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!
Awaiting PGS but out of 18 eggs retrieved, 15 mature, 13 fertilized and 7 made to blastocysts.
One 6AA
One 5AA
One 5BB
One 5BC
Three 6BC
Do You think I have a good shot of normal baby or hopefully 2 in there?
I’m 32 (endometriosis, AMH 2.53)
Husband is 34 (good count, borderline morph, borderline motility, DFI range 40-53).
Thank you!
I think you have an excellent shot of a few good ones.
Good luck!
Geoff Sher
Hi Dr
Please assist
3 Day transfer done the 15 February 2017 (3 Embryo’s)
Following hcg:
25 Feb – 53.8 (10 days post transfer) (Had bleeding)
27 Feb – 66.5 (12 days post transfer) Had Bleeding
1 March – 90.9 (14 days post transfer) Had bleeding
6 March- 301.9 (19 days post transfer) No bleeding
Ultrasound did on 6 March could not see anything also looked for Ectopic nothing.
10 Mrach – 1072 (23 Days post transfer)
Please help what is going on. This is my 5th IVF and 1st time having this.
Kind Regards
Chantal.
Unfortunately, this is a failing implantation. A definite eye needs to be kept on the possibility of an ectopic.
Geoff Sher
Monday 28th last week tested positive for pregnancy but on the Wednesday 1 March I began spotting which today March 9 have turned into bright red blood and a lot of pain in my lower abdomen aRea. I also did an obstretics ultrasound which showed thd sac. Am due for another ultrasound tomorrow. I also had a myomectomy April 26 2016, what do u think could be the cause of the bleeding?
It sounds like a suchorionic blead that has broken through. Alas, all you can do is wait it out.
Vaginal bleeding occurs in about 25% of all pregnancies. When it happens, it almost invariably raises the concern of pregnancy loss (miscarriage). Bleeding can also be a sign of a tubal (ectopic) pregnancy, and in cases where the distended Fallopian tube ruptures it can precipitate a life-threatening crises. However, a small amount of painless vaginal bleeding can also be the result of normal embryo implantation (i.e. implantation bleeding) or it can result a local erosion of the vagina or cervix and/or trauma during intercourse.
Notwithstanding, in virtually all cases the occurrence of early pregnancy vaginal bleeding congers concerns or even alarm regarding the possibility of miscarriage. And when this happens to women who conceived following infertility treatment, the alarm often turns into panic. However, the truth is that in most such cases the bleeding soon stops and the pregnancy proceeds unabated to the birth of a healthy baby. However, because some do progress and end in miscarriage, and in most cases, only time will tell how things will ultimately turn out, we use the term “threatened miscarriage” to describe such early bleeding. The term “inevitable miscarriage” is used once symptoms and signs confirm a miscarriage is in progress. The term “complete miscarriage” is used if all products of conception are passed, leaving the uterus “empty”. An “incomplete miscarriage” refers to cases where some products remain retained in the uterus.
Miscarriage: Mild painless vaginal bleeding (often referred to as “spotting”) is usually due to hormonally induced eversion of the glandular cells that line the inner cervical canal, such that erosion develops on the outer part of the cervix that protrudes onto the vagina. The everted glandular tissue is fragile and susceptible to contact trauma, brought about sexual penetration or the insertion of vaginal suppositories. Since such local bleeding does not involve the developing conceptus located inside the uterus it is almost always innocuous. The diagnosis of a local cause of bleeding requires visual inspection of the vagina and cervical inlet a speculum examination. Thereupon, provided that the pregnancy has advanced beyond 5-6 weeks, a concomitant sonogram could confirm the presence of an unaffected pregnancy. Patients are advised to be more careful in inserting vaginal suppositories and to avoid sexual penetration until the bleeding has stopped for at least 1 week.
Sometimes bleeding occurs behind the conceptus inside the uterus (retrochorionic bleeding). Some blood will usually track down through the cervix and into the vagina. A speculum examination will often reveal blood tracking into the vagina through the cervical canal and a sonogram will reveal the presence of a retrochorionic blood clot. Although such retrochorionic bleeding can become an inevitable miscarriage, it often abates and over time the blood clot in the uterus absorbs, and the pregnancy continues normally. Treatment involves careful observation, avoidance of aspirin and other non-steroidal anti-inflammatory medications, bed rest and avoidance of vaginal penetration until the condition stabilizes, is essential.
While mild painless vaginal bleeding is usually innocuous, bright red bleeding that increases in amount and is accompanied by escalating pain is another matter altogether. It often suggests an impending inevitable miscarriage.
Before the 7th week of pregnancy a normally rising blood hCG (pregnancy hormone) titers is a comforting indicator that the pregnancy is more than likely progressing normally. Likewise, the detection of a normal heartbeat detected by ultrasound examination done after the 7th week of pregnancy is a very reassuring finding. However, even such findings by no means exclude the possibility of an inevitable miscarriage.
The causes of a miscarriage are multiple and diverse. However in most cases it is due to the developing conceptus being chromosomally/genetically abnormal. However, early miscarriages that reoccur more than twice in a row (Recurrent Pregnancy Loss-RPL) often suggest of an underlying implantation problem that could be due to a poorly developed uterine lining (endometrium) or immunologic dysfunction involving activated immune cells known as uterine natural killer (NK) and/or T-cells. Treatment requires an accurate diagnosis of the cause and selective therapy.
An ectopic pregnancy must be excluded: .Bleeding in the first 2-3 months of pregnancy especially if associated with the sudden onset of acute abdominal pain that is aggravated by movement and is accompanied by right shoulder tip pain, and light headedness or fainting could point to a bleeding ectopic pregnancy (one that is located in a Fallopian tube, outside the uterus) . The condition can be life endangering and warrants an immediate trip to the hospital as it often requires emergency surgery.
Molar pregnancy: Molar pregnancies are due to rapid overgrowth of the trophoblastic tissue that forms the placenta. Although infrequent they can cause early vaginal bleeding in pregnancy. Bleeding from molar pregnancies is often present with typical bleeding which resembles “red currents floating in a red jelly”. Bleeding from a molar pregnancy can either painful or painless. The condition is often associated with severe vomiting in early pregnancy, disproportionate enlargement of the uterus, and very elevated blood levels of hCG. Ultrasound evaluation, often reveals a rather characteristic snow-storm like image.
Patients with vaginal bleeding are often told to stay in bed. While this might reduce visible blood loss, there is no tangible evidence that it will prevent a miscarriage. Unfortunately, there is no definite treatment for this kind of bleeding in the early stages of pregnancy. Alas, in most cases only time will provide the answer.
I wish you the best!
Geoff Sher
Hi Dr. Sher.
I had an FET and had a positive blood test yesterday at 9dt5dt. My HCG was 92 but my progesterone was only a 7. I’m already on supplements 3x a day so I feel as if they should be higher. My dr said this is low normal, but I’ve read that this can signal an abnormal pregnancy. I had my levels tested the morning of the transfer and my progesterone was 18 then. My questions are:
1. Do you consider this a normal level?
2. Do you think this is normal with all the progesterone supplementation I’m taking?
3. Do you think this could be a viable pregnancy or is the number worrisome to you?
4. Is it normal to have such a large drop in progesterone? 18 the day of transfer to 7 9day past?
As always, thank you so much for your insight.
1. Do you consider this a normal level?
A: It is definitely on the low side.
2. Do you think this is normal with all the progesterone supplementation I’m taking?
A: No!
3. Do you think this could be a viable pregnancy or is the number worrisome to you?
A: It could be but time will tell!
4. Is it normal to have such a large drop in progesterone? 18 the day of transfer to 7 9day past?
A: No it is not usual, in my opinion.
Good luck!
Geoff Sher
Hello,
I am writing on behalf of a friend with infertility. I have gone through it myself but we have different issues and I have been able to have children.
She is 43 and has never gotten pregnant naturally, with iui or ivf. She and her husband have had traditional testing with RE’s but not with an RI. Her RE also does not believe they should do further testing. They just completed their first DE cycle with his sperm, transferred one embryo and still got a negative. Her RE thinks they have no issues but I suspect she has implantation or immune issues that are undiagnosed.
They have three frozen embryo’s left. Her RE wants to do a FET. What would be your recommendation based on this basic history I have provided and possible tests to consider? She is in NYC.
Thank you so much!!
~~Kate