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.
Sorry, I mean’t I have no known fertility issues.
Dear Dr. Sher,
I hope you are still answering questions. I am a 31 year old with known fertility issues (I have a one year old). I am pursing IVF to screen for Oculopharyngeal Muscular Dystrophy (OPMD). This is a single gene disorder that my dad has been recently diagnosed with.
I consulted with a local RE that said anecdotally that he has seen poor response in his patients that are carriers of some genetic diseases even when their pre-cycle testing numbers are normal. He wants to start me with higher doses of meds than what my pre-cycle tests would call for to try to overcome what he thinks will be a bad response. He admits that he has not dealt with my particular disease or know anything about it but he wants to prepare me for difficulties- he thinks that we may only get 1 or 2 embryos to test if I end up responding like some of his other PGD patients.
I have done some research after talking to him and the only thing I could find suggesting reduced stim response was regarding myotonic muscular dystrophy, which seems like a very different disease than what I am dealing with. OPMD is late onset (I do not have any symptoms and should not have any for another 20 years or so) and OPMD is only known to target the eyelids, throat, and limb muscles.
I would like a second opinion on what my outlook is and if I should start my cycle with higher dose meds. My local RE said that there is no risk to doing higher dose meds initially since we can scale back if I indeed do respond well but I am worried about OHSS and whether higher than needed dosages of meds could affect the egg quality of the eggs we do retrieve if the higher dose is really not needed. My condition is so rare that I do not expect any RE to have had any experience with it.
Do you think I am likely to be a bad responder (assuming my precycle testing numbers are normal)? Should I go with the higher dose meds like the local RE suggests?
Thank you so much.
Very respectfully, I do not agree with your RE’s position here. In my opinion, the protocol used should be tailored to your ovarian reserve and should not be influenced by your being a carrier.
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
•Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
•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)
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
•Optimizing Response to Ovarian Stimulation in Women with Compromised Ovarian Response to Ovarian Stimulation: A Personal Approach.
•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
•Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
•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
Please feel free to call or email Julie Dahan, my patient concierge if you would like 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 Dr. Sher,
My husband and I are trying to conceive. He is taking medication against hair loss and has been for 5 months already. It’s called Fernasteride 5mg which he takes one daily. Could this be preventing conception or harm the baby in some way? Should he stop the medication? He’s afraid to stop because then he will lose more hair. Please let me know.
Thank you,
Sherry
A Finasteride does not
appear to adversely affect sperm production or function. In addition,
the level present in the ejaculate of patients taking 1 mg
appears to be negligible. Thus, there does not appear to
be any need to stop 1 mg of finasteride in those patients
trying to conceive.
Geoff Sher
I am an experienced gestational carrier, the first Jorney I became pregnant by fertilizing one embryo with a fresh transfer. The second journey, I had two failed transfers, both in which one frozen embryo was transferred each time. Currently, I just transferred to frozen embryos on 2/9, wonderfully graded, healthy uterus and am almost positive that this again has failed. (I’m 8 days passed a 5 day transfer with all negative HPTs)
Hi emma,
The HPT is notoriously insensitive so early on. Please await the blood test and then if negative there could be an implantation issue that might need investigation if you plan on trying again.
Good luck!
Geoff Sher
I just failed a transfer with a euploid blast. I did intralipids, prednisone, lovenox, and baby aspirin for my FET. I have elevated TNF alpha and borderline anti phospholoid antibodies. I got pregnant with 2 children via frozen embryo transfers before, and I didnt use any immune treatments other than lovenox for my second conception (nothing for my first). But I have failed a few CGH normal transfers now, and so I saw an immunologist who prescribed the above given my numbers. He is now recommending IVIG – instead of the intralipids. Do you think that someone who has 2 previous healthy pregnancies with high TNF Alpha (39) and borderline anti phosopholoid antibodies needs IVIG???? I am a little scared of doing IVIG.