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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

You are here: Experts > Health/Fitness > Women's Health > Infertility/Fertility > Early miscarriage

Infertility/Fertility - Early miscarriage

Expert: Edward Joseph Ramirez, MD, FACOG - 11/10/2009

Question
Hello Dr. Ramirez,
I am 40 years old and have been married to my husband for 3 years.I have one child from my first marriage. For the past three years, we have not used birth control in any form. Our feelings have always been if we had a child, great! If not, it was not meant to be for us. However, I have had four of what we believe to be early miscarriages but they were never confirmed by home pregnancy tests. These events happened exactly the same way... 1 week before my period was to start...extensive bleeding with a large clot followed by smaller ones, cramping with several days of darker bleeding and then an abrupt stop. The onset is always sudden unlike my regular period and I experience no warning signs typical of my normal cycle...back ache, bloating...My question is that is this indicative of a chemical pregnancy or am I experiencing changes of age? My regular OB/GYN has not acknowledged these events as pregnancies because they were not confirmed. Initial bloodwork he ordered showed that my prolactin levels elevated. I am scheduled to see an infertility specialist in 2 weeks but I am not sure what to even ask. I do know that I feel such as sense of loss after each of these events. If I am indeed getting pregnant and then losing the pregnancy...what tests can be ordered to find possible solutions?
Additionally, are there tests available for identifying pregnancy in the first 2-3 weeks? Thank you so much for your time.

Answer
Hello Julia from the U.S.,

I cannot acknowledge that you were pregnant and miscarried either. First of all, most chemical pregnancies would last a little longer. That is, you would be late for your period. In the ones where the period comes on time, there would be no noticable difference with your normal period because the pregnancy never developed enough to cause a change. The heavier bleeding, clotting and cramping usually comes after 6 weeks gestational age because there is a distinct sac that has developed and grown and sometimes a fetus. For that reason there is more tissue to expel(heavier bleeding and clots) and the uterus has to work harder at it (increased cramping). So I don't believe you have a recurrent miscarriage problem and would not recommend anything for it at this time. That is, I would not recommend an evaluation for recurrent miscarriage or treatment for recurrent miscarriage. You would need to prove that you are getting pregnant first.

Because of your age, the chances of pregnancy are significantly decreased (10% per year of trying. It is 85% per year prior to 30 years old). There is also an increased risk of miscarriage due to abnormal embryos. Those are your two obstacles and they are big ones. A reproductive specialist will probably recommend IVF to you as the treatment of choice just because of your age. It gives you the highest chances of success (27-30% per attempt vs 1% per month naturally). However, this is the most invasive method and the most expensive. If you and your husband are going to accept not having children ("if we had a child, great, if not, it was not meant to be for us"), then you may not want to proceed with this treatment. However, if you are determined to have a child, which is within the realm of pssibility, then this is the best option for you. If you choose the letter, then I would recommend that you not get frustrated or feel bad if your period starts, acknowledging that you are not pregnant. I know that is a hard thing to do, but if you are going to leave it to chance, why worry or think about it? If you really want it, go after it with earnest.

In terms of what could be causing this change in bleeding, it could be an age related change. A cycle day # 2 or 3 hormone test will be able to see if your ovaries are nearing menopause already. In terms of testing for pregnancy, we can usually detect pregnancy within 7-10 days after ovulation by a blood pregnancy test. You could do that prior to the onset of your period to see if you might be pregnant.

I hope this helps,

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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