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Your Trusted Fertility Clinic In New York, NY

Your Journey. Your Family.

At Sher Fertility Solutions, we understand that each patient is unique. Everything we do is customized to you and your specific needs.

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Your Trusted Fertility Clinic In New York, NY

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Your Trusted Fertility Clinic in New York, NY

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Dr. Drew V Tortoriello MD

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Infertility diagnosis/treatment

The causes of infertility are multiple and are often difficult to define but may include anatomical conditions involving tubal patency and/or function as well as diseases of the testicles and/or or sperm ducts, dysfunctional levels of certain hormones in both men and women, and ovulation difficulties in women.

Recurrent miscarriage diagnosis/treatment

The time has come to embrace the reality that the term “unexplained” is rarely applicable to 1) infertility of unknown cause, 2) repeated IVF failure, and 3) recurrent pregnancy loss (RPL). More often than not, rather than being “unexplained,” the condition is simply ignored and as such remains “undiagnosed.” All that is needed is to investigate and treat the issue appropriately in order to solve the problem.

Egg freezing for future fertility

There are many reasons why patients may need to preserve their fertility. For some, it may be a focus on education and career delays and for others it may be due to an illness. Although the decline in reproductive potential that occurs with age cannot be reversed, freezing your eggs at a younger age may allow the eggs to be preserved until you are ready to conceive. While there are no guarantees, using cryopreserved eggs may improve your chances for pregnancy in the future.

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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

I Have a Question

Ivf protocol low reponder

Name: Sandra W

Dear Dr. Sher, five and a half years ago my husband and I conceived naturally in our first cycle. I gave birth to a healthy baby boy 9 month later. Two years after that we tried to have another child, after six cycles my gyn said I should go to a fertility clinic. I was 37 at that time and I had a low amh of 0,33 but regular menstrual cycles. 1,5 years later, with now 39, I am still within this journey. Summary of treatsments:
1) ICSI: Stimulation with Pergoeris 375 IE from day 3 to 10 -> two follices but no egg retrival
2) Natural ICSI few months later: 0,25mg Clomiphene from day 3 to 8 -> one follicel, 10 cell ambry transfer 3 days after punction, negative
3) Next cycle tried yet again with Clomiphene, same plan: more follicel than usual in both ovaries but no growth or even shrinking. After getting off of Clomiphene eventually one follicel did grow but persisted as my fsh and lh levels were high even due estrogen was high too
3) after pausing for few months we started now with a new stimulation cycle with 150 IE Menopur from day 3. As it looks for now just one follicel is growing and the other ones are not or some of them with smaller size disappear.

I am getting really frustarated with my clinic as they just have two possibilities high or “low” dosage of stimulation. I still have reagulary cycles with ovulation, high endometrium line (before ovulation approx. 9-10 mm, 7 days after ovulation approx. 13 mm), and in normal cycles my eggs will grow till approx. 12 mm and then stop to let the dominate follicle to grow further. But with stimulation starting on day3 everything changes and except the dominant follicel others just stop growing or shrink/disappear. I am always downregulating at day 7, never before that. I do not have much eggs and in most cycles 3-4 are visible on day 2.

Dr. Sher, what could be the reason for my body to react like what could be a better stimulation protocol for someone like me? I know that I will not produce many follicels, but I cannot understand why my body just refuses to accept any stimulation drugs.

Thanks in advance!

Best

Answer:

Thanks for the inquiry. I think I can help here.

Might I suggest that you contact my assistant Patti Converse at 702-533-2691 and set up an online consultation with me to discuss in depth.

I would need a lot more information but my first thought is that there might be diminished ovarian reserve and if so, you will need a very individualized protocol for ovarian stimulation.

 

Geoff Sher

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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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

  1. 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.
  2. 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.
  3. 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:
  1. 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.
  1. 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
  1. 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.

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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

 

  1. 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\

 

 

 

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Our Team

The emphasis we put on innovative, state-of-the-art technology began with our founder, Dr. Geoffrey Sher, one of the pioneers in the field of IVF, who has been influential in the births of more than 17,000 IVF babies. Dr. Sher plays an active role alongside our medical director, Dr. Drew Tortoriello. Together they have over 55 years of clinical and academic experience in the field of Reproductive Medicine.

Together, they were the first to introduce Preimplantation Genetic Testing which vastly increases the chances of IVF success and is now performed worldwide. They also pioneered the testing and treatment of Immunologic Implantation Dysfunction (IID) that frequently leads to “unexplained” infertility, repeated IVF failure, and recurrent miscarriage. We’re able to conduct a variety of other treatments and tests right on site. For example, we offer on-site sperm testing to ensure proper sperm selection techniques are used to create the healthiest possible embryos.

For those women seeking to preserve their fertility, we offer vitrification, a state-of-the-art technology that ensures their eggs will ultimately be thawed successfully.

From the moment you walk into our state-of-the-art New York fertility clinic, you’ll feel the warmth and compassion that will define your experience with us. Drew Tortoriello, MD serves as our Medical Director. He’s an outstanding fertility specialist that you’ll find to be caring, compassionate and personable.

When you receive fertility treatment with us, your doctor will participate with hands-on management of your case throughout your treatment. We’ve gained a reputation of being the place to turn to when all other treatment options have failed, and patients are searching for hope and fresh alternatives.

TL;DR:

  • Our doctors are among the best in the world, with over 55 years of combined experience
  • Together, they pioneered several tests and treatments that can help where other treatments have failed
  • We do many tests right here at the clinic, which means faster results and ensures proper techniques are used
  • Your doctor will be with you at every step of your treatment
  • Everyone here will get to know you during your treatment so you won’t just feel like a number
  • We’re known for being the clinic to go to when all other treatments have failed