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 Dr. Sher,
I am 39 years old and about to turn 40. My husband and I decided to go down the IVF path even though the chances of success are only about 20-25%; I just wouldn’t be able to live with myself if we didn’t go for broke and try. We have a plan that covers two retrievals, and I just had my first attempt February 28th. Of 8 total follicles, they retrieved 6 eggs and all 6 fertilized, but on day 5 they explained that only 1 embryo made it and I just received news last night that the PGS testing came back abnormal. Of course I am beyond saddened and wondering what purpose I have at this point, BUT I have always followed through on everything I have started so I am attempting round 2. I went in to the center yesterday on CD3 and they initially planned on giving me birth control for cysts for 1 month, but decided that there are only 2 cysts and that my follicle count has substantially now dropped to 5. They started Stim Start last night on me and had me get my AM and PM doses in, so now I guess I am starting my 2nd journey of IVF. I randomly was researching if there is anything I can do to improve egg quality and came across your site. I am doing acupuncture for stress, eating organic as much as possible… eliminated coffee, red meat and dairy, and taking CoQ10, Colostrum, Royal Jelly, Wheat Grass, DHEA and Omega-3 daily. Is there anything else that I can be doing to help this round? Thanks for your time.
I personally am not in favor of starting a stimulation if there are ovarian cysts. I prefer to aspirate them on the spot and then reassess to m,ake sure thios was successful before proceeding. As for egg quality, most supplements wont help . The most important is the protocol used for ovarian stimulation…see below. And if as sounds to be the case , you have DOR, then you should consider Staggered IVF with PGS and embryo banking to try and make hay while the sun still shines.
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
Hello,
To start, I am 26 years old and my partner is 27 years old. We first started with 2 rounds of clomid, and 1 IUI, both failed.
We have done 4 rounds of IVF. The first 2 cycles failed, the 3rd didn’t progress after about 5 weeks and I miscarried naturally around 10 weeks. Then we switched RE’s and did our 4th round, which I just found out also failed. I had great looking 5 day blastocysts and have transferred 2 almost every time. I had surgery for stage 3 endometriosis (bilateral endometriomas) last year and didn’t seem to have as many follicles as the previous fresh round (prior to laparoscopy) but the RE thought my numbers looked fine. My partners sample is okay, low morphology/motility but we did ICSI.
What should our next step be? I’m not sure if an egg donor is something I should be looking into or if there are other options. I am only 26 so the idea of an egg donor is a little off-putting right now, but so is the idea of another failed IVF cycle.
Thank you for your help in advance.
– Nicole
I suspect that you have endometriosis related immunologic implantation dysfunction. Also, in my opinion, endometriomas should be removed before IVF….see below.
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.
•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!
•Infection: How can it Affect IUI/IVF Outcome? 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
•How Many Embryos should be transferred: A Critical Decision in IVF.
•Endometriosis and Infertily
•Endometriosis and Immunologic Implantation Dysfunction (IID) and IVF
•Endometriosis and Infertility: Why IVF Rather than IUI or Surgery Should be the Treatment of Choice.
•Endometriosis and Infertility: The Influence of Age and Severity on Treatment Options
•Treating Ovarian Endometriomas with Sclerotherapy.
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.
Dear Dr. Sher,
I am now on medicated cycle day 6 and preparing for my fifth FET. We will transfer two last blastocysts so I am quite nervous…
I just received the message from my clinic abroad that they will want to do GCSF infusions into the uterus before the transfer. From reading information online I am really scared and I would love to hear your opinion on this treatment. Usually my lining was between 7 and 8 by cd10 and by transfer between 8 and 9 (sometimes even above 9).
Also, the clinic insists on doing Intralipid infusion just around the transfer. But I have no activation of NK confirmed by ReproSource – can this infusion compromise anything?
Thank you so much for being here!
Zuza
I personally do not believe in GCSF therapy or the use of IL if it is not infused 10 days (or so) prior to ET.
Geoff sher
We have been working with Oregon Reproductive Medicine on IVF and are in the process of selecting a surrogate. We just moved to Vegas this last weekend and are in the middle of this whole process. ORM instructed us to contact a fertility clinic in Las Vegas and were willing to work with them on the compleation of this process. We would love to speak to you further to see if you would be able help us…thank you
Feel freed to call 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
Dr. Sher Im really on pins and needles, i received a call today from obgyn, they adv me that my HCG levels were 195679. This is the only HCG I’ve done and Im now 8 weeks, I was 7 weeks when the bloodwork was done. Should i worry this is a Molar pregnancy?
So concerned
I would have an US done. This could be molar.
Geoff Sher