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.
P.S. Additionally: between Saizen vs Omnitrope, which one in your opinion is better in patients with DOR ?
Same thing!
Geoff Sher
Dear doctor,
I am 41 y.o. with DOR (AMH 0.26, FSH 12.9).
I just switched RE and my new doctor is suggesting a very high dose of FSH (900 of Gonal f) with no Menopur, but instead with a low dose of HCG. (Plus Saizen or Omnitrope). I haven’t heard of anyone using over 750 ui daily of Gonal f. What are your thoughts? Thank you, Marina
That is a rather high dosage. The use would be very dependent o9n the severity of your DOR.
In my opinion, the protocol used for ovarian stimulation, against the backdrop of age, and ovarian reserve are the drivers of egg quality and egg quality is the most important factor affecting embryo “competency”.
Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
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.
•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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•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.
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
•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?
•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.
•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
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
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 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,
We are hearing conflicting indications regarding use of folic acid with MTHFR C677T heterozygous mutation …
First the clinic prescribed methylated form of folate and additionally 5mg of regular folic acid. Now the doctor wants to postpone FET because she says that all that folic acid that has been taken can harm the potential pregnancy even if it’s stopped it now.
What is your opinion – should FET be postponed?
Is there any blood work I should do to check if this folic acid created problems?
Is folic acid really that dangerous to pregnancy with MTHFR mutation?
What dosage of folate you would recommend?
Many, many thanks in advance!
Aga
I advocate methyl folate and no (discuss the dosage with your RE). I would not cancel the cycle.
Geoff Sher !
Dear Doctor,i had icsi procedure done and egg retreval is 4th august,Emryo transfer is 09th august and transferred 3 embroys.my 7 days hcg on 16 th august is 147.but after that from 5th week starting i observed vaginal bleeding and clots of blood is droppin with lower abdominal pain. When i visited doctor there were Two tiny sacs seen on ultra sound.does this bleeding indicates chance of loosing pregnancy.please advise.
A vaginal speculum examination should be done to make sure that the bleeding is not coming from a friable cervix. But ultimately it will take another ultrasound examination of the uterus 1-2 weeks after the 1st one to see what is happening.
Good luck!
Geoff Sher
Hello Dr. Sher,
I’m male 27 years old, I had leukemia, and I received chemotherapy at the age of four.
Now I have a severe lack of hormone testosterone , LH and FSH. due to that I’m about to use the following 6-month treatment course for infertility.
first 3 months , taking day after day Pregnyl 5000 injection.
second 3 months , taking Gonal day after day in addition to Pregnyl 5000 injection.
my question is, dosed this treatment in my case will cause any type of cancers? specially for the pituitary gland.
Best regards
No it is unlikely to do so. However, the injections are not ordinarily given every day. They are done 3 times per week, in my opinion
Good luck!
Geoff Sher