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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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Embryos & Genetic Testing Nov 29, 2022

What causes embryos to arrest during development?

I recently completed my 2nd egg retrieval at age 36 and had very different results. I have PCOS (high AMH =15 and many follicles, regular periods, thin/normal BMI ) and respond well to meds. We used 75 Menopur, 100 Gonal… — Maya S.

Dr. Geoffrey Sher answered

It could be an inherent underlying egg defect. However, more commonly it has to do with the selection of an optimal protocol for ovarian stimulation, the type of "trigger used" and the implementation of said protocol. The importance of the IVF stimulation protocol on egg/embryo quality cannot be…
Egg Health & Ovarian Reserve Nov 29, 2022

POI and egg quality

Hello, a few weeks ago I was diagnosed with POI by my OB - I had one blood test that showed my FSH at 100, AMH at .003, and Estriadol at 17. I do not know my AFC yet, I… — Caitlin D.

Dr. Geoffrey Sher answered

I doubt it has anything to do with your long term use of BCP. What I can say is that with your FSH of 100 and very low AMH, I am doubtful you will respond to stimulation for IVF. However, if you do, your age would be in…
Egg Health & Ovarian Reserve Nov 29, 2022

Getting FSH to rise following BCP

Hi Dr Sher, You've written that for women launching COS coming off a BCP something needs to be done to cause a rise in FSH for 5-7 days to facilitate PAF to AF conversion. You suggest that this be done… — Gautam J.

Dr. Geoffrey Sher answered

Theoretically this might be achievable through administration of gonadotropins for several days longer while still on BCP but in my pinion would hold no advantage.
Ovarian Stimulation & OHSS Nov 28, 2022

Use of the Birth Control Pill (BCP) to launch IVF-COS

Dear Dr Sher, You have written that pre-antral follicles require exposure to FSH for 5 - 7 days to be able to develop into Antral Follicles. However, taking Birth Control Pills (BCPs) prior to COS suppresses FSH, and therefore does… — Gautam J.

Dr. Geoffrey Sher answered

Thank you for your very thought provoking comments and questions. Frankly, I cannot disagree that administration of FSH-in small amounts over the last few days of the BCP might not have a similar effect to overlapping with Lupron. It might however add an additional unnecessary variable and expense.…
Clinic & Practice Nov 27, 2022

Video consultation please for an old patient please

Hi Dr Tortoriello, I met you years ago in nyc at your practice. I already had a daughter and wanted in vitro for a son. As my husband and I moved around this time to London we went ahead and… — Elizabeth G.

Dr. Geoffrey Sher answered

Thank you kindly! It would be a pleasure to talk with you. Please call my assistant, Patti Converse (702-533-2691 tomorrow and set up an online consultation with me. Thank you! Geoff Sher
Hormones & Ovulation Nov 25, 2022

2 IVF failures and 1 cancellation

I’m 36 (insulin resistant & subclinical hypothyroidism + DOR 4.0 pmol) I have been trying for 4.5 years, I have completed two ivf cycles (Gonal F 450 and Menopur 150) First ivf cycle with Testosterone gel, which resulted in 3… — Mychelle G.

Dr. Geoffrey Sher answered

There are several possible factors :Diminished ovarian reserve: Protocol selection for ovarian stimulation; Male factor; egg quality; implantation dysfunction (possibly related to an autoimmune, immunologic implantation dysfunction.(IID) such as Thyroid autoimmune disease and underlying ndometriosis. Obviously I cannot address all these here. I suggest we talk....SO, I invite…
Immunology & Implantation Nov 23, 2022

RIF and DE cycles

I have had 5 DE failed cycles. I’m Kir-Aa, I have Hashimotos, and I’ve been on Lovenox, Prednisone and Aspirin for the last 3 rounds and still failed despite high quality embryos. The donor was HLA. Now we can start… — Sophie W.

Dr. Geoffrey Sher answered

WE really should talk! To me it seams that there is an underlying implantation dysfunction that is likely immunologic in origin. If I am correct then respectfully, in my opinion, the treatment to address the immunologic implantation dysfunction (IID) was not optimal/adequate.I invite you to contact my assistant,…
Uterine & Endometrial Health Nov 23, 2022

Lining issues

I’m 32 & have severe PCOS. I have a history of uterine cancer in which I was very fortunate to have caught it at stage 1. 8 months of immunotherapy using an IUD & now cancer free for 2 years.… — Yasmeen L.

Dr. Geoffrey Sher answered

I think we should talk! You clearly have an implantation dysfunction which needs to be identified, quantified and addressed. I invite you to contact my assistant, Patti Converse at 702-533-2691 and set up an online consultation with me. Implantation dysfunction is unfortunately often overlooked as an important cause…
Embryos & Genetic Testing Nov 23, 2022

32, 3 failed IUIs, 1 failed IVF transfer

Hi, I’m 32 years old and was diagnosed with mild endo which was removed last year. I’ve also had a few polyps, fibroids and cysts removed in the past 2 years. I had 3 failed IUIs and recently my first… — Miranda B.

Dr. Geoffrey Sher answered

I suggest we talk. Please consider calling Patti Converse (my assistant) at 702-533-2691 and set up an online consultation with me to discuss. 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…
Immunology & Implantation Nov 23, 2022

Hla DQ aplha

Hello, I saw your podcast with Dr Aimee. I wanted to ask what treatments is given in case of HLA DQ alpha in both partners? We both have it unfortunately and are experiencing recurrent ivf failure ( had two chemicals… — Liza S.

Dr. Geoffrey Sher answered

I really think I can help you. I invite you to contact my assistant, Patti Converse at 702-533-2691 and set up an online consultation with me. Currently, with few exceptions, practitioners of assisted reproduction tend to attribute “unexplained and/or repeated” IVF failure(s), almost exclusively to poor embryo quality,…
Immunology & Implantation Nov 23, 2022

Free immunology e-book link

Good afternoon, I recently heard your interview with Dr. Aimee (the Egg whisperer) about reoccurring implantation failure. My husband and I are seeing a fertility specialist in the Chicagoland area and we have gone through the gambit of miscarriage from… — Rachel P.

Dr. Geoffrey Sher answered

I really suspect an underlying implantation dysfunction...probably an immunologic implantation dysfunction. If I am correct, you were not (in my opinion) adequately treated. WE should talk!! Might I suggest that you contact my assistant, Patti Converse at 702-533-2691 and set up an online consultation with me. I believe…
Ovarian Stimulation & OHSS Nov 22, 2022

24 mm Follicle Pre Trigger

Hello, I am on cycle day 12 and went for my bloodwork and ultrasound. My ultrasound showed a dominant follicle in the left measuring 24mm and my bloodwork was showing I was going to ovulate soon. My doctor instructed me… — Eliza T.

Dr. Geoffrey Sher answered

In my opinion, follicles of >22mm in mean diameter, are much less likely to house viable , 'competent" eggs , post "trigger". The ideal pre "trigger" measurement is 18-22mm. And No, they should not grow after the hCG "trigger".. Either way, there is no harm giving it a…
Male Infertility Nov 21, 2022

What does your clinic do differently?

Hello, My husband and I have been trying to have a baby for 8 years now. We reside Alberta, Canada. We have attempted 5.5 IVF ICSI cycles. I am wondering if your clinic does the IVF procedures differently then in… — Masuma M.

Dr. Geoffrey Sher answered

You are only 34y of age, So when it comes to egg/embryo quality, regardless of your ovarian reserve, you should be able to do better. Your husbands sperm dysfunction could be contributing factor but in my opinion, the protocol used for ovarian stimulation and its implementation is the…
Egg Health & Ovarian Reserve Nov 21, 2022

IVF advice for optimal cycles

Hi Dr. Sher, I’m 34 with history of 2 early losses last year and DOR (last AMH 1.49). I have around 16 antral follicles based on ultrasound. Just finished my first round of stims and only yielded 6 eggs. Only… — Lauren M.

Dr. Geoffrey Sher answered

You are only 34y of age and with your high AFC, I expect that you ave ample ovarian reserve. My hunch is that you poor response could have to do with the protocol used for ovarian stimulation and its implementation.I really think we should talk!!. The importance of…
Ovarian Stimulation & OHSS Nov 20, 2022

IVF protocol meds

Hi, I have already had three cycles of IVF with my last one being the most successful. My protocol was 7 units omnitrope and testosterone gel with norethindrone for a few weeks before stopping norethindrone to start my cycle. I… — Vivian K.

Dr. Geoffrey Sher answered

I just don't know how the replacement of Menopur with low-dosage hCG would stack up as I personally have never used hCG in this way during stimulation. On the face of it it probably would work OK but it would be preferable if you could access other HMG…

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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