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, which medication do you prefer? what is better decapeptyl or ovitrelle ..
I know it depends on situation- but do you see better results with one or another?
thanks lynn
I do not trigger with agonists such as decapeptyl. And if Ovitrelle is to be used, it is my opinion 500mcg should be used.
Geoff Sher
Hello,
I am 29 years old and have been seeking infertility treatment since August 2016. My husband and I conceived naturally in September 2015, but unfortunately miscarried at 6 weeks. My husband’s SA is normal (in fact, excellent). My day 3 blood work revealed FSH- 9, LH- 6.7, Estradiol- 51.7. My HSG was clear. My AMH was not tested (my fertility clinic believes AMH is unreliable). My RE believes my only problem is that I am not ovulating regularly. I get regular 28 day periods but with anywhere from 3-7 days of pre-menstrual spotting. We have tried timed intercourse with Femara, ovidrel trigger, and progesterone suppositories in luteal phrase (which mostly stops spotting) for three cycles. The first cycle I produced one 19 mm follicle on 2.5 mg Femara. On my second cycle, I did not produce any mature follicles (but had sufficient lining and still had a period). In my 3rd cycle, my dose was increased to 5 mg Femara and I produced one 19 mm follicle and one 15 mm follicle. Next, we tried IUI on 5 mg of Femara with one 19 mm follicle again. Our most recent cycle, I took Femara 5mg on days 3-7 and Follistim 75 iu on days 8 and 9. On my CD 8 ultrasound, I had one 15 mm follicle and the rest were small 6-10. By CD 10, the others did not catch up and I again had one 19 mm follicle. The RE assured me that one follicle was just fine, so we had a second IUI. My husband’s count was 125 million and motility 89%. This cycle was STILL unsuccessful. I am concerned that we are wasting time and money on IUI’s with only one follicle each time. I am also concerned about my follicle being 15 mm on CD 8. Would this be considered early recruitment? My question is, do we continue to try IUI with one follicle or should we begin the IVF process? My RE assures me that this is not a case of Diminished Ovarian Reserve, but I am disappointed in my responses to medication and worried that they are perhaps overlooking a bigger problem than just irregular ovulation. If my problem was anovulation or irregular ovulation, wouldn’t I have conceived by now?
Thank you
I very respectfully differ with your RE’s opinion. With your response and your FSH of 9.0MIU/ml, you could well have DOR and if you do, then in my opinion, treatment needs to be more proactive and the protocol used for ovarian stimulation needs to be reviewed and if need be, revised . I also differ in than my opinion is that AMH is a far more reliable measure of ovarian reserve than is FSH/E2. If I were managing your case , that is the ist thing I would get done.
Please know that the protocol used for ovarian stimulation needs to be planned strategically, especially when it comes to women who have DOR. Otherwise egg/embryo development and “competency are at risk.
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.
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•IVF Failure and Implantation Dysfunction:
•The Role of 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
•Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
•Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•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
•The Role of Nutritional Supplements in Preparing for IVF
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!
•IUI-Reflecting upon its Use and Misuse : Time for a Serious “Reality Check”.
•Micro-IVF: Often Preferable to Ovarian Stimulation with or Without IUI
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 an IVF success story on the first cycle! 🙂 My question is how likely is a spontaneous pregnancy after IVF? I’m 35. Three of my friends had this happen after IVF. Seems like a lot. Your thoughts? Thanks for the time!
It does happen in about 5-10% of cases, depending of course on the cause of the infertility.
Geoff Sher
Hi Dr Sher, I have 2 IVF cycles done and my second IVF cycle I delivered a healthy baby boy who is now 2 years old. Recently I went for FET with 2 frozen grade A embies and one implanted. My HCG level was 1484 on day 16 and 5936 on day 20. Unfortunately I bleed and miscarried my baby at 5 weeks and 5 days despite my doubling HCG levels. No bloods were checked for progesterone when I got my BFP. I was given utrogestan 200mg bd 3 days before ET and continued until my miscarriage. My question to you is: could it be that during my cycle, i did not ovulate and thus there was no corpus luteum to provide intrinsic hormonal support for the pregnancy and the utrogestan was not absorbed well into my body. It was a natural FET cycle and notably the utrogestan dosage was lower for this cycle compared to the one in which i gave birth to my baby boy; that was 200 mg tds.
My OB was blaming on either the embryo was chromosomally abnormal or that i have immunological issues since I have 1 IVF cycle which failed with 4 good looking embryos.
Can a chromosomally abnormal embryo produce good hcg as in my case? It was developing well in the lab and was a day 3-4 morula during the transfer. So we are very shattered by the loss.
I forgot to add that a gestation sac was seen at 5 weeks 3 days – that was when hcg levels was 5936. And after i started bleeding the day before the scan, i have proluton injection as well. But nothing helped because I bleed so heavily 2 days later the GS was passed out.
It could be any of the factors you referred to.
Geoff Sher
Dear Dr. Sher,
I am a 43 year old male with a low sperm count and also decreased sperm motility. I and my wife are planing an IVF cycle with a donated egg. My question to you is whether a fresh semen sample would be better than a frozen one for the fertilization process.
Many thanks,
Mark
If your husband is fertile, and the sperm is frozen correctly, there is no difference.
Geoff Sher