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.
Hello Dr. Sher.
I am preparing for my first frozen egg transfer next month with no previous IVF cycles or pregnancies. Unfortunately my husband and I only have one frozen embryo to work with after an egg retrieval count of 41. Do you have any suggestions of things I can do or foods to eat/avoid to up our chances of success. I am trying to remain hopeful but can’t help but think it will take us more than one cycle for success. As a side note, I suffer from PCOS. Thank you for any advice!
Hi KP,
I agree that having just 1 (non-PGS tested) blastocyst available is risky. I suggest that you stockpile competent (chromosomally normal) embryos for future use before time on the biological clock runs out.
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
After my Ivf cycle with an 5day blastocyte (both donors) my 11 day Hcg reading is under 5. Does that meand failure?
I am afraid it does not look good.
Geoff Sher
Dear Doctor Sher,
Back in April/2015 I had a skype consult with you. I was planning on doing my third Own egg cycle. As I have endometriosis and had never been pregnant in almost 6 years of trying you tested me for K-562 targe, APA, DQ-aplha, anti-TPO, THAB and all came back normal. I proceed with my third IVF with my own eggs with another clinic (due to costs, sorry!) and I had a chemical. It was the first time in 6 years that I ever got pregnant. It was also the first time I was taking clexane 40mg and 25mg of prednisolone.
I decided to move on to donor eggs because my long history and many doctors opinions always pointed to egg quality. My first DE cycle was a fresh one where I synced with donor. I end up taking estrace for 28 days. My protocol also included clexane but no prednisolone. We had 3 extended blasts on day 5 and one extended blast on day 6. They were all tested (Complete chromosome screening) on day 5. We transferred on day 6 bc they were tested on day 5. It didn’t work. Second cycle, it was a FET. I had an endo scratch and sonogram to prepare before transfer of remaining 2 embryos (one day 5 and day 6). This time we did a natural cycle. I triggered on CD17 and transfer was on CD24. My natural cycles are normally only 25 days. My lining was 9 and triple. This time 25 mg of prednisolone was added to my protocol and I started 3 weeks before transfer. I still didn’t conceive.
Besides mild endometriosis, my laparoscopy, sonograms have always been normal and local RE says that my uterus is normal and there is nothing wrong with it. I never had a polyp, fibroid, nothing. I would love to hear your opinion to why I am still not conceiving with donor eggs, chromosomes normal embryos and no implantation issues?
Thank you,
We would need to talk after I have had the opportunity to review the immune test results as well as the records from your previous cycles.
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.
Hi Dr Sher, I’m considering seeing you but I have seen many fertility specialists and I have a question that I would like your response to.
What role does LH have in IVF? My understanding is the theca cells are fundamental for follicular growth, providing all the androgens required by the developing follicles for conversion into estrogens by the granulosa cells. But what if you are on synthetic estrogen? Surely then the role of LH is redundant given the follicles are growing in an estrogenised environment? I’m on 10mg of prednisone and 1,000 ng of metformin, which from my understanding depletes androgen levels. I take synthetic estrogen starting 7 days prior to starting FSH injections and all through the cycle. I’ve noticed that my LH is very low the day before FSH injections start. In my recent cycle, my LH was 0.6 and after 3 days of FSH injections it went down to 0.4. If I am taking synthetic estrogen and there is no problem with my lining, how much LH is required during folliculogenesis in IVF? You indicated a small amount, but how small? Is 0.4 sufficient? And when is LH needed? Is it usually at the beginning of FSH injections or after the antagonist is administered? I found a journal article that said LH levels should be between 0.5-1.0 after the administration of the antagonist, but then there’s another study that said implantation is improved when LH is above 1.0. There seems to be two achos of thought but no conclusive answer on the role of LH during stimulation. If LH levels between 0.4-0.6 are maintained throughout the IVF cycle and one is taking synthetic estrogen, is that enough? I must say that adding estrogen has resulted in a good quality day 5 blast, but it could have been aneuploid as it didn’t implant and it was only 6 cells on day 3.
LH stimulates the ovarian connective tissue (stroma/theca) to produce male hormones or androgens(mainly testosterone) which is delivered to the follicle granulosa cells where under the influence of FSH it is converted through enigmatic action to estradiol. So some LH-induced testosterone is vital to follicle ande egg development but too much testosterone gets into the follicular fluid and compromises follicle/egg development increasing the likelihood of chromosomal egg numerical abnormalities during meiosis. This sets you up for embryo aneuploidy (incompetence) and failure.
We can discuss further when we meet!
Goo luck!
Geoff Sher
One more thing-would you recommend genetic testing for my eggs?
WE would need to talk first!
Geoff Sher