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Our Medical Directors are outstanding physicians that you will find to be very personable and compassionate, who take care to ensure that you have the most cutting-edge fertility treatments at your disposal. This is your outlet to ask your questions to the 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

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230 answers

Ovarian Stimulation & OHSS

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Hormones & Ovulation May 24, 2023

Letrozole + HRT for ovulation induction

I am 40-year-old female trying to get pregnant. My estrogen levels and my AMH are rather low and my follicular phase very long of 27 days. Before going for IVF I am trying to improve my ovulation. My gynecologist gave… — Lucie M.

Dr. Geoffrey Sher answered

This is a very unconventional approach that I both do not advocate nor use. The protocol used for ovarian stimulation in women with DOR is very important. Consider the following: It is primarily the egg (rather than the sperm) that determines the chromosomal integrity (karyotype) of the embryo,…
Ovarian Stimulation & OHSS May 24, 2023

IVF protocol

Hello there! I’m currently on my first cycle of IVF after 4 failed attempts of IUI. I have been prescribed 150 units of gonal f, and 75 units of menopur. At my first scan on day 6 of being on… — Steevie D.

Dr. Geoffrey Sher answered

The rate of follicle growth to reach full development is not important here. Rather, it is that they develop fully and that the timing of an adequate hCG trigger is well decided. I cannot respond as to whether or to what extent the dosages should be altered. For…
Ovarian Stimulation & OHSS May 22, 2023

Egg Retrieval

Hi doctor Sher During my egg retrieval yesterday they only found some cumulus cells no oocytes. What does this mean? Can there be cumulus cells without eggs? — Gauri P.

Dr. Geoffrey Sher answered

There is in my opinion no such entity as “Empty Follicle Syndrome”. All follicles contain eggs. Failure to access those eggs at ER can often be a result of the protocol used for controlled ovarian stimulation (COS. Not infrequently, when following vigorous and often repeated flushing of follicles…
Hormones & Ovulation May 22, 2023

PCOS But regular period

Hi Dr Sher I am diagnosed with pcos but my cycles are regular but I was not able to conceive despite trying for 2 years. After every ovulation my basal body temperature increased and progesterone also increased ( my gynecologist… — Teresa M.

Dr. Geoffrey Sher answered

I need much more information to provide an authoritative response . Please call my assistant, Patti at 702-533-2691 and set op an online consultation with me to discuss. ADDITIONAL INFORMATION: I am attaching online links to two E-books which I recently co-authored with my partner at SFS-NY (Drew…
Ovarian Stimulation & OHSS May 18, 2023

Overmature Follicles?

Hi Dr. Sher, I am writing to you because I am extremely upset at the negligence of my clinic and am looking for some insight. The clinic upped my meds of rekovelle and menopur and decided to wait 3 days… — Kristin C.

Dr. Geoffrey Sher answered

Of course I cannot say with certainty, but in my experience follicles >22mm will commonly produce poor quality eggs. I believe in triggering when several follicles reach 20-22mm. After this cycle is over, I suggest we talk. If interested, please contact my assistant Patti Converse at 702-533-2691 and…
Ovarian Stimulation & OHSS May 10, 2023

Menopur – Mistake

Hi Dr. Sher, I am so upset with myself. Tonight will be my sixth day of taking menopur 75 IUs (along with rekovelle). I was not aspirating it correctly into the syringe and as such, a few times, some of… — Kristin C.

Dr. Geoffrey Sher answered

Don't be too hard on yourself. These things happen. Besides it will likely in no way prejudice your cycle. Good luck and G-d bless! Geoff Sher 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).......…
Egg Health & Ovarian Reserve May 10, 2023

Empty Follicle

Dear Dr, what could possible be the cause of having empty follicle on egg retrieval day for ivf. I took the trigger 34hrs before the retrieval and I’m 34yra — Faith A.

Dr. Geoffrey Sher answered

Frequently, when following vigorous and often repeated flushing of follicles at egg retrieval they fail to yield eggs, it is ascribed to “Empty Follicle Syndrome.” This is a gross misnomer, because all follicles contain eggs. So why were no eggs retrieved from the follicles? Most likely it was…
Ovarian Stimulation & OHSS May 1, 2023

Lupron and retrieval

Hi How are you? I'm currently going through my second round of IVF and had a chemical pregnancy with a pgt normal embryo. I had endometritis before and they cleared it with cipro. I changed my doc since and my… — Lynn C.

Dr. Geoffrey Sher answered

Respectfully, I would not recommend depot Lupron prior to FET. After a few months, it can interfere with endometrial receptivity by down-regulation estrogen receptors. AND yes! I would recommend another ER sooner rather than later to try and " make hay while the sun still shines". Endometriosis is…
Egg Health & Ovarian Reserve Apr 26, 2023

low immature oocytes

Hello, I have recently had a failed IVF cycle, and I think it might be due to the lupron being used as a trigger shot. I am 34, healthy, non smoker, active. We are doing IVF due to mail fertility… — Rana N.

Dr. Geoffrey Sher answered

Very respectfully, I must agree that the protocol used for ovarian stimulation was likely an issue here. I think we need to talk . Please contact my assistant, Patti Converse at 702-533-2691 and set up an online consultation with me. Regards, Geoff Sher The importance of the IVF…
Ovarian Stimulation & OHSS Apr 24, 2023

Transfer Prep

Hi Dr. Sher, I wrote to you a while back asking for your opinion on next steps. You suggested an additional transfer which I did-making three transfers. We are finally moving to a transfer (5 day frozen, tested) which will… — Danielle B.

Dr. Geoffrey Sher answered

This is my approach but your RE might prefer a different methodology!! Until less than a decade ago, most women undergoing IVF would have embryos transferred to the uterus in the same cycle that the egg retrieval was performed (“Fresh” Embryo Transfer). This was because embryo cryopreservation (freezing)…
Egg Health & Ovarian Reserve Apr 17, 2023

31y, normal AMH, no blasts after 3 rounds

Hi Dr. Sher, I started IVF when I was 30y/o and did 1 round with the standard antagonist protocol in March 2022 at CCRM Houston (BCP priming, 225u follistim, 2 vials menopur, ganirelix, combo trigger, dexamethasone qd). Stimmed for 8… — Macy S.

Dr. Geoffrey Sher answered

I believe that your problem can be resolved! We should talk........ I suggest that you call my assistant, Patti Converse (702-533-2691) and set up an online consultation with me to discuss your case in depth. While age and ovarian reserve can and do affect egg quality, these are…
Age & Fertility Apr 16, 2023

Question re: ideal protocol for 40 yo woman with low AMH/

Hello Dr Sher I have diminished ovarian reserve. My AMH 2 yrs ago was 0.36. Its likely even lower now :( I have been a poor responder to high dose IVF with gonal-f (450 units) and menopur 150 units. Prior… — Yvette R.

Dr. Geoffrey Sher answered

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 propagate a “competent” embryo. In turn,…
Egg Health & Ovarian Reserve Apr 15, 2023

What next?

Hi Dr Sher, we are a couple aged 35 and 34. We had 2 natural pregnancies which resulted in first trimester miscarriages. We later found out that my husband has balanced translocation and I have low amh of about 0.8ng/ml… — Sofia C.

Dr. Geoffrey Sher answered

Whenever a patient fails to achieve a viable pregnancy following embryo transfer (ET), the first question asked is why! Was it simply due to, bad luck?, How likely is the failure to recur in future attempts and what can be done differently, to avoid it happening next time?.…
Egg Health & Ovarian Reserve Apr 12, 2023

low immature oocytes

Hello, I had a failed IVF cycle. I am 34, healthy (No smoking, healthy diet, yoga 3 times a week), BMI 22 and doing IVF due to male infertility reasons. My Dr gave me the short protocol, my body responded… — Rana N.

Dr. Geoffrey Sher answered

I do not believe that this is likely to be due to an intrinsic egg issue. It is likely due to the type of protocol used and/or the type and typing/dosage/timing of the "trigger". We really need to talk. I suggest you call my assistant, Patti Converse at…
Egg Health & Ovarian Reserve Apr 12, 2023

Low amh clomid protocol advice

n online consultation with me to discuss.Hello, I'm almost 39yo with an amh of 0.3 and 6 follicles at baseline. Trying for a second child. Started a max dose ivf antagonist protocol and responded really fast, 7 days of stim… — Yasmin G.

Dr. Geoffrey Sher answered

Respectfully, In my opinion neither mini-IVF nor clomiphene is good in women with diminished ovarian reserve. 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…

Ask Our Doctors

Supporting Your Journey

Our Medical Directors are outstanding physicians that you will find to be very personable and compassionate, who take care to ensure that you have the most cutting-edge fertility treatments at your disposal. This is your outlet to ask your questions to the doctors.

230 answers

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