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, If your sperm analysis is below par and you do ICSI, are the success rates of doing ICSI the same as having normal sperm? My partner’s progressively motility is only between 10% to 20%. His morphology is 4% (which is normal). He also has high sperm volume of between 5-9ml. It is usually over 5.5ml.
No Sheena! In my opinion, ICSI will significantly improve results but will not bring them to the same level as when there is no male factor.
Male infertility is reported as a factor in 30-50% of infertility cases. In fact, many fertility specialists will recommend a semen analysis as one of the very first tests that should be done. It is relatively simple, inexpensive and yields much information.
The two main causes of male factor infertility can be divided into either problems in manufacturing sperm or problems in getting sperm outside of the body (ejaculation of viable sperm). Sperm manufacturing problems can arise from problems in the testicle itself or from signaling problems from the brain to the testicle. Problems in ejaculation of sperm can arise from obstructions such as previous vasectomies to spinal cord injuries resulting in damage of nerves that innervate the testicle and male reproductive tract.
The initial work up for sperm problems should include a comprehensive semen analysis which will evaluate the semen against fertility standards. These include the volume of the ejaculate (2-6mL), concentration of sperm (>20M/mL), motility (>50%) and morphology (Strict >14%). The semen analysis will frequently drive the remainder of the male evaluation if warranted. For example, in severe male factor cases, where concentration is extremely low, a hormonal and genetic evaluation of the male partner including an FSH, LH, total testosterone level, TSH and prolactin might be indicated. These tests will assist in determining if the problem lies in the proper signaling of the testicle from the brain in order to manufacture sperm.
A further evaluation including a blood karyotype will further assist in determining if there is a genetic abnormality in the male causing lack of sperm manufacturing. Once these things are ruled out, then issues of obstruction must be considered. This will usually involve a urologist who specializes in male infertility. After a thorough history and physical exam of the male partner, a urologist might perform an ultrasound of the testicle, a dye test (vasogram) of the male reproductive tract, and possibly a biopsy of the testicle. There are all rather minor procedures that require very little down time.
Treatment of male factor infertility can range from intrauterine inseminations to in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). In severe cases, it might be necessary to biopsy the testicle, a procedure called “testicular sperm extraction” (TESE). The biopsied sperm cells can then be used to inject into the eggs for hopeful fertilization. This procedure can diagnose as well as treat severe male factor cases.
Some cases of male factor infertility are beyond using the male partner’s sperm, and in these cases, there is still hope by using donor sperm. The use of donor sperm is safe and effective.
ANNOUNCEMENTS:
1.About my Retirement by mid-2018:
After > 30 years in the field of Assisted Reproduction (AR), the time is approaching for my retirement. 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.
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.
Geoffrey Sher MD
Dr. Sher,
After undergoing an ERA (endometrial receptivity test), the results say that I am 24 pre-recptive so badically I need 1 more more day of progesterone before transfer of my pgs normal embryo. The ERA testing group, however, recommends retesting as they only have 80-90% confidence in their findings. I am struggling between the decision to transfer now or undergo another cycle of ERA testing to confirm/ improve the confidence level on their results. What are your thoughts on the ERA test, retesting and specifically our dilema? Should we retest, or is that overkill?
We have 3 pgs normal eggs remaining and we already failed to achieve pregnancy on 1 pgs normal. We are Not able to complete any more IVF cycles.
Thank you,
Paulina
Respectfully Paulina, I do not believe in the validity of ERA testing and thus cannot provide constructive advice in this regard. I do not recommend ERA to my patients.
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
•Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
•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
ANNOUNCEMENTS:
1.About my Retirement by mid-2018:
After > 30 years in the field of Assisted Reproduction (AR), the time is approaching for my retirement. 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.
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.
Geoffrey Sher MD
How long does IVIG stay active in your system to prevent implantation failure? I had IVIG 5 days before transfer, and today is 1 week post transfer, so 12 days ago. Would IVIG be lowering Those immune cells still working now?
In my opinion, IVIG or Intralipid should be infused at least 7 days prior vto ET and preferably 10-14 days prior. It’s effect should last at least 1 month.
Geoff Sher
At 19, I had an ovary and a half removed due to a cancerous tumor. I was able to get pregnant last year but had a miscarriage at 9 weeks. I’m 31. Altogether including miscarriage, we’ve been trying for two years. Does this make me a candidate for IVF or not because I got pregnant before? Should I consider freezing eggs (in case I’m running out and want to have multiple kids– I’m sorry, I don’t know how this works 🙂 ) Is it possible I run out? I’m setting up a consultation with you in your office soon! I just thought I would say HI and ask these preliminary questions. Thanks!
You need to have your ovarian reserve tested (Day 3 FSH/LH/E2 and AMH) and if there is diminished ovarian reserve, egg freezing over several cycles should be considered or alternatively IVF ASAP.
Good luck!
Geoff Sher
I am undergoing Ivf treatment and am an egg donor recipient. I took gonapeptyl injection on my day 21 of periods and apparently I was supposed to bleed after day. 14 days again and start taking estro-pause tablets but I haven’t had my periods still and it’s now day 19 since I had the gonapeptyl injection. No bleeding yet should I worry and what is the process now going to be. Will I still be able to have my donor eggs transferred? transfer
You need to see your RE for an ultrasound examination and a blood estradiol measurement to exclude an ovarian cyst that might have been induced by the agonist.
Geoff Sher