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.
Hello Dr. Sher, I am 36 yrs old and undergoing IVF treatment. My ET (2 blastocysts) was done on May 20. I got a positive beta with 272 HCG; the second test showed my HCG as 324; the third test, 48 hours later was 679 which was a sigh of relief. I have been asked to do an early pregnancy scan on 6/15. I do not have any pelvic pain or bleeding; just had occasional (twice) abdominal pain on the left side. Should I be worried doctor? Is there any chance of ectopic pregnancy without any symptoms?
This could be an ectopic and it needs to be closely assessed.
Good luck!
Geoff Sher
Hi Dr Sher, I am from Melbourne Australia and am about to start my 4th IVF cycle with Monash IVF. I am not sure I am on the best protocol to ensure the best result for stimulation. My FS is using an FSH protocol, so testosterone patches for 10 days prior to day 1 then 450 of Bemfola on day 2 and AM orgalutran injections from day 5. I only seem to get about 5 to 6 follicles max and last EC they couldn’t get to my left lead ovary so only collected 2 eggs. I had a good quality embryo transferred on day 3, as my FS felt it was best to transfer then due to my older eggs and wanted to reduce any stress on the embryo. I didn’t not get pregnant. I am very keen to get your opinion on a the best protocol for maximising my follicle numbers and egg collection outcome a the age of 40.
I really do appreciate your advise here and we will even look at travelling to see you if that is what it will take.
Kind Regards,
Verity
Hi Verity,
Based upon your response, it sounds as if you have diminished ovarian reserve. I really think we should talk and I encourage you to call and set up Skype consultation with me….see below.
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”.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
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.
•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 Aproach
•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)
•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?
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
ANNOUNCEMENTS
1.About my Retirement:
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 ear. 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
I am newly pregnant after a FET- 2 good strong betas so far, 48 hours apart. I had IVIG 5 days before my transfer. And was taking steroids. Do I need another dose of IVIG after a positive pregnancy test, or can I do intralipids instead? My doc seems on the fence. Obviously prefer not to go to the trouble of IVIG if not necessary. Also, how long to stay on steroids? What factors do you consider? Thx
Also, for history, I have 2 kids from 2 successful FET with no immune treatments. Have had a number of chemical pregnancies where beta started low and didnt double. No miscarriages (other than chemical pregnancies). Bloodwork is normal except TNF alpha (NKs normal, etc.). TNF alpha has been high, which was why we did IVIG and prednisone before transfer (and prednisone continuing until TBD).
I really do not know for certain, but in my opinion it would probably be fine to switch to IL.
Good luck!
Geoff Sher
Dr Sher,
I am doing an donor egg cycle but not a medicated one. We are doing natural, using my natural hormones. My RE wants me to use 400 mg of progesterone pessaries a day but on previous transfer she had me on 800 mg. She says as I will be producing progesterone on my own I don’t need a high dose. What is your recommended dose for natural cycles? Thanks,
Even 400mg is a robust dosage.
Geoff Sher
Dear Dr Sher
My protocol says to inject Gonapeptyl one week before my period. I just injected and period had suddenly arrived (one week early). Can I still do embryo transfer or is my cycle now not ideal anymore? (I am normally super regular with 29 days but this time after22 days). And will day one count to start my medication?
This is really something you really need to discuss with your RE.
Geoff Sher