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…another question from a face book member:
Is Assisted Hatching and embryo glue both necessary for an older ivf patient?
AH might possibly help but definitely (in my opinion) NOT embryo glue.
Geoff Sher
Thank you for the reply dr. I am in South Africa and surely hope they will know how to test for this. I am 100% sure this is the reason for my ivf latching problemes and that we can get this sorted because i wont be able to handel another emotional disappointment. I appreciate your advice and time dr.
Good luck and G-d bless Amanda!
Geoff Sher
Is there a maximum number of days that you be on the stimulation meds? I am currently on Day 10 of my stim meds (although only Day 8 of 75u Menopur, as my RE adds it in after 2 days of Gonal-F (600u), which is then lowered to 300u for the remaining stim days. ) I think I may stim for 1-2 more days and wonder if the longer stimulation will affect egg quality?
The length of stimulation can vary widely. It depends on response! There is no finite cut-off time.
Geoff Sher
I was diagnosed with sever endomitriose at age 19 i am now 41. I had so many lap’s, histo’s, cyst polyps and endomitriose remove that i cant even remember the number. Last opp was aug”16 and dr said endomitriose is level 2 and he removed two old almost stone like from my womb. At age 37 i was diagnosed with pre-mature ovarian failure and got placed on hormon replacement Femosten 28. We had one ivf with 1 egg(my own) but it didnt implant, treid one insemination didnt work, 2 egg donation ivf’s first one only 2 eggs but they didn’t implant. Last cycle was now August’17b 7 eggs, 6 firtelized trough iccis, 1 deid 3 frozen and 2 grade AA4 blastocyst and endo linning 8mm and above, so perfek. To day got my negative blood test? Again they didn’t implant? The 4 time what can it be can the natural bornkiller be present because of my long run with endomitriose?
Please help
Clearly you need IVF with OD because of your premature ovarian failure. However, it is important to know that your endometriosis could be adding another element to your problem, namely an implantation dysfunction which must be investigated and if present , be addressed.
More than half of women who have endometriosis harbor antiphospholipid antibodies (APA) that can compromise development of the embryo’s root system (trophoblast). In addition and far more serious, is the fact that in about one third of cases endometriosis, regardless of its severity is associated with NKa and cytotoxic uterine lymphocytes (CTL) which can seriously jeopardize implantation. This immunologic implantation dysfunction (IID) is diagnosed by testing the woman’s blood for APA, for NKa (using the K-562 target cell test or by endometrial biopsy for cytokine activity) and, for CTL (by a blood immunophenotype). Activated NK cells attack the invading trophoblast cells (developing “root system” of the embryo/early conceptus) as soon as it tries to gain attachment to the uterine wall. In most cases, this results in rejection of the embryo even before the pregnancy is diagnosed and sometimes, in a chemical pregnancy or an early miscarriage. As such, many women with endometriosis, rather than being infertile, in the strict sense of the word, often actually experience repeated undetected “mini-miscarriages”.
Women who harbor APA’s often experience improved IVF birth rates when heparinoids (Clexane/Lovenox) are administered from the onset of ovarian stimulation with gonadotropins until the 10th week of pregnancy. NKa is treated with a combination of Intralipid (IL) and steroid therapy: Intralipid (IL) is a solution of small lipid droplets suspended in water. When administered intravenously, IL provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid.IL is made up of 20% soybean oil/fatty acids (comprising linoleic acid, oleic acid, palmitic acid, linolenic acid and stearic acid) , 1.2% egg yolk phospholipids (1.2%), glycerin (2.25%) and water (76.5%).IL exerts a modulating effect on certain immune cellular mechanisms largely by down-regulating NKa.
The therapeutic effect of IL/steroid therapy is likely due to an ability to suppress pro-inflammatory cellular (Type-1) cytokines such as interferon gamma and TNF-alpha. IL/steroids down-regulates NKa within 2-3 weeks of treatment the vast majority of women experiencing immunologic implantation dysfunction. In this regard IL is just as effective as Intravenous Gamma globulin (IVIg) but at a fraction of the cost and with a far lower incidence of side-effects. Its effect lasts for 4-9 weeks when administered in early pregnancy.
The toxic pelvic environment caused by endometriosis, profoundly reduces natural fertilization potential. As a result normally ovulating infertile women with endometriosis and patent Fallopian tubes are much less likely to conceive naturally, or by using fertility agents alone (with or without intrauterine (IUI) insemination. The only effective way to bypass this adverse pelvic environment is through IVF. I am not suggesting here that all women who have endometriosis require IVF! Rather, I am saying that in cases where the condition is further compromised by an IID associated with NKa and/or for older women(over 35y) who have diminished ovarian reserve (DOR) where time is of the essence, it is my opinion that IVF is the treatment of choice.
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.
Geoff Sher
Hello: We just recently completed an unsuccessful IVF cycle. (40 yr old female w/ endometriosis). We had 5 embryos, which were ICSI’d b/c we planned to do PGD. The lab/Dr says the embryos all stopped growing after 3-4 days. Is this common?
Does the skill of the ICSI technicians or the equipment they are using have any correlation to viable embryo development?
Is there anything else we could have done to ensure viable embryos developed?
Thanks so much,
Robyn
To follow-on, after day 7 of not growing, they said they were unusable. Is this also true? We’re so sad to have to give up on them, but our Dr. is saying it is not their policy to observe them any further after 7 days when there has been no further evidence of growth in the dish. Does this sound right? Thanks so much!
It is VERY rarely a lab issue. Almost always it is an egg quality issue which might be intrinsic or due to the protocol used for ovarian stimulation.
Geoff Sher