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.
Dr Sher,
If I am doing long Lupron cycle with dexamethasone (to suppress any adrenal LH contribution), would you still recommend only adding 75 Menopur at day 4. If my endogenous LH is supposedly completely suppressed should I add 75 of Menopur on day 1?
In the vast majority of cases, I start the 75U Menopur on day 3.
Geoff Sher
Hello Dr. Sheer,
I have a question for you. At 5 weeks, 5 days, my doctor found a subchronic hematoma. Approx. 5 days prior to this ultrasound, I had cramping and light spotting. This baby was a FET.
We did an ultrasound 10 days later, and he said the bleed has gotten worse. We were able to hear a heart beat yesterday, and see it beating. My cramping and spotting is less than previous weeks (which is odd)
He has not put me on bed rest, however has limited my activity (thankfully my job is very stationary).
My question is – at what point do we need to be worried about this bleed? If it does not resolve itself, what is done about it?
Our doctor seems not at all worried – however he is very relaxed in nature.
He stated with a good heart beat like we had there’s a 2% chance of miscarriage at this point.
We scheduled another scan for another 10 days from now.
Thanks so much!
Many of these SCHs will absorb and not be a problem. Just follow the good advice given by your doctor to the letter!
Geoff Sher
I am 40 years old. I have recently undergone 2 rounds of fertility treatment which have been unsuccessful. Only 2 eggs produced across 2 cycles, one fertilised by ICSI but stopped developing day 2 and failed to make it to blast. I’m described as a ‘poor responder’. (menopur long protocol for the first cycle (I think) and Gonal F short protocol for the second, dose 225)
I had an amh level of 12.7 – but im getting no explanation, or hope, at my current clinic for having a successful outcome.
is there any hope for me?
In my opinion, the protocol used for ovarian stimulation, against the backdrop of age, and ovarian reserve are the drivers of egg quality and egg quality is the most important factor affecting embryo “competency”.
Women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which 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 effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, 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 those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, 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, https://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
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.
Geoff Sher
Thanks for sharing the best posts they very nice and very useful to us. I am impressed with your site and your posts they amazing.
http://www.ivfadvanced.com/ivf-procedure/
Thank you kindly!
Geoff Sher
Dear Dr Sher:
I love reading your professional articles, especially on the indication and timing on the use of IVIG during IVF, very precise and informative. I have two questions that I would like to ask.
1. For clomiphene resistance PCOS patients, sometimes fertility doctors would prescribe aromatase inhibitor such as letrozole for ovulation induction instead, but it is my understanding that one of the PCOS’ pathogenesis is hyperandrogenism, so wouldn’t letrozole aggravate the hyperandrogenism conditions?
2. If GnRH antagonist is used to inhibit premature LH surge during IVF, will the use of HMG after starting GnRH antagonist actually increase the risk of premature LH surge? Since HMG contain LH and HCG components.
Thank you so much~
Best regards
Frank
1. For clomiphene resistance PCOS patients, sometimes fertility doctors would prescribe aromatase inhibitor such as letrozole for ovulation induction instead, but it is my understanding that one of the PCOS’ pathogenesis is hyperandrogenism, so wouldn’t letrozole aggravate the hyperandrogenism conditions?
A: It works in many but yes, by increasing LH, it does increase ovarian androgens!
2. If GnRH antagonist is used to inhibit premature LH surge during IVF, will the use of HMG after starting GnRH antagonist actually increase the risk of premature LH surge? Since HMG contain LH and HCG components.
A: Yes but less so than clomiphene and letrozole.
Geoff Sher