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Hi Dr Ramirez,

I have found this site all the way from New Zealand and am hoping you could provide me with some other answers?
I already have a daughter who was conceived, carried and delivered easily with no problems at all (that I know of). For the past two years I have been trying to add to my family, and have suffered 6 chemical pregnancies. I recently saw a specialist but after 3 of my chemical's being with him, I am unsure how concerned he is with my problem as he only books me in for actual appointments every 3 months. I have had my egg reserve tested, my husbands sperm tested (count nad DNA fragmentation, have had a hysteroscopy and countless blood tests (DNA, chromosome, progesterone, thyroid, clotting etc) all of which have come back normal and clear! Yes, very frustrating!
What I want to know is, is there something else that should be looked at? I am currently on my 4th cycle of Clomid, and this will be my 2nd of progesterone pessaries, and my 3rd of baby aspirin. This all ontop of what I have been taking before and that is prenatal vitamins (Elevit) and Vitamin B complex.
I have home pregnancy tests that confirm I get pregnant, and then blood tests which is usually done around 14 days past ovulation. The blood tests never show HcG higher than 25. And they then continue to drop until I then essentially miscarry.
I worry that there maybe something else that is an issue? Other internal organs etc and someone has mentioned my Cervix?
Any insight to what could possibly be causing this to happen the exact same way (3 months in a row just recently) and what else I can be doing/taking?
Thank you so much for your time, and I hope my message isn't too long!

Hello Emma from New Zealand,

You don't mention your age which could be a significant factor.  If you are 35 years or older, then the most common reason for first trimester (before 12 weeks) miscarriage is spontaneous genetic abnormalities in the embryo.  This means that the chromosomes suffer some type of breakage or incorrect replication leading to a genetically abnormal fetus.  There are no treatments for this but IVF with preimplantation genetic testing (screening) could help to find the normal embryo for a successful pregnancy.

If you are under 35 years old, then only 25% are attributed to genetic abnormalities, in which case, other sources need to be evaluated.  These include many of the tests you have had done but you don't mention if you have had MTHFR or Immunologic testing done. If not, then I would recommend these.  Immunologic tests include: a full antiphospholipid antibody panel, antinuclear antibody, anticardiolipin antibody, antithyroid antibody, lupus anticoagulant.

The only other thing I can offer would be empirical treatment using low dose aspirin 81 mg per day daily (starting right away), progesterone supplementation in the luteal phase, low dose heparin 2000 units twice per day beginning at the start of menses and Medrol (prednisolone) 16 mg starting with menses then decrease to 8 mg per day at the time of ovulation.  These all should be continued until 10 weeks gestational age if you get pregnant.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at  This service will allow you to have your own personal on-demand infertility expert.


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Edward Joseph Ramirez, MD, FACOG


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.


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 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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