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 40 yrs old and I have two children natural. I had to go thru IVF due to both tubes being blocked and covered with scare tissue. I had my first transfer in August with a positive and lost it at 6 weeks for unknown reasons. Then I had my second transfer in November with a positive and lost it at 5 weeks 3 days. We were able to test the tissue and it came back normal. What could be causing my body to reject the implanted embryo. What are your suggestions on testing that I should ask to be done. We only have one more shot at this. I want to make sure that I have covered all that I can before this last transfer.
Hi,
I’m about to undergo IVF for baby #2. We were successful on our first attempt but just had a failed frozen transfer from that same batch (our only remaining embryo). I think I may be advised to stick with the same protocol since it worked last time, however it was very touch and go with my follicles developing at different rates, so there was a real possibility of ovulating too early before the others had a chance to catch up. I’ve been told there’s no way to avoid this happening but want to ask if there is a certain approach that can be taken to avoid this? I was on the short protocol last time and was 34; I am now 36.
Thanks!
Hello,
I am 43.5 years old. Got married only 3 months ago. All is new for me as I live in traditional society (no premarital sex)… my doctor suggest IVF right away given my age (she said I don’t have much room, after 45 she wouldn’t do such procedure for me).
I had my first cycle already (3 ova retrieved, only 1 embryo transferred at day 3). I got negative pregnancy test on Monday 18/12/2017).
she had me prepared before hand for this possibility “given my age”. all I have been reading online seems against me or not in favor of people in my age category.
is it worth trying again? or I will be always faced with the age reply (All hormonal screening was within normal range except AMH which was 0.55).
(donor egg and adoption are not an option in my society and also not acceptable from my personal religious view – with all due respect to people who opt for such solutions).
Thank you
Given your age and low AMH (diminished ovarian reserve, there is no doubt that IVF is your only rational option. However IVF with egg donation is by far the best option. However, if you insist upon using own eggs in spite of advice to the contrary, then consider the following:
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
Hi Dr. Sher, what are your thoughts on natural cycle v. medicated FET? I’m 42 and after 2 cycles of IVF that produced a good number of eggs, I have only one chromosomally normal embryo to transfer. I ovulate regularly and endometrial lining is above average thickness. Thanks!
Tanya, I much prefer medicated FET’s because using this approach, we are much more able to pinpoint the transfer for tghe window of implantation. . Your poor yield of euploid blastocysts could have to =do with the protocol used for ovarian stimulation.
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.
Hi Dr Sher
I have missed 20 days of my periods but pregnancy test is negative and beta hcg level is 5.14umi/ml .I have passed from ectoic pregnancy 6months ago and Dr remove one tube I want to be pregnant guide me please
What can I do now?
Your hCG level must drop to zero before you can start treatment. I would be happy to discuss your case with you but to do so I would need a great deal more information.
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.
Geoff Sher