Welcome to IVF Authority - World Renowned Resource for IVF Information

Welcome to IVF Authority Blog

Search by Topic

    Search by Date

      << Back to IVF Page
      • lupron and IVF

      Lupron Therapy and IVF

      Dr. Geoffrey Sher Recommends

      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      Phone:
      702-892-9696

      Fax:
      702-892-9666

      All gonadotropin releasing hormone (GnRH) agonists act by rapidly expunging reservoirs of follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. GnRH agonists can be administered by intramuscular injection (e.g. Lupron, Buserelin) or through intranasal administration (Nafarelin, Synarel). The intramuscular route which insures more even absorption is preferred.

      At SIRM we prescribe leuprolide acetate (Lupron) to launch most IVF in controlled ovarian hyperstimulation (COH) cycles. Lupron is very similar in structure to GnRH. As such, its initial effect (for about 2-4 days or so) is to stimulate the pituitary gland to produce both LH and FSH. As soon as the pituitary starts to recognize the difference in chemical structure between the Leuprolide and normal GnRH, it profoundly reduces its output of biologically active LH and FSH production. This is referred to as “pituitary down-regulation” and the effect continues for as long as Lupron therapy is maintained uninterrupted. The initial increase in FSH and LH production during the first 4-6 days of leuprolide therapy is accompanied by a transient, but very significant increase in estrogen release by the ovary. The initial rise in LH and FSH production results in a rise in estradiol, and the subsequent pituitary “down-regulation” is followed by a precipitous fall in blood estrogen levels, until gonadotropin or estrogen administration commences.

      The reason that agonists are administered to women receiving Gonadotropin therapy for IVF is because of its ability to suppress LH and so prevent a premature rise in LH which is most likely to occur in older women or those with have diminished ovarian reserve. When this happens the cells lining the follicles undergo premature change (premature luteinization), compromising further follicle development and egg/embryo quality. Such premature luteinization (previously referred to as “premature LH surge”) severely compromises further follicle development as well as egg/embryo quality. Women with reduced ovarian reserve (who are resistant to ovarian stimulation) are most susceptible to this happening.

      There is often talk of agonists “over-suppressing” ovarian response to gonadotropins. The reason for this concern is that agonists probably compete with FSH for receptor binding sites on the granulosa cells that line the ovarian follicles and produce estrogen…and so can blunt ovarian follicle response to FSH. However, since antagonists apparently do not exert the same effect, by supplanting Lupron with an antagonist prior to starting gonadotropin therapy, avoids this problem (see the agonist/antagonist conversion protocol -A/ACP below). While both antagonists and agonists block LH activity, antagonists do so much more rapidly (within hours) than agonists (within a few days).

      Use of Lupron to Launch COH for IVF
      At SIRM we launch COH for IVF by putting the woman on a birth control pill (BCP) for 10-25 days, to suppress ovarian response to FSH/LH. Thereupon, Lupron is overlapped with the BCP for 2-4 days. Then the BCP is discontinued and daily Lupron therapy is continued until menstruation ensues. By varying the length of time on Lupron it is possible to control the timing of the onset of menstruation and reduce the incidence of cycle cancellation due to ovarian cyst formation. Menstruation will usually occur 4-7 days after stopping the BCP. Thereupon, one of two variations in approach is taken. Either the long Lupron approach or the agonist/antagonist conversion protocol (A/ACP) is used. With the A/ACP, Lupron is supplanted by low dosage antagonist therapy. In both cases, daily Gonadotropin (FSH and LH) injections are concomitantly initiated and continued with the agonist or antagonist until the day of the hCG trigger.

      In some cases of markedly diminished ovarian reserve, we preempt the initiation of gonadotropin therapy with “estrogen priming”. It involves twice weekly injections of estradiol valerate for 8-10 days and then we initiate Gonadotropin therapy which is continued until more than 50% of the developing follicles reach at least 12mm in diameter. The addition of estrogen in this way is believed to improve ovarian response to gonadotropins as well as endometrial response to estrogen stimulation. In both the long Lupron approach and the A/ACP, daily shots of antagonist or antagonist are continued up to the day of the hCG trigger. The egg retrieval (ER) is performed 35-37 hours following hCG administration.

      Lupron Use in Embryo Recipient Cycles
      Cases of egg donation, embryo donation, gestational surrogacy, and frozen/thawed embryo transfers (FET) undergo a similar regime of BCP/agonist preparation as do those who undergo ovarian stimulation, except that instead of receiving gonadotropin injections, these women receive daily estradiol valerate injections. Thereupon, progesterone therapy (administered by intramuscular injection and/or by vaginal administration) is added for several days. The combination of estrogen and progesterone therapy prepares the uterine lining for embryo implantation. Lupron therapy is discontinued 5-7 days prior to Embryo Transfer (ET) in such cases.

      There is really no need to be overwhelmed by what at first might seem to be a complex treatment regimen. Extensive studies on non-human primates, as well as limited human evaluations, indicate that Lupron is relatively harmless to both mother and baby. The drug is eliminated from the system within hours of discontinuing its administration. At SIRM we discontinue Lupron therapy at least 5-7 days prior to transferring embryos/blastocysts to the woman’s uterus. The administration of subcutaneous or trans-nasal agonist is rarely associated with significant side effects. Some women experience temporary fluctuations in mood, hot flashes, nausea, and symptoms not similar to PMS. No serious long-lasting side-effects have been reported.

      The subcutaneous injection of Lupron is relatively painless. Unfortunately, the drug will incur a modest additional financial burden. Lupron administration as described above spares women the inconvenience and frustration of unnecessary cancelled treatment cycles with gonadotropins. As such, the use of Lupron in reality reduces the overall cost of ovulation induction.

      Tags: , , , , ,

      39 Responses to “Lupron Therapy and IVF”

      1. Geoffrey Sher, MD says:
        November 5, 2009 at 12:33 am

        Thank you.

        Geoff Sher

        Reply
      2. Nancy says:
        November 7, 2009 at 11:02 am

        Dear Dr. Sher,

        Hope all is well. We had a consultation previously and I was looking to cycle possibly in December. Sorry I don't have any way to ask this privately. My husband and I would like to have a consultation on one of those Fridays but the office said you only were available next Monday and Tuesday and would be away for 2 1/2 weeks.

        So we will go ahead and ask our question here. Is there an alternative to Lupron? After Channel 13's very negative report on Lupron recently, it became a worry. So we would like to know if there is any suggestion to replace Lupron during the IVF treatment.

        Thanks,
        Nancy

        Reply
      3. Candide says:
        December 4, 2009 at 11:11 am

        Dear Dr. Sher,

        I'm getting ready to start an IVF cycle and have been diagnosed with DOR (FSH after CCT of 12.5, I think). I had a miracle baby with a single IUI after taking the lowest dose of Clomid 1.5 years ago.

        I'm wondering whether I'm on the right protocol (estrogen priming / antagonist). Do you think I would produce more and/or better quality eggs if I was using the microdose lupron protocol?

        I haven't been able to find much difference in outcomes on PubMed, but it would be great to get a clinician's opinion. I will be 38 in Feb.

        Thanks so much,
        Hopeful Mom

        Reply
      4. Geoffrey Sher, MD says:
        December 4, 2009 at 3:54 pm

        Please read ny articlwes elsewhere on this blog regarding "Diminished Ovarian Reserve…". The last thing you need is a microdose flare protocol. The suggested protocol is a better one.

        good luck!

        Geoff Sher

        Reply
      5. Candide says:
        December 9, 2009 at 9:50 am

        Thank you!!! You have really put my mind at ease.

        Warmest wishes,
        Hopeful Mom

        Reply
      6. Candide says:
        December 9, 2009 at 10:35 am

        Ok. Read the posts. It sounds like you'd recommend an agonist/antagonist conversion protocol instead? Not sure I understand it completely, but it sounds like the key part is remaining on a low dose of antagonist during stimulation??? And you wouldn't stimulate with menopur at all?

        As it stands, I'll be on estrogen and progesterone for ~2 weeks, then ganirelix for a week, followed by follistim and menopur and potentially more ganirelix (is this considered late antagonist?) before triggering with ovidrel. Does this sound ok? I'm not sure if my LH was high or not, and I did respond well to clomid, so maybe my DOR isn't super severe yet?

        I want to understand as much as I can before going through this process, but it is a lot to learn in a short amount of time.

        What do you think about DHEA supplementation, by the way? Dangerous because it could lead to too much testosterone? There seem to be some promising papers on it in the literature…

        Thanks again!
        Hopeful Mom

        Reply
      7. Geoffrey Sher, MD says:
        December 11, 2009 at 2:51 pm

        I do not recommend DHEA as it is an androgen and metabolizes to testosterone. Too much ovarian testosterione is not good for the eggs.

        Ovidrel is not my fovourite either…UNLESS a double dosage is given. In the single dose I believe it to be less biologically active than 10,000U of hCG

        In many cases, especially older women and/or women who have diminished ovarian reserve, Menopur and Repronex in large doses deliver more LH and thus LH-induced testosterone than is good for normal follicle growth and egg development.

        In my opinion, 2 weeks of progesterone followed by a week of antagonist is too long. It is likely to suppress the final 5 day process of egg recruitment which is driven by the rising FSH level that occurs spontaneously preceding the initiation of menstruation. Since such prolonged premenstrual administration of progesterone/ganirelix will suppress FSH it could result it taking much longer than necessary to stimulate you.

        Please read the article elsewhere in this blog entitled; "An Individualized Aproach to Ovarian Stimulation".

        Good luck!

        Geoff Sher

        Reply
      8. Sean says:
        December 11, 2009 at 11:32 pm

        If using Lupron as a trigger, is it injected intramuscularly?

        Reply
      9. Candide says:
        December 13, 2009 at 6:52 pm

        Hmmm…what would you do instead of menopur? Just use a higher dose of follistim? (I may be getting a little out of my league here.)

        My doctor does retrievals/implantations during the same week for all of her patients, so maybe that's why the long progesterone/ganirelix portion – to get me on their schedule…?

        Even if it takes a long time to stimulate me, will the results (i.e., egg number/quality) be similar to a shorter stimulation period?

        Thanks for wishing me luck – seems like I'm going to need it! :)

        Thanks again,
        H.M.

        P.S. Couldn't find the exact title you mention in your blog, but I ran across this elsewhere on the web – is it similar to what you wanted me to read?

        http://forums.haveababy.com/lofiversion/index.php?t865.html

        Reply
      10. Geoffrey Sher, MD says:
        December 15, 2009 at 5:11 pm

        It is basically the same.

        I cannot represent that using P4/Ganirelix premenstrually will yield the same results as an an "agonist) premenstrually would do. It might be OK but I am not sure.

        Yes! you can simply increase the dose of Folistim.

        Good luck!

        Geoff Sher

        Reply
      11. Sophia says:
        March 5, 2010 at 5:37 pm

        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

        Reply
      12. Geoffrey Sher, MD says:
        March 8, 2010 at 10:32 pm

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

        Geoff Sher

        Reply
      13. Michelle says:
        June 5, 2012 at 9:38 pm

        Dear Dr. Sher,

        My RE had me start 20 units Lupron on day 22 (my cycles are ~30 days long) with no u/s or bloodwork. I am to continue this for 15 days. Then I have my first u/s and bloodwork and start 10 units Lupron for 18 days. Then start stims with 5 units Lupron for 10 days. NO birth control pills. This seems like a very long time with Lupron (43 days)! Does this protocol sound okay?

        I’ve read about cyst formation side effects. Also, I am worried that I was supposed to have an u/s BEFORE starting Lupron to make sure I ovulated. What are some potential problems of not having an u/s? I mentioned my concerns to the nurse, but she told me that they “did not have enough time to wait for wait for a cycle and start of day 21 of the next month.” What??? I could’ve started Lupron on day 21, but they said to start day 22. I’m concerned that I’m being overlooked or confused with another patient.

        Reply
        • Geoffrey Sher says:
          June 6, 2012 at 7:51 am

          Very respectfully, this approach is strange!

          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. “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”
          5. “A Stepwise Approach to IVF At SIRM” (Posted on March 9th, 2012)
          6. Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
          7. “Use of Lupron in IVF”
          8. “Use of the birth control pill in IVF”

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

          Geoff Sher

          Reply
      14. Laura Jester says:
        August 31, 2012 at 10:42 pm

        I have had trouble with headaches when on Lupron. For a number of reasons. I would rather not take loads of ibuprophen. Although seems to be the only thing that seems to help. One of the problems with it is the rebound headache effect. I have heard that taking MSM daily is a natural way to relieve headaches without rebound effects. Have any studies been done on the effect of MSM on fertility?

        Reply
        • Geoffrey Sher says:
          September 6, 2012 at 9:07 am

          The Lupron taken for no more than 5 days should be OK. I do not think the MSM will do harm, but first discuss with your own RE.

          Geoff Sher

          Reply
      15. Shelly says:
        October 31, 2012 at 11:00 am

        I am on a day 21 lurpon protocol. Today I should have begun my stims (follistom/menopur). Unfortunately the hurricane has knocked both of my doctors offices. They are advising me to continue lurpon until they are operational again. Is it possible to start the stims after more than 2 weeks of lurpon? I have no idea what to do and there is not anyone I can speak with at the doctors office.

        Reply
      16. farhy says:
        February 26, 2013 at 1:01 pm

        Hello Dr Sher

        I have been on Lupron depot treatment for the past 3 months for endo and now getting ready for FET. My current protocol is to start with Lupron 10 units and then include estrogen shots after I get a period. My questions, if you would be kind enough to answer are:
        1. Does Microdose Lupron overlapped with my current cycle of Lupron Depot shot, bring about a period? I thought that the Depot for past 3months would have shrunk my lining, how does the Lupron act in this situation to bring about a period?
        2. I received intralipid last time for my failed IVF, but its not in my calender this time. Is it recommended to also go for the Intralipid therapy and dexamethasone this time despite the Lupron Depot treatment cycle?

        Many thanks,

        Reply
        • Geoffrey Sher says:
          February 26, 2013 at 2:07 pm

          1. Does Microdose Lupron overlapped with my current cycle of Lupron Depot shot, bring about a period? I thought that the Depot for past 3months would have shrunk my lining, how does the Lupron act in this situation to bring about a period?

          A: It probably will not bring on a period. Personally, I do not use depot Lupron as a launch.

          2. I received intralipid last time for my failed IVF, but its not in my calender this time. Is it recommended to also go for the Intralipid therapy and dexamethasone this time despite the Lupron Depot treatment cycle?

          A: AS answered elsewhere, if you truly do NOT have NKa+, then the IL will likely be of no benefit in my opinion.

          Geoff Sher

          Reply
      17. Stillhopeful says:
        March 6, 2013 at 2:36 pm

        Dr Sher,
        Back end of January I underwent prep for a fresh donor egg transfer due to DOR with BCP x 1 month then began lupron 5 units daily along with estrogen patches. Unfortunatly my doctor didnt check my linning during my prep while waiting for the donor and I ended up shedding my linning for some reason. so we stopped the lupron stepped down off the estrogen patches and did prometrium for 10 days.
        My question is how long after stopping the daily lupron/estrogen and prometrum will it take for my system to get back normal in terms of a cycle? have always been regular in the past but now its almost 30 days since my last bleeding and no cycle (yes, we did a HPT to make sure and it is negative)

        Reply
        • Geoffrey Sher says:
          March 6, 2013 at 3:17 pm

          It could take 6 weeks!

          I really do not comprehend why on hormonal replacement, you would shed your endometrium… Something was not right.

          Geoff Sher

          Reply
      18. Stillhopeful says:
        March 7, 2013 at 12:04 pm

        I didnt understand it either, unless I ovulated on my own (no problems with ovulation just DOR). Doctor thought perhaps I didnt get enough estrogen through the patches or didnt absorb them transdermally for some reason. I worry the same thing will happen again if we try a FET.

        Reply
      19. JC says:
        March 11, 2013 at 3:08 pm

        My wife’s IVF clinic prescribed this protocol for a donor cycle: Scheduled transfer: 4/23/2013
        Lupron Depot: 3.75mg on 3/13/2013
        Estrimax: 2mg 3x daily starting 4/2/2013
        Do you think that the Lupron shot will be too high for this time period? Would you recommend any alternatives?

        Thank You

        Reply
      20. Jodi says:
        March 18, 2013 at 7:16 pm

        Dr Sher,
        My FET was cancelled last week after I started bleeding and shedding my lining despite the delestrogen IM injections and Lupron. My estradiol levels had been rising and there was no indication that things weren’t progressing correctly until I started bleeding. I was on the same Lupron suppression protocol for my fresh IVF cycle and had no issues. Could I have ovulated despite being on Lupron? Do you have any other thoughts on what could have happened? Thanks for your thoughts.

        Reply
        • Geoffrey Sher says:
          March 18, 2013 at 9:19 pm

          No I do not think you ovulated . I would need to know the dosage of Delestrogen and your blood estradiol level when you bled to be able to comment as to the cause.

          Good luck!

          Geoff Sher

          Reply
      21. Meg says:
        March 19, 2013 at 1:26 pm

        Dr. Sher,
        We are planning a FET soon and my doctor said he plans to start the lupron after completing a month of birth control pills as he likes to get a “flare” before starting the low dose daily lupron. What would the purpose of the flare be if we plan to shut down my ovaries and suplement with estrogen and progesterone? thanks!

        Reply
      22. JC says:
        March 22, 2013 at 6:38 pm

        She took the Lupron Depot 3.75mg injection on 3/13/2013 and started her memstration on 3/21. Based on her 28 day cycle, she would start another menstration on 4/16. Do you know if the Lupron will prevent the period on 4/16? If she does have a period on 4/16, would it be possible to still have the embryo transfer on 4/23?

        Reply
        • Geoffrey Sher says:
          March 24, 2013 at 12:47 pm

          There is a distinct possibility that she will be late on her period. It is also very unlikely to be ready for an ET 7-8 days later.

          Good luck!

          Geoff Sher

          Reply
      23. Cristina says:
        April 5, 2013 at 8:20 pm

        Hi Dr Sher,

        I will be on .5 lupron for 11 days before my ultrasound to start the stimulation ( 6 of these days are on BCP+lupron). Do you think 11 days on lupron is to much? Will this oversupress me? I am a normal responder to meds and my FSH is around 6 on day 3. AMH 2.6

        Thank you,
        Cristina

        Reply
      24. Kris says:
        April 11, 2013 at 9:25 am

        Dr. Sher,
        My husband and I are finally ready to move foward with a FET. Previously I have had difficulty getting my linning above 7mm. I see some people use delestrogen injections a few times a week to help with this. What are your thoughts on injections versus vaginal pills or patches.
        thanks
        Kris

        Reply
        • Geoffrey Sher says:
          April 11, 2013 at 10:41 am

          Kris,

          For more information on endometrial thickness and treatment of a thin lining, 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 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. “Endometrial Thickness and IVF”

          2. “Viagra therapy in IVF”

          3. “Agonist/Antagonist Conversion Protocol”

          4. “Frozen Embryo Transfer (FET)”

          If you need to talk with me in the future, 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
      25. Jen says:
        April 17, 2013 at 8:23 am

        Hi Dr. Sher,
        I am 34 and my husband is 42. We were diagnosed with unexplained infertility. We have had 6 failed IUIs and now our first failed IVF cycle. My doctor utilized the long lupron protocol with ovidrel trigger. He removed 17 mature eggs and 14 fertilized. Unfortunately, by day 3, the embryos were “slow dividers” and the clinic recommended that we do a day 3 transfer of 2 5-cell embryos. This resulted in a chemical pregnancy. My doctor now wants to change the protocol to utilize a lupron trigger (as opposed to the ovidrel). He thinks this could improve the quality of the eggs. What do you think? Based on my research, I do not see how a lupron trigger will change the quality of the eggs. Would you recommend a different protocol? Thank you!

        Reply
        • Geoffrey Sher says:
          April 17, 2013 at 11:22 am

          I respectfully never use 250mcg Ovidrel, the dosage in my opinion is too low. I use 10,000 Novarel, Profasi, or Pregnyl on my patients. I am NOT a fan of Lupron triggers, especially not in women who have been on Lupron down-regulation which depletes LH and thus can compromise a surge (needed) with the Lupron trigger. In my opinion you need a long down regulation protocol but I would use the agonist/antagonist conversion protocol (A/ACP) with a Novarel trigger as stated above. Then I would ONLY transfer blastocysts because embryos that do not reach blastocyst are almost always aneuploid and “incompetent”.

          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”

          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
      26. Jen says:
        April 17, 2013 at 1:45 pm

        Thank you for your response! I should have included that I had a little bit of OHSS and because of high e2 levels they had me coast for 2 days. Would you still recommend the A/ACP under these circumstances?

        Reply

      Leave a Reply

       
      Financial Risk-Sharing: Reducing the Cost of Having a Baby

      In the United States, the richest and most technically advanced nation on earth, millions of couples remain involuntarily ... Read more

      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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 ... Read more

      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      Why IVF Pregnancies Are “Higher Risk”

      While many IVF pregnancies will progress normally and without any increased risk to mother or baby, there is little doubt ... Read more

      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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 ... Read more

      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...

      Top Search Terms for In Vitro Fertilization

      Dr. Geoffrey Sher Recommends

      Embryo Quality & Embryo “Competence” – Part III – Testing the Seed
      This is the third and final post in three part series on embryo quality. In the prior two posts, I outlined the intrinsic/physiological factors and the clinical factors that can impact embryo “competence”.  In this post, I will discuss the rol... more
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      Embryo Quality & Embryo “Competence” – Part One: Planting a Good Seed
      “At 45 years of age the incidence of aneuploidy is likely to be nine in ten.” Several weeks ago, I posted an article about endometrial receptivity and its effect on IVF success. This, as I noted, was the “Soil” component of the “See... more
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      The Needle vs. the Dish: Should ICSI Be Used in All IVF?
      The introduction of Intracytoplasmic Sperm Injection or ICSI has made it possible to fertilize eggs with sperm derived from men with the severest degrees of male infertility. What’s more, pregnancy rates achieved by this method of fertilization are... more
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      Embryo Implantation: What Farmers Can Teach us About Growing Healthy Babies
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      IVF Authority - Dr. Sher's Blog
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      Wennerlinds
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...
      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
      1 Star2 Stars3 Stars4 Stars5 Stars
      Loading ... Loading ...

      Ask Dr. Geoffrey Sher

      PST: Pacific Standard Time
      CAPTCHA Image

      Enter Code*:
      Reload Image
      Business Hours
      Mon - Fri ( 9a - 5p ) PST
      CALL US TOLL FREE : (866)428-3222
      Ask Our Doctors
      A Question

      Latest News and Events

      Denton Mom Gets First Mother’s Day Thanks to SIRM..
      WMBD: Dr. Gary Horowitz on Endometriosis
      Couple Celebrates Mother’s Day Thanks to SIRM-Dal..
      Dr. Fisch Leaving SIRM
      Webinar with Dr. Sher – Immunologic Causes of Inf..
      Fox News: Dr. Sher Discusses Possible Hope For Infertil..
      Southwest moms share their stories of trials and tribul..
      7 Simple Things You Can Do to Increase Infertility Awar..
      Karmann and Ryan – Nine Miscarriages, Then Hope!..
      Farewell Robert Edwards and Thank You!