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.
Dear Doctor Sher,
I am 5 week 5 days pregnant now (I know exactly as my cycle was monitored). When I was 5w 3d pregnant, there was an ultrasound. They found a gestational sac, a yolk sac and an embryo without heartbeat. Embryo was already 4 mm (CRL). My hcg at that time was 10000 IU/l, then it only went up two days later to 15000 IU/l. One day later there was an ultrasound again, embryo was 4.5 mm (without a hb). I am really worried as I read that for a 4-4.5 mm embryo usually has a viable heartbeat. Also I don’t like that my hcg doubles now only in 96 hours. What do you think? I know they usually don’t see a heartbeat until someone reach 6. week but if the embryo is so big, doesn’t he have to have a heartbeat?
Thank you, Nora
Hi Nora,
Repeat the hCG test 2 days later (it should double) and do another US in a week. That is the best way to make sure.
Geoff Sher
Wish I could be of more help here but that is the best I can suggest.
My wife and I where ttc for about 6/7 years before we then decided to try ART in 2012( by then I am 30 and she is 29 yrs of age). So we ended up with 4 AA blastocysts via ICSI as my motility was in the 40-45% range( at this point we were told this could be the cause of inferiority as everything else was perfect for both of us). So we had the first fresh transfer and by miracle it worked and we have our son by c section. So we waited for another 18 months or so to allow the c section scar to heal as advised by our doctors and then proceeded with one of the 3 frozen blastocysts which failed and the other two have failed since- Done the endometrial extract for the Last fail- otherwise followed the same process each time.
So before we started on another round of IVF we raised concerns with our doctors and from that done further testing and my wife tested for NK Cells which came back as being quite elevated. So we then proceeded on another round of IVF and ended up with only 2 blastocysts which where grade AA again, done the same process as but this time had the intralipids and then dexo steroids began the day after egg collection. This was a fresh transfer which we had a lot of hope would work as our initial fresh tranfer resulted in our son. So by then we where both thinking maybe the recurrent failures where due to being frozen transfers. This unfortunately failed and now we are worried that maybe the scar tissue from the c section along with the NKCs could also be causing the now 4 successive implantation failures. We raised this with the doctors who said there is no scientific studies to confirm whether scar tissue from c sections could be the cause.
I read on your site that the dexo steroids should be administered 14 days before tranfer so this is one thing we didn’t do.
We are from Ireland and receiving treatment here.
Would you have any insight as to whether this has been the cause of 4 successive failures with grade AA blastocysts on a fertile, healthy woman under 35 who had a a child on her first Tranfer?
100c of IL 20% diluted in 500cc normal sline solution + corticosteroids, starting at least 10-14 days prior to ET is in my opinion, the recipe.
While Primary infertility refers to the inability of a woman who has never been pregnant in the past, to conceive, Secondary Infertility is defined as an inability to conceive more than 1 year after having conceived in the past. Most patients find it difficult to accept the fact that having once been able to conceive they are now unable to do so. When confronted with the proposition that they need IVF, women who have Secondary Infertility find it harder to accept than do those who have Primary Infertility. It commonly raises issues of guilt, a declining sense of self-worth and ultimately self-recrimination impacting rational decision making, family dynamics that involve partners and siblings and relatives. The fact is that secondary infertility can be just as difficult for individuals and family to deal with as primary infertility.
There are several factors that contribute to the problem of Secondary Infertility. These include:
•Social and marital factors: In this modern day and age where at least one in two marriages ends in divorce, it is not surprising that there would be an inevitable hiatus in childbearing. This often results in a considerable delay in re-initiating family building. Since the biological clock keeps on ticking in the interim, advancing age can, and often does, have a profound effect on a woman’s ability to subsequently conceive and successfully complete a pregnancy. In my experience, this is one of the most common reasons for secondary infertility. In addition, by the time a decision is made to enter a new relationship, many men and women will have undergone a prior sterilization procedure which now needs to be addressed. To make matters worse, many such men and women first opt for surgical reversal of their occlusive surgery, only to learn in the end that the procedures were not successful, and they now need to consider in vitro fertilization (IVF) in one form or another.
•Financial factors: Here, the cost of raising a child often weighs heavily, especially in this present tough economic climate. This is becoming more of an issue as women playing an ever increasing role as a primary bread winner.
•Career demands: There can be little doubt that when it comes to climbing the career ladder, women are considerably disadvantaged by the fact that pregnancy and the immediate demands of child rearing take away from their ability to compete with men. As such, many women choose to delay having another child until such time as they have been able to make up for prior lost opportunity.
•Medical barriers to fertility: Certain common medical conditions, while not absolutely precluding pregnancy, make it much more difficult to conceive.
•Endometriosis: It is not uncommon for women with endometriosis to achieve a pregnancy, but find difficulty in doing so again at a later date. The reason for this is that while most women with endometriosis have patent fallopian tubes, the environment surrounding their tubes is compromised due to pelvic toxins that are produced by the endometriotic implants. These toxins compromise egg fertilization potential, making it more difficult for sperm in the fallopian tube to fertilize the egg upon its arrival there. As such, endometriosis is one of the commonest causes of secondary infertility.
•Tubal damage due to prior pelvic inflammatory disease: In first world countries, the early and often indiscriminate use of antibiotics for the slightest symptom has led to the point where an acute attack of pelvic inflammatory disease is often masked. As such, less than 30% of American women with tubal damage have knowledge that their tubes are compromised and that they might have subsequent difficulty in conceiving. Since, in many such cases the tubal damage will not have totally blocked both tubes, some of the women so affected might experience a pregnancy but have difficulty in conceiving again later down the line.
•Dysfunctional ovulation: Since ovulation as well as normal hormonal support of the early implanting embryo are both essential for a healthy pregnancy to occur, it follows that women with irregular or dysfunctional ovulation (e.g., polycystic ovarian syndrome – PCOS, persistent follicular luteal phase deficiencies or post birth control pill ovulatory problems) might sporadically conceive and thereupon find it difficult to do achieve another pregnancy later on.
•Immunologic Implantation Dysfunction (IID): has become ever more apparent that immunologic factors play an important role in achieving healthy implantation. Women with endometriosis (regardless of its severity), those with a personal or family history of autoimmune diseases such as lupus erythematosus, rheumatoid arthritis and thyroid autoimmunity (TAI), and some cases where the man and the woman share certain genetic similarities involving DQ alpha and HLA genotype (alloimmune implantation dysfunction), will have activated T cells (cytotoxic lymphocytes) and natural killer cells (NKa)CTL/NK cells that can inhibit or compromise healthy implantation. This is an often overlooked cause of secondary infertility. Most such autoimmune/alloimmune cases require selective immunotherapy and IVF.
•Anti-sperm Antibodies: Although infrequent, some cases of secondary infertility might also be caused by the woman harboring anti-sperm antibodies. In such cases IVF is mandated.
•Previous post-pregnancy uterine inflammation: Retention of products of conception after the birth of a child, miscarriage, or abortion can so damage the uterine lining as to result in subsequent implantation failure. Unless specifically looked for, this will usually be unknown to the patient, who will simply present with secondary infertility. Treatment is often difficult because such patients might not respond adequately to surgical removal of intrauterine scar tissue or to hormonal or Viagra therapy.
Male immunologic factors: Most men who have undergone a previous vasectomy more than 10 years earlier, will have anti-sperm antibodies that will interfere with fertilization. Such cases require IVF with intracytoplasmic sperm injection (ICSI). Here we offer a few words of caution to men who are considering undergoing surgical reversal of vasectomy. Always first have a test done to exclude the presence of circulating anti-sperm antibodies, because in such cases, even if the reversal is successfully performed, they will not be able to initiate a pregnancy without IVF/ICSI.
Whatever the cause, Secondary Infertility often affects older couples disproportionately, creating a sense of urgency and even desperation in achieving a viable pregnancy before time runs out. It is for this reason that IVF becomes the treatment of choice in such cases. However, even IVF becomes progressively less successful with advancing age of the woman (whose eggs are being fertilized). In such cases it is important for the couple to be realistic with regard to their expectations. Here, options that include embryo banking and egg donation should be carefully considered.
Finally, whenever a regularly ovulating younger woman (under 36 years of age) with patent fallopian tubes is diagnosed with secondary infertility, it is essential to consider underlying endometriosis or non-obstructive tubal disease as a possible cause. In such cases, IVF often becomes the treatment of choice.
Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, find the “search bar” and 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
•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)
•Traveling for IVF from Out of State/Country–
•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
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
How often should intralipids be repeated after a positive pregnancy test?
Once for autoimmune implantation dysfunction and 2-4 weekly (until the 24th week) for alloimmune implantation dysfunction (DQa/HLA matching.
Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, find the “search bar” and 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Dear Doctor,
I see that many clinics offer IVM option where smaller follicles are matured in the lab. Can this really be done and is there any research to suggest success with maturing immature eggs to eggs that can be transferred with success?
At first it seemed to be a potential break through but als it has not nearly lived up to original expectations.
Geoff Sher
Hi Dr Sher, I recently did a FET with a PGS normal blastocyst which unfortunately ended in a chemical pregnancy. The HCG on day 14 was 66 however the levels only rose slightly and then decreased. I was taking Aspirin, Progynova, Crinone Gel with Prednisome for this protocol. In your opinion where could the failure have occurred? We used IMSI technique for the fertilisation and I have been diagnosed with PCOS.
Many thanks,
Hannah
Dear Dr. Sher,
Thank you for this blog that is a massive service to all going through the process of trying to have a baby.
I want to know, is 15,000 units of Pregnyl too much? Generally I get 10,000 and have been fine but wondered why 15,000 is recommended in some cases.
While more than needed, I do not believe it is likely to pose a problem.
Geoff Sher