19,771 Comments

1. Mimi on October 16, 2017 at 5:38 pm

   Hi Dr. Sher,
   I am 43 yrs old, had 5 cycles of IUI and 1 failed IVF cycle. My FSH is 17, LH is 6.8 and AMH is almost non existence ( .16). I am thinking of donor egg but still wanted to try another IVF that is tailored base on my situation.
   My previous IVF I was prescribed 225 of Follistim and 10 u of micro Hcg, Ive got 2 big follicles and they increase Follistim to 3oo on day 8, I’ve got another 2 follicles but didn’t make it to Egg retrieval. I was told that my eggs have poor quality and the other one didn’t fertilized.
   My questions are..
   Is my egg really bad (I’ve been taking omega 3, Coq10, dhea for morethan a year), that is why non of the egg fertilized? in this situation is there still hope that i can have a good quality eggs that can still make me pregnant? does the meds also have a role for a not successful IVF cycle?
   Do you accept client with a case like me?
   Dr. I told myself 3 months ago, I just wanted to give it a try with 1 cycle after that I can move on with donor egg but my experience with this clinic was I felt like I was in a drive thru, never had the chance to talk to a RE during and after my cycle which left many unanswered questions on my part 🙁

   Thank you!

   • Dr. Geoffrey Sher on October 16, 2017 at 8:19 pm

     At 43y with severely diminished ovarian reserve you absolutely should almost exclusively be considering egg donation. However, if this is out of the question then consider then please following:

     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”.
     Older women as well as those who (regardless of age) have diminished ovarian reserve (DOR) tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend to have increased LH biological activity which often results in excessive LH-induced ovarian testosterone production which in turn can have a deleterious effect on egg/embryo “competency”.
     Certain ovarian stimulation regimes either promote excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), augment LH/hCG delivered through additional administration (e.g. high dosage menotropins such as Menopur), or fail to protect against body’s own/self-produced LH (e.g. late antagonist protocols where drugs such as Ganirelix/Cetrotide/Orgalutron that are first administered 6-7 days after ovarian stimulation has commenced).
     I try to avoid using such protocols/regimes (especially) in older women and those with DOR, favoring instead the use of a modified, long pituitary down-regulation protocol (the agonist/antagonist conversion protocol-A/ACP) augmented by adding supplementary human growth hormone (HGH). I further recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing/NGS)-normal blastocysts in such cases. This type of approach will in my opinion, optimize the chance of a viable pregnancy per embryo transfer procedure and provide an opportunity to capitalize on whatever residual ovarian reserve and egg quality still exists, allowing the chance to “make hay while the sun still shines”.
     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.

     •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
     •Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
     •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.
     •Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
     •Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
     •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?
     •Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
     •Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
     •Preimplantation Genetic Testing (PGS) in IVF: It Should be Used Selectively and NOT be Routine.
     •Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
     •PGS in IVF: Are Some Chromosomally abnormal Embryos Capable of Resulting in Normal Babies and Being Wrongly Discarded?
     •PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
     •Implications of “Empty Follicle Syndrome and “Premature Luteinization”
     •Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.

     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 book,”In Vitro Fertilization, the ART of Making Babies” is now available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.

     Geoffrey Sher MD

2. Carol on October 16, 2017 at 3:34 pm

   Hi Doctor Sher. Is there an interaction between Progesterone and TSH/T3/T4 hormones? I’m 8 weeks pregnant after successful IVF FET, and I’m now on very large doses of progesterone. For the past two weeks I’ve have had pain in my neck and difficulty swallowing my food and my pills, often vomiting them as they’re too difficult to swallow. I had my TSH tested before I fell pregnant, and it was normal (1.51). I have not had my T4 or T3 levels tested yet.

   Also, is there any increased if miscarriage if TSH/T4/T3 hormones are too high or low?

   Thank you greatly for considering this and replying. Bless you.

   • Dr. Geoffrey Sher on October 16, 2017 at 8:17 pm

     There is no such interaction, but indeed, if T4/T3 is low, there would be an increase in the possibility for miscarriage.

     Geoff Sher

3. LHH on October 16, 2017 at 1:49 pm

   Hi Dr Sher,

   I am 42 years old and am currently doing mimi-stim IVF with a local clinic. I have low ovarian reserve and have gone through 2 cycles of 5 days clomid/ 150iu gonal-F/75iu menopur/centrotide (3 days each) and HCG & Lupron trigger. I have 3 antral follicles but the doctor was only able to stimulate one follicle each cycle resulting in one egg retrieval the first cycle and no egg this last cycle. The doctor wants to put me back on birth control for 2 wks and start another cycle. We originally were planning on doing 3 mini-stims but ideally, the doctor wants 5 eggs before transfer of all the eggs at once (which means we will have to do more than 3 cycles at this rate).

   I would like to know if there are any other combinations/ different types or quantities of drugs we should consider to get all 3 antral follicles to respond and possibly produce 3 eggs each cycle? I am confused as to why only one follicle has responded and I yielded no eggs this last cycle. Any advice or thoughts you can provide are greatly appreciated. Thanks! -Linda

4. Lina on October 16, 2017 at 1:19 pm

   Hello Dr Sher,

   I understand ICSI is mandatory for reliable PGD. However, in your opinion, is ICSI also absolutely required for reliable PGS results?

5. Barbara on October 16, 2017 at 12:03 pm

   Dear Dr Sher,

   Thank you very much for your very informative blog, and the opportunity like this to ask you a direct question.
   I am currently gearing up to start Gonal-F (and Menopur, and Cetrotide) injections to prepare for egg donation for friends of mine. The clinic they have chosen (based in Cyprus) have sent me a medication schedule, which has me on 450 IU of Gonal F for 4 days (day 3-6), then scaling back to 300 IU per day until day 12, but adding 150 IU of Menopur. Cetrotide might be added based on ultrasound results starting day 9.
   This seems like a very high dose of medication to me (going off of what other women have posted on forums, etc), and it is my first round of egg donation. I have no prior experience with this, so neither I, nor the clinic, know what my response to these medications is.
   I believe they have chosen these doses due to my AMH and FSH levels: 1.16 ng/ml and 9.5 mIU/ml, respectively. I am 33 years old, so I’m not a young egg donor, and I realize that these values are not great. Still, I am worried about hyperstimulation, and concerned that the clinic has not taken my own health into account.
   I would be very happy if you could share your opinion on the dosage, and any advice that you may have!
   Thank you very much,
   Barbara

   • Dr. Geoffrey Sher on October 16, 2017 at 8:14 pm

     You seem to have prematurely diminishing ovarian reserve. Thus I agree with using a higher dosage of gonadotropins in your case.

     Geoff sher