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, we finally have good IVF news! I posted about a year ago (that twin pregnancy did fail early at about 4wks) but this last round, we had only one fresh cycle embryo to transfer (a day 5 donor embryo) but it was an early blast (which we were worried about personally). But the embryologist thought it looked pretty good and recommended we go forward. We did and first hCG was 31 but after the forty-eight hour retest, it was 95! We are thrilled. We now have to wait until the 7wk ultrasound–but we’re feeling optimistic for sure!!! Thoughts??
Looking good! Congratulations!!
Good luck!
Geoff Sher
I have pcos and have had 2 IVF miscarriages. I have done an over stimulated egg retrieval. I transferred day 5 embryos. Is it possible that my embryos are not competent?
Also, in your opinion do you have your patients do intralipids or ivig when they do IVF transfers?
IL/steroid administration is done selectively in women who have activated uterine NK cells.
Let me start by saying that there is no doubt that PCOS exacts a toll on egg quality. This having been said, the egg quality can in large part protected through the judicious implementation of an individualized protocol for ovarian stimulation.
Women with PCOS are hypersensitive to gonadotropin stimulation and are often at risk of developing serious complications associated with severe ovarian hyperstimulation syndrome (OHSS). Concern for this occurring often leads the treating physician to take precautionary measures aimed at slowing down or stopping hyperstimulation. Such measures include:
1.Cutting the stimulation short to prevent the E2 from rising too high. Unfortunately this often results in the eggs being underdeveloped at the time of the “trigger” and thus, far more likely to end up being “immature”., “dysmature” and “incompetent”.
2.Administering a lower “trigger dosage” of hCG , supplanting it (partially or completely) with an Agonist trigger (e.g. Lupron/Buserelin/aminopeptidyl/Superfact). While such measures can certainly reduce the risk/severity of OHSS, it often comes at the expense of egg competency (see below).
In my opinion, another error of commission during ovarian stimulation of women with PCOS is the indiscriminate use of drugs that either elicit an exaggerated ovarian LH-induced testosterone response (e.g. clomiphene or Letrozole), or provide too much LH (e.g. Menopur/Menogon). Too much ovarian testosterone is harmful to egg development and thus prejudicial to embryo quality/competency.
In my opinion the best way to approach ovarian stimulation for IVF in women with PCOS, is through the use of a low dosage, FSH-dominant Long ovarian down-regulation protocol, done in readiness for “prolonged coasting” (see below) and “triggering” egg maturation with a full 10,00U dosage of hCG or (no less than) 500mcg of recombinant hCG (Ovidrel)….see belowis If this is implemented appropriately, with proper timing, egg/embryo quality can be optimized.
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.
•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
•Taking A Fresh Look at Ovarian Hyperstimulation Syndrome (OHSS), its Presentation, Prevention and Management
•Preventing Severe Ovarian Hyperstimulation Syndrome (OHSS) with “Prolonged Coasting”
•Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols.
•“Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
•The “Lupron Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
ANNOUNCEMENTS:
1.About my Retirement
After > 30 years in the field of Assisted Reproduction (AR), the time has finally come for me to contemplate retiring from full-time clinical medicine. 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
Currently, I’m three month pregnant after conceiving using a 5 day FET. I have been taking metformin twice daily, estrace 3 times daily, and one crinone applicator daily.
Saw our doctor yesterday and he is recommending I start to ween off my estrace – however remain on all other medications.
Is it safe to stop the estrace? Do you typically have your patients continue it?
Since I only do FET’s in hormone replacement cycles, I prescribe estrogen till the 10th week of pregnancy.
Geoff Sher
Hi Dr.Sher,
In preparation for my FET, my RE had me to take a trigger short (HCG) tomorrow (Wed) before 10 pm and scheduled my FET next Tue at 10 am (6 days after). My frozen embryo is a 5-day blast. Do you think it might be a bit too early for transfer? Shouldn’t it be on Wed (7 days after) instead? Is there a window of time for transfer after trigger shot? Thanks in advance, Dr.Sher!
I really do not know, because I do not do FET’s in hormone stimulated cycles.
Geoff Sher
Hi Dr Sher!
Do you supplement estrogen even for Fresh IVF transfer? Or do you only do so for FET? My e2 was quiet good throughout stims (2400 ng/ml on day 10 of stims, triggered on day 12). I am on 2m per day of estradiol tablet. Is that sufficient in your opinon?
Not in the injectable form, except for embryo recipoient cycles where we do supplement estradiol valerate. But we add vaginal E &P suppositories post ET in all cases.
Geoff Sher