Hi Dr. Ramirez,
Like clockwork every month on day 21 (7dpo) I get really bad cramps that last until I get my period which is cycle day 30. As well as the cramps I get this tender hot feeling and a feeling of hot liquid inside. I also get weak and shaky a few days before my period. I've recently had a laparoscopy which confirmed PCO and found Endometriosis on one of my ovaries which was removed but unfortunately it hasn't stopped or helped my symptoms. I'm absolutely petrified that these cramps are preventing me from getting pregnant as I had them with my previous failed IVF. We are doing another round of IVF soon and I'm so anxious about these pains as I feel they will stop an embryo from implanting as they are so severe I'm literally on my hands and knees from the pain. Could I have a luetal phase defect or an implantation problem?

Hello Christina from Ireland,

The pain is not due to implantation failure or luteal phase defect and I can't speak to why you might have failed the previous IVF cycle without a thorough review of those records.

The pain sounds very much like endometriosis pain, and maybe it was not eradicated in the laparoscopy.  Not having done the laparoscopy or seen a video or pictures, it is hard to know for sure.  One what to test this is a 3-6 month course of Lupron Depot to treat for any residual endometriosis.  If this is successful in relieving the pain then you have your answer.

Another possibility is a form of endometriosis within the muscle of the uterus called "Adenomyosis".  This is not diagnosable by laparoscopy or any other means.  It is a diagnosis of exclusion, or diagnosed at the time of hysterectomy.  Lupron Depot will help with this as well.

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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