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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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225 answers

Ovarian Stimulation & OHSS

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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…
Egg Health & Ovarian Reserve Nov 21, 2022

IVF advice for optimal cycles

Hi Dr. Sher, I’m 34 with history of 2 early losses last year and DOR (last AMH 1.49). I have around 16 antral follicles based on ultrasound. Just finished my first round of stims and only yielded 6 eggs. Only… — Lauren M.

Dr. Geoffrey Sher answered

You are only 34y of age and with your high AFC, I expect that you ave ample ovarian reserve. My hunch is that you poor response could have to do with the protocol used for ovarian stimulation and its implementation.I really think we should talk!!. The importance of…
Ovarian Stimulation & OHSS Nov 20, 2022

IVF protocol meds

Hi, I have already had three cycles of IVF with my last one being the most successful. My protocol was 7 units omnitrope and testosterone gel with norethindrone for a few weeks before stopping norethindrone to start my cycle. I… — Vivian K.

Dr. Geoffrey Sher answered

I just don't know how the replacement of Menopur with low-dosage hCG would stack up as I personally have never used hCG in this way during stimulation. On the face of it it probably would work OK but it would be preferable if you could access other HMG…
Egg Health & Ovarian Reserve Nov 19, 2022

Infertility

I am 32, have PCO. I have experienced EFS in all egg collections, medicated and unmedicated. Recently, I found out I have ZP1 homozygous mutation (autosomal recessive) which means maturation oocyte defect. Is there a way to find eggs or… — Andria E.

Dr. Geoffrey Sher answered

There is certainly room for differing opinions her, But I would not go straight to egg donation. There are so many factors that impact egg quality in women with PCOS, but most of them are amenable to treatment using an individualized protocol for ovarian stimulation. Polycystic ovary syndrome…
Hormones & Ovulation Nov 19, 2022

IVF

Dr. Sher, My husband and I are 25 years old and have been trying for 2 years to conceive. I have stage 4 endometriosis, and had our first transfer 10/10 which failed. The protocol I was placed on was just… — Ashleigh G.

Dr. Geoffrey Sher answered

When women with infertility due to endometriosis seek treatment, they are all too often advised to first try ovarian stimulation (ovulation Induction) with intrauterine insemination (IUI) ………as if to say that this would be just as likely to result in a baby as would in vitro fertilization (IVF).…
Ovarian Stimulation & OHSS Nov 15, 2022

Stim Protocol

Dear Dr. Sher, My spouse and I are both 36 years old with unexplained infertility. We've had 6 failed IUIs (4 with letrozole, 1 with letrozole and Menopur, and 1 with Gonal-F). My spouse's AMH is 1.27 ng/mL and AFC… — Gautam J.

Dr. Geoffrey Sher answered

. Obviously there are differences of opinion. What I have espoused is based upon 38Y in the field and >17000babies. 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…

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.

225 answers

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