Uterine & Endometrial Health
ERA testing
Dr. Geoffrey Sher answered
i PERSONALLY AM NOT A BIG BELIEVER IN THE VALUE OF ERA TESTING. GEOFF SHER
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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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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Answers from our doctors
Search 1,017 questions patients have already asked, or narrow them by topic.
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Infertility Basics
unexplained infertility age 33
I have unexplained infertility, age 33, partner 29. We have done all the testing(HSG,bloodwork,ultrasounds) and everything looks very normal. AMH 1.1 (which I’ve been told is a little low for my age but still normal). We have tried for 1.5… — Nour N.
Dr. Geoffrey Sher answered
UNEXPLAINED” INFERTILITY: A RATIONAL APPROACH TO MANAGEMENT Infertility affects y 10%-15% of couples who are unable to conceive. In some cases, the cause of infertility cannot be determined using conventional diagnostic methods, leading to a diagnosis of "unexplained infertility." However, it is important to note that in most…
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Ovarian Stimulation & OHSS
Fresh or frozen transfer
I’m currently on a short antagonist with a fresh cycle, following my egg retrieval the doctor noted she could see triple layer endometrium but there was no triple layer detected in the most recent scan so mentioned as she didn’t… — Louise S.
Dr. Geoffrey Sher answered
Yes you can go ahead. However, please be aware that 30% of women with endometriosis (regardless of severity, havd an immunologic implantation dysfunction (see below) which needs treatment. Geoff Sher Contact my Office manager..for appointment: Concierge@sherivf.com ENDOMETRIOSIS AND IMMUNOLOGIC IMPLANTATION FAILURE. Patients with endometriosis have immunologic abnormalities. The…
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Ovarian Stimulation & OHSS
Agonist/Antagonist Conversion protocol-meds
Hello Dr. Sher. I have a question about the Agonist/Antagonist Conversion protocol I am to start this protocol, and I wonder if it matters if I use Menopur or Gonal-F/Follistim during the stimulation? The reason for this question is that… — Liz S.
Dr. Geoffrey Sher answered
Embarking on the journey of in vitro fertilization (IVF) can be a daunting experience especially for women with sub-normal AMH levels (diminished ovarian reserve -DOR). Here is a novel and highly effective protocol known as the Agonist/Antagonist Conversion Protocol (A/ACP), designed to optimize the chances of success for…
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Age & Fertility
Reoccurring GeneticRisk
I am turning 41 in a couple weeks and unfortunately just had to make the heart wrenching choice to medically terminate our Trisomy 21 pregnancy at 13 weeks. Two years ago, I had a miscarriage/ D&C due to Trisomy 10.… — Kim S.
Dr. Geoffrey Sher answered
The cause of your trisomy pregnancy was likely age-related egg aneuploidy. The chance of an embryo having the right chromosomal configuration declines with with advancing age. Since you already have several children, you might want to stop. However, since you et pregnant quite easily on your own, and…
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Immunology & Implantation
Reproductive Immunology
Hello, I have had two, late, second trimester losses, back to back. Both of these losses have happened since I was diagnosed with a rare autoimmune, eosinophillic esophagitis. What is your familiarity with reproductive immunology and how likely is there… — Kathryn C.
Dr. Geoffrey Sher answered
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 oversimplifies the situation. The process of embryo implantation, which begins about six or seven days after fertilization, involves a complex interaction…
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Hormones & Ovulation
High testosterone during hormone suppression prior to fet
Hi I am currently doing suppression before embryo transfer. I am almost 2 month into suppression with lupron depot, letrozole, and norethindrone. I had done 2 months of suppression with just lupron about 6 months ago before a transfer that… — Holly F.
Dr. Geoffrey Sher answered
A high testosterone has an adverse effect on egg/embryo quality and endometriosis can adversely affect embryo attachment (implantation) through an immune mechanism. Feel free to email my assistant, Patti (concierge@sherivf.com if you wish to discuss your case with me online. Geoff Sher
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Ovarian Stimulation & OHSS
DOR,age,IVF
Hello, dear doctor. Listened to you podcast and been blown away by your expertise! I am a youthful 45 year old trying to get pregnant. Gotten pregnant 2 years ago naturally, but miscarried in week 9. Had done 3 IVF… — Maja S.
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…
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Early Pregnancy & hCG
Heavy bleeding after possible implantations
Hi, I've had two egg collections resulting in 5 embryos (3 of which didn't survive thawing) and 3 on the second round. In my first fresh embryo transfer I passed a couple of large blood clots the day after transfer,… — Megan M.
Dr. Geoffrey Sher answered
IMPLANTATION DYSFUNCTION 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.…
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Ovarian Stimulation & OHSS
4th IVF cycle questions on microdose flare protocol
Hello Dr. Sher, I am 42 yrs old with a low AMH (less than 1) trying to get pregnant for the 2nd time. My first pregnancy was natural when I was 38. I started my 2nd fertility journey with IUI… — Terri M.
Dr. Geoffrey Sher answered
At 42 years of age and especially if you are experiencing diminishing ovarian reserve, a flare protocol (in my opinion) is less than ideal. I suggest you call my assistant, Patti at 702-533-2691 and set up an online consultation with me. Geoff Sher EGG/ EMBRYO QUALITY IN IVF…
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Hormones & Ovulation
estradiol
Can you kindly tell me what is the appropriate level of estradiol in a modified natural cycle? I am in the middle of a MN cycle. They had me take letrozole for 5 days and roughly 10 days later I… — Carmela R.
Dr. Geoffrey Sher answered
Each follicle should contribute 150-200pg/ml to the E2 level. Your dropping E2 is concerning and suggests premature luteinization. I think when this cycle is over we should talk. The protocol used for ovarian stimulation and its implementation are both pivotal. Call my assistant, Patti at 702-533-2691 and set…
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Ovarian Stimulation & OHSS
IUD/Egg Retrieval
Hello! I’m interested in getting an IUD and freezing my eggs. I’d like to do the IUD insertion while under anesthetia for egg retrieval. Is that possible? Thanks! Isabella — Isabella G.
Dr. Geoffrey Sher answered
WE can help! Please call us and ask for Dr Ravikumar.
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Embryos & Genetic Testing
Recurrent Failed implantation
H! Dr. Sher , I am honored to have a chance to ask you some questions about IVF . My husband and I just had a failed embryo transfer which was our 4th transfer with a euploid embryo and all… — Maria P.
Dr. Geoffrey Sher answered
Thank you for your communication. Below please find information that I feel confident will help explain the possible reasons for implantation dysfunction. Thereupon, if you would like to have a consultation with me to discuss your circumstances and potential remedies, please call or text my assistant, Patti Converse…
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Immunology & Implantation
covid
Hi, Dr Sher I got COVID 1 day prior to FET My FET was cancelled They say I can proceed next cycle. Do you agree that next cycle we can proceed or should be a longer washout period to allow… — Carmela R.
Dr. Geoffrey Sher answered
I agree with the advice given by your doctor! Good luck! Geoff Sher
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Immunology & Implantation
implantation dysfunction
Listened to you on a podcast recently and appreciate you so much for sharing your knowledge on this topic. Wondering if you have any input for next steps after 2 implantation failures (of 5AA embryos without PGT-A testing, female age… — Ashley S.
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…