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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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Hormones & Ovulation Nov 19, 2022

IVF

Dr. Sher, My husband and I are 25 years old and have been trying for 2 years to conceive. I have stage 4 endometriosis, and had our first transfer 10/10 which failed. The protocol I was placed on was just… — Ashleigh G.

Dr. Geoffrey Sher answered

When women with infertility due to endometriosis seek treatment, they are all too often advised to first try ovarian stimulation (ovulation Induction) with intrauterine insemination (IUI) ………as if to say that this would be just as likely to result in a baby as would in vitro fertilization (IVF).…
Age & Fertility Nov 14, 2022

Stimulation with LH in older women

Dear Dr. Sher, thank you very much for all the things you do for our community of fertility warriors. I have heard that gonadotrophins stimulation in older women with low ovarian reserve should only be done with FSH and no… — Shira M.

Dr. Geoffrey Sher answered

It is primarily the egg (rather than the sperm) that determines the chromosomal integrity (karyotype) of the embryo, the most important determinant of egg/embryo competency”. A “competent” egg is therefore one that has a normal karyotype and has the best potential to propagate a “competent” embryo. In turn,…
Hormones & Ovulation Oct 28, 2022

Testosterone Prime

Thoughts on priming with estrace and testosterone? — Christine K.

Dr. Geoffrey Sher answered

Estrogen priming for cases of severely diminished ovarian reserve is in my opinion worthy of consideration. Rarely is testosterone priming beneficial! Geoff Sher
Egg Health & Ovarian Reserve Oct 15, 2022

High AFC with PCOS and pregnancy

Hi Dr. I am 39 and have PCOS. I went for my day 3 AFC and I was informed by the nurse that I have 20 follicles on my left ovary and another 20 on my right. The strange thing… — Kristin C.

Dr. Geoffrey Sher answered

Quite frankly, at 39y ,with PCOS, I would favor IVF over ovarian stimulation with or without IUI. Polycystic ovary syndrome (PCOS) is a common hormonal system disorder among women affecting between 5% and 10% of women of reproductive age worldwide. Women with PCOS may have enlarged ovaries that…
Hormones & Ovulation Sep 8, 2022

Estrogen levels

Hello doctor Sher, Thanks for taking the time to answer our questions!! Is it true that vaginal estrogen route result in higher serum estradiol unlike transdermal and intramuscular? Does the estradiol level a day to pio matter ? Can it… — Indo I.

Dr. Geoffrey Sher answered

My preference is subcutaneous estradiol twice weekly injections.. My second preference is trans dermal. Vaginal estradiol is not evenly absorbed and oral estradiol is in my opinion the poorest choice because absorption through the GIT passes via the liver to the systemic circulation and this can alter the…
Hormones & Ovulation Aug 29, 2022

Low Testosterone

Wondering what your thoughts are on lower testosterone but very high sperm count? My husband has 150 million motile sperm count but his testosterone is only 8.77 (and the lab values like to see at least 9.9). His morphology is… — Maya J.

Dr. Geoffrey Sher answered

I am not at all concerned about your husband's sperm quality. The lowish testosterone is another issue altogether. I would caution against him taking testosterone supplements as this would likely worsen his sperm parameters. Geoff Sher
Hormones & Ovulation Aug 29, 2022

Conception

My boyfriend and I have been trying to get pregnant for about 9 months, unprotected intercourse, I have been tracking my ovulation and “highest days to get pregnant” and it’s been very difficult for us. We are both 27years old-… — Kãlah S.

Dr. Geoffrey Sher answered

You need to give it more time. If no pregnancy in 6 months from now, then you can start the evaluation process! Geoff Sher
Hormones & Ovulation Aug 21, 2022

Carrier Requirements

Hello! I was wondering what requirements you have for the surrogates that your patients might work with if they choose the gestational surrogacy route. Is there an age limit or BMI limit? Would a surrogate who had diet-controlled gestational diabetes… — Jessi W.

Dr. Geoffrey Sher answered

Of course all the factors you mention and many more are part of the screening process. Also, I advocate that you meet with the surrogate. IVF surrogacy involves the transfer of one or more embryos into the uterus of a surrogate, who provides a host womb and carries…
Hormones & Ovulation Aug 15, 2022

Hoshimoto’s question

Dear Dr. Sher, I've been following your comments for years. Thanks for the info. on 2 shots of Ovidrel. I'm interested in what you say here about Hoshimoto's and what you call "Immunologic Implantation Dysfunction." You mention that 50% of… — Katharine C.

Dr. Geoffrey Sher answered

I published on this 25y ago. Sher G, Maassarani G, Zouves C, Feinman M, Sohn S, Matzner W, Chong P, Ching W. "The use of Combined Heparin/Aspirin and Immunoglobulin G. Therapy in the Treatment of IVF Patients with Antithyroid Antibodies" Am J Repr Immunol, 1998; 39:223-5.
Hormones & Ovulation Aug 11, 2022

Hormone-producing simple cyst found at baseline scan

Dear Dr Sher, I recently had a baseline scan and oestrogen and progesterone blood tests for an upcoming FET cycle. The scan and blood tests identified a 2.5cm hormone-producing simple cyst on my left ovary. I have been prescribed 21… — Charlotte D.

Dr. Geoffrey Sher answered

Yes! It is likely to cause the functional cyst to absorb by the next period! An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. An ovarian follicle that is larger than 22mm is termed a functional follicular cyst. They are…
Hormones & Ovulation Aug 10, 2022

Estradiol maximum levels before FET

Good day Dr. Geoffrey, I salute you from Mexico City. I'm in the mieddle of the preparatios for the FET, and I want to know what should the maximium estradiol levels be at the day before my FET. Today I'm… — Jimena A.

Dr. Geoffrey Sher answered

I prescribe twice weekly injections of estradiol valerate (Delestrogen). Using this approach, I aim for peak E2 values ranging between 500 and 1000pg/ml! Good luck!
Hormones & Ovulation Aug 4, 2022

Follicle Size – Immature at LH Surge?

Hi Dr. Sher, Just following up from my last question regarding my 14mm follicle on day 15 when I had a LH surge... isn't this too small of a follicle for a surge to happen meaning an immature/eggless follicle? I… — Elona K.

Dr. Geoffrey Sher answered

My response was based upon he suspicion that this 14mm follicle was actually 18mm + a day or so before and the reduction in size was due to partial ovulation.
Hormones & Ovulation Aug 4, 2022

Surge on day 15 with 14mm follicle

Hi Dr.Sher, I am doing an investigative cycle through my fertility clinic this month. Yesterday was my day 15 and on ultrasound I had a dominant follicle measuring 14mm. It was growing at a rate of 1mm per day since… — Elona K.

Dr. Geoffrey Sher answered

The most likely explanation is that when (on day 15 the 14mm follicle was seen, ovulation had already commenced!

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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