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.
Hello Dr. Sher,
Greetings. My wife is 8 weeks pregnant and she is on Progesterone shot and also on endometrium (3 time a day through vaginal) and got hives since last Friday. We don’t think the hives are caused by food as we use organic food only. We are imaging it may be because of Progesterone or Endometrin and day by day the hives are getting worse. The face is also swollen and rashes across the body including face. We called our Doctor’s office and they are asking to continue progrestorene vacination with a olive oil instead of sesame and asked to take daily 1cc instead of once in two days and asked to stop Endometrin. Can you please let us know if this is going to help to cure hives?
Thanks & Regards,
Raj
Thanks & Regards,
Rajani
Hi Rajani,
You should by not be out of danger and in my opinion, not really need additional progesterone any longer. However, this should only be subject to the approval of your personal RE.
Geoff Sher
Good luck,
Geoff Sher
I am a cervical cancer survivor who had a radical vaginal trachelectomy. Do you have experience with this? My husband and I have had the bank (and our hearts) broken after seeing a fertility doctor who finally admitted (after two cycles we thought were going well) that he can’t figure out where the opening is to do a transfer. We are hoping with your reputation you may be able to help us…or at least be honest about moving forward.
Indeed I can help because even if the cervical canal cannot be engaged there is a procedure known as transmyometrial embryo transfer which can readily be done provided there is the required expertise …which can bypass the problem quite readily.
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
Dear Dr Sher,
I’d be very grateful if you could answer a question for me. I’m 42 and currently undergoing my 2nd IVF/ICSI treatment. I had two day 5 early blastocycsts transferred yesterday morning. In the evening when inserting the progesterone pessary, my flesh felt a bit tender which I thought was normal. About an hour later I went to the toilet and noticed brown discharge when I wiped. Is this normal? Or has my body rejected the embryos?
Thank you for your help,
Dora
It is in no way abnormal!
Good luck!
Geoff Sher
Dr. Sher,
My husband and I are both 30. We have been TTC for 4 years. We have done genetic testing, blood tests, and my husband has done an advanced semen analysis. Everything came back in the normal range for all tests. We have done several failed IUIs. I had stage 1 endometriosis and had it removed prior to my first IVF attempt. My first IVF was a fresh cycle that ended in an ectopic pregnancy, and I had to have my right tube removed. Our 2nd IVF was a frozen transfer and no pregnancy was achieved. After the 2 IVF attempts, I thought back to my first IVF cycle. I did acupuncture with that cycle. I started reading online about blood flow impairments to the uterus. I have bad circulation in my legs and I thought maybe to have bad blood flow to my uterus as well. With my first cycle, my day 5 embryos were to the preblast stage. On my 2nd IVF, the Dr. said my 2 embryos started to slow down in the growing process around day 3 or 4. I read that impaired blood flow can effect egg health. My question for you is: Can anything be done medically to help blood flow to the uterus? I have read that acupuncture, fish oils, and possibly baby aspirin can help. Do you have any other recommendations? Thank you .
I do not think your egg problem is likely to be due to impaired blood flow, nor do I think your possible implantation issues have to do with this either.
Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
1.Age: The chance of a woman under 35Y of age having a baby per embryo transfer is about 35-40%. From there it declines progressively to under 5% by the time she reaches her mid-forties. This is largely due to declining chromosomal integrity of the eggs with advancing age…”a wear and tear effect” on eggs that are in the ovaries from birth.
2.Embryo Quality/”competency (capable of propagating a viable pregnancy)”. As stated, the woman’s age plays a big role in determining egg/embryo quality/”competency”. This having been said, aside from age the protocol used for controlled ovarian stimulation (COS) is the next most important factor. It is especially important when it comes to older women, and women with diminished ovarian reserve (DOR) where it becomes essential to be aggressive, and to customize and individualize the ovarian stimulation protocol.
We used to believe that the uterine environment is more beneficial to embryo development than is the incubator/petri dish and that accordingly, the earlier on in development that embryos are transferred to the uterus, the better. To achieve this goal, we used to select embryos for transfer based upon their day two or microscopic appearance (“grade”). But we have since learned that the further an embryo has advanced in its development, the more likely it is to be “competent” and that embryos failing to reach the expanded blastocyst stage within 5-6 days of being fertilized are almost invariably “incompetent” and are unworthy of being transferred. Moreover, the introduction into clinical practice about a decade ago, (by Levent Keskintepe PhD and myself) of Preimplantation Genetic Sampling (PGS), which assesses for the presence of all the embryos chromosomes (complete chromosomal karyotyping), provides another tool by which to select the most “competent” embryos for transfer. This methodology has selective benefit when it comes to older women, women with DOR, cases of unexplained repeated IVF failure and women who experience recurrent pregnancy loss (RPL).
3.The number of the embryos transferred: Most patients believe that the more embryos transferred the greater the chance of success. To some extent this might be true, but if the problem lies with the use of a suboptimal COS protocol, transferring more embryos at a time won’t improve the chance of success. Nor will the transfer of a greater number of embryos solve an underlying embryo implantation dysfunction (anatomical molecular or immunologic).Moreover, the transfer of multiple embryos, should they implant, can and all too often does result in triplets or greater (high order multiples) which increases the incidence of maternal pregnancy-induced complications and of premature delivery with its serious risks to the newborn. It is for this reason that I rarely recommend the transfer of more than 2 embryos at a time and am moving in the direction of advising single embryo transfers …especially when it comes to transferring embryos derived through the fertilization of eggs from young women.
4.Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF 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 IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, 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
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
Hi dr Sher-
I’m 31, unexplained infertility. Had ivf at 29, 13 blastocysts frozen. Couldn’t do transfer w ivf because of risk of ohss. Fet #1- I had my daughter. Now going for baby #2. Fet #1 for baby #2, miscarriage at 7 weeks. Sack was always a week behind and no baby ever developed. Natural mc. Fet #2- negative
It’s so frustrating that it doesn’t seem to be working now and was so easy (relatively speaking) with my daughter. I really thought frozen embryo transfers were my “cure” to infertility.
What are your thoughts on this? Would you keep trying with the existing embryos? (10 left all are 4aa, ab and ba grade. Would you suggest another ivf? Anything I’m missing? PGs testing on remaining embryos? I’m at a loss here.
Could have been bad luck. I would keep trying!
Geoff Sher