (mainly testosterone) and poor follicle and egg development is well established. It is also well known that such hormonal changes can be transmitted to the adjacent uterus, thereby adversely affecting endometrial development.
Clearly the question arises as to whether the negative effect of an elevated BMI (>25) on general fertility potential and IVF outcome compromises egg development, endometrial receptivity to the implanting embryo, or both. In my opinion, while a direct ovarian influence probably predominates, there is also likely to be an adverse influence on endometrial development. This endometrial affect is commonly seen in PCOS women who, when they develop severe ovarian hyperstimulation on fertility drugs, often have a very thin (< 8mm) endometrium. Finally, it is important to emphasize that overweight women are at far greater risk during pregnancy than are women of normal body weight. As previously mentioned, the miscarriage rate is much higher. So is the incidence of diabetes, high blood pressure, preeclampsia, premature labor, surgically assisted deliveries, stillbirth and neonatal death. Maternal complications that occur after birth of the baby (i.e., infection, uterine post partum hemorrhage, etc.) are also much more common. Babies born to such mothers are also at great risk of developing respiratory distress syndrome (RDS). This condition, which ordinarily only occurs in preterm babies, can also occur in the absence of prematurity in such cases. RDS is the most common reason for the newborn having to be admitted to a neonatal intensive care unit, and also the most common cause of death in the first week of life. Please visit my new Blog on this very site, 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 •Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP) •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) •Launching Ovarian Stimulation with a BCP: How Does it Affect Response?•The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response? 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