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.
I have done my first beta with a result of 83.1 and second beta with 194 and I have been spotting the whole time after my first beta and goes from light to dark and then I just saw bright red. I go for a ultra sound on 10/9 but I am thinking to go in earlier to make sure my levels are still rising. Is this common? Should I be worried ?
I would wait for the scheduled US as there is nothing to be done in the interim that could alter the course of this pregnancy…in my opinion.
My guess is that all will be fine.
Good luck and G-d bless!
Geoff Sher
Hi Dr. Sher,
I was wondering at what week a fetal heartbeat should be heard? What should I hope to see at my first ultrasound at 6 weeks 2 days? Thank you,
Karina
Hi Dr Sher,
I have had 5 failed IVFs, 4 with my own eggs and one donated embryos.
My amh 2 years ago was 4 pmol (I live in England).
For the past year I have been having night sweats before each period and my cycles have got shorter (from 23 days to 21/22) I was sure I was perimenopausal so went to see my doctor who tested my day 3 LH, FSH and estrodiol. My results were
LH 3.0
FSH 8.4
Estrodiol 123 pmol
My doctor is confused because she says these are normal results but I have been told for the last 7 years that I have awful eggs and do not ovulate. Am I starting menopause?
Thankyou,
Jennifer
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.
Dear Dr Sher
it’s Fiona here I have a question for you as again as you gave us such good advice last time and we are really at the end of our fertility journey and nothing has worked after 7 years.
Please can I ask your opinion on something confidentially – we have selected a donor who is 25 and her hormone results have come back from Day 3 and I’m worried about her FSH which seems high for her age.
Here are the results
Day 3 hormone results
FSH 8.5
AMH 5.6 n/gol and pmol 40.56
LH 2.9
Oestrodial 120
Left ovary follicles
18 x <5mm largest 22mm
Right ovary follicles
13 x <5mm largest 32mm
It should be perfect for us to spend lots of money on donor treatment but she had 2 successful pregnancies before when she donated eggs to couples. What do you think? Would you go with her (she's perfect in every other way) or change the donor?
Please could you give us a confidential opinion if this donor looks ok from a fertility profile?
It's our last chance with donors and we desperately don't want to get the wrong one. Also doesn't her AMH looks too high to you?
Thank-you v much – please could you help us one more time with your opinion.
Fiona Skinner
I think this is a good donor. I would not be concerned about her basal FSH as this is not nearly as important as her AMH which is good and suggests that her ovarian reserve is twice the normal. I would definitely go with her if she meets your other requirement.
Geoff Sher
Have you heard of this https://www.yadtech.com/product/inosia-2/
any merit in it?
My RE recommended it today.
Polycystic ovary syndrome (PCOS) is a common disorder characterized by anovulation, hyperandrogenaemia and insulin resistance. Its prevalence is 5 to 10% in women of reproductive age.
Insulin resistance has a key role in the pathophysiology of polycystic ovary syndrome PCOS. Jnsulin resistance and hyperinsulinemia, possibly because of a deficiency of a inositol-containing phosphoglycan that mediates the action of insulin may play a key role in the pathogenesis of PCOS. Administration of inositol might replenish stores of the mediator and improve insulin sensitivity in patients with the polycystic ovary syndrome (PCOS), thereby improving ovulatory function and decreasing serum male hormone (androgen) concentrations, blood pressure, plasma triglyceride concentrations and thereby help ameliorate some of the metabolic and physical manifestations of this condition.
More than 18 trials have specifically examined the effects of these drugs on ovulation, and other features of altered metabolism in PCOS. Most of these studies reported have not been randomized but the results appear to be quite promising. It would seem that inositol may improve the potential for ovulatory cycles in patients with PCOS.
Good luck!
Geoff Sher
.
Hello Dr. Sher
I am not presently living in the UK but I can travel there as I have the visa for that country. My ivf cycles have been done in India and the units they use to measure AMH is in ngm/ mL . Kindly advise me if I you think I have DOR or am I moving towards OHS because I am worried about the rise in my AMH values. Your advice will help me in deciding if I should go for another IVF cycle with my own eggs or use donor eggs.
Thank you.
You need to repost this question filling in the detailed background information on your ovarian reserve (AMH/FSH/LH/E2). I will then respond.
Geoff Sher