Hi Sir,
On 12th Day of period i have done TVS and one 30x23mm, one 16mm and 3/4 other smaller follicle on my right ovary.
Will i be able to conceive with these?
Thanks
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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
Fill in the following information and we’ll get back to you.
Follicular Analyses
Name: Farjana Y
Hi Sir,
On 12th Day of period i have done TVS and one 30x23mm, one 16mm and 3/4 other smaller follicle on my right ovary.
Will i be able to conceive with these?
Thanks
Answer:
The 30mm follicle is likely cystic and unlikely to house a good quality egg and the 16mm follicle is too immature to house a competent egg!
Sorry!
Geoff Sher
________________________________________________________
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 go to concierge@sherivf.com .
- Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!
IVF own eggs after failed attempt
Name: Yasmin V
Hello, I am considering treatment at a new clinic after a disappointing first attempt at IVF. I am 46 years old and tried using my own eggs. From my last blood test some two months ago I had an AMH of 0.98 ng/ml or 7 pmol/l and took pergoveris for the ovarian stimulation (300 units/day) for 9 days before the trigger on day 10. I had 15 eggs retrieved and 13 of those were mature enough to be fertilised, then 7 were fertilised, and 3 got to blastocyst stage but sadly the PGA-T testing showed the three embryos to be aneuploid. Given the relatively high quantity of eggs, do you think it’s realistic to try a second cycle or simply a waste of money, and I should try a donor egg instead?
Thank you in advance for your response.
Answer:
You certainly could try again, but please know that age is a major factor affecting IVF outcome. Women over 44y of age are advised to do egg donation.
Age should never be a barrier to hope and fulfillment when it comes to IVF. Many women in their early to mid-40s are successfully having IVF babies using their own eggs, especially if they have a good number of eggs left in their ovaries. However, for women with diminished ovarian reserve (DOR) or those over the age of 44, where the chances of success with their own eggs are low, IVF with egg donation can be a highly successful and safe option. Let’s explore why age affects IVF outcomes and discover the possibilities that lie ahead.
The egg plays a crucial role in determining the quality of the embryo, with a “competent” egg having the best chance of developing into a healthy baby. As women age, the chances of having eggs with an irregular number of chromosomes (aneuploid) increase significantly. Fertilizing an aneuploid egg will result in an embryo with an abnormal number of chromosomes, making it unable to develop into a healthy baby.
Chromosomal abnormalities are the main cause of failed implantation, pregnancy losses, and birth defects. As women get older, the risk of chromosomal abnormalities in embryos rises, leading to lower IVF success rates. Additionally, older women may experience hormonal imbalances that further affect egg quality and development. However, personalized stimulation protocols can help protect egg quality and improve IVF outcomes by regulating hormone production and activity.
When it comes to IVF in older women, selecting the right ovarian stimulation protocol is crucial. Various protocols are available, each tailored to meet individual needs. However, certain protocols should be avoided for older women or those with DOR to optimize chances of success.
I selectively use a variety of ovarian stimulation protocols for ovarian stimulation/IVF in older women and those with DOR :
- The conventional long pituitary down-regulation protocol: This involves administering a GnRH agonist like Lupron or Buserelin for a few days prior to initiating ovarian stimulation with gonadotropins. Then, a combination of FSH-dominant gonadotropin and a small dose of Menopur is administered, and ultrasound and blood tests are done to monitor follicle development. The eggs are triggered for maturation with hCG, and the egg retrieval is scheduled for approximately 36 hours later. This protocol is often preferred for older women who have adequate ovarian reserve (AMH=>1.5ng/ml).
- The agonist/antagonist conversion protocol (A/ACP):, This is similar to the conventional long down-regulation protocol. However, instead of using an agonist, a GnRH antagonist is administered from the onset of stimulation with gonadotropins. This protocol is often preferred for older women who have moderately severe DOR (AMH=0.5-1.5ng/ml).
- A/ACP with Estrogen “priming”; For women with very severe, DORI prescribe estrogen “priming “with skin estradiol (E2) patches or Estradiol injections administered bi-weekly. For some time before commencing gonadotropin stimulation, in an attempt to enhance ovarian response to stimulation. This protocol is sometimes used in older women who have severe DOR ( <0.5-1.5ng/ml).
In my opinion, the following ovarian stimulation protocols all promote over-exposure to LH-induced ovarian testosterone and are best avoided in older women and women with DOR, undergoing ovarian stimulation for IVF:
- Agonist “flare” protocols, which cause a surge of pituitary-LH at the wrong time.
- High dosages , LH-containing fertility drugs (e.g., menotropins such as Menopur).
- Testosterone-based supplements like Androgel.
- DHEA supplementation: DHEA is converted to testosterone in the ovaries.
- Clomiphene citrate & Letrozole, promote exaggerated pituitary LH release that can result in over-production of ovarian testosterone.
- Triggering egg maturation with too low a dosage of hCG (the ideal dosage is 10,000U of urine derived hCG) andf Recombinant DNA-derived hCG ( the ideal dosage is 500mcg of Ovidrel).
In cases where using their own eggs is no longer viable due to age and severe DOR, using donor eggs provides a fulfilling path to parenthood. Although some may initially hesitate due to the lack of genetic relation, it’s important to understand that the person who gives birth is considered the true biological parent in most cultures and legal systems. Becoming a parent through this connection can bring immense joy and fulfillment, as countless successful cases have shown.
Age may reduce the chances, but it does not eliminate the possibility of having a child through IVF. When IVF with own eggs is not an option, embracing the alternative of egg donation opens doors to highly successful and fulfilling paths to parenthood. It’s time to unlock the possibilities and embark on the journey towards creating a loving family.
GS
________________________________________________________________________
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 go to concierge@sherivf.com .
- Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!
Ivf
Name: Akanksha M
Is it normal to have bleeding during IVF stimulation
Answer:
In the very early stage of stimulation, it could simply be a result of the period that launched the cycle. However, if it occurs several days into stimulation…that is NOT normal.
Geoff Sher
_______________________________________________________________________________
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 go to concierge@sherivf.com .
- Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!
Frozen Transfer
Name: Brittany M
Hello!
I am wondering what the process would be to book in for a frozen transfer this coming fall/winter. I currently have embryos stored in New York, Would it be possible to book a call with either Dr. Sher or a nurse from the New York clinic to discuss? (I had a successful pregnancy from a frozen transfer done last January. My son will be 1 as of Sept 25th)
Thank you very much!
– Brittany Minchin
Answer:
It would be our privilege to be of service:
See Below!
GS
____________________________________________________________________
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 go to concierge@sherivf.com .
- Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!
Embryo Transfer
Name: Rosie S
If two untested embryos are transferred & one is a normal embryo, the other is abnormal – does the abnormal embryo ‘kill off’ or damage the normal embryo? Thanks 😉
Answer:
In my opinion.the concomitant transfer of the abnormal embryo should not prejudice the normal one.
Geoff Sher
_____________________________________________________\
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 go to concierge@sherivf.com .
- Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!
Ethanol Sclerotherapy?
Name: Sarah K
Hi, I have what appears to be a 7cm endometrioma on my left ovary. I had surgery to remove an ovarian cyst on the same ovary a year ago and it regrew to the same size within 4 months. An interesting side note is that they tested my last cyst and there were no endometrial cells found, even though the cyst was filled with old blood. They are still calling my new cyst an endometrioma, even though they are not sure it actually is one. My GYN is now suggesting surgery to remove the entire ovary because it regrew so quickly. I would like to avoid surgery if at all possible because I had complications during my last one. Do you offer the ovarian sclerotherapy procedure? If not, do you know who would?
Answer:
I introduced ovarian sclerotherapy using 5% tetracycline hydrochloride (THCL). Unfortunately we cannot access THCL any longer. Therefore, surgery is advised in your case. Personally, it is rarely necessary to remove the entire ovary. In my opinion, the cyst should be isolated and removed leaving most of the ovary intact.
GS
______________________________________________________
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 go to concierge@sherivf.com .
- Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!