My daughter did IVF treatments and froze her eggs one month ago. She was very hormonal during treatments, moody and yelling and screaming at every one. She does not act that way normally. Her behavior has not changed back, she is still acting very hormonal. Could doing IVF trigger any mental illness? I am getting concerned about her.
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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.
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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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IVF fertility freezing egg
Name: Deborah L
My daughter did IVF treatments and froze her eggs one month ago. She was very hormonal during treatments, moody and yelling and screaming at every one. She does not act that way normally. Her behavior has not changed back, she is still acting very hormonal. Could doing IVF trigger any mental illness? I am getting concerned about her.
Answer:
I doubt it, but the stress of going through this might be playing a role.
GS
High beta hcg
Name: Suhaida S
My beta hcg at 6 weeks pregnancy is 220000 and repeated 48 hour is 331000. Abdominal scan show iugs and fetal heart. What would the cause of high beta hcg?
Answer:
Hard to say, unless there is some molar degeneration in the trophoblast. I doubt it though!
Geoff Sher
Fertility
Name: Takida H
I’ve done fertility treatment before. Two rounds of letrozole. Wanted to try another round of letrozole
Answer:
Perhaps we should talk first.
I am attaching online links to two E-books which I 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
- “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link
https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
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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Clomid
Name: Erin K
Hello, I was treated with Clomid day 5-9 and I am 36 years old. I failed to get pregnant 5 months and was prescribed this because of pcos. At the ultrasound at 12 days I had 4 mm endometrium and 21 mom follicle. I had a positive ovulating test (lh surge in urine test) two days later. My cycle was longer than usual (40 days compared to 34) and I had my period more than 3.5 weeks after ovulation test was positive. Today I went for baseline scan and doctor suspended Clomid and told me I have a 40mm follicle. What could have happened? Will this 40 mm follicle resolve on its own and what does it mean for this cycle?
Answer:
Clomiphene citrate (Clomid, Serophene) is the most popular agent used for inducing ovulation and in the 1980’s was also the most widely used method for COH in preparation for In Vitro Fertilization (IVF). Clomiphene citrate is a synthetic hormone that deceives the hypothalamus into thinking that the body’s estrogen level is too low. In response, the hypothalamus releases GnRH (gonadotropin-releasing hormone), which in turn prompts the pituitary gland to release an exaggerated amount of FSH (follicle-stimulating hormone). As happens in nature, the increased secretion of FSH stimulates development of the follicles, ultimately resulting in ovulation. The growing follicles secrete estrogen into the bloodstream, thus closing the feedback circle that the hypothalamus initiated in response to the anti-estrogen properties of Clomiphene.
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ADDITIONAL INFORMATION:
I am attaching online links to two E-books which I 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
- “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link
https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
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
………………………………………………………………..
Administration of Clomiphene citrate enhances the normal cyclical pattern of follicular development and ovulation. If initiated as early as day 2 or day 3 of the menstrual cycle, it usually induces ovulation on day 13 or 14 of a regular 28-day cycle. If administered later, such as on day 5, ovulation could occur as late as day 16 or 17, and the length of the cycle may be extended. If the woman does not stimulate appropriately on the original dosage of Clomiphene, the dosage may be increased to achieve optimal stimulation. We sometimes administer hCG to the patient once ultrasound examinations and hormonal evaluations confirm optimal follicular development. In such cases ovulation will usually occur about 38 hours later.
Two major advantages of Clomiphene are its relatively low cost and the fact that it can be taken orally instead of by injection. A distinct disadvantage is that when administered alone it does not stimulate the growth and maturation of as many follicles as do alternative therapies such as gonadotropins alone ore in combination with Clomiphene; accordingly, fewer eggs can be retrieved
Safety and Side Effects of Clomiphene: The side effects associated with Clomiphene are related to the follicular development the drug has stimulated. When administered alone, a luteal-phase defect (deficiency in progesterone production following ovulation) may result if the follicles do not develop properly. This would hinder implantation by preventing the endometrium (uterine lining) from responding optimally to the progesterone produced by the corpus luteum. Clomiphene may also interfere with the nurturing effect estrogen must have on the developing endometrium. In addition, traces of Clomiphene that might linger in the woman’s circulatory system for many weeks may inhibit the normal function of enzymes produced by the developing follicular cells.
Too high a dose of Clomiphene may cause follicles to grow too rapidly, producing large fluid-filled collections known as cysts. This may lead to tenderness and swelling of the ovaries, visual disturbances, and hot flashes similar to those at menopause.
The progressive build-up of Clomiphene in the body over a period of three (3) or more consecutive months of treatment compounds its anti-estrogenic properties and effects and leads to: a) a reduction in the quality of the cervical mucus, with negative implications for the capacitation and transportation of the sperm and b) a profound thinning of the uterine lining (endometrium), which seriously compromises embryo implantation. These two effects probably explain why prolonged usage of Clomiphene ( i.e.; for three (3) or more back-to-back cycles of treatment) without allowing for at least one month’s break before re-initiating therapy, seriously with compromises fertility, and results in a significant increase in the risk of early spontaneous abortion. Unless allowance is made for such a break in therapy, each additional, consecutive Clomiphene treatment cycle will inevitably result in a progressive decline in pregnancy potential and/ or reproductive performance. In fact if administered for more than six (6) consecutive back-to back cycles (without allowing for at least one (1) resting cycle), a progressive escalation in Clomiphene anti-estrogenic effects will convert this fertility agent into a “relative contraceptive”. Fortunately, the cessation of Clomiphene treatment for only one (1) month is sufficient to completely reverse such highly undesirable side-effects.
It has been observed that few women over 40 years respond well to Clomiphene. In spite of the fact that they appear to ovulate on Clomiphene treatment, they frequently develop poor mucus and a poor endometrial lining from the inception of Clomiphene administration. We accordingly believe that Clomiphene treatment is relatively contraindicated in women over the age of 40.
Some studies have suggested that Clomiphene citrate has caused birth defects or a higher miscarriage rate in laboratory animals and could, therefore, potentially threaten human offspring. We, however, believe that when Clomiphene is taken under proper supervision these risks should not be of major significance.
The fear that Clomiphene might cause birth defects arises from the fact that its inner structure, or nucleus, is very similar to that of the hormone DES, which is known to have caused so many birth defects when administered to pregnant women. Although it is theoretically possible that Clomiphene might cause such defects; birth statistics do not indicate an increased birth-defect rate after stimulation with the drug. The laboratory studies mentioned above should not be ignored, however, but should be heeded as a guide to safe, prudent administration of fertility drugs. We caution that Clomiphene citrate should be taken only when it is absolutely certain that the woman is not pregnant. (The appearance of a menstrual period does not provide adequate certainty because more than 10% of women might bleed during early pregnancy. Assessment by a physician, or even a home pregnancy test, provides greater assurance that a pregnancy does not exist.)
The administration of Clomiphene as a fertility agent over a series of months might also promote ovulatory problems. It has been observed that in one out of five cases where Clomiphene is administered, the egg remains trapped in the follicle after ovulation. Therefore, the practice of physicians saying to patients, “Here’s some Clomiphene-take some each month and call me if you miss your period” should be deplored.
Finally, recent reports suggest that women who take Clomiphene uninterrupted for more than one (1) year might be at increased risk of developing ovarian cancer in later life.
But if Clomiphene citrate is taken under proper supervision and the woman has previously determined that she is not pregnant, its safety is beyond question. This has prompted many IVF programs to continue using Clomiphene. Those that do so, however, invariably report a lower pregnancy rate than that which can be achieved by other methods of controlled ovarian hyperstimulation.
________________________________________________________________________
ADDITIONAL INFORMATION:
I am attaching online links to two E-books which I 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
- “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link
https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
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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Day 5 Early Blasts
Name: Alysha G
Hi Dr. Sher,
I just received my day 5 call and the nurse said I have 14 early blasts (and one more developing). Is this good news or should they all have reached blastocyst stage by now? Is it likely that I will get a big drop off before tomorrow Day 6?
Answer:
As long as they reach expanded blastocyst stage by day 6, you should still be OK
Good luck!
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ADDITIONAL INFORMATION:
I am attaching online links to two E-books which I 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
- “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link
https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
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
………………………………………………………………..
IVF with low ovarian reserve
Name: Amanda M
Hello,
I am 40 yr old female with low ovarian reserve. I responded poorly to my first protocol OCP/antagonist. That cycle was cancelled and I was restarted on estrogen priming antagonist protocol with clomid and omnitrope adjuncts. I cleared my baseline US on 5/18 with follicles seen on both the right and left. However today on my day 4 US, they said both ovaries were “quiet” and no follicles seen. How can this be?
In addition, my estradiol level was checked and is below 5 and I feel awful. I’m horribly fatigued with horrible brain fog making it almost impossible to get through the day. Why would it be so low after estrogen priming? It was completely normal on all previous checks, with the last just two weeks ago?
To give you a better timeline of events:
Esterase 5/13-5/18
Cycle day 1 and baseline US 5/18
Started Clomid and Omnitrope 5/19
Started gonal f (150) and menopur 150 5/21
Finished Clomid 5/23
My AFC and AMH were very low at baseline when I started IVF. My expectations are realistic given these numbers. However, I’m hoping you can help me understand a bit more about what’s going on.
With gratitude
Amanda
Answer:
Understanding the impact of age and ovarian reserve on the success of in vitro fertilization (IVF) is crucial when it comes to reproductive health. This article aims to simplify and clarify these concepts, emphasizing their significance in the selection of ovarian stimulation protocols for IVF. By providing you with this information, we hope to shed light on the importance of considering these factors and making informed decisions regarding fertility treatments.
- The Role of Eggs in Chromosomal Integrity: In the process of creating a healthy embryo, it is primarily the egg that determines the chromosomal integrity, which is crucial for the embryo’s competency. A competent egg possesses a normal karyotype, increasing the chances of developing into a healthy baby. It’s important to note that not all eggs are competent, and the incidence of irregular chromosome numbers (aneuploidy) increases with age.
- Meiosis and Fertilization: Following the initiation of the LH surge or the hCG trigger shot, the egg undergoes a process called meiosis, halving its chromosomes to 23. During this process, a structure called the polar body is expelled from the egg, while the remaining chromosomes are retained. The mature sperm, also undergoing meiosis, contributes 23 chromosomes. Fertilization occurs when these chromosomes combine, resulting in a euploid embryo with 46 chromosomes. Only euploid embryos are competent and capable of developing into healthy babies.
- The Significance of Embryo Ploidy: Embryo ploidy, referring to the numerical chromosomal integrity, is a critical factor in determining embryo competency. Aneuploid embryos, which have an irregular number of chromosomes, are often incompetent and unable to propagate healthy pregnancies. Failed nidation, miscarriages, and chromosomal birth defects can be linked to embryo ploidy issues. Both egg and sperm aneuploidy can contribute, but egg aneuploidy is usually the primary cause.
- Embryo Development and Competency: Embryos that develop too slowly or too quickly, have abnormal cell counts, contain debris or fragments, or fail to reach the blastocyst stage are often aneuploid and incompetent. Monitoring these developmental aspects can provide valuable insights into embryo competency.
- Diminished Ovarian Reserve (DOR): As women advance in their reproductive age, the number of remaining eggs in the ovaries decreases. Diminished ovarian reserve (DOR) occurs when the egg count falls below a certain threshold, making it more challenging to respond to fertility drugs effectively. This condition is often indicated by specific hormone levels, such as elevated FSH and decreased AMH. DOR can affect women over 40, but it can also occur in younger
Why IVF should be regarded as treatment of choice for older women an those who have diminished ovarian reserve ( DOR):
Understanding the following factors will go a long way in helping you to make an informed decision and thereby improve the chances of a successful IVF outcome.
- Age and Ovarian Reserve: Chronological age plays a vital role in determining the quality of eggs and embryos. As women age, there is an increased risk of aneuploidy (abnormal chromosome numbers) in eggs and embryos, leading to reduced competency. Additionally, women with declining ovarian reserve (DOR), regardless of their age, are more likely to have aneuploid eggs/embryos. Therefore, it is crucial to address age-related factors and ovarian reserve to enhance IVF success.
- Excessive Luteinizing Hormone (LH) and Testosterone Effects: In women with DOR, their ovaries and developing eggs are susceptible to the adverse effects of excessive LH, which stimulates the overproduction of male hormones like testosterone. While some testosterone promotes healthy follicle growth and egg development, an excess of testosterone has a negative impact. Therefore, in older women or those with DOR, ovarian stimulation protocols that down-regulate LH activity before starting gonadotropins are necessary to improve egg/embryo quality and IVF outcomes.
- Individualized Ovarian Stimulation Protocols: Although age is a significant factor in aneuploidy, it is possible to prevent further decline in egg/embryo competency by tailoring ovarian stimulation protocols. Here are my preferred protocols for women with relatively normal ovarian reserve:
- Conventional Long Pituitary Down Regulation Protocol:
- Begin birth control pills (BCP) early in the cycle for at least 10 days.
- Three days before stopping BCP, overlap with an agonist like Lupron for three days.
- Continue daily Lupron until menstruation begins.
- Conduct ultrasound and blood estradiol measurements to assess ovarian status.
- Administer FSH-dominant gonadotropin along with Menopur for stimulation.
- Monitor follicle development through ultrasound and blood estradiol measurements.
- Trigger egg maturation using hCG injection, followed by egg retrieval.
- Agonist/Antagonist Conversion Protocol (A/ACP):
- Similar to the conventional long down regulation protocol but replace the agonist with a GnRH antagonist from the onset of post-BCP menstruation until the trigger day.
- Consider adding supplementary human growth hormone (HGH) for women with DOR.
- Consider using “priming” with estrogen prior to gonadotropin administration
- Protocols to Avoid for Older Women or Those with DOR: Certain ovarian stimulation protocols may not be suitable for older women or those with declining ovarian reserve:
- Microdose agonist “flare” protocols
- High dosages of LH-containing fertility drugs such as Menopur
- Testosterone-based supplementation
- DHEA supplementation
- Clomiphene citrate or Letrozole
- Low-dosage hCG triggering or agonist triggering for women with DOR
Preimplantation Genetic Screening/Testing(PGS/T): PGS/T is a valuable tool for identifying chromosomal abnormalities in eggs and embryos. By selecting the most competent (euploid) embryos, PGS/T significantly improves the success of IVF, especially in older women or those with DOR.
Understanding the impact of advancing age and declining ovarian reserve on IVF outcomes is essential when making decisions about fertility treatments. Age-related factors can affect egg quality and increase the likelihood of aneuploid embryos with resultant IVF failure. Diminished ovarian reserve (DOR) further complicates the process. By considering these factors, you can make informed choices and work closely with fertility specialists to optimize your chances of success. Remember, knowledge is power, and being aware of these aspects empowers you to take control of your reproductive journey.
________________________________________________________________
ADDITIONAL INFORMATION:
I am attaching online links to two E-books which I 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
- “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link
https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view
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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