Ask Our Doctors

Supporting Your Journey

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 Patients,

    I created this forum to welcome any questions you have on the topic of infertility, IVF, conception, testing, evaluation, or any related topics. I do my best to answer all questions in less than 24 hours. I know your question is important and, in many cases, I will answer within just a few hours. Thank you for taking the time to trust me with your concern.

    – Geoffrey Sher, MD

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Seeking advice – IUI + letrozole

Name: Mallory F

Hi Dr. Sher,
I listened to the podcast on IUI with you and Dr. Aimee, the egg whisperer and I wanted to reach out to you in hopes of seeking your advice. I am a 34 year old who is “unexplained” and I normally ovulate on my own. All blood work has been normal for me except for high TPO antibodies which the doctor has had me on a low dose of levothyroxine for a while now. My husband has a normal semen analysis. We have been trying for 2 years and the first time we conceived back in October 2022, I was on letrozole for “superovulation” and ended up having two mature follicles one on each ovary and we just did timed intercourse that cycle, but I ended up having a missed miscarriage at 7 weeks. We decided to try on our own for several months after without taking letrozole and we were not having any luck. In August 2023 we decided to try IUI so we did letrozole and the trigger shot and it actually worked until it ended in a chemical miscarriage. We did two more rounds of IUI after that and have not had success.
Do you feel IUI is even worth pursuing a couple more times given that I ovulate on my own and my husband’s SA is normal? Did the letrozole help us conceive, could it have caused the miscarriages? Would it be the same success rate as if we just tried on our own without even taking letrozole? I am so confused and at a loss on what to try and how long I should keep trying before considering IVF. Thank you in advance for taking the time to read this.

Thank you,
Mallory

Author

Answer:

My bigger concern is that you might have an immunologic inmmplantation dysfunction and if so , IUI alone wont bve effective. This could explain your losses too.

Between 2% and 5% of women in their childbearing years deal with hypothyroidism, a condition that affects women more than men. This issue with the thyroid often leads to difficulties in getting pregnant or maintaining a pregnancy.

Hypothyroidism in women often  happens because the immune system attacks the thyroid gland. The condition is known as Autoimmune Hypothyroidism or Hashimoto’s disease. Specific antibodies, like antithyroglobulin and thyroid peroxidase (TPO) antibodies, slowly reduce thyroid hormone production. Genetics, estrogen effects, and X chromosome abnormalities also contribute to its prevalence among women.

Here’s a surprising fact: Even women who don’t show obvious thyroid problems might have thyroid antibodies linked to trouble conceiving or experiencing recurrent pregnancy loss (RPL). These sneaky antibodies can linger without clear signs of hypothyroidism in clinical or lab tests. And commonly, even after treating hypothyroidism with hormone supplements, these antibodies stick around.

More than two decades ago, I performed a study and reported on the fact that almost 50% of women with thyroid antibodies, regardless of thyroid function, had overactive uterine natural killer cells (NKa) and activated cytotoxic lymphocytes (CTLa) that are capable of  attacking  the embryo’s “root system”  (trophoblast) and compromising implantation. The result was often total implantation failure (often erroneously diagnosed as infertility) or early pregnancy loss. Testing for NKa and CTLa requires access to  few highly specialized  Reproductive Immunology Reference laboratories. We demonstrated that treating these women with immune therapies like Intralipid or immunoglobulin-G, along with a sprinkle of low-dose steroids, significantly boosted their chances of successful reproduction.

For example, let’s take a peek at the journey of a one of my patients, a 42-year-old Australian physician. She faced a whopping 23 unsuccessful IVF attempts due to Hashimoto’s disease. We rapidly identified underlying NKa/CTLa  and after a single cycle of tailored immune therapy ( as above) she conceived and gave birth to a healthy baby boy—an incredible glimmer of hope in her life.

It’s important to note that not every woman with thyroid antibodies experiences an immune cell party in her body. However, understanding this unique relationship and providing the right treatments can reverse immunologic implantation dysfunction (IID) caused by NKa/CTLa. This knowledge offers renewed hope, making the journey to successful reproduction a brighter and more achievable adventure.

In the end, remember this: Even when your body throws a curveball like autoimmune thyroid IID the game isn’t over. With the right strategies, a sprinkle of hope, and a dash of persistence, victory is within each. So, chin up and keep moving forward.

 PLEASE SHARE THIS WITH OTHERS AND HELP SPREAD THE WORD!!

 

Herewith are  online links to 2  E-books recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)……. for your reading pleasure:

  1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

 

  1. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

 

I invite you to visit my very recently launched “Podcast”,  “HAVE A BABY” on RUMBLE;   https://rumble.com/c/c-3304480

If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\

Quiero tener un bb tengo 55 ano

Name: Neibe C

Quiero tener un bb

Author

Answer:

Please re-post in English!

Geoff Sher

Pregunta sobre fertilidad

Name: Alexa A

Quiero saber el precio y los pasos a seguir

Author

Answer:

Please re-post in English!

Geoff Sher
_____________________________________________________

Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)……. for your reading pleasure:
1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

2. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\

Polypectomy

Name: Tania L

Hi I was trying to do a treatment on another facility I have two frozen embryos. I want to know if I could do the Polypectomy at your office and do my check up on your office. I don’t know if we can get the frozen embryos transfer to your office. I hope you could help me. Thank you. I was your patient long time ago. My daughter it’s going to turn 10.

Author

Answer:

Absolutely this can be done. AND it is easy to relocate embryos to us. We do so all the time from all over the world. We in large part help facilitate this for you!

G-d bless!

Geoff Sher
________________________________________________
Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)……. for your reading pleasure:
1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

2. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\

Donor embryo transfer

Name: Mayumi K

Hi Dr. Sher,

My husband and I struggled with infertility and failed with IVF. Now we are pursuing embryo donation and we were matched with a couple whose embryos are stored at your clinic. We live in Rochester, NY and I was wondering if my local clinic (university of Rochester) can monitor me and I go to your clinic for transfer. Please let me know how many trips to NYC I have to make in order to transfer embryos that are stored at your clinic. Thank you.

Author

Answer:

Absolutely, we often do this. It would probably take no more than 4-5 visits at our center over a 10 day period of time. all the time!

More and more American women are exploring IVF treatments in their late 30s and in their 40s. This trend often stems from the choice to pursue their career dreams before starting a family. While this delay is completely understandable, it presents challenges, as success rates decline rapidly and progressively as women reach their late 30s and advance into their 40s.

As women age beyond 35, there’s a natural increase in chromosomal abnormalities in their eggs. This can make it challenging for embryos to develop healthily. Additionally, the ovarian egg supply decreases ( I.e., diminishing ovarian reserve-DOR) as women get older, profoundly affecting the number of viable embryos available for IVF.

But here’s the exciting part: advancements in science and technology are lighting the way for a brighter future which holds promise. We’re on the brink of remarkable breakthroughs that could change the game. They could potentially pause the biological clock, allowing for family planning that aligns with their goals.

Imagine a world where we can navigate these obstacles, helping women have the family they’ve always dreamed of, even if they choose to wait a bit longer. That’s the future we’re working towards—a future full of hope, possibility, and fulfilling dreams.

Let’s dive into an exciting concept of “Embryo Banking or Stockpiling”! This holds immense potential, especially given the inevitability that advancing age will ultimately profoundly compromise reproductive potential. It offers the potential to defy the ticking “biological clock.”

Picture this: a method that lets you freeze and store embryos for future use, giving you more control over when to start a family. How does it work? Through IVF, eggs are retrieved and fertilized, embryos are propagated and those that reach the advanced stage of development (blastocysts) are biopsied and ultra rapidly frozen using an advanced method known as “vitrification”’ which allows them to be banked or stored indefinitely with minimal risk to their viability.

What’s thrilling is that this technology wasn’t available 20 years ago. In addition, advanced genetic testing like next-generation gene sequencing (NGS) now enables us to identify the healthiest embryos along, determine their gender and then selectively vitrify and bank them for future use. And guess what? Thawing and transferring these embryos in the future is virtually as successful in propagating healthy pregnancies as using fresh ones.

This innovation is like hitting pause on the “biological clock,” allowing for a more flexible and promising family planning journey. It’s a game-changer, especially for those dreaming of having children while using their own eggs. The future looks bright and full of possibilities with these incredible breakthroughs!

Let’s explore an empowering aspect of embryo banking: You have options! Preimplantation genetic screening (PGS) / preimplantation genetic testing for aneuploidy (PGT-A) which enables testing for the embryo’s chromosomal integrity is a valuable tool that helps us pick the most promising embryos.

Imagine having the ability to choose the embryos that stand the best chance, boosting the possibility of a successful pregnancy and at the same time identifying their gender. PGS/PGT-A isn’t about making the embryos better; it’s about selecting the strongest contenders for transfer, greatly increasing the chance of a healthy baby with each attempt.

It’s vital to understand that as women age, chromosomal abnormalities in eggs and embryos become more common, making it crucial to identify the most “competent” ones. By doing so, we not only heighten the chances of IVF success, but we also reduce the risks of miscarriages and certain birth defects.

In our quest to improve IVF, we were pioneers in introducing PGS/PGT-A into the field. Starting with one method, we finally embraced a better technique called next generation gene sequencing ( NGS) , advancing our ability to select the best embryos. Success stories have poured in since, and this approach is now widely accepted in the world of IVF.

Today, we proudly offer selective embryo banking, giving more and more older women and those with DOR hope for a brighter family future. The path to achieving your family dreams is now clearer and more promising than ever!.

_____________________________________________________________________________________________
Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)……. for your reading pleasure:
1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

2. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\

Endometrioma cyst

Name: Lizeth C

Hello:) I have an endometrioma cyst on my right ovary the drs want to do laparoscopy surgery but it runs the risk of getting good ovarian tissue and since I only have the right ovary I don’t want to do that. I’ve looked up different methods and I found out about sclerotherapy I wanted to ask about that if you can please help me out with that! Thank you in advance!!:)

Author

Answer:

It is excellent alternative but unfortunately the medication needed to be injected into the cyst is no longer available. I wish I could help you!

Geoff Sher

Here is an article I wrote some time ago!

• Effect of Advanced Endometriosis with Endometriotic cysts (Endometriomas) on IVF Outcome & Treatment Options.

Advanced endometriosis is often associated with ovarian endometriotic cysts, known as endometriomas. In my opinion, such cysts, if numerous or sizable (>1cm) can and often do activate the surrounding ovarian connective tissue to locally produce excessive amounts of male hormones such as testosterone. This effect can often not be detected in the blood but nevertheless occurs in the affected ovary where, upon entering the follicles, it can i(n my opinion) compromise egg development which in turn often can result in abnormal egg development during ovarian stimulation. This can in my opinion, lead to increased numerical chromosomal abnormalities (aneuploidy), reducing egg/embryo competency”. Thus it is my opinion that any ovarian endometriomas larger than 1cm in diameter, should be removed eliminated before embarking on IVF.

Aside from compromising egg quality in the involved ovary, endometriomas can also cause severe and intractable pelvic pain, heavy menstruation (menometrorrhagia) and painful intercourse. They can also rupture leading to dissemination throughout the abdominal-pelvic cavity. Accordingly, they are best addressed sooner rather than later.
SurgicalTreatment: Conventional treatment of endometriomas involves complete surgical removal, usually conducted laparoscopically. Unfortunately, with surgery normal ovarian tissue can inadvertently be removed/damaged and result in scarring that that can compromise subsequent egg development in the affected ovary. Since many women who have endometriomas have already undergone previous surgery (ies) for endometriosis. Both the surgery (ies) and the advanced endometriosis will often have resulted in significant scarring and adhesion formation that can compromise subsequent visualization of, and access to anatomic structures during surgery, thereby increasing the risk of surgical complications. As such, many women with recurrent ovarian endometriomas are uncomfortable with the prospect of repeat surgery and its avoidance is often a factor in their decision to proceed with IVF.
Sclerotherapy: About 15 years ago I reported on a new, safe and highly effective outpatient approach to treating endometriomas in women planning to undergo IVF. This treatment, referred to as sclerotherapy involves ultrasound needle guided aspiration of the “chocolate colored liquid content of the endometriotic cyst, followed by the injection of 5% tetracycline hydrochloride into the cyst cavity. In more than 75% of cases, this will result in disappearance of the lesion within 6-8 weeks. In some cases the injection of tetracycline into the endometrioma causes a reaction that results in clear or blood stained fluid collecting in the original cyst cavity where the endometrioma had been. Upon re-aspirating the fluid in the seroma, the lesion will usually disappears permanently. In a small number of cases, the endometrioma comes back and sclerotherapy must be repeated or surgical removal undertaken.
Ovarian sclerotherapy can be performed under local anesthesia or under conscious sedation. It has the advantage of being an ambulatory in-office procedure, low cost, and has a low incidence of significant post-procedural pain or complications as well as the avoidance of the need for invasive surgery. As such, sclerotherapy is in my opinion, the preferred treatment of endometriomas in women contemplating IVF and thus wish to preserve as much ovarian function as possible. It is a safe, effective and relatively inexpensive alternative to surgery. Since the procedure is associated with a small, but yet realistic possibility of pelvic adhesion formation; its use should in my opinion be confined to cases where IVF is the only treatment available to the patient or for women who intend to try and conceive through fertilization in their fallopian tubes (e.g. following natural conception or intrauterine insemination), who in my opinion would be better off undergoing laparotomy or laparoscopy for the treatment of their endometriomas.

____________________________________________________________________________________________
Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)……. for your reading pleasure:
1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) ; http://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

2. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link ;https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

I invite you to visit my very recently launched “Podcast”, “HAVE A BABY” on RUMBLE; https://rumble.com/c/c-3304480
If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or email her at concierge@sherivf.com\

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