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,
I’m a 41 yo with two natural miscarriages. I recently underwent two rounds of IVF and after retrieval and fertilization of 20 embryos I had 3 that made it to blast and all came back PGS abnormal. These are the results from the 3 embryos:
1.) 47,XX; +19, 2.) 45,XY; del(1)(pter-p31.1), -18 3.) 44,XX; -19, -21
Would you consider transferring any of these?
Thank you for your time.
Anne
No Anne…I personally would not transfer these.
Geoff Sher
Hi Dr Sher, I’ve noticed every time I take Chinese herbs my day 3 estrogen is elevated on a natural cycle. In all your years of cycling women on IVF, have you noticed those women taking Chinese herbs have improved their egg quality?
No Abi!
That is new to me!
Geoff Sher
Hi Dr Sher,
I had a successful FET some 4 weeks ago but I’m very concerned about my beta levels. They are through the roof while an ultrasound scan at exactly 6wks showed only one gestational sac and one heart.
-10 days past 4-day embryo transfer (14 dpo) 340
-12 dpt (16 dpo) 840 — doubling time 36.8 h
-17 dpt (21 dpo) 6,500 — doubling time 41 h
-24 dpt (28 dpo) 46,000 — doubling time 60 h
What could be the reason why the levels are so high? Is there an elevated risk of chromosomal abnormalities or miscarriage? I’m so stressed about it.
Looks good to me!
Remember, after the beta goes over about 6,000, it no longer will double every 48h.
Good luck!
Geoff Sher
I’ve had 2 ICSI cycles already, first 24 eggs retrieved but only 2 embryos came from that. Second cycle (lower meds) 15 eggs retrieved but again only 2 embryos in the end. I was told most eggs were immature. My AMH is 4.6 and I am 33 years old, no male factor. Why are my results so bad? I have a feeling I’m being stimmed wrong, both times Gonal F CD3-4, orgalutran, and no BCP.
I forgot to add that both cycles were antagonist protocols, first cycle I had Gonal f 150 IU CD3-CD12, with 75 IU luveris and 250mg cetrotide started CD5,
then ovidrelle 250mg trigger.
Second was Gonal F CD4-10, with orgalutran CD6-8, then ovidrelle 250mg trigger
In my opinion, the most important consideration should be selection of an ideal protocol for ovarian stimulation.
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
I had a recent failed IVF for unexplained infertility (I had asked my doc to skip the initial IUI’s because we want a baby sooner than later due to the uncertain health status of my grandmother and father in law). Well the IVF was a dismal failure with only one embryo after ICSI of 5 eggs (I have AMH 0.64). So my doctor asked me to at least go through the usual protocol and give him a shot with 3 IUI’s since I’m 34 and have 2 children (my husband has no bio children). I deep down felt the IUI’s were a waste of time because another RE had told my husband that we couldn’t get pregnant via IUI because he has DNA fragmentation. But, low and behold, the final IUI I became pregnant (I had my husband collect a double sample into the sample cup for the first time and his post wash count went up from his prior counts of 1mil and 3.8mil to 28mil for this double collection!). So now I am 5 weeks and 3 days post IUI. No symptoms of miscarriage, however I am concerned about my betas. 11 days post IUI my beta was 37.5, 5 days later it was 214.9, and then 8 days later (today) it was 1714. So, if I calculated properly, the doubling time is around 64 hours. I can’t find any definitive information online as to whether this doubling time is acceptable, and I was wondering your thoughts. Thank you so much!
It is a slowish rise but this can vary. So I would repeat it in 2 days time to see if it doubles and thereupon, about a week later, do an ultrasound to determine what is happening with more confidence.
Good luck!
Geoff Sher