IVF Authority

Micro-IVF is a low intensity Might I recommend tha...

2012-02-15T17:50:18.538-08:00

Micro-IVF is a low intensity Might I recommend that you go to www.IVFauthority.com. When you get to the home page on that site , you will find a "search bar" in the upper right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

1. "An Individualized Approach to Ovarian stimulation" Posted on November 22nd, 2010
2. “Agonist/Antagonist Conversion Protocol”
3. “IVF success: Factors that influence outcome”

Please consider calling 800-780-7437 or 702-699-7437 to set up a telephone consultation (which is free for those living in the U.S.A or Canada) with me so we might discuss your case in detail.

Geoff Sher
cycle for women under 35Y. You might want to consider our 2-cycle plan instead.

I have a question? I have 4 kids am at 38 years o...

2012-02-15T16:12:06.430-08:00

I have a question? I have 4 kids am at 38 years old. Still ovulating and menstrating... I got pregnant on 3 Birth controls incl Norplant and depoprovera injection. I had a tubal is Micro a good idea? Also what are the meds that are used for that.. So I can be looking at costs..
M

1.The agonist protocol is what I refer to in the b...

2012-02-14T17:19:54.162-08:00

1.The agonist protocol is what I refer to in the blog as the long-GnRH agonist protocol(probably coming off the BCP).

2. The antagonist protocol is the GnRH antagonist protocol

3. The microdose flare protocol is the same as the GnRH ("microflare") protocol

4. The long Luteal protocol is the same as #1 above only, (I think) not coming off the BCP but instead being started on/around day 21 of a natural cycle.

I cannot without more information. I can tell you that I am NOT a fan of "microflare" protocols. I can not tell you what I would choose for you without more information. Feel free to call 800-780-7437 and set up a telephone consultation to discuss.

I do not advocate the use of DHEA because it metabolized in the ovaries to testosterone and too much ovarian testosterone is the last thing you need.

Hope this helps.

Geoff Sher

Follow-up to my comment at 2:34 pm: I spoke with ...

2012-02-14T15:11:49.873-08:00

Follow-up to my comment at 2:34 pm:

I spoke with my Dr.'s office and they told me they usually use the following four protocols, tweaked as necessary for individual patients: (1) agonist, (2) antagonist, (3) microdose flare, and (4) long luteal. Since the names of these protocols are different than the five you describe above I wasn't sure how they correspond to your five protocols above. I asked about estrogen priming and she said they sometimes do it but not always. Given the choices above, which protocol do you think is most suitable for me?

Also, I have been taking DHEA for around 4 months. Do you recommend that to your patients? I've also read about positive responses with melatonin, but my RE said not to take it. Any thoughts on that?

Thanks again.

I wish I could provide you with a simple answer. U...

2012-02-14T15:03:43.930-08:00

I wish I could provide you with a simple answer. Unfortunately without much more information, that would not be fair or right. So, please consider calling 800-780-7437 or 702-699-7437 to set up a telephone consultation (which is free for those living in the U.S.A or Canada) with me so we might discuss your case in detail.

In the meanwhile, might I recommend that you go to www.IVFauthority.com. When you get to the home page on that site , you will find a "search bar" in the upper right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

1. "An Individualized Approach to Ovarian stimulation" Posted on November 22nd, 2010
2. “Agonist/Antagonist Conversion Protocol”
3. "Immunologic Implantation Dysfunction" (posted on May, 10th and on May 16th respectively.
4. “IVF success: Factors that influence outcome”

Geoff Sher

Hello, I am 38 and have been ttc for about 8 mont...

2012-02-14T14:34:25.632-08:00

Hello,

I am 38 and have been ttc for about 8 months, starting when I was 37. Given my FSH level (13.6) I moved on to fertility drugs very quickly after only trying naturally for a couple of months, first with letrozole (four cycles, two of which were with IUIs) and one cycle of injectibles (Menopur). On the Meonupur cycle, I started out with 3 vials and the response was not great, so they upped it to 4 vials and I had 4 follicles at around 13 mm, but only two matured. I did an IUI and it did not take. I am moving on to IVF next.

I had a consult with the IVF RE and he generally went over the protocol they use but I don't remember the specifics. I know that he usually uses BCPs first, and the way the scheduling is working out with my cycle, I would be on BCPs for a full SIX WEEKS before starting the stimulation. I am very concerned, based on what I have read, that this would over-suppress my already sleepy ovaries. Is this a valid concern? Would it be a better idea to do another cycle of injectibles with IUI (which would take me over to the next four weeks), and then go on the BCPs for only two weeks before the stimulation?

Also, any particular IVF protocol you would recommend? I've seen on your blog that you would not recommend Monopur and "micro-flare" protocols for DOR women, but what would you recommend instead?

Also, would you recommend taking Lupron overlapping with BCPs even for DOR women? (I ask because I've heard Lupron can also have suppressive effects, and I'm not sure if this counts as the no-no Lupron protocl for DOR women or not.)

Very confused here, but I want to make the most out of my first IVF cycle. Thanks so much for your help.

You are most welcome. Geoff Sher

2012-02-09T09:52:06.246-08:00

You are most welcome.

Geoff Sher

thanks a lot for your reply

2012-02-09T04:55:33.352-08:00

thanks a lot for your reply

I do not think that Yasmin will do harm but talk t...

2012-02-08T21:45:51.533-08:00

I do not think that Yasmin will do harm but talk to your own RE first.

Geoff Sher

hi there. i have recently been told i have a mild ...

2012-02-08T17:24:55.776-08:00

hi there. i have recently been told i have a mild pcos, and since stopping yasmin (which completely masked these symptoms) 2 years ago, when ttc, unsuccessfully i have developed acne and hairloss from the hairline. i have been referred for ICSI in 3-4 months time, and as the hairloss is increasingly worsening i wanted to ask you if it would be possible to start taking yasmin again in these months preceeding the treatment, as we have been told it is impossible for us to conceive naturally anyway. i am gradually losing self confidence, but if it will compromise my treatment, obviously i will not go back on the bcp as that is my priority. thanks so much for taking the time to read this.

Indeed, you need IVF but not until the cyst has be...

2012-02-08T13:59:40.619-08:00

Indeed, you need IVF but not until the cyst has been eliminated completely. Hopefully you miscommunicated the information and they actually removed or laser-ablated the entire lining of the endometriotic cyst (endometrioma). This is because if you drain an endometriotic cyst it will return and if it does,the eggs removed from that ovary will often (usually) be of poor quality.

I suggest you go to the home page on this site, find a "search bar" in the upper right hand column and type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

1. "Endometriosis and IVF"
2. "Endometrioma"
3. "An Individualized Approach to Ovarian stimulation" Posted on November 22nd, 2010)
4. “Agonist/Antagonist Conversion Protocol”
4. "Immunologic Implantation Dysfunction" (posted on May, 10th and on May 16th respectively.
5. “IVF success: Factors that influence outcome”

When you have read these (and any others that might interest you), consider calling 800-780-7437 or 702-699-7437 to set up a telephone consultation (which is free for those living in the U.S.A or Canada) with me so we might discuss your case in detail.

Geoff Sher

Hi Dr. Geoff, This blog is very helpful. Thanks fo...

2012-02-08T12:13:54.608-08:00

Hi Dr. Geoff,
This blog is very helpful. Thanks for ur detailed explanations. I was diagonized with endometriosis in 2006 and underwent an open surgery to remove it as the size of the cyst was about the size of a large orange and the adhesions it caused. My gynaec told me that the procedure was complicated as the chocolate cyst was stuck to all my parts. She had to scrap my ovarian wall and stitch my ovary together. I got married 3 years later and have been trying to get pregnant for the past year. In the meantime, I started having painful periods and visited a fertility doctor this time. She put me on pills and suggested we try to get pregnant natural ways, but two months after the treatment, she suggested we do a lapro as she was seeing some cysts on my ovary again. I underwent the lapro last week and drained my cyst and the doctor tells me that there were adhesions and she suggests that I am on Luprin and try IVF after 3 months since the area where the egg meets the sperm is very small due to the adhesions and I am already 32. Do you think I should go with IVF or try to get pregnant naturally? Also, what are the chances of success with IVF and how long does it take after I start the IVF treatment to get pregnant?

Please post your question here and I will respond....

2012-02-08T11:59:46.599-08:00

Please post your question here and I will respond.

Geoff Sher

Hi i’m Heather! I have a question for you! Please ...

2012-02-08T11:35:07.551-08:00

Hi i’m Heather! I have a question for you! Please email me :)
HeatherVonSJ[at]gmail[dot]com

With endometriosis, IUI notoriously yields poor re...

2012-02-07T11:15:15.422-08:00

With endometriosis, IUI notoriously yields poor results. I can confidently tell you that with your situation IVF is needed, but not before the endometrioma has been dealt with and you have been thoroughly assessed for an immunologic implantation Dysfunction (IID). Might I recommend that you go to the home page on this site, find a "search bar" in the upper right hand column and type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

1. “Endometriosis”
2. Ovarian Endometrioma”
3. Intrauterine Insemination”
4. "An Individualized Approach to Ovarian stimulation" Posted on November 22nd, 2010
5. “Agonist/Antagonist Conversion Protocol”
6. "Immunologic Implantation Dysfunction" (posted on May, 10th and on May 16th respectively.
7. “IVF success: Factors that influence outcome”

When you have read these (and any others that might interest you), consider calling 800-780-7437 or 702-699-7437 to set up a telephone consultation (which is free for those living in the U.S.A or Canada) with me so we might discuss your case in detail.

Geoff Sher

Hi Dr Sher, I am 30 years and my husband is 33 ye...

2012-02-07T00:17:46.558-08:00

Hi Dr Sher,

I am 30 years and my husband is 33 years old. We are trying to conceive from past 18 months. In Nov 2010 i got to know that i have cyst in my right ovary which was persitant in next 6-7 cycles and that my hymen was intact. My gynac suggested for a D&C which i did in April 2011 and after that tried naturally for six months with letroz but waste. Then my gynac said might be it is endometriosis and i had a chocolate cyst in my right ovary and did Lap in Oct 2010 which showed i had a mild endo and they drained the cyst. now .i have tried for 4 IUI cycles with no success. Can you please suggest whether should i go for 1-2 more IUI's or should go for IVF...? My husbands sperm count is good. Regards NS

You would be an excellent candidate! If you wish, ...

2012-02-06T18:48:59.501-08:00

You would be an excellent candidate! If you wish, call 800-780-=7437 so we can di9scuss.

Geoff Sher

Ask for the K-562 Target Cell Test. There are less...

2012-02-06T18:44:50.211-08:00

Ask for the K-562 Target Cell Test. There are less than 1/2 dozen Reproductive Immunology Reference Labs in this country that can perform this test optimally, in my opinion. I use Reprosource, Boston, MA or Reproductive Immunology Associates, Van Nuys, CA.

Geoff Sher

I am 40 but have been trying to get pregnant for 2...

2012-02-06T15:17:13.038-08:00

I am 40 but have been trying to get pregnant for 2 years. I have Hashimotos. My anatomy is fine. My levels are not great, but not terrible either. I have done one IVF that failed. I have not been tested for NK cells, but would like to be before I continue. What test should I be requesting?

Hello Dr Geoffrey, I am 42. My Day 3 blood work r...

2012-02-06T13:58:01.002-08:00

Hello Dr Geoffrey,

I am 42. My Day 3 blood work results are: FSH:7, AMH: .54ng/ml and Estradiol 36.2 pg/ml.
Would I be a good candidate for IVF / Embryo Bnaking? please advise. Thank you.

PV

I really think we should talk because while some o...

2012-02-04T13:31:27.546-08:00

I really think we should talk because while some of what you expressed that your RE told you is correct it might have been overstated. There are several options.

Call 800-780-7437 for a consultation. If you live in the U.S or Canada, the phone consultation will be free.

Geoff Sher

Dear Dr Sher, Hope you are well. Thank you so muc...

2012-02-04T07:52:46.421-08:00

Dear Dr Sher,

Hope you are well. Thank you so much for your comments. I had a chemical pregnancy in Jan 2012, with a hcg of 24 on the 7th day, but after that it decreased.

I asked my doctor the cause and he said that it was because there was some abnormality in the embryo which they cannot determine from before.

The doctor told us that my husband has 90% abnormality in his sperm, and low motility which means every time it would be the Russian roulette with us :(. He said as long as we had girls it would be fine, else boys would have the same thing as my husband. Its heartbreaking to know this. My husband is devastated.

My question is, the tests that he told us about where they send the embryos to lab, and they find out if there is any abnormality or not, the cost price for this was very high coming till 15000$. Is there anything that is a cost affordable where we can have our wish for having normal and living children.

Hello Dr. Sher, We transferred 2 beautiful Frozen...

2012-02-03T11:05:16.376-08:00

Hello Dr. Sher,

We transferred 2 beautiful Frozen Blastocysts and I am currently 11 days past transfer. I had my beta this morning and it was only 25. I had a positive Urine test at 7 days past transfer and thought that my beta would be much higher by now.

Do Frozen blasts tend to start slower than a fresh blast?

Best regards,

Susan

I do not prescribe Depot Lupron, but indeed, your ...

2012-02-02T12:10:16.783-08:00

I do not prescribe Depot Lupron, but indeed, your RE is correct when this long acting form of Lupron is used.

Geoff Sher

I just did my first shot of depot lupron on 1/27/2...

2012-02-02T09:37:10.730-08:00

I just did my first shot of depot lupron on 1/27/2012.Will be doing 3 months of lupron. I will be doing a medicated FET after that.I met up with my RE and he says I do not need to wait for a period and just go from depot lupron to taking estrogen to build up my lining for FET. Do you think this is good idea? He does not think it is necessary to do birth control and lupron 10unit and 5 units. What are the pros and cons of waiting for a period and not waiting for a period before FET?