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.
We are a young couple (H:
32 years, W: 27 years). We
were trying to conceive
since more than 2 years.
Failed 1 IUI cycle in July
2015. Finally decided to
go for IVF. Our clinic
suggested we should do
hysteroscopy before IVF.
During hysteroscopy, they
found tiny polyps over
anterior wall of the
endometrium of my wife.
The polyp was excised
with scissors and also
lateral metroplasty was
done. Finally in November
2015, we did our 1st IVF
cycle with 3 fresh embryo.
It resulted in failure. We
were left with 3 embryo
(2x grade 1 and 1x grade
2). In February 2016, the
FET was done with THAW
protocol. Also my wife
went through 2 intralipid
infusions before FET
(because doctors wanted
to suppress uterian NK
cells). By God’s grace now
she is ~7 weeks pregnant.
The 14 days post FET
bHCG was 418. Doctors
suggest to continue
intralipid every 15 days till
3 months.
Now my questions:
1) What is your opinion
about the cause of
infertility in 1st place? May
be uterian NK cells?
2) Considering the
presence of uterian polyp
(now removed), will it have
any effect on healthy
growth of the baby?
3. Upto what time do we need to continue intralipid infusion? Currently we are into 7th week & doing intralipid infusion every 15 days.
1) What is your opinion about the cause of
infertility in 1st place? May
be uterian NK cells?
A: Without proof of such it is hard to say…but certainly possible and perhaps even likely!
2) Considering the
presence of uterian polyp
(now removed), will it have
any effect on healthy
growth of the baby?
A: Not at all!
3. Up to what time do we need to continue intralipid infusion? Currently we are into 7th week & doing intralipid infusion every 15 days.
Without knowing whether you ideed have NK cell activation and if so, what the cause is (autoimmmune or alloimmune, I cannot say with any degree of authority.
Good luck!
Geoff Sher
Hi Dr Sher
I had a 5 day hatching blastocyst transferred on 22 Feb. I’ve had four BETA tests done. 79, 281.5, 340 and 401. First test done on 2 March, last done 15 March. I know this doesn’t look good. The clinic aren’t giving me any specifics and asked me to go back for another BETA in a week.
This is quite tortuous. I have pregnancy symptoms and have had no spotting/bleeding.
Is there some percentages/statistics on outcomes of pregnant when they start like this.
I’ve had one other cycle before this and my fist BETA test was under 5, so not pregnant. I’m 42.
Thank you
I agree this does not look good…but miracles can and do happen. I would repeat the beta in a week and if >1000U, I would do an Ultrasound. It is important that your RE be on the lookout for an ectpic (tubal) pregnancy here.
Good luck and G-d bless!
Geoff Sher
Dr Sher
My wife and I after several unsuccessful rounds of ivf are now using an egg and sperm donor to start our family. Both have great track records and are young egg donor 23 and sperm donor 28. Both have all confirmed pregnancies. My wife 43yrs has undergone extensive testing and has passed all of them. We are also going to get the eggs pgs tested as well. My question is that the clinic we are dealing with is offering a success gurantee plan so if we don’t get a baby after all of the embryos have been transferred we get the ivf part of the money back. We are also most likely going to transfer 2 x embryos. My questions given all of the above information do you think it is worth while spending the extra $6,000 to do this. I think the odds are really stacked in our favour if anything but would love your take on this matter. Regards Glen
Sounds like an attractive and creative plan to me. It all depends on the bottom line…i.e. How much overall would it cost you if you get a baby and how much would it compute to if you do not!
Good luck!
Geoff Sher
Hello DrGeoff
Im currently miscarrying my ivf bby,I had a Fet D5post fertilisation embroy,a good embroy,i think it wast 3/4AA It was already hartching out of the cell.When i was supposed to be 8wks on ultrasound,the baby was measuring 6wks2d and was not growing well&no heartbeat,What could be there problem here?I was on Estrogen 2tds and progesterone pessary 2tabs tds,i was on Gestone shots for a week before i started the pessary.I dnt knw what caused the M/C,my heart is very sore,im devastated.Plz help,what can we do next time to improve,as i have 2embroys in 1straw left to transfere
Thanx in advance
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).
My answer to patients who ask me when is the time to stop undergoing IVF is ….Aside from the weight of the financial burden, the time to stop is when in spite of thorough and comprehensive evaluation, there is no remediable and treatable explanation for repeated failure.
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
•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?
•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)
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to 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,
I was diagnosed with PCOS in my early twenties. While I was diagnosed early on, I didn’t create any action or lifestyle changes as a result. It wasn’t until I started trying to conceive, did having PCOS become a disadvantage. Sure, there were times when my cycles were averaging 40days or so and I would have to use prometrium to actually have a period but my weight was within normal ranges. I looked fine. I felt ok.
Fast forward to today where I am nearing 39 and trying to conceive. I’ve had 6 failed IVFs. While I have an abundance of follicles retrieving 20 or more eggs at a time, my embryos are chromosomally abnormal.
My A1c test came back 5.1 (normal), my fasting glucose level is 104 and my fasting insulin level is 5.7. I’m currently waiting to get the results of my testosterone level.
My question to you – do you see a problem with my current levels listed above? If so, what would you advise? Medication?
What could I be doing differently to create genetically normal embryos?
What medication protocol would you suggest?
Your expertise in the matter is greatly appreciated,
TW
Additional info:
I have created PGD normal embryos however they failed to implant. I’ve completed two Fresh transfers. These embryos were created with doing a mini IVF. My most recent IVF yielded 21 eggs, 19 fertilized, 7 became day 5 embryos. 2 were considered “high quality and perfect” while 2 were rated as good and were reputed as ok and 1 being terrible. This was of course under observation. PGD revealed 6 embryos were abnormal in variously different ways. 1 embryo was a “no call”. This embryo was one of the grade 3 embryos. At this clinic grade 4 is best and 1 is worst.
Tziporah,
Aside from age, the most important determinant of egg/embryo quality is the ovarian environment created by the protocol used for stimulation. This needs to be carefully individualized and strategically implemented. The latter becomes ever more difficult in women with either high ovarian reserve (e.g. PCOS women) and those with diminished ovarian reserve (DOR). AT 39, and with PCOS, you have to deal with the effect of age on egg quality as well as the effects of PCOS on ovarian endocrinology and egg/embryo quality.
In my opinion, you need a modified, long pituitary down-regulation protocol. with human growth hormone (HGH) augmentation and would recommend Staggered IVF with PGS (next generation gene sequencing)-normal blastocysts, to select the best possible “competent” embryos for transfer.
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
•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.
•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?
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•Secondary Infertility: Addressing the Root Causes
•Traveling for IVF from Out of State/Country–
•A personalized, stepwise approach to IVF
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
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