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Question
Hi!
I have a beautiful two year old daughter, but I can't seem to carry another baby. I had a chemical pregnancy earlier this year followed by a blighted ovum. Since then, I have had a recurrent loss panel run. Everything came back normal but a positive ANA result. My doctor told me to start on 81 mg of aspirin a day, but even with the baby aspirin, I've had two more chemical pregnancies and am scared that I'm having another. How could my tests come back normal and I'm still having such a hard time? I had no complications with my daughter and I'm only 25 years old. Please help. I'm desperate and losing hope.

Answer
Hello Amanda from the U.S. (Arkansas),

Recurrent pregnancy loss is a difficult problem, and it is possible that the cause has not yet been found, rather than everything being normal.  Have you had the following tests:
1.  Chromosomal testing in you and your husband
2.  Lupus anticoagulant
3.  Antiphospholipid panel
4.  MTHFR
5.  Hysteroscopy

In my patients, often everything will turn up negative, so I then treat empirically with low dose aspirin, mini dose heparin, estrogen, progesterone, and medrol.  This is a standard RPL protocol used by many docs.  You might want to discuss this with your doctor.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@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.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

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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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