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,
At age 31 I was diagnosed with DOR with an undetectable AMH of 0.16. I did one cycle of IVF with estrogen priming, got 3 eggs, all fertilized and 2 made it to day 3. That cycle resulted in my now 3 year old son. I also had a natural pregnancy and also have a 2 year old daughter. I recently turned 36 and strongly desire another child. Being that on a very aggressive protocol almost 4 years ago I only produced 3 follicles, should I stick with that same protocol? It’s been a while, but I remember starting an estrogen patch after ovulation, and then used Follistim, menopur, bravelle and gannetelix. I know I am older now but hoping there is one more golden egg left! I have regular 28 days cycles but after 6 month of trying on our own I figure we better not waste any more time and move straight to IVF.
Thank you for your time!
Lori
If you wish to try again, I would go with what worked before, if itv is not too late to try.
Good luck!
Geoff Sher
Being that my amh is extremely low for 36 years old, does that mean that there is an increased likely good that the majority of eggs I do have left are of poor quality? I still have regular cycles and predictably ovulate. I was under the impression that amh was more of an indication of quantity. Is it possible to have fewer number of eggs but still obtain a quality egg? In your professional opinion, is the protocol the most important factor in obtaining quality eggs when the supply is compromised? Or is it just luck and the possibility of requiring multiple cycles to hopefully “catch” the golden egg? Thank you so much for taking time out of your busy schedule to answer questions! The information on your site has been extremely helpful and educational!
I have Hashimoto’s and I had a poor stimulation with my first round of IVF. 6 eggs were retrieved but one made it. I had the transfer and it did not work. I had been able to get pregnant twice last year on my own but miscarried both times. I asked about thyroid medications because I have seen studies that say that it may help even when you are euthyroid but my RE said it isn’t recommended any more. I was just wondering if there was any recent research I could share with him that may help make my case that maybe I need to be more aggressive? I appreciate your time.
Hashimoto’s disease is an autoimmune condition.Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.
I strongly recommend that you visit https://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.
• Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
• 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?
• Blastocyst Embryo Transfers Should be the Standard of Care in IVF
• IVF: How Many Attempts should be considered before Stopping?
• “Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
• 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
• 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:
• 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.
Hi I understand you don’t recommend endometrial scratch to help implantation? Why is that? What is your reasoning and why do you think so many clinics do it?
Because a) the procedure could introduce infection and b) there is in my opinion no sound evidence of efficacy.
Geoff Sher
Hi Dr, with regards to NGS testing of embryos on day 5, I wonder if you could tell me the accuracy of this testing method when it comes to determining gender? Thank you
Should be virtually 100%
Geoff Sher
Hi Dr. Sher,
Thank you for taking time to answer questions! After a sucessful donor egg cycle, should my hormone levels be monitored as I am stopping the estrogen injections at 10 weeks? Do you recommend tapering off or stopping cold turkey? I have the same questions about dexamethasone which I am supposed to stop at 12 weeks–do you agree with stopping at 12 weeks and should my blood levels be monitored as I come off that and should it be tapered off? Thank you for your time and advice!
Mary
It probably wont do much harm, but I prefer to stop meds by 10th week, by which time full transition to placental hormonal support is done. The dexamethasone is tailed off over about 10 days.
Geoff Sher