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.
Dr. Sher,
During my wife’s frozen embryo transfer (pgs tested normal), the doctor did not successfully transfer the embryo with the first attempt. The embryologist found it still in the catheter so they had to try a 2nd time, at which point they indicated the transfer was successful as it was no longer in the catheter. Do you think this could decrease the chance of pregnancy?
We are now 8 day post transfer and my wife is having cramps, soar achy body and hunger, all of her normal period signs. Is it possible that this is due in part to the progesterone shots and/or implantation?
Thank you,
Peter
As long as the embryo ultimately reached the uterine cavity safely, a second attempt should not really prejudice outcome.
Give it a few days and you will have a provisional answer.
Good luck!
Geoff Sher
Hi Dr. Sher and thank you for the wealth of information you provide on your site. It is greatly appreciated! I have trawled through as much as possible to find my answer before asking my question but so far – no luck so I’ll just ask! I am 42 years of age and have a 6 year old from a natural cycle. I have been trying for number 2 for about 4 and a half years with no luck. We have been classed as ‘unexplained’ as all results have appeared to be good ‘for my age’ (if only I knew those words would mean something when I was in my 20’s!). I had my first round of IVF in mid January 2017, which resulted in 4 mature and fertilised eggs. We had decided to go for PGS and our clinic said they would only do this if we got to 5 day blastocyst stage. They also encouraged us to transfer one on Day 3 and let the other three progress. Unfortunately, the cells did not develop beyond Day 3 although none arrested. They left them until day 5 but our embryologist said that nothing moved after Day 3 at which point they were all 12 cells. Although we did not do the test for sperm defrag, we have worked on the basis that there may have been a male factor and obviously there is nothing I can do about my age!! Since that point, my partner has been on the supplementation programme for the defrag problem and I have also been on multiple supplements (including coq10), on top of the regular conception supplements I have been on for years. We have allowed one cycle lapse since then and I have been doing a ‘priming cycle’ this month consisting of Estradiol and Duphaston. I will be starting stimming at the end of this week with a view to an egg collection in week 2 of April. THIS IS OUR ABSOLUTE LAST SHOT – we cannot afford another attempt and I also have severe osteo arthritis in both hips and need to address this problem before much more time is let pass to get back to a good quality of life, as my 6 year old son deserves from me.
Because of my age we are still very keen to go with PGS or more likely NGS to rule out genetic abnormalities. We are also thinking of trying PICSI rather than ICSI in case there is a male factor involved. However, our clinic are pushing hard for us to go with a three day transfer. I have seen so many conflicting opinions and reports about the merits of Day 3 versus Day 5 implantations/pgs. It makes it very difficult for an ‘average Joe’ with no medical knowledge to make such a big decision, that ultimately, only we will have to live with the consequences of. Could you give me your opinion (based on the little knowledge you have on us I know) on which is the better option for us to go for? Day 3 or holding out for Day 5 blasts for NGS, as is our extinct. And on a side note would you support choosing PICSI over ICSI? I appreciate your advice so much and thank you again for being so giving of your time. Ciara
I would go with a blastocyst transfer of PGS-tested normal blastocysts. Embryos that do not make it to blastocyst are virtually invariably incompetent and had they been transferred earlier would not have propagated a viable healthy pregnancy anyway. The most important consideration for you is the selection of the protocol needed for ovarian stimulation because aside from age and ovarian reserve, this is in my opinion the most important consideration.
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those 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 age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can 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 older women and those 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 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, http://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.
Hi Dr Sher, I was looking at your presentation in February about iui in normally ovulating women only allowing the lead follicle to ovulate because of the body’s mechanism . My question is , if there are several follicles say four over 18mm there about (various sizes) and an hcg trigger is given , will this allow all the follicles to ovulate ?
Usually, if the woman ovulates regularly, spontaneously and normally on her olwn, only one egg will ovulate…in my opinion.
Geoff Sher
Dr Sher,
I’m worried because my clinic had me start Estrace the evening of cycle day 3 for my FET (I believe because they forgot to tell me to start cycle day 1 which feel on a weekend), will this have messed up this cycle? My transfer is scheduled for cycle day 20. Thank you.
I doubt it will make a difference!
Good luck!
Geoff Sher
Hi Dr Sher,
I just had my recent blood done on CD1 (4 days after stopping bcp. I was on it for 23 days).
E2 – 12.8 ng/l
fsh – 5.3 iu/L
LH – 6.6 iu/ L
1. Is my e2 too low? Am I over suppressed to start stims?
2. I believe my FSH is great for CD1?
3. I am a little worried about my LH because is a bit high for CD1 (and also higher that my FSH) Should I be worried?
Thank you in advance!
It looks OK. The LH is a little high but the right protocol would take care of it!
Geoff Sher