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.
I have just had a donor egg cycle. The donor was 31, AMH 10. She did not respond will to stimulation and produced 4 eggs of which only 3 fertilised normally. All 3 turned into hatching blastocysts and one was transferred. I got a positive urine test 10dpo. I used a clearblue digital test and it indicated 1-2 weeks pregnant up until the afternoon of 14dpo where it changed to 2-3 weeks pregnant. 17dpo the test showed 1-2 weeks pregnant again so I took a blood test which has come in at only 65.
I had a hysteroscopy 3 months prior to transfer.
It looks like this pregnancy is failing and I’m trying to understand why. The donor did not produce many eggs – should this have been known from her screening? What is the most likely reason for the embryo to fail? If it was egg quality then why did it implant?
I have 2 frozen blastocycsts and I am emotional that these will also fail.
Any insights would be appreciated..
J
Perhaps the protocol used for ovarian stimulation needs to be adjusted next time round
Here is the protocol I advise for women, <40Y who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur---no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://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.
• 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
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
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
Good morning Dr.Sher! I saw a documentary about your practice on Netflix. It was very touching and connceted to me in some way. I’m currently going through infertility treatments with Kaiser Permanente Reproductive Endocrinology. I’ve done 3 prior cycles with clomid all chemical pregnancies with a prior doctor. With Kaiser I’ve donde 2 cycles with clomid+trigger+endometrin inserts and one with injectibles (menopu+trigger+PIO) and also all ended in chemical pregnancies. I currently take prenantals, fertileaid,ovaboost,and dhea. I’m interested in the Immunologic Implantation Dysfunction treatment. We live in the Orange County area. Thank You Very Much!
Implantation dysfunction is a very common (often overlooked) cause of “unexplained” infertility and of treatment failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated failure in such women. Common sense dictates that implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
Certain causes of infertility are repetitive and thus cannot readily be reversed. Examples include advanced age of the woman; severe male infertility; immunologic infertility associated with alloimmune implantation dysfunction (especially if it is a “complete DQ alpha genetic match between partners plus uterine natural killer cell activation (NKa).
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.
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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
•IVF: How Many Attempts should be considered before Stopping?
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•IVF Failure and Implantation Dysfunction:
•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
•Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
•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!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
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. Sher,
I am 40, with DOR, undergoing 5th IVF attempt (Day 9). I know that you advise to use a Pituitary down-Regulation Protocol in cases like mine, but my doctor decided to use the microflare protocol. I only have 3 antral follicles in this cycle.
My hormones on Day 2:
FSH 19.53 IU/l,
LH 10.52 IU/l
Estradiol 25.84 pg/mL
Progesterone 0.16 ng/mL
Day 6, lead follicle 10 mm
LH 12.25 IU/l
Estradiol 339.14 pg/mL
Progesterone 0.29 ng/mL
Day 8, lead follicle 13 mm
LH 7.17 IU/l
Estradiol 744.48 pg/mL
Progesterone 0.41 ng/mL
1. Is it possible that I have had an LH peak between Day 2 and Day 6 (value has slightly increased, instead of decreasing) or is it too early in the cycle for that? Can I safely assume that LH is decreasing as it should?
2. Is it possible that my FSH and LH have increased because of birth control pills taken the previous month (I took them for 19 days and have never been on BCP in my life)? So far, my highest FSH has been 12.7 and LH goes as high as 5-6. Will this ruin my eggs in this cycle?
3. Do I have any chance of competent eggs with FSH as high as 19.5? Would you recommend cancelling this cycle?
I am stimulated with Decapeptyl 0.1 on Day 2 and Decapeptyl 0.1 and FSHr of 300U each subsequent day.
I would really appreciate your opinion, because this is probably going to be my last attempt.
Thank you and best regards!
1. Is it possible that I have had an LH peak between Day 2 and Day 6 (value has slightly increased, instead of decreasing) or is it too early in the cycle for that? Can I safely assume that LH is decreasing as it should?
A: It is likely that the flare effect of the agonist caused the increase in LH early on but now it seems to be coming down. I cannot comment on the effect of the initial rise, because I just do not know. What would be telling is what happens with the E2 as the stimulation proceeds and egg/embryo quality in the final analysis.
2. Is it possible that my FSH and LH have increased because of birth control pills taken the previous month (I took them for 19 days and have never been on BCP in my life)? So far, my highest FSH has been 12.7 and LH goes as high as 5-6. Will this ruin my eggs in this cycle?
A: In my opinion ..no!
3. Do I have any chance of competent eggs with FSH as high as 19.5? Would you recommend cancelling this cycle?
A: At this stage I would simply proceed as planned
Good luck!
Geoff her
Dear Dr Sher, Sir I am not sure if you might wish to assist me by a reply but it would be so very appreciated. Very briefly not sure my clinic hasn’t missed something but they get a bit defensive if we question: Me 32yrs, husband 35. 2yrs TTC, so far diagnosis unexplained. Good AMH, apparently good semen analysis, 33 day (approx.) cycle, ovulate ok (so they say) all other levels ok. Straight to first fresh cycle as nothing else suggested, we have put off our first home due to this expense, stims show roughly 16 good sized follicles (plus more smaller) then -devastatingly only 4 oocytes retrieved! No explanation just nothing. Anyway, only 1 fertilised. 5 day grade 1-2 embryo transferred, progesterone pessaries, result looking negative, HCG only 36 at first beta bloods. Understand first time success would be rare but the low egg retrieval number against so many good follicles makes me question the protocol, trigger shot, maybe even the expertise of the person aspirating. Is it reasonable to question this? We are healthy non smokers, good BMI, try very hard to do all the right things. Are there specific questions we should ask when we meet to regroup? We are not American but found you accidentally, you sound kind and we are lost. Thank you even if you only read this.
All that matters here is ultimate outcome. Hopefully all will work out. That having been said, I would need to know much more about your case to advise regarding the protocol used for stimulation…but that can be addressed if this cycle is not successful.
Here is the protocol I advise for women, <40Y who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur---no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://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.
• 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
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
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
We were started on our first IVF cycle with a med error. We were given and told the wrong dose (wrong concentration) and they started us on 1mg Lupron instead of 40 micrograms.
We are on day 6 of stims. We only have 10 follicles. Do you think the Lupron could have any thing to do with the low count? Should we start over?
I doubt that is the reason!
Geoff Sher