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.
Hi Dr. Sher,
I just turned 40 years with normal ovarian reserve.
Had my son naturally at age 38 and 2 early miscarriages (5 weeks and chemical) at age 39.
I am to start IVF treatment next month – Spontaneous Antagonist Lupron Trigger Freeze All
I will be taking Cetrotide .25mg, Gonal F 300IU, Menopur 75IU, and Leuprolide acetate.
Any thoughts on this treatment plan for my age? Would you recommend the same? Thank you!
There are many approaches to ovarian stimulation in women with normal ovarian reserve. Here is the protocol I advise for women, 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
Hi Dr. Sher,
Do you find in some cases, estrace pills causes fluid in the lining? Do you have any recommendations on how to eliminate the fluid? Would you aspirate the fluid prior to transfer?
Thanks!
Estrace won’t cause this. Usually the fluid is cervical mucous that back-tracks from the cervixd into the uterine cavity. It will absorb with progesterone in most cases and allow you top proceed with ET. In some cases it can be due to a surface lesion in the uterine cavity ( a polyp/fibroid/scars tissue) that irritates the uterine lining causing secretions to build up. You need a diagnostic/therapeutic hysteroscopy to address the latter.
Geoff Sher
Is there a way I can have my medical records sent to you and then have your nurse coordinator call me for pricing info with medication regimen? Due to my schedule, I really need to know before I start this process again
Yes indeed!! Please call Julie Dahan (Patient concierge) at 800-780-7437). She will assist you.
Geoff Sher
This was my first IVF attempt with egg retrieval on 11/14/17. I started with Gonal 150 and menopur 150. Around day 3 I lowered to Gonal 75 and menopur 75 if not mistaken. It could have been the other way around, not sure. After a couple more days I was on Gonal 75 and menopur 75. I also used certitude. Anyhow I retrieved 19 eggs, only 8 fertilized naturally, 4 made it to day 5. They were sent for PGS, none were good. I am 39 with PCOS, I had my left Fallopian tube removed in Sept. I am taking Ovasitol instead of metformin, just wondering if I should take metformin instead. I really would like to come for a consultation but I live in Atlanta. How long would it take for STIM and egg retrieval if I come to you? Also do you send embryos for PGS? If so how much? I tried to call but they did not have any answers
Apologies for the duplication, there seems to be an issue with reCAPTCHA. Please delete if this has already come through, even though i can’t see it!
Hi Dr Sher,
I went to my RE and asked him if I could do 2 days with 450IU Gonal F and then drop down to 300IU on the third day (using your A/ACP). He told me it’s not a good idea to start high and dose down on Gonal F because it can result in follicle apoptosis if the follicles aren’t getting the same consistent amount of FSH each day. I told him the high dose for the first few days recruits a bigger crop of follicles and then the dose can be dialled down to 300 until trigger. But he refused! I know that this is not your opinion since you do this, but are there instances where this could happen in your experience? Interested to hear your thoughts.
Respectfully…I completely disagree with this advice given to you.
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