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 Doctor,
My wife had two embryos transfer on 21st March and had blood test on March 30th. The HCG level was 42 on March 30th and today (April 1st) in her bloog test HCG level dropped and is 38. Can you please let me know if there are still hopes of pregnancy?
Sadly it would seem that pregnancy is failing.
Geoff Sher
Hello again. What specifically seems to be wrong with my protocol and how would you suggest revising it?
Dr. Sher,
I transferred a genetically normal 5 day embryo. First beta 10 days post transfer was 210, however 2nd beta 2 days later was 377- should I be concerned? Plan is to recheck beta again in 2 days. Thank yoi!
I would repeat the beta in 2 days to see if it picks up appropriately.
Geoff Sher
Dr. Sher,
I recently transferred a genetically normal 5 day embryo (fet). First beta at 10dpt was 210. 2nd beta 12 dpt was 377. I Am repeating beta in 2 days but should I be concerned? Thank you!
Hi Dr. Sher,
I always have really good AFC usually about 20 follicles. After my fibroid retrieval Jan 2017 I had 33. After 3 days of stimming I showed 28 were growing. My estrogen stays rather low for the amount of follicles. I did min stim of 200 gonal f for the first 7 days and then adding 75 menopur and reducing my gonal to 125, 25 units of omnitrope and ganirelex. The last day of my cycle I did 150 menopur, ganirelex and 25 units of omnitrope. My estrodial 2 level was 671 the day after trigger. I do a double trigger of hcg (5,000) and Lupron (100).
I retrieved 14 eggs which is rather low for me. The size of my largest follicle was 16. I mature eggs are mature from a 13 size follicle. Can the low estrogen affect quality of eggs? And is it advised to take some estrogen pills to up the estrogen to help quality. I am 44 have 1 normal and am searching for my 2nd normal.
Thank you for time.
Respectfully, I truly believe that your protocol should be carefully reviewed and probably significantly revised. This response is disappointing. having said this , you must be aware that age impacts egg and embryo quality and thus it is important for you to be proactive.
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. Much of this is due to the fact that in such women , LH biological activity is increased and this 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 should be limited.
I try to avoid using such protocols/regimes (especially) in older women 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, 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.
Would you recommend rhogam shot for miscarriage at 4 weeks in which hcg didn’t rise above 50-55… rh negative blood.
Hi Dr Sher, you advised below to speak to my RE about residual discomfort from my egg retrieval complication that happened 6 months ago. So I went to have a scan. The scan showed the blood has all gone. The doctor said he could not see anything and did not provide much info other than to wait. I have never had any discomfort during intercourse in all my life. It did get better since 7 Mar (when I first had intercourse after the ER) but there is still a bit of discomfort now. How can I find out more information … what is your opinion and what do you think I should do. As I am scared since it has been so long.
I do not know your case but perhaps you have endometriosis. See your OB/GYN and possibly have a diagnostic laparoscopy.
Good luck!
Geoff Sher