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IVF With a Thin Uterine Lining: Vaginal Viagra is Often The Answer
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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”.
48 Responses to “IVF With a Thin Uterine Lining: Vaginal Viagra is Often The Answer”
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Ask Our DoctorsA Question
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
I really don't know. Try the "American Pharmacy" in London for information.
Geoff Sher
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
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.
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
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!
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
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
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.
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
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.
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
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.
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
Thanks a lot for your quick answer
I will call to arrange a Skype meeting
Best regards
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.
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
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!
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
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.
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
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
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
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.
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?
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
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?
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
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?
It should make no difference. The IL lasts for at least 4 weeks.
Geoff Sher
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.
This is a very small dosage of gonadotropins even for a person with PCOS who is a high responder.
Geoff Sher
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.
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
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.
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
Hello,
I have a beautiful 3 year old daughter delivered by csection. I am 39 years old and been trying for 2 years to conceive a second child. I have been working with my area Fertility Specialist and OB. My progesterone is low with a thin Uterus Lining not getting past a six. Is there any recommends you have to try/work with. I have used Letrozole and currently doing acupuncture as well two failed IUIs.. I conceived my daughter the second month trying after being on the birth control pill for 15 years. Just found your site and wanted to get another opinion.
Thank you
Hi Jennifer,
I appreciate the post you did. However, the information provided is not sufficient to allow for a competent response. 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
Thank you! Is there any specific information that you would need for the skype call? I have about 18 months of records and want to have any info to help with any details.
You will be emailed a questionnaire. Try to fill in all the information requested from the records you have…and forward the scanned medical information too.
Geoff Sher
Dear Dr Sher. I wonder if you can help me. 6 months ago I underwent uterine artery embolisation to treat innumerable uterine fibroids which had completely filled the surface and distorted my womb, and increased its size to that of a five month pregnancy. My womb has now shrunk by 75%, but the surface is still covered in the dead tissue from the fibroids and We are still failing to conceive. My radiologist tells me that I have a thin uterine lining and also that removal of the dead tissue would not be of benefit because there is unlikely to be much healthy tissue underneath.
Is it likely that the vaginal viagra treatment would help to thicken my womb lining?
That is the biggest draw back with fibroid embololization, it also often compromises blood flow to the uterine lining leaving it incapable of responding to estrogen. This often leads to a need for aa gestational carrier.
Sorry!
Geoff Sher
Dear Sher,
Infact I have been having sleepness nights until I came across your blog and reading some of your write ups gave me hope. I am 44years old and had my first child (girl) nine (9) years ago and since then i have not been able to concieve. I have been followed up by my Doctors with clomids and HCG but to no avial . I have done three (3) IVFs and no success. My problem is my Lining. I have done Hysteroscopy and everything is ok. the 2nd and 3rd IVF was with egg donor and the 3rd with Viagra but my lining could only get to 8.5 and yet no luck. Please kindly advise.
I think I can help here. Please call 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail
Also, please go to the home page of this blog, http://www.IVFauthority.com. When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
9. “Endometrial Thickness and IVF”
10.“Use of the birth contol pill in IVF”
Geoff Sher
Hi Dr. Sher,
I have severe asherman’s with multiple corrective surgeries and have 2 failed fresh IVFs and 1 failed frozen transfer. I am currently cycling my “last chance” fresh cycle right now at age 40. My estrogen levels are good 2100 with 10 measurable follicles but my lining is only 3.7 on cycle day 7. I will be monitored daily now and hope that my lining comes up, but I know that my lining never got to 8 with my other cycles, somewhere in the 7s I believe. Can vaginal Viagra be used during this cycle? I know that my chances are low and I hope to be able to proceed even if my lining doesn’t respond as it should. I am not sure that waiting for a frozen cycle would really get it to where it needs to be anyway. Do you have any suggestions or any advice would be appreciated. Thanks, Michelle
Alas, such a thin lining caused by destruction of the basal endometrium by scarring, is not likely to respond to Viagra therapy or anything else…in my opinion. Your only rational option might well be gestational surrogacy.
Geoff Sher
Hi Dr. Sher
I am 36 years old and have yet to get pregnant. I was on the pill for 16years, had clamidia (once as a teen and once when I was 27). I have been married for 5 years and been trying to get pregnant for 4 years.
My tubes were completely blocked and they opted to have them removed. I have had 3 retrivels with a total of 8 transfers (2-6 embryos at a time). The embryo quality have been a full range from poor to great.
I have been struggling with a very thin lining but all tests have come back positive. Not a lot of scarring and good blood flow.
We have experimented with multiple drug formulas thru out the years including taking viagra but never vaginally…only orally.
I recently changed clinics and was going thru my first mock cycle with them; unfortunately it was just cancelled b/c my lining is not thick enough (4mm’s on day 21 and climbed to 8mg of estrace/day nothing else). They are now slowly moving me off the estrace and giving me one progesterone a night in hopes of creating a thick period and starting the process again for the next cycle.
Do you have any suggestions/thoughts?
I reside in Canada and desperately want to get pregnant. I am very concerned that my uteris will simply put: not work. Would you suggest banking some embryos so that I can have a serrogate carry if need be?
I would greatly appreciate your opinion and so glad I found your website.
Thanks kindly,
Leigh
I really think I might be able to help here, but to do so, I would need to consult with you. The issues are: (a) the uterine lining (b) Do you have a hydrosalpinx (fluid filled tubes) (c) The protocol needed for optimal ovarian stimulation (d) possible implantation issues.
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. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
3. “Agonist/Antagonist Conversion Protocol”
4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
8. “IVF success: Factors that influence outcome”
9. “hydrosalpinx”
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