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 in Australia. My Dr knows nothing of Dq alpha /HLA testing. What tests do i need to get done? Also, i have been told i have moderately high nkcells. Does this mean they are activated?
Thank you
Tracy!
The concentration of NK cells is totally irrelevant. Itv is NK cell activation as measured by the K-562 target cell test that matters.
I am sending you a list of articles to research on my blog which, if you read will enlighten you.
Patient: (F) Gretchen Almeida Age: 43
Partner: (M) Jason Almeida Age: 37
Email Address: G4SURFING@GMAIL.COM
Contact Phone #: (303) 507-7717
___________________________________________________________________
Dear Gretchen, ,
I really enjoyed meeting and interacting with you. Thank you kindly for your interest in my opinion and in my services.
Below, please find a summary of our consultation for your records. Also, please know that you will be contacted by an office administrator to help you understand the financial options, as well as by a clinical coordinator who will discuss clinical aspects of treatment with me in Las Vegas.
I typically schedule my IVF cycles 6 months in advance, for specific dates. The cycles last about two weeks, and I do limit the number of cases in each batch in order to make sure I can personally monitor the cycles, and dedicate special attention to each patient. Given my very busy schedule, it is always advisable for you to schedule possible treatment for the earliest convenient date. Both, the financial and clinical coordinators will help you work out logistic issues, and assist you in finalizing the ideal dates for your treatment. We require that all patients make a modest non-refundable deposit to secure the date. This deposit is deducted from the cost of the cycle of treatment.
We recognize that regardless of the nature of your reproductive issue both partners have a stake in the process and its outcome. Accordingly both would usually wish to be present throughout most of the 7-14 days of management. From a practical standpoint however, this might not always be possible (or even necessary). In such cases, we would be able to provide the male partner at least 3 days advance notice of when he would be to be present in Las Vegas for one day. In cases where frozen embryo transfers (FETs) are being done, the male partner will not even be required to be present in Las Vegas. Moreover, selectively when sperm is required from a fertile male partner, we can even arrange for frozen semen sample to be shipped timely for the fertilization process.
There is rarely a need for women undergoing controlled ovarian stimulation (COS) for IVF to begin serial monitoring by ultrasound and/or blood testing prior to the 7th day of stimulation. As such, the female partner is not needed to arrive in Las Vegas prior to the 7th day of fertility drug administration, All preliminary preparatory testing can thus be done at your home setting by your primary GP or OB/GYN, including (if needed) bloodwork and a baseline ultrasound examination with the start of the menstrual period that launches the cycle of ovarian stimulation. After treatment is completed, you can return home. We will follow up with you and/or your partner by phone or Skype communication. We will also interact as needed with your primary care OB/GYN to supervise post-treatment and early-pregnancy management.
While this process might at first glance seem somewhat complex, in reality with a dedicated Clinical Coordinator assisting you, we have developed over the past 30 years of providing infertility treatment to more than 70,000 patients a very easy, convenient, safe and effective method for treating local patients as well as those traveling to Las Vegas from out of state or from abroad.
I provide my cell phone number and email address (702) 281-7437 to all my patients and as such I invite you to call me if you have any questions or issues that need to be addressed. If I am not immediately available, leave your name and phone number and I will get back to you promptly.
Thank you again for your interest
–
CONSULTATION SUMMARY:
Date of Consultation: July 31st, 2017
Nature of the Reproductive Dysfunction:
Age:X1
•G P M A E G2 P0 Misc (2-2016/2017)) both at 7-8 wks. after FHH
•Duration of infertility: 4y
•Menstruation: normal
•Pain with deep penetration during intercourse:no
•Pain with ovulation:no
•PAP Smears:Has had abnormal PAP smear in past but no longer abnormal
•Previous pelvic inflammatory disease:yes (1997)
•Prior abdominal-pelvic surgeries:no
•Systemic History:unremarkable
•Current Medications:none
•Allergic to: none
•Substances:
oSmoking:no
oAlcohol:yes-socially
oSubstance abuseno
•Family History:Grave’s disease/Hashimoto’s/Breast cancer.
•Ovarian reserve:DOR
•Prior tests:
oTests for Ovarian Reserve:AMH=0.555ng/ml; FSH=13MIU/ml
oImmunologic Implantation Dysfunction (IID)no
oOther blood tests:TSH=1.6MIU/ml; Prolactin=16.5ng/ml
oPrevious Hysterosalpingogram (HSG)Bicornuate Uterus
oPrevious Hysterosonogram (HSN)no
oHysteroscopyno
oUltrasounds__
•Male partnernormal
oInitiated pregnancies X2
o
•Previous infertility treatment:1 X failed clomiphene IUI in 2016
SUMMATION: Age factor (43y). Has DOR (AMH=0.55ng/ml) 2 X spont. Miscarriage; Age Factor; No prior IVF; Clomiphene in 2016 with IUI…failed.; Bicornuate uterus. Needs St-IVF ASAP with Banking and PGS
PLAN
1.Immunologic: APA/ATA/RIP/NKa/DQa/HLA
2.HSN (at ER
3.St-IVF with embryo banking and PGS. Requires LA-8/HGH…October cycle.
4.CC/F consultation
5.BCP
¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬____________________________________
ADDITIONAL INFORMATION!
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 “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)
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
•Optimizing Response to Ovarian Stimulation in Women with Compromised Ovarian Response to Ovarian Stimulation: A Personal Approach.
•The Importance of Individualizing Ovarian Stimulation Protocols IVF in “Poor responders” (i.e. DOR) and “High Responders” (Elevated Ovarian Reserve
•Egg Maturation in IVF: How Egg “Immaturity”, “Post-maturity” and “Dysmaturity” Influence IVF Outcome:
•Commonly Asked Question in IVF: “Why Did so Few of my Eggs Fertilize and, so Many Fail to Reach Blastocyst?”
•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
•Why did my IVF Fail
•Unexplained IVF Failure
•IVF Should Supplant Tubal Fertility Surgery.
•IVF: How Many Attempts should be considered before Stopping?
•Optimize Treatment by Understanding the Cause of Your Infertility Treatment
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•Secondary Infertility: Addressing the Root Causes
•Recurrent Pregnancy Loss (RPL): Why do I keep losing my Pregnancies
•Multiple Pregnancies Carry Serious Risks: How Many Embryos Should we Transfer at One Time?
•Cervical Incompetence (CI): A common Cause of Late Miscarriage, Premature Birth and 2nd Trimester Recurrent Pregnancy Loss (RPL)
•Hereditary Clotting Defects (Thrombophilia)
•Blastocyst Embryo Transfers done 5-6 Days Following Fertilization are Fast Replacing Earlier day 2-3 Transfers of Cleaved Embryos.
•Embryo Transfer: The “Holy Grail in IVF.
•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.
•IVF: Selecting the Best Quality Embryos to Transfer
•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
•IVF: The first Choice for Infertile Women 40 to 43 Years of Age!
•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!
•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
•IVF Egg Donation: A Comprehensive Overview
•Trigger” to Prevent Severe OHSS: What are the Pro’s and Con’s?
•Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!
•IUI-Reflecting upon its Use and Misuse: Time for a Serious “Reality Check”.
•Induction of Ovulation With Clomiphene Citrate: Mode of Action, Indications, Benefits, Limitations and Contraindications for its ue
•Clomiphene Induction of Ovulation: Its Use
*FYI
The 4th edition of my newest book ,”In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoffrey Sher MD
Hello. After a 5 day transfer, I am currently one day shy of 6 weeks pregnant. At 5 days, hog was between 5100-5200. Today my levels tested about 9000, slightly above I believe. My team has told me these levels are “reassuring” and to wait for my ultrasound in a few weeks. However, this seems off as they are not going up as much as I believed they were to.
When the hCG reaches this level, it does rise a little slower. I would not be over-concerned. I think an US on Monday would be definitive.
Good luck!
Geoff Sher
Hi Dr, I’m hoping you can shed some light here as I’m a bundle of nerves. On July 13th I had my 2nd FET and 8 days later went for first blood test. My HcG level came back at a 14, two days later it dropped to 12.9, two days later went to 19 and then today rose to 32.9. My dr said this is an abnormal pregnancy and I should expect it to be an early loss however he said he is not pulling the plug just yet. He’s keeping me on my meds- estrace and progesterone and I go back Monday for ultrasound and blood test again. Can hcg levels just rise slow? Can this still be a viable pregnancy? They also told me it could be eptopic. I’ve read it could also be a vanishing twin??
Hi Kriten,
I tend to concur with your RE on this. BUT, miracles can and do happen!
I wish you well!
Geoff Sher
My question is regarding whether or not weight plays a factor into the dosage of prednisone leading up to IVF. It seems that the “general” dose given is 20mg starting with stims, but if I am petite will that make a difference? I’m 5’3” and 106lbs.
I do not regulate based on weight but in my opinion, even 10mg can suffice.
Geoff Sher
Hi,
Thank you for your time.
I’m S 35. We have been TTC for 5 years. My baseline reports are as AMH-3.4, ANA-0.410 , FSH-6.63, LH-5.04, PRL-17.81, Vit D3-11.63. Right ovary measures 4.4* 3.2 cms Multiple corpora lutea seen. Left ovary measures 3.8* 2.9 cms. Multiple corporea lutea seen.
Uterus is retroverted. Two intramural myomas seen: 10 mm, 8.8mm away from cavity.
Husband is 41 with tetratozoospermia with B/L lymph varix.
We have had 2 ICSI failures. Details as below:
1st attempt: 16 eggs picked up,14 injected, 1o
0 fertilized, 8 cleaved.
Embryos: D3 1 x 8 11
1 x7 11
2 x 6 11
FET was done. BHCG was negative.
Medicines: Recaogon 200 IU increased to 225 IU+ Inj Luveri 75 IU
2nd attempt: 8 eggs aspirated (2 with central pitting, 1 with no resistance to injections, 1 with large PVS)
6 injected.1 fertilized.
All poor quality embryos C D4 1 X 2111, 1 x 3111 , cycle cancelled
Is it possible to get success in any further attempts?
It is possible that this is due to either a sperm issue , a stimulation protocol issue or both. Since ICSI in large opart addresses the sperm component, I suggest that te focus be placed mainly on reviewing and revising the protocol for stimulation.
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:
• Male Infertility
•Hormonal Treatment of Male Infertility
•Antisperm Antibodies, Infertility and the Role of IVF with Intracytoplasmic Sperm Injection (ICSI)
•Testicular Sperm Extraction (TESE) and Testicular Sperm Aspiration (TESA): Surgical Approaches for Accessing Sperm from men who have no sperm in their ejaculates (Azoospermia)
•Varicocele and Male Infertility: When and how should it be treated?
•The Sperm Chromatin Structure Assay (SCSA): A Measure of the Potential of Sperm to Help Propagate a Viable Pregnancy
If you are interested in seeking my advice or services, 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 .
*FYI
The 4th edition of my newest book ,”In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoffrey Sher MD