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Geoffrey
Sher, M.D.
 Educated
in South Africa, Dr. Sher was a Senior Specialist of Obstetrics
and Gynecology at the prestigious Groote Schuur Hospital (the
teaching institution for the University of Cape Town), where the
world's first human heart transplant was performed. In 1975, he
was recruited by the University of North Carolina in Chapel Hill
to assume a faculty position in the Department of Obstetrics and
Gynecology. In 1979, Dr. Sher entered private practice in Nevada
where he is currently a Clinical Professor of Obstetrics and Gynecology
at the University of Nevada School of Medicine. In 1982, Dr. Patrick
Steptoe, the father of In vitro Fertilization (IVF), afforded
Dr. Sher an opportunity to study under him at Bourn Hall in England.
Dr Sher returned to the United States and in January 1983 opened
the nation's first private, non-university based IVF center (the
fourth IVF program in the USA), in Reno, Nevada. He is Board Certified
in Obstetrics and Gynecology in South Africa, England and in the
United States and also has Sub-specialty Board Certification in
Maternal-Fetal Medicine.
Between
1987 and 1998, Dr. Sher opened the California based Pacific
Fertility Medical Centers (PFMC) with three locations. During
his tenure with PFMC, Dr. Sher was largely responsible
for the Group's emergence as one of the leading IVF programs in
the nation. In ten (10) years he propelled PFMC into the forefront
of clinical performance and research, introducing several major
medical break-throughs that impacted positively on the treatment
of infertility. In 1990 Dr. Sher was the first to point to the
fact that ultrasound evaluation of the uterine lining prior to
IVF, allows for prediction as to the likelihood of a subsequent
pregnancy. In 2000 he demonstrated that the administration of
Sildenafil (Viagra) to women with poor endometrial linings, improves
uterine blood flow and enhances hormonal thickening. In the field
of reproductive immunology, Dr Sher was the first to link immunologic
problems causally, to female-related resistant infertility and
repeated IVF failure, introducing immunotherapies that have virtually
doubled the IVF birthrates in such cases.
In
1995, Dr. Sher and his team introduced a novel consumer-friendly
concept in fee structuring for IVF. This so called Outcome-Based
Pricing (OBP)-arrangement granted eligible patients a 70-100%
refund of medical fees, if they did not have a successful outcome
after IVF treatment. In the absence of IVF insurance coverage,
this risk- sharing financial arrangement was welcomed by IVF patients
across the board, but was strongly criticized by almost all IVF
physicians who felt that widespread introduction of such an arrangement
would place them at financial risk. After waging a relentless
and often single-handed crusade, Dr. Sher was successful in getting
this plan accepted by SART, the IVF medical governing body, as
well as by the IVF medical community. Currently, more than 50
of an estimated 350 IVF programs in the nation offer it as an
option, in one form or another, to their patients.
Dr Sher is
a strong proponent of accountability on the part of IVF programs
for the success rates they report to consumers, favoring the establishment
of an accreditation process for all centers that provide IVF and
related services. He believes that in order to render IVF treatment
affordable to all Americans, regardless of their socioeconomic
status government should mandate insurance coverage for couples
undergoing IVF through providers who meet well defined, validated
outcome-based performance standards.
Dr. Sher was
a founding Board Member of SART. He has more than 200 accredited
scientific publications and abstracts to his credit and has co-authored
two consumer-oriented medical books; "Your Pregnancy,"
published by Simon and Schuster in the 1980's and "In
vitro Fertilization, the A.R.T. of Making Babies", published
by Facts on File. The latter is currently one of the most widely
read consumer books on the subject of IVF, in the USA. "In
vitro . . . " was written to assist infertile couples
in evaluating their options with regard to the various advanced
fertility procedures.
In 1998, Dr.
Sher separated from PFMC to found the Sher Institute
for Reproductive Medicine (SIRM), a state-of-the-art facility
that offers advanced fertility treatment and research. SIRM
programs are located in programs in: Las Vegas, Los Angeles, Sacramento,
St. Louis, Central IL, Chicago and soon to be in New York City
(Spring 2004).
Dr Sher has
been influential in the births of more than 6,000 of an estimated
100,000 IVF babies born in the United States, to date.
Return
to StorkNet's interview with Dr. Sher.
Visit
Dr. Sher's home page.
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Geoffrey
Sher, M.D.'s
Basic
Comprehensive General Infertility Work-up
Prepratory
Tests:
- On the
third day of a spontaneous or progesterone withdrawal menstruation,
blood is drawn for the measurement of Estradiol (E2), FSH, LH
and Inhibin-B. The specimen of blood should be sent to Millenova
Laboratories in Chicago (312) 274-1928 by overnight Federal
Express for the performance of the Inhibin-B test.
- Blood
should also be drawn (any time) for the measurement of Prolactin,
TSH and antisperm antibodies (ASA).
- Commencing
on the second day (2nd) of the menstrual cycle, a basal body
temperature chart should be initiated. A thermometer is placed
in the mouth for a period of two (2) minutes upon awakening
(prior to the ingestion of food/liquid and brushing of your
teeth). The temperature should be documented graphically on
the basal body temperature chart provided.
- For
women less than 35yrs without evidence or symptoms sugesting
underlying organic pelvic disease (eg; endometriosis, chronic
inflamation, pelvic adhesions, fibroids etc):
A hysterosalpingogram
(HSG) should be performed within a week of the cessation of
menstruation. This out-patient procedure involves injection
of a radio-opaque dye which outlines the Fallopian tubes allowing
the diagnosis of tubal blockage. To a lesser degree, it permits
the detection of surface lesions inside the uterine cavity.
OR
For
all women over 35yrs of age and for younger women who have
evidence or symptoms pointing to underlying organic pelvic
disease (eg; endometriosis,chronic inflamation,pelvic adhesions,
fibroids etc):
A laparoscopy/hysteroscopy
should be performed within a week of the cessation of menstruation.
Laparoscopy is a procedure where a telescope-like instrument
is introduced through the belly button into the abdominal/pelvic
cavity allowing diagnosis and treatment of ovarian cysts/endometriomas/benign
tumors, uterine fibroids, tubal blockage, ectopic pregnancy,
appendicitis, pelvic adhesions etc. Laparoscopy is usually
performed as an out-patient procedure with the patient under
general anesthesia. It is one of the only ways to diagnose
early pelvic endometriosis acurately. Hysteroscopy is a procedure
where a telescope-like instrument is inserted, via the vagina
through the cervical canal into the uterine cavity, for the
evaluation of the interior of the uterus. It is an important
procedure because it allows for diagnosis and treatment of
small surface lesions inside the uterine cavity (e.g. polyps,
scarring or adhesions) tha adversely affect the ability of
an embryo to attach to the uterine lining. Such lesions are
often missed through the performance of an HSG.
- Commencing
at least 17 days before te expected next menstrual period (ie;
usually about 10 days following the initiation of menstruation),
urine should be collected twice daily and tested for the onset
of the spontaneous LH surge. The initiation of the LH surge
usually precedes ovulation by 8 to 36 hours. In order to detect
the onset of the LH surge as early as possible, it is important
that urine be tested at least twice daily. This is done
as follows:
The bladder
is emptied first thing in the morning, upon awakening.
One half-hour later urine is collected (only a very small
amount is required) and tested using an over-the-counter LH
- kit (obtainable over the counter at a drug store). The earliest
sign of any color change should be documented. It need
not be a pronounced color change as suggested by the insert
in the kit. Any alteration in coloration is significant.
The same process of testing is then repeated at night
before retiring.
At the
earliest sign of a color change the couple should:
- have intercourse,
arrange to have the first in-office physician's
assessment within 6- 18 hours following intercourse.
- the woman
should RUSH IN to the physician's office ASAP to have her
blood drawn for the measurement of estradiol (E2) l level (
NOTE: timing is critical because within approximately 6 hrs
of detecting LH in the urine, (which roughly coincides with
12 hours after the actual onset of the LH surge), blood estradiol
levels start to fall precipitously and if blood is drawn too
late, the measurement of estradiol will be of little value.
Note:
If the color change is observed in the early morning, the woman
should schedule the "first in-office assessment" at
the doctor's office for the afternoon of the same day. If
it occurs at night, the doctor's office should be contacted
first thing the next morning and the "first office assessment"
should take place within hours.
The First In-Office
Assessment:
| A.
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A
Post-Coital Test (PCT) or Huhner test is performed on
the cervical mucus. The purpose of the PCT is to assess
sperm survival within the mucus. Since sperm can only survive
for six hours in the vagina, a positive PCT is indicative
of:
- Good
quality sperm.
- Good
sperm - cervical mucus interaction suggesting that there
will be safe passage of sperm to the uterine cavity.
- Absence
of ASA antibodies in the sperm or mucus.
- That
the production of estrogen is adequate.
-
That the endometrial lining is well primed by estrogen,
which is essential for adequate preparation of the uterine
lining for implantation.
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| B.
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Cervical
mucus is cultured for:
- Ureaplasma
Urealyticum (this requires a specialized medium to transport
the specimen to the laboratory).
- Chlamydia
and Gonococcus (these also require a specialized transport
medium).
- Aerobic
and anaerobic pathogens.
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| C. |
A cervical mucus evaluation: A sample of the cervical
mucus is allowed to dry on a glass slide and is examined under
the microscope for specific features such as "ferning,"
which is indicative of an adequate estrogen effect. |
| D. |
A
vaginal ultrasound examination
is performed to detect the presence of at least one dominant
follicle that measures18 mm in mean diameter thus helping
confirm that ovulation is imminent. It also allows for the
assessment of the thickness and appearance of the endometrial
lining. A normal endometrium should measure at least 9 millimeters
in sagital diameter at this time.
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The Second
In-Office Assessment
This visit
is scheduled three (3) days after the first office assessment.
At this visit a vaginal ultrasound exam is performed to check
whether ovulation has occurred (i.e. whether the egg has been
released). The presence of small amount of fluid collecting
in the lower most region of the pelvis or a change in the shape
of the follicle is suggestive of ovulation.
The Third
In-Office Assessment
The third
visit takes place five (5) days after the 2nd visit. At this
visit blood is drawn for the measurement of progesterone (P4)
and E2.
The Fourth
In-Office Assessment
The fourth
and final visit is scheduled for five (5) days after the office
assessment.At this visit an endometrial biopsy is performed.
This is a simple in-office procedure, whereby a slither of uterine
lining (endometrium) is removed and sent to the laboratory to
evaluate histologic changes in the endometrium.
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