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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 > Regarding Missed Abortions!!

Infertility/Fertility - Regarding Missed Abortions!!

Expert: Edward Joseph Ramirez, MD, FACOG - 11/4/2009

Question
QUESTION: Hello doctor,

I get conceived naturaly. But the baby's heart beat stops when it grows to 58-65 days and the doctor confirms it as Missed Abortions. I have already had 8 abortions till now all falls in the same period of 58-65 days. I have taken all the test like Antibodies, TORCH, LH, FSH, BOH Panel, TSH and even a laproscopy of my uterus. There are no abnormalities in any of the above reports. The doctor had even sent the Chorionic villi cells (POC) for chromosome test after they do the MT (Aboriton).But the result is cultures did not show any metaphases. i have takent he chromosomal analysis for both and the sperm count of my husband is more 70% (Motility. Please help me

ANSWER: Hello Priya from India,

If you have had 8 miscarriages in the early first trimester, you have a disorder called recurrent abortions and need to undergo a thorough evaluation. You have done a lot of this testing. You don't mention your age, but that could be a factor as well. The incident of miscarriages increases with increasing age due to spontaneous chromosomal abnormalities. It is too bad that the POC could not be cultured for the chromosomes because that would have been an important finding. Based on what you say, I presume your chromosomal testing and your husband's chromosomal testing were normal.

The only other testing that would need to be done is immunological testing. This would be a complete antiphospholipid antibody screen (21 points#.

In my patients, one they have recurrent miscarriages, I automatically use the following protocol:

Aspirin 81 mg daily beginning with the onset of the period.
Heparin 2000U injections twice per day beginning with the onset of the period
Medrol 16 mg daily starting with the beginning of the period then decreasing to 8 mg after ovulation.
Progesterone #Crinone or Endometrin) starting on cycle day#16.

The Medrol is stopped if the pregnancy test is positive, and the rest of the medications are continued until the pregnancy is 10 weeks gestational age. These are mainly treating immunologic causes for the miscarriage, so you have to make sure that it is not genetically caused.

That is what I would recommend for you to try.

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: Doctor,

Thanks a lot for your reply as all the doctors would give me a plain blank answer as Unexplained Infertility and would discuss this issue with my doctor. You had asked about my age. I am 28 years and my husband is 30 years old.Both our chromosomal reports show they are normal and no abnormalities. They have not used the above medicine for me. The Doctor has told that she would give me asprin once my pregnancy is confirmed. I am just waiting to check my pregnancy as i went through a follicular study and had a natural way of conception. I had tried IUI twice before but the result was same missed abortion. My doctor has told that she would try IVF once and then ET. Is there any chance that my baby would survive after doing an IVF or ET. Please help me. Can i try these medicines without my doctors consultation and just wanted to know are there any side effects for these medicines. Please help me....

Answer
Hello Again,

You will need to discuss your options with your doctor. Because you are young, your miscarriages are not the result of age related factors, so there could be something else going on. In my clinic, I would put you on the medications I mentioned previously.

You need to be monitored by a doctor if you take these medications so I do not recommend that you put them on yourself without a doctor's prescription.

IVF is the treatment of choice in your case, and you might want to proceed to that treatment level.

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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