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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 > Tamoxifen for infertility
Expert: Edward Joseph Ramirez, MD, FACOG - 10/28/2009
Question
QUESTION: My husband (41) and I (35) are in WI and have been TTC off and on for #2 for the past 3 years. We conceived our son (born 12/2004) after 6 rounds of injections and IUI's. I have hypothalamic ammenorhhea-likely in part due to body fat below 15% (I am genetically very muscular, but of normal body weight). In 2008 I did another 4 rounds of injectable with IUI, but no pregnancy. I took a break, but recently had an increase in my estrogen level due to an Rx change in my seizure drug. I tried clomid again given that this changed and no result. I would like to try another drug- and tamoxifen was mentioned by one specialist, but the one I worked with in the past with the injectable said that if clomid didn't work, neither would any other oral medication. Do you have any thoughts on this. I would love to have another child- but can't afford to go back to the injectable / IUI or IVF.
ANSWER: Hello Dana from the U.S.,
Tamoxifen would not work. It is an site specific estrogen, just like Clomid, which works by blocking the estrogen receptors and tricking the brain into thinking that it is not producing adequate estrogen. The brain (hypothalamus and pituitary) then increase their secretion of FSH to stimulate the ovary to produce more estrogen, which is done through ovulation.
If your estrogen levels are already increased, these drugs do nothing to stimulate more FSH production. In addition, if you have a hypothalamic disorder, FSH is not being produced, which is why you don't ovulate. The ovary can only be stimulated to ovulate with FSH. You have to provide FSH, which is only available by injectable medications.
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
---------- FOLLOW-UP ----------
QUESTION: what if the ammenorhea is simply "unexplained"? Does the above response still apply?
Answer
Hello Again,
Amenorrhea should not be "unexplained." There must be a reason for it. Hormone blood testing will usually reveal the answer. If the FSH and LH levels are low or nonexistent, then it is pituitary or hypothalamic. If they are normal, then it is ovarian. If it is ovarian, i.e. normal FSH/LH levels, then Clomid might help, but there is a subset of patients with ovarian dysfunction, called PCOD, that do not respond to Clomid. In this case, FSH must be given as an injectable medication to try to stimulate the ovary.
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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