Infertility/Fertility/Recurrent miscarriage


MY wife has undergone two miscarriages (missed miscarriage) between 6-8 weeks in last Aug and Dec. Both were IUIs. Before this she had undergone 3 unsuccesful IUI and 1 IVF (also unsuccessful). After that she underwent leukocyte immunization. Both IUIs done after that resulted in conception but embryo stopped growing in 6-8 weeks (no heart beat). We have done almost all tests available here in India (thrombophilia profile,various antibodies ,karyotype for both of us etc.product of conception could not be tested ) but could not find much wrong. Her AMH was 0.01 ng/ml after second miscarriage, but is now 1.83 ng/ml. It was 4.7 before we started infertility treatment.

Can you please advise next steps. Should we  look at natural killer cells. Is there any value in doing this.  What is your opinion on doing natural cycle IUI (as we suspect the problem is egg quality and perhaps natural selection might be a better choice?)

Hello Martin from India,

Most early first trimester miscarriages, especially those that show development of a gestational sac but without a fetus or heart motion, are due to a spontaneous chromosomal defect.  That means that as the cell was dividing, one or often more of the chromosomes broke off or divided abnormally leading to a major genetic defect.  Therefore, the fetus did not develop or survive and the body realized this leading to the miscarriage.

The good thing to keep in mind is that your wife has proven that she can become pregnant.  All that is needed now is a perfect embryo.  I am not convinced that it is an immunological problem, although we tend to grasp at anything we (doctors) can when we can't explain something.  It is unfortunate that none of the tissue was ever available for genetic evaluation.

I cannot advise what should be done next without a thorough review of your medical records.  If I did, it would just be guessing.  The first question to ask is why are the embryos abnormal?  In most cases we cannot answer this question.  It is "spontaneous" as mentioned above, but in most cases, it is due to poor quality eggs as found in women over the age of 35.  Is your wife's age over 35 years old?  Beyond 35, a woman's fertility declines because her egg quality declines.  There is no treatment for this except continuing to try until that perfect egg is found.

It has been shown that in recurrent pregnancy loss, the following regimen has been successful: low dose heparin/lovenox, medrol, low dose aspirin, increased progesterone and additional estrogen.

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, 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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