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.
Dear Dr. Sher,
I’m a 35yo newly married person who has not been actively trying to get pregnant but due to my age I went to have a discussion with my OB and found that I have an AMH of .89 I followed this up with chemistries and found that I had a very high Prolactin in the 30’s it normalized a bit with thyroid therapy but to date it has spiked and the MRI confirmed a micro adenoma. All my other labs and follicular count have been normal. What do you recommend do you recommend since I will be treating this adenoma with medication and it should bring back my fertility that I try to get pregnant at home? Is there an inverse correlation with AMH and Prolactin? or should I move ahead to IVF and not waste time?
Thank you,
Sarah
Since you already have signs of diminishing ovartian reserve, I suggest you be proactive and to IVF with embryo banking.
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”.
Women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
Please visit my new Blog on this very site, https://www.drgeoffreysherivf.com, 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)
• 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.
• The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
• 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?
• Blastocyst Embryo Transfers should be the Standard of Care in IVF
• Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
• Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
• 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
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
• Traveling for IVF from Out of State/Country–
• A personalized, stepwise approach to IVF
• How Many Embryos should be transferred: A Critical Decision in IVF.
• The Role of Nutritional Supplements in Preparing for IVF
• Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
• IVF Egg Donation: A Comprehensive Overview
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
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.
Dr Sher,
I am 34 and have had a failed IVF. We just had ER for IVF #2 yesterday so we don’t know how many will make it to blast. We are planning a frozen cycle to improve birth rate. Since we are doing a frozen, would you recommend PGS? I have read all your articles on genetic screening but still wanted to ask if it was better to know definitively that we are transferring a genetically normal embryo.
No I do not routinely do PGS testing in younger women who have normal ovarian reserve. Hardly any advantage over transferring 2 untested expanded blastocysts.
Good luck!
Geoff Sher
Hi Dr Sher! I recently had a cancelled cycle (after 8 days of stims). I got AF today (perfect 27 day cycle as usual!). I want to redo my hormones test in 2 days (CD 3). I will be testing my FSH, AMH, LH and E2. I last tested in December 2016 but i was already on 1 month of BCP then.
The reason for wanting to test again now is to try and get a true reflection of my ovarian reserve without the mask of BCP.
I however want to know:
1.Will the drugs that i used for stim a few weeks ago (gonaf and menopur) affect the results of my tests now in any way?
2. Also, is it possible to do the A/ACP protocol without starting with BCP to avoid oversuppression? Is this even advisable?
Thank you!
1.Will the drugs that i used for stim a few weeks ago (gonaf and menopur) affect the results of my tests now in any way?
A: Unlikely
2. Also, is it possible to do the A/ACP protocol without starting with BCP to avoid oversuppression? Is this even advisable?
A: Yes it is possible to do….and probably will be fine.
Good luck!
Geoff Sher
Thank you! Out of curiosity though, is it ok to do the FSH, LH and AMH tests while on BCPs? Will it give true reflective values of the ovarian reserve (I have read that BCPs may suppress this hormones?)?
Hello DR Sher. I just did my first round of clomid 100mg cd 3-7 . I have tracked bbt the past 4 months and previous to this month I would get a temp shift cd12-14 with a positive OPK about a day or two before the temp shift. This month on clomid my temp shift happened on cd8, only 1 day after my last clomid dose. I hadn’t started using OPK yet, I started on cd9 and today was my third day of temps above my cover line but was also the first day I got a flashing smile on the clear blue easy monitor. Is it possible to ovulate one day after taking clomid or is the clomid effecting my bbt and I should just go by the OPK? I didn’t have ultrasound monitoring as it was our first round on clomid. Thank you in advance for your time.
While you might have ovulated early on clomiphene , it is in my opinion more likely that the clomiphene triggered a premature LH surge in your case.
Geoff Sher
Dr Sher,
My progesterone the day of trigger was 1.47 but we happened to measure it day of ER and it was 7.7. I know the decision of fresh vs frozen is usually based on trigger day progesterone but would the higher number at ER imply that a fresh transfer is not a good idea. Thank you!
No…it seems in order to me!
Geoff Sher