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QUESTION: Dear Dr Ramierez,
Let me start by saying thank you for the time you spend answering these types of questions. I've read your responses & appreciate your compassion & expertise. Here is some info about my situation. I am 33.5 yrs old. My husband & I found out we were expecting our 1st child (my 1st pregnancy) on my 33rd birthday. Sadly, we miscarried at 9.5 weeks (Sept 22, 2012)) I decided to proceed with a medically managed miscarriage (Cytotec) but it was incomplete & I had to get a D&C to eliminate the rest of the material on Oct 18, 2012. I had my 1st menstrual period about 2-3 weeks later. I have used OTC Clearblue Easy ovulation tests & which have indicated that I have ovulated every month since the D&C. I also continue to take prenatal vitamins but have not become pregnant. I am worried that I have a fertility issue as my husband I have tried to conceive since I went off of oral contraceptives in May 2011. Until that time I had taken various oral contraceptives regularly since the age of 18. I had taken them mostly because I had agonizingly heavy & painful periods. With regard to my periods now that I am off the contraceptives they are very heavy for about 3-4 days with heavy cramping, heavy bleeding & nausea; I also have significantly more acne. My menstrual cylcle was 27-32 days before miscarriage but is now 26-28 days. Since the miscarriage I've also experienced increased breast pain with clear nipple discharge & back pain on top of the other symptoms. I also have a small fibroid about the size of a nickel & a small polyp (smaller than a dime) I am told but my ob/gyn said their location @ the lower part of my uterus & small size shouldn't impact my ability to conceive? So here are my questions:
1) Do you agree that the size & location of the fibroid & polyp are not worrysome?
2) Could I have a low progesterone problem? I've had anxiety for yrs & have read that this in combination with the acne, longstanding oral contraceptive use, amenorrhea & my thin frame 5'8" @ 137lbs  could indicate that I am not producing enough progesterone.
3) Could I have some other sort of hormonal imbalance?
4) Is it normal for period symptoms to become more severe after a miscarriage or is this a potential fertility problem?
5) Would you recommend that I see a fertility specialist?
6) Is there anything I can do on my own to improve my chances of becoming pregnant? I continue to take prenatal vitamins & just started taking other supplements like Vitex & evening primrose oil. I avoid alcohol & caffeine but sadly can't seem to reduce my stress. Otherwise I am in good health & have no other medical conditions
7) Is there a genetic component to miscarriages? My mother had a total 3 miscarriages out of 5 pregnancies. I have 1 sibling. My maternal granmother gave birth to twins (1 of which was stillborn)

I know this is lengthy so I thank you for your thoughtful consideration of my situation. We'd really love to have a child soon.
Kyle

ANSWER: Hello Kyle from the U.S. (Illinois),

Let me take your questions in sequence:

1.  The size and location of the polyp should not interfere with your fertility.
2.  The symptoms you are having do not correlate with progesterone.
3.  There could be some type of hormone imbalance based on some of the symptoms that you have such as increased acne.  
4.  It is not normal for menstruation to change after a miscarriage, unless there was some pregnancy tissue left behind (retained products of conception), and this should not be a cause of a fertility problem.  Getting pregnant occurs way before the menstruation would stop and in fact, menstruation will not occur if you become pregnant.
5.  Yes.  Make sure you find a competent and compassionate one.  Don't go to a factor fertility center.
6.  Other than timing your intercourse appropriately, there is nothing else that can help, except maybe taking a low dose aspirin tablet (81mg) per day.
7.  Most miscarriages occur because of spontaneous genetic abnormalities.  These are genetic defects that occur as the embryo is dividing and not necessarily due to an abnormality that you or your husband carry.  However, a genetic abnormality that you are carrying can lead to recurrent miscarriages.

Good Luck,

Dr. 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 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


---------- FOLLOW-UP ----------

QUESTION: Thanks again for taking the time to answer all of my questions.  One last follow up question:
1) what is a factor fertility center?

Much appreciation,
Kyle

Answer
Hello Again,

I must say that I have absolutely no idea what a "factor fertility center" is.  I've never heard of it or such a thing.  Let me know what you find out.  Could it just be the name of a regular fertility clinic?  Maybe the doctor's last name is "Factor"?

Good Luck,

Dr. 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 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

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 19 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, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

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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