Questions for Dr. Sher

Questions for Dr. Sher ~ Consult 6.15.11

DIAGNOSIS QUESTIONS
• Why do I have Diminished Ovarian Reserve at such a young age? Is there any explanation? Does the fact that I’m young bode well for me? (vs. a 30-40 year old with DOR or does it matter?)
• What exactly does it mean to have elevated Antiphosphatidylserine IGM? Is this an indicator that I may have abnormal levels of Natural Killer Cells? Am I correct that this is an autoimmune issue? If so, what is the best treatment? My doctor doesn’t think it’s a very significant finding.
• Why do I have recurrent pregnancy loss? (6 early losses) Do you think it’s bad luck, chromosomal issues, or poor egg quality? My uterus and lining have always looked excellent. Do you think something could have been overlooked? Or is it most likely my eggs?
• Each time I’ve had a chemical pregnancy, my betas have only been in the single digits – is there anything significant about that? Why haven’t I ever had higher betas or surpassed 5 weeks?
• How long do you think I have before reaching menopause? I’ve been told early 30’s.

SYMPTOMS/CONCERNS
• I have been noticing some symptoms over the past year or so. I’m not sure if they mean anything. Acne, weight gain, excessive sweating, increased hair growth on face, hair loss, hot flashes, and night sweats. Are these signs that I’m pre-menopausal? Could they mean something else?
• I switched from tampons to pads over a year ago. I have been observing that my menstrual flow does not actually “flow”. Even on my heavy days, the pad does not become full at all. The flow only occurs when I use the restroom. Is this a problem? I wonder if I’m properly shedding my old lining?

LABS
• My first FSH level taken in 12/2009 was 11.6. The past 2 levels in 6/2010 and 1/2011 were 8. Shouldn’t my FSH be higher, considering that my AMH is very low (0.3) and my antral follicle count is also very low (6-7)? I would think it would be a good thing that it’s low? Does the fact that it’s lower mean anything?
• Should I have another AMH level taken (the first and only level was done in 1/2010)? Is this something that should be monitored more closely due to my diagnosis of Diminished Ovarian Reserve?
• I don’t recall ever having an FSH to LH ratio done on CD 3. Do you see anything in my records that I’m missing? Should E2 also be done on CD 3? How often do you recommend having CD 3 labs done?
• I haven’t had my progesterone levels checked consistently. Should it be checked every cycle?

PROCEDURES
• I had an HSG in 12/2009. It was completely normal and clear. Do you recommend having another one done? How often should this procedure be done?
• My mother has Endometriosis, but I have no symptoms. Do you think it would be worthwhile to have a Lap done?
• Are there any other tests or procedures that you would recommend? Are there procedures that can be done, not only for diagnostic purposes, but also to increase fertility?

VITAMINS/SUPPLEMENTS
• My current doctor recommends DHEA 25mg 3x day. Do you think it is helpful? Do you recommend any other supplements?
• I asked to be tested for vitamin deficiencies, but was not tested. Do you think it’s worthwhile to check? (Like Vitamin D for instance)
• What about Folate deficiency? How much Folic Acid should I be taking?

MEDICATIONS
• What is your opinion on Lovenox and when should it be taken? My current doctor is fighting me on this medication. He thinks it should only be administered after pregnancy is confirmed, and no sooner. I can barely make it to the point of getting a beta done before I’m already losing the pregnancy. Can Lovenox help with implantation for women who have chemical pregnancies?
• Can steroids be useful for women with multiples losses? Do you prescribe it only with IVF, or do you also give it during IUIs or timed intercourse cycles? When is the key time to take it?
• Whenever I take an hcg trigger shot, I begin cramping and sometimes spotting once it begins to wear off. Are booster shots useful? What days and dosages would be most beneficial?
• I have only ever used progesterone suppositories (even with IVF). Are Progesterone in Oil injections better? If suppositories are okay, what dose is best?

IUIs/IVF
• We have conceived 3 times with timed intercourse and 3 times with IUI. Do you think IUI is even worthwhile for someone with my diagnosis (and considering that my husband has no fertility issues)?
• I did 2 IVF cycles and have tried the Lupron Flare protocol and the Antagonist protocol. The Flare protocol did not work – my cycle was cancelled due to poor response and converted to IUI. The Antagonist protocol seemed to work pretty well. We even added Clomid because I respond so well to it. Would you use the same Antagonist protocol or do something different? Why do I seem to respond so well to Clomid? Could I take a higher dose of FSH?
• Do you think I could get more than 6 mature eggs, or is that probably the best case scenario, considering my low antral follicle count?
• How many embryos would you transfer for someone with my situation?
• Would you do a 3 or 5 day transfer?

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17 thoughts on “Questions for Dr. Sher

  1. wow you have clearly done your homework here !! I am hoping you get some insight and am looking forward to hearing the responses you get. Good luck!!

  2. You go, girl! Great to be so prepared and know that you can squeeze out every answer you need. Like everyone else, I hope you get some of the answers you need and the right plan for you.

  3. I look forward to hearing your answers from Dr Sher. I think you've got some great questions lined up and I"m curious as to what he has to say about DOR, that's my current diagnosis and I think it's pretty crappy.

  4. These are really grea questions and I am really looking forward to seeing the results (as I have DOR (diagnosed at age 31, now 33) as well. There sounds like there is something else going on with all your early losses as well. My sister has DOR (0.3) at age 29 and she got pregnant with twins on her first IUI, so I guess there are no hard answers on any of this.

  5. You are wonderfully organized!!! I will tell you he will do a day 5 transfer; he hates day 3's unless he has to (not many remaining on day 3 and the woman wants to just transfer). The endo, you can have it without symptoms, but if you do IVF it will bypass any issues it may be causing. I hope you like him 🙂

  6. Excellent questions and some of your symtopms are identical to mine, so I hope you post the answers, because I am curious to what he says.If I was going to make a non-medical diagnosis, I am going to guess its somethign autoimmune going on, and they will definately help in that area, I think he specilizes in that. I'm sure you already know, but just in case not, he has a great blog!!Good Luck! So excited for you to get answers.!

  7. I would also ask him if he recommends having an endometrial biopsy and B-integrin testing. Personally I'd strongly recommend having the lap done, but I'm curious to see what he says. I had 7 early m/c's/cps and they found and removed minimal endo from both ovaries and my uterus. I got pregnant and have stayed pregnant (so far anyway) the first cycle after the lap. Check these studies out-http://scholar.google.com/scholar?q=endometrial+injury+and+implantation&hl=en&btnG=Search&as_sdt=1%2C10&as_sdtp=onI'd also ask him what his thoughts are on luteal phase progesterone and possibly estrogen supplementation during your luteal phase even in unmedicated cycles. Best of luck =)-jodi

  8. Hi there. I just happened upon your blog, and I hope you don't mind my reading/commenting. I don't have a blog, so I'm sorry this is an anonymous comment. I just wanted to give you a virtual hug, and say that there are others out there just like you, and thank you for sharing your story. I too am young, only 28, and have be dx with DOR (normal fsh but high amh) I also have endometriomas (prob endometriosis) on both ovaries, a small uterine septum, and possible adenomyosis. We've been trying 3 years. We did our first IVF/ICSI in Jan, they only retrieved 4 eggs, 3 fert and transferred, and we had a chemical. I've also been looking into Dr. Sher, but I'm still trying to decide if we want to try IVF again or not. I'll be interested to see what you hear from him. I hope you get good, encouraging news. Best of luck to you. ~ Annah

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