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About Edward 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
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You are here: Experts > Health/Fitness > Women's Health > Infertility/Fertility > 5 IVF failure
Expert: Edward Joseph Ramirez, MD, FACOG - 10/24/2009
Question
Dear Dr. Ramirez
I am 37 years old. Married for 6 years. After I knew that I have Endometriosis I started IVF treatment and already did 5 IVF with 3 different fertility clinics with no success. In all trials the short protocol was used.
Now I’m in the process to do another trial with new doctor. He suggested to using the long protocol and expecting that the problem is in implementation. He asked for some new blood tests knowing all previous blood tests were OK. In the new blood test the CA-125 resulted 12.2. He found the following are not normal:
TNF – Alpha = 8.9
NK Lymphs % of Lymphs (CD16+56+/CD45+) = 16
He also asked for diagnostic laparascopy for uterus, I will be doing it tomorrow.
I need your opinion regarding above. What would you do if I were your patient?
Thanks for taking time reading and answering my question.
Answer
Hello Razoune from Syria,
I would not do a laparoscopy if you are going to continue with IVF.
However, I would need to review all your IVF records to see what was done and what may not have worked. IVF results are highly variable and very dependent on each IVF clinic. At your age, you should have gotten pregnant by 5 attempts, so something is not right. It could be something within you, or more likely, something with the clinic. I have seen an increase in our IVF pregnancy rates just from changing offices, where now, the air flow in our procedure room and embryology lab are isolated from the rest of the clinic. So, a simple thing like air flow and quality could make a difference in pregnancy rates. I am not a believer in the immunologic tests that your doctor did, however, I automatically add low dose aspirin 81mg per day and low dose heparin 2000 U twice per day, both starting with the IVF cycle, in patients that have failed. This generally covers the immunologic problems.
That is about as specific as I can be with the limited information that you gave me.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf
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