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,
Thank you for this forum and the chance to ask you questions!
I have severe DOR but have managed to get 2 embryos so far doing natural cycles( frozen).
On this current cycle I did not grow a follicle so LH went all the way to 100 on cd18 and e2 was undetectable. I thought the game is over for me and then to my surprise we saw a follicle today on CD30. I had blood work(unfortunately no scan) on CD26 and e2 was 52. Today cd30, e2 is 83 and LH has dropped to 63. I am hoping that maybe I can catch this follicle to do natural cycle IVF.
Usually when the follicle is at 13mm I use one ganirelix injection together with 150iu of menopur. I trigger at 18mm with 10, 000 of HCG.
Sometimes I ovulate through the ganirelix so I just had this thought:
Is it possible to take two ganirelix injections per day( am +pm) and will I have to take 150iu of menopur /follistim with each ganirelix?(so a total of 300iu of fsh). Do I double the dose of FSH if I double the ganirelix?
I have read everywhere to find an answer but can’t. I will really appreciate hearing your valuable advice.
Thank you,
Annie
Hi Dr. Sher,
I just received results from my Ovarian Assessment Report. The retrieval score index was 15 and other results included:
AMH – 3.76 ng/mL (High likelihood of good ovulatory response)
Estradiol – 34.4 pg/mL (Good)
FSH – 7.22 mlU/ml (Good)
Inhibin B – 96.0 pg/ml (Good)
LH – 2.71 mlU/ml (Good)
I had this test done two years ago when I was 27 and my overall score was only 13 (still good) at that time. How is it possible for my score to improve with age? It was my understand that this test measured egg quantity, which should decline with age. Since the last test, I went through IVF, which resulted in a successful pregnancy with my daughter. We also had a failed FET.
Thanks for helping us understand how the results could improve. We are trying to decide if we need to move forward again with IVF.
These levels are all excellent. While they can fluctuate slightly, they usually are quite steady until diminishing ovarian reserve (DOR) sets in.
Geoff Sher
In your opinion how common are missed miscarriages?
Not that common…they are however like any other miscarriage only they are not immediatyely revealed. About 10-15% of pregnancies in women under 35y will miscarry. thereafter the incidence increases progressively.
Geoff Sher
Is a saline sonogram of similar utility to a hysteroscopy in terms of evaluating the uterine cavity for abnormalities, scar tissue, etc. Do you do in-office hysteroscopy for diagnosis or only do saline sonogram? I had a hysteroscopy last summer to repair adhesions, and I’ve had a few failures since then, although the lining looks good on FET, so we’re going to do some further investigation through saline sonogram to make sure the cavity looks ok, but wondering if saline sonogram will tell us as much as a diagnostic hysteroscopy would? Would saline sonogram be enough under these circumstances?
Yes!c as a diagnostic tool for the integrity of the uterine cavity, a HSN is equivalent.
Geoff Sher
Dear Dr Sher i recently had my 3rd ivf attempt (using elonva and orgalutran and 1 vial of puregon 150iu and 1 luveris 150iu) but only produced sized follicle (18) which at pick up was empty.
Previously in June last year in another round we had 4 follicles at pick up ,2survived but didnt fertlise after day 1.
My latest amh was 0.41 and fsh 20.
last june it was 0.41amh and fsh 12.
all the doctors are advising me to try egg donor as they said im not producing good eggs.. im 39 and my partner is 40. i really welcome any thoights
Egg donation is certainly a rational option. However, there is another alternative…
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”.
Women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
Please visit my new Blog on this very site, https://www.drgeoffreysherivf.com, find the “search bar” and 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 Approach
• 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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
• 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?
• Blastocyst Embryo Transfers should be the Standard of Care in IVF
• Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
• Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
• 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
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
• Traveling for IVF from Out of State/Country–
• 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
• Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
• IVF Egg Donation: A Comprehensive Overview
I invite you to arrange to have a Skype or an in-person consultation with me to discuss your case in detail. If you are interested, please contact Julie Dahan, at:
Email: Julied@sherivf.com
OR
Phone: 702-533-2691
800-780-7437
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.
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