Fertility Q&A with Dr. Sheeva Talebian of CCRM New York
Some of the hardest fertility questions are the ones that show up after you have already done everything right. Unexplained infertility with no clear direction. Failed euploid transfers without a pattern. Conflicting advice about endometriosis. Confusion about whether to keep trying, switch protocols, or move to donor eggs or surrogacy.
These are the moments when straight answers from a seasoned reproductive endocrinologist can save months of confusion and give you a path forward.
I recently hosted a one hour live Q&A with Dr. Sheeva Talebian, Director of Third Party Reproduction at CCRM Fertility of New York. She is board certified in Reproductive Endocrinology and Infertility and known for her evidence based, patient centered approach to fertility care. She is also on the Medical Advisory Board of CoFertility and co-founded Truly MD.
Below are key takeaways from our conversation.
Key Takeaways from the Q&A with Dr. Talebian
1. Unexplained infertility is often not unexplained
Up to 30 percent of individuals and couples receive an unexplained infertility diagnosis. Dr. Talebian emphasized that repeated failed euploid transfers are a major red flag for silent endometriosis. She often orders ReceptivaDx and BCL6 testing after one or two failed transfers to assess for inflammation that standard testing misses.
2. Endometriosis treatment should be tailored
She helps patients decide between laparoscopy and medical suppression based on symptoms, history, and mood vulnerability. For many, surgery offers clearer answers and better long term outcomes. For others, a lower side effect suppression protocol may be appropriate.
3. What to do after failed euploid transfers
Once an embryo is genetically normal, the question becomes whether the uterine environment is obstructing implantation. Dr. Talebian shared when she repeats testing, when she avoids ERA, and how she uses natural or modified natural FET cycles. She also discussed antihistamine protocols, baby aspirin, and selective use of steroids.
4. Fresh vs frozen donor eggs
Frozen donor egg banks offer speed and lower cost but produce fewer embryos per cycle. Fresh cycles through an agency give cumulative higher success rates and are ideal for those who want more than one child from the same donor. She broke down how to choose based on family building goals.
5. Low AMH does not predict egg quality
AMH only reflects quantity. It does not tell you whether an egg can fertilize or become euploid. For some patients over 40, it may be more helpful to fertilize remaining eggs rather than continue freezing cycles that produce low numbers.
6. Gestational carriers in their forties can be appropriate
Dr. Talebian discussed when a GC in her forties is medically appropriate, what risks to consider, and how lining thickness differs for carriers. She also addressed cases involving embryos frozen years earlier after cancer treatment.
7. Lifestyle, exercise, and GLP 1 medications
She explained how to exercise safely during stimulation, why bed rest is not recommended after transfer, and when GLP 1 medications are useful. A full two month washout is needed before embryo transfer.
Watch the Full Q&A
About Dr. Sheeva Talebian
Director of Third Party Reproduction at CCRM Fertility of New York.
Board certified reproductive endocrinologist specializing in infertility, IVF, surrogacy, and egg donation.
Member of the Medical Advisory Board at CoFertility and co founder of Truly MD.
