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Endometriosis: IVF is Much More Succesful and Cost-effective Than IUI

Dr. Geoffrey Sher Recommends

Understanding Immunologic Implantation Dysfunction Part 2: A Rational Basis for Selective Intralipid & IVIg Immunotherapy in IVF
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When women with infertility due to endometriosis seek treatment they are all too often advised to undergo ovarian stimulation 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). Nothing could be further from fact. It is time to set the record straight. And hence this blog!

Let me start by saying that regardless of age or the severity of her disease, women with infertility due to endometriosis are at least 5 times more likely to have a baby per treatment cycle of IVF than with IUI. The recent introduction of low cost Micro IVF (http://www.haveababy.com/ ), where qualifying women can undergo IVF at a per treatment cost that is comparable to gonadotropin medicated IUI, makes the understanding of this fact even more relevant. Besides, when one considers treatment in terms of the cost per baby rather than cost per treatment, then the benefit of doing IVF first rather than as a last resort becomes apparent.

So then, why is it that many doctors still recommend IUI preferentially to women with endometriosis? Perhaps it is in part self-serving, given the fact that most doctors do not have IVF programs but are still readily able to provide and be remunerated for IUI services. Or maybe it is because they believe that all such women (who usually have regular ovulation, patent Fallopian tubes and fertile male partners) need is to have multiple ovulations at a time and so increase the odds that at least one embryo will take and propagate a baby. But this is a total misperception. It fails to take important factors involved in the complex genesis of endometriosis-related infertility into account.

So let me take a stab at explaining why IVF is far more successful than IUI in the treatment of endometriosis-related infertility:
Endometriosis is a condition where the lining of the uterus (the endometrium) grows outside the uterus. After a time these deposits bleed and when the blood absorbs it leaves a visible pigment that can be identified upon surgical exposure of the pelvis. Such endometriotic deposits invariably produce and release toxins” into the pelvic secretions that coat the surface of the membrane (the peritoneum) that envelops all abdominal and pelvic organs, including the uterus, tubes and ovaries. These toxins are referred to as “the peritoneal factor”. Following ovulation, the egg(s) must pass from the ovary (ies), through these toxic secretions to reach the sperm lying in wait in the outer part the fallopian tube (s) tube(s) where, the sperm lie in waiting. In the process of going from the ovary(ies) to the Fallopian tube(s) these eggs become exposed to the “peritoneal toxins” which alter s the envelopment of the egg (i.e. zona pellucida) making it much less receptive to being fertilized by sperm. As a consequence, if they are chromosomally normal such eggs are rendered much less likely to be successfully fertilized. Since all women with endometriosis have this problem, it is not difficult to understand why they are invariably far less likely to conceive following natural or fertility-drug-induced ovulation. In fact because of this problem a young ovulating woman with (even mild) endometriosis is likely to have less than a 5% chance of conceiving naturally per month of trying as compared to 15-20% for women of comparable age, who do not have endometriosis. This “toxic peritoneal factor impacts on eggs that are ovulated whether spontaneously (as in natural cycles) or following the use of fertility drugs and serves to explain why the chance of pregnancy is so profoundly reduced in normally ovulating women with endometriosis.

Endometriosis can be considered to be a “work in progress” because new lesions are constantly developing. So it is that for every endometriotic seen there are many non-pigmented deposits that are in the process of evolving but are not yet visible to the naked eye. Please bear in mind that such evolving (non-visible) lesions also release the same “toxins that damage the egg. Accordingly even after surgical removal of all visible lesions the invisible ones continue to release “toxins” and retain the ability to compromise natural fertilization. It also explains why surgery to remove endometriotic deposits fails to significantly improve pregnancy generating potential. In contrast, IVF, by removing eggs from the ovaries prior to ovulation, fertilizing these outside of the body and then transferring the resulting embryo(s) to the uterus, bypasses the toxic pelvic environment and is therefore is the treatment of choice in cases of endometriosis-related infertility.

I am not suggesting that all women with infertility-related endometriosis should automatically resort to In Vitro Fertilization (IVF). Quite to the contrary…. In spite of having reduced fertility potential, many women with mild to moderate endometriosis can and do go on to conceive on their own (without treatment). It is just that the chance of this happening is so is much lower than normal. So for young ovulating women (under 35 years) with endometriosis, who have normal reproductive anatomy and have fertile male partners, expectant treatment is often preferable to IUI or IVF. However, if there is any other factor is added, to the equation (pelvic adhesions, ovarian chocolate cysts, male infertility, immunologic implantation problems, advancing age (over 35 years) or diminishing ovarian reserve, IVF becomes the treatment of choice. In such cases there is simply stated, no time to waste.

Tags: conceiving, Endometriosis, In Vitro Fertilization (IVF), insemination, iui, IVF Authority

40 Responses to “Endometriosis: IVF is Much More Succesful and Cost-effective Than IUI”

Anonymous says:

June 11, 2009 at 7:02 am

In light of this information I cannot understand why doctors persist in recommending IUI to me. I have stage 2 endometriosis and am 41 years of age and have done 4 IUI's in the last year. What a waste of time!

It just makes me angry because it's so unfair.

CZ

Reply
ttc1 says:

August 6, 2009 at 12:32 pm

Can you please explain what an expectant treatment would be for unexplained infertility with open tubes and good sperm quality?

Reply
Geoffrey Sher, MD says:

August 6, 2009 at 12:55 pm

That is a question that cannot be answered without knowing the details of the case in question. The reason is that most cases of "unexplained infertility" are really not unexplained but undiagnosed.

I suggest you go to http://www.haveababy.com and set up a free consultation to discuss this matter in detail.

Geoff Sher

Reply
Tam says:

August 21, 2009 at 7:58 am

Two doctors have diagnosed me with Stage 4 Endometriosis. Both recommend that I proceed directly to IVF, bypassing IUI. However, my RE told me that 10 years ago, they would go in with surgery to remove my endometriosis/endometriomas; and that now they wouldn't. I went for a second consult (plus my RE doesn't do IVF) with a IVF specialist. He recommends laparoscopic surgery to remove the endometriomas. From what I read, this doesn't seem to boost success rate, and there's a risk that I will lose follicles. Is this correct? Should I go forward with the surgery?

Reply
Geoffrey Sher, MD says:

March 8, 2010 at 11:00 pm

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

Geoff Sher

Reply
Roma Waterman says:

November 2, 2010 at 12:09 am

Hello I have severe endo on the bowel and pouch of douglas. I had one op and was able to conceive naturally without much trouble at 35. I have been trying to have another child for 4 years with no luck. After a second operation there has still been no luck. My doctor suggested that IVF would be a very viable option considering there is no endo on the fertility organs. What is your experience of people with endo on the bowel and secondary infertility? I really don't want to have a third operation – the last one made no different to pain or fertility, so I am guessing IVF is my only hope.

Reply
Geoffrey Sher, MD says:

November 3, 2010 at 12:47 pm

Endometriosis is one of the commonest causes of secondary infertility. The MAIN reason is that all women with endometriosis, regardless of its severity, have a "toxic pelvic environment" through which the ovulated egg must pass en route to the tube where the sperm waiting to fertilize it. The toxins render the egg envelopment relatively resistant to the sperm entering.

The fact that your endometriosis did not delay your getting pregnant before was due to "your good fortune or "luck" but this does not diminish the likelihood having difficulty in conceiving subsequently.

See the articles on endometriosis elsewhere on this blog and you will understand better.

Good luck!

Geoff sHER

Reply
Beach house wedding says:

January 23, 2011 at 9:10 am

I found this article very helpful. I was diagnosed on January 12th with Stage 4 ENDO. My husband and I have been trying to get pregnant for over a year. I have it everywhere: on my ovaries, around my tubes, on my ovarian blood supply (which they won't touch until I conceive), on my bowels, but mostly my uterus and bladder were attached with it. I meet with my physician tomorrow and want to have things laid on the table. She talked about doing IUI with clomid/trigger…should I try this times 3 months or just push forward to the IVF. She said she got most of the ENDO impeding with my fertility, but I am so worried about wasting the next 12 months then needing more surgery! Do you have any suggestions?

Reply
Perla says:

March 26, 2011 at 1:16 pm

Dr. Sher,
My husband and I have been trying to get pregnant for about two years.
We saw an specialist next week, he found an endometrioma on my right ovary through an ultrasound. It measures 22mmX19mm.
He suggests we try no more than 3 IUIs and clomid before moving on to something more aggresive. The HSG test will be done during the first cycle.
The question is: are we wasting our time and money with and IUI cycle if:
1. Endometriosis have not properly being diagnosed.
2. We don't know if my tubes are open or blocked.
3. Clomid may worsen endometriosis
4. There is a toxic enviroment for the egg
5. Adhesions may impede the egg and sperm from meeting and therefore fertilizing?
6. Would an embryo be killed or affected by the toxic enviroment?

Reply
jdeutsch says:

April 27, 2011 at 5:40 pm

Do you have any insight into G-CSF improving endometrium as stated here on this infertility clinic's site: http://www.centerforhumanreprod.com/news_csf_endometrium_cases.html

Reply
Geoffrey Sher, MD says:

April 28, 2011 at 3:46 pm

I really have no experience with this but it strikes me that the data and the proof of efficacy is sparce at this time.

Geoff Sher

Reply
missbecky55 says:

April 30, 2011 at 10:19 pm

Dr. Sher,
Six years ago I had a laparoscopy done and the dr. removed my endometriosis. Two months later, I conceived my son with the help of Clomid. We tried for our second two years ago and I miscarried. We recently had every test done and then proceeded straight to IVF. Our first round of IVF failed. We met with our specialist and he said everything looked great with the embryology report and the doctor has no idea what went wrong. My question is, should I repeat another laparoscopy before a second round of IVF? I fear that the endo has returned and is causing implantation problems.

Reply
Geoffrey Sher, MD says:

May 2, 2011 at 1:36 pm

Hi April,

Unless you have an endometrioma (ovarian chocolate cyst) that would readily be recognizable by vaginal US examination, I would not do another laparoscopy. I would advise another IVF attempt. However, beforte doing this I would test for an immunologic implantation dysfunction by having your blood tested for natural killer cell activation (the K-562 target cell test). 1/3 of women with endometriosis might develop this problem and if you are one, you will not coceive even with good embryos, unless the problem is corrected through selective immunotherapy with heparanoid (heparin/lovenox/clexane)+intralipid. Read up on these topics elsewhere on this site.

Geoff Sher

P.S: Feel free to call 800-780-7437 to discuss your case with me in a free conference call by telephone.

Geoff Sher

Reply
Life in the slow lane says:

July 1, 2011 at 3:34 pm

Wow, what great information. I just completed a failed IVF cycle. I had/have stage 4 endo. I had excision surgery to remove all the adhesions and endo a couple of years ago. I developed an endometrioma during stimulation but my RE wasn't concerned about it. I'm curious how much that may have affected the failure. We transferred two gorgeous AA blasts. I also have Multiple Sclerosis so my body is very prone to inflammation. I'm curious about K-562 testing. I have tested + for lupus anticoagulant in the past. Took baby aspirin this cycle after egg retrieval.
Thank you for the information.

Reply
Geoffrey Sher, MD says:

July 1, 2011 at 5:13 pm

I understand. I responded to your post on the SIRM Discussion Board -Western Region. Please go there for details.

Read the articles elsewhere on this site pertaining to "Immunologic Implantation Dysfunction" as well as the one on "Sclerotherapy".

Feel free to call 800-780-7437 if you are interested in having a telephone consultation to discuss.

Geoff Sher

Reply
8f064e4c-c5dc-11e0-aa61-000bcdcb471e says:

August 13, 2011 at 11:46 am

Hi Dr. Sher,
My husband and I have been trying to conceive a second child now for 15months..I have done 5 IUI's involing clomid, then femara, then Gonal-f. I have been pregnant twice, one resulting in a beautiful son and another resulting in a miscarriage- both of which I got pregnant without the need of any treatment and on the first try… . My RE thinks I may have developed endometriosis since based on all my diagnostic tests (all normal)/treatments I "should" be pregnant by now. Should I do a laproscopy to determine whether I do in fact have endometriosis or should I proceed to IVF without doing the laproscopy?

Reply
Mandy says:

April 17, 2012 at 11:13 pm

Dr. Sher,

My husband and I are both 25. We have been trying for a baby for almost 3 years. Last September we went and saw a fertility specialist and after lap sugery she diagnosed me sevre endo. The sugery was in November in the meantime everything else came back ok with my husband. My Doctor said she was able to remove most of it and my tubes were no longer blocked. We did 2 rounds of IUI with clomid and my body responded fine, but we didn’t have any luck. My Doctor said IVF is our best bet and has said this from day one, but due to finanical troulbe (our insurance doesn’t cover any fertility) we decided to go with the IUI’s. Finally we have some money to do the IVF, but only once. I am scared that this may not work and be a waste of time and money. What are your thoughts on this?

Reply
Geoffrey Sher says:

April 18, 2012 at 1:00 am

IVF is/was definitely the way to go. However, 1/3 of women with endometriosis (regardless of its severity have, in addition, immunologic implantation dysfunction associated with activated uterine natural killer cell activation (NKa) You need to get a blood test (the K-562 target cell test) to have this done because if it is positive, you will likely have an immunologic implantation dysfunction (IID) that will make the chance of pregnancy much less likely.

Also, IUI is highly UNLIKELY to be successful in endometriosis.

Please go to the articles I wrote elsewhere on this blog pertaining to NKa, Endometriosis and IID.

Feel free to call 800-780-7437 if you wish to discuss this in greater detail.

Geoff Sher

Reply
Imane says:

December 24, 2012 at 4:07 pm

Hi,
My doctor think that i can have endo but to be sure she want to do a laparoscopy to be sure and i read that some people discover it only by ultrasound can you please clarify this issue for me, thank you.

Reply
- Geoffrey Sher says:
  
  December 24, 2012 at 7:18 pm
  
  It requires a laparoscopy to diagnose.
  
  Geoff Sher
  
  Reply
CJ says:

January 26, 2013 at 8:11 pm

Hi Dr Sher,
We are trying to decide between now trying up to 3 rounds of IUI or skipping that and moving right to IVF as i have moderate endo which was removed over 6 months ago. Money is not really an issue as our health insurance will cover costs but our current FS will not consider moving straight to IVF for us. I also have high levels of ANA antibodies as well as thyroid antibodies and hashimotos. In your opinion could the additional 3 cycles of IUI in someway reduce our chances of pregnancy or just potentially delay it? I am 31.
Thanks very much,
CJ

Reply
- Geoffrey Sher says:
  
  January 26, 2013 at 9:03 pm
  
  Respectfully, in my opinion the decision is ” a no brainer”. You should go directly to IVF …and here is why:
  
  Endometriosis gives very poor results with IUI (see below) and both endometriosis (regardless of its severity and Hashimoto’s predispose you to an immunologic implantation dysfunction (see below). In my opinion you will need IVF with selective immunotherapy for a likely associated immunologic implantation dysfunction (see below).
  
  Please go to the home page of this blog, (www.IVFauthority.com). 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. “Endometriosis and IVF”
  
  2. “Intrauterine insemination (IUI)”
  
  3. “Thyroid autoimmune disease and IVF”
  
  4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
  
  5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  8. “IVF success: Factors that influence outcome”
  
  You might consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
  
  Geoff Sher
  
  Reply
dilana says:

March 10, 2013 at 8:04 am

Hi doctor;
I have a severe endo and I want to do IVF ,I had a laproscopy 2 months ago for my right ovarian chocklet cyst .. what is your advice to me ? Do I need to do a ( K-562 test)?
thanks.

Reply
- Geoffrey Sher says:
  
  March 10, 2013 at 3:26 pm
  
  Endometriosis is associated with many complexities that involve egg quality as well as implantation issues in some. Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.
  
  In thew meanwhile, I suggest that you to the home page of this blog at http://www.IVFauthority.com . When you get to home page, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  5.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  6. “ Endometriosis and IVF”
  
  Sincerely,
  
  Geoff Sher
  
  Reply
Heidi says:

April 21, 2013 at 4:00 pm

Hello Dr.,
After 15 months of unexplained infertility, my Dr. wanted to do IUI with clomid. When I went in for the ultrasound before the IUI they could see that I had an dermoid ovarian cyst. A month later they did a lap to take it out. During surgery they found very mild endo behind my uterus that my Dr. cauterized. She seemed optimistic about pregnancy after the surgery. My husband and I tried to get pregnant on our own with clomid for the past 2 months with no luck. My dr. wants to try IUI again with clomid.
Do you recommend this? Would another fertility drug be better? Should we just move right to IVF?
Thank you so much!
Love from Nebraska!

Reply
- Geoffrey Sher says:
  
  April 21, 2013 at 6:17 pm
  
  You can try but in my experience women with endometriosis do not do as well as controls with IUI. Read my blog on intrauterine insemination and on endometriosis on this site.
  
  Geoff Sher
  
  Reply
Ferhana says:

April 26, 2013 at 2:47 am

Dr Sher

My husband and I have been trying to conceive for the last 9 yrs. I have been for IVF but this was unsuccessful, as all 6 embryos died on day 5. The days prior to that the embryos were all grade 1. My Dr’s are not sure what went wrong and why all 6 embryos just died on day 5. I have just been diagnosed with having an endometrioma in my left ovary. And another specialist which i have been to see has told me that once the endometrioma has been removed surgically by laporoscopy, I should just try Artificial insemination and that should work. However, thats kind of hard for me to believe, as I have been trying to conceive for 9yrs. Do you think I should just go straight to another round of IVF once the endometrioma has been removed?

Reply
- Geoffrey Sher says:
  
  April 26, 2013 at 10:37 am
  
  No doubt, an ovary with a greater than 1cm endometrioma will not likely produce good quality eggs/embryos. This would help explain why the embryos did not reach blastocyst. Remember, embryos that do not maker it to blastocyst are almost invariably chromosomally abnormal and “incompetent”. The endometrioma should be removed by surgery or sclerotherapy before embarking on another IVF attempt. Thereupon, the protocol of ovarian stimulation needs to be re-evaluated.
  
  Please go to the home page of this blog, http://www.IVFauthority.com . When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
  
  5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  8. “IVF success: Factors that influence outcome”
  
  9. “Endometriosis”
  
  10.“Sclerotherapy of ovarian endometrioma’s”
  
  Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
  
  Geoff Sher
  
  Reply
Ferhana says:

April 26, 2013 at 2:52 am

Dr Sher

Something else I meant to ask you is, do you think that having the endometrioma could have affected the quality of my eggs during the ivf cycle causing all my embryos to die?
Because my Dr suggested that it could by that my eggs quality is poor. I know that AMH tests do not tell you the quality of the egg only the reserve but my AMH level was very good. I think 6.8ng.
I am 36 yrs old, therefore the Dr suspects poor egg quality being the reason for the embryo’s dying.

Reply
- Geoffrey Sher says:
  
  April 26, 2013 at 10:37 am
  
  I respectfully disagree with that opinion…see my response below.
  
  Geoff Sher
  
  Reply
flora lee says:

May 8, 2013 at 10:53 pm

Hi Dr Sher,

I am 36 years old. I have a endometrioma on left ovary. I have good number for AMH and all other tests.

I started the first IVF in May 2013. After 4 days of stimulation, I get 8-9 enlarged follicles on right side, but only 2-3 on left. Apparently, the left ovary is not stimulated well.

Do you think the stimulation inefficacy on left is due to the endometrioma?

I have consulted 2 RE doctors (including the IVF doc), they both suggested not removing the cyst. But the stimulation fact says the opposite. What do you think?

I am very much worried that for there won’t be good quality eggs retrieved. Time will tell soon.

Thanks a lot,

Flora from California

Reply
- Geoffrey Sher says:
  
  May 9, 2013 at 5:12 am
  
  In my opinion it is very likely the endometrioma having an adverse effect on follicle/egg development on your affected side. I would strongly advocate its removal.
  
  Geoff Sher
  
  Reply
flora lee says:

May 8, 2013 at 10:55 pm

Sorry, forgot to mention the endometrioma size is 2.46cm.

Reply
- Geoffrey Sher says:
  
  May 9, 2013 at 5:10 am
  
  Copy! That is large enough to warrant removal or sclerotherapy.
  
  Geoff Sher
  
  Reply
flora lee says:

May 8, 2013 at 11:11 pm

The reason why those REs recommend not removing endometrioma is to preserve as much follicles as possible. Any surgical procedure will damage follicles.

My AFC is 14, 7 on each side. That is why I am very disappointed on left side ovary respond poorly to stimulation medication.

Flora from CA

Reply
- Geoffrey Sher says:
  
  May 9, 2013 at 5:08 am
  
  I understand but there is a trade off. That is also where sclerotherapy comes in because it is a non-surgical way to effectively treat endometriomas. Read up on Sclerotherapy on this blog.
  
  Geoff Sher
  
  Reply
Roma Waterman says:

May 16, 2013 at 2:28 pm

Thanks for such a great blog. I have had stage 4 endo my whole life, conceived naturally after an op to remove it at 35, then tried for five years with no luck. I did everything you said here – more operations, clomid, IUI with no luck. Then tried IVF and it worked first go! I could hardly believe it. Our second child is almost 2 now. I would recommend going straight to IVF with anyone with Endo. The other problem I noticed was the drugs used made my endo worse, so being on them for longer just caused so much pain, so doing IVF at least is a better option in this regard, as after egg pick up you will hopefully not need any meds during implanation etc.

Reply
- Geoffrey Sher says:
  
  May 16, 2013 at 5:30 pm
  
  WE should talk. Please call 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
  
  Geoff Sher
  
  Reply
Kristen says:

May 17, 2013 at 6:12 am

I have endo and and have been seeing my gyn for 5 months for ttc. I had 3 rounds of clomid 50 mg day with timed intercourse. 2 IUI with clomid. Last dose was 100 mg day. Now my period cramps started 4 dp iui. I’m having severe menstrual cramps and very sad and upset. Do you think I should keep my appointment with an RE next week or just quit trying. Does every clinic text for toxins caused by endo and killer cells? I had to quit my job due to the pain.
Thank you very much.

Reply
- Geoffrey Sher says:
  
  May 17, 2013 at 8:58 am
  
  Perhaps we should talk.
  
  Please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
  
  5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  8. “Endometriosis”
  
  Call 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
  
  Geoff Sher
  
  Reply

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I often refer to the conception process in terms of a “seed/soil” relationship. Just as a plant can’t grow and thrive without first assuring that both seed and soil are good, neither can a pregnancy be successful without both the seed (e... more

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Acupuncture and IVF: Does it Improve Success?

Acupuncture involves the insertion of thin needles into the skin along so-called meridians (energy channels). It has been used in China for centuries to regulate and treat many health disorders including ailments involving the female reproductive sys... more

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My IVF Cycle Failed – What Went Wrong? Question #17: Why Didn’t I Get Pregnant When I Used a Young Egg Donor and Had Good Quality Embryos?

This is #17 in a series of answers to common questions about failed IVF. For women whose advancing age and/or ovarian resistance make having a baby with their own eggs unfeasible or unlikely, IVF using donated eggs from a young donor (under 35 years)... more

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My IVF Cycle Failed – What Went Wrong? Question #15: Might My Mental State Have Played a Role?

This is the 15th in a series of responses to common questions about failed IVF There is little doubt that stress and emotional lability plays a role in the normal physiological/hormonal regulation of the menstrual cycle.After all, Eskimos often stopp... more

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Understanding Immunologic Implantation Dysfunction Part 1: Setting the Stage for Selective Immunotherapy with Intralipid and IVIg

It is an unfortunate reality that many IVF programs attach little importance to factors that affect embryo implantation in general, and immunologic implantation dysfunction (IID) in specific (see below). Perhaps the lack of attention given to evaluat... more

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IVF: Coping With the Emotional Roller Coaster Ride

Procreation – and with it the ability to achieve immortality by living on through one’s children – is one of the most insatiable human needs. This strong natural urge exerts tremendous pressure on couples unable to have a baby. And ... more

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DQ alpha/HLA Sharing: Does It Always Lead To Reproductive Failure?

It is not unusual for couples who share DQ alpha/HLA similarities to first give birth to a healthy baby only to subsequently develop infertility, recurrent IVF failure or recurrent pregnancy loss. Such couples find it hard to comprehend how after hav... more

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Dr. Geoffrey Sher Recommends

CGH Embryo vs. Blastocyst vs. Cleaved Embryo

IVF Success Rate Reporting – Are We There Yet?

Please join me on Wed, February 6 at 8:30pm Eastern for a live webinar where I’ll discuss this topic in detail and take your questions. For more information or to register, click HERE ————- I have, for many years, tak... more

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IVF Success Rate Statistics: The Time Has Come to Revise the Present Reporting System

IVF programs currently report their outcome statistics in a number of categories: a) Number of IVF cycles initiated in a given year b) Number of single and multiple pregnancies that occurred c) Number of cycles that res... more

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Mother Gives Birth Using Daughter’s Eggs: Was It “Ill Conceived”?

I wish to share a very interesting case with you; one that I’m pretty sure will meet with the approval of some and evoke criticism by others. Before I even tell you about it, let me say that I and my team thought long and hard before going ahead wi... more

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Gender Selection in IVF: What Is Its Place?

Couples have for centuries sought to influence the gender of their offspring. More than seven centuries ago the ancient Chinese developed a birth calendar said to be able to predict gender on the basis of when conception occurred. Later, the ancient ... more

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Acupuncture and IVF: Does it Improve Success?

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Understanding Immunologic Implantation Dysfunction Part 2: A Rational Basis for Selective Intralipid & IVIg Immunotherapy in IVF

ALLOIMMUNE VS. AUTOIMMUNE DYSFUNCTION Alloimmune Implantation Dysfunction Every human being has two DQ-alpha genes. One is contributed by the father and the other by the mother. In a small percentage of patients undergoing IVF, paternal-maternal DQ-a... more

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Understanding Immunologic Implantation Dysfunction Part 1: Setting the Stage for Selective Immunotherapy with Intralipid and IVIg

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DQ-alpha Matching in IVF: The Controversy, How It Affects Outcome, & How to Treat!

IVF patients, especially those who find themselves inexplicably repeatedly failing treatment after treatment are no longer willing to blindly accept platitudes from those who would ignore the role of immunologic causes of IVF failure while unable to ... more

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Unexplained Infertility: True Diagnosis or Cop Out?

For about 10% of all infertile couples, the cause of the infertility cannot be readily determined using conventional diagnostic methods. Such cases are often referred to as “unexplained infertility.” The truth, however, is that in most su... more

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Egg Banking of Genetically (CGH)-Tested Eggs Could Change The Face Of IVF-Ovum Donation

For more than a quarter century, medical scientists have attempted to defy the biological clock by freezing a woman’s eggs to preserve her fertility. Most of these efforts have failed. Consider the fact that since the birth of the world’s 1st “... more

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Case Study: Hydrosalpinx (Blocked/Fluid Filled Fallopian Tubes) and IVF Failure

RL, a 31-year-old woman, presented with a 7 year history of inability to conceive, in spite of 2 prior fresh and 1 frozen IVF attempts, where a total of six good quality blastocysts had been transferred to her uterus. Her husband PL, had normal spe... more

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Recurrent Unexplained IVF Failure with “Good Quality” Embryos

The following is a case study of a recent patient that came to me for treatment. CJ, a 34 year old, and her husband RJ (age 35) presented to me with a six-year history of infertility. Based on semen analysis, RJ, who had initiated two pregnancies i... more

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Karmann and Ryan’s Journey – My Approach to Their Treatment

Please refer to last week’s blog post, where Karmann tells in her own words her struggles with recurrent miscarriage – nine miscarriages to be exact – and her long journey of heartbreak, disappointment, and finally – hope.... more

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Karmann and Ryan – Nine Miscarriages, Then Hope!

In observation of National Infertility Awareness Week (NIAW), I wanted to share the touching story of a couple that I first met last year – after they had already experienced 8 years of heartbreak and frustration. Their story is representativ... more

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IVF in a Same-Sex Male Couple: A Case Study

Background: About two years ago, I received a call from a gentleman that I will call “John”. John was a movie producer who stated that he and his partner “Brian” had been in a monogamous same-sex relationship for 7 years and each wanted to si... more

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Recurrent Molar Pregnancy Treated By “IVF Genetic Chess”

Background: Maria (fictitious name), a childless 34-year-old Hispanic lady, presented with a history of having had five (5) successive spontaneous pregnancy losses at 7 weeks gestation, all due to hydatidiform moles. Four (4) of these losses were �... more

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Case Study: Donor Egg IVF in a Post Menopausal Woman

Mary (fictitious name), a 54 year menopausal woman, presented at SIRM-Las Vegas for IVF using an egg donor. She had been menopausal for 7-plus years and had NOT been on any hormone replacement therapy. Mary gave a history of having undergone IVF with... more

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Case Study: Endometriosis Presenting as “Unexplained Infertility”

I consulted with a 36 year old lady (whom I will refer to as “Sandra”) and her partner, about 18 months ago. She and her husband of 5 years had been having regular unprotected intercourse throughout this time and had been unable to conceive. Sand... more

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Case Study: Pelvic Tuberculosis, Hypothyroidism, and Immune Implantation Dysfunction

About 18 months ago I saw an Asian Indian couple who presented with a very interesting history. The female partner (whom I will refer to as DB) had regular menstrual cycles and normal ovarian reserve, was ovulating regularly and had a fertile male pa... more

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Dear Dr. Sher: A Healthy Baby Followed by Multiple Miscarriages

This is the second in a series of posts taken from questions that have been submitted to me via email, website, or discussion boards. This question is from a patient who had a healthy baby from her first pregnancy, but then went through a period of... more

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Karmann and Ryan’s Journey – My Approach to Their Treatment

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Why Did My IVF Fail? Part 2 – Uterine Receptivity and Transfer Technique

This is the second part of a two-part post on IVF failure. In my January 22nd post, I discussed what I often refer to as the “seed” variable in the “seed/soil” relationship – the embryo. This week’s post will address the “soil” variab... more

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My IVF Cycle Failed – What Went Wrong? Question #19: Why Do I Keep Having Chemical Pregnancies and Miscarrying?

This is the 19th in a series of answers to common questions about failed IVF. Early pregnancy loss – whether due to miscarriage or chemical pregnancy – is due to two major factors. In more than 70-80% of cases the cause is attributable to... more

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My IVF Cycle Failed – What Went Wrong? Question #18: My Fertility Clinic Reports a High Success Rate – How Could I Have 2 Failed Cycles In A Row?

This is no. 18 in a series of answers to common questions about failed IVF. While it is true that IVF failure can be due to preventable factors, it is as important to understand that optimal medical care does not always equate with an optimal outcome... more

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My IVF Cycle Failed – What Went Wrong? Question #17: Why Didn’t I Get Pregnant When I Used a Young Egg Donor and Had Good Quality Embryos?

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My IVF Cycle Failed – What Went Wrong? Question #16: Why did my hCG levels stop rising properly?

This is the 16th in a series of answers to common questions about failed IVF. Immediately following implantation, the root system (trophoblast) of the embryo begins to release the pregnancyhormone, human chorionic gonadotropin (hCG) into the surround... more

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My IVF Cycle Failed – What Went Wrong? Question #15: Might My Mental State Have Played a Role?

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My IVF Cycle Failed – What Went Wrong? Question #14: Could it Have Been Due to Inadequate Hormonal Support After the Egg Retrieval & Embryo Transfer?

This is the 14th in a series of answers to common questions about failed IVF. In vitro fertilization establishes an abnormal hormonal environment in the uterus.In some cases (especially older women and those with a diminished ovarian reserve), high o... more

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My IVF Cycle Failed – What Went Wrong? Question #13: Did the Number of Embryos I Had Transferred Play a Role?

This is the 13th in a series of answers to common questions about failed IVF. Virtually everyone recognizes that pregnancy with multiples (especially triplets or greater) is associated with a high incidence of premature delivery that has serious cons... more

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My IVF Cycle Failed – What Went Wrong? Question #12: Might the Timing of Embryo Transfer – Day 2-3 (Cleaved) vs. Day 5-6 (Blastocyst) Play a Role?

This is the 12th in a series of answers to common questions about failed IVF. (Note: I’ll be hosting a live video chat on Aug. 2 on the topic of Failed IVF where I’ll discuss the issues addressed in this series of posts and take your ques... more

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