Your Trusted Fertility Clinic In New York, NY

Limited Time Offer

Starting October 1, 2023

$6,500 Egg Banking

Group photo of the Sher Fertility Solutions clinic team

Where Are You On Your Fertility Journey?

I´m just starting out

I need more information

Ready to get started

Book a consultation

I need help

Ask a question

Your Trusted Fertility Clinic In New York, NY

Five Start Rating

The Best of Dr. Sher on The Egg Whisperer Show

Step 1 of 5

Our Services

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.

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

Name: Alyssa J

Hi Dr. Sher,

I’m writing you at a complete loss and low point in my treatment. I am 34. My husband is 41. We started to try to conceive when I was age 31 and within 3 months, I became pregnant but quickly found out it was a chemical pregnancy. I then pushed for testing and it was found I had DOR with an AMh of .06 and an FSH of 22. I tried 2 rounds of IVF with my own eggs. The first round was canceled due to no response and 2nd cycle was converted to an IUI and was unsuccessful. We are from Rhode Island, but then looked into donor eggs at Utah Fertility Center as they have a great program. Our donor produced 10 pgt tested normal eggs. I did a hysteroscopy beforehand as Dr. Foulk found that I had some adhesions in my lining. I went through one transfer in December that was a chemical. My lining also struggled to increase past 7mm. After that we did an RPL panel and found out I had high natural killer cells and MTFHR. I also did an ERA and found out I needed 8 more hours of progesterone. Dr. Foulk did another hysteroscopy and was about to put me on Lupron Depot, but then said he didn’t think it was necessary as my adenomyosis was mild. This transfer I’m March we did a round of intralipids, used the ERA timing, added a Neupogen wash and my lining got up to 7.5. This round has failed. I feel so confused and out of options. I’m looking to transfer my embryos back to a New England based clinic as the travel is too much emotionally and financially. Just feeling super lost and wondering if we should move on to adoption. I would not consider surrogacy as it’s not something I feel comfortable doing. Thanks,
Alyssa

Answer:

There is very likely to be an implantation dysfunction. We should talk. I suggest you   call my assistant, Patti Converse (702-533-02691 and set up an online consultation with me.

Implantation dysfunction is unfortunately often overlooked as an important cause of IVF failure. In the pursuit of optimizing outcome with IVF, the clinician has a profound responsibility to meticulously assess and address this important issue if IVF success is to be optimized. This is especially relevant in cases of “unexplained IVF failure, Recurrent Pregnancy Loss (RPL) and in women suspected of having underlying anatomical and immunologic factors. Doing so  will not only maximize the chance of a viable pregnancy but enhancing placentation, will at the same time  promote the noble objective of optimizing the quality of life after birth.”

IVF success rates have been improving over the last decade. The average live birth rate per embryo transfer in the U.S.A for women under 40y using their own eggs , is currently better than 1:3 women. However, there is still a wide variation from program to program for IVF live birth rates, ranging from 20% to near 50%. Based upon these statistics, the majority of women undergoing IVF in the United States require two or more attempts to have a baby. IVF practitioners in the United States commonly attribute the wide dichotomy in IVF success rates to variability in expertise of the various embryology laboratories. This is far from accurate. In fact, other factors such as wide variations in patient selection and the failure to develop individualized protocols for ovarian stimulation or to address those infective, anatomical and immunologic factors that influence embryo implantation are at least equally important.

About 80% of IVF failures are due to “embryo incompetency” that is largely due to an irregular quota of chromosomes (aneuploidy) which is usually related to advancing age of the woman and is further influenced by other factors such as the protocol selected for ovarian stimulation, diminished ovarian reserve (DOR)m and severe male factor infertility. However in about 20% of dysfunctional cases embryo implantation is the cause of failure.

This blog article will focus on implantation dysfunction and IVF failure due to:

  • Anatomical abnormalities in the uterine cavity  (polyps/scarring/internal fibroids)

Several studies performed both in the United States and abroad have confirmed that a dye X-Ray or hysterosalpingogram (HSG) will fail to identify small endouterine surface lesions in >20% of cases. This is significant because even small uterine lesions have the potential to adversely affect implantation. Hysteroscopy is the traditional method for evaluating the integrity of the uterine cavity in preparation for IVF. It also permits resection of most uterine surface lesions, such as submucous uterine fibroids (myomas), intrauterine adhesions and endometrial or placental polyps. All of these can interfere with implantation by producing a local “inflammatory- type” response similar in nature to that which is caused by an intrauterine contraceptive device. Hysterosonography (syn; HSN/ saline ultrasound examination) and hysteroscopy have all but supplanted HSG to assess the uterine cavity in preparation for IVF. HSN which is less invasive and far less expensive than is than hysteroscopy involves  a small amount of a sterile saline solution is injected into the uterine cavity, whereupon a vaginal ultrasound examination is performed to assess the contour of the uterine cavity.

  • Endometrial Thickness: As far back as in 1989 I first reported  on the finding  that ultrasound assessment of the late proliferative phase endometrium following ovarian stimulation in preparation for IVF, permits better identification of those candidates who are least likely to conceive. We noted that the ideal thickness of the endometrium at the time of ovulation or egg retrieval is >9 mm and that a thickness of less than 8 mm bodes poorly for a successful outcome following IVF.

Then in 1993, I demonstrated that sildenafil (Viagra) introduced into the vagina prior to hCG administration can improve endometrial growth in many women with poor endometrial development. Viagra’s mechanism of action is improvement in uterine blood flow with improved estrogen delivery…thereby enhancing endometrial development.

  • Immunologic factors: These also play a role in IVF failure. Some women develop antibodies to components of their own cells. This “autoimmune” process involves the production of antiphospholipid, antithyroid, and/or anti-ovarian antibodies – all of which may be associated with activation of Natural Killer (NK) cells in the uterine lining. Activated NK cells (NKa) release certain cytokines (TH-I) that if present in excess, often damage the trophoblast (the embryo’s root system) resulting in immunologic implantation dysfunction (IID). This can manifest as “infertility” or as early miscarriages). In other cases (though less common), the problem is due to “alloimmune” dysfunction. Here the genetic contribution by the male partner renders the embryo “too similar” to the mother. This in turn activates NK cells leading to implantation dysfunction. These IID’s are treated using combinations of medications such as heparin, Clexane, Lovenox, corticosteroids and intralipid (IL).

I strongly recommend that you visit www.SherIVF.com. Then go to my Blog and access the “search bar”. Type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select.  Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.

 

  • A Fresh Look at the Indications for IVF
  • The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
  • Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
  • IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
  • The Fundamental Requirements For Achieving Optimal IVF Success
  • Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
  • Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
  • IVF and the use of Supplementary Human Growth Hormone (HGH) : Is it Worth Trying and who needs it?
  • The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
  • Blastocyst Embryo Transfers Should be the Standard of Care in IVF
  • Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
  • IVF: Approach to Selecting the Best Embryos for Transfer to the Uterus.
  • Fresh versus Frozen Embryo Transfers (FET) Enhance IVF Outcome
  • Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
  • Genetically Testing Embryos for IVF
  • Staggered IVF
  • Staggered IVF with PGS- Selection of “Competent” Embryos Greatly Enhances the Utility & Efficiency of IVF.
  • Preimplantation Genetic Testing (PGS) in IVF: It should be Used Selectively and NOT be Routine.
  • IVF: Selecting the Best Quality Embryos to Transfer
  • Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
  • PGS in IVF: Are Some Chromosomally abnormal Embryos Capable of Resulting in Normal Babies and Being Wrongly Discarded?
  • PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
  • Endometrial Receptivity Array (ERA): Is There an actual “There, There”?
  • IVF Failure and Implantation Dysfunction:
  • Diagnosing and Treating Immunologic Implantation Dysfunction (IID)
  • The Role of Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 1-Background
  • Immunologic Implantation Dysfunction (IID) & Infertility (IID):PART 2- Making a Diagnosis
  • Immunologic Dysfunction (IID) & Infertility (IID):PART 3-Treatment
  • Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)
  • Immunologic Implantation Dysfunction: Importance of Meticulous Evaluation and Strategic Management:(Case Report
  • Intralipid and IVIG therapy: Understanding the Basis for its use in the Treatment of Immunologic Implantation Dysfunction (IID)
  • Intralipid (IL) Administration in IVF: It’s Composition; How it Works; Administration; Side-effects; Reactions and Precautions
  • Natural Killer Cell Activation (NKa) and Immunologic Implantation Dysfunction in IVF: The Controversy!
  • Endometrial Thickness, Uterine Pathology and Immunologic Factors
  • Vaginally Administered Viagra is Often a Highly Effective Treatment to Help Thicken a Thin Uterine Lining
  • A Thin Uterine Lining: Vaginal Viagra is Often the Answer (update)
  • Cervical Ureaplasma Urealyticum Infection: How can it Affect IUI/IVF Outcome?
  • The Role of Nutritional Supplements in Preparing for IVF
  • The Basic Infertility Work-Up
  • Defining and Addressing an Abnormal Luteal Phase
  • Male Factor Infertility
  • Routine Fertilization by Intracytoplasmic Sperm Injection (ICSI): An Argument in Favor
  • Hormonal Treatment of Male Infertility
  • Hormonal Treatment of Male Infertility
  • Antisperm Antibodies, Infertility and the Role of IVF with Intracytoplasmic Sperm Injection (ICSI)
  • Endometriosis and Infertily
  • Endometriosis and Immunologic Implantation Dysfunction (IID) and IVF
  • Endometriosis and Infertility: Why IVF Rather than IUI or Surgery Should be the Treatment of Choice.
  • Endometriosis and Infertility: The Influence of Age and Severity on Treatment Options
  • Early -Endometriosis-related Infertility: Ovulation Induction (with or without Intrauterine Insemination) and Reproductive Surgery  Versus IVF
  • Deciding Between Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF).
  • Intrauterine Insemination (IUI): Who Needs it & who Does Not: Pro’s & Con’s!IUI-Reflecting upon its Use and Misuse: Time for a Serious “Reality Check
  • Mode of Action, Indications, Benefits, Limitations and Contraindications for its ue
  • Clomiphene Induction of Ovulation: Its Use and Misuse!

ADDENDUM: PLEASE READ!!

INTRODUCING SHER FERTILITY SOLUTIONS (SFS)

Founded in April 2019, Sher Fertility Solutions (SFS) offers online (Skype/FaceTime) consultations to patients from > 40 different countries. All consultations are followed by a detailed written report presenting my personal recommendations for treatment of what often constitute complex Reproductive Issues.

 

If you wish to schedule an online consultation with me, please contact my assistant (Patti Converse) by phone (800-780-7437/702-533-2691), email (concierge@SherIVF.com) or,  enroll online on then home-page of my website (www.SherIVF.com). 

_________________________________________________________________________________

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

  1. “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link

https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

………………………………………………………………..

 

Latest Videos

Blog

No Results Found

The page you requested could not be found. Try refining your search, or use the navigation above to locate the post.

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