Ask Our 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
Fill in the following information and we’ll get back to you.
I am 37, have low egg count and poor egg quality in the last 3 egg retreivals. There is mild adenomyosis and possible endometrioma on my scans. I don’t have any known autoimmune conditions. My fertility specialist feels I might have endometriosis which is affecting egg quality and possible embryo implantation. They have recommended intralipid this time. I have noticed it’s 200kCal per infusion. Does intralipid cause weight gain? Or any long term side effects? Thank you for your time and generosity with sharing your knowledge.
I had my first beta draw at 12 DPO (October 2) and it was 85. I had my second draw (October 5) and it was 315. What are the chances of this being a viable pregnancy? My doubling time according to these tests is 1.6 days and my 2 day change is a 139.5% increase.
Hi my beta hcg report value is 819mlu/ml ..means I’m 100% pergenant or not
Hello there, and thank you for your generosity with responses and for publishing so many valuable resources! After RPL and testing high for immunoglobulin E, my IVF clinic is suggesting we enlist prednisone and lovenox as a means to prevent another miscarriage. However they caveated that this is not their specialty and suggested I reach out to a reproductive immunologist if I wanted further information – are either Dr. Sher or Dr. Tortoriello reproductive immunologists? I’m having a difficult time finding one. I’ve read all the ebooks and resources on this site and other types of immunoglobulin are referenced, but not E. I don’t want to take medications that aren’t going to help my cause and my clinic just seems inexperienced in this area.
I am 42 old woman, planning for IVF in next few months. What supplements, dosage and duration would you recommend for me? Thank you
Hello,
My wife and I are about to undergo an egg donor cycle for IVF. Im 40 years old, healthy weight, non-smoker, and have undergone a semen analysis and all the parameters are normal (75×10^6 concentration, 62% motile, 6% normal morphology). I took a DNA fragmentation test and have a slightly higher 25% DFI, but have been taking steps to get that lower.
A couple weeks ago I gave a sample to be frozen as a backup and the plan was to give a fresh sample on the transfer day next week. Then on Monday disaster struck and I contracted COVID. I had a fever between 101-101,5F for about 36 hours before it broke.
I know that a fever can affect sperm quality and am now unsure of whether I should go ahead with a fresh sample or should use the backup sample? I would think that the frozen sample is better since it was before the fever, but maybe a fresh sample would still be preferable for other reasons? Maybe the fever wouldnt have an immediate impact since I would likely be providing it roughly 8-10 days after the fever? Are there any downsides to just using a frozen sample?
Thanks for any help,
Mark
Hi Dr you come so highly recommended. Would you transfer an embro with 35% mosaicism on chromosome 18? My current gyanae thinks it’ll correct itself in the womb. Thank you
Hello. My husband and I are trying for our first. I am 44. My AMH was assessed 8 months ago and was .09. At the time my FSH was 14. I took a urine sample this cycle and it is .36. Is IVF even a realistic possibility for us? Thank you in advance for your time.
Dear Doctor,
I am not sure who I should contact but I used to love going on your social media pages as they were both insightful and encouraging. Some days the posts were very medical and some days the post just made me laugh and forget all my fertility issues. I have noticed your posts the last couple of months are just medical – no feeling, no emotion, no making the patient relax for awhile. Why did you change doing this? This was one of the reasons I went to your social media every day and now I am thinking of unfriending your center. It seems like the personal touch is gone and to be honest that is what I am looking for in a fertility center. Someone who cares about their patients and that is no longer present in your social media.
On 9/22 I had an HCG test done and my numbers were 8,221.0 and then I got my HCG test done again on 9/27 and the numbers were 11,225.0. Are the numbers rising at a good pace?
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.
Thank you!!
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!
Hi Dr. Sher,
At what stage of the menstrual cycle do you recommend starting the birth control pill, prior to initiating ivf stimulation protocol?
Thank you for your help.
Regards,
RACHEL
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.
Hi there,
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!
Dear Dr. T,
When is one directed towards the surrogacy option?
Thank you.
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:
Avgust 2021:
– 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.
November 2021:
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.
March 2023:
– 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?