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 Dr Sher,
I am currently around 5 weeks (naturally) and have had several beta HCGs. They are rising but slowly.
May 18: 34
May 20: 77
May 22: 157
May 24: 212
May 26: 296
May 28: 484
My clinic wants to repeat beta again in 2d.
What do you think is going on? How worried about an ectopic should I be? Any chance this is viable?
Thanks!
This does not seem to be increasing at a normal rate, unfortunately. However, only time will tell whether the prgnancy will be lost or continue.As far as the risk of an ectopic is concerned, it is probably too early to tell.
Good luck!
Geoff Sher
If you have a patient on Lovenox during FET for blood clotting issues and or immunomodulatory effects, do you have them abstain on the day of the ET itself? I am taking Lovenox for mild factor 2 issue and MTHFR and borderline anti phospholipid. also taking baby aspirin. my immunologist didnt say anything about not taking day of ET, but the RE office transfer instructions say no aspirin day of transfer. Do you have patients skip that day?
Not necessarily…. because heparin (Lovenox) does NOT increase the bleeding tendecy and thus when the ET is done it will not increase the risk of concealed intrauterine bleeding which if it occurs can prejudice implantation.
Geoff Sher
Hi Dr S! I’m asking for a facebook friend. She is supposed to start a MDL cycle today (she’s 35, no infertility history. She’s donating for her sister). She was on 13 days of nordette (from CD6). She stopped bcps on `Thursday (3 days ago) and went in for her baseline check today, 3 days after bcps. AFTER the blood draw (before getting the blood test result), she took her first dose of microdose lupron 40ug(ultrasound gave all clear). Her results came 8 hours later are as follows:
e2: 12 ng/ml
fsh: 3.9 u/l
lh: 7.8 u/l
1. She doesnt have PCOS so we are a bit confused about 2:1 ratio o fsh/lh. her previous tests on CD3 always comes out more or less 1:1. Could this discrepancy be caused because the test was done before bleeding started? or because the cycle was dramatically shortened by the short course of bcp?
2. Her RE is no contemplating switching her to antagonist instead of continuing on MDL cos he’s worried about the fsh/lh ratio and that the flare might raise lh too much.
Can this be done even though she already took a dose this morning?
Is it better to just continue with thr mdl tonight, or wait for period, start stims and start antagonist on cd 6 or thereabouts?
Your advise her is greatly craved!
While the MDL protocol does have a place in IVF simulations and can result in pregnancies, I do not use it on my patients at all. I am against it because it routinely results in increased LH production and thus in ovarian testosterone which if in excess, can and does compromise egg-embryo competency. I am particularly against MDL being used in older women, those with DOR and women with PCOs, all of who already often have increases biological LH activity. It is in such cases that a further rise in LH activity brought about by an MDL protocol further increases ovarian testosterone to the detriment of egg competency.In addition, the MDL protocol if used should in my opinion not be launched coming off a BCP which suppresses FSH and thus compromises antral follicle development (see article on use of the BCP, below).
Your questions:
1. She doesnt have PCOS so we are a bit confused about 2:1 ratio o fsh/lh. her previous tests on CD3 always comes out more or less 1:1. Could this discrepancy be caused because the test was done before bleeding started? or because the cycle was dramatically shortened by the short course of bcp?
A: Possibly so
2. Her RE is not contemplating switching her to antagonist instead of continuing on MDL cos he’s worried about the fsh/lh ratio and that the flare might raise lh too much.
A: see above
My advice is to 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, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (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 commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://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.
Hello!
We have 3 PGS normal embryos
5AA- normal mitograde
6AA- elevated mitograde
6BC-normal mitograde
What are the chances that all 3 implant? I read that high mitograde (even though it’s a perfect 6AA) ) has a 10% of implanting where the other 2 have a 65% chance. Even though 6BC is not the best quality.
We can only afford one transfer and I feel like one might implant maybe two but not three.
I have no belief in the mitograde. However, I would transfer the 5AA.
Good luck!
Geoff Sher
I was raped on a dailey basis from 6->10ish yrs old. And then a few more times at 16. Puberty started (arm pit hair growth) when I was 10 & was over all in the norm basically except I did change sooner than the rest of my classmates. I started my period when I was 13 & have them at the beginning of every month. I did bleed from my vagina, caused by the trauma, on a few occasions before I actually had my period though. At 16, I thought I was pregnant because, after intercourse (which took place at the start of the month) I did not have my period for the following 4 months. I took a pregnancy test the 4th month & it was negative. My periods resumed after that. Knowing all of this, what damage was done to my vagina/reproductive system? Are you worried about any issues that might be there?
This is horrific. I cannot even imagine the amount of emotional trauma. My heart goes out to you.
I do not think the physical trauma explains your periods being absent and clearly you are not pregnant . however, the emotional impact of what you have endured could easily disrupt your hormonal cycliciy leading to irregularity of your periods. Notwithstanding you do need a comprehensive medical assessment and I hope you are receiving the therapy you need.
G-d bless!
Geoff Sher