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.
First off, thank you so much for your invaluable resources to the fertility community. Your blog posts and responses to questions are filled with a plethora of knowledge, so thank you! Also, the question I have is what (if any) detrimental effect could an elevated level of DHEA-S have during a FET? Could it cause implantation failure and/or early loss (i.e., chemical pregnancy)? If pregnancy is achieved, could it have a negative impact on the pregnancy and development of the fetus? Would you recommend the use of Dexmethesone to help address this? Thanks in advance!
Elevated DHEAS points to a increased/and possibly excessive male hormone production by the adrenal gland ,,,which could affect both egg development and uterine receptivity.could compromise the uterine lining and I would treat this with steroids regardless of whether for a fresh or frozen cycle.
Geoff Sher
Hi Dr. Sher,
Why do I always have 10mm follicle during my baseline appointment for IVF. My AMH is 0.36 and FSH 4.5-6.7. I am currently on Famara/Menopur/GonalF and HGH, earlier I was on BCP/GonalF/Menopur and Clomid/Menopur/Follistim. All three time, I had 10mm follicle at baseline and only my one ovary produced 2 eggs. Is there a better protocol for me? Would priming help?
Thanks
Katy
The 10mm baseline follicle is irrelevant. You clearly have severely diminished ovarian reserve.
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
my name is viktorija..
I have hashimoto.. I don’t want this for my kids at any cost…. I am hypothryoid.
I got this email from another net fertility source.
I wanted to know the risk for inheretance to my baby. my siblings sisters have hashimoto and mom.
I can chose PGD for male baby.. but I was told chances are higher than 50%. since 50 of my genes get mixed with 50% of genes from my husband.. I was told chances are high.
So my second option was donor egg to avoid this. This is more realistic option.
But I talked to few doctors, i had one say me as a mother my anti bodies pass the placenta and can still have adverse effect.
I had one endo tell me there is no effect, and another tell me i need to take PTU or MCI to stop the antibodies..
To give the donor egg baby develop healthy thyroid. Which one is it ?
I was given your clinic, I want to know the cost for the second option with the donor egg..
IS the risk the same with donor egg? Is the baby under attack in those 9 months thru the placenta?
I know I have to have TSH below 2.5, I currently take T3 Eurothyroxin 100mg. I might have to up that during pregnancy..
But even with TSH controlled What are the risks?
, do i have to take medicine blockers? how does it work?
If the risk is the same why do donor egg?
I had few endocrinologist doctors give me different answers?
Sincerely,
Viktorija @ MIle Sambevski
There is no way without doing egg donation to eliminate this risk and it can be genetically transmitted.
Geoff Sher
How would the use of Synarel help with obtaining trilaminar lining?
I would not use Synarel!
Please set up a consultation to discuss!
Geoff Sher
800-780-7437
Dr Sher do you cycle women back to back on your preferred agonist antagonist conversion protocol? Is there any harm in doing this or is it best to wait a month to allow your ovaries to recover after the first stim cycle?
I do not do back-to back fresh stimulation cycles. I require at least 1 month rest between.
Geoff Sher