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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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Page 24 of 68

Egg Health & Ovarian Reserve Feb 25, 2024

Egg Retrieval with Immature Eggs

I got 29 eggs during my egg retrieval but was told that only 5 were mature. I am trying to understand why my maturity rate was so low. I triggered when 10+ follicles were at 20mm, and many at 18mm.… — Stephanie T.

Dr. Geoffrey Sher answered

Embarking on the journey of IVF often raises questions about the likelihood of success and the quality of embryos. While it’s challenging to predict outcomes due to various factors, there’s hope and information to guide you. Firstly, the key to fertilization potential lies in the chromosomal integrity of…
Uterine & Endometrial Health Feb 23, 2024

Re: progesterone level before FET transfer

Good afternoon Dr. Tortoriello, I'm doing a fifth stimulated frozen embryo transfer due to thin lining issues and now have the best lining I've ever had of 8.7 mm, trilaminar. I expect to do my trigger injection tonight and start… — Eliana G.

Dr. Drew Tortoriello answered

Here is my suggested/personal approach to FET: Two decades ago, when women went through IVF (in vitro fertilization), they usually had their embryos put in the uterus right after the eggs were collected in the same cycle (known as "Fresh" Embryo Transfer). Freezing embryos at that time was…
IVF Failure & Pregnancy Loss Feb 22, 2024

Ivf

Dr am 44 had a miscarriage in October naturally without ivf thinking of starting ivf last period was January 21 until date no flow and am not pregnant your advice pls and thxs — Vera E.

Dr. Geoffrey Sher answered

_ Age should never be a barrier to hope and fulfillment when it comes to IVF. Many women in their early to mid-40s are successfully having IVF babies using their own eggs, especially if they have a good number of eggs left in their ovaries. However, for women…
Egg Health & Ovarian Reserve Feb 22, 2024

Low Amh

Hello doctor , I’m 33yrs old ….AMH came back .56 and progesterone on day 3 was 16.6 and I had chemical pregnancy in 2020….i don’t have kids and I’m not going to have any kids naturally …so even ivf is… — A C.

Dr. Geoffrey Sher answered

The AMH is NOT too low for IVF. In fact IVF is indicated but the protocol used for ovarian stimulation must be tailored. Understanding the impact of ovarian reserve on the success of in vitro fertilization (IVF) is crucial when it comes to reproductive health. This article aims…
Ovarian Stimulation & OHSS Feb 21, 2024

What is the likelihood of my pregnancy succeeding

I had my first blood test done my levels are around 57 and they couldnt see anything on an ultrasound they had me wait 4 days to do repeat testing and my numbers are only at 71 — Shelby N.

Dr. Geoffrey Sher answered

This is a slow rise and the likelihood is that the pregnancy will not survive! However, repeat th hCG test in 2 days to see if it doubles as it should. So sorry! Going through IVF is a major investment, emotionally, physically, and financially, for every patient or…
Egg Health & Ovarian Reserve Feb 20, 2024

IVF consultation

1.3, 2.1cm Trigger was 10000 IU Gonasi HP (hCG) and on day 11. Only 1 mature egg was retrieved, and fertilised using ICSI. My day 3 update is a slow growing embryo of 3 cells with some fragmentation. I don't… — Vessie V.

Dr. Geoffrey Sher answered

"Empowering Choices: Embryo Banking vs. Egg Banking for Fertility Preservation" It's crucial for women to make informed decisions about preserving their fertility. Delaying trying to conceive, relying on egg freezing, or assuming the biological clock can be paused are misconceptions. As women age, egg quality declines, affecting the…
Egg Health & Ovarian Reserve Feb 16, 2024

Stimulation Protocol for Severe DOR

I'm 40 about to turn 41 with what's been described as severe DOR, amh is dropping fast. 2 years ago it was .22, last april .08 and this past test (after my stimulation complications) it's now .03. Last year I… — Private

Dr. Geoffrey Sher answered

Understanding the impact of age and ovarian reserve on the success of in vitro fertilization (IVF) is crucial when it comes to reproductive health. This article aims to simplify and clarify these concepts, emphasizing their significance in the selection of ovarian stimulation protocols for IVF. By providing you…
Embryos & Genetic Testing Feb 16, 2024

High TNF alpha

What is the recommended transfer protocol for someone with high TNF Alpha. I was given prednisone but it did not work. Prior to transfer it was 45.0 and I was prescribed 25mg prednisone for a month but it increased to… — Private

Dr. Geoffrey Sher answered

Elevated TNF alpha indicates activated natural killer cell activity. A RATIONAL BASIS FOR MANAGEMENT OF IMMUNOLOGIC CAUSES OF EMBRYO IMPLANTATION DYSFUNCTION In the world of assisted reproduction, when IVF fails repeatedly or without explanation, it's often assumed that poor embryo quality is the main culprit. However, this view…
Ovarian Stimulation & OHSS Feb 14, 2024

Suggested ivf protocol

Dear doctor Sher I am a 44.5 femal, suffering from secondary repeated miscarriages due to alloiimunity (dq-alpha gene match + extremly elevated nk cells). Right now I am going through the 7th miscarriage. I had the 6th miscarriage on October… — Irit B.

Dr. Geoffrey Sher answered

Clearly you are a candidate for gestational surrogacy, provided that you have competent, euploid embryos available to transfer. Using a gestational surrogate for transfer of such a blastocyst, is pretty straight forward. Most IVF programs that do FET can advise appropriately. However, be sure that the blastocyst transferred…
Hormones & Ovulation Feb 6, 2024

Failed ivf cycle

Hello doctor; i am 32 yo female, amh 1.59 ng/ml. Partner 32 years old with varicocele, 0 morphology and very low count. (Impossible to check for dna fragmentation) I am Insulin resistant, on metformin 750 for 5 months now with… — Nino K.

Dr. Geoffrey Sher answered

There clearly is both male factor infertility and diminished ovarian reserve (DOR). Both issues need to be thoroughly evaluated and addressed. The cause of the male factor will need further testing and the DOR requires a very individualized approach to ovarian stimulation...(see below). I strongly suggest that you…
Immunology & Implantation Feb 5, 2024

Natural Conception with NKa and DQa Partial Match

Hello Dr. Sher, I'm hoping you can provide me some insight and comfort. Quick history - I have had 6 early losses prior to 7 weeks over 4 years. After a lot of testing and trials with my RE, we… — Jessica B.

Dr. Geoffrey Sher answered

Anything is possible, and I hope it works out. However, it would be of no value in my opinion, to start with immunotherapy now. Intralipid therapy should be initiated 10-14 days before conception to be of significant help! Good luck and G-d bless! Geoff Sher
Egg Health & Ovarian Reserve Feb 5, 2024

Canceling when antral follicle count is too low

Dear Dr. Sher, My periods are getting shorter (around 20 days). Since December, my doctor has been doing this: (already three consecutive times now) starts the Estradiol pretreatment, FSH, Ganirelix and Omnitrope and then stops after a couple of days,… — Anne C.

Dr. Geoffrey Sher answered

It sounds as if you have age related diminished ovarian reserve. Respectfully, your antral folicle count can be expected to be low and if you wish to try for a baby through IVF using your own eggs, the number of AFs will not improve and you will have…
Early Pregnancy & hCG Feb 1, 2024

Hcg blood test

My period is usually iregular. I started my last one december 15 . And now my period is late by 11 days. I took two at home test which were both negative and today I did a blood test that… — Leopolina D.

Dr. Geoffrey Sher answered

So Sorry! This does not look good! Going through IVF is a major investment, emotionally, physically, and financially, for every patient or couple. One of the most crucial moments is receiving the result of the blood test for human chorionic gonadotropin (hCG) pregnancy. It's a big deal! The…
Embryos & Genetic Testing Jan 29, 2024

Multiple failures after live birth from IVF

My first FET in 2020 was successful and resulted in the birth of my son. Since 2022, I have had four more FETs: the first one failed to implant and the next three implanted but miscarried between 5-6 weeks. The… — Kelsey H.

Dr. Geoffrey Sher answered

Implantation dysfunction is often overlooked as a significant reason for IVF failure. This is especially true when IVF failure is unexplained, or when there are recurring pregnancy losses or underlying issues with the uterus, such as endo-uterine surface lesions, thin uterine lining (endometrium), or immunological factors. IVF success…
Embryos & Genetic Testing Jan 29, 2024

DQ-Alpha match & positive receptiva post lap

I hope you can advise me on the situation below. I had Pregmune testing completed in January 2023. It showed my husband and I have DQ alpha match: DQ Alpha - full match, DQ Beta - partial match, HLA-DRB1 -… — Vilma C.

Dr. Geoffrey Sher answered

From your description, it certainly sounds as if your failures are due to an implantation dysfunction...likely, an immunologic implantation dysfrunction (IID). If so, then you MUST have a concommitant natural killer cell activation (NKa). Even though endometriosis can result in an autoimmune IID, and a matchibng D alpha…

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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