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, I had a Fet in march which failed. I had a period after that. But this was my 1st natural cycle after the medicated FET and I have been chatting my BBTand everything looked ok. I ovulated 4 days late so I was expecting my period late. Today is when my period was due but instead of full flow I had very light spotting. I have also been spotting brown blood the past 5 days (one a day) but today I started spotting red blood. I’m not sure what is going on. I can’t get an appointment to see my doctor for a week, and I’m already worrying why my period is not full flow.
Hi Anita,
The amount that you bleed should not over-concern you. It is highly unlikely that anything serious is happening.
Geoff Sher
Hi Dr Sher
Hope you are in good health.
I recently had ET and my outcome was sadly negative. I had a 1 grade 1 8 cell embie transferred on day 3. The clinic advised starting on progesterone 2 days after EC. I have had previous bleeds before OTD and the clinic advised only 400mg of cyclogest at night. I had some pio from a previous cycle and started on this. 60mg daily, increasing this to 120mg around day6/7. Around implantation i had a red/dry rash around my mouth appear. This settled down after 2/3 days but then pigmented under my mouth. I still have it now. My concern is that I have an immune issue and would benefit from a dose of prednisolone on next cycle?? Also i got a negative on OTD and got my period that same day. I had some brown spotting on day 13/14dpt. Does having immune issues hinder progesterone absorption? I also had the same skin issue in 2012 with my fresh transfer. I had a successful FET in 2011. Does pregnancy cause immune isdues to show themselves? I am 36 with PCOS.
Thank you for any advice.
Gulnax
Hi Naz,
Thanks for posting but I would need a great deal more information to be able to comment authoritatively. I can tell you that nothing you report here suggests an underlying immune issue. I suggest that you call 800-780-7437 and set up a Skype consultation with me to discuss.
Geoff Sher
Hi Dr Sher,
This might be such a silly question,
I want to know do Winter/Summer affect the Treatment outcome make you react better/worse to the medication…the reason why Im asking is alot of stories on the internet suggest that its better ti do treatment in spring….my previous cycle was over summer….didnt work…so I do not believe that all can be true, that the season of the year can make such a big difference????
In my opinion, this ios a myth without foundation. The season in which treatment is undertaken has nothing whatsoever to do with outcome.
Geoff Sher
I recently an unsuccessful egg retrieval. No eggs! I triggered with Lupron due to high OHSS risk (I am under 30, very petite, and I have PCOS). One injection 36 hours prior to retrieval and one 24 hours prior to scheduled retrieval. My eggs were not mature and did not detach from the follicle wall. The doctor considered having me do an hCG trigger and returning in 36 hours for a 2nd retrieval attempt; however, ultimately the cycle was cancelled as I already had mild OHSS with fluid seen in my abdominal cavity. What went wrong? What should I do next?
For this cycle I did 150 units of Follistim for 10 days, then down to 100 for a day, then 75 for 2 days. All FSH injections coupled with low dose hCG. Cetrotide starting day 8.
Thank you
Frequently, when following vigorous and often repeated flushing of follicles at egg retrieval they fail to yield eggs, it is ascribed to “Empty Follicle Syndrome.” This is a gross misnomer, because all follicles contain eggs. So why were no eggs retrieved from the follicles? Most likely it was because they would/could not yield the eggs they harbored.
This situation is most commonly seen in older women, women who have severely diminished ovarian reserve, and in women with polycystic ovarian syndrome (PCOS). In my opinion it is often preventable when an optimal, individualized and strategic protocol for controlled ovarian stimulation (COS) is employed and the correct timing and dosage is applied to the “hCG trigger shot.”
Normally, following optimal ovarian stimulation, the hCG “trigger shot” is given for the purpose of it triggering meiosis (reproductive division) that is intended to halve the number of chromosomes from 46 to 23 within 32-36 hours. The hCG trigger also enables the egg to signal the “cumulus cells” that bind it firmly to the inner wall of the follicle (through enzymatic activity), to loosen or disperse, so that the egg can detach and readily be captured at egg retrieval (ER).
Ordinarily, normal eggs (and even those with only one or two chromosomal irregularities) will readily detach and be captured with the very first attempt to empty a follicle. Eggs that have several chromosomal numerical abnormalities (i.e., are “complex aneuploid”) are often unable to facilitate this process. This explains why when the egg is complex aneuploid, its follicle will not yield an egg…and why, when it requires repeated flushing of a follicle to harvest an egg, it is highly suggestive of it being aneuploid and thus “incompetent” (i.e., incapable of subsequently propagating a normal embryo).
Older women, women with diminished ovarian reserve, and those with polycystic ovarian syndrome, tend to have more biologically active LH in circulation. LH causes production of male hormone (androgens, predominantly testosterone), by ovarian connective tissue (stroma/theca). A little testosterone is needed for optimal follicle development and for FSH-induced ovogenesis (egg development). Too much LH activity compromises the latter, and eggs so affected are far more likely to be aneuploid following meiosis.
Women with the above conditions have increased LH activity and are thus more likely to produce excessive ovarian testosterone. It follows that 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.”
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.
•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?
•Taking A Fresh Look at Ovarian Hyperstimulation Syndrome (OHSS), its Presentation, Prevention and Management
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•“Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
•My Retirement in the Year Ahead: A letter of Thanks From me to You!
ANNOUNCEMENTS:
1.About my Retirement by mid-2018:
After > 30 years in the field of Assisted Reproduction (AR), the time has finally come for me to plan on retiring from full-time clinical medicine within a year. If you are interested in my medical services prior to my retirement, I urge you to contact my concierge, Julie Dahan ASAP to set up a Skype or an in-person consultation with me. You can also contact Julie by phone or via email at 702-533-2691/ Julied@sherivf.com. You can also apply online at http://www.SherIVF.com.
2.The 4th edition of my newest book ,
“In Vitro Fertilization, the ART of Making Babies” is now available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
I’m 41, and I had my only child through IVF a few years ago. After our son was one, we did IVF another three times all resulting in chemical or PUL. My lining isn’t too thick (6.5mm) and I’m sure my eggs are old. We can’t afford IVF anymore. What are my odds if we were to continue fertility by doing IUI since that’s covered more with insurance? Worth it or no? Thanks for your opinion.
At v41y of age and a lining of <8mm...the chances are not good! Discuss with your RE.
Sorry!
Geoff Sher