Ask Our 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
Fill in the following information and we’ll get back to you.
Hello!
I have recently turned 43 and wondering whether to keep trying IVF. Have done 5 cycles in the past 12 months. AMH is 30 and AFC ~35. But, only get around 7-12 eggs at a time and poor fertilisation (<50%). Have not made any blasts last two rounds. All protocols have been FSH (Puregon, Bemfola, Menopur all tried individually) 225-450 dose + orgalutran + single trigger.
Thanks so much for your time!.
I have an embryo that has a monosomy but I would like to transfer it. I have had two clinics refuse to transfer.
Specifically I have a 45 XX (-14)
I figured it’s incompatible with life if results are accurate so should be low risk transfer. I would like to attempt to transfer this one even with the very low chance that it will take before starting a whole new cycle.
Thank you for your input!
Hello Dr Sher, thank you for your very thorough
response. I forgot to mention with my AMH being 15 which is satisfactory for my age do you think I will ever be able to have a child naturally ?
Thank you,
Laura
Hello Dr Sher, thank you for your very thorough
response. I forgot to mention with my AMH being 15 which is satisfactory for my age do you think I will ever be able to have a child naturally ?
Thank you,
Laura
Hello Dr Sher I have just completed my 2nd ivf which failed due to my 13 follicles in egg collection being empty. The consultant diagnosed me with genuine empty follicle syndrome.
I am 36 years old with a AMH of 15. I had a short protocol this time with ovaleap and fyremadel firstly. All my follicles were roughly between 19-22 mm before egg collection. They triggered me this time with 250 ovitrelle and 1ml of buserelin. I had a reaction to the buserelin as it brought my stomach instantly into a lump. I found it strange how my last scan I literally felt like I was going to pop , however the following morning after I double triggered the night before I woke up to no more pain or uncomfortable bloating. I contacted my nurse and she said it could be due to the follicles being told to stop growing so to speak. But I felt odd how the pain had gone completely.
My previous 1st cycle if ivf was a long protocol. Again they used Ovitrelle 250 and again could only get 1 egg out,the rest where again empty. This one egg resulted in my 21 month old daughter.
They took a blood test after the 1st egg collection and found the trigger shot had absorbed. But not at the normal rate.
This cycle they didn’t take a blood test after and the consultant said that re-triggering after 36 hours would not work. In hindsight I wish I pushed this but due to the shock and groggyness of the drugs. I didn’t push it. Do you think this may have worked?
Do you think I should change the trigger shot or dosage? I don’t have pcos, endo or heavy periods. I have a regular 26-28 cycle. But I only have a 2-3 day cycle now. My husband is 38 and his results have always come back fine.
Any advice would be much appreciated, thank you,
Laura
In 2020 (age 42), we had 2 natural pregnancies at 6-8 weeks and miscarried naturally. In 2021, we tried IVF, we had 2 cycles that gave us 11 embryos, only 1 grew and it was abnormal. In July of 2022, we decided to use an egg donor and travel to South Africa to do this. We did a fresh transfer with 1 embryo and froze the rest. All 11 were graded really high but untested. I got pregnant but at my 1st & 2nd ultrasound, there was just an empty sack. I miscarried around 10 weeks after a D&C. In Nov we tried a FET again with 2 embryos. Lining was too thin, 6mm so they increased my estrogen to 6mg orally in AM and 6mg in PM. In 2 days it jumped to 7.3mm and we transferred 2 but they didn’t stick. My doctor then suggested a hysteroscopy and testing the embryos. We tested and have 3 normal embryos (out of 7). The hysteroscopy was performed on day CD 17 (Jan 24 2023) by my OBGYN here in the US and he removed some adhesions. We tried again recently in March 2023 but my lining only got to 5.6mm after 3 extra days with added estrogen (6mg in AM and 6mg in PM plus I was taking a patch every other day from the beginning) so we had to cancel. Why would my lining get thinner after a hysteroscopy and with added estrogen? My SA doctor thinks I need another hysteroscopy between day 1-10 of my cycle and wants to test for chronic endometritis. My OBGYN here doesn’t think I would benefit from another one. I’m also having issues hearing back from him on whether or not he had tested for chronic endometritis. What would you suggest at this point?
Hi Dr. Sher , I have scheduled a robotic assisted laparoscopy to remove the endometriomas off of my ovaries based on your advice last year . My procedure description is “robotic assisted laparoscopy , lysis of adhesions , resection / fulgerartion of endometriosis, bilateral cysectomy , chromopertubation, and resection of villar nodule . My question is do you think that is an appropriate technique? I read so many posts against that kind of heat , and I don’t necessarily know if “burning “ it out would help my chances of ivf success in the future. This is being performed by a doctor recommended by my fertility doctor . I’m 40 years old with 3 failed cycles behind me . Any thoughts on this style of surgery for endometriosis? I have pain sometimes but I am mostly doing this to get the cysts off my ovaries for future IVF . Thank for your time , Mindy D .
Dear doctor Sher,
I am 33 years old and my husband is 36. After 5 months of trying to conceive (that was back in November 2022), we decided to visit a fertility specialist in
Switzerland where we are currently located. He ran the basic hormonal exams on the 4th day of my cycle (4th day from flow, 5th day from light spotting) identifying a low AMH (0.56 ng/ml). For reference my estradiol levels were 723 pmol/l, my FSH was 4.5 IU (I know high estradiol could have suppressed this hormone) and my LH was 7.4 IU. He did not check for testosterone or DHEA levels. AFC on day 8 of the cycle was 5 (only in one ovary – I should probably mention that only one ovary has a normal size while the other is small which I know is another indication of a reduced ovarian reserve). I did ovulate slightly earlier than what I am used to that month and had my period earlier as well. Ovulation was confirmed on day 10 (through ovulation kits I have confirmed that I am ovulating between the 11th-14th day). Follicle was of mature size. Progesterone levels after ovulation were normal (luteal phase duration is also normal – 15-16 days long).Thickness of uterus was good as well. In the following months, I also did a hysteroscopy and everything appeared normal. I should probably mention that my husband had 1% of normal sperm morphology (everything else is good). Thus, we decided to proceed with IVF and more precisely, ICSI.
My doctor had me on Primolut n for 5 days and on the 4th day after I stopped taking it, I got my period. On the second day of my period, I started taking Pergoveris
350 IU per day. I took it for 3 days and then I went in for blood work and an ultrasound (STIM DAY4). The ultrasound showed only 4 very small follicles, two in each
ovary. The doctor commented that they were still small and that the bloodwork corresponded to their small size. He augmented the dose to 400 IU per day for 3 days again. On STIM DAY7, I went again for bloodwork and an ultrasound. Still he could only see 4 follicles (13.5 mm, 10.8 mm, 10.9 mm, 9.8 mm). Oestradiol levels were around 1230 pmol/l while LH levels were more than 9 IU. On that day he increased the dose of Pergoveris to 450 IU and on that night I started taking Cetrotide 0,25 mg. Two days after, I went for another round of blood work and ultrasound (STIM DAY9) where he told me that estradiol was increased but did not mention how much. Ultrasound showed 5 follicles this time (two smaller than 10 mm, 1 at 11 mm, 1 at 12.5 mm and one at 18.5 mm). Thus, on that day I took another 450 IU of Pergoveris during the day, a Cetrotide 0.25 mg and Ovitrelle 250 μg during the night. He advised us to go through with the retrieval of eggs just to see also their quality, although in reality there was only one mature follicle (he also mentioned that my uterus was ready). I did go through the retrieval yesterday (36 hours after trigger shot) and they informed me that they had collected two eggs but both of them were immature. We were surprised as one of the follicles seemed to have had the appropriate size. The day of the retrieval would have been day 11 of stimulation. On day 10, I received no hormones.
I apologize for not having more details with regards to my blood exams but this is what I remember from what he had shown me at the office. I don’t have any of the blood work results from the ovarian stimulation phase. I am not sure if the protocol was the right one for my case or if I have an egg quality problem along with the poor response and the problem of the low ovarian reserve. I am starting to believe that I am a lost cause and that I should not proceed with another round of IVF. I always wanted to have at least one biological kid but I also wanted to adopt. We are not considering donor eggs. I would very much appreciate your expert opinion on my case. I did read your response here https://sherfertilitysolutions.com/ask-our-doctors/egg-immaturity/ and if I understood
correctly there were some things that the doctor could have done differently. Therefore, my question is am I a lost cause or some modifications to the protocol could bring better results?
P.S. Doctor mentioned that I may be a poor responder because the FSH receptors on my ovaries do not communicate properly with my pituitary gland which is shown from me not responding to high doses of FSH. Could that be a possibility and is there anything that can be done about it?
Also, I have been taking these vitamins – http://www.fol-ino.ch/women/fr/index.php – that my doctor prescribed but I wonder If I should have been taking something else (CoEnzyme Q10 and DHEA along with folic acid and Vitamin D?) as they seem to be appropriate only for people with PCOS. I have taken them for 2.5 months.
Thank you in advance for your response and thank you for taking the time to read my very long email.
Kind regards,
Alexandra
Hi Dr Sher
I’m a 30 year old living in London. I have had 2 IVF cycles, but after both, all embryos stopped growing after 2-3 days post egg retrieval. I was also told I have mild PCO in my right ovary. Left ovary is normal. I don’t have any other symptoms of PCOS and have regular monthly cycles and also ovulate, so they concluded that I have unexplained infertility.
The first cycle was with with Puregon (225iu reduced to 150iu), orgalutran and triggered with Mochida HCG 10,000 IU.
They retrieved 21 eggs, 9 matured, 5 fertilised but all stopped growing between day 2-3.
The second cycle I was given menopur 225iu and orgalutran and triggered with mochida hcg 15,000 iu. This time 10 eggs were retrieved but only 2 were matured. Both fertilised one stopped growing after day 2, and one stopped at day 4.
Both triggers were when follicles measured around 17/18mm and during both cycles I took folic acid and a multivitamin.
I saw my doctor for a follow up today and he joked that I can just be an Aunty one day instead. He said that it’s likely a genetic issue with my eggs. This was very painful for me to hear but forced me to start researching into why embryos stop growing and why so many of mine were immature but I can’t seem to find a definitive answer. Some places say a lot about PCOS and needing to use myo inositol or metformin for egg quality and others I see that the trigger is important. After my doctors joke about being an Aunty it has worried me to think I may not actually be able to have children of my own which is my strongest desire. Do you think he’s right after my two failures?
Thanks
Abi
Hello Dr. Sher,
I am a 49 year old female with two miscarriages behind me. In both cases the embryos were found to be genetically abnormal. My husband and I have two genetically normally (tested) embryos from our younger days we have frozen. Given my age would love to know your thoughts about if you’d recommend transferring one embryo (set) or both (det). There seems to be so much conflicting data out there. Your thoughts would be very much appreciated and welcome.
Thank you for your time
Hi,
I have come across contradictory information regarding egg freezing and COVID-19 and it’s impact on the eggs and overall IVF success.
How long after getting COVID-19 is it safe to proceed with an egg retrieval ? I have come across information indicating you can proceed as soon as you don’t have symptoms and other information saying a month is enough and information advising to wait 3 months as this is the time it takes to eggs to develop once recruited and it’s best to avoid exposure to COVID in this time?
Can you advise on this?
If you get COVID-19 and then have egg retrieval within 3 months does it affect the quality of the eggs or the outcome?
And then affect the IVF and pregnancy outcome?
Thank you!!
Hello Dr, Sher, from one South African to another 🙂
I am living in Portugal now, and am trying to fall pregnant. I have been diagnosed with diffuse adenomyosis (mild) which is at the top of my uterus. Mainly on the left hand side.
My AMH levels are 1.25. I am 39 years old and have had two recurrent miscarriages. My specialist here thinks it is to do more with my age than the adenomyosis diagnosis. My husband has great sperm – the fertility doctor said absolutely no problem there.
He recommended we continue trying naturally for three months and then think about IVF and PDG.
One option is for us to take ovary stimulating drugs that would make me ovulate more than one egg per month. The thinking here was that it may raise my chances of falling pregnant naturally, instead of taking the odds that just one ovulated egg will be normal.
Do you think this is a good approach, or do you think we should move straight to IVF?
Many thanks for your help and have a wonderful day xx
Hello – I’ve just finished my second egg retrieval, both of which had disappointing results. I am 36 years old with a low AMH (0.69 as checked in November of 2022). Last FSH was 7.7. First egg retrieval was in December, second in March. Here are the 2 protocols I’ve used:
December:
0.20 of Lupron starting CD 1 (microdose morning and evening)
300 follistim nightly
150 menopur nightly
2 vials Omnitrope (0.50 every other day for first 7 days, so total of 4 doses)
Followed this protocol from November 25 – December 6, Lupron AM on December 7th, triggered with Novarel IM 5,000 on December 7th. ER yielded 9 eggs. 1 mature at collection, 2 matured overnight. From that, we did end up with 1 euploid embryo.
Second retrieval was yesterday, 3/22.
Started on CD 3 (saw RE on CD2, started the next night):
Same Omnitrope protocol
Menopur 150 nightly
Follistim 300 nightly
Ganirelix started on CD 7.
Triggered on CD 13 with 7,500 Pregnyl. (I asked for 10,000 but my RE said my estrogen was above 4,000 and I would be at risk for OHSS with 10,000).
They retrieved 14 eggs from me, but found out today only 2 were mature.
I’m honestly devastated and not sure what to do. We don’t have the financial resources to do more than 1 more retrieval (and even that’s stretching it).
I had been supplementing with 75mg of DHEA prior to both, but my levels were never checked.
Hello, I am 41 years old. I am a friend of Ivan Sher’s for many years and he mentioned I could get some help from Dr. Sher on here. My AMH levels are 2.87. We started IVF when I was 40, in July 2022. Mainly because of reasons not for me. In July we retrieved 27 eggs, 25 mature, 17 fertilized, 7 embryos, after PGT 1 normal and 1 low level +19 mosaic. We used fresh sperm. CoQ10 and prenatal vitamins only supplements. Second retrieval in September 2022. 27 retrieved, 25 mature, 22 fertilized, 9 embryos, 2 normal after PGT and 1 inconclusive. We used fresh sperm again and same supplements. Did a transfer in October and I was pregnant. Mis carried at 9 weeks, end of November. Did a second transfer in January and that transfer failed. switched doctors. Did a mock trial. Doctor said I have a little bit of andemyosis on one part of my lining that we will supress for 3 months with Lupron Depot then we can do a 3rd transfer in June. I said I will do a 3rd retrieval to try and bank more embryos for the future. I asked if we should supress before retrieval and they told me no that my ovaries don’t have anything to do with my uterus and the andemyosis is only on my uterus. March 2023 i do my 3rd retrieval. We received 32 eggs, 21 mature, 15 fertilized and ONLY 1 EMBRYO THIS TIME which is currently out for PGT. I was in complete shock with the difference in my results. We used Frozen Sperm this time and an entire list of supplements the doc gave me. I asked my Doctor WHY this happened ? He said either the frozen sperm didn’t work well or my andemyosis progressed and stimulated during stim. I told him I had asked to supress prior to the retrieval and they told me I don’t need to and he said that we didn’t know It progressed and obviously they still don’t know. It is just a guess either that happened or it’s the frozen sperm. I’m incredibly frustrated. Last Friday I took my first shot of Lupron. I have one normal and one embryo left and one out for PGT … God knows if that one will come back normal. I’m 41.5 now and I just want to have our baby. I really don’t want to do a 4th retrieval and want to just transfer in June. My question is, why do you feel my results this time came back with almost no embryos ? Doc said most arrested around day 4 and 5. I wish they had called me at Day 3 to update me. Any advice on what I should do next after I am on this Lupron for 3 months ? I’m worried if i do a 4th retrieval and then a frozen transfer 5 days after in June, I risk my embryo implanting due to my andemyosis being triggered again from stims, even after Lupron. I was thinking either to do a 4th retrieval in June and transfer 3 day 3 fresh embryos from that retrieval as to not risk losing embryos again and then if there are more embryos, freeze them and send out for PGT testing. That way I still have one normal and one mosaic frozen and if June transfer fails, i can do another transfer in July with a frozen. I am trying to not waste time. Luckily I have a high egg count but this process has been very frustrating and disheartening. a lot of trial and error. I don’t believe i ever had endometriosis or andeymosis before starting IVF. I have been pregnant naturally before. I would love to hopefully hear back from you. I really appreciate your advice. Ivan speaks so incredibly highly of you !!! I wish I could meet you ! you have helped some friends of mine as well.
Hello, Im 41 . I had to have a myomectomy in 2021 which made me wait 6 months from consult to surgery then 7 months recovery. Long story short Dr did not tell me I had low ovarian reserve till later when I went in for recheck after surgery. I did 2 IUI then went to IVF. I had 3 IVF cycles cancelled one to not having enough antra follicles second cyst. The last time checked if cyst was gone it was so took me off bc and put me Omnitrop when I went in for baseline cyst was back in 1 week and I was ready to ovulate so IVF cancelled again and said i could try another IUI so I did. unsuccessful. I just feel they keep doing the same thing an expecting a different result and nothing. I feel hopeless. I have been going since 2022 June .They do batch cycles I’m always waiting and waiting. I have contacted other facilities but they all are hrs ways from me and still have not gotten anywhere so far. I don’t think I should be put on birth control having low amh but they say it will stop the cyst but it has not. Also I have been doing the proove test and I do ovulate and have low progesterone. This last cycyle I did the complete which should I have low FSH as well. I have another cycle planned for April 7th. Can you advise and speak to the my clinic. If I get advise how can I get them to hear me. Any clinic near me you recommend. I am in Moweaqua il going to clinic in Springfield Il. Dr. Loret De Mola. Egg whispers advises Therilogix Co-q10 but it only has like 100mg so you take 5 a day to get 500mg? I am taking Jarrows formula QH-PQQ absorb (ubiquinol, pyrroloquinoline quinone Disodium from the book starts with an egg. and many other supplements.
Kind regards, Iris
I usually have a thick lining and went in for US and it’s already at 11 after 6 days of estrogen (one 0.10mg patch March 15 and changed the patch on Saturday to a new 0.10mg patch).. When I went in on CD2 my lining was still thick (9mm~) and my doc wanted me to bleed some more so I came back on CD4 and started one patch of estrogen 0.10mg. My doc has me coming back Friday for US but doubling my patches tomorrow. Worried my lining will get too thick. Anyone had a thick lining (13+) and had a success FET? My first FET failed. This FET we are doing medicated to see if we can control the thickness. I just read a study that showed between 7-15mm is good. But I’d like to see what you guys think. Anyone had a success medicated FET With a thick lining?
https://www.fertstert.org/article/S0015-0282(21)01432-1/fulltext this is the study btw
Hi Dr Sher,
I listened to you on The Egg Whisperer podcast. I found your way of explaining and just the overall wealth of knowledge you proved in just a couple of podcasts so incredibly helpful. Thank you for everting that you have done in this field. I recently visited your website as I was curious if I was able to book an appt with you. I saw this option to ask a question, so here we are and here is my question. I will try my best to keep it short.
I am 41 years old. I have a 21 year old daughter. I concisely decided to wait until later in life to have more children. I regularly got my levels checked until the last time which was 2019 (I was 37). Right before COVID. At that time I was considering freezing my eggs. No-one seemed to think I was in a “dangerous” spot and did not overly encourage me but of course COVID came and so it kind of died off.
We decided in July of last year (2022) we wanted to start trying. We started trying on our own by just planned intercourse but we were not able to get the timing right. We wanted to have 2 children so in an effort to not waste time thought it best to contact a clinic as we were aware what we were dealing with regarding my age. So, in September we had a meeting with a doctor at a local Fertility clinic that a colleague had highly recommended. Prior to that meeting I had my blood drawn and an ultrasound. Chris had a sperm check which came back very good. We also did the genetic testing which came back good. And based on all of this combined info the doctor recommended IUI. Although it was brought to my attention after this that I had low ovarian reserve but it wasn’t quite explained to me what this meant and there did not seem to be any urgency. So, the next cycle (October) we did our first IUI and I got pregnant. Sadly, in December at about 8 w 6d our baby stopped growing and there was no heartbeat when I went in for the ultrasound. Obviously we were completely devastated. We did the D&C so we could get testing but they were unable to get any conclusive answers so we will never have a definite confirmation but my Ob said she could say with a very high certainly it was a genetic defect. I decided I did not want to do take any more chances so we went straight to IVF.
On 2/6 I started my first round of IVF with the intention to do a duo stim cycle. I was a slow responder and we ended up getting only 2 eggs. We did discuss canceling but thankfully our insurance covers lifetime cycles so we were able to proceed. I was so shocked as I thought I would get so many more eggs. This was my protocol:
Letrozole 5 mg PO
Gonal 150 iu SQ
Menopur 75 iu SQ
Omnitrope 8 units
The 1 egg made it to blast and was Pgs testing and came back normal!! I was told it was a “good grade”.
On 2/27 I started the duo stim cycle. I ended up getting 5 eggs, 4 normal, 2 made it to blast and 1 is normal and currently being pgs tested.
This was my protocol:
Follistim 225 iu SQ
Menopur 75 iu SQ
Omnitrope 8 units
My question is, should I do another cycle or move ahead with transfer or our normal embryo. I am praying for this 2nd embryo and if I find out it is normal I will likely move ahead with transfer but if I have to make the decision before we find out what do we do?
If I could choose I would transfer as this road has been incredibly difficult and I also do not want to keep getting older and older. I want to have a baby! But I don’t want to not be able to give that baby a sibling as if we transfer in April I will be 42 when the baby is born. Of course that is if all goes well. And I could potentially start IVF again if needed and almost feel like I would feel better about it after having my healthy baby. But I don’t want to not be successful if I wait a year to start again. Please if you can give me your opinion I would so appreciate it.
Thank you so much for your time. And thank you for everything you have done in this field. I had no idea what I was in for with IVF. I think that there definitely needs to be more information out there for women who wait on it thinking it is a cure all. I definitely wish I froze a bunch of eggs in my late 30s and tell anyone who will listen to do just that.
Hi could you please provide me approximate cost for 1 cycle of egg freezing, in house monitoring, medication, and 1 -3 year storage fees?