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,
I am almost 38 years old, with low antral follicle count and FSH of 22.8. I tried IVF at your NYC clinic this past spring and it actually started out pretty well – 12 eggs retrieved, 8 embryos, 4 blastocysts frozen and sent out for testing. Unfortunately, all 4 of the blasts were abnormal 🙁 Is it worth another shot or with my age and FSH is there really no/low chances of ever getting a normal embryo? Is there anything I can take for egg quality at this point or is it too late? I was on a standard cycle last time, lupron start, 300 gonal f, 1 vial menopur, added in ganirelix toward the end. Thank you for your advice.
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”.
Women 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 effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, 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 women 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 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, https://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 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
I need some help or advice, I have just had my 3rd round of Ivf. First round I had pgd testing, had 3 embryos tested 1 normal, put in as a FET and failed. My 2nd round I had 4 good quality blastocysts tested at day 5 with acgh testing, 1 normal. Me and my husband have worked hard over 3 and half months to change our diets, reduced parabens and bpa in our household/toiletries etc taken various supplements (Fairhaven ovaboost, vitamin b6,c,d&e, melatonin, ubiquinol, omega 3, pre conception multi vitamin, dhea) my 3rd collection was last week, our numbers were the best they have ever been from us, we had 21 fertilized and 14 at day 5 but then had the devastating news none of the 14 had developed anymore, they all got to compact morulas and just stopped. The lab left them an extra day or so to see if they would get to blastocyst but they didn’t. Can you give any advice as to why such a high number all just stopped. Thank you
Hi Doctor, I have been advised to take my trigger injection tomorrow, I was prescribed 10,000 Pregnyl. But my pharmacy doesn’t have this, and so the doctor said to take 10,000 Gonasi instead. Is this the same thing? Will it work as effectively? Or should I keep trying to get the Pregnyl?
Same thing!
Good luck!
Geoff Sher
Hello Dr. Sher. My question – how long should a man (with no sperm issues) stay abstinent for ahead of the ICSI procedure? My clinic recommends 3-5 days, however I’ve also read that 1-2 days may actually produce better quality sperm, and given ICSI is less concerned by overall sperm numbers, a shorter period of abstinence may actually be a better way to go. I appreciate your thoughts on this.
I concur with your Clinic’s advice.
Good luck!
Geoff Sher
Hello. During our FET, we transferred 2 embryos, and recently found out we were pregnant. My first HCG beta was 304 at 13 days past ovulation, and my 2nd beta was 756 at 15 days past. Do you think these numbers indicate twins?
Hi Dr Sher,
I’m booked to go overseas to my chosen clinic for pretesting tomorrow but my period isn’t here, this will be my second period since I stopped breastfeeding so seems it is delayed as I am on cycle day 34 which is late for me.
My clinic says I can have pretesting done at ANY point in my cycle, albeit the first two weeks is preferable, but they have told me not to worry.
I have never heard of anyone having pretesting done on cycle day 35 so rightly or wrongly, I feel a bit nervous
Which tests would you delay until the first few days of my next cycle, if any?
They want me tested for:
Hormonal levels (FSH, LH, Oestradiol, Prolactin)
2) Thyroid results (TSH, fT4) and AMH hormone
3) Vaginal ultrasound scan of uterus and ovaries (antral follicle count)
Thanks
Sarah
AMH and prolactin can be measured anytime. FSH/LH/E2 + AFC should be measured no later than day 4…in my opinion.
Geoff Sher