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 a 36 year old female going thru unsuccessful IVF attempts for the last 3 years.
I have been pregnant 3 times naturally within first time of trying. I was diagnosed with hypothyroidism during my 1st pregnancy and have been taking medicines since then.
– I have one healthy 7 year old born in 2010, when I was 29 years.
– I got pregnant again naturally in 2013. But I was diagnosed with Fragile X permutation. I went thru Amniocentesis and found the baby had full mutation. So the pregnancy was terminated and I had a D&C
– We tried IVF with PGD/PGS testing. I had 2 frozen embryo cycles and both failed
– Then in 2016, I got pregnant again naturally but unfortunately had to terminate again due to Fragile X full mutation
– In mid-2016, I went to a different IVF clinic which used minimal stimulation. I ended up with 3 PGD/PGS tested embryos. Have tried 2 cycles of frozen embryo transfer both with one embryo each. I was able to get positive pregnancy test but both ended up being chemical pregnancies. One transfer included Prednisone.
Question: Why am able to get pregnant naturally but unable to with IVF even with PGD/PGS tested embryos?
week 7 day 1 post FET. on estrogen 2mg TID, progesterone supp 200 mg QID. today, bHcg 9926 and estrogen 145. progesterone was 10.8 (June 21), so increased supp from TID to QID, then it was 15.4 (June 27). today down to 13.5 (still QID). Told prog levels should be 15-20. should the supp be increased to x5/day? thank you
I concur with the approach!
Geoff Sher
Hi Dr Sher,
I have a question about low LH levels. I’m 43, about to start down-regging. My cycle day 2 LH is 1.57, FSH is 5.17 and AMH is 0.9 ng/ml. I also have elevated prolactine levels at around 38 (lab range is up to 29).
I have read that such low LH levels can impair the quality of eggs. Is there anything that can be done during or before stimulation to treat that? Thank you.
Indeed there is… The addition of a small amount of Menopur will counter that effect.
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”.
I favor d 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 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
Hello Dr Sher, I’ve been trying to get pregnant for over 2y. I had an endometrial polyp which was removed last Oct and then we had 3 unsuccessful attempts for IUI. Finally went ahead w/IVF FET/ISCI. I had PGS 1 tested embryo transferred and I got pregnant. However around week 6 I had some bleeding w/clots and following week the embryo didn’t grow and neither had a heartbeat so the doctor concluded that it was unviable pregnancy. This followed w/D&C and a POC testing of fetal tissue which came back normal. Are there any known causes of such a miscarriage. I’m also on Thryoxine medication, though my TSH have been normal over 2 years, were higher than where my doc wanted to be but before transfer it was around 2. Would appreciate any further steps you can recommend
The fact that you are on Thyroxine suggests an under-active thyroid which in women is often due to an autoimmune process (antithyroid antibodies). In 50% of autoimmune thyroid disease there is an immunologic implantation dysfunction which if present in your case, could explain your situation fully.
Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss (RPL). The condition is 5-10 times more common in women than in men. In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity (Hashimoto’s disease) caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies.
The increased prevalence of hypothyroidism and thyroid autoimmunity (TAI) in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities. This having been said, there is significantly increased incidence of thyroid antibodies in non-pregnant women with a history of infertility and recurrent pregnancy loss and thyroid antibodies can be present asymptomatically in women without them manifesting with overt clinical or endocrinologic evidence of thyroid disease. In addition, these antibodies may persist in women who have suffered from hyper- or hypothyroidism even after normalization of their thyroid function by appropriate pharmacological treatment. The manifestations of reproductive dysfunction thus seem to be linked more to the presence of thyroid autoimmunity (TAI) than to clinical existence of hypothyroidism and treatment of the latter does not routinely result in a subsequent improvement in reproductive performance.
It follows, that if antithyroid autoantibodies are associated with reproductive dysfunction they may serve as useful markers for predicting poor outcome in patients undergoing assisted reproductive technologies.
Some years back, I reported on the fact that 47% of women who harbor thyroid autoantibodies, regardless of the absence or presence of clinical hypothyroidism, have activated uterine natural killer cells (NKa) cells and cytotoxic lymphocytes (CTL) and that such women often present with reproductive dysfunction. We demonstrated that appropriate immunotherapy with IVIG or intralipid (IL) and steroids, subsequently often results in a significant improvement in reproductive performance in such cases.
The fact that almost 50% of women who harbor antithyroid antibodies do not have activated CTL/NK cells suggests that it is NOT the antithyroid antibodies themselves that cause reproductive dysfunction. The activation of CTL and NK cells that occurs in half of the cases with TAI is probably an epiphenomenon with the associated reproductive dysfunction being due to CTL/NK cell activation that damages the early “root system” (trophoblast) of the implanting embryo. We have shown that treatment of those women who have thyroid antibodies + NKa/CTL using IL/steroids, improves subsequent reproductive performance while women with thyroid antibodies who do not harbor NKa/CTL do not require or benefit from such treatment.
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.
•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
•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!
•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
•How Many Embryos should be transferred: A Critical Decision in IVF.
•Avoiding High Order Multiple Pregnancies (Triplets or Greater) with IVF
•The Role of Nutritional Supplements in Preparing for IVF
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
Dear Dr
We have obstructive azzospermia(suspected ED blockage because the Vas Defrenc and Epidydimus are dilated.
Trans Resection of the ejaculatory duct done in 2010
Testi Biopsy show good sperm development.
We also have one blocked fallopian tube.
Cystopic Ovarian syndrome treated through a laparoscopy in 2011.
Two Fibrods remove in 2014.
Abortion in 2007
From 2013 to 2017 we have done 9 ET.
Three 3day ET and 6 5day ET.
Two pregnacies in 2017 after introduction of IL though loss occurred at early stage.
First pregnancy, HCG got up to 4000 at week 6 but lost it at week 7 after severe bleeding.
Second pregnacy, HCG started at 20 on day 8 after transfer and rose to 48 on day 10 and 66 on day 12. Low positive detected.
Saw blood glot on day 16 and going for ultrasound scan on day 20, Friday 07 July 2017. We are already suspecting loss as there are no pregnancy symptoms till today.
The DR is always happy with the lining and hormones.
We transferred a couple of Blastocysts, Expanded Blastocysts and Hatching embryos in vain.
Our questions is, what else can we ask our doctor to do in South Africa?
Immunologic Implantation Dysfunction?
DQ alpha genetic match?
Surrogacy?
Trans Resection of the ejaculatory duct repeat or any other means to remove obstruction?
Egg donor?
Sperm donor?
Embryo Donor?
We remain hopeful that we can have our own offspring if we get the right treatment and advice.
I read plenty of your advices/blog comments and strated reading your book now.