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 dr. Sher,
What would your advice be? Taking the Pregnyl 36 or 34 hours before the egg collection? Will it make a big difference in the maturationprocess if it is taken 34 hours before the egg collection?
Thank you for your response!
My patients advised to take the hCG 36h prior to ER but honestly, I don’t believe 34h would make much difference.
Geoff Sher
How much does the expansion of the blastocyst by day 5 (i.e., ranging from 1-5) impact success rates? Do blastocysts that are graded at an expansion of 2-3 have a chance of being successful if the ICM and TE grading are high (i.e., A and/or B)?
That is subjective but certainly the more expanded it is by day 5 or at the latest by day 6…. the better.
Geoff Sher
Hi Dr. Sher,
I have been a patient at NYU Fertility Center for about 1 year now at the age of 29 (i just turned 30 last month). This came about after learning through a urologist that my husband, age 31, had low sperm count more than likely from a varicocele (under 10 million and around 2 million post wash). We couldn’t even proceed with IUI as it would have likely been a waste of our time. All testing on me to date came back normal – my entire life, my menstrual cycle has always been normal/28-29 days, excellent ovarian reserve, great AMA, FSH, all blood work, hormone levels, HSG, salinesonogram etc. I don’t have any underlying health issues whatsoever and my family has no history of infertility or any reproductive issues either. Neither of us had ever conceived before so IVF was what was recommended to us with ICSI considering we were a severe MFI case. We completed IVF cycle # 1 in June 2017 with PGS testing. I had 14 ER, 6 making it to blastocyst stage. We were thrilled! Until we got the devastating news from PGS/Reprogenetics that ALL 6 of our embryos were abnormal (2 were mosaic – 4 were a mix of monosomy/trisomy). Our RE chalked it up to just being bad luck and had us do a subsequent cycle in August/Sept, 2017 with just a very slight change in protocol. I ended up with 25 ER and 7 making it to blastocyst and again had PGS testing performed from Natera this time and THREE came back as normal. We were ecstatic and thought, “yes – that first IVF round was just a fluke.” I just had my 1st FET -eSET on Nov. 8th with our PGS normal, hatching blastocyst which was graded as a 5BB and was given a 65% chance of all 3 of my embryos resulting in live birth. I was on estrace pills and 1.5cc of progesterone injections 1x at night. My transfer itself was rated perfect, my RE said from cycle day 1 to transfer date all of my hormone levels, my lining (10.5mm) were “textbook” perfect. I got the devastating news on Nov 17th that the FET failed. My beta was <.01 – it did not even slightly implant. I am crushed and now my RE wants me to do an endometrial biopsy (check for endometritis) and another salinesonogram next week before FET #2. I guess was is concerning me was how genuinely "concerned" my RE was. She was in shock and had no answer as to why it didn't work and has now put all of these thoughts in my head that there is something seriously wrong and i am doomed for failure. I don't know how much more disappointment i can take so I am reaching out to you for any hope or advice. Many thanks 🙂
It is an indisputable fact that any IVF procedure is at least as likely to fail as it is to succeed. Thus when it comes to outcome, luck is an undeniable factor. Notwithstanding, it is incumbent upon the treating physician to carefully consider and address the causes of IVF failure before proceeding to another attempt:
Implantation Dysfunction (ID): Implantation dysfunction is a very common (often overlooked) cause of “unexplained” IVF failure. This is especially the case in young ovulating women who have normal ovarian reserve and have fertile partners. Failure to identify, typify, and address such issues is, in my opinion, an unfortunate and relatively common cause of repeated IVF failure in such women. Common sense dictates that if ultrasound guided embryo transfer is performed competently and yet repeated IVF attempts fail to propagate a viable pregnancy, implantation dysfunction must be seriously considered. Yet ID is probably the most overlooked factor. The most common causes of implantation dysfunction are:
a.A“ thin uterine lining”
b.A uterus with surface lesions in the cavity (polyps, fibroids, scar tissue)
c.Immunologic implantation dysfunction (IID)
d.Endocrine/molecular endometrial receptivity issues
You should have your blood tested for natural killer cell activity using the K-562 target cell test; antiphospholipid antibody panel; antithyroglobulin and antimicrosomal antibodies and a full reproductive immunophenotype. In addition, both you and your partner should also be tested for DQ alpha/HLA genetic matching The latter, if accompanied by you having NK cell activation could constitute an alloimmune implantation dysfunction and be problematic.
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.
•Ovarian Stimulation in Women Who have Diminished Ovarian Reserve (DOR): Introducing the Agonist/Antagonist Conversion protocol
•Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
•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?
•Blastocyst Embryo Transfers should be the Standard of Care in IVF
•IVF: How Many Attempts should be considered before Stopping?
•“Unexplained” Infertility: Often a matter of the Diagnosis Being Overlooked!
•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!
•Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
•Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
•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
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 .
*The 4th edition of my 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
Hi Dr. Sher,
I have two questions. First, is 25 mg (hypothyroid med) a safe med to use daily during pregnancy?
Second, I’m 40 and pregnant with my first child after doing ivf. I have some frozen embryos. How soon Can I do a FET after giving birth? I would like to breastfeed for three months or so. How long do I have to wait to do my frozen embryo transfer? I would like to try to get pregnant right away after having my first, if possible.
Thank you in advance for your advice!
Sherry
It probably won’t do harm but only use the thyroid supplementation if needed based upon an elevated TSH and under direction of your treating MD.
I would await the passage of 2 regular menstrual cycles and a normal blood prolactin level after stopping breast feeding, before doing an FET.
Geoff Sher
Hi Dr. Sher,
I am trying to understand why, for autoimmune treatment, lipid infusions are done only twice (once 7-14 before transfer and once after positive pregnancy test), but for alloimmune treatment lipid infusions are done up to 24 weeks?
Also, if a prescription for lipid infusions has been stopped after 14 weeks of pregnancy and the person has alloimmune issues, how concerned should they be that they will lose the baby?
Thank you for your time,
Randi
Hi randi,
We take additional precautions with alloimmune ID and prolong the infusions just as a precautionary measure. This is because with the advancement of the rapid and progressive advancement of the embryo’s root system, more and more NK cells can become activated while with autoimmune IID, we believe that NK cell activity is eliminated from the get go and since there is no matching, further expansion of the embryos root system will not likely evoke further activation of uterine NK cells. In all likelihood, IL up to 14 weeks should be OK for both…but this is simply going to extra length to try and avoid a loss later on.
Geoff Sher