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.
I’ve recently had a failed cycle. I am 37, amh 5.7pmol. I had three eggs retrieved. I have two questions:
1) I was on 300 menopur for 12 days. For my next cycle I think they will tell me to go up to 450. I am worried that all I’ll be doing is giving myself more drugs for the same result. Do you agree?
2) They advised me to put two embryos back. I said I was worried about that as I have a partial da alpha match and thought that would only double the chances of my body attacking them. They said it would not and still advised two. It was a day 2 transfer. What are your thoughts?
Actually one more question – is there any reason why I could not do another ivf right away rather than waiting several months? I’ve read that sometimes back to back ivf can yield more eggs.
Thank you.
1) I was on 300 menopur for 12 days. For my next cycle I think they will tell me to go up to 450. I am worried that all I’ll be doing is giving myself more drugs for the same result. Do you agree?
A: Respectfully, in my opinion the focus should be on FSH-dominant medication rather than menotropins (Menpur) which I keep below 75U per day.
1) I was on 300 menopur for 12 days. For my next cycle I think they will tell me to go up to 450. I am worried that all I’ll be doing is giving myself more drugs for the same result. Do you agree?
2) They advised me to put two embryos back. I said I was worried about that as I have a partial da alpha match and thought that would only double the chances of my body attacking them. They said it would not and still advised two. It was a day 2 transfer. What are your thoughts?
A: If you have NK cell activation by the K-562 target cell test, I would not transfer >1 blastocyst. If there is no NKa+, it woyld not matter if 2 were transfered.
3. Actually one more question – is there any reason why I could not do another ivf right away rather than waiting several months? I’ve read that sometimes back to back ivf can yield more eggs.
A: In my opinion it is advisable to take at least 1 cycle break between fresh IVF cycles.
Good luck!
Geoff Sher
PH: 800-780-7437
Dear Dr. Sher,
I have had 5 failed FET. The most recent was a big disappointment because every thing seemed perfect. The prior 4 there were issues either from fibroids or liquid in the uterine cavity. I have had 3 myomectomies in the past – 2 laparotomies and 1 laparoscopy. I also had my tubes removed as it was thought to be the cause of the liquid in the cavity due to hydrosalpinges which it wasnt. My last FET the embryo was the 5th of 7. Grade 5 AA. No more liquid in the cavity as I had had 3 months of Decapeptyl injections and 2 cycle of Doxycycline antibiotics for chronic endometritis. I also did a thing called immunomodulation where they take blood from me, isolate the cells and inject them in the uterine cavity 3 days prior to the transfer. I also did acupuncture. What would you recommend I do with the 2 remaining embryos if surrogacy is not an option? I am 35 y.o and my fertility doctor does not transfer more than 1 embryo at a time before 37 y.o. Thanks in advance
Hi Dr. Sher,
Looking for some insight into our first (failed) IVF cycle. Background: 35, delivered a healthy 3.5 year old with no trouble conceiving. After TTC for over a year, my day 3 labs were: AMH 1.10, AFC 12, FSH 9.9. 5x IUI cycles all BFN. We just had our 1st IVF and it went poorly – 12 eggs retrieved, 11 fertilized, 1 made it to day 5 and is frozen. Protocol was 300 gonal f, 150 menopur for 10 days. Introduced .25 cetrotide day 6. No BCP prior to the cycle.
We will probably be transferring the frozen in November – but looking ahead to another IVF cycle – should we forgo the BCPs for the frozen cycle, because if the embryo doesn’t take, we run the risk of still being suppressed from the FET? And what could we do differently from a protocol perspective? I took CoQ10 400 mg, fish oil – acupuncture weekly, more of a vegetable/plant based diet, regular exercise and yoga, etc. I am simply devastated we only had 1 day 5 embryo and don’t know what to do.
Here is the protocol I advise for women, <40Y who have reasonable ovarian reserve (yours is slightly reduced).
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
if the blood flow to the lining is poor, will the lining be thin?
Usually yes!
Geoff Sher
Hi, Dr. Sher. I have a question. I’m pregnant now but we just got our bill for keeping our embryo frozen. I have a 3BB blastocyst left that is PGS normal. I’m so very torn. I want to transfer in the high hopes it’ll work but I’ll be crushed if it doesn’t. What do you think the chances are that it’ll work. I really can’t see spending all that money on a transfer that may or may not work. Do 3BB embryos most likely turn into healthy pregnancies? Thank you so much for the time.
I would need much more information to be able to respond authoritatively,
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