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      • IVF With a Thin Uterine Lining: Vaginal Viagra is Often The Answer

      Dr. Geoffrey Sher Recommends

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      It has been more than a decade since we reported the first IVF baby born following vaginal Viagra treatment for an “insufficient” endometrial lining. Since that time, worldwide, thousands of women with “unexplained IVF failures”, recurrent miscarriages and late pregnancy loss as a result of poor intrauterine growth and development due to thin uterine lining have subsequently gone on to achieve healthy, normal pregnancies.

      An endometrial thickness of greater than 9mm at the time of the hCG trigger as determined by vaginal ultrasound, correlates well with an optimal chance of a successful pregnancy following IVF, while a lining of less than 8mm is associated with a poor prognosis. Measurements between 8 and 9mm represent an “intermediate zone” where outcome is somewhat poorer. To be more specific, in my personal IVF practice, I have found over the years that an endometrial lining of under 8mm, is associated with about an 80% reduction in the likelihood of a successful outcome (for any given age group). When the lining thickness at the time of the hCG trigger is 8-9mm (“intermediate”) the comparative birth rate is about 50% lower. Efforts to improve the development of the endometrial lining through administration of estrogen supplementation or aspirin have proved disappointing.

      To be effective and safe, Viagra must be administered vaginally and not orally. The reason is that when absorbed vaginally, Viagra immediately enters the uterine blood circulation in a high concentration, and is thus able to improve blood flow and estrogen delivery to the inner (germinal or basal) endometrial lining. From the uterine lining, the Viagra then immediately passes into the systemic blood circulation in a very low concentration, and thus rarely causes any side effects or complications. Conversely, when administered orally, Viagra absorbs from the upper gastrointestinal tract and reaches the systemic circulation in a relatively high concentration and can thus cause side effects. In women with coronary, neural or peripheral vascular disease, it can even result in serious complications.

      The recommended dosage is one 20mg vaginal Viagra suppository (inserted high in the vagina), ideally starting soon after menstruation ceases and continuing until the hCG trigger. We recently noted that it is possible to adequately improve a “thin” endometrium with at least 2 days of Viagra therapy.

      For embryo recipients who in spite of adequate estrogen therapy to build a uterine lining in preparation for a frozen embryo transfer (or a fresh embryo transfer following an egg donor or gestational surrogacy cycle) have “thin” endometrial linings, Viagra therapy often proves effective. In such patients, treatment should be discontinued on the day that progesterone therapy is initiated.

      In my practice I often recommend combining Viagra administration with 5mg of oral terbutaline taken 3 times a day. The latter, by relaxing the uterine muscle allows further improvement in blood flow through the uterus, thereby improving estrogen delivery to the lining. The only problem in using Terbutaline is that some women do not tolerate it well, experiencing severe agitation, tremors and palpitations. In such cases, the terbutaline should be discontinued. Terbutaline should also not be used women who have cardiac disease or in those who have an irregular heart beat.

      About 75% of women with “thin” uterine linings see a positive response to treatment within 2-3 days. The ones that do not respond well to this treatment are those who have severely damaged inner (basal/germinal) endometrial linings, such that no improvement in uterine blood flow can coax an improved response. Such cases are most commonly the result of prior pregnancy-related inflammations that sometimes occur post abortally or following infected vaginal and/or cesarean delivery.

      Viagra therapy has proven to be a godsend for thousands of woman who, because of a “thin” uterine lining, would otherwise never be able to successfully complete the journey “from infertility to family”.

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      36 Responses to “IVF With a Thin Uterine Lining: Vaginal Viagra is Often The Answer”

      1. joejoe75 says:
        July 18, 2011 at 1:45 pm

        I am in the uk and have abandoned 3 FET (2 x medicated with progynova and oestradiol) and 1 non medicated cycles due to thin uterine lining. Where can I buy vaginal viagra as my IVF clinic do not prescribe this as part of their drug regime.
        Many thanks

        Reply
      2. Geoffrey Sher, MD says:
        July 19, 2011 at 3:18 pm

        I really don't know. Try the "American Pharmacy" in London for information.

        Geoff Sher

        Reply
      3. SowmyaSowmya says:
        June 7, 2012 at 8:01 pm

        Dear dr sher
        Iam from India and have a problem of persistantly poor endometrium . Iam married since eight years and 32 years old. Also failed two ivf cycles with poor endometrium . Wasa only in oral Viagra 50 mg and 100 mg is available in India. I cannot afford to come to U.S for treatment and I have oral Viagra preparation available in India through the vaginal route in my previous ivf cycles but I noticed that the tab would not dissolve and remain the same even after two days. What can I do improve vaginal absorption. Iam a great follower of your blog and iam hoping that you would reply to my query.
        They have also prescribed vaginal estrogen tablets to improve my endometrium. Is there Any other special vaginal preparation to be used

        Reply
        • Geoffrey Sher says:
          June 8, 2012 at 5:15 am

          It all depends on the cause of your thin lining. Provided no previous inflammatory damage was done to the basal (germinal) layer of endometrium, Viagra vaginal suppositories should help. Oral Viagra will not help, nor will insertion of pills into the vagina.

          Contact Robert Makhane at MDR Pharmacy at 818–788-5858 in LosAngeles and see if they can access the suppositories to you in India (mention my name).

          Good luck!

          Geoff Sher

          P.S. Rule out endometrial tuberculosis which is common in your country.

          Reply
      4. Dionne says:
        July 8, 2012 at 11:36 pm

        Dear Dr Sher, the most my lining has measured is between 3.5 and 5.5. I’ve had blood flow test and told it is good, my hormone levels are good, all infection tests are clear, i’ve also had a camera inside to check for scarring etc, again all is good.This time i will be having progynova and oral viagra (unable to get suppositories in uk) i have had light periods (max 3 day) all my life any ideas? my doctors are at a loss.I will try usa for suppositories but my doctors seem to think it won’t help as i do not have blood flow issues, many thanks Dionne

        Reply
      5. ryma says:
        August 1, 2012 at 10:13 pm

        Hi Dr. Sher,

        Three years ago I underwent an IVF cycle and delivered a healthy baby boy via atraumatic c section. For the past 7 months We’ve been trying to have a FET, but have been unsuccessful due to poor endometrial lining (we’ve yet to even make it to transfer) We have used a combination of patches, oral and vaginal estrace to no
        avail. The most recent protocol was to do 2 months of Premarin and subsequent Provera to prime the uterus and then to start injectable estrace. Today, we’ve had to cancel yet another cycle as my lining went from 6mm a week ago to 3.7mm yesterday. My serum E2 have always responded beautifully (2414 two days ago), the uterine lining just doesn’t correlate. in your opinion do you think I am a good candidate for Viagra therapy?

        Thank you for your time and expertise!

        Reply
      6. Karthika N says:
        September 11, 2012 at 2:21 pm

        Dear Dr. Sher, I am 38 years old. I Had a mis-carraige at 18 weeks aug 12, 2010 and was told it was due to incompetent cervix. Subsequently, I have had two more at weeks 8 and 6, January 18, 2011 and July 26th 2011, the latter two with D and C’s. I have not gotten pregnant since the last abortion and noted to have very scant periods subsequent to last D & C, I have tried femara then , clomid, with estrogen, progestrone plus HCG shots to no avail. My endometrial lining does not thicken past 5mm or 6mm. Now my fertility specialist here in PR, dr. Beauchamp wants to try FSH shots starting day 4 of my cycle. I failed to mention that in may of this year a diagnostic Hysteroscopy with laparoscopy was done and showed a smooth endometrium with no scarring with basal cells intact. All of the other extensive blood work is normal. My question is should I approach my doctor with the vaginal Viagra treatment, could that be used in addition to the FSH shots? My worst fear of course is that I won’t ever conceive. But I am desperately trying not to be negative and your blog gives me so much hope. Please do contact me at your earliest and share your wisdom with me, thank you sir, sincerely, Karthika

        Reply
        • Geoffrey Sher says:
          September 11, 2012 at 7:23 pm

          You do not have to have uterine scarring to have damaged your basal (germinal) endometrium from post abortal endometritis. This sounds very much like what might have happened in your case. You can try Viagra, but in such cases it will often not work.

          Feel free to call 800-780-7437 if you wish to discuss with me by way of video call or phone call.

          Geoff Sher

          Reply
      7. Megha says:
        October 23, 2012 at 11:39 am

        Dear Dr.,

        I am from India and just went through and IVF Cycle which failed due to thin endometrium wall. I do have a past histrionic of TB which has damaged the fallopain tubes. What can i do to acheive a healthy growth of the uterus inorder to conceive through IVF.
        Regards.

        Reply
        • Geoffrey Sher says:
          October 23, 2012 at 8:37 pm

          If your thin endometrium is due to tuberculous endometritis, I am afraid the prognosis is poor. If it is due to something else, then perhaps vaginal Viagra therapy might help. Read elsewhere on this blog about Viagra therapy in IVF.

          Geoff Sher

          Reply
      8. Jaana Tikkanen says:
        November 14, 2012 at 3:15 am

        Hi! I have thin endometrium due to D&C right after my first delivery. I got pregnant again and had a little girl 1 year ago thanks to your discovery of how sildenafil can improve endometrium. We don’t have viagra suppositories here in Finland so I crushed the pills. My endometrium was 6.6 mm on day 9 and I used gonadotropins 225 iu/day, got then pregnant naturally. Now I am trying to conceive again with the same method but somehow it does not work anymore. My endometrium was only 5 mm in this cycle on day 9 and two follicles. What more can I do ? I eat vitamin e, miniaspirin and folic acid. Thank you very much for your answer.

        Reply
        • Geoffrey Sher says:
          November 14, 2012 at 8:25 pm

          Unfortunately you cannot optimally improve the uterine lining with crushed Viagra vaginally. It must be compiled in a suppository that optimizes absorption. We have organic pharmacists in the U.S.A that prepare this for our patients.

          Good luck!

          Geoff Sher

          Reply
      9. sherazade says:
        November 20, 2012 at 3:11 pm

        Dear doctor Sher,
        I am writing from France where i have just done 2 IVF. The first reason for ivf is my husband who has a Kalmann syndrome and who is treated with hormones for 3 years in order to produce spermatozoa, thanks to the treatment he went from 0 to 1 million spermatozoa, but not enough for natural conception. Then we discovered that i have a thin uterine lining ( i am 37 years old now), first ivf it went up to 5.5mm, i got pregnant than lost the baby at 4 weeks, second ivf the uterine lining was 6 mm and i didn’t get pregnant. I am followed by a very well known doctor here in Paris, but my doctor never told me about vaginal viagra, the only treatment he gave me after the first ivf failure is vitamin E (once a day) and Pentoxifylline (800 mg a day). Doctor says we have no way to understand at this point if the reason of failure is due to poor quality spermatozoa and embryos, or if it is due to thin uterine lining. I am going to do a third ivf in february and i am wondering if i should try myself vaginal viagra, what do you think? thanks a lot for your help. Best whishes.

        Reply
        • Geoffrey Sher says:
          November 20, 2012 at 5:16 pm

          I really think you should not undergo any treatment without your RE’s approval. Also, there are many causes of a refractory thin lining and only about 1/2 of them are candidates for Viagra therapy. The rest will not respond.

          Also, if your husband indeed has Kalmann’s syndrome he should have responded much better to gonadotropin therapy. Remember, clomiphene therapy won’t work in cases of Kalmann’s.

          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”
           “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”
           “Hormonal treatment of Male Infertility”
           “Endometrial Thickness and Viagra”

          Consider calling 702-699-7437 to arrange a telephone or Skype consultation. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

          Reply
      10. Sherazade says:
        November 21, 2012 at 12:34 am

        Thanks a lot for your quick answer
        I will call to arrange a Skype meeting
        Best regards

        Reply
      11. Deana says:
        November 27, 2012 at 3:35 pm

        Dr. Sher
        I have a thin endometrium due to a Her Option Cryobliation that I had on 10/14/2011. I am 36 years old with an 8 year old son. My husband and thought we were done having children when I decided to have the procedure done. To help with brutal menstrual period I was having every month. After the procedure I am still getting periods every 26-28 days. They are light to a medium flo lasting about 4 days. I recently had found out that I was pregnant this past October 2012. My husband I were shocked but very excited! I miscarried at 6 weeks. After miscarrying my husband I became hopeful that we would actually still be able to have another child. We have seen several doctors already but no one seems to be able to help me. I had a water sonogram done and it showed that my uterus lining was 5 mm and that I had minimal scarring. Everything else was intact and healthy. I have been doing a lot of research and came across your sight. I am curious if you feel that Vaginal Viagar might work for my situation? I live in New York on Long Island. My goal is to hopefully improve the lining of my uterus so that we might have a better chance at a successful pregnancy. I would really appreciate any input or information you could offer me.
        Thank you for your time.

        Reply
        • Geoffrey Sher says:
          November 27, 2012 at 5:20 pm

          With endometrial cryo-ablation it is unlikely that your uterine lining will be responsive to therapy ai9med at thickening it. You can contact Dr Tortorielo at SIRM-NY (646-792-7476) and have him evaluate you…but the chance of a successful pregnancy (regardless of treatment) are small.

          So sorry!

          Geoff Sher

          Reply
      12. Cynthia says:
        November 30, 2012 at 9:48 am

        Dear Dr. Sher,
        I am so happy I found your blog. I suffer from thin lining and usually my endometrium does not go above 6.9mm. I did a histeroscopy and it showed no adhesions or anything abnormal. In one of your commentaries above you mention that one does not have to have uterine scarring to have damaged basal (germinal) endometrium. So how can one check if the germinal endometrium is not working properly? I had a miscarriage at 6 weeks but did not need D&C.
        Thanks for your time!

        Reply
        • Geoffrey Sher says:
          November 30, 2012 at 1:00 pm

          You would need a mock cycle with estrogen therapy and vaginal Viagra. It is also possible that the protocol of stimulation you were on might have so increased ovarian androgen (t6estosterone) production that this might have down-regulated endometrial response to estrogen.

          Might I recommend that you go to the home page on this site (www.ivfauthority.com) , 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.

           “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”
           “Endometrial Thickness and Viagra Therapy) .
           “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 March, 21st 2012)
           “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
           “IVF success: Factors that influence outcome”

          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
      13. Cynthia says:
        December 6, 2012 at 8:31 am

        Dear Dr. Sher,
        Thank you so much for your reply. I read all the posts! I did not mention before, but I had tried estrogen and vaginal viagra when I was trying for a FET. Both times my cycles got cancelled because the endometrium would not go over 7mm. So, does that mean that I probably have a damaged basal endometrium, eventhough it does not show up in the hysteroscopy? My RE instructed me to use the viagra pill vaginally and said it has the same effect. Above, you say it won´t work. How do I get a pharmacy to make the supositories (they probably won´t know what to mix it with without a prescription).
        I live in South America. If I call the number you gave me, will I get instructed how much would cost the Skype/phone consultation?
        Thanks for your time, I really appreciate it.

        Reply
        • Geoffrey Sher says:
          December 6, 2012 at 9:46 am

          The vaginal pill will not absorb as nearly well as the suppository.

          You can ask your RE to comtact MDRX Pharmacy in Los Angeles. Ask for (Robert Mhakane) the pharmacist there. His # is 818-788-5858.

          Geoff Sher

          Reply
      14. leanne lear says:
        December 18, 2012 at 1:06 pm

        Hi,

        I have recently suffered 2 miscarriages and and ectopic pregnancy resulting in the loss of my right fallopian tube, my main question relates to hereditary. is a thin uterus lining problem hereditary?

        I look forward to a response soon. Many thanks, Leanne Lear UK

        Reply
        • Geoffrey Sher says:
          December 18, 2012 at 2:52 pm

          It is not hereditary but sometimes can occur in a daughter when her mother took certain hormones (such as DES) during pregnancy. Usually it is acquired and often can be reversed. 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?”
           “Endometrial Thickness”
           “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
           “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)
           “IVF success: Factors that influence outcome”
           “Staggered IVF”

          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
          be due to your

          Reply
      15. A says:
        January 17, 2013 at 11:52 pm

        hello;
        I am 38. I have done one time IUI and 5 times ICSI in last time I have 2 frozen embryos which has been transfered in 28th of period cycle with thickness of endometrium about 8(7.8) and my test
        was neg. I am sooooo hopeless. the main problem is related to my husband unforetunately. one time I had a pregnancy in right tube. I have a question how it is happened when thickness of lining is so inportant but embryo sticks to lining of tube. I am so depressed and there is no way to do. My age is increasing and I am so worried.

        Reply
      16. C says:
        January 25, 2013 at 8:28 pm

        Miscarried after ARTx 2 at wk 5.5, 7.5. No prior issues with endometrial lining (generally 4-7-11mm progression for 4 IuI, 1 IVF, I FET). Had to have D&C, then hysteroscopy and D&C for missed tissue. This cycle progression is slow (3-4-5mm) even with extra estrogen, may have to cancel FET. Is this common after D&C, any recommendations?

        Reply
        • Geoffrey Sher says:
          January 26, 2013 at 6:25 am

          The concern here is not the D&C…as this rarely will irreparably damage the basal (germinal) endometrium. Rather the concern I would have is that the retained products of conception that led to the secondary D&C, might have resulted in endometritis that has in fact severely compromised the basal endometrium and its ability to respond to estrogen. If this is so it will not be amenable to growth with estrogen treatment and even Viagra will likely not work. Read the blog on “Endometrial Thickness and Viagra therapy)

          Geoff Sher

          Reply
      17. Katie says:
        February 24, 2013 at 12:44 pm

        I have done 2 fresh ivf cycles with sher institute with no issues with my lining. I am currently undergoing a frozen transfer with a new Dr at sher institute and was just told my transfer would be pushed back due to my lining. I’m doing the vaginal suppositories. But my question, why has it been good in the past and now suddenly I’m having lining issues?

        Reply
        • Geoffrey Sher says:
          February 24, 2013 at 6:59 pm

          Hi Katie,
          Without access to your records, I could not say. I can tell you that it is not wise to transfer embryos to a fully estrogenized endometrial cavity where the measurement is under 8mm.

          Geoff Sher

          Reply
      18. Katie says:
        February 24, 2013 at 12:49 pm

        One other thing. I have NK Cells and did the intra lipid infusion on 2/19. Now that my transfer date has been pushed back from 2/28 to 3/7, is the IV infusion still going to be effective?

        Reply
      19. Kylie says:
        February 27, 2013 at 6:01 pm

        Hi I am in Australia undergoing a FET cycle. I had a D & C following missed miscarriage in December 2012. This is my first cycle since then. I have severe PCOS. I am have been taking gonal f 25 units from 16/02 – 25/02 (bloods on 25/02 showed I was still baseline and endo was 7b, I had 18x small follicles on left ovary and 10x small follicles on right ovary. I was advised to increase gonal f to 50 units a day. Went for another BT and scan today 28/02 and endo lining is 6c and 20x small follicles on left ovary and 17 x small follicles on right. Why is my endo lining decreasing when my medication has increased? Confused. Your advice is appreciated. PS This is now my 6th ET.

        Reply
      20. Tina says:
        April 23, 2013 at 7:47 am

        Hi Dr Sher,

        I am 32 years old. I had a miscarriage in May 2011 and underwent a D&C. However 2 months after that I had to undergo another D&C due to retained product of conception.

        It took 4 months for my periods to start but they were very scant. So I had a Hysteroscopy in April 2012. The doctor found some adhesions and removed them.

        Post hysteroscopy I have had ultrasound monitored cycles and my uterine lining on day of ovulation goes upto 7.7 mm in a natural cycle (upto 8.5 mm in medicated cycle with HMG injectibles). The blood flow to the lining was also good.

        I have been trying to get pregnant both nautrally (4 cycles) and through IUIs(3 cycles) but no positive result yet. I had a HSG test also which shows that tubes are fine.

        Will the viagra therepy help improve the lining in my case? Do I have a better chance with IVF?

        Your expert advice is much appreciated.

        Reply
        • Geoffrey Sher says:
          April 23, 2013 at 10:24 am

          It could help…but no guarantee because the retained POC’s might through infection (endometritis) have permanently damaged the basal endometrium from which the lining develops cyclically.

          I hope I am mistaken here.

          good luck!

          Geoff Sher

          Reply
      21. becky says:
        May 21, 2013 at 6:49 pm

        Hi Dear Dr Sher, I am 37yrs old with no issue, I had a mis misabortion in july 2012 at 11wks which dated 6wks 4dys, had a D&C on july 20th, did not see my period till Dec. 2012, went to RE who told me I have Asherman’s syndrome, I had operation to this effect. I was given progynova 1mg to take for 2×2 for 24 days with duphaston 10mg 2×1 for d last 10dys. checked my endometrium in Jan. 2013 but too Thin, d Dr asked me to take progynova again but later find out I was pregnant, with low progesterone (7.5), then d Dr asked me to take UTROGESTAN 100mg 3cap. daily, though it increases d level to 15.6 after 2wks but end up losing d pregnancy after 6wks. Now I’m trying again but to no avail, I was told yesterday that my endometrium is to thin (4mm). please Dr what can I do to increase the thickness of my endometrium or what drug can I use? I really need your help, my husband is planning to impregnate another woman.

        Reply
        • Geoffrey Sher says:
          May 21, 2013 at 10:18 pm

          Dear Becky!

          I wish I had a magic formula for you but I do not. When Asherman’s results in a very thin lining it is due to intractable damage to the basal (germinal) endometrium. While surgery to free the scarring and adhesions inside the uterus sometimes helps, it often will not…unfortunately neither will estrogen therapy, antiprostaglandins or Viagra. If the lining can not be brought to at least 8mm in response to estrogen, it is usually a hopeless situation…I am afraid. In many cases a gestational carrier offers the only solution.

          Please go to http://www.IVFauthority.com . When you get there, go to the home page and look for the “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. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

          2. “Asherman’s syndrome”

          3.“Endometrial Thickness”

          4. “Gestational Surrogacy”

          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

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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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      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
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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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      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
      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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      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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      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
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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
       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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      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?
      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 #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?
      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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      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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