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,
Would you recommend EPP for a 30 year old pt with normal AFC/AMH and low FSH/LH with a history of very poor response to stims? I only ever produced one mature follicle usually after 10+days of Menopur. Most of what I read states it’s used for poor responders with high FSH. Wonder what it would do for someone with a FSH of 4.5?
No! I would not! I would recommend a robust, modified long pituitary down-regulation protocol (agonist/antagonist conversion protocol-A/ACP)-see below + human growth hormone augmentation. I would also suggest PGS embryo testing with embryo banking to ,make hay while the sun still shines.
Please visit my new Blog on this very site, 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Hello Dr. Sher.
I am 28 years old. FSH 16, AMH .56. Antral follicle count 8-10. I don’t know if it matters, but my low egg reserve is the result of 4 surgeries on my ovaries in my late teens/early 20s to remove ovarian cysts. I usually have 2-3 follicles one one ovary, 6-8 on the other.
I am starting my first IVF next month and doing estrogren priming. My protocol seems to vary from yours and I wanted to know if you thought it was suitable or could use some modifications.
Month 1
CD10 start testing for LH surge
Day of positive surge: Come in for bloodwork to confirm surge
10 days post surge: Begin estrace 2 mg twice a day
11 days post surge: Continue Estrace, add Ganirelix in the AM
12 days post surge: continue estrace and Ganirelix in the AM
13 days post surge: Continue estrace, take Ganirelix for last time.
Continue Estrace until period starts.
Month 2
CD1: When period starts call clinic for baseline bloodwork. First day of period will be last day of Estrace twice a day.
CD2: Baseline ultrasound, E2, P4, Beta. No medications.
Cd3: Stim day 1. 225 iu menopur in AM and 225 iu in PM
CD4: 225 iu menopur in AM and 225 iu in PM
CD5: 225 iu menopur in AM and 225 iu in PM
CD6: 225 iu menopur in AM. Return to clinic for bloodwork and ultrasound.
Monitor every 1-2 days and adjustments to meds will be made as necessary and instructions on when to start ganirelix, administer trigger.
There are no doubt different approaches to ovarian stimulation. This is not one that I use or prefer. I would use an agonist/antagonist conversion protocol with human growth hormone augmentation (see below). I would also seriously consider embryo banking of PGS normal blastocysts to enable you to try and make hay while thew sun still shines.
Please visit my new Blog on this very site, 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•Ovarian Stimulation for IVF: Comparing “conventional” use of GnRH antagonists to the Agonist/Antagonist Conversion Protocol (A/ACP)
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•Launching Ovarian Stimulation with a BCP: How Does it Affect Response?
•Frozen Embryo Transfer (FET): What Does it Involve?
•Hereditary Clotting Defects (Thrombophilia)
•Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
•PGS-Biopsy for the Assessment of Embryo Numerical Chromosomal integrity (Ploidy): Should it be done on Day 3 or on Day 5-6 post fertilization?
•Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
•Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Hi Dr. Sher,
I ran across your website in my search for information regarding premature ovarian failure/diminished ovarian reserve.
A little bit about my reproductive background is as follows. I have had four dermoid ovarian cysts thoughtout my life which resulted in removal of my right ovary back in 2001. The first one was in 1993, at the age of 14 on the right ovary, and the second one also being on the right ovary in 2001. The following year, I had a dermoid cyst on my left ovary, which was removed laproscopically. Finally in 2009, I had another dermoid cyst on my remaining ovary, which was removed by a laporotomy. I seemed to have what was a normal cycle after my surgery, but about two months after surgery I started getting hot flashes, night sweats…basically all the symptoms of menopause. The RE did blood work, at which time, my FSH came back around 100. Immediately I was put on birth control. It helped with the symptoms, but basically that doctor wanted to just push me off to DE. In 2014 I consulted with a different RE who ran more labs. At this point my FSH was suppressed to the birth control pills, however my AMH came back at 0.03. This particular doctor put me on changing doses of Estrace, along with DHEA in order to try and recruit follicles. My AMH always remained the same. In May of 2015, I postponed treatment with this doctor, and decided to try out a NaPro doctor. They had me discontinue the Estrace and DHEA, and within a month my “menopausal” symptoms reappeared. My FSH had been back up to 85. Since then I have been doing cyclic HRT with Estrace and progesterone. I consulted with my third RE in November, who is willing to try a medicated cycle with TI for me and my husband due to our religious beliefs (we just got married in May). Currently he has me on estrogen primming to try and lower my FSH as much as possible, and increase my estrogen levels. From there it sounds like he will do either Femara, or a Femara/Follistim combo. In your opinion, what kinds of protocols have you had success with in patients like me? We are not ready to give up on my own eggs, as I have also included supplements, vitamins, and acupuncture. Is there any supplement regimine that you can suggest to help?
Thanks,
Carli
Hi Carli,
It sounds as if your very severely diminished ovarian reserve is a prelude to an imminent menopause. I would encourage you not to “waste time” trying to conceive with own eggs and rather to come terms with the fact that to have a baby you will need egg donation.
Please visit my new Blog on this very site, 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
•The “Biological Clock” and how it Should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.:
•IVF Egg Donation: A Comprehensive Overview
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Dear dr sher , from where can I order the Intralipids please ? What is the name of the steroid and the milligrams you recommend to take with the intralipids ? Thank you
Dr.sher why would it be that a low percentage of my eggs will be mature when at least 50% of them were over 14mm when we started coasting?