The bottom line is that because of the traumatic effect of freezing on egg viability and “competency” the statistical chance of each frozen/ thawed egg ultimately resulting in a baby is only at best 6-8%. So, while success rates following the transfer of embryos...

Prolactin (PRL) is a protein hormone (closely related to human growth hormone) that is secreted by specialized cells in the anterior part of the pituitary gland. In addition, the hormone is also produced and secreted by a broad range of other cells in the body, most...

Geoffrey Sher MD & Drew Tortoriello MD Mini-IVF is a procedure that involves ovarian stimulation with oral fertility drugs such as clomiphene or letrozole to promote the development of follicles, for egg extraction. This is on the pretext that Mini-IVF, involves the...

Pelvic Inflammatory Disease (PID) refers to inflammation of pelvic structures including the uterus, fallopian tubes, ovaries, bowel, and the smooth membrane that lines the surface of the pelvic cavity (the peritoneum). PID follows infection which reaches pelvic...

With the launching of Sher-Fertility Solutions (SFS), I will as of April 1st, take on a new and expanded consultation role. Rather than having hands-on involvement with IVF procedures I will, through SFS, instead provide fertility consultations (via SKYPE) to the...

Sher-Fertility Solutions (SFS)  Through SFS, I provide online fertility consultations (via SKYPE and FaceTime) to an ever-growing number of patients (from >40 countries) with complex Reproductive Dysfunction (RD) who seek access to my input and services. I now perform...

This February 13th is the day you get closer to having the family of your dreams. Join SFS Fertility Las Vegas for a patient-focused seminar where you can: ✨ Win a Donated IVF Cycle ✔️ Schedule a Free Consult to Review Your RecordsMeet The New SFS Fertility TeamLearn...

Ovarian hyperstimulation syndrome (OHS) is a condition where a woman receiving fertility drugs (usually gonadotropins) over-responds by developing a large number of ovarian follicles which upon administration of hCG, “triggers” a series of systemic events that can...

In the United States, effective treatment of  natural killer cell /cytotoxic lymphocyte (NK/CTL)-activation associated with either alloimmune or autoimmune implantation dysfunction requires the administration of primarily Intralipid (IL) or Intravenous gamma-globulin...

Today, due to a myriad of factors, IVF is regarded as one of the main thoroughfares for helping couples achieve the goal of creating a family. However, no two IVF candidates are exactly alike and there is no single approach that is applicable to every patient. In the...

The numerical chromosomal configuration of a cell is referred to as its karyotype or ploidy. A cell with an irregular chromosome number is referred to as aneuploid while one with a normal karyotype, as euploid. It is predominantly (but not exclusively) the ploidy of...

[CASE REPORT]This is a re-Post for purposes of follow-up (see post-script at the end).Background: Mary, 30 years of age and married to a fertile male partner, presented to me about four years ago with primary amenorrhea (i.e. she had never menstruated) and wanting to...

Because of the emotional, physical, and financial toll exacted by IVF, it is preferable that no one undertake a one‑shot attempt. If a couple can only afford one treatment cycle, IVF is probably not the right course of action.  After all, with conventional IVF there...

Polycystic ovary syndrome (PCOS) is a common hormonal system disorder among women affecting between 5% and 10% of women of reproductive age worldwide. Women with PCOS may have enlarged ovaries that contain multiple small collections of fluid (subcapsular microcysts)...

Many infertile patients, are erroneously advised by their physicians to first try IUI several times before resorting to IVF. Additionally many misguided insurance providers often, purely for economic reasons, require that infertile female enrollees who have at least 1...

It is primarily the egg (rather than the sperm) that determines the chromosomal integrity (karyotype) of the embryo, the most important determinant of egg/embryo competency. A “competent” egg is therefore one that has a normal karyotype and has the best potential to...

Polycystic ovary syndrome (PCOS) is a common hormonal system disorder among women affecting between 5% and 10% of women of reproductive age worldwide. Women with PCOS may have enlarged ovaries that contain multiple small collections of fluid (subcapsular microcysts)...

Mini-IVF is a procedure that involves ovarian stimulation using low dosage medications (often oral drugs like clomiphene and letrozole) under the premise that it is a “safer” and less expensive than conventional gonadotropin stimulation regimes while yielding...

Advanced endometriosis is often associated with ovarian endometriotic cysts, known as endometriomas. The cysts contain decomposed menstrual blood that looks like melted chocolate – hence the name “chocolate cysts.” They are space occupying cystic lesions within the...

Staggered-IVF involves the use of Preimplantation Genetic Testing of advanced embryos (blastocysts) to identify those that are euploid (“competent”) and thereupon  the subsequent transfer to the uterus of embryos identified as being chromosomally “competent” in later...

Endometriosis is a complex condition where, the lack or relative absence of an overt anatomical barrier to fertility often belies the true extent of reproductive problem(s). All too often the view is expounded that the severity of endometriosis-related infertility is...

All multiple pregnancies pose a risk to both mother and offspring. Pregnancy induced maternal complications such as miscarriage, pre-eclampsia, antepartum and post-partum hemorrhage become progressively more prevalent the higher the multiple gestation. For the babies,...

Most pregnancy induced placental complications that compromise placentation and intrauterine development have their origin in conditions that present prior to conception. As such, a patient requiring IVF presents her RE with a golden opportunity to preemptively...

Indiscriminate selection and use of protocols of Controlled Ovarian Stimulation (COS) can be decidedly detrimental to egg and embryo competency/quality especially when it comes to IVF conducted in women on opposite sides of the spectrum of response to fertility drugs...

Oscar-nominated director Amanda Micheli’s provocative documentary, Vegas Baby followed several aspiring parents, who desperately wanted to have a baby but were struggling with infertility as well as the high cost of treatments, through a contest that offered a prize...

About 1/3 of infertility is caused by a male factor, one third by a female factor and another third is due to a combination of both male and female factors. Thus, in more than 50% of cases, a male factor causes or contributes to the problem. Today, with very few...

In 2005, my associate Levent Keskintepe PhD and I introduced Preimplantation Genetic Testing (PGT) with the ability to identify all chromosomes in the embryo’s cells, into the field of IVF. This approach, which is now widely used throughout the world, permits...

Neither sex contributes more heavily than the other to infertility problems. Roughly one‑third of all infertile couples can trace their infertility to the woman, one‑third to the man, and one‑third to both partners. In practice this means that in >50% of cases there...

I am very proud to be featured in a new documentary film, VEGAS BABY, which follows several of my patients gambling on infertility treatment and the emotional, physical and financial costs involved.  Amanda Micheli, the director, has struggled with infertility...

Everything Has its SeasonGeoffrey Sher MDDear Patients and Friends, After some 35 years in the field of Assisted Reproduction (AR), having founded the First Private (non-university based) IVF program in the United States in 1984, and having been influential in the...

It is important for patients/couples contemplating IVF with their own eggs, to be aware that usually, in more than 50% of cases a single attempt will not result in a live birth and furthermore that the chance of success declines with advancing age of the egg provider....

There is a great deal of confusion when it comes to defining egg “quality.” Most people interpret terms such as “mature/immature/post-mature” eggs as implying that the timing of egg retrieval was off. This is, at best, a gross over-simplification and at worst,...

Embryo transfer (ET) is undoubtedly a rate limiting factor in IVF. Unquestionably, the IVF doctor’s expertise in performing ET as one of the most important factors that will determine IVF outcome. It takes confidence, dexterity, skill, gentility and above all,...

It is only through propagation of our biological offspring that we as humans can leave a lasting legacy of our existence. Perhaps this explains why the desire to have children is a basic human instincts and why an inability to achieve this goal (infertility) often...

The conventional way of conducting IVF treatment is to provide patients with opportunity to undergo treatment any time they are ready to do so. But such delivery of services in fact often falls short of affording access to the most efficient and best quality of...

It is hard for me to believe that more than three decades have flown by since I first introduced intrauterine insemination into the clinical arena (Journal of Fertility & Sterility, April, 1984). At that time and for more than 2 decades thereafter, I held the strong...

Unless tests for immunologic implantation dysfunction (IID) immunologic implantation dysfunction are performed correctly and conducted by a one of the few reliable reproductive immunology reference laboratory in the United States, treatment will likely be...

All multiple pregnancies pose a risk to both mother and offspring. Pregnancy induced maternal complications such as miscarriage, pre-eclampsia, antepartum and post-partum hemorrhage become progressively more prevalent the higher the multiple gestation. For the babies,...

Ovarian hyperstimulation syndrome (OHSS) is a life-endangering condition that occurs following ovarian stimulation for the treatment of infertility. It occurs due to overstimulation of the ovaries with the development of numerous follicles in susceptible women....

The numerical chromosomal configuration of a cell is referred to as its karyotype or ploidy. A cell with an irregular chromosome number is referred to as aneuploid while one with a normal karyotype, as euploid. It is predominantly (but not exclusively) the chromosomal...

Male factor problems as a contributing cause of infertility are very common. Male infertility is reported as a factor in 30-50% of infertility cases. In fact, many fertility specialists will recommend a semen analysis as one of the very first tests that should be...

The objective with In Vitro Fertilization is to consistently transfer competent embryos into a receptive uterine environment. This requires a very individualized and meticulous approach to evaluating and addressing those factors that can influence IVF outcome: All...

I have all too often heard it said that medical providers knowingly place unsuspecting infertile women at risk of developing cancer through the fertility injectable drugs and treatment they administer and that we knowingly place patients at risk by understating...

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...

With cervical Incompetence (CI) the cervix starts to shorten (efface) and dilate too early in the pregnancy giving rise to late (2nd trimester) miscarriage or premature birth. It can occur with first pregnancies (“Primary Cervical Incompetence”) or after a prior...

About a decade ago, I, along with my associate, Levent Keskintepe PhD were the first to introduce full chromosome Preimplantation Genetic Testing (PGT) into the IVF clinical realm to try and identify euploid embryos whose cells contained the required 46 chromosomes...

Case Report: **For the purposes of anonymity, I will be referring to the patient as RL throughout this blog.** RL, a 31-year-old woman, presented with a 7 year history of inability to conceive, in spite of 2 prior fresh and 1 frozen IVF attempts, where a total of six...

Hi Dr Sher, I’m 42 years of age. Until very recently, I knew nothing about IVF, and I now find myself in a scramble to optimize my chances with it. Despite a lifelong dream of having a healthy baby and happy family, it has taken me this long to find a great man/dad I...

Following ovulation, what remains of the ruptured follicle transforms itself into a structure called the Corpus Luteum (CL) which produces progesterone. The purpose of progesterone is to prepare the uterus to accept and support an early pregnancy until it is able to...

Consider the fact that between 40 and 43 of age, the success rate per cycle of treatment with injectible fertility drugs alone, with or without intrauterine insemination (IUI) is 2- 3%. Since it is 6-8 times higher with “conventional” With “conventional IVF” it...

For about 10% of all infertile couples, the cause of the infertility cannot be readily determined using conventional diagnostic methods. Such cases are often referred to as "unexplained infertility." The truth however is that in most such cases, the diagnosis of...

Tubal damage is one of the commonest causes of infertility. It is most often due to pelvic inflammatory disease (PID) caused by sexually transmitted bacterial infection with chlamydia trachomatis and Neisseria gonorrhea. Acute PID caused by such usually are associated...

The use of GnRH antagonists, as currently prescribed in ovarian stimulation cycles, i.e. the administration of 250mcg daily from the 6or 7th day of stimulation with gonadotropins, is in my opinion problematic when used in women who have diminished ovarian reserve...

Ever since January 1993 when a study was reported by researchers at Stanford University suggesting that the use of fertility agents increased the risk of ovarian cancer, there has been tremendous concern and anxiety among women who use fertility drugs. At first, the...

Intralipid (IL) is a solution of small lipid droplets suspended in water. When administered intravenously, IL provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid. It is made up of 20% soybean...

A hydatidiform molar pregnancy happens when tissue that normally forms the placenta instead becomes a growth, that triggers symptoms of pregnancy. A hydatidiform mole is a benign tumor of the root system (trophoblast) of the embryo which under normal conditions...

Today, in first world environments where there is ready access to advanced medical technology, many women undergo ultrasound diagnosis of pregnancy as early as 5-6 weeks after their last menstrual period. As a result, multiple pregnancies are often recognized very...

Older women, and those who have diminished ovarian reserve (DOR) with resistance to ovarian stimulation (“poor responders” are often labeled as being producers of “poor quality" eggs and embryos, and advised to seek IVF with egg donation. In fact, in my opinion such...

While most IVF pregnancies will progress normally and without any increased risk to mother or baby, there is little doubt that women who conceive in this manner as well as their babies are potentially at increased risk. In fact, women who give birth after IVF...

For more than three decades, about 70% of the patients that I have performed IVF on, have journeyed to see me from out state or out of country. Over the years, I have been repeatedly asked how, given the distance separates us from our patients, we are able to provide...

Two main factors determine the quality of a woman’s eggs at ovulation or egg retrieval. First is her age and second is the protocol used for ovarian stimulation. With the possible the exception of cases where there is severe sperm dysfunction, it is the chromosomal...

Cytomegalovirus (CMV) belongs to the Herpes group and, like Herpes, can remain dormant in the body for long periods of time (even for life). CMV infection is very common, such that by age 40Y >50% of adults will bear evidence of previous infection (i.e. test IgG +…see...

Clomiphene citrate (Clomid) is by far the most commonly used fertility drug in the world. Used in the right circumstances and with appropriate application, it can be and is effective in assisting conception. Ideally the use of clomiphene use should be confined to...

  Vaginal bleeding occurs in about 25% of all pregnancies. When it happens, it almost invariably raises the concern of pregnancy loss (miscarriage). Bleeding can also be a sign of a tubal (ectopic) pregnancy, and in cases where the distended Fallopian tube ruptures it...

After 1 year of unsuccessfully trying to have a baby, it is time to have a basic infertility evaluation. And the urgency increases the older the woman is.A: Preparatory Tests done on the woman:Tests for Ovarian Reserve: On the third day of spontaneous or progesterone...

Men with no sperm in their ejaculates (azoospermia), whether due to non-obstructive or obstructive (usually post-vasectomy) causes, can have their sperm accessed surgically and still propagate pregnancies. There are 2 methods by which this can be achieved. : 1) TESE...

Embryo transfer (ET) is undoubtedly a rate limiting factor when it comes to IVF outcome. In fact, in my opinion, it is the single most important procedural step in IVF. Optimal performance of ET takes practice, confidence, dexterity, timing, gentility and skill. Out...

Intracytoplasmic Sperm Injection ICSI, which began in 1992 as a treatment for severe male factor infertility, involves the direct injection of a single sperm into each egg under direct microscopic vision.Soon after the turn of the 20th century, it was reported that...

Until less than a decade ago, most women undergoing IVF would have their embryos transferred to the uterus in the same cycle that the egg retrieval was performed (“Fresh” Embryo Transfer). This was because embryo cryopreservation (freezing) was a hazardous...

About a decade ago, we, (Sher, and Keskintepe, L; et al) introduced full chromosomal karyotyping for preimplantation genetic sampling – (PGS) to assess egg/embryo “competency” for IVF. We performed and reported on 3 separate studies that served to herald...

Pelvic inflammatory disease (PID) is a condition where inflammation of pelvic structures occurs, as a result of one of the following: sexual transmission via the vagina and cervix, contamination from other inflamed structures in the abdominal cavity (appendix,...

The precise mechanism by which ovarian endometrioma causes infertility is unknown. In women with ovarian endometriomas, infertility is potentially associated with a decreased oocyte retrieval rate, reduced oocyte quality and reduced embryo quality. I personally...

The Sampson Theory for the pathogenesis of endometriosis is the oldest, but remains the most widely popular and accepted hypothesis. It is based on observations made as early as in 1938, that that endometriotic implants in the pelvis arise from retrograde (reversed)...

In 1 to 2 percent of cases, male infertility is the result of problems in an area of the brain (the hypothalamus) and or in a small gland situated just below the base of the brain known as the pituitary gland. The pituitary gland produces two gonadotropin hormones:...

Older women, as well as those who (regardless of age) have diminished ovarian reserve (DOR), tend to produce fewer and less “competent” eggs, the main reason for reduced IVF success in such cases. The compromised outcome is largely due to the fact that such women tend...

 Dehydroepiandrosterone (DHEA), is steroid hormone produced by the adrenal glands and ovary. It is involved in producing the male hormones, androstenedione testosterone and also estrogen. DHEA blood levels tend to decline naturally with age. Under the effect of...

Ovulation occurs within 38-42 hours of initiation of the spontaneous luteinizing hormone (LH) surge (which can be detected in the blood or urine prior to this event) and/or hCG administered following controlled ovarian stimulation (COS) with gonadotropins.One or more...

Antisperm antibodies (ASA) are immunoglobulins that attach to sperm. They are most commonly encountered in semen, blood, cervical mucous and follicular fluid. Not all ASA bind to sperm; however, those that do so can inhibit fertilization....

Ideal egg development sets the scene for optimal egg maturation that occurs 36-42h prior to ovulation or egg retrieval. Without prior optimal egg development (ovogenesis), egg maturation will be dysfunctional and most eggs will be rendered “incompetent” and unable...

Approximately 1 out of every 100 embryos will implant and grow outside of the uterine cavity, almost always in a fallopian tube. This is defined as an ectopic pregnancy. Infrequently, an ectopic pregnancy attaches to an ovary or to one or more other pelvic organs. On...

Given the considerable emotional, physical and financial investment associated with IVF treatment, it is essential that factors known to affect success be identified and regulated in advance of initiating treatment and to always thoroughly and meticulously “plan the...

An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. An ovarian follicle that is larger than 22mm is termed a functional follicular cyst. They are non-malignant (benign) and harmless and in most cases, don’t even cause symptoms,...

What is a varicocele? The testicles are housed in the scrotum, a skin-covered sac that houses the two testicles as well as blood vessels that deliver blood to these glands, nerves, and lymphatics. An abnormality of the plexus of veins (the pampiniform plexus) that...

About seventeen years ago, after reporting on the benefit of vaginal Sildenafil (Viagra) for women who had implantation dysfunction due to thin endometrial linings, I was proud to announce the birth of the world’s first “Viagra baby.”  For those of you who aren’t...

There is an ever growing realization, recognition, and acceptance of the fact that uterine immunologic dysfunction can lead to immunologic implantation dysfunction (IID) with “unexplained” infertility, IVF failure, and recurrent pregnancy loss (RPL). Although there...

More and more women are deciding, based upon personal preference and professional necessity, to postpone having a family to a later age. In fact, very recently Janet Jackson (49Y) was in the news stating that she was cancelling her tour to prepare for treatment needed...

The prevalence of obesity in Western societies is on the rise, which has a profound effect on the reproductive performance of women who are trying to have a baby. Recent evidence suggests that obesity in women of reproductive age is associated with decreased birth...

Patrick Steptoe and Robert Edwards were responsible for the birth of the world’s 1st IVF baby, Louise Brown, in 1978. Since then about 4 million babies have been born worldwide, and the number is growing fast. The introduction of this Assisted Reproductive technology...