Ask Our Doctors
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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I just completed my second fairly disappointing cycle.
I’ve been told my AMH is high for my age, although, I have not been formally diagnosed with PCOS and my RE told me not to be too concerned (but I am). I have regular cycles, I’ve been pregnant twice naturally, I have a normal BMI, no family history w/ infertility, and no ovarian cysts.
Syeda (leading up)
Testosterone cream primer
Metformin (for the AMH)
15 retrieved, 11 mature, 9 fertilized, 3 blastocysts, 3 aneuploid
Great quality Blasts (4AA, 4AA, 4BB)
**2nd: cycle (“mini stim”):
Testosterone cream primer
Menopur (removed Gonal, increased Menopur)
Omnitrope (increased dosage)
12 retrieved, 10 mature, 10 fertilized, only 1 blastocyst (currently testing)
One good blast (5AB)
I’m ready and prepared to try again, but I want to go in with as much knowledge as possible and know that I’m doing anything I can do for better results! I am now taking 300mg CoQ10 (bio-active), ALA, a Prenatal with Folate and DHA, Myo-inositol, and an Omega blend. I maintain a fairly healthy/balanced diet although I’m sure I could do more. I’ve also started acupuncture and I ensure to get at least 30-60min of exercise 3x/week. 7-8hrs of sleep.
1. Is it possible to improve these results? Is there anything else I should/could be doing?
2. I received a bioscan from my Chinese Medicine Specialist last week and the results determined I have mitochondrial and metabolic fatigue (Prior to starting CoQ10) – do you think this could have a big impact on the results I’ve been experiencing? The eggs and embryos just do not have the energy or power to divide and thrive?
3. Did I just roll the wrong dice?
**We have a consultation with a new clinic for a second opinion in a few weeks!
Dear Dr Sher,
I’m 37.5 years old and have a long history of unsuccessful IVF rounds albeit with one successful cycle four years ago. My case has been classed as quite challenging. I’ve undergone 13 IVF cycles under the care of a leading UK physician and have good ovarian reserve for my age notwithstanding PCOS. Throughout the past 13 cycles, I’ve consistently had between 19-35 eggs retrieved all being immature. I did have one successful cycle which was a rescue IVF as 8 of the eggs matured overnight in the lab and ICSI was successful. I’ve just finished completed another disappointing cycle in which 19 immature eggs were collected on day 19 of my cycle. The usual protocol applied for me has been to use Letrozole throughout treatment starting on day 2 or 3 of my cycle along with GONAL-F. Fyremadel is then administered once the lead follicle reaches 14mm. Due to concerns of ohss (which I’ve never had with all 13 cycles), a trigger of 0.5 buselin and 7-8 clicks of Ovitrelle is administered typically any day between day 14 – day 17 of my cycle with an EC 36 hours later. I’m frustrated and would appreciate your thoughts on what other protocol to try. I would like to give my child a sibling but cannot continue to do the same thing and same results!
Your thoughts would be gratefully received.
Hi Dr Sher,
My husband and I are using donated embryos from a clinic program after 8 rounds of failed IVF due to low AMH 0.19 & diminished ovarian reserve. I have endometriomas in my ovaries and am now 44 years old. We started IVF in Jan 2020.
The embryos are made with donor eggs, the male donor was 52 at the time and the egg donor was 25. 15 embryos were made, the donating family transferred 2 and had one child. The remaining embryos were split, 8 to us and 7 to another couple. The donor has had successful pregnancies with each donation. She donated 10 times and this was donation #7. The embryos were made in 2012 and slow freeze was used. They are not PGT tested.
We transferred one Good/Good embryo and no pregnancy. One embryo did not survive the thaw. We then transferred 2 Good/Good embryos and had a pregnancy but 7 week ultrasound showed a blighted ovum. I have done 2 months depot Lupron, for the 2nd transfer I did more daily Leuprolide, lipid infusion, dexamethasone and prednisone.
We have 4 embryos of Fair/Fair quality left. Based on your experience, do you think that we will be able to have a successful pregnancy and live birth? Any insight you have to improve our success would be appreciated. Thank you.
Hi, we are doing an ivf cycle in canada and plan to continue that here. However, we would like to get consultation from Dr. Sher to review our file, details, previous tries and provide recommendations remotely. We might be wrong but think the current clinic we are in and the previous one had limited resources or expertise.
we would like to book a consultation and hopefully you can help us with your expert opinion
I scored 1.8 on the Receptiva test, and had a laparoscopy two weeks ago that revealed pelvic and bowel adhesions, and a blocked tube (all likely caused by a past silent infection – not from endo?). They also found less than 1 cm of endometriosis on my left pelvic wall. All adhesions and endo were excised and the tube was removed, as well as a 9mm polyp in my uterus. My RE is saying that doing one month of Lupron will give me the best possible chance for my first upcoming FET to suppress any endo potentially missed or unseen. I’m wondering, would a month Lupron really make a difference when there was so little endo found? If it truly will increase my success rate for transferring, I’m open to trying it. But lupron seems to come with potential high risks so I don’t want to take it without likely impact for success!
I also saw your posts about blood testing for IID, including the APA and NKa. Is this something you advise testing prior to any FETs? And is that something our RE would be able to order, and how would we go about using one of the 3 reputable labs? (I live in AZ!)
Thank you in advance. I greatly appreciate you sharing your wisdom.
I recently moved to Las Vegas after being in Japan for 2 years. I had an embryo transfer on the 15th of July but its looking to be a blighted ovum. I have a confirmatory ultrasound scheduled for Monday with my primary OB provider.
I’m a little lost on how to move forward. I have 3 embryos still in Japan with no stateside clinic and no stateside provider who can perform FET. I had a successful FET last year and wanted to continue growing my family. But my job has strict limitations on where I can go and how long I can be gone for. Do you have any suggestions on how I can proceed forward?
As a follow up to my last question. Could you still do an FET if the lining thickens to a good size although the follicle is slow to develop/lack of ovulation. My lining is close to 7 mm despite having a small 10 mm follicle. Could I not transfer and supplement with progesterone since a thick lining is the most important?
Hi Dr. Sher,
I had a dating ultrasound last week on Tuesday and was measuring 5 w and 5 d and they did an hcg test with and my levels were 52819 H. Yesterday I had another ultrasound and measuring 6w and 2D with an hcg level of 55810 H. We saw a heart rate of 96 bpm. Should I be concerned of this pregnancy.
I am almost 40 and just did an egg retrieval on may. I have 5 euploids and 1 LLM. I also have pcos. I was hoping to do a modified natural cycle this month using 5mgs of letrozole. I have always responded well to letrozole on the past when I was doing timed intercourse. I’ve done 7 cycles in total using letrozole and ovidrel.
On day 10 all my follicles were between 7-9 mms and my lining was 6. Today, day 13 my biggest follicle is 10 mm and my lining is 6.7. I’m so discouraged. I have to go back in 3 days for a recheck. My cycles are fairly regular, between 30-32 days.
Do you think this mean I’m out this month? Could I try letrozole at 7.5 mgs next month? I’m trying to stay away from taking estrace. I also don’t want to take clomid due to ovarian cancer risks.
I am currently 18 weeks pregnant following a fresh IVF transfer.
Would you advise that I stay on lovenox 0.4 during the whole pregnancy since I have the following genetic mutations?
– homogenous MTHFR 677CT
– heterozygous PAI 4G/5G
Also would it be advised that I take a low dose of progesterone throughout the pregnancy?
I do not have recurrent miscarriage but it took me 6 years in total to get a continuing pregnancy. My last pregnancy ended in a miscarriage at 9 weeks (following IVF but I wasn’t on any medication), 3.5 years ago. After that we had a lot of failed transfers before our successful transfer.
Hi Dr Sher, apologies to bother you again, your insights are so helpful and I’m worried this IVF round isn’t going to work! It’s a Euploid embryo being transferred that I don’t want to wast. We’re doing a modified natural cycle (as mentioned in my previous message).. and instead of triggering the day dominant follicle was 20mm.. we waited a day, so a day later on day 11.. so not before the LH surge, but close to it, if not on it.. We’ll be transferring in 7 days time (from trigger) and will be starting progesterone support in 24 hours time.. I’m worried the timing will be out because we triggered one day late.. would you recommend we cancel? Many thanks in advance! Best wishes, Cassidy
I went in for a scan today in anticipation of doing a modified natural cycle, it’s day 10 – LH levels are rising -I’ve not reached ovulation yet, LH normally surges on day 14 for me. The lining was trilaminar and 9.5mm in thickness and lead follicle was 23mm. The nurse said trigger tonight and come in next Monday for transfer. I asked whether there was any benefit in delaying trigger, letting my lining grow a bit more naturally before we trigger (historically it has grown a bit each day). She said she was happy to postpone the transfer date by a couple of days.. so that’s what we’re doing.. The plan is to trigger on day 12 (instead of day 10), assuming I’ve not got my surge before then, and start progesterone that day and transfer 7 days after trigger…Does that sound like a sensible plan to you – does it hurt to let the lining grow a bit thicker before we trigger? Many thanks for your help in advance! Best wishes, Cassidy.