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, A Facebook member is asking— when the lab freezes embryos : Do they freeze them separately or freeze them in a batch? thanks lynn
In my opinion they should ideally be frozen separately.
Geoff Sher
Hello, we recently had our first IVF cycle (I am 29, husband 30 and both “unexplained” after two years of failed IUI’s and tests). We retrieved 27 eggs out of those 23 were mature and 14 fertilized with ICSI. All 14 grew and were considered “fair” until day 4 where all but 1 arrested and we had the 1 make it to expanded blast on day 6. We are devastated. Any thoughts what to do differently next time? I was on gonal f, menopur, and Cetrotide. I have been taking coq10, myoinositol, vitamin d, folic acid, and prenatal. We eat well, exercise well and have a healthy BMI. Thank you!
Thank you so much for sharing your expertise! My doctor thinks I may have PCOS because although I ovulate with normal 28 day cycles, no cysts noted on my ovaries, and a normal for age AMH, I do meet the criteria for having a high AFC. Would you still treat me like I have pcos with your pcos protocol or continue with the one above for women with normal ovarian reserve who are <40?
Dear Dr.Sher. I’m currently 11 weeks and 4 days pregnant with twins after the embrio transfer with donor eggs .I’m 46 years old . We made an unfortunate choice to use an ivf clinic in Greece and I’m left without any after transfer care whatsoever as the doctor doesn’t even remember who I am when I call or email him . So I hope you can help me . My oestradiol level seems to be within norm and growing steadily. However my progesteron is very low and I still need to take progesteron injections 3 times a day ( 25mg of medicine in UK called Lubion or in some other European countries called Prolutex ) I take it every 8 hours and I also take one Crinone at night .I do blood tests every week and just before my second injection per day my progesteron level last was week was around 105 nml/L ( around 33.2 ng/ml ) I tried to reduce injections to 2 per day and use more Crinone instead but I started spotting and had to go back to taking 3 injections per day . From what I know I suppose to take progesterone supplements only until 12 week or pregnancy and after that placenta should start producing it . If I take the injections any longer is it going to affect my babies ? When do you think I will be able to start reducing it ? Thank you in advance for your time .
I frankly am not concerned by the 33ng/ml P4 level. I would not continue taking progesterone beyond the 1st trimester…but that is my opinion. Others might differ.
Geoff Sher
When is it safe to have sex after a frozen embryo transfer?
In my opinion …after ultrasound confirmation of pregnancy or earlier if pregnancy can be discounted.
Geoff Sher
Good day
Please help me, I’m so heartbroken and I don’t know what to do. I’m 40 years of age and I just had my 1st positive EFT ( donor egg) out of 2 failed ones. I did my transfer on the 22 may and my my 1st HCG was 7( 10 days) and the 2nd HCG was 10 on 12 days and my 3rd HCG was 29 on day 14, and on the 21 June I had my 1st scan and Dr saw a little sac and confirm it’s not optopic pregnancy. Then dr suggested I should do another blood test same day and it came back 12? It has dropped and they advice me to continue with my medication ( prednisone 2 in AM and estrofem 1 in AM, and 2 estrofem in the afternoon, plus 1 pregesterone and 1 claxine in the afternoon). And I’m going back next week for another blood test and scan. I would like to know if there’s any chance for me? Should you think I should change or add something? I’m not bleeding bt just a mild cramps once off… I really need your help, I don’t know what to do or think I’m so heartbroken been thinking this pregnancy is going to be fine. Any advice or guild lines will be appreciated.
The older a woman becomes, the more likely it is that her eggs will be chromosomally/genetically “incompetent” (not have the potential upon being fertilized and transferred, to result in a viable pregnancy). That is why, the likelihood of failure to conceive, miscarrying and of giving birth to a chromosomally defective child (e.g. with Down Syndrome) increases with the woman’s advancing age. In addition, as women age beyond 35Y there is commonly a progressive diminution in the number of eggs left in the ovaries, i.e. diminished ovarian reserve (DOR). So it is that older women as well as those who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the age-related effect on the woman’s “biological clock, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
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)
•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 Approach
•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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
•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?
•Blastocyst Embryo Transfers Should be the Standard of Care in IVF
•Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•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
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•Traveling for IVF from Out of State/Country–
•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
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
•IVF Egg Donation: A Comprehensive Overview
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. 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