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.
Dear Dr.Sher
I am 35 yrs old – The my OBGYN said i have premature ovarian failure since i had an AMH test to count the eggs reserves. the AMH was 0.1
Then, My first IVF cycle included the following drugs:
I had 4 Fostimone shots (4 powder + 2 Water) in addition to decapeptyl 0.1 mg shot for 2 weeks before egg retrieval I had 4 follicles ranging in sizes between 15-20 and I had 2 trigger shots midnight Saturday and I had the retrieval done on Sunday morning.
However, my retrieval process was unsuccessful since there no eggs!!
Is it still possible that I would have an egg and thus get pregnant?? is there any suggested protocols different than the one I been through (which is short protocol)??
Hi Maryam,
No doubt you do have very severely diminished ovarian reserve (DOR). This would result in it being it very difficult to make you respond without in the process causing premature luteinization and perhaps (in your case) resulting in “empty follicles” (see below). There is no doubt that egg donation would give by far the best result. However, because you are still relatively young (35y) you might still be able to make it with own eggs. If this is your direction, then you would in my opinion be best served by using a modified, robust, long pituitary down-regulation protocol. I would use an agonist/antagonist conversion protocol with human growth hormone (HGH) augmentation and would recommend Staggered IVF with embryo banking of PGS (next generation gene sequencing)-normal blastocysts, to make hay while the sun still shines.
Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, find the “search bar” and 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
•Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the“Conventional” Antagonist Aproach
•IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
•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)
•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?
•Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
•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 Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
•IVF Failure and Implantation Dysfunction: The Role of Endometrial Thickness, Uterine Pathology and Immunologic Factors
•Implications of “Empty Follicle Syndrome and “Premature Luteinization”
•Premature Luteinization (“the premature LH surge): Why it Happens and how it can be Prevented.
I invite you to call 702-699-7437 or 800-780-7437 or go online on this site and set up a one hour Skype consultation with me to discuss your case in detail.
I also suggest that you access the 4th edition of my book ,”In Vitro Fertilization, the ART of Making Babies”. It is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoff Sher
Dear Doctor Sher,
-Are antral follicles visible during egg retrieval?
-In patients with cancer can antral follicle pool be transferred from bad ovary to good ovary to prolong fertility?
Hi Fiona,
The answer to both questions is unfortunately not!!
Geoff Sher
Hi Dr Sher, I have just completed one cycle of embryo banking and am looking to do one or two more. How much rest in between cycles do you recommend. Is there any correlation between successfully collecting higher quality/quantity of eggs and the amount of rest in between cycles? My Traditional Chinese Doctor has suggested that I will collect more eggs if I take a longer rest (eg 3 months rather than only 1 or 2 months).
Many thanks! Sheena
You do not (in my opinion) need > 1 full resting month between cycles.
Good luck!
Geoff Sher
Hello Dr Sher. I am 32 and recently became pregnant, however my hCG levels dropped from 574 to about half that over 48 hours so I’m waiting now to bleed. I’ve charted for a year or so and my luteal phase varies from 9 days to 15. Mostly over 10, but I’ve had the occasional 9. I often spot brown blood prior to my period and just before I conceived I had only one day of red blood with two thin brown fluid days either side. Is this a luteal phase disorder, and how do I proceed in getting diagnosed and treated? Any advice greatly appreciated. Thank you so much.
You need a thorough work-up. You cannot diagnose a luteal phase defect with so little to ggo on. See a local reproductive endocrinologist.
Good luck!
Geoff Sher
Hi Sheena,
I respectfully disagree. In my opinion, you do not need > 1 full month with no treatment between each cycle.
Good luck!
Geoff Sher
Hey Dr. Sher, just got home from the ER after a scare at 7 weeks 4 days pregnancy.
-Had mild cramping last night in my pelvis– felt a lot like period cramps
-Woke up this morning at 6 am– no cramping, no blood, felt fine.
-Went for 45 minute walk at 8:00 am
-Came back and had significant amount of blood (not full on shooting blood, but more than just spotting– red color).
So I had my husband take me to the ER at 9 am. Bleeding had stopped– again no cramping was alongside with it earlier (just overnight). They did an abdominal and a transvaginal ultrasound and everything looked good, heartbeat at 153 bmp and measuring exactly 7 weeks 3 days.
However, now I’m concerned about the transvaginal ultrasound. This was my 3rd (had one at 5 weeks and one at 6 weeks)– and this technician in particular was in there for a LONG time. Like 10 minutes. She kept the wand moving, but was insistent on getting pictures of everything for the radiology report.
When I asked the Dr. about the safety of transvaginal ultrasounds he gave me a not so confident reply. Then when I googled it (I shouldn’t have, I know…), I read a ton of information stating they could be very harmful– especially one that was this long.
Now they want me to go back to my OBGYN tomorrow for ANOTHER one as a follow-up.
So my question: Do I need to be concerned about tv ultrasounds safety/frequency at this stage?
Also– they couldn’t pinpoint the cause of the bleeding. No hemmorage, no sex recently, no urinary tract infections, etc. Could it just be an irritated cervix from expanding last night (thus, my cramps in the middle of the night?)
Appreciate your advice very much.
Please believe me when I tell you that it is HIGHLY unlikely that the US will cause harm.
I predict that this too will pass and all will be well!
G-d bless!
Geoff Sher