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Hi again Dr, Ramirez, it's Karri again in Buffalo.  I have a question about fetal heart rates.  I changed RE's a few months ago within the practice because the original RE wouldn't look for any problems and was constantly yelling at me and being very rude and unhelpful.  I LOVE my new RE.  Thankfully, he ran some extra tests and listened to my story and found more issues.  He immediately started me on Bravelle, which I took from days 3-10.  I triggered with HCG on day 10, but had a +OPK earlier in the day.  Based on the meds, u/s x2, and charting, I know I ovulated on both 11 dpo and 12 dpo.  With these meds, I got a +hpt on 9 dpo, and for the first time in 10 pregnancies, my betas doubled accordingly.  On 18 dpo, the beta was 744.  20 dpo it went to 1744.  Progesterone was 27.5 at this time, which is almost double what it had been.  I went for an u/s to check for placement at 4w2d (LMP)/4w6d (based on ovulation).  A gestational sac was present at that time and measured 6.4 mm.  There was a yolk sac of 1.4 mm.  Yesterday I went back for a follow up for growth.  (5w2d/5w6d)  The gestational sac measured 16.4 mm (told =to 6w 0d), the yolk had grown to 4 mm, and there was a crl of 3.5 mm (told 6w0d +/-2 dayss) and a heart beat measuring 99.  I felt pretty good about that considering where I have been and the improvement in one week.  Unfortunately, my RE was out of the office and the old RE came in to review my results.  I am certain that I ovulated on CD 11 and 12 (3 follicles, 2 were gone on cd 12 when I had the IUI), so growth seemed right on track.  My new RE said he would be very surprised to see a HB at this point.  Old RE came in the room and said, "Congratulations.  I am concerned about the HB.  It should be faster.  This is too low.  I am telling you this because I don't want you coming back when you miscarry blaming me for not telling you that the heart rate was slow.  It could still work out, but I would have been much happier if it was higher."  and out he walked.  From everything I can find, 99 is good at 5w6d.  I am not sure if he glanced at my chart and believed I was further along, or if this really is too low, or if he was just being spiteful because I demanded that he no longer be my doctor.  I am certain I am no further along, as I had an u/s the day of the trigger and all 3 follicles were a day or two away from releasing.  Is this doctor trying to scare me or is 99 really to low for this poing in the pregnancy.  I finally felt like maybe the 10th time could be a charm, but now I am left worrying that I will be headed back to the OR for another d&c.  Could you please tell me if these numbers are okay and what the normal rates are for the early weeks?  I have another u/s Monday with my (nice) doctor and I am praying everything is really fine and he was just being mean.  Thank you so much for your help.

Hello Karri from the U.S. (New York),

You just described someone who should not be a doctor!

Actually, fetal heart motion starts at the end of the 5th or early 6th week so you were lucky to even find one based on your gestational age.  And, the rate was fine at this this point! At this point, enjoy the fact that you are pregnant, no matter what the outcome because you now know that it can work, and wait and see how things progress.  So far, you are doing just fine! :)

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.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate  


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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, 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

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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