– Geoffrey Sher, MD
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Ovarian Stimulation & OHSS
Dear Dr. Sher, Do very thin women with low BMI still need the Ovidrel double dosage? (250x2) Thank in advance for the guidance, Anne — Anne C.
Dr. Geoffrey Sher answered
Perhaps not but since it will do no harm..."Rather safe than sorry". So yes, I would still "trigger with 500mcg Ovidrel. Geoff Sher
Age & Fertility
Dear Dr Sher, I’d like some advice regarding protocol choice for what will be my 4th IVF-ICSI cycle. I am in the UK. I have no medical problems, but I do have a BMI of 33 (prev 43), I have… — Elizabeth T.
Dr. Geoffrey Sher answered
WE really should talk. If interested, please call my assistant, Patti Converse (702-533-2691) and set up an online consultation with me. In the interim, please review the articles below. GS Overcoming Age Barriers in IVF and Embracing New Pathways to Parenthood: Unlocking the Possibilities. Age should never be…
Embryos & Genetic Testing
Dear Dr. Sher, I am 43 years old, and due to the high rate of aneuploidy in the previous two attempts, and following your teachings, I convinced my doctor not to use Decapeptyl in the dual trigger, but only Ovidrel… — Anne C.
Dr. Geoffrey Sher answered
I really cannot suggest how to approach your doctor on this matter! So sorry! Geoff Sher
Fertility Preservation
I am considering the second attempt of IVF and choosing the clinic, but prior wanted to briefly get some consultancy concerning the chances for success. I live in Milan and last year made an attempt of egg freezing at IVI… — Ella B.
Dr. Geoffrey Sher answered
Respectfully, Freezing eggs in a woman of your age (regardless of ovarian reserve), yields very disappointing results. It is far better to fertilize the eggs, take them to blastocyst and to biopsy those that make it to that stage by no later than day 6...and do PGS/PGT to…
Egg Health & Ovarian Reserve
Hi Dr. Sher, I'm 32 and am a Fragile X premutation carrier (90 repeats) with diminished ovarian reserve (AMH 0.44, on whatever scale the US uses). I just did my first stim cycle starting birth control on day 2 of… — Caitlin F.
Dr. Geoffrey Sher answered
Respectfully, In my opinion what you were on was a "microflare" protocol. I suspect that this might have been a factor. We should talk. I suggest that you contact my assistant, Patti Converse at 702-533-2691 and set up an online consultation with me to discuss in depth. EGG/…
Egg Health & Ovarian Reserve
Dear Dr. Sher, I am 43 years old and am trying for the last time, after five unsuccessful attempts (I have reached the euploid stage before). This time I have 9 antral follicles, but I also have a follicular cyst.… — Anne C.
Dr. Geoffrey Sher answered
I see no reason not to proceed with the cycle! Geoff Sher PLEASE SHARE THIS WITH OTHERS AND HELP SPREAD THE WORD!! Herewith are online links to 2 E-books recently co-authored with my partner at SFS-NY (Drew Tortoriello MD)....... for your reading pleasure: From In Vitro Fertilization to…
Ovarian Stimulation & OHSS
Hi Dr Geoffrey, I’ve been dealing with fertility issues for years (endometriosis, fibroids) and last year, after two unsuccessful embryo transfers (of genetically normal embryos), I decided to have a laparoscopy surgery to treat the endometriosis and remove the intramural… — Carolina G.
Dr. Geoffrey Sher answered
Asherman Syndrome is a medical condition characterized by severe intrauterine adhesions, also known as synechiae. These adhesions can cause significant damage to the basal layer of the endometrium, the part of the uterus responsible for developing the uterine lining (endometrium) under the influence of hormones like estrogen and…
IVF Failure & Pregnancy Loss
aI am a 36 y.o. female with PCOS. I have had 2 miscarriages at 6 weeks (1 from an IVF transfer recently and 1 from letrozole round several years ago) , and 2 failed IVF transfers that failed to implant.… — Christy L.
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…
IVF Failure & Pregnancy Loss
Hello! I am a 24 y.o. female, Gravida 0, AMH 0.2-0.8, four failed IUI’s, and now 4 failed transfers with 5 embryos never implanting. I’ve done two ERA’s (both postreceptive at 96 and 72 hours) but we’ve ignored these results… — Delaney D.
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…
Egg Health & Ovarian Reserve
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…
Ovarian Stimulation & OHSS
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
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
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
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
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…
