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 Doctor,
I had written to you early last year about my case. The link for it is here: http://haveababy.com/fertility-information/ivf-authority/ask-dr-sher-open-forum/comment-page-2293#comment-166462.
Begining of this year my husband and me were ready for the IVF treatment and visited my gynecologist. She put me on HRT tablets for 1 month(Dec 2016) followed by BCP for 2 months (Jan and Feb 2017). Day 2 reading of LH for the first month (Jan) when I was taking BCP was 15.0 and for the second month(Feb) was 20.9. Since I have had a history of OHSS, she did not want to take any risk so did not go ahead with the IVF for both those months. The problem is I am facing severe migraine problem just before the on-set of my periods on the months that I am on BCP. It was unberable during the Feb cycle. My dctor had advised me to get another reading of LH at the end of Day 2 for the Feb cycle where the reading came as 15.47. She has advised me to take Primolut – N (1 in the morning and 1 in the night) for 15 days.Would it be ideal to go ahead with IVF for this cycle or take the tablets ad prescribed by her, Please advice.
I really cannot insert myself into the treatment by another RE. If you would like to discuss with me you would need 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 morning, is there any problem to have the last stims (gonal menopur and ceteotide) two hours before the trigger shot? Or this can corrupt the evolution or meiosis of he eggs. I though the day of the trigger there are no stims
It won’t corrupt meiosis but I do not see the point.
Geoff Sher
We began secondary infertility treatment in Jan 2017. I have a 19 yr old, my only pregnancy delivered by C-Section. We were told that my AMH was low (.3??). I am 39 years old. All other hormones were ok. My doc then scheduled an HSG. She discovered that both tubes were blocked and that there was possible scar tissue within the uterine cavity, but she was unsure. She advised us that IVF would not be worth pursuing nor would a hysteroscopy and that our only hope would be a carrier. Is it normal to see POSSIBLE scar tissue so severe during an HSG to where a doctor would not even explore to find out a more detailed condition of the uterus before advising a patient in this manner? How did she know IVF was not a solution if she was unsure what the HSG showed? Why not offer to see if the possible scar tissue could be removed? Her responses were muddled so I’d like your honest opinion. Thanks.
I am not sure as to why your RE took such a radical step without first doing a hysteroscopy or at the very least, a sonohysterogram…Either way, at 39y with DOR whether the ET is done to your uterus or to that of a gestational surrogate, your 1st step is to obtain enough chromosomally normal blastocysts banked . This would require staggered IVF with PGS testing done .thereupon a decision can be made based on a subsequent hysteroscopy, sonohysterogram and your ability to generate an adequate uterine lining.
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.
•IVF Failure and Implantation Dysfunction:
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
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
My wife and I recently completed our second ivf cycle. She is 32, slightly lower than average amh. First cycle 15 eggs 11 mature and 8 fertilized and only 1 blast which ended in early miscarriage. This cycle 18 eggs 11 mature 9 fertilized. All looked good on day 3 and we by day 5 no blastocyst. Both cycles everything looked good until after day 3. What could be causing things to take a turn for worse after day 3? We are at a loss and not sure if donor eggs are our only option?
I would want to look at the specifics of your ovarian reserve and how you were stimulated. The protocol used for ovarian stimulation is central to success, especially in women with DOR or older women.
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.
•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
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.
Hello Dr. Sherr. If we were to do PGS testing we would have to wait for day 5 to do testing. But with a fresh implant you can transfer day 3 as I understand. But some embryos may not make it to day 5. Wouldn’t some of those embryos have possibly survived if implanted on day 3? Instead of waiting to day 5? Or if an embryo doesn’t make it to day 5 do you assume it had problems and that is why so it would have resulted in it not sticking if that same embryo had been transferred Day 3? Or would have resulted in a miscarriage? I guess my point is don’t you risk losing good embryos that would have been transferred Day 3 by waiting to test day 5 for PGS?
Hi Lisa…Good question?
In my opinion, the truth is that embryos that don’t advance to the blastocyst stage are incompetent and incapable of propagating a viable healthy pregnancy anyway. This is why I very rarely transfer anything other than embryos that have made it to the blastocyst stage by no later than day 6 post fertilization. There is no point in doing so.
Geoff Sher