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

      • Use of the Birth Control Pill Prior to IVF Ovarian Stimulation: Does it Suppress Response and/or Compromise Egg/Embryo Quality?

      Dr. Geoffrey Sher Recommends

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

      Fax:
      702-892-9666

      All too often, I hear of women (even young ones) who are prescribed the birth control pill (BCP) or receive prolonged estrogen therapy as a “lead in” to controlled ovarian stimulation (COS) for IVF that go on to experience slow and/or poor follicular development, and low numbers /poor quality eggs / embryos. In many cases, this is ascribed to the BCP having a suppressant (dampening) effect on ovarian response to stimulation. But that is an erroneous assumption; it is not the whole story.

      In fact, in most such cases further inquiry will reveal that the woman went directly from such hormonal treatment into a cycle of ovarian stimulation without having first received a GnRH agonist (GnRHa) such as Lupron or Superfact for 4-6 days prior to menstruation. Herein usually lies the root of the problem.

      You see, in non-pregnant ovulating women, a physiologic rise in blood FSH takes place about 4-6 days prior to menstruation. This is an essential prerequisite for proper recruitment of antral follicles (AF), without which subsequent FSH-induced follicle growth and development might be delayed, or may not occur in an orderly fashion. The BCP or prolonged premenstrual estrogen administration invariably suppresses pituitary production of FSH (and also LH). As a result, antral follicle development is often compromised. This problem can only be overcome by withholding use of the BCP/estrogen or by causing FSH to be released while on the BCP by administering GnRHa (overlapped with the BCP) for several days prior to menstruation.

      In my opinion, the overlooking of this important consideration is what has led to the erroneous belief that the BCP suppresses response to COS. Unfortunately too many women (often to their own detriment) are taken directly from menstruation that follows withdrawal of the BCP/prolonged estrogen treatment, to COS without such a GnRHa overlap, only to end up with slow and disorderly follicle growth, compromised egg development and poor embryo quality.

      Notably, this concern does not apply in cases where, coming off regular non-hormonally treated ovulatory cycles, GnRHa down-regulation is initiated about 5 days prior to menstruation or COS. In such cases, the physiological premenstrual rise in FSH will promote orderly antral follicle development.

      Thus the adage that use of the BCP or sustained premenstrual estrogen therapy hinders follicle and egg development is completely erroneous. In fact, quite to the contrary, it can offer distinct advantages to patients as well as to the treating IVF team. Here is how :

      By lowering LH prior to COS, it reduces sustained stromal (thecal) production of androgens (testosterone and androstenedione). The latter, if produced in excess (as in often the case with older women, women with diminished ovarian reserve, and those with PCOS) might otherwise compromise follicular growth and egg quality.
      By shortening or lengthening the cycle prior to COS, it allows for precise timing of the IVF cycle. This, without any real negative effects, allows cycles to be conducted and, at the same time, facilitates proper cycle “batching” to the convenience and cost-effectiveness of the IVF program.
      There are certain situations where use of the BCP might increase risk to the patient. These include a history of thromboembolism, a hereditary clotting defect (i.e., thrombophilia), obesity, severe diabetes, lupus erythematosus etc. Such conditions might either preclude use of the BCP altogether or necessitate that antithrombotic drugs (e.g., aspirin, coumadin’s etc.) be added to the treatment regimen. Clearly this decision requires a very careful assessment of the risk/benefit ratio.

      Tags: , ,

      31 Responses to “Use of the Birth Control Pill Prior to IVF Ovarian Stimulation: Does it Suppress Response and/or Compromise Egg/Embryo Quality?”

      1. Tina says:
        April 15, 2012 at 5:33 am

        Hi, If I ovulated while taking the pill and lupron will this lessen the effect on outcome of my cycle? Does this change anything at all.

        Thanks,
        Tina

        Reply
      2. Tina says:
        April 15, 2012 at 10:30 pm

        Thanks:)

        Reply
      3. Maria says:
        September 21, 2012 at 8:31 pm

        So what happens to people who want to do IVF and are not able to take pills for whatever reason?

        Reply
      4. Kristy says:
        October 13, 2012 at 11:39 am

        If I was Rx’d BCP without the pre-menstruation Lupron, but was put on antagonist protocol, could that have affected my previous cycles? I am 40 and have had 2 IVF cycles this year and my doctor said I was a poor responder. The BCP was Rx’d to coordinate timing of my menstruation cycle since travel was included.

        Reply
        • Geoffrey Sher says:
          October 14, 2012 at 10:27 pm

          It could well, but I would need much more information to comment properly.

          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). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

           “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
           “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
           “Agonist/Antagonist Conversion Protocol”
           “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
           “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
           “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

          Please 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). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

          Reply
      5. lana2020 says:
        October 14, 2012 at 7:55 pm

        I am a low responder. My fsh is 8 and I am 33 years. When I use BCPs my FSH went to 10 or 12 and last cycle I was on BCP for three months and my FSH went to 18!!!!
        When I stop taking any medicine and my period come my FSH was 10 then 8!!!
        AMH is 1.77. Stay always the same.
        I only get 5 to 7 eggs mature when I went with short protocol without BCP but If they used long protocol I had 4 to three mature eggs.. The qualiy always good.
        I am claim BCP for being bad responder. What do you think?

        Reply
        • Geoffrey Sher says:
          October 14, 2012 at 10:19 pm

          Hi lana,

          i would need a great deal more information to comment constructively. I can tell you that the BCP cannot increase your FSH. It will lower it. Also the highest FSH is the one we look at and quite frankly the way you have responded suggests that this is the case with you too. Your AMH is the outlying result. I would like to know what the normal AMH range is in the lab that measured it. Either way I would repeat the AMH. I strongly suspect that the protocol for ovarian stimulation needs to be strategically individualized in your case. Given that you likely have diminished ovarian reserve (which is gets progressively worse over time) you should seriously consider “Staggered IV” with Embryo banking” (see below).

          Please go to http://www.IVFauthority.co and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

           “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
           “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
           “Agonist/Antagonist Conversion Protocol”
           “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
           “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
           “IVF success: Factors that influence outcome”
           “Staggered IVF”
           “Embryo Banking”

          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). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

          Reply
          • lana2020 says:
            October 16, 2012 at 9:21 am

            THanks so much. My AMH level was 1.74 in US standard. I had problem with FSH which is always change from month to month between 8 to 16!!
            I did long protocol on 2009 with 300IU and I get 7 eggs and 5 embryos. Short protocol on 2010 I had same result but more follicles!!!
            last month I did Gainrelex protocol and 13 follicles and 8 mature but bad quality and I was on 450 IU gonal F and 375 Menapoure.
            Now my RE need to try MIcroflare protocol. Can I have natural cycle with this protocol without BCP ?!
            However, I had three natural pregnancy witout any problem. I am trying IVF with PGD for gender selection because all three kids are girls with C-section.

            What do you think?

            Reply
            • Geoffrey Sher says:
              October 16, 2012 at 2:37 pm

              I personally am not very enthusiastic about microflare protocols. This is explained in the article “An Individualized approach to Ovarian Stimulation for IVF”, elsewhere on this site.

              Geoff Sher

              Reply
      6. Birdy says:
        October 17, 2012 at 11:34 am

        Hi,
        thank you for your artcle. I am just getting prepared for IVF and now I am wondering… my doctor put me on progesteron on day 20-27 of previous cycle, and planned to start with hormon injections on day 2 of the IVF cycle. No Lupron in between or overlapping with hormon injections is planned…my first trial with this approach (premesntrual progesteron) resulted in no follicles at day of menstruation (first time ever!). After reading your article, could this be due to reduced follicle development due to permenstrual progesteron treatment? I would be not surprised….

        By the way, I am 40, and have low AMH (0.6), but regular cycle and good response to stimulation. Usually a good amount of follicles develop..

        Thanks for your answer in advance!

        Reply
        • Geoffrey Sher says:
          October 17, 2012 at 3:37 pm

          You could be correct. However, I would much prefer to review your medical records with you in order to provide a more informed opinion.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). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Might I suggest that you go to the home page on this blog (www.IVFauthority.com) and when you get to there, look for a “search bar” in the upper right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

           “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
           “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
           “Agonist/Antagonist Conversion Protocol”
           “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
           “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
           “IVF success: Factors that influence outcome”
           “ Use of the birth control pill in VF”

          Sincerely,

          Geoff Sher

          Reply
      7. Corry Bleath says:
        October 31, 2012 at 5:45 pm

        Thanks much for this article because I too felt like BCP slows the floicle growth. And I greatly appreciate you diligently responding to questions.

        My doctor, has recommended me to take BCP after the menstruation for 10 days before I start my medication leading to egg retrieval (because one of my blood test result will not arrive on time and I don’t want to wait for another two months). Will BCP after menstruation before medication be a problem?

        Reply
        • Geoffrey Sher says:
          October 31, 2012 at 9:35 pm

          Please go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

           “Use of the birth control pill in IVF””
           “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
           “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
           “Agonist/Antagonist Conversion Protocol
           “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
           “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
           “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

          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). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

          Reply
      8. 2girls says:
        January 9, 2013 at 10:01 am

        Hi i have a question.my amh came back really high at 14.i am 27 years old mother of two kids going for ivf for boy.

        my DR has put me for bcp for 43 days then lupron 10 units for 5 days and 5 units for 15 days.dexa 0.75 mg for 20 days and gonal f 150 units for 3 days and gonal f 75 units for 4 days.

        what do you think about my protocol

        Reply
      9. saanya21 says:
        February 20, 2013 at 9:54 pm

        If somebody has an AMH of 14 .no infertility two kids .going for sex selection.

        how long should i take bcp prior to cycle.i will be cycling after 3 months (for my protocol i have to take for 40 days for sure) but.my nurse is suggesting to continue it for 3 months but i am afraid of continuing for so long.what do you suggest?

        Reply
      10. lucy says:
        April 30, 2013 at 8:43 am

        Hi Dr Sher,

        I have a diminished ovarian reserve and am going to IVF#2.
        My Dr. prescribed BCP + growth hormone (seizen)to be taken at the same time, does this make any sense?
        My question is if the follicles that I have when starting the BCP will be the same to be stimulated by hormones later? Or once I have my menses after the BCP will it be a new group of follicles?
        Thank you in advance for any insight.

        Reply
      11. alma says:
        May 3, 2013 at 7:11 pm

        Hi Doctor Sher,

        If you take BCP for 3 weeks what is supposed to see at an ultrasound on day 3 after stopped BCP? I mean do you need to see the follicles or not ?
        Thank you

        Reply
      12. UpNorth says:
        May 13, 2013 at 2:23 pm

        Hi there,

        Thank you so much for your amazing & insightful articles. I’ve spent days reading your publishings and am much more educated thanks to the time spending posting this info. However, I am now a bit concerned with my first upcoming IVF cycle!

        I am 33 and TTC #1 since 2010 with no known issues. We recently lost our first son (natural pregnancy) in the 2nd trimester due to chromosomal issues and are now moving to IVF with PGS even though that was thought to be a “fluke”. My highest FSH has been 8.23 (back in early 2011), AMH last July was 5.57. My LH was double FSH once but typically is about 1:1 with LH (e.g. LH 8-FSH 6.89 last September).

        Anyway, I am ready to get the ball rolling and just received my IVF calendar last week but all of my new “knowledge” has me a bit worried and I’m wondering if it is justified. I’m waiting for my cycle to start later this week and then I will go in for day 3 bloodwork and start BCPs. My schedule only has me on BCPs for about 8 days (assuming my cycle starts on time) ending on 5/25, baseline 5/28, 225 IU Follistim & 150 IU Menopur starting 5/30. They will tell me when to start Ganirelix. No Lupron. My clinic obviously batches cycles.

        I haven’t seen this “fast” of a cycle before but of course I am very new to all of this. I have never had a hard time stimulating to clomid and my BMI is about 18.5 (5’7″, 115lbs). My concern is will this type of protocol decrease my egg quality before they really have a shot? After what happend to our son, I am very nervous about egg quality and have been taking various supplements since mid-March to improve any issues (e.g. CoQ10, L-Arginine, Inositol, etc). I would hate for all of this to go to waste if the protocol is not a good one! Does that protocol seem OK?

        Reply
        • Geoffrey Sher says:
          May 13, 2013 at 6:18 pm

          My only concern is going on to stimulation coming directly off the BCP. Please read the article entitled “Use of the Birth Control Pill in IVF” elsewhere on this blog and you will see why…..

          Geoff Sher

          Reply
      13. mrs aamir says:
        May 22, 2013 at 1:45 am

        Hi sher,i m so worried obout me and my icsi result.i m 37 and i got two icsi cycles but no mature follicles.actually my fsh is 14to15 some time to be13.but i have 28 days cycle every month.i had icsi cycle start of this month my doctor put me on short flair protocol.tjey gave me gonal f5 and menogon 75iu1amp and suprefact 50iu.xs/c daily 2after 6days altrasonnd showed 1follicle1.2cm and no of follicle 4to6 only and these are tiny and right overy had 4 to 6 follicles and all are tiny.and after two days situation was same and my
        E2 was 130 so they cancelled my cycle.and i want to tell u about the same situation before 4years ago but that time doctor done my laproscopy due to cyst in my overies and minor endometriosis.after laproscopy they put me on decapeptyle inj for 3 months and then started mu icsi cyle wity puregon highest amp but no follicles and that time my fsh was9.i got the point now that all both these situation are due to suppression my overis bc i have allready rise fsh and doctor suppressed my overies more and result 0%.although i have regular cycle means 28 days cycle and i have 1.5cm and 1.8cm follicles in both overies in the month before starting the icsi procedure of this month on seventh day of period .i mean sometime without taking pill i get mature follicles in month.please doctor suggest me something.

        Reply
        • Geoffrey Sher says:
          May 22, 2013 at 9:07 am

          Dear Mrs Aamir,

          Your issues are multiple:

          1. You have diminished ovarian reserve, Which in my opinion is not ideally suited to microglare protocols (see below). You need a long pituitary down-regulation protocol (the agonist/antagonist conversion protocol) probably with estrogen priming.

          2, You have endometriosis which in 30% of cases is associated with an immunologic implantation dysfunction (see below)

          3. There is a male factor involved.

          Please go to the home page of 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. “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. “Endometriosis”

          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. “Male infertility”

          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
      14. mrs aamir says:
        May 22, 2013 at 3:09 am

        I am sorry i forgot yo tell u about my husband that he is 48 amd he has low motility and 0%rapid linear progression.100%sperms are slow linear progression.4years ago he used proxeed plus for 3 month but useless and nowadays using oncosten oral vial.how is it?.and my Lh ,progesstron, prolactin and other test are normal in range.i dont know about
        Amh stands for?i dont know my amh.

        Reply
      15. mrs aamir says:
        May 22, 2013 at 12:10 pm

        Hi sher thanx 4 reply.dr i dont have endometriosis now ihad it four years ago and my doctor did laproscopy to clean that so i am free from it thanxgod.i couldnt understand ur answer means where should i see ur answer.

        Reply
        • Geoffrey Sher says:
          May 22, 2013 at 4:40 pm

          That is not correct. You NEVER are free of endometriosis. It cannot be totally eradicated through ablation at surgery.. The reason is that you can only treat that which you can see and for every lesion visible there are numerous still in the process of developing.

          Geoff Sher

          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!