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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 Sep 20, 2023

RPL

Hi Dr. Sher We started trying for a baby a year ago. Fast forward to now and I've had 2 chemical pregnancies, 1 missed miscarriage (embryos heart stopped at 6 weeks 3 days) and now a blighted ovum (gestational sac… — Marie N.

Dr. Geoffrey Sher answered

When it comes to reproduction, humans face challenges compared to other mammals. A significant number of fertilized eggs in humans do not result in live births, with up to 75% failing to develop, and around 30% of pregnancies ending within the first 10 weeks (first trimester). Recurrent pregnancy…
Early Pregnancy & hCG Sep 4, 2023

Failed euploid transfer

Dear dr Sher, Thank you so much giving me the option to ask you a question! I’m very curious about what your differential diagnosis/following steps would be. I’m 34 years old and we have been dealing with unexplained infertility for… — Eline L.

Dr. Geoffrey Sher answered

In my opinion, this sounds very much like an implantation dysfunction. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> IVF FAILURE WITH “NORMAL” EMBRYOS: EXAMINING AND ADDRESSING ANATOMICAL AND IMMUNOLOGIC CAUSES. Geoffrey Sher MD Implantation dysfunction is often overlooked as a significant reason for IVF failure. This is especially true when IVF failure is unexplained,…
Embryos & Genetic Testing Aug 30, 2023

international patient

Hello Dr. Tortoriello, My name is Jeffrey Dorr and I am a US physician (neuroradiologist) living overseas in Japan. My wife is 41 yo, and has undergone fertility treatment here in Japan for the last 16 months, including 6 rounds… — Jeffrey D.

Dr. Geoffrey Sher answered

Dear Dr Dorr, We do not manage patients during pregnancy.We only address reproductive dysfunction. Might I I suggest that you reach out to an obstetrician to look after your wife while you are in NY. If you need help in finding one., please let me know and I…
Embryos & Genetic Testing Aug 30, 2023

TSH prior to FET

Hello, I was wondering what the recommended parameters are for TSH/T4 level prior to FET. I have no issues with thyroid and my most recent TSH level was 3.6 and T4 1.3, just wondering if these are good numbers for… — Julie M.

Dr. Geoffrey Sher answered

Your TSH is modestly elevated. In my opinion this is an indication to evaluate for antithyroid antibodies, which if present, could suggest an underlying autoimmune, immunologic implantation dysfunction linked to activation of uterine natural killer cells (NKa). This should be addressed in advance of undergoing FET in my…
Embryos & Genetic Testing Aug 28, 2023

2 failed IVF frozen embryo transfers

Hello, I am 39 years old. I have now had 2 failed FET cycles. I’m getting frustrated bc my levels For everything have been “ideal” per my doctor and they are not sure why it is not working. I have… — Nikki F.

Dr. Geoffrey Sher answered

This sounds like an 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…
Egg Health & Ovarian Reserve Aug 24, 2023

Fertilizing well, but with really high attrition rates

Age: 39.5 AMH 3.6 FSH 6.1 LH 4.6 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… — Taylor M.

Dr. Geoffrey Sher answered

In my provisional opinion, this is likely attributable to the protocols used for ovarian stimulation. I do not agree with testosterone supplementation or concomitant clomiphene included in the cycle. I think we should talk and I urge you to contact Patti Converse (my assistant) at 702-533-2691 (see below).…
Embryos & Genetic Testing Aug 23, 2023

Slow Freeze Donated Embryos

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… — Naz C.

Dr. Geoffrey Sher answered

It is important to understand that endometriosis can be associated with an autoimmune, immunologic implantation dysfunction in about 30% of cases (regardless of its severity). This should, in my opinion, be thoroughly evaluated before transferring any more of these embryos! In the world of assisted reproduction, when IVF…
Embryos & Genetic Testing Aug 21, 2023

Frozen Embryo Transfer

Hello, 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… — Zanetta F.

Dr. Geoffrey Sher answered

I recommend that you contact Dr Jeffrey Fisch in Henderson Nevada! 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…
Embryos & Genetic Testing Aug 15, 2023

Optimal trigger

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… — Cassidy O.

Dr. Geoffrey Sher answered

No! It sounds as if the timing will still be OK! Good luck! Geoff Sher
Embryos & Genetic Testing Aug 15, 2023

Is there an optimal timing of the trigger/embryo transfer on a modified natural cycle

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… — Cassidy O.

Dr. Geoffrey Sher answered

Candidly, I am not a fan of modified natural cycle FET's. However, the time to trigger is just before the onset of the natural LH surge.; This is determined by the size (20+mm) of the dominaqnt follicle and bloopd E2. (150pg/ml+ or 300+ if there are >2 dominant…
Embryos & Genetic Testing Aug 12, 2023

Second hand infertility

Hi, I came across your podcast about implantation issues. I went thru infertility issues for 4 years (Ivf wasn’t covered) 19iuis- I had a miscarriage in the 2nd trimester- 3 chemical pregnancies and 2 miscarriages ending before 9 weeks we… — Lauren B.

Dr. Geoffrey Sher answered

Clearly you have recurrent pregnancy loss...likely due to an implantation dysfunction (anatomical or immunologic.However, I would need much more information to be able to comment authoritatively. When it comes to reproduction, humans face challenges compared to other mammals. A significant number of fertilized eggs in humans do not…
Egg Health & Ovarian Reserve Aug 11, 2023

Failing to achieve an euploid

Dear Dr. Sher, 42 year old here desperately wanting to be mother for the first time! 6 year unknown infertility, 99 lbs, 5'6'', eat healthy, taking COQ10 and prenatal, very healthy and no disease illnesses in the past. My AMH… — Anne C.

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…
Egg Health & Ovarian Reserve Aug 11, 2023

PGTA/Endometriosis

Hi, quick background info- 37 years old, husband is 48 years old. I have stage 4 endometriosis with bilateral endometriomas about 4-5 cm on both ovaries. AMH of 3.8, FSH 5.5, Estradiol 45. Sperm analysis is above normal. I just… — Marie F.

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).…
Embryos & Genetic Testing Aug 8, 2023

Balanced translocation & IVF Chemical Pregnancy

Hello Dr. Sher, After having two miscarriages (1 natural and 1 IUI), I found out that I have a robertsonian balanced translocation (13:14). My RE said that my best bet would be to do IVF with PGT-SR testing. I did… — Caitlin D.

Dr. Geoffrey Sher answered

The fact that the embryo transferred was euploid does not guarantee that it is was normal. There are genetic and metabolic factors that also can play a role. As for the low yield of "competent embryos, that likely has to do with the protocol used for ovarian stimulation.…
Embryos & Genetic Testing Aug 7, 2023

Embryo sizing is 6week (.27cm) while GS is 8weeks.

Could this be a early sing of miscarriage? HGC levels have growth 35% form 3 days ago. — Daniela M.

Dr. Geoffrey Sher answered

I am afraid that bhis does not look promising. I hope I am proven wrong but I think you are likely t5o lose this pregnancy. Geoff Sher ADDITIONAL INFORMATION: I am attaching online links to two E-books which I recently co-authored with my partner at SFS-NY (Drew Tortoriello…

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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