IVF Authority

No! You would likely be better off with convention...

2010-03-08T23:03:14.133-08:00

No! You would likely be better off with conventional IVF since you are probably a poor responder who would need aggressive stimulation and monitoring.

Geoff Sher

You need IVF but only after any endometriomas have...

2010-03-08T23:00:42.345-08:00

You need IVF but only after any endometriomas have been removed surgically or by in-office sclerotherapy.

Geoff Sher

It very much depends on the type of IID you have. ...

2010-03-08T22:57:54.644-08:00

It very much depends on the type of IID you have. As an example , if it is alloimmune, heparin wont help. Nor will it help if there is increased NK cell activation.

Geoff Sher

Whether Viagra will help depends very much on the ...

2010-03-08T22:55:31.939-08:00

Whether Viagra will help depends very much on the reason for a thin lining. If it is due to previous inection of the uterine lining (endometritis) it often will not work. Sometimes using a suboptimal protocol of ovarian stimulation will render the endometrium less responsive to estrogen in that cycle. FET's traditionally give the best chance of a good lining because you avert some of the negative influences of a poor stimulation protocol thereby.

Geoff Sher

Vasa Previa is NOT more common with IVF. The beta ...

2010-03-08T22:50:49.347-08:00

Vasa Previa is NOT more common with IVF. The beta results should start coming in 1 week after a blastocyst transfer.

Geoff Sher

NK cell concentration is not relevant. It is the N...

2010-03-08T22:46:49.381-08:00

NK cell concentration is not relevant. It is the NK cell activation as measured by the K-562 target cell test that matters. If that is elevated then intralipid +corticosteroid therapy is best. If there is no NK cell activation then neither intralipid or IVIG is indicated for this problem. However I would advise both alloimmune and other autoimmune tests be done too. See my arrticle elsewhere on this blog relating to immunologic implantation dysfunction.

Geoff Sher

The measurement of FSH/Inhibin B/antimullerian hor...

2010-03-08T22:43:35.105-08:00

The measurement of FSH/Inhibin B/antimullerian hormone-AMH and antral follicle count on day 3 of a spontaneous cycle.

Geoff Sher

Age correlates with embryo competency. Thus the ch...

2010-03-08T22:42:05.271-08:00

Age correlates with embryo competency. Thus the chance of a good looking embryo/blastocyst making a bay at 35 years of age is probably double the chance at 40 years.

I am pro blastocyst transfer because those embryos that do not survive to the blastocyst stage are probably defective anyway.

Geoff Sher

If the embryo makes a good quality blastocyst by d...

2010-03-08T22:39:29.059-08:00

If the embryo makes a good quality blastocyst by day 6 npost-fertilization,regardless of its cleavage on day 3, it has a chance of making a baby.

I do NOT believe in traversing the cervix twice in one cycle of IVF. The risk of introducing infection is too great. Thus I am against "interval transfers".

Geoff Sher

Respectfully, I would disagree. Geoff sher

2010-03-08T22:35:52.753-08:00

Respectfully, I would disagree.

Geoff sher

Please read my article elsewhere on theis blog on ...

2010-03-08T22:32:32.850-08:00

Please read my article elsewhere on theis blog on use of the BCP in IVF.

Geoff Sher

ICSI is/was mandatory here in my opinion. Geoff S...

2010-03-08T22:30:52.631-08:00

ICSI is/was mandatory here in my opinion.

Geoff Sher

Thank you! Geoff Sher

2010-03-08T22:29:36.833-08:00

Thank you!

Geoff Sher

I agree trhat the protocol should not be a microfl...

2010-03-08T22:28:27.203-08:00

I agree trhat the protocol should not be a microflare approach. However, in my opinion you might rather consider a long pituitary down regulation protocol with Lupron.

Geoff Sher

Thank you! Geoff sher

2010-03-08T22:26:13.435-08:00

Thank you!

Geoff sher

Thank you Susan. Geoff Sher

2010-03-08T22:25:15.986-08:00

Thank you Susan.

Geoff Sher

I can tell you that it is not available in Austral...

2010-03-08T22:23:35.437-08:00

I can tell you that it is not available in Australia since I see many patients here iun the U.S from your country.

I suggest you have your blood tested for NKa and that your and your husband's blood be matched for both DQ alpha and HLA similarities. The bloods can be sent to Reproductive Immunology Associates (RIA) in the U.S.A. Call them at 818-648-3551 and they will provide details.

Geoff Sher

Dear Kay, Sorry for the delay in responding. I w...

2010-03-08T22:18:57.528-08:00

Dear Kay,

Sorry for the delay in responding.

I would respectfully point out that in my opinion microflare protocols are suboptimal for women with diminished ovarian reserve (DOR). Please read my article that deals with "IVF ovarian stimulation: An individualized aproach" ..elsewhere on this blog. What you need is an agressive agonist antagonist conversion protocol-A/ACP (to be found in an article I wrote for this blog, elsewhere).

Also IUI ( proudly a procedure that I introduced into the field in the early 80's) is relatively contraindicated in cases of DOR...see my article on IUI elsewhere in this blog.

You certainly need IVF with a very customized protocol of stimulation. ...and you need it soon.

I look forward to our telephone consultation when we can explore your issues in detail.

Geoff Sher

You are most welcome!

2010-03-08T22:08:30.169-08:00

You are most welcome!

Dear Dr. Sher, How to determine BCP and Lupron ar...

2010-03-05T17:37:57.917-08:00

Dear Dr. Sher,

How to determine BCP and Lupron are needed in a cycle?
The reason I asked this is because I was told by a nurse from Gonal-F that I was over-suppressed and that's why I even didn't respond to 575 unit gonal-F which was considered high dose based on her opinion and my age (37).
Also, my best friend was on a protocol without BCP and micro-dose lupron. She is pregant. We are at same age. Both of us are poor responders. both of us never take BCP until do IVF. Both of us have FSH around 7-9.
Now, my doctor is put me on lupron + Cetrotide then + gonal-F 750, why?

Thanks,

Rebecca

Thanks for sharing!

2010-03-05T06:10:24.398-08:00

Thanks for sharing!

I am scheduled for an interval transfer, 1 emb on ...

2010-03-01T03:14:20.928-08:00

I am scheduled for an interval transfer, 1 emb on day 3 and 1 emb on day 5. What are your thoughts on this method?
I had my EC yesterday, as of today 8 eggs fertilized, seven of which are of good quality.

I forgot to mention that my husband's sperm count/...

2010-02-27T09:04:53.679-08:00

I forgot to mention that my husband's sperm count/motility was excellent.

I am 35 years old, a non-smoker, 120 pounds. I hav...

2010-02-27T09:03:33.434-08:00

I am 35 years old, a non-smoker,
120 pounds. I have a history of severe endometriosis and cysts and fibroids.
I had laparotomy to have it all removed 1 1/2 years ago. I conceived naturally 5 cycles after the surgery healing period, but I had an early miscarriage at 5 1/2 weeks. That was one year ago almost, and I have been trying to conceive since then with no luck. I have regular cycles (approximately 26/27-day cycles) and ovulate on my own every cycle
approximately day 12/13. I have a few days of spotting prior to onset of my periods.

I tried 4 cycles of Clomid this past fall to see whether it would help. I had 5 follicles develop one cycle on just 50 mg of Clomid, and my Dr. reduced my dose to 25 mg for the remaining 3 cycles. I didn't conceive,though. During that time, I did one unsuccessful IUI. My RE strongly recommends I move to IVF now and mentioned she would put me at the higher dose of drugs due to my having endo, which confuses me given my response to the small dose of Clomid.

My lining is good, my progesterone is always good, and as far as I know all other blood work I've had has been normal. I've not had ovarian reserve testing yet, though.

I should mention that since my surgery, my right ovary is apparently stuck behind my uterus. My current RE did not seem to think that would cause a problem for egg retrieval, though a previous RE I saw wasn't sure.

Would I be a good candidate for Micro-IVF? I'll be 36 in August, so would need to move on it relatively soon...

Thanks!

Do you feel a blastocyst has a higher propensity t...

2010-02-26T15:22:43.901-08:00

Do you feel a blastocyst has a higher propensity to result in a viable pregnancy even if it was a slower growing embryo? For example, would you consider a blastocyst with no fragmentation a good option for transfer, even if it was only 4 cells on day 3? Does the rate of growth affect the viability, or growth rate a non-issue because it made it to blast stage regardless? Thank you for your time!