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 would love to hear your opinion about our chances based on the results below… it’s our 5th transfer and first time we made it this far… We transferred one 6-day blastocyst 3BC and one 5-day bastocyst 1BB
6dpt:
B-HCG 3.5
E2 1779
PGR 35,85
8dpt:
B-HCG – 19.2
9dpt:
B-HCG – 28.8
E2 – 2882
PGR – 20.20
10dpt:
B-HCG – 44.1
E2 – 3007
PGR – 19.80
12dpt:
BHCG – 139
Estradiol – 973
Progesterone – 10.6
14dpt:
BHCG – 317
Estradiol – 3576
Progesterone – 27.9
16dpt:
BHCG – 580
Estradiol – 2620
Progesterone -26.7
1. Beta slowed down today (16dpt) is it a reason for concern?
2. What is your opinion on levels of Estradiol and Progesteron? (I am taking a lot! of medications)
3. Is there anything I can do to help this process e.g. no physical activity/bad rest or mild activity, maybe acupuncture? What can i do? I try to stay positive but it is not easy!
Thank you,
Zuza
It i difficult to say. Certainly implantation is taking place but the erratic rise in hCG might point to an abnormal implantation in the uterus or a tube (Ectopic).
You need to do man US examination in about 1 week to determine.
Good luck!
Geoff Sher
Hi Dr Sher. I am 37 years old, recent POI diagnosis with 0.04 AMH and fluctuating high/low FSH and just had a failed first mini IVF. At beginning of cycle FSH 13, and I was started on 2.5 weeks of BCPs then Clomid for 5 days. I only had one growing follicle and did not do injectables due to FSH 44 and E2 61. I was then prescribed Estrace 2mg bid and stopped when follicle was 17.5×19.5mm, in which time we triggered with 4mg Lupron SQ and 5000 Pregnyl SQ. They easily retrieved one egg and we were happy. Initial feedback from RE said egg looks “expanded and mature”. Several hours later, I get a call from nurse saying egg retrieval report was GV immature and that it was discarded. When I spoke to doctor several hours later, he reported that egg was EZ Empty Zona per embryologist and that we should try again. Egg retrieval report still shows GV but nurse explained it was coded incorrectly which I believe was unacceptable. What is empty zona and has this scenario happened in your experience? Should I attempt IVF again and what do you think would help increase chance to have successful IVF? Appreciate your expert opinion.
dear dr sher,
i have gone through several egg retrievals and transfers without issues. the last retrieval i did, when i came back home i felt blood moving down me. when i looked there was blood all over my thighs and a clump on my clothes but it subsided gradually and there was light bleeding before transfer. after the 2ww and now about 10 days after my BFN. i have a slight dull pain sort of like a dull pull about two inches below my belly button and towards left side abdomen. since my left ovary is removed, i am wondering what could cause this pain? could an injury have happened during egg retrieval of right ovary where a nerve was pulled or something was bruised or injured?
Hi Kelly,
It is not common, but trauma to adjacent structures can occur with ER. I suggest you see your doctor again and have this evaluated. An US examination might be revealing.
Good luck!
Geoff Sher
Hi dr Sher is it recomended to continue Chinese herbs once your taking the ivf medication?
i was doing acup[uncture and took chinese herbal teas twice a day during my ivf cycle.. and it procued one folicle with no eg inside.. 8 months prior to acupunture and herbs i had 4 eggs twice, with two embryos but uncessexful transfers.
Thanks, nini
You can continue in my opinion. It should not do significant harm.
Geoff Sher
Thank you for answering questions Doctor. I am about to start my first IVF cycle. I do not have any fertility programs but need IVF for PGD because we are carriers for SMA. My doctor is planning to put me on 1 mg of lupron starting cycle day 21. I am 31. My AMH is 4.91. FSH is 7. Antral follicle count was over 25 (doctor stopped counting). Does the lupron dosage seem too high to you? I am afraid of being over suppressed because I read the dose is normally only 5-10 units and 1 mg would be 20 units.
Thank you! You are most welcome.
My advice is that you use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger.An FSH-dominant gonadotropin such as Follistim or Gonal-f 250U daily is started with the period for 2 days and then the dosage is reduced to 150U FSH and a small amount of Menopur (no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later.
I personally would advise against using Lupron in “flare protocol” arrangement where the Lupron starts with the onset of gonadotropin administration.
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.
•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
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
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.