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.
Hello Doctor Sher. Can you please explain if my wife might have any pregnancy complications following a Hysteroscopy resection of some polyps and fibroids which was done before her IVF procedure? She’s now 10 weeks pregnant, and has been spotting for 2 weeks now and our doctor can’t identify/explain what’s causing this. I appreciate your thoughts on this? Also, what further tests or investigations would you recommend in the case of spotting for 2+ weeks?
I strongly doubt the hysteroscopy is in any way responsible for the spotting. Many women with healthy pregnancies experience early pregnancy bleeding which often resolves without consequence. There is probably nothing to be done but take a wait and see approach here.
Good luck and G-d bless!
Geoff sher
Hi Dr. Sher,
I saw your vedio on endometriosis.Its very informative.I need your best advice.Please help.
Recently I have been diagnosed with endometrioma(chocolate cyst) of 6.7 in my right ovary.My HSG shows that I have a distal and proximal blockage in both tubes.Left ovary looks fine but might get affected because of the right ovarian cyst.I have a Low ovarian reserve as well.My egg quality seems good.The doctor advised me to freeze the egg before surgery because he might have to remove the right ovary completely as the size of the cyst is big.I told him to give me the best possible treatment as I can’t afford to loose my eggs after the surgery.
So is it safe to take injections for egg retrieval before the surgery or should I go for the surgery first and then Retrieve my eggs? Is there a possibility that I would be able to conceive after surgery on my own or IVF is the only solution for me?
I dnt have any children got married 3 years back.My present age is 33 and my husband is 36.
My husband blood reports and Siemen count has come out good.
I’m confused and tensed at the same time as IVF is not covered in insurance and I dnt know what will happen after surgery.Kindly give me your best possible advice.
In my opinion, unless the endometrioma (if sizeable) is removed prior to ovarian stimulation, the eggs from the affected ovary would likely be compromised with regard to their competency. Thusa I would first deal with the endometrioma and then, if you have DOR, I would proceed about 2 months later with the IVF cycle.
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”.
Women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.
While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy
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.
•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.
• A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
•Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
•Optimizing Response to Ovarian Stimulation in Women with Compromised Ovarian Response to Ovarian Stimulation: A Personal Approach.
•Egg Maturation in IVF: How Egg “Immaturity”, “Post-maturity” and “Dysmaturity” Influence IVF Outcome:
•Commonly Asked Question in IVF: “Why Did so Few of my Eggs Fertilize and, so Many Fail to Reach Blastocyst?”
•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?
•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!
•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
•How Many Embryos should be transferred: A Critical Decision in IVF.
•Endometriosis and Immunologic Implantation Dysfunction (IID) and IVF
•Endometriosis and Infertility: Why IVF Rather than IUI or Surgery Should be the Treatment of Choice.
•Endometriosis and Infertility: The Influence of Age and Severity on Treatment Options
•Early -Endometriosis-related Infertility: Ovulation Induction (with or without Intrauterine Insemination) and Reproductive Surgery Versus IVF
•Treating Ovarian Endometriomas with Sclerotherapy.
•Effect of Advanced Endometriosis with Endometriotic cysts (Endometriomas) on IVF Outcome & Treatment Options.
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.
Hi Dr Sher, you said previously that you do not recommend hcg shot after ET. But I just wondered why that was? Because I thought hcg helps us to produce progesterone which helps sustain the pregnant? Thank you
It confuses the ability to diagnose a pregnancy earl on as it often results in a false diagnosis. Also, the administration of progesterone will have the desired effect without falsely elevating hCG in the blood.
Geoff Sher
good morning DR Sher
I am 6 w 6 days preg and my US showed a HR of 119 today. Is this OK?
Thank you for your help
That is OK!
Should be fine!
Good luck!
Geoff Sher
Hello,
I was diagnosed with PCOS in my early 20s and since entering my mid-30’s have become pregnant twice and both times the pregnancy resulted in an early miscarriage at 7 weeks. I had a DNC the second time and after performing genetic testing, we learned that the miscarriage was a result of triploidy. My husband and I also performed genetic testing on ourselves and my results came back with 2 of my 50 cells tested showing a third copy of chromosomes. My research has confirmed that this is a greater abnormality than would be expected for a mid-30 female who’s never smoked, is relatively healthy and slightly overweight. First, I guess I’m wondering if the cell abnormality is related to my PCOS? And I’m also wondering if there are options (other than IVF) that we can explore to avoid another heartbreak? For what it’s worth, we got pregnant the first month that we tried both times and we live in NYC.
thank you!
There is no connection to PCOS. This having been said, the eggs (and resulting embryos) of women with PCOS are more likely to be chromosomally abnormal (aneuploid). This can happen with natural conception, after the use of fertility drugs (with or without IUI) and following IVF. However, with IVF the embryos can be tested through PGS and the risk of aneuploidy-related egg-embryo abnormalities reduced significantly. There is aside from IVF with PGS , no way to alter the risk.
Geoff sher