Ask Our Doctors
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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Hi Dr. Sher,
I’m wondering what your opinion is on using HGH specifically for egg QUALITY (not quantity). I’m turning 44 in a week and although my reserve seems to be fine, it’s the quality that I’m attempting to help. So far I’ve had one doctor tell me that HGH can possibly help with quality and another day that there is no research indicating that and given quantity is not my concern, it would not make sense to use HGH.
Any thoughts would be greatly appreciated.
We are 20 weeks and have our anatomy scan next week. Very anxious! Day 5 4AA euploid embryo. Quad screen levels all looked perfect at 16 weeks. Is it safe to relax now? Does a tested high-quality embryo with a negative quad screen all but guarantee a live birth? Thank you so much!
Dear dr. Sher!
I have a question about Clexane. I’m 17 weeks pregnant, I’ve been injecting 0.4 clexane since the beginning, I started at about 67 kg and gained about 3 kg so far.
I am on immune therapy due to previous treatments, from there the doctor sent me to a hematologist with a question mark, because I only had minor deviations, both of them thought a lot about whether I needed the injection but in the end the hematologist prescribed it. (Only one value I had was really bad, the anti-c1q.)
Since then, I havent been visiting the hematologist separately, but we checked the thrombosis values (INR, APTI, Fibrogen) at the lab, they were in the normal range, but I only attend immune controls and gynecological examinations.
Now, for the next immune control, the doctor asked for anti-xa results which I have just learned is necessary for the proper injection dose. It will be in 2 days, and it can take up to 20 days to see the results.
Because of this, I am a little scared that we hadn’t watched anti-xa separately until now. Everything was fine with the baby, including the measures, heartbeats, etc.
My question is, could this cause a problem if we haven’t watched anti-xa more often? Is it too late that the data will only be revealed after about 3 weeks? Would I have had symptoms/signs if the current dosage was not enough?
Thank you very much for the answers.
I was wondering why you decrease the dosage of Lupron once the Estrogen begins? I struggle with a thin endometrium lining and was reading your protocol for FET. I was wondering if the reason why my lining may not get so thick is because the Lupon dosage that I took is 10 IU 5 days prior to stopping birth control and then remains the same amount instead of decreasing it once estrogen starts. I have had multiple hysteroscopies and no longer have scar tissue. I also did a mock transfer and they did not detect endometriosis or endometritis. Curious if the lack of decreasing the Lupron might have something to do with it? Thanks or your help!
Hi there, I just turned 42 w an AMH of 1.33-1.71 and have been undergoing IVF treatments for over three years with some success – I was pregnant twice, both unviable and resulting in two D&Cs. This is in addition to a natural pregnancy when I was 32 that ended w a D&C due to fetal demise. I recently had a battery of bloodwork conducted and several levels came back abnormal/high:
-Immunoglobulin E (134 kU/L)
-DHEA Sulfate (209 mcg/dL)
-Sex Hormone Binding Globulin (139 nmol/L)
Only the Immunoglobulin E appears connected to recurrent pregnancy loss, as my level indicates some kind of overactivity w my immune system. I’ve read online about how Prednisone and Lovenox can address this and I’m writing to find out what kind of protocol you’d recommend given my situation.
I appreciate your help!!
My name is Polona, I’m 50 and I’ve done four IVF cycles, all in North Cyprus, two of them when I was 48 and two of them at 50, for the last one I changed clinics. I’m planning to do one more round with my own eggs and need some advise with the stimulation protocol, since all my doctors use only basic protocols. I listened to your webinar IVF stimmulation protocols and was really impressed, but also confussed. Most of the doctors say that you have to add more LH in older women, because they don’t have enough of it and their receptors for LH are damaged. And also most of them use Femara. I know that at my age is almost imposssible to get an euploid embryo,but want to try one more time with optimal protocol. After that, if I fail to get euploids, I want to transfer one of the donor embryos (I had tandem cycle last round).
I have PCOS, but I don’t have many symptoms – I’m skinny ( but have to watch my diet and do a lot of sports), I don’t have high androgens, I think I don’t have insulin resistance, but I don’t ovulate if I don’t take Femara (day 3 to 7) and even Femara sometimes doesn’t help.
My latest bloodwork and AFC (after fourth IVF):
25.8.2023, day 2 (after the last IVF
FSH= 4.4 mIU/L
LH= 4.2 mIU/L )
prolactin= 6.4 microg/L
estradiol= 111.6 pmol/L
AMH= 5.60 ng/mL
AFC at day 4: 13+13=26
My bloodwork and AFC (before starting the fourth IVF):
4.5.2023, day 3:
FSH= 7.0 mIU/L (it was 12.4 in 2021)
LH= 5.8 mIU/L (it was 15.35 in 2021)
prolactin= 14.5 microg/L
estradiol= 90.9 pmol/L ( it was 33.17 in 2021)
AMH= 4.05 ng/mL ( it was 3.99 in 2021)
AFC at day 4: 7+7 =14
22.5.2023, day 21:
progesteron= 30.61 nmol/L (it was 44.77 in 2021)
testosteron= 0.14 nmol/L
I’m taking a lot of supplements for last two years and doing red light theraphy from May 2023.
My stimulation protocols and results were:
– Gonal f 300IU for 9 days (plus Femara for first 5 days),
– adding Cetrotide from day 7
– trigger with Gonapeptyl day 10
22 collected – 7 mature – 3 fertilized – 3 frozen at day 3
After the egg collection I had HSG done and they discovered I had an Y shaped uterus and they operated and I think it is now ok.
the same, only a day more of Gonal f and trigger one day later
15 collected – 9 mature – 7 fertilized – 6 frozen on day 3
They did PGT on all embrios together, but only 5 chromosome FISH (13, 18, 21, X, Y), two came out normal, one was monosomy 18, X0.
I transfered all three (one by one), but didn’t implant.
– Gonal f for 9 days (plus Femara day 1 to 5)
– adding Dabroston pills at day 7 ( instead of Cetrotide)
– trigger with Gonapeptyl at day 13 (I overslept the trigger and did it 8 hours late), they collected 11h after the trigger.
I ovulated before collecting, I think at day 7, I think because I wasn’t taking Certrotide injections, but they said, Dabrostone pills were OK.
7 collected (the big ones ovulated before collection) – 3 mature – 0 by day 3
After that failed cycle I changed the clinic, but wasn’t sure from the start if the stimulation protocol they prescribed would be ok for me (high doses of FSH). I did an estrogen priming, but my doctor didn’t read my mails and he didn’t know I did it. My follicles weren’t growing at all at the beginning (because of estrogen priming, but I didn t know at first that was the cause), I told the nurse about the estrogen priming, but I think she didn’t tell the doctor, so he just kept highering the dose of meds. At trigger day they said that there were a lot of big follicles, but then they collected only four (I still don’t know what happened to the rest, because I left right after the egg retrieval and I still didn’ t get an explanation by mail). Only two were fertilized and only one made it to day 5 to early blastocyte stage, but it was tested chaotic. They did a cytoplasmic transfer on both of them and also fertilized 7 donor eggs with the same donor sperm, but only 3 got to day 5. I still didn’t get an explanation, what was the problem, but anyway, I have three frozen donor embryos there and two frozen donor eggs. I took hGh for 8 weeks before and during the last stimulation. Last stimulation protocol and results:
July 2023, (AFC at day 3 was 10):
Day 1 to 5: Gonal f 375 IU and Femara
Day 6: Gonal f 300 IU, Meriofert 150 IU
Day 7 to 12: Gonal f 350 IU, Meriofert 150 IU
Day 13 and 14: Gonal f 350 IU, Meriofert 300 IU, Cetrotide
Day 15: trigger with Gonapeptyl, half of Ovitrelle and Cetrotide
Day 17: 4 collected – 2 fertillized- one early blastocyst at day 5, tested chaotic
If it is possible, I would be glad to have an online consultation about my case. I’m from Slovenia (Europe).
Thank you for your answer!
Hello, I’m at 38 year old, female with low ovarian reserve and type 1 diabetes. My partner has male infertility, requiring tese. We had a successful IVF pregnancy with a day 3 embryo in 2018.
For the last two years we have completed seven egg retrievals and six medicated FETs of multiple day 3 embryos. All embryo transfers had one or more good quality embryos and one or more fair quality, but I never became pregnant.
We have worked on identifying the cause of failure to implant by completing Era, Emma, Alice, Receceptiva, laparoscopy, saline sonogram, HSG and hysteroscopy. Everything came back normal.
My diabetes is very well controlled and other blood work including thyroid have been normal.
We have one euploid and two mosaics frozen from when I was 36 and 37. What more can we do to identify my issues with implantation and to give these remaining embryos the best chance?
Hello I’m concerned because my ultrasound yesterday 9-22 had my lining at 6.2. My doctor gave me the green light to continue but I’m worried my lining isn’t good enough to go through the transfer and I can’t afford to risk losing the 2 embryos I plan to transfer. What would your recommendation be
I am wondering what your opinion is on why so many reproductive endocrinologists tell women with high BMIs that they cannot do IVF (or sometimes even IUI?) I have a BMI of about 55 but have had a general anesthetic (once) and sedation (a few times) and come out of it just fine. I am getting older (turning 38) and my partner isn’t yet ready for a kid so I would love to freeze my eggs, but all four clinics in my city (in Canada) have said absolutely not. Do I have any options, or do I need to just give up?
I am 42yrs old.Have 1 daughter 19yrs.Finished round 1 of ivf treatment,got 2follicles measuring 20mm 1 in each ovary.During retrieval was informed that the follicles were empty.I live in Kenya,Can you please refer me to a Doctor in Kenya you may have worked with in the past,kindly
Hi Dr. T,
Thank you so much for your quick response to my other question.
I’m trying to make a decision as to whether to begin my second cycle with my current doctor or not and was wondering if I could have your input on our current protocol.
I’ll be 44 in 2 weeks, AMH is 2.4, had one natural pregnancy that ended in miscarriage at 10 weeks and one failed cycle of IVF (21 eggs retrieved, 10 fertilized, zero blastocysts).
The protocol for my first round was:
-priming with estradiol and progesterone starting the day after ovulation.
– 14 days later, began injections of 150 Menopur, 300 Gonal F
-on 5th day we added Cetrotide in the morning
-triggered with Ovidrel and Lupron
Changes she’s making to this round:
– lower dose of Menopur & Gonal F
– add Clomid
Your last response stated I would need a highly intelligently designed protocol. Wondering if this sounds like that to you or if you’d recommend I see a different doctor for a different protocol? (I need to decide quickly because this is day 1 of my period).
Hi Dr. Sher,
Is there a big benefit to doing back to back cycles of egg retrieval? I’m questioning whether I want to stay with my current clinic or switch to a new one. But switching means that I will likely need to skip a month. Is this okay or is there more of a benefit to staying with my current clinic and do another retrieval as soon as possible?
Hi doctor Sher! I used to go to your clinic when I lived in NYC, but now I’m living in the UK and the early obstetric care on the NHS is pretty limited and I have no one to ask about my HCG doubling concern. HCG was rising, nice and quickly but in my sixth week it slowed down considerably and is continuing to slow. I’ve had two ultrasounds that showed a heartbeat at 6 weeks, 1 day and 7 week 2 days, but I’m still very nervous as we have experienced many losses. Below are my last few HCG tests:
3 Sept – 2,396
7 Sept – 5,717
12 Sept – 16,049 (6w 2d)
15 Sept – 26,861
18 Sept – 38,482 (7w 1d)
Thank you so much for taking time with my question.
Hi Dr. Sher
We started trying for a baby a year ago. Fast forward to now and I’ve had 2 chemical pregnancies, 1 missed miscarriage (embryos heart stopped at 6 weeks 3 days) and now a blighted ovum (gestational sac and yolk sac present but not fetal pole).
My notmal gynecologist keeps saying these things are common, but I really don’t think 4 failures in a row is normal.
Could it be just bad luck – I.e. chromosomally abnormal eggs or could there be an implantation problem? I’ve had generic testing, antiphospholid, thyroid testing etc etc done and all seems normal.
I just can’t believe that this is due to just bad luck?
Can endometritis cause this, do you think?
Hi Dr. Sher,
I have gone through 2 ivf cycles and one FET done so far – i had 5 eggs retrieved in first cycle , 4 fert, resulting in 1 euploid embryo . Second cycle – 8 follicles, 6 eggs retrieved, 3 fert, no viable embryos. As part of second cycle, got the embryo transferred which failed to implant.
My doc now wants to try a micro dose flare lupron cycle – 2 weeks of micro dose lupron along with Gonal F + menopur + Omnitrope.
I read your blog post https://sherfertilitysolutions.com/egg-embryo-quality-in-ivf-how-selection-of-the-ideal-protocol-for-ovarian-stimulation-influences-egg-embryo-quality-and-outcome/
Where you refer to this protocol :Short GnRH-Agonist (“Flare”) Protocol and advised against it.
Could you explain further on why this maybe a bad idea for someone like me who has been diagnosed with DOR – my AMH is 0.7 and i am 33 years old.
Appreciate your blog posts .