Dr. Geoffrey Sher

Launching Ovarian Stimulation with a BCP: How Does it Affect Response?

One often hears the expressed opinion that the BCP suppresses response
to ovarian stimulation. This is not the case, provided that the BCP is
overlapped with administration of an agonist (e.g. Lupron, Buserelin,
Superfact) for several days leading up to the start of menstruation
and the initiation of ovarian stimulation cycle with gonadotropin
drugs. If the latter precaution is not taken, and the cycle of
stimulation is initiated coming directly off the BCP the response will
oft…

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Frozen Embryo Transfer (FET): What Does it Involve?

By Dr. Geoffrey Sher

Frozen Embryo Transfer (FET) A frozen embryo transfer cycle is
initiated by administering an oral contraceptive (OC) to the
recipient. This is later overlapped with Lupron daily for 5-6 days.
The OC is then withdrawn, but the daily Lupron injections are
continued until the onset of menstruation. Next, the Lupron dosage is
reduced and intramuscular (IM) estradiol valerate (Delestrogen) is
administered every 3 days. The objective of the estradiol is to
achieve and sustain an optim…

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Immunologic Implantation Dysfunction (IID) & Infertility (IID): PART 1-Background

By Dr. Geoffrey Sher

In 15-20% of women who have infertility or RPL, the cause will be
immunologic implantation dysfunction (IID). Accordingly, all women who
have predisposing factors such as endometriosis, unexplained
infertility/repeated failed IVF, RPL, or have a personal/family
history of primary autoimmune conditions, should be evaluated and
treated appropriately. By doing so, we as phys…

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Implications of Empty Follicle Syndrome and Premature Luteinization

By Dr. Geoffrey Sher

Frequently, when following vigorous and often repeated flushing of
follicles at egg retrieval they fail to yield eggs, it is ascribed to
“Empty Follicle Syndrome.” This is a gross misnomer, because all
follicles contain eggs. So why were no eggs retrieved from the
follicles? Most likely it was because they would/could not yield the
eggs they harbored.

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Preventing Severe Ovarian Hyperstimulation Syndrome with “Prolonged Coasting”

By Dr. Geoffrey Sher

I do not use antagonists in high responders (e.g., PCOS) because it
interferes with the assay of E2 (often causing the value to be
understated), a valuable index in assessing risk for the development
of severe/critical OHSS. I also do not believe in the agonist trigger
to prevent OHSS. The reason is that the magnitude of the induced LH
surge varies and if too little LH is released, meiosis can be
compromised, thereby increasing the oocyte aneuploidy index.

Down-re…

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Secondary Infertility: Addressing the Root Causes

By Dr. Geoffrey Sher

It is one thing for a woman who has never been able to conceive
(primary infertility) to come to grips with undergoing In Vitro
Fertilization. It is quite another matter for someone who has
successfully achieved a pregnancy in the past having to come to terms
with a subsequent inability to conceive (secondary infertility). When
this happens, it raises issues of guilt, a declining sense of
self-worth and ultimately self-recrimination. The ramifications often
impact family relatio…

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Staggered IVF: An Excellent Option When Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate

By Dr. Geoffrey Sher

Many physicians treating infertile women over 40 years old who have
patent fallopian tubes still opt to start with the least invasive
strategy rather than going straight to IVF. This usually begins with
the prescribing of oral and then injectable fertility drugs with or
without artificial insemination/IUI. The rationale for this approach
is that IVF is significantly more expensive than such alternatives.
While the cost of an IVF procedure is certainly more expensive, what
is o…

Staggered IVF: An Excellent Option When Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate Read More »

The Role of Nutritional Supplements in Preparing for IVF

By Dr. Geoffrey Sher

It is important to take care of yourself mentally and physically when
preparing and going through your IVF journey. This starts with trying
to have a positive attitude about what you are about to go through,
creating a stress support system for yourself by using tools such as
visualization, acupuncture and meditation, eating the right foods
taking a few supplements (see below) and balancing exercise with
sufficient rest. . Not only will it help your experience but it may
also he…

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Thyroid autoantibodies and Immunologic Implantation Dysfunction (IID)

By Dr. Geoffrey Sher

Between 2% and 5% of women of the childbearing age have reduced
thyroid hormone activity (hypothyroidism). Women with hypothyroidism
often manifest with reproductive failure i.e. infertility, unexplained
(often repeated) IVF failure, or recurrent pregnancy loss (RPL). The
condition is 5-10 times more common in women than in men. In most
cases hypothyroidism is caused by damage to the thyroid gland
resulting from of thyroid autoimmunity (Hashimoto’s disease) caused
by damage do…

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Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols

By Dr. Geoffrey Sher

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 contain
small collections of fluid — called follicles — located in each
ovary as seen during an ultrasound. The condition is characterized by
abn…

Understanding Polycystic Ovarian Syndrome (PCOS) and the Need to Customize Ovarian Stimulation Protocols Read More »

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