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.
This question is about my daughter. She is 22, and by all accounts, a virgin. She has never had sex with neither men, nor women, as she identifies as asexual. She desperately wants a baby though and I support her decision. I started helping her chart her BBT, and ovulation in Jan of this year. Her menses has always come regular, around 28 days, and her temperature always went up about 2 days after an LH surge on an OPK test strip. She decided to try insemination this past March, and used 2 vials. Neither took, and her period showed like clockwork, and on time. The problem is, that since then, we have gone back to taking her BBT and charting her, and suddenly she does not seem to be ovulating. Her ovulation usually occurs on cd13 or cd14. Right now she is at cd19, with no usual temperature spike that accompanies ovulation. Plus her OPK sticks have only shown a positive once on cd17, but this time she ALWAYS has a slight second line on the test strip, whereas all her other times, there never were. She’s taken pregnancy tests just to make sure and they are always negative. Why would her ovulation suddenly stall/stop after being so regular her whole life? She had her thyroid checked just a few weeks ago and she was normal and no signs of diabetes either. She takes prenatal vitamins only, no other medication and recently started taking Vitamin C and B6 on top of the prenatals to help with conception. Should we be concerned about this? Have you ever heard of this happening before?
Hi Jen,
I wish I could advise you authoritatively as to the cause of your daughter’s secondary ovulation dysfunction, but that would be impossible without much more information. What I can tell you is that it is not unusual or abnormal for women to experience dysfunctional cycles every now and again and if it becomes protracted, it is usually a functional problem that is not necessarily an indication of underlying pathology. Such cases do well with ovulation induction using relatively benign oral agents such as clomiphene or letrozole.
Give her a month or two. It is possible that the stress related to her situation is throwing off her hypothalamic-pituitary-ovarian cyclicity.
Good luck!
Geoff Sher
Hi Doctor! I had a 5day embryo transfer (donor egg) on 13th April. Day 2 post transfer I experienced some mild cramps left side of lower abdomen all day, and night. Also noticed mild cramps each time I insert the prontogest pessaries. Today (d7 post et) I felt same cramps but this time there was quite some bleeding and my doc said to get progesterone injection immediately to curb the bleeding and also advised to stop inserting pessaries till bleeding stops. Am worried. Could this be the beginning of a miscarriage?? Due for test on 25th this month. Please advice. Going crazy with worry.
PS. This is my first attempt at IVF. Age 37.
It is impossible to say. Only time will tell. However, bleeding that does not increase in ammount and is not associated with progressively increasing pain and cramping is not necessarily ominous.
Hang in there and wait for the beta hCG tests.
Geoff Sher
Hello Dr.Geoffrey ,
We have recently had our 3 failed ivf transfer and our second retrieval.
Our first resulted in two embryos , we did one fresh transfer ( failed) and a second FET and miscarried at 9 weeks. We had our second retrieval in January with very similar results, two embryos which we did a freeze all cycle. We recently did our transfer of our genetically tested normal embryo which resulted in a failed cycle. Our question is if I can carry , both my husband and I have been through all the genetic testing , I’ve had all the test and ultrasounds that state I have a “beautiful” uterus and we are perfectly healthy. We have unexplained infertility and no clear directions. Also, both retrialvs resulted in 13 embryos 10 fertilized and most making it to day 5 but not lasting until day 6 . Our md thought our numbers where odd given the amount that fertilized both times. We are looking for some clarity and direction before we proceed with our last genetically tested embryo. Thank you!
Dr Sher,
Is there any role for empiric heparin or lovenox if RPL work up is negative? I’ve had two FETs result in chemical pregnancies.
Not in my opinion, Deidre!
Geoff Sher
Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the “Conventional” Antagonist Approach
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•IVF: How Many Attempts should be considered before Stopping?
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•IVF Failure and Implantation Dysfunction:
•The Role of 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)
•Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report
•Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
•Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
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
Hi, I had contacted you previously explaining that I have had a failed IVF cycle and have an underactive thyroid. You had mentioned thyroid antibodies. I actually then got tested for these and I have very high levels of thyroid antibodies. I explained this to my private fertility doctor and asked to be put on steroids. He reluctantly said I could get a prescription for this but he doesn’t recommend this as he doesn’t think I need them plus there are risks involved. Surely I do require steroids if I’m struggling to conceive plus I have had a failed IVF cycle? Also, do you know what risks are involved in taking steroids if trying to conceive? Thanks so much again for your help.
All my patients undergoing IVF-ET receive low dose steroids. If you have an autoimmune implantation dysfunction you will also have activated uterine natural killer cells (NKa) which would require intralipid/steroid therapy. Steroids alone would not address the problem. Make sure you have this evaluated by having a K-562 target cell test done to measure NKa.
If you wish to discuss….feel free to call or email Julie Dahan, my patient concierge 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