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 am trying desperately to learn more about the amount of blood passed durring menstruation in relation to fertility. I have very little bleeding (20-30ml) 3 days, within a cycle of 30-34 days. I have ovulation pain due to cystic ovaries, I get tender breasts from about 14th day until the start of the next period. Lots of PMS symptoms leading up to menstruation (mood, cramping, acne etc.)
We had an early misscariage this year, and have been trying for 4 months since. I wonder if I’m unable to build up a substantial lining for implantation, judging by how little I bleed?
Hi SJ
The amount of visible bleeding does not necessarily correlate with endometrial thickness or fertility potential. Have an ultrasound at the time of ovulation and if the lining is at least b8mm thick you should have no problem.
Geoff Sher
Cycle 1: Clomid & Estrace priming, 300 Follistim, 150 Menopur, Ganirelex added, Trigger 10,000 Pregnyl and Lupron; 3 retrieved, 0 fertilized
Cycle 2: Lupron priming, 225 Follistim, 150 Menopur, Trigger 10,000 Pregnyl & 450 Follistim; 6 retrieved, 5 fertilized, 5 frozen day 3
Cycle 3: same as C2, added Ganirelex, Trigger 5,000 Pregnyl & 450 Follistim; 8 retrieved, 6 fertilized, 4 fresh day 3 transfer and 1 frozen
1 natural pregnancy at 42.3 ended in MC. C1 at CCRM at 43.3. Originally planned to CCS test. Transferred to a local clinic for C2 & C3. Given results from first cycle, our RE felt we should do a day 3 transfer. Just turned 44. Doing one more banking cycle before FETs. With all cycles right side peters out but did better with Cycle 2 & 3. Typically I have about 12 follicles. RE wants to add HGH this cycle and plans to keep protocol the same. Should we grow to day 5 and PGS test? Day 3 quality on C1 & C2 has been excellent. Is there anything you would do different with protocol? What are your thoughts on scratch and ERA test?
Dear Dr. Sher,
I’m 38, just not my second IVF cycle. I was on Menopur 450 iu in the first cycle and in this one, but have had poor response (2 eggs in both cycles). Any idea why this might be? My first cycle was with cetrotide, and this one is with Buserelin.
I would need to know much more regarding your ovarian reserve as well as the details regarding the stimulation to be able to comment authoritatively.
Geoff Sher
I am 42 years old, I was diagnosed with pcos in 2009. I had 5 cycles of IVF in 2014 — 2017, all of which have failed.
* I had 4 eggs retrieved with 150 IU of menopur in the first cycle, resulting in 2 embryos.
*The dose was increased to 225 IU for the second cycle resulting in 18 eggs being retrieved out of which 8 embryos were formed.
* 225 IU was administered for the third cycle as well resulting in 13 eggs, out of which 8 embryos formed.
*Afterwards, I underwent hysteroscopy in which my right f.tube was clipped. In the following ivf, in 2016, I was given 300 IU highly purified FHS , trigger used was hcg . This resulted in a single egg being retieved which resulted in an embryo. I had a viable pregnancy till 8-9 weeks,
foetal heartbeat could also be seen on the sonography. But around 9-10 th week I had a missed abortion.
* Next cycle with 300 IU of menopur resulted in 10 eggs, 4 of which went on to become embryos.
* In the next upcoming cycle my gynac is planning to give me recombinent FSH 300 along with 150 IU of LH as the agonist.
* In your opinion which one out of Highly purified FSH and Recombinant FSH is better at my age and would give better quality and/or more eggs? I will be taking OCP (ovral g) for one month prior to the Ivf cycle. Also my gynac has put me on Metformin 500 mg TDS 30 mins after meals.
*Do you think this will improve my chances of getting more eggs resulting in an viable pregnancy?
* My FSH is 5.41 mIU/ml
LH is 2.52 mIU/ml
E2 is 22.0 pg/ml
these values are on day three of my periods in this ongoing month of October 2017.
* Would the Agonist/antagonist conversion cycle be advisable for me with these values?
*. My AMH levels in July 2016 were 3.95 ngm/ml and has increased to 6.50 ngm/ml in July 2017. What does this indicate? Am I going towards OHS or any other pathology?
*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.
*Would my eggs have more chromosomal anamolies at 42 or are there some healthy eggs also remaining at this age?
I thank you Dr. Sher for all your patience and advice.
First, your history is not typical of PCOS. You seem to be ovulating on your own, you do not have an inverted FSH:LH ratio and your response to stimulation is not over the top. I do not think you are at risk of developing OHSS. While your response to stimulation is often blunted, your AMH is good and so you should respond better. I do believe that your protocol for ovarian stimulation needs to be critically reviewed and revised.
Here is the protocol I advise for women, <40Y who have adequate ovarian reserve.
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
hello Dr sheriv in OHSS hystrogest and decapeptyl can be taken? best thanks
In my opinion, yes!
Geoff Sher