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.
Dear Dr Sher,
I am 41 years old and in my third round of IVF. I began 400 units of Puregon on cycle day 5, and increased to 450 units on cycle day 7. I have also taken Synarel 2x per day since starting Puregon. My response this cycle was significantly below the previous attempts (in which I typically had 8-10 mature follicles). As of this morning (day 8 of stimulation), I only have 3 follicles (18, 16, 13). I am awaiting news from my doctor but am hoping he will let me have an insemination this round instead of a full IVF.
I know there are many reasons why my response could be low (not the least of which is my age). But I would very much value your opinion as to whether delaying the start of stimulation until the 5th day of my natural cycle might be causing some of what we are seeing. As further context, this basically came about because of a clerical error (as opposed to be something which he intentionally prescribed based on my situation and past experiences).
Kind regards,
Martha
Hi martha,
I feel that the sooner the stimulation is initiated after the beginning of the period, the better. If you wait as lote as day 5 to start, this would mean that selection to follicle dominance might already be underway by that time and in my opinion, this could prejudice orderly follicle growth and development.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•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?
•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
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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.
Geoff Sher
Hi
I am 37 & about to embark on cycle # 5
I have moved clinic and my new doctor has thrown a few new things into mix. For the first time I will be doing an estrogen priming antagonist protocol. This time we are adding in 0.4cc of size not daily during stimms.
I am taking 6mg of estrogen a day for 5/7 days before my period. However, have read lots of interesting data on continuing the estrogen through stimulation. Do you have any thoughts on this.
Really interestingly my dr would like me to have a scan on day 3 of my period to check the size of the follicles. She would like to see them at between 6-8mm (ideally8mm) before I start stimm’ing. If there is more even sizes she thinks I will not need to stimm for 13 days etc. She also says that this should mean that everything grows a little more uniformly as I have in the past had a wide range of sizes of follicles.
I am taken saizen this time. Do you think it depends on the patient as to whether it works or not? Could it be the magic elixir?
Thanks
Clementine.
Hi Clementine,
This frankly is not an approach I am familiar with or have tried…so I really cannot comment….Sorry.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•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?
•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
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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.
Geoff Sher
Hi Dr Sher, what would you estimate the success rate to be with one 8 cell day 3 embryo transferred to a 36 year old? Minimal fragmentation, slightly uneven cells but otherwise looking good. So disappointed that this was all that made it to transfer.
Without knowing much more about your case Beth, I really cannot comment authoritatively.
Geoff Sher
Hello Dr Sher. AFter 11 attempt of IVF all failed. I finally have 2 good girl embryos in storage. one from a cycle in 2006 and one from a cycle this month with your protocol. agonist/antagonist conversion protocol with growth hormones. You have changed my life. I am 41 year old and was ready to give up on ever getting another good embryo. Thank you soo much. Now I further need your advise. I have had 18 colon operations in the past so my body is not so good to me. I did bloodtest and they established that I have killer cells in my uterus as well as not enough good blood cells in my body. I also have endometrios and I had a miss fored uterus. the Uterus has been reshaped and pollyps removed from my lining. however after a 3 month course on lucrin the myoma found in the uterus did not shrink at all so they will have to go in and surgically remove it. Due to previous operations I have plates in my stomach so going in with tubes only is not an option. We will have to operate by cutting open on the original scars. this in turn buys me about 3 month to get my body more healthy and ready for the transfer. What can you suggest I add to my treatment to help the implantation. So far this is what I have in mind: Clexane (not sure when to start with this), Prednisone (not sure when to start), intralipid drips, endo scratching, GCSF, Neupogen wash. Please if there is anything else you can suggest please please can you help me . I believe in you soo much. Everyone at Vitalab knows that it is your protocol that changed my life. I am on a whole list of vitamins also: Vitamin B, B Complex, D3, Folic Acid, Omega 3, Probiotic Xtensiflora 9, Q10, Amino 75 Acids, Iron, Ecotrin, PH Balance Alkaline Powder and even organic toothpaste.
Hi Rene,
Wow, youncertainly have been through a great deal…so sorry! I am pleased that you do have 2 good embryos, but I am wondering, given your history, whether after so many surgeries, failed IVF attempts and a complex immunologicproblem you should not consider using a gestational carrier instead of trying on your own. If you do decide to endure a major surgery, then after recovery ( afewmonths), when you do undergo embryo transfer, you will probably need both IL and steroid therapy. However I am not a believer in the value of the “scratch” approach , GCSF or in there being any benefit from a Neupogen uterine wash.
I do suggest that before undergoing an ET, you and your partner also get tested for alloimmune matching (DQ alpha/HLA genotypic similarities) which could alter the way in which the immune issue is addressed.
Good luck!
Geoff Sher
PH: 702-699-7437.
.
Hi,
we have just done our round 1 of IVF which was unsuccessful.
I am 33 with low AMH and endometrioses which I had surgery to remove Nov 2015. My partner is 39 and has a high sperm count but 97% antibodies present due to a vasectomy reversal.
I was put on an antagonistic cycle with 300mg Gonal F in which I produced 10 eggs, 9 mature, 7 fertilised. 6 were still strong on day 3, but between day 3 and day 5 the following occurred – 2 developed abnormal, 2 slow developing, 2 morula. We transferred the best looking morola, they watched the others til day 7 – 2 arrested and the other morula developed further but not to freezable quality.
The other issue we had was my progesterone was too high at trigger and I was advised to freeze all, however we had nothing to freeze.
Pretty devastated that we had such a great pick up and everything went downhill quickly. What is your opinion on why this has happened? do you think its a quality issue or a chromosomal problem or something else? concerned this is going to happen again next cycle.
Hi Krissy,
ther are several issues. The first is the endometriosis which presents very specific issues (see the reference to my blog below). The second is the protocol used for ovariaq stimulation , in my opinion needs to be revised. The fact that your progesterone level was raised prior to hCG trigger, suggests premature luteinization which in turn suggests that the protocol might not have been optimal.Women with increased LH activity and are thus more likely to produce excessive ovarian testosterone. Sustained, premature elevations in LH or premature luteinization (often referred to as a “premature LH surge”) will prejudice egg development. Such compromised eggs are much more likely to end up being complex aneuploid following the administration of the hCG trigger, leading to fruitless attempts at retrieval and the so called “empty follicle syndrome.”
The importance of individualizing COS protocol selection, precision with regard to the dosage and type of hCG trigger used, and the timing of its administration in such cases cannot be overstated.
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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?
•Why did my IVF Fail
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•Endometriosis and Infertily
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
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.
Geoff Sher
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