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.
Thank you Dr. Sher. What things should I be tested for besides natural killer cells?
WE would need to talk Erin…I would need many more specifics to be able to advise authoritatively!
Geoff Sher
My Antinuclear antibodies direct is positive. My Ana pattern is nucleolar. I plan to do a frozen embryo transfer months after egg retrieval. Does any action need to be taken before or while stimming? What needs to be done before and after transfer? Thank you!
I would absolutely have an evaluation for a possible immunologic implantation dysfunction.
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
Hello Dr. Sher,
The closer I am to FET, the more in panic and more questions in my head…
1. Our FET will be in a clinic overseas and they prescribed Utrogestan to start 5 days before transfer. It is not available in US, so I was told to use Crinone gel instead.
I always used Endometrin and still have a lot remaining from the previous cycles.
– Is in your opinion, Crinone Gel better than Endometrin to start before transfer?
– Should I switch with Utrogestan once I get to the clinic?
2. My transfer was originally scheduled for 19 cd but now due to scheduling it may be on the 22nd cd. I understand that the most important factor is endometrium and that it should have at least 8mm at start of progesterone.
– Would it be OK to extend taking Estradiol for 2 extra days once endometrium already achieved 8 mm?
– Would it be better to have FET on day 19th vs 22nd?
3. We will transfer tested hatching blastocyst. I am to take progesterone for 5 days and FET will be on day 6th. All my previous transfers were like that except the last one (early blastocyst – 1BB + blastocyst from day 6 – 3BC; not tested), where I took progesterone for only 4 days and this was the only pregnancy I ever achieved (ended in miscarriage).
– could this mean that my implantation window is shifted and I should start progesterone 1 day later? or days of progesterone were adjusted then to the development stage of the embryos?
I am probably overanalyzing everything, but I want to do all I can to make this one work.
Thank you sooo much,
Zuza
1. Our FET will be in a clinic overseas and they prescribed Utrogestan to start 5 days before transfer. It is not available in US, so I was told to use Crinone gel instead.
I always used Endometrin and still have a lot remaining from the previous cycles.
– Is in your opinion, Crinone Gel better than Endometrin to start before transfer?
– Should I switch with Utrogestan once I get to the clinic?
A: It sounds OK what they are proposing.
2. My transfer was originally scheduled for 19 cd but now due to scheduling it may be on the 22nd cd. I understand that the most important factor is endometrium and that it should have at least 8mm at start of progesterone.
– Would it be OK to extend taking Estradiol for 2 extra days once endometrium already achieved 8 mm?
A: In my opinion, yes!
– Would it be better to have FET on day 19th vs 22nd?
3. We will transfer tested hatching blastocyst. I am to take progesterone for 5 days and FET will be on day 6th. All my previous transfers were like that except the last one (early blastocyst – 1BB + blastocyst from day 6 – 3BC; not tested), where I took progesterone for only 4 days and this was the only pregnancy I ever achieved (ended in miscarriage).
A: I think what they propose is reasonable
Good luck!
Geoff Sher
Hi Dr Sher I have had two early miscarriages at age 37. I have undergone 4 stimulaiton cycles. We have not proceed yet with a transfer as we are trying to bank a few normal embryos. We have only obtained 1 normal embryo. All PGS tested abnormal trisomy for a few different chromosomes. Cycle 1 – 11 eggs retrieved, 7 fertilized, 3 blast- 2 abnormal, 1 normal using 275 folistim and 75 iu menopure
Cycle 2 – 5 retrieved, 1 fertilizer, 0 blast using 300 folistim and 75 menopure
Cycle 3 – 8 retrieved, 3 fertilized, 1 blast abnomal using luperon flare 275 folistim and 75 menopure . Cycle 4 – 6 retrieved, 4 fertilized, 1 blast abnormal using androgen priming testosterone 300 gonal F and 150 menopure. Can you suggest any drug protocol that could enhance egg quality or egg quantity. I have also tried suppliment DHEA, CoQ10, Accupunture. Is it worth a 5th cycle at this point? Your advise is much appreciated.
Hi Mary,
In my opinion, your stimulation protocol could well be the problem. This should be reviewed and revised as a priority.
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:
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
I,m 39in
Married for 14years ago
I get pregnant after 6years and get miscarried after 5months on 2009 then removed multiple Fiproid on 2010 then get tupes bloke by lateral
Then I dessidded to do IVF trying
Avery thing was good but unfortunately noprogress
Then I designed to another trring on 2014 and fall led to second time
And go to do labroscobyes
And I went to Jordan on 2017 and do myoctmey opening one tupe the left one