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,
Should I wait a number of cycles before starting IVF after stopping breastfeeding? If so, how many?
Thanks
Two cycles of regular menstruation should suffice.
Good luck!~
Geoff Sher
Hi Dr Sher,
I am nearly 41 with an AMH of 0.98, FSH 12.9 and 8 antral follicles. I had my 3 children quickly and easily (ages 5, 3.5, 17 months) and I am now in the process of beginning IVF with ACGH including checking gender. Could you please tell me your opinion about the protocol the clinic gave me?
Many, Many thanks
Day 1
Femara/Letrazole 2.5mg one Morning One Evening
Merional/Menopur 375
Day 2
Femara/Letrazole 2.5mg one Morning One Evening
Merional/Menopur375
Day 3
Femara/Letrazole 2.5mg one Morning One Evening
Merional/Menopur375q
Day 4
Femara/Letrazole 2.5mg one Morning One Evening
Merional/Menopur375
Day 5
Femara/Letrazole 2.5mg one Morning One Evening
Merional/Menopur375
Day 6
Orgalutran/Cetrotide 0,25mg
Scan to measure follicle development in Cyprus
Merioanl/menopur 375
Day 7
Orgalutron/Cetrotide 0.25mg
Merional/Menopur375
Day 8
Orgalutron/Cetrotide 0.25mg
Merional/Menopur
Day 9
Orgalutron/Cetrotide 0.25mg
Merional/Menopur
Day 10
Follicle scan and E2 + P4 blood test
Orgalutron/Cetrotide 0.25mg
Orally:
VITAMIN D 5 drops
PRE-NATAL VITAMIN
OMEGA 3 FISH OIL
FOLIC ACID
Respectfully, I do not espouse to the use of Femara for ovarian stimulation…especially not for older women or those with DOR..
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 Femara/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
Dear Dr Sher,
Is it OK to combine the trigger shot using 1 x ovitrelle (250) and 2 x pregnyl (1,500 each)? I make this a total of 9,500 units.
I’ve always used 10,000 pregnyl in the past but in Europe there is a shortage of the 5,000 vials and I am unable to source them and ovitrelle is very very expensive. The alternative would be that I use the 1,500 pregnyl vials but I would need to inject 6 of them to get to 9,000 units!
Thanks
Kat
I guess not…but frankly I have never tried this and thus cannot recommend it. Talk to your RE.
Geoff Sher
Do you recommend progesterone in oil over the crinone gel vaginally? I have been doing the PIO but it hurts so much and I can barely sit or walk up stairs. Just wondering if it’s ok to switch or if you prefer one over the other?
Yes! I do recommend PIO preferentially but Crinone is probably OK too/.
Geoff Sher
Dear Dr Sher, I have a DQ alpha question. My husband and I have a match. His profile is homozygous 1.2, 1.2 and mine is 1.2,3.1. Given this and other autoimmune factors on my side, we have decided to pursue gestational surrogacy as we have embryos frozen. We have found a wonderful surrogate (who has 2 children of her own). Before proceeding, I thought we should get her DQ alpha profile tested, especially given that my husband’s is homozygous. Her results have just come in and she is 5.1, 5.1. In your opinion, is this a match-free situation? I wasn’t sure whether the 1 element counts as a match or just the first number is relevant. I would be very grateful for your view on this. Many thanks in advance (and by the way I think it’s just fantastic that you welcome questions on your website – big thanks for that).
There is no match here, so provided the GS does not have activation of NK cells by the K-562 test, she should be fine.
God luck and G-d bless!
Geoff Sher