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.
Hi Dr. Sher. I’m 35 years old with normal FSH and AFC, but a low AMH of .647. My first round of IVF I got pregnant with fraternal twins but miscarried at 7.5 weeks. Testing of POC showed that both fetuses had a trisomy on the 15 chromosome. Second round of IVF I got pregnant with a singleton but miscarried at 8 weeks. Again, POC testing showed that it had a trisomy on the 15 chromosome. My husband and I were both karyotyped between cycles 1 and 2, and our karyotyping came back normal. Do you have any guess as to what might be going on? Do you think that the karyotyping result may be wrong and one of us in fact has a translocation on the 15? It’s my understanding that his is not a common trisomy to have, and now we’ve had it in three out of three embryos.
Thanks, Michelle
No Michelle…I think this is simply coincidence. However, I would love to know more about the protocol used for ovarian stimulation as this could play a role in egg/embryo ploidy, especially in women with DOR.
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 have a very stressful job and keep inadvertently missing entire doses of my Estrace in prep for FET. If I have already ovulated will this adversely affect the FET? Is there a way to know if I’ve ovulated? Thank you so much!!
It could affect FET. Have a blood progesterone measured. If it is raised you may well have ovulated. Discuss with your RE.
Geoff Sher
Hi Dr. Sher- why do some women get mucus/fluid in their uterine lining during stimulation during fresh cycle? Is this indicative of any problem? I know it’s not ideal for transfer/implantation, but this is a freeze all cycle and I haven’t had it in prior FET. I always get it during a fresh cycle though. Is there any reason to be concerned?
It is back-pressure from the cervix into the uterus. It usually absorbs on its own after a few days of exposure to endogenous or exogenous progesterone and if it disappears…no problem.
Geoff sher
Hi Dr,
I have completed three failed IVF cycles.
My first cycle (short protocol) using Gonal-f, orgalutron and Ovidrel resulted in 7 follicles, with four eggs retrieved. The rest described as “empty”. Of these four, all fertilized but were described as grainy and one was transferred with the rest arresting before day 5.
Second attempt was a long protocol, again triggering with Ovidrel. Which resulted in 12 follicles, with 6 eggs retrieved. All fertilized but again described as very fragmented and again all arrested before being able to be frozen. I am 31 and the doctors said my eggs are acting as though I’m mid 40s.
Our third cycle I did some research and requested to change our trigger to Pregnyl. The doctor was reluctant, before agreeing to 5000 Pregnyl and a shot of Decapeptyl as the trigger. This was a short protocol which produced 6 follicles, 4 eggs. They transferred back two of the eggs on Day 1 so I’m not sure what the quality was like but of the remaining two, one actually made it to blast stage and the other arrested on Day 5. We were told there was minimal fragmentation and the embryos were better quality. Unfortunately none of these resulted in pregnancy.
Do you think it’s worth us trying again? Am I right to think we should try a higher dose of Pregnyl to negate these empty follicles and bad quality eggs being produced?
Thanks so much.
I think, the use of 250mcg Ovidrel (rather than 500mcg) as a trigger is part of the problem. I also believe that 5000U hCG is not enough to trigger optimal egg maturation. I am pretty convinced that your issue has to do with the protocolused for ovarian stimulation and/or its implementation. …see below.
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.
•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?
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
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.
Good day, I some how came across you looking for Pro Bono IVF. I am not sure that you do this. My wife has wants to have a child so bad. We have been looking all around the St. Louis location. We are 24 but I have been with my wife since we were 16. That is when I moved in. We have the same birthday, same year. we recently gotten married on our 7th year anniversary back in April of last year. She possible has PCOS and Endometriosis. I have a low sperm count. I was wondering if you do any type of pro-bono since The cost of IVF is very expensive and we just don’t have that amount of money at this moment. She would be an amazing mother. She takes care of us and the whole family. She is a loving aunt and an amazing person. She really deserves to be a mother and it sucks that we don’t have the money for IVF at the moment and most likely will not get pregnant naturally. So if you could get back to me with any information that would be great. Thank you so much
Sorry,
We don’t routinely po pro-bono IVF. I suggest you contact INCIID by going to http://www.INCIID.org.
Good luck!
Geoff Sher