AboutEdward Joseph Ramirez, MD, FACOG Expertise I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications American Journal of Obstetrics and Gynecology
Education/Credentials Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
Question First, let me give you some background info. I am 30 and my husband is 32. I
have a 2 1/2 year old son that was conceived the first month of trying. My
husband and i have been trying to get pregnant again for 15 months. I am
currently seeing a fertility specialist. My husbands tests were normal and all
of my blood & urine tests were normal. My FSH was 6.1. My periods are
regular every 28-30 days. BBT looks ovulatory, I get a positive ov. predictor
every month and have eggwhite CM for 2-4 days a month. My questions are:
In the last 15 months I have had 2 months where I spotted and had cramping
5 -7 days before my period. What could be causing that? Could it have been
early miscarriages? What else causes spotting?
Last month I had spotting and cramping on days 14 & 15 of my cycle.
However, my eggwhite CM was gone by day 13. Could I be ovulating after my
CM dries up?
My progesterone was tested in June on day 19 of my cycle and reflected
ovulation. Is that sufficient testing to rule out low progesterone? The RE hasn't
done any further progesterone testing.
What are other causes of infertiliy, other than male factor and ovulatory
problems?
Thanks for taking the time to answer my questions!!!
Answer Hello Kristen,
Thank you for your question. Please let me know where you are writing from.
There is certainly something going on but it has not been found yet. What you know thus far is:
1. You are ovulatory (regular cycles, positive OPK, normal progesterone level)
2. Your husband semen analysis is normal
Have you had an HSG (hysterosalpingogram) done yet to determine if your tubes are open. Sometimes, women can form a mucus plug in the tubes, preventing the sperm from entering. The HSG can push out this plug and open the tubes. Therefore, despite the fact that you have gotten pregnant in the past, I would recommend that you have an HSG. The other test that you may require is a laparoscopy. This is used to detect pelvic abnormalities such as endometriosis and scar tissue. Circumstances, age and time could have led to one of these, and this may be causing the infertility as well. Endometriosis certainly increases with age. Have you had any abdominal or pelvic surgeries?
I hope that this helps.
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
