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.
Dear Dr. Sher
Our dream is a babysister for our son. It has been a dream for me my whole life to get a daughter.
But now I am absolutely devastated. I have been trough 4 cycles:
2 cycles at Team Miracle with microsort and FISH: 2 transfers of 1 good, second transfer 2 xx embryos – 1 good / 1 regular
2 BFN. None of them stuck. The doctors could not explain it since my lining was perfect
2 cycles at Cube in Prague. No microsort, but NGD, frozen.
First cycle 17 eggs retrieved, 16 fertilised, 6 Pgd tested, 3 healthy xy embryos. The rest 3 unhealthy xx embryos.
We decided on a last attempt and did a tandem egg collection. Ended up with 4 blastocyst and pgd tested and just received the news that we have 2 healthy xy embryos and that the other 2 are xx embryos but unhealthy.
So we now have 5 male embryos and would have been superhappy with just one female embryo.
I am in big grief and sorrow and can’t believe these results after all we have been through. I am beginning to think my partner can only produce healthy y sperm?
Can you explain what might be the reason? My partners X sperm or my egg quality?
Why are all the XX embros bad? Are we not able to produce girls do you think?
Is it possible to examine the X sperm on a pre-elininary examination?
What treatment do you recommend? I do not even know if I am able to convince my partner again. This was supposed to be our last try
Hope for all the help, recommendation, ideas or thoughts you have
We are from Scandinavia where Genderselection is illegal unfortunately
Could you please handle this discreetly.
It sounds to me like an anatomical or immunologic (more likely) implantation dysfunction!
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 .
*The 4th edition of my 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
Just wanted to find out if you have heard of anyone who had success with one fertilized egg. I had 4 removed and only 1 fertilized. Currently day 2 but going out my mind wondering what my chances are with just the one. Thank you for this blog.
Ye indeed, but that depends on the quality of the embryo it propagates upon fertilization.
Good luck and G-d bless!
Geoff Sher
Hi Dr. Sher,
How many intralipid infusion would you recommend to have after FET? I had a successful FET and the embryo was implanted successfully. My RE had me to have 2 infusions post transfer. I am now 12 weeks pregnant and all OB plus NT scans suggest the baby is developing well. But my RE wants me to have 2 more intralipid infusion as he said both my both my NK assay and TH1:2 levels are slightly elevated in my NK Assay follow up panel, which was conducted during my 11 weeks.
I would greatly appreciate your insights. Thanks in advance!
Only one is needed once the pregnancy test becomes positive..but more will not likely do any harm.
Geoff Sher
Hello,
My daughter was in a horrible car accident 2 1/2 months ago and at 38 weeks lost her daughter, due to the severity of the accident in order to save her life they had to remove her uterus as well but did leave her ovaries. She is only 27yrs and is looking into harvesting her eggs for a future child. My question to you is what are the chances of her ovaries still being functional after such a traumatic removal of her uterus and if there is a low count will the eggs be useable?
So sorry to here about this. However, ity should NOT in any way affect her ovaries and egg quantity/quality.
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 .
*The 4th edition of my 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
After years of infertility IVF finally worked for us!! We have twins! Now I’m having a second set but these are identical naturally. I have frozen embryos remaining and would like to use 1. If my embryo split without lab assistance, and I know IVF raises identical twin risk, can a single embryo of PGS normal have a higher chance of splitting with my new set on the way? Thank you.
Any time you create an hiatus 9an opening) in the envelopment of the embryo ( as you must do to access cells for PGS biopsy or as you do with assisted hatching (AH) of an embryo, you increase the chance of it splitting and resulting in identical twinning…..But, the incidence is still very low.
Geoff Sher