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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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Egg Health & Ovarian Reserve Jan 12, 2023

Low AFC in IVF cycle after BCP vs IUI

Hi Dr Sher, I’ve done 5 IUIs before and my AFC has varied between 13 and 18. I’m now doing IVF. After 13 days of taking BCP, my ultrasound only showed 9 follicles and I was asked to start stims.… — Sophie J.

Dr. Geoffrey Sher answered

I would not take this AFC count as an accurate indication of how many follicles you might end up with. I suspect that with stimulation there will likely be more. Good luck! Geoff Sher ADDITIONAL INFORMATION: I am attaching online links to two E-books which I recently co-authored…
Egg Health & Ovarian Reserve Jan 10, 2023

Unexpected IVF Results

Hi Dr. Sher- I just completed my first failed IVF cycle and I'm left shocked and confused by the results, for both egg retrieval and transfer. I am 38 years old, AMH is 5.12, FSH 6.3, follicle count around 40-… — Jennifer M.

Dr. Geoffrey Sher answered

One of the commonest questions asked by patients undergoing IVF relates to the likelihood of their eggs fertilizing and the likely “quality of their eggs and embryos. This is also one of the most difficult questions to answer. On the one hand many factors that profoundly influence egg…
Hormones & Ovulation Jan 7, 2023

38 and ovulation infection meds

I’m 38 years old and having difficulty conceiving. I developed Ashermans (moderate) in 2020. I got lysis of adhesions and conceived my daughter shortly after at 36 years old. I ovulate and haven’t regular cycles. My doctor is giving me… — Sarah E.

Dr. Geoffrey Sher answered

Respectfully, . After Ashernan's, endometrial thickness poses a real problem in many cases. In my opinion, Tamoxifen will make matters worse as far as the uterine lining is concerned. Look this up in my book, From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS)…
Egg Health & Ovarian Reserve Dec 27, 2022

Are my poor outcomes just related to age?

[et_pb_section admin_label="section"] [et_pb_row admin_label="row"] [et_pb_column type="4_4"][et_pb_text admin_label="Text"]Hello, I had my daughter via ivf aged 40 after 2 cycles (first and only FET). Have been trying for a second (aged 41-42 years) over 4 cycles. My AMH is 31 and I… — Kay L.

Dr. Geoffrey Sher answered

Age could well be a factor, however, the protocol used for ovarian stimulation should be reviewed and if need be, revised. Also, I do suggest doing PGT on all blastocyst sand selective transferring only "competent" ones. Geoff Sher The importance of the IVF stimulation protocol on egg/embryo quality…
Ovarian Stimulation & OHSS Dec 27, 2022

FET Protocol

Hello I will be going for my next FET for baby #2, I have PCOS, any supplements advices , I will be taking aspirin for my pre eclampsia for sure, i just completed 5 days of Provera for period for… — Steph P.

Dr. Geoffrey Sher answered

There are many approaches to prepare for FET. Below is my preferred method! Geoff Sher 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…
IUI & Insemination Dec 17, 2022

TFMR with natural pregnancy followed by failed IUI, FET

Hi Dr.Sher, Thank you for taking the time to help all of us. I was on Birth Control for two years, came out of it and became pregnant naturally. Unfortunately the baby had a severe heart defect and we had… — Naveena S.

Dr. Geoffrey Sher answered

Perhaps you do have underlying endometriosis but taking the BCP for some time before conceiving probably had nothing to do with your original success. Perhaps we should talk about your secondary infertility. It is one thing for a woman who has never been able to conceive (primary infertility)…
Ovarian Stimulation & OHSS Dec 13, 2022

Provera IVF Protocol

Dr Sher, I was supposed to start IVF in December. My Provera IVF protocol is birth control, followed by stims and antagonist, and trigger with HCG (10,000). However, I did not get my period (Cycle Day 40 today) and my… — Sophie J.

Dr. Geoffrey Sher answered

No real concern at all. However, make certain that you are not pregnant before taking Provera. Do a urine pregnancy test! ADDITIONAL INFORMATION: I am attaching online links to two E-books that I recently co-authored with my partner at SFS-NY (Drew Tortoriello MD) for your reading pleasure: From…
Egg Health & Ovarian Reserve Dec 12, 2022

Egg Maturity

What approach is best for optimising egg maturity? Would HGH be useful for this? I already use a double ovidrel trigger, but only get 1-3 mature eggs, despite retrieving about 8 eggs. I also stimulate rather quickly, with my follicles… — Cristina Y.

Dr. Geoffrey Sher answered

The importance of the IVF stimulation protocol on egg/embryo quality cannot be overstated. This factor seems often to be overlooked or discounted by t IVF practitioners who use a “one-size-fits-all” approach to ovarian stimulation. My experience is that the use of individualized/customized COS protocols can greatly improve IVF…
Embryos & Genetic Testing Nov 30, 2022

FET Protocol Opinion

Hi, I just wanted a second opinion on what my FET protocol looks like given my personal situation. I was diagnosed with endometriosis via laparoscopy in 2018. I did a total of 6 IUIs in 2021-2022 with my 4th one… — Taylor A.

Dr. Geoffrey Sher answered

This is an inordinate drop off from egg to "competent" embryo. In my opinion, , in spite of your borderline AMH (1.48ng/ml) which would suggest otherwise, you are a high responder to fertility drugs. The most likely explanation for your poor egg to "competent" embryo conversion has to…
Embryos & Genetic Testing Nov 29, 2022

What causes embryos to arrest during development?

I recently completed my 2nd egg retrieval at age 36 and had very different results. I have PCOS (high AMH =15 and many follicles, regular periods, thin/normal BMI ) and respond well to meds. We used 75 Menopur, 100 Gonal… — Maya S.

Dr. Geoffrey Sher answered

It could be an inherent underlying egg defect. However, more commonly it has to do with the selection of an optimal protocol for ovarian stimulation, the type of "trigger used" and the implementation of said protocol. The importance of the IVF stimulation protocol on egg/embryo quality cannot be…
Egg Health & Ovarian Reserve Nov 29, 2022

Getting FSH to rise following BCP

Hi Dr Sher, You've written that for women launching COS coming off a BCP something needs to be done to cause a rise in FSH for 5-7 days to facilitate PAF to AF conversion. You suggest that this be done… — Gautam J.

Dr. Geoffrey Sher answered

Theoretically this might be achievable through administration of gonadotropins for several days longer while still on BCP but in my pinion would hold no advantage.
Ovarian Stimulation & OHSS Nov 28, 2022

Use of the Birth Control Pill (BCP) to launch IVF-COS

Dear Dr Sher, You have written that pre-antral follicles require exposure to FSH for 5 - 7 days to be able to develop into Antral Follicles. However, taking Birth Control Pills (BCPs) prior to COS suppresses FSH, and therefore does… — Gautam J.

Dr. Geoffrey Sher answered

Thank you for your very thought provoking comments and questions. Frankly, I cannot disagree that administration of FSH-in small amounts over the last few days of the BCP might not have a similar effect to overlapping with Lupron. It might however add an additional unnecessary variable and expense.…
Hormones & Ovulation Nov 25, 2022

2 IVF failures and 1 cancellation

I’m 36 (insulin resistant & subclinical hypothyroidism + DOR 4.0 pmol) I have been trying for 4.5 years, I have completed two ivf cycles (Gonal F 450 and Menopur 150) First ivf cycle with Testosterone gel, which resulted in 3… — Mychelle G.

Dr. Geoffrey Sher answered

There are several possible factors :Diminished ovarian reserve: Protocol selection for ovarian stimulation; Male factor; egg quality; implantation dysfunction (possibly related to an autoimmune, immunologic implantation dysfunction.(IID) such as Thyroid autoimmune disease and underlying ndometriosis. Obviously I cannot address all these here. I suggest we talk....SO, I invite…
Ovarian Stimulation & OHSS Nov 22, 2022

24 mm Follicle Pre Trigger

Hello, I am on cycle day 12 and went for my bloodwork and ultrasound. My ultrasound showed a dominant follicle in the left measuring 24mm and my bloodwork was showing I was going to ovulate soon. My doctor instructed me… — Eliza T.

Dr. Geoffrey Sher answered

In my opinion, follicles of >22mm in mean diameter, are much less likely to house viable , 'competent" eggs , post "trigger". The ideal pre "trigger" measurement is 18-22mm. And No, they should not grow after the hCG "trigger".. Either way, there is no harm giving it a…
Male Infertility Nov 21, 2022

What does your clinic do differently?

Hello, My husband and I have been trying to have a baby for 8 years now. We reside Alberta, Canada. We have attempted 5.5 IVF ICSI cycles. I am wondering if your clinic does the IVF procedures differently then in… — Masuma M.

Dr. Geoffrey Sher answered

You are only 34y of age, So when it comes to egg/embryo quality, regardless of your ovarian reserve, you should be able to do better. Your husbands sperm dysfunction could be contributing factor but in my opinion, the protocol used for ovarian stimulation and its implementation is the…

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.

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