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, for the purposes of determining whether one’s lining is too thin to proceed with an embryo transfer, when is the best time to measure one’s lining to make that determination? Is it the day of trigger, the day of egg collection or the day of transfer? A lot of fertility specialists measure it a day or two before trigger, but they never go back to measure it the day of trigger, EPU or transfer. When is the best time and when do you do it?
The thickness needs in my opinion to definitely be >8mm (and preferably >9mm) prior to trigger.
Geoff Sher
Hi Dr Sher,
At my scan this morning (10 days after stimulation), I had a lining of 7.1 mm and 13 follicles. The majority were 14.25, 14.50, 15, 16, 17 and 18. I have to trigger tomorrow night (in 24 hours) because my clinic only does EPU twice a week and I have no choice. My estrogen is currently 603 pg/mL and progesterone is 0.54 ng/mL. This suggests I’ve only got 2 mature follicles. Does that mean I’ll only get two eggs or is it likely they’ll grow at another 1 mm in 24 hours to increase my estrogen and make a few more mature? Does estrogen rise steadily in the last day or can it double?
They usually grow at least 2mm per 24H. The lining needs in my opinion to be at least 8mm (and preferably >9mm) by the time of the “trigger”.
Geoff Sher
Dear Dr Sher, I suffer from thin endometrial lining (less than 8mm). I have had some adhesions removed so that is no longer an issue. My estrogen levels are also normal. I am now starting a cycle on Viagra (inserted vaginally). My question is: does it make sense for me to take Viagra alone or should it always be combined with estrogen supplements or fsh stimulating medication? Thank you for your time.
If you are on a gonadotropin stimulation protocol, no estrogen should be needed. If an FET then yes, E2 is needed.
Geoff Sher
Hi, my last cycle was my first time doing long down reg cycle. I got only one follicke at 25mm. I was taking Menopur 450. I went to collection and woke up with 0 eggs as it was empty. Can you provide any suggestions?
Respectfully, in my opinion, for women with DOR, that is too much Menopur because has a lot of hCG/LH activity which in excess can be harmful for egg development.
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
Hi I’m 39YO mother of three. I had a tubal ligation after my third child in 2003. Am I candidate for IVF?
Absolutely yes! There is a relatively high success rates following tubal re-connection (reanastomosisis) in cases of previous tubal ligation (a birth rate of +/- 50% within 3 years of a successful surgery). However, IVF performed in a center of excellence produces almost the same success rate following a single attempt and is far less invasive than surgery. IVF also does not require general anesthesia, hospitalization, or a protracted time off work. Moreover by doing IVF and leaving the tubal ligation undisturbed, the woman retains subsequent control over family planning without having to resort to using some other form of contraception. Another point to be considered is the high incidence of tubal or ectopic pregnancy following the performance of tubal reanastomosisis high (about 20%).Major surgery also requires a few days of hospitalization and subsequently a few weeks of convalescence. There is also a risk of post-operative complications, increased cost, and time away from work, incapacitation, and significantly greater discomfort. The cost of a full cycle of IVF is in fact comparable to that of tubal reanastamosisis.
In my opinion, provided that IVF is performed in a program with high success rates, tubal surgery for fixing damaged or blocked Fallopian tubes, with few exceptions, can no longer be justified financially or ethically.
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?
•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 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.