Ask Our Doctors
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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This question is about reciprocal IVF. Im 21 and my wife is 58. She hasn’t reached menopause and I have irregular periods. I was diagnosed with infertility at a young age after a miscarriage. Who would you recommend to use the eggs and carry? We want to use my eggs and have her carry but unsure if it’ll be safe
He realizado mi primer ciclo para vitrificar ovulos, sin embargo de 5 fólicos que han engordado sólo se ha podido obtener un óvulo maduro.
Tengo 37 años y AMH de 0,33. En la ecografía se observaban 10 folículos.
El tratamiento del primer ciclo ha sido:
– Inicio del tratamiento: 3/4 día de regla ya que hay problemas para detectarlo porque inicio con manchado y no con sangre. El dia anterior inicio tratamiento: estradiol a 75 y 7 folículos antrales.l (ya menos que las otras ecografías semanas antes que eran 10).
– 1 y 2 dia de tratamiento se ha suministrado meriofert 150 UI, mientras que del 3 al 9 se ha puesto dosis de 300 UI.
– Día 6 de tratamiento se ven dos folículos muy evolucionados (17-15, mientras el resto a 6-6-8)
– 5 al 9 dia tratamiento se ha suministrado orgalutran 0,25
– el 10 dia a las 21:30 se ha suministrado decapeptyl 0,2 y ovitrelle 250 “dual trigger”. Tamaño: 23-19-15-14-13
– del 1 al 9 del tratamiento se ha administado cleoxane 40mg por riesgo trombosis
– el día 11 del tratamiento 9:40 se realiza punción y sólo se obtiene uno maduro el que el día 5 medía 8mm y el día 10, 15mm. El resto de folículos el aspirado sale vacío.
Mis dudas son:
(i) ¿ha podido influenciar el día de inicio del tratamiento y que se haya suministado los dos primeros días una dosis menor de meriofert (150 vs los 300 que correspondía)?
(ii) ¿Es necesario suministrar 300 ui o con mi número folículos / reserva con 150 ui no se va a notar diferencia?
(iii) Ahora dicen incluir anticonceptivos previos, según indica pareciera ser adecuado. ¿Cuándo y como?
(iv) ¿A su parecer cómo debería ser el protocolo más adecuado? Me dicen que vuelva a probar ciclo entero pero me preocupa que sólo sea 1 y la carga hormonal (antecedente cáncer de mama).
(v) Así mismo he leído estudios que denotan que si se suministra 36 horas antes de la punción ovitrelle, y luego 12 horas después otra dosis – esto es 24 h antes de la punción – puede mejorar que los folículos si desprendan el óvulo porque puede ser que el aspirado salga vacío a pesar de que haya óvulo adherido entre el cumulus oophorus y la pared folicular pero que el aspirado no sea capaz de absorber y con esta segunda dosis a las 12 horas permite mayor relajación. Otra opción en estudios he leído que es doble aspirado. ¿Tiene usted experiencia o apoya alguna?
(vi) Así mismo puede ser que si están vacíos y se repite la punción al día siguiente puedan desprenderse?
(vii) ¿Hay alguna técnica o medidor que prediga que salgan vacíos? Tenía el estradiol a 900 el día 10.
(viii) el clexane / heparina ha podido afectar?
(ix) ¿Es recomendable tomar complementos coencima Q10 / acido / vitaminas/etc? ¿Recomienda alguna concreta?
Millones de gracias, porque estoy dudando si he escogido la clínica correcta y no se ha seguido el protocolo y debo buscar alternativas o es correcto y debo asumir la realidad?
Primero agradecer su trabajo.
Le escribo para saber según su opinión ¿Cuál es el mejor protocolo de medicamentos para una estimulación ovárica para mi con 37 años y 0,3 de antimulleriana?
Con otras respuestas no consigo entender día a día que debería ser lo propio.
Primer ciclo sólo salió un óvulo maduro de 7 folículos que se veían. ¿Cómo evitar ese efecto?
Hello, I am trying to conceive and have been told the issue is I have a 5cm endometrioma. I am hoping to have this aspirated before starting any treatments. I do not want surgery to remove it as they want to take my ovary. Please let me know and if you do this or know someone who does I would love to make an appointment.
Hi Dr. Sher,
I’m here because, like many women who come to you, I have had multiple failed FETs. I did IVF back in 2017 due to male Factor infertility, azoospermia. I was 30 years old and my embryos were all highly graded.
My first transfer was successful, I have an almost 6 year old son. I had transferred to embryos and one survived, my son who was born at 30 weeks premature.
About a year and a half ago, I transferred another highly graded embryo, that was healthy and all scans, until I lost him at 13 weeks gestation. After some testing I found out that I have APS. Due to anemia I had to get better before I could do my next transfer. I did my next transfer in September and another one in October both of which failed to implant. On my second transfer of this year, my RE added Lovenox, aspirin, methylprednisone, claritin, and antibiotics which I took prior to the transfer that still failed.
I have one more embryo left. Can you help me find the right protocol so that this last embryo sticks?
Hi Dr Sher
I’m 43 year old woman with PCOS and Type 2 Diabetes and have endometrial hyperplasia atypia. My doctor initially recommend a hysterectomy but I would like to have a family. I realise I will likely require IVF once the hyperplasia is under control due to my age and medical history.
I have undergone multiple hysteroscopy procedures and had the Mirena coil fitted anumber of times. At first the thickness of the lining decreased but more recently that hasn’t happened. In August 2023 hysteroscopy showed that the thickness had increased and i had the previous coil replaced with another. I was prescribed Provera 200mg three times daily to help this issue.
I am having a check up very soon after being on this medication for 10 weeks, and my question to you Dr Sher is, would this be the same way you would approach the issue of a patient with endometrial hyperplasia atypia who would like to have a family? When would I be clear to go forward with IVF? One clinic has recommended egg/embryo banking sooner rather than later.
I have been unable to find a lot of helpful information and want to be sure there’s nothing further I should try or questions to ask my doctor. Any advice would be appreciated.
I was diagnosed with DOR at age 29 with AMH 0.3 (AMH stable x 3yr, FSH ~12), otherwise no reproductive abnormalities for myself or my husband. Over the past 2yr, I have completed 12 rounds of IVF – the first 6 were poor response with only 1-3 follicles appearing mature on imaging and estrogen levels (medium and high antagonist, flare protocol, and mini IVF), trigger with 10k HCG + lupron and only 2 germinal vesicles retrieved. Next 6 cycles moved to high dose antagonist at a new clinic with 4-9 mature follicles per cycles, trigger with 20k HCG/lupron x2 each retrieval at 36-38hr and 12h later, with 0-3 eggs retrieved, all germinal vesicle stage. Is there anything that can be added? Are further IVF attempts futile? Is timed intercourse futile?
Hi- I have recurrent unexplained pregnancy loss:
Recently got a positive test and have the following HCG results… The third draws doubling time threw me off a bit but today had a good rise… any insight into what to expect from these numbers?🤞🤞
Hello. I am 45 and I am days away from medicated FET. I did a mock FET first, and then I was cancelled during my last FET round (right at the end) because I ovulated. So I waited, scheduled a few FET, and they gave me Lupron this time. Well, in a true moment of “IVF,” with all there is to remember, I did my first PIO injection in hurry, and made it ten minutes late for the exact time on my protocol. The nurse said since it was so close, they would not cancel me. After-hours last night as I checked protocol for the next day (today) I realized I took 25 mg of progesterone (I read it has .25 ml) instead of 50 mg, or .5 ml. So I took the missed amount many hours later. This round has gone beautifully. My health and mindset are dialed. I have taken every single supplement, Lupron injection, viagra, and estradiol like clockwork — never missed a thing, and I am killing myself over this small mistake. Uterine lining, and levels are great. This is our only embryo (tested among 3 blasts from my first ER). I love my clinic, but I feel strongly if I alert them to this small shortage, they will cancel my cycle. The spending has been as high as you can imagine. Many cancellations of subsequent ER attempts, the last FET cancellation, the mock, etc. Can I truly impact my entire cycle from 12.5 mg of PIO? I am set to begin 1.5 Ml daily (no vaginal inserts) today. Day 2. With my FET scheduled for Tuesday the 14th. That is 5 days and a few hours from now. Thank you so much!
s ago. Hi! I read about an IVF alternative called CAPA-IVM from this article: https://www.sciencealert.com/ivf-alternative-first-baby-born-in-australia-through-cheaper-safer-fertility-treatment
I want to know if you offer this procedure or, if not, can you recommend a place that does it in the US? Thanks!
I don’t seem to understand these hcg levels. I did a blood test the first time and it showed that my hcg levels were on 6105 and I am 5 weeks pregnant. I did a test again a week after and it shows 1501 hcg levels and my nurse says I am 6 weeks 2 days pregnant. Exactly what could it be because isn’t the number supposed to be higher at 6 weeks
nd can use own eggs/embryos.
I am a current patient. 2 failed ivf. High NK. Myself and husband have 2 variants of MTHFR I did intralipids in both. I was wondering if we would have better chances if we used a donor embryo vs using embryo we have using my husbands sperm. With that said do you recommend a donor embryo site or do you have donor embryos that are best suited for us?
Hello Dr Sher,
I hope you’re well.
We just had a dating scan at 13w1d, they confirmed everything looks good. However, in the printed report, it states that for the Dopler Ultrasound there is a “notch right” – they didn’t discuss this with us, but the PI left reading was 0.780 and the PI Right reading was 1.255, mean PI was 1.255, suggesting there is an imbalance.. does the mean potential hypertension/preeclampsia later on in pregnancy? Is there anything I could do to improve the position, to the extent it needs to be improved.. I’m taking 75mg of baby aspirin perhaps 150mg would be help.
I look forward to your reply.
Many thanks and best regards,