Your Trusted Fertility Clinic In New York, NY

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Your Trusted Fertility Clinic In New York, NY

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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.

Testimonials

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: Shelby N

I had my first blood test done my levels are around 57 and they couldnt see anything on an ultrasound they had me wait 4 days to do repeat testing and my numbers are only at 71

Answer:

This is a slow rise and the likelihood is that the pregnancy will not survive! However, repeat th hCG test in 2 days to see if it doubles as it should.

So sorry!

 

Going through IVF is a major investment, emotionally, physically, and financially, for every patient or couple. One of the most crucial moments is receiving the result of the blood test for human chorionic gonadotropin (hCG) pregnancy. It’s a big deal! The days after the embryo transfer, waiting for this result, can be extremely stressful. That’s why it’s crucial for the IVF doctor and staff to handle this information with care and professionalism. They should be accessible to the patient/couple and provide results promptly and sensitively.

Testing urine or blood to check for human chorionic gonadotropin (hCG) is the best way to confirm pregnancy. Urine tests are cheaper and more commonly used. They are also more convenient because they can be done anywhere. However, blood tests are more reliable and sensitive than urine tests. They can detect pregnancy earlier and at lower hCG levels. Blood tests are also more accurate and can track changes in hCG levels over time. Urine tests can detect hCG when blood levels are above 20IU, which is about 16-18 days after ovulation or 2-3 days after a missed period. Blood tests can measure any concentration of hCG about 12-13 days after ovulation.

Detecting hCG in the blood early on and tracking its increase is especially useful for women undergoing fertility treatments like controlled ovarian stimulation or in vitro fertilization. The sooner hCG is detected and measured, the more information can be gathered about the success of implantation and the health of the developing embryo.

Typically, two beta hCG blood tests are done, spaced 2-4 days apart. It’s best to wait for the results of the second test before reporting on the pregnancy. This is because an initial result can change, even from equivocal or negative to positive. Sometimes a normal embryo takes longer to implant, and the hCG level can be initially low or undetectable. Regardless of the initial level, the test should be repeated after two days to check for a significant rise in hCG. A significant rise usually indicates that an embryo is implanting, which suggests a possible pregnancy. Waiting for the second test result helps avoid conveying false hope or disappointment.


It’s important to note that beta hCG levels don’t double every two days throughout pregnancy. Once the levels rise above 4,000U, they tend to increase more slowly. Except in specific cases like IVF using an egg donor or transfer of genetically tested embryos, the birth rate following IVF in younger women is around 40% per embryo transfer. Patients need to have realistic expectations and should be informed about how and when they will receive the news, as well as counseling in case of a negative outcome.

When an embryo starts to implant, it releases the pregnancy hormone hCG into the woman’s bloodstream. Around 12 days after egg retrieval, 9 days after a day 3 embryo transfer, or 7 days after a blastocyst transfer, a woman should have a quantitative beta hCG blood pregnancy test performed. By that time, most of the hCG injected to prepare the eggs for retrieval should have cleared from the bloodstream. So, if the test detects more than 10 IU of hCG per ml of blood, it indicates that the embryo has attempted to implant. In third-party IVF (e.g., ovum donation, gestational surrogacy, embryo adoption, or frozen embryo transfers), no hCG trigger is administered, so any amount of hCG detected in the blood is considered significant.

Sometimes, there is a slow initial rise in hCG between the first and second tests (failure to double every 48 hours). In such cases, a third and sometimes a fourth hCG test should be done at two-day intervals. A failure to double on the third and/or fourth test is a poor sign and could indicate a failed or dysfunctional implantation. In some cases, a progressively slow rising hCG level might indicate an ectopic pregnancy, which requires additional testing and follow-up.

In certain situations, the first beta hCG level starts high, drops with the second test, and then starts doubling again. This could suggest that initially, multiple embryos started to implant but only one survived to continue a healthy implantation.

It’s customary for the IVF clinic staff to inform the patient/couple and the referring physician about the hCG pregnancy test results. Often, the IVF physician or nurse-coordinator coordinates with the referring physician to arrange all necessary pregnancy tests. If the patient/couple prefer to make their own arrangements, the program should provide detailed instructions.

In some cases, when the two blood pregnancy tests show that one or more embryos are implanting, certain programs recommend daily injections of progesterone or the use of vaginal hormone suppositories for several weeks to support the implantation process. Others give hCG injections three times a week until the pregnancy can be confirmed by ultrasound examination. Some IVF programs don’t prescribe any hormones after the embryo transfer.

Patients with appropriate doubling of hCG levels within two days after frozen embryo transfer (FET) or third-party IVF procedures such as surrogacy or egg donation may receive estradiol and progesterone injections, often along with vaginal hormone suppositories, for 10 weeks after the implantation is diagnosed by blood pregnancy testing.

A positive Beta hCG blood pregnancy test indicates the possibility of conception, but ultrasound confirmation is needed to confirm the pregnancy. Until then, it is referred to as a “chemical pregnancy.” Only when ultrasound examination confirms the presence of a gestational sac, clinical examination establishes a viable pregnancy, or after abortion when products of conception are detected, is it called a clinical intrauterine pregnancy.

A significantly elevated  hCG blood level without concomitant detection of an gestational sac inside the uterus by ultrasound after 5 weeks gestation raises the suspicion of an ectopic (tubal) pregnancy.

The risk of miscarriage gradually decreases once a viable clinical pregnancy is diagnosed (a conceptus with a regular heartbeat of 110-180 beats per minute). From this point onward, the risk of miscarriage is usually 10- 15% for women under 40 years old and around 35% for women in their early forties.

Dealing with successful IVF cases is relatively easy as everyone feels happy and validated. The real challenge lies in handling unsuccessful cases. Setting rational expectations from the beginning is crucial. In some cases (fortunately rare), emotional pressure may overwhelm the patient/couple, leading to a need for counseling or psychiatric therapy. I always advise my patients that receiving optimal care doesn’t always guarantee the desired outcome. There are many variables beyond our control, especially the unpredictable nature of fate. With around 36 years of experience in this field, I strongly believe that when it comes to IVF, the saying “man proposes while God disposes” always holds.

There are a few important things to consider when interpreting blood hCG levels. Levels can vary widely, ranging from 5mIU/ml to over 400mIU/ml, 10 days after ovulation or egg retrieval. The levels double every 48-72 hours until the 6th week of pregnancy, after which the doubling rate slows down to about 96 hours. By the end of the 1st trimester, hCG levels reach 13,000-290,000 IU and then slowly decline to around 26,000-300,000 IU at full term. Here are the average hCG levels during the first trimester:

  • 3 weeks after the last menstrual period (LMP): 5-50 IU
  • 4 weeks LMP: 5-426 IU
  • 5 weeks LMP: 18-7,340 IU
  • 6 weeks LMP: 1,080-56,500 IU
  • 7-8 weeks LMP: 7,650-229,000 IU
  • 9-12 weeks LMP: 25,700-288,000 IU

Most doctors wait until around the 7th week to perform an ultrasound to confirm pregnancy. By that time, the heartbeat should be clearly visible, providing a more reliable assessment of the pregnancy’s viability.

In some cases, blood hCG levels can be unusually high or increase faster than normal. This could indicate multiple pregnancies or a molar pregnancy. Rarely, conditions unrelated to pregnancy, such as certain ovarian tumors or cancers, can cause detectable hCG levels in both blood and urine.

 

To summarize, testing urine or blood for hCG is the most reliable way to confirm pregnancy. Urine tests are more common and convenient, while blood tests are more accurate and can detect pregnancy earlier. Tracking hCG levels in the blood is especially important for women undergoing fertility treatments. It’s essential to wait for the results of a second blood test before confirming pregnancy to avoid false hope or disappointment. Interpreting hCG levels requires considering various factors, and doctors usually perform an ultrasound around the 7th week for a more accurate assessment. Unusually high hCG levels may indicate multiple pregnancies or other conditions unrelated to pregnancy. Providing sensitive and timely communication of results is crucial for IVF clinics to support patients through the emotional journey.

Geoff Sher

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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