– Geoffrey Sher, MD
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Name: jose s
Buenas tardes Dr
El resultado del examen PGT de mi esposa fue
Sample ID Sample Barcode Result Sex Chromosomes Impacted Interpretation
LB1 2023061467 Aneuploid XY +9 Abnormal
LB2 2023061467 Mosaic XY -Y [mos] Low Level Mosaic
Aconseja implantar el LB2 que es mosaico, que probabilidad de exito y bebe sano
gracias
Please re-post in English!
Geoff Sher
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) ; https://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\
Name: Anne C
Dear Dr. Sher,
Should Omnitrope continue to be taken on the day of the trigger and the next day, all the way till egg retrieval day, or stop two days before, when FSH stops? And what’s the optimal dosage?
Thanks for the kind and expert guidance,
A.C.
No! It stops on the day of the “trigger”.
Good luck!
Geoff Sher
______________________________________________________________________________________
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) ; https://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\
Name: Monika O
I am currently 33 years old and have already had 3 ICSIs. However, the first one was 5 years ago. Last year I stimulated for 2 days with 375 Gonal f and 75 Menopur and then with 225 Gonal f and 75 Menopur. Ovulation was suppressed with Cetrotide and triggered with 2 injections of Decapeptyl. Of 15 follicles, 14 were mature and could be fertilised, we had 8 embryos.
During the IVF this year in another clinic, I continuously stimulated with 300 Gonal f and 150 Menopur. This time I received a Decapepyl depot injection 2 weeks before the start of stimulation for downregulation. It was triggered with 250 Ovitrelle. I had 15 follicles, but only 6 eggs, 4 of which fertilised and we have 2 embryos. This time we are having them genetically tested for the first time (PGT-A). The doctor told me that the result was good, but I was shocked by the high number of empty follicles. I wonder if something could be changed in the protocol next time. Our doctor thought it was good the way it went. But I’m afraid that we’ll end up with so many empty follicles again. My AMH is “only” 1.7 ng/ml, which is within the normal range.
“Empty Follicle Syndrome” is a misleading term because follicles always contain eggs. However, some eggs may have difficulties detaching and being retrieved. This is more likely to happen when multiple attempts are needed to retrieve an egg from a follicle, indicating the egg may have chromosomal abnormalities.
The hormonal environment created during controlled ovarian stimulation plays a significant role in egg development. In certain cases, follicles may not release their eggs during retrieval, leading to the misconception of “empty” follicles.
This situation is most commonly encountered in older women, those with diminished ovarian reserve (DOR), and women with polycystic ovarian syndrome (PCOS). To address this problem, personalized protocols for controlled ovarian stimulation and careful administration of the hCG trigger shot are important.
The hCG trigger shot is given after optimal ovarian stimulation to initiate the process of reducing the number of chromosomes in the egg. It also helps the egg detach from the follicle’s inner wall. This allows for easier retrieval during the egg retrieval procedure.
Women with increased LH activity, such as older women, those with DOR, and women with PCOS, are more susceptible to the negative effects of LH-induced ovarian testosterone. Excessive LH activity can compromise egg development and increase the chances of chromosomal abnormalities. Medications like clomiphene and Letrozole can stimulate LH release, and certain drugs containing LH or hCG can have negative consequences.
Individualizing the controlled ovarian stimulation protocol, determining the correct dosage and type of hCG trigger, and administering it at the right time are crucial. The recommended dosage of urinary-derived hCG products is 10,000 units, while for recombinant DNA-derived hCG, the optimal dosage is 500 micrograms. A lower dosage of hCG can increase the risk of chromosomal abnormalities in the eggs and negatively impact the outcome of IVF.
Understanding the role of LH activity, the effects of medications on hormone release, and the importance of personalized protocols are vital. By optimizing these factors, the risk of failed egg retrieval and “empty follicle syndrome” can be minimized, improving the chances of successful IVF outcomes.
____________________________________________________
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) ; https://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\
Name: Irit L
Dear Dr. Sher,
Thank you for your answer.
I did take ivig before pregnancy was diagnosed. Took 30g ivig on ovulation and on positive hgc test but it faild to relax my immune system.
I refuse to take steroids as i was provided with 20mg prednison for 8 months. I had adison crises and ovarian shutdown with extremly elevated fsh. Took me a year to heal my ovaries and get pregnant again after i did a big research how to heal my ovaries and it luckily worked.
I want to try treatments that wont affect egg quality at all like ivig, lit, intralipids and plasmapheresis. I hope that i’ll manage to bank embryos for surrogacy but i am 44 so i need to see if ivf works for me.
I have a few questions:
1. I Did 3 lit treatments 1.5 years ago. Lads were negative.
After the last pregnancy loss I did the 4th lit. Finally lad became weak positive 40%. Do you think that positive lads gives me a better chance to carry a pregnancy?
2. Do you think tacro can be a good option after failing with ivig? Does it have horrible side effects like steroids?
Thanks a lot for your advises and terrific website. It helped me a lot.
Irit
This is my original message:
Just had my 6th miscarriage, natural conception with ivig and lit.
I am disgnosed with partial dq-alpha gene match (0301) and elevated nk cells.
We have a 4.5 years old son concieved naturaly and easily.
My miscarriages are very early.
We had 3 LITs a year and a half ago however LAD is still negative.
I took 30g IVIG on ovulution and on positive hgc test.
Aldo added ovidral on positive hgc test.
Immune pannel taken a day after the second ivig showed elevated tnf-alpha, elevated nk cell activity and 29.4% nk cell count.
We lost the pregnancy, the sac was empty and matched 4 weeks size.
I Did 3 lit treatments 1.5 years ago. Lads were negative.
After the last pregnancy loss I did the 4th lit. Finally lad became weak positive 40%. Do you think that positive lads gives me a better chance to carry a pregnancy?
A: I do not believe this to be so
2. Do you think tacro can be a good option after failing with ivig? Does it have horrible side effects like steroids?
A: Sorry, I have no experience with this treatment.
Name: Arielle M
I’ve had ECF ever since a d&c and forcep removal of rpoc in Jan 2022. I’ve taken prophylactic abx, hysteroscopy with loa and normal lap, 2.5 months lupron and letrozole for adeno. Failed medicated FET.
1) should I do a modified natural right away or do more lupron first?
2) I assume fluid is from adenomyosis (mri confirmed) but I’ve been trying to push my rei to do Emma and Alice to make sure no bacterial cause of fluid and inflammation but he doesn’t do. How can I find a doctor who will do it near me or is fertilysis of menstrual blood as good?
You can reply with med terms as I am a physician thanks!
There is too much here to discuss with a short response. We should talk. 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 <a href="mailto:concierge@sherivf.com.
GS
Name: Tasha T
For thin lining I am considering trying viagra suppositories. Is there a difference between just using the regular tablet vs. Having it compounded?
As info, with just estradiol, my lining seems to max out at about 7.2, hoping based on your research that Viagra can help push me to over 8!
Back in 1989, I conducted a study that examined how the thickness of a woman’s uterine lining, known as the endometrium, affected the successful implantation of embryos in IVF patients. The study revealed that when the uterine lining measured less than 8mm in thickness by the day of the “hCG trigger” in fresh IVF cycles, or at the start of progesterone therapy in embryo recipient cycles (such as frozen embryo transfers or egg donation IVF), the chances of pregnancy and birth were significantly improved. In my opinion, an ideal estrogen-promoted endometrial lining should measure at least 9mm in thickness, while a lining of 8-9mm is considered “intermediate.” In most cases, an estrogenic lining of less than 8mm is unlikely to result in a viable pregnancy.
A “poor” uterine lining typically occurs when the innermost layer of the endometrium, called the basal or germinal endometrium, fails to respond to estrogen and cannot develop a thick enough outer “functional” layer to support optimal embryo implantation and placenta development. The “functional” layer makes up two-thirds of the total endometrial thickness and is the layer that sheds during menstruation if no pregnancy occurs.
The main causes of a “poor” uterine lining include:
1. Damage to the basal endometrium due to:
o Inflammation of the endometrium (endometritis) often resulting from retained products of conception after abortion, miscarriage, or birth.
o Surgical trauma caused by aggressive uterine scraping during procedures like D&C.
2. Insensitivity of the basal endometrium to estrogen due to:
o Prolonged or excessive use of clomiphene citrate.
o Prenatal exposure to diethylstilbestrol (DES), a drug given to pregnant women in the 1960s to prevent miscarriage.
3. Overexposure of the uterine lining to ovarian male hormones, mainly testosterone, which can occur in older women, women with diminished ovarian reserve, and women with polycystic ovarian syndrome (PCOS) who have increased LH biological activity. This hormonal imbalance leads to the overproduction of testosterone in the ovary’s connective tissue, further exacerbated by certain ovarian stimulation methods used in IVF.
4. Reduced blood flow to the basal endometrium, often caused by:
o Multiple uterine fibroids, especially those located beneath the endometrium (submucosal).
o Uterine adenomyosis, an abnormal invasion of endometrial glands into the uterine muscle.
“The Viagra Connection”
Eighteen years ago, I reported on the successful use of vaginal Sildenafil (Viagra) in treating women with implantation dysfunction caused by thin endometrial linings. This breakthrough led to the birth of the world’s first “Viagra baby.” Since then, thousands of women with thin uterine linings have been treated with Viagra, and many have gone on to have babies after multiple unsuccessful IVF attempts.
Viagra gained popularity in the 1990s as an oral treatment for erectile dysfunction. Inspired by its mechanism of action, which increases penile blood flow through enhanced nitric oxide activity, I investigated whether vaginal administration of Viagra could improve uterine blood flow, deliver more estrogen to the basal endometrium, and promote endometrial thickening. Our findings confirmed that vaginal Viagra achieved these effects, while oral administration did not provide significant benefits. To facilitate treatment, we collaborated with a compound pharmacy to produce vaginal Viagra suppositories.
In our initial trial, four women with a history of poor endometrial development and failed conception underwent IVF treatment combined with vaginal Viagra therapy. The Viagra suppositories were administered four times daily for 8-11 days and stopped 5-7 days before embryo transfer. This treatment resulted in a rapid and significant improvement in uterine blood flow, leading to enhanced endometrial development in all four cases. Three of these women subsequently conceived. In 2002, I expanded the trial to include 105 women with repeated IVF failure due to persistently thin endometrial linings. About 70% of these women responded positively to Viagra therapy, with a notable increase in endometrial thickness. Forty-five percent achieved live births after a single cycle of IVF with Viagra treatment, and the miscarriage rate was only 9%. Women who did not show improvement in endometrial thickness following Viagra treatment did not achieve viable pregnancies.
When administered vaginally, Viagra is quickly absorbed and reaches the uterine blood system in high concentrations. It then dilutes as it enters the systemic circulation, explaining why treatment is virtually free from systemic side effects.
It is important to note that Viagra may not improve endometrial thickness in all cases. Approximately 30-40% of women treated may not experience any improvement. In severe cases of thin uterine linings where the basal endometrium has been permanently damaged and becomes unresponsive to estrogen, Viagra treatment is unlikely to be effective. This can occur due to conditions such as post-pregnancy endometritis, chronic inflammation resulting from uterine tuberculosis (rare in the United States), or extensive surgical damage to the basal endometrium.
In my practice, I sometimes recommend combining vaginal Viagra administration with oral Terbutaline (5mg). Viagra relaxes the muscle walls of uterine spiral arteries, while terbutaline relaxes the uterine muscle itself. The combination of these medications synergistically enhances blood flow through the uterus, improving estrogen delivery to the endometrial lining. However, it’s important to monitor potential side effects of Terbutaline such as agitation, tremors, and palpitations. Women with cardiac disease or irregular heartbeat should not use Terbutaline.
Approximately 75% of women with thin uterine linings respond positively to treatment within 2-3 days. Those who do not respond well often have severe inner ( (basal) endometrial lining damage, where improved uterine blood flow cannot stimulate a positive response. Such cases are commonly associated with previous pregnancy-related endometrial inflammation, occurring after abortions, infected vaginal deliveries, or cesarean sections.
Viagra therapy has been a game-changer for thousands of women with thin uterine linings, allowing them to successfully overcome infertility and build their families.
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 <a href="mailto:concierge@sherivf.co
PS: You need to use specially compounded vaginal Viagra suppositories. The pill wont work.
