Ask Dr. Sher – Open Forum

22 Nov

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This is a forum where I welcome any questions you have on the topic of infertility, IVF, conception, testing, evaluation, or any other related topic.

I try to answer all questions in less than 24 hours. In many cases, I will answer within just a few hours.

– Geoffrey Sher, MD

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  • Katy says:

    In Oct 2010, at the age of 28, I was diagnosed with lean PCOS (3/3 of the Rotterdam criteria), with AMH 28 pmol/l, FSH 3.1, and an AFC of 42

    5 years later at the age of 33, I now fulfil 0/3 of the Rotterdam criteria and have DOR: my July bloods showed AMH 1.5 pmol/l, FSH 17.6 and an AFC of just 5. My most recent bloods showed my FSH had gone down to 9.5, however given that one is only as good as one’s worst FSH, the picture is not exactly rosy.

    I am pursuing IVF aggressively, however I would welcome your opinion as to what may have caused my ovarian reserves to have declined so spectacularly in the space of just 5 years (and how I seem to have un-polycystic-ed myself)…

    • Geoffrey Sher says:

      Hi Katy,

      This is a hard blow and my heart goes out to you.

      An AMH of 1.5 pmol/L is really an indication of very severe DOR and at 33y this suggests that you could be headed to premature menopause.

      You might still have a chance with a very aggressive agonist/antagonist conversion protocol + estrogen priming and HGH supplementation, embryo banking and PGS embryo selection…but that is still a long shot.

      Please go to the home page of this blog, . When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

      1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

      2. Ovarian Stimulation for IVF: The most important determinant of IVF Outcome” (Nov. 2103)

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

      5. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

      6.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

      7. “IVF success: Factors that influence outcome”

      8 “Use of the Birth Control Pill in IVF”

      9.”Staggered IVF”

      10.“Embryo Banking”

      11.“Array CGH versus metaphase CGH in IVF patients….’


      Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization: The ART of Making Babies”. The book is available through “” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

      • Katy says:

        Thank you Dr Sher. It really was devastating to believe I had one fertility issue – and fantastic ovarian reserve – to then feel like the rug has been pulled out from under my feet. I felt like I had done everything right in investigating my fertility at a relatively young age: the irony was that I enquired about egg freezing, however I don’t believe vitrification technology was as advanced as it is now, and so I was advised that there was no evidence (at that time) that it was likely to be successful for ‘social’ fertility preservation. Oh with the benefit of hindsight!

        There seems to be one theory that the transition from PCOS to DOR in lean women is related to FMR1 premutations, I wondered if you had any thoughts about this? Although I suppose it is somewhat academic what has brought about this case of the disappearing eggs – it’s more about a plan of action than pondering why….

        I am undergoing my first cycle on high dose stims (short antagonist protocol), and have my first scan (Day 6) tomorrow, so will see if there’s any response. I have just finished your book and read about the A/A conversion protocol with interest. I appreciate that different physicans have different approaches, and I took the view that we didn’t have time to waste and that the first cycle would be a useful diagnostic exercise if nothing else. My consultant trained with Professor Lord Winston so whatever the outcome (and however I respond to this protocol), I think it made sense to go full steam ahead with a top local (London based) fertility specialist for this first cycle at least. However I would absolutely consider coming to the US for my next cycle! I may well be in touch with your office for a Skype consultation – once again thank you so much for responding. V best regards.

        • Geoffrey Sher says:

          Alas…causation is an academic consideration at this time…. I personally do NOT favor the use of short “flare” protocols in women with DOR (see my blog).

          Geoff Sher

  • Honey says:

    Dear Dr Sher,
    apropos pregnancy tests (pee sticks): I tested 8 dpo and had a faint positive pretty quickly on two different brands of tests. Today 9 dpo I tested again and still had faint positives but less quickly. Can this only be read as a falling hcg? Or is the hcg so low at this stage that you wont see a big difference from day to day neccessarily?
    Have a lovely evening!