Monday, December 26, 2011

Implantation Problems & Causes Of Chemical Pregnancy


Question:

Hi again, it's K. in NY. I have written to you in the past about my difficulties staying pregnant. I have had 7 chemical pregnancies in the past 18 months and one miscarriage at 9 weeks after using femara (you felt it was probably due to a respiratory virus I contrated around 6 weeks). I tested positive for MTHFR mutation heterozygous but also this didn't appear to be the issue.

I guess I have a 2 part question for you. The first would be related to causes of chemical pregnancies. My progesterone levels have been on the low side of normal (even during the pregnancy that ended in miscarrige) and I really thought that was the cause. I was placed on 50 mg suppositories 2 months ago and I did get a positive result this month (8 DPO Hcg 12, progesterone 18.8, took femara and progesterone) but my HCG level was back to <5 on 10 DPO.

Are there other implantation issues that could be my problem besides chromosomal abnormalities and low progesterone that lead to a pregnancy not progressing? I know I shouldn't test early, but I was trying to establish if low progesterone levels were the cause of my losses.

Part 2: is it possible to just have an underlying HCG level that elevates above 5 regularly, and if so, what would that signify? As you may remember, my old RE wrote off the HCG values as me eating too much cereal and developing an antibody to HCG that triggers pregnancy tests. I will be visiting a new RE soon and want to be sure to ask the right questions and supply the best information.Thank you very much for all of your insight and for volunteering your services. Merry Christmas!

Answer:
Hello K. from the U.S. (New York),

Let me take the second question first since it is the easier of the two to answer. The answer is NO, you can't have an underlying HCG level from cereal or any other source other than pregnancy. Serum pregnancy tests are very sensitive and testing for the beta subtype (bHCG), so there is no cross reaction even if the cows you were using the milk from were given hormones for some reason (I presume that is what your old RE was thinking as a source. A little far fetched if you ask me).

In terms of your chemical pregnancies, that is a difficult problem to answer. If you have already undergone a complete recurrent miscarriage evaluation (hormones, infectious diseases, anatomical, genetic, immunologic) then we may not have the technology to find the exact cause. However, the hormonal is easy to check through blood tests, and I automatically place my patients on progesterone supplementation just in case; anatomical testing would take an ultrasound and hysteroscopy, again an easy test; and infectious diseases and genetic are also easy to test. The only one that is difficult and not completely understood is the immunologic component. Many authorities have looked into many different immune factors.

If you look at a website by Reproductive Immunology Associates, who have made a practice of the immunologic causes of miscarriage, you will see lots of different test that they recommend. Because this component is so difficult to define, experts have conflicting opinions.

If you were my patient, I would put you on a protocol that I use and, for the most part, have been successful with. It involves taking aspirin 81 mg per day starting at the beginning of the cycle, medrol (prednisone) 16 mg per day taken from the beginning of the cycle then decreasing to 8 mg after ovulation, progesterone vaginal suppositories beginning after ovulation and, finally, heparin 2000 units twice per day subcutaneously beginning at the start of the cycle. The aspirin, medrol and heparin treat for subclinical immunologic problems and the aspirin and heparin also help to increase blood flow at the microvascular level at the implantation.

Good Luck & Merry Christmas to you too :) ,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.

Comment: Thank you SO much for your opinion. I will definitely have to look into these additional things. Glad to hear that I am doing all that I can do on my own and that I am advocating for the right things. It makes a HUGE difference when you have an idea what direction you should be headed so that you can work with a doctor to get there. Merry Christmas!

137 comments:

  1. I've now had 4, possibly 5, CP's. Thank you for the advice. I am going to show my RE.

    ReplyDelete
  2. Hi Dr. R, this question is unrelated to CP but I was unable to add to the bleeding after ET section. I hadmy day 5 blastocyst frozen embryo transfer yesterday morning. I had been on daily progesterone pessaries but yesterday swapped to injectable progesterone. This morning when I went to the bathroom I have passed a small bright red clot and have very light red blood on wiping as well as light stomach cramps and lower back pain. It is too early for my period but I am very worried and am still waiting to hear back from my clinic. I would appreciate any advice. Thank you
    -J

    ReplyDelete
    Replies
    1. Hi,

      There is no way to know what exactly is going on but keep in mind that not all vaginal bleeding ends up as a miscarriage. I have had, and many have also reported many cases, of post IVF patients having vaginal bleeding and continuing with a successful pregnancy. At this point, you'll have to wait until you have your pregnancy test to know what the result is. That is all that can be said at this point.

      Good Luck

      Delete
  3. i had a positive pregnancy test sept 9th and went to the dr on sept 25 they told me i wasnt pregnat and didnt explain anything and didnt even do an ultrasound or anything... af came on sept30 which used to be normal but 2 months before concieveing i was getting 2 menstrals a month and going with the one i got pregnat on i should have been due for it on sept 16th. im so confused as to everything because my Dr didnt really say anything and looked at me crazy when i told her i am 100% sure i was pregnat. i also had mirenia and had it removed in april any advice to concieving woud be GREAT because this game of trying is making me lose sleep

    ReplyDelete
    Replies
    1. I'm afraid I wasn't quite following your story but the best advice I can give is for you to see an infertility specialist, NOT a GP or general Ob/Gyn. That specialist could then advise you on how to proceed to here so that you don't "lose sleep" trying to get pregnant. Also, you need to find a doctor that listens to you and NOT think you're crazy.

      Delete
  4. I just had my 4th chemical pregnacy i have a blood clotting disorder my doctor gives me clexane only once we know if im pregnant my question is would it help to take clexane after i have my iui could this help

    ReplyDelete
    Replies
    1. I will not contract your doctor's protocol, as protocols can vary widely. But in general, with patients that have recurrent pregnancy losses, the medication is taken on a daily basis from the beginning of the cycle where you are attempting pregnancy and continued until 10 weeks gestational age of the pregnancy. It is stopped if the pregnancy test is negative.

      You'll need to ask your doctor about the specifics of the protocol he is using and also ask him if he can refer you to information regarding that protocol.

      Delete
  5. Hi docter

    I am 33 years old living in isreal i have had 4 chemical pregnacies the specialist said once i fall pegnant to start pregnel injecion twice a week but that did not work my doctor is now startng me on clexane from day 12 of my cycle along with 20mg of prednisone until 6 weeks of pregnacy i do have a bloog clotting disorder the docter found clymidia but it was taken care of with antibiotics
    do you think this is the right treatment
    thanks
    dani

    ReplyDelete
    Replies
    1. I will not contradict or comment regarding your doctor's protocol. There are lots of variations, none of which are absolutes.

      My protocol in recurrent pregnancy loss patients is to use low dose aspirin 81 mg from the start of the cycle, heparin or equivalent from the start of the cycle, medrol (methylprednisolon) 16 mg from the beginning of the cycle, estrogen from the beginning of the cycle and then progesterone (both injectable and vaginal) from just after ovulation. These are all continued until 10 weeks gestational age if pregnancy occurs.

      Not all doctors use this protocol.

      Delete
  6. hi doctor im 26years old female wt 56kg with normal BMI want to concieve since 2years my fsh lh ratio is altered 3.6:7 and i have oligomenhorrea so my doctor diagnosed me as pco i got ovulation induction with clomiphene citrate 50mg od and responded in my third cycle with 150mg dose on day 12 i had scan for follicular tracking that showed mature follicle i got beta hcg inj im but i didn't concieved in that cycle after that i took an other cycle of clomiphene 150mg after 1 week of missing period i got my urine pt positive and after 1 more week i had my scan that showed non gravid slightly enlarge uterus with thick endometrium after then within 2 days i had miscarrige may be loss of chemical pregnancy my doctor advised me not to take ovulation induction for 3 months after that miscarriage i had my menses after 35 days and in this cycle im 2 days overdue than my 35 day cycle but my urine pt is still not positive im taking tab duphstan 10mg as hormonal support but i m confused of my situation and want your expert opinion for my case what will you suggest if im your patient

    ReplyDelete
  7. Hi !moiseur ! Im from india.
    Im 25 yrs old and mom for 2 childrens and
    Ttc for 3rd child for 1yr,i have pco past 1 yr,
    And my fsh,lh all hormonal test are normal,
    For my last two babies are formed normally
    But y I can't concive naturally? My doctor prescribed metformin daily,3-7 days of my cycle letrozole 2.5mg 2 tab at night, she told me to reduce my weight and she told u will be concive this month or continue this tab next month u will concive other wise come at march 2013 we will see an x-ray ...would I get pregnant or our fails? And one more thing I need yo concive and give birth to boy baby..any way for it?
    MERCY BOQUE...MERRY CHRISTMAS AND HAPPY NEWYEAR..!

    ReplyDelete
    Replies
    1. Hello,

      I'm American, just so you know. I'm skeptical of the doctor you are seeing because she is not monitoring your response to treatment. Usually an ultrasound is used to evaluate the ovaries to see if you are responding to that particular dose of medication. She is not doing that. How can she know if you are responding, how many follicles are forming, whether or not they are growing and when ovulation is going to take place? A good and competent doctor would be checking and that is what you need.

      If ovulation is the only problem that you have, assuming you have had a complete infertility evaluation, then once you arrive at the problem medication and dosage to get you ovulating, I would expect you to eventually achieve pregnancy.

      I would stop the metformin. I don't think it is necessary unless you have been shown to have insulin resistance. Most doctors over use this medication thinking it is the treatment for all PCOD patients. It only works in about 30%.

      Finally, in terms of having a designated sex in your baby, the only way to do that is to undergo IVF with preimplantation genetic testing.

      Good Luck

      Delete
  8. Hello Dr. Ramirez,

    I've had 3 miscarriages (all between 6 - 11 weeks) and I am now almost 36 years old. I've had all the testing done (except for loss genetic testing) and I'm fine on all testing. 2 Fertility specialist have referred me over for IVF or to consider an egg donor ... one considered treating me for the immune problem by using neupogen (although I haven't really had any 'immune elaborate type' testing).

    The only thing I did in the last misscarriage was that I used progesterone, metformin, baby aspirin and synthroid. I'm still taking the metformin and synthroid ... it's now about 2 years later almost 3 yrs down the road and I'm starting to have different results now on my hormone testing (AMH, FSH, Estradiol) which again the reproductive specialist said I'm probably going into premenopause now. I was adviced to try naturally on my own again and test at home for my LH surge then start the heparin and progesterone on day 4 past my LH surge. So i've tested this month from calendar day 10 to day 18 all with negative (or no LH surge). My question is ... should I start the heparin and progesterone just in case I might be pregnant?? (With my previous pregnancies the progesterone was started well after 4 weeks of already being pregnant and perhaps it was too late to prevent a misscarriage). Trying these medications is all I've got left since I don't have kids and don't have the funds for IVF here in the states. Also I've always gotten pregnant on my first try without timing ovulation and my husband does have a child on his own already so he is not the problem.

    Thank you for your time and suggestions.

    Colombian from the Southeast.

    ReplyDelete
    Replies
    1. Hello,

      Unfortunately you have eliminated the ideal treatment at this point (IVF), which would give you the highest chances for pregnancy. If you are going to try naturally then I would recommend low dose aspirin, medrol, heparin and progesterone. The aspirin, medrol and heparin are started at the beginning of the cycle and taken all the way through. The progesterone is not started until after ovulation. Because you will have progesterone on board, you will not necessarily have a period so a pregnancy test has to be planned.

      Keep in mind that ALL these treatments should be under the direction of your doctor.

      Good Luck

      Delete
  9. Sir,
    Greetings
    We r from india.we want your valuable advice.we are trying to concieve for the last four years but failed.As per mt gyn. my sperm count,motility,morphology normal.Hee M.C. regular.tubes are open .ovulating regularly.every reports are normal.we did 6 iui but failed.now what sir?

    ReplyDelete
    Replies
    1. There is something wrong but it has not been found yet. In general, if IUI fails four times, we recommend that you move to IVF because something is interfering with the natural process to achieve pregnancy. I think you are at that point. If you don't want to do IVF, then you would need to have a laparoscopy to see if there is endometriosis or scar tissue within the pelvis, a hysteroscopy to check for uterine cavity issue, a cycle day #2 or 3 hormone panel, and an end of the month endometrial biopsy for dating to rule out luteal phase defect. These are the tests you don't mention whether or not you have had done. I would not recommend any more IUI's.

      Delete
    2. i forgot to mention that we did laproscopy.gyn says my wife has polycystes ovarian syndrom and we did a n operation with the laproscopy to remove it.the other things are quite normal as laproscopy report.one thing i want to add is that her weight is only 38.plz advice.

      Delete
    3. If you have done the laparoscopy (PCOD is an ultrasound and hormonal diagnosis, not a laparoscopic one) and you have failed at least four IUI cycles, then the next treatment recommendation would be IVF.

      Delete
    4. I am from Nepal. I am 33 yearrs old.I have had 2 miscarriage,one with blighted ovum and one is spontaneous miscarriage. I am really desperate to try again but my doc suggested me to wait for 6 months, Is it necessary to wait?

      Delete
  10. Hello. I had 3 miscarriage the last one on 1-5-2013 we want to have one more baby

    ReplyDelete
    Replies
    1. You need to see a fertility specialist and undergo testing for recurrent miscarriage.

      Delete
  11. Hello,

    I have been trying to have another child for the past 8 years. I have gotten pregnant several times without help and they have all ended in miscarriage. After my son was born in 2002 I decided to go with a copper iud for birth control. I had it removed 4 months later due to heavy and painful menstrual cycles. Since the removal, my cycles have not changed. My cycles are heavy and clotty. I have been to 2 different RE and have had rpl blood tests done and everything always comes back normal. I had a d&c and testing on the fetus which all came back normal as well. I am now 35 years old and would like to have one more child. I am married and haven't changed partners. My husband has also been tested and all is normal. My question is do you think something could have gone wrong with the iud or do you have any suggestions on what you think may be happening and how I can maintain a pregnancy?

    ReplyDelete
    Replies
    1. Hello,

      I can't give you any specific suggestions without a review of your medical records to see what tests have been done and whether there are any that have been missed.

      Delete
  12. Hi doctor,

    Is there any difference in progesterone quality between endometrin and prometrium?

    ReplyDelete
    Replies
    1. There is no difference except that Endometrin was made specifically for vaginal supplementation and Prometrium was not. You can use either one and they both work adequately.

      Delete
  13. Hello, I'm 39 with a 19 year old. Been ttc on and off for 17 yrs. Have had 30 cps. Genetic tests done on me and dh, everything was normal. Never gotten pregnant on a medical cycle. I mc by 4 weeks. My uterus is normal. Was wondering what good will IVF do if the embryo has difficulty implanting? Also I've been on progesterone suppositories and injection, some months they work others the don't the biopsy has come back 9 days off. Havent been able to regulate anything or to find a real reason after all this time.

    ReplyDelete
    Replies
    1. Hi,

      Because of your age, you are at high risk for miscarriages. This is what we call the "age factor". A woman's eggs become more and more debilitated with age and so lead to increased chromosomal breaks and abnormalities.

      IVF is the treatment of choice for recurrent pregnancy loss, especially if genetic testing is done on the embryos prior to implantation.

      If the endometrial biopsies are still showing a lag in development after progesterone treatment, that means you need to increase the amount of progesterone.

      Finally, there may be other causes of miscarriages including hormonal, genetic, anatomical, immunologic, infectious disease. All these need to be evaluated.

      Delete
  14. Hi Dr. Ramirez,

    I am currently going through a chemical pregnancy on the first time I have gotten pregnant after trying for many months. I have had a short luteal phase but this past month when I got pregnant, I used soy (known as nature's clomid) and ovulated much earlier in my cycle. I've had the CD 3 and CD 21 day tests and everything was normal except for a very slightly elevated (4.005) TSH (which I am now taking synthroid for).

    My question is about a weak lh surge or weak ovulation. I have been using opk's twice a day using several different brands for the past 4 months and have never had a positive (I see faint lines but never as dark as the control line). I am still ovulating as my progesterone was 10.7 on CD21 and I get a temp. rise every month. Could the negative opk's indicate a weak ovulation? Could this be the cause of my difficulties getting pregnant and chemical pregnancy?

    If so, would clomid be the fix for this?

    I really would appreciate your opinion.

    Thanks.

    ReplyDelete
    Replies
    1. Hello,

      There is no such thing as a "weak" ovulation. Ovulation either occurs or it doesn't occur. Your mid luteal progesterone levels indicate that you ovulated so the ovulation predictor kits are probably defective.

      Early pregnancy losses occur for embryo abnormalities, implantation problems, endometrial problems or hormonal problems. An reduced thyroid level could certainly be a cause for an early miscarriage, as could inadequate progesterone levels (luteal phase defect).

      Good Luck

      Delete
  15. Hi, i am 30 years old and having been trying for a baby for nearly 4 years. I have suffered from 2 miscarriages about 2 years ago both at about 8 weeks gone. After the miscarriages i have struggled to get pregnant again and my periods were all over the place, sometimes not having one for about 3 or 4 months. I was referred for tests including a lap and dye test. They found i had Polysticic ovaries which could be reason for irregular periods. I was prescribed clomid and for the 1st cycle it didnt work as i didnt have any mature follicles. The 2nd cycle was alot better and i was told i had 1 mature follice and was then given an injection to help me ovulate. I did a pregnany test the day of missed period and there was a very faint line i then did a digital test a couple of days later which showed i was pregnantc 1-2 weeks. A few days later i started suffering from cramps and had a brown discharge. I decided to do another test which then showed i wasnt pregnant. As you can imagine i was really confused, was i pregnant or not?? I have now started bleeding heavily.
    My first question is have i suffered from a chemical pregnancy and is this bleeding classed as a proper period? Secondly should i start my next round of clomid? I'm worried if i dont take it then i might not have another period for a few months. Any advice would be appreciated.

    ReplyDelete
    Replies
    1. Hello,

      It is possible you had a chemical pregnancy but without having done a blood pregnancy test, that cannot be confirmed. I don't try home pregnancy tests as my definitive test.

      If you have PCOD, that means you have an ovarian dysfunction that is causing a lack of ovulation. That is the reason why you skip periods. In order to get pregnant, you have to undergo a treatment called ovulation induction, which is what you did with the Clomid. It can also be done using other medications such as Latrezole or the injectables. You will have to use one of these. I would also recommend that the Clomid dose be increased since you only had one follicle. Finally, if done correctly (and your doctor knows what he/she is doing) almost all fertility specialists will supplement the postovulatory luteal phase with progesterone to prevent a chemical pregnancy or miscarriage that occurs because of inadequate progesterone (luteal phase defect).

      Good Luck

      Delete
  16. Hello,

    It sounds like you may have had a chemical pregnancy. I might recommend that if your doctor is going to prescribe Clomid for you that you should have him do a scheduled pregnancy test 10-14 days after the time of ovulation. It is more reliable that a urine test AND it is good information to know because you know the cycle worked.

    In addition, it is standard to use progesterone supplementation with Clomid cycles to help the luteal phase, which is important for implantation and maintenance of the early pregnancy. You didn't mention that you did this but if your doctor knows anything about infertility, that is, he is a specialist, then he should know this too.

    Finally, I would recommend that you take low dose aspirin (81 mg) with your cycles.

    PCO is a difficult problem to treat adequately and you really need to seek out a doctor that IS a specialist and has experience in treating it.

    Good Luck

    ReplyDelete
  17. Hello,
    Im 27 yrs old and my husband is 33 yrs . We ve been trying for 2 yrs now unsuccessfully and decided to do an iui in november . I was tested before the iui and sperm count was normal and my blood works and hsg was normal .That cycle was a failure . The next cycle after that i got my periods on time , but started bleeding 2 weeks later and my hcg was 60 . I was told that i had a chemical oregnancy . 2 months since then i ve been trying naturally with no luck . Im confused about what should be my next step . Iui or ivf . Im extremely stressed and worried with all these things .I would like to know what sould be my next step . Thank you for your time and help

    ReplyDelete
    Replies
    1. Hello,

      If you had a "natural" chemical pregnancy after your first IUI, that shows that you have the ability to get pregnant by natural means. IUI is a "natural" treatment because it relies on the body to do all the steps naturally. My recommendation would be to continue trying with IUI. I don't think you need to do IVF yet (unless you want ot get pregnant fastor). Keep in mind that because IUI is a "natural" treatment, it can take several attempts (up to four) just as it can take several months for a normal woman to get pregnant when trying naturally. We don't recommend more than four attempts because statistically most women will be pregnant by four attempts. Since you got pregnant previously, you would start your count over. If you fail after four attempts, then you should proceed to IVF.

      Good Luck

      Delete
  18. Hi, I am 29 years old and I have had 1X ICSI and 1X FET and despite having transferred excellent day 5 blastocysts no success. My FS proceeded to do blood tests (to rule out immunological issues) and did a hysteroscopy and D&C. The results came back normal for the blood tests and other than a thick fundus and 3X 1-2mm fibroids; my uterus appears to be normal. So nothing was found to explain why the embryos did not implant.

    The protocol that my fertility specialist (FS) followed for my IVF is as follows: Lupron (1X per day), Gonal F (3X per day), Ovitrelle (trigger) and cyclogest (started taking them the day of trigger). My FS retrieved 10 eggs of which all fertilised.

    FET: Estrofem and cyclogest

    Are there any supplements that I can take or is there anything that can be added to my next cycle that might help with implantation issues?

    Kind regards
    A

    ReplyDelete
    Replies
    1. Hello,

      Implantation is dependent on many factors including the embryo, uterine lining, hormonal support, blood flow, immunological factors and embryo transfer technique. The latter tends to be the most common reason for implantation failure and should not be overlooked. That is why pregnancy rates vary from doctor to doctor and clinic to clinic.

      There are many different protocols that can be used in cases of implantation failure, too many to mention here. That would require a thorough review of your medical records and a consultation, which you can schedule via my website. You might also want to read through what I have written about implantation failure within this blog.

      Good Luck

      Delete
  19. Dr. Ramirez,
    I recently had a chemical pregnancy and I was wondering if I should wait a regular cycle before we continue trying to conceive or if we can continue right away? I don't really want to wait as it took us 8 months just to have the chemical pregnancy, but I don't want to risk causing any problem or causing another chemical pregnancy. Are there any risks / benefits associated with either waiting or trying right away? - Thank you

    ReplyDelete
    Replies
    1. There is no reason to wait. Recent studies have shown that a woman's chances of pregnancy increase within the first 6 months after a miscarriage. Once your cycles return, you can start trying for pregnancy again.

      Good Luck

      Delete
  20. Dear Dr. Ramirez,

    I am 42 y old single currently leaving in indonesia.
    i had my first failed IVF in november 2012, protocol antagonist, 2 eggs grad A only, both fertilized and both were returned on day 2(4cells).Unfortunately did not work. I have planned my next one in march after a DHEA suggested treatment, but on february 20th my menses arrived very early (20 days only cycle).
    I have informed my doctor via email (in india) and she suggested to take baby pill to control the next cycle, after 2 days i have read on the net that the combination of DHEA and birth control pill was not recommended, so I ask my doctor and she agree and told me to stop the pill. Today 28 february I am bleeding again...
    My questions are:
    Is DHEA recommended for my case of diminished ovarian reserved ? Could it improve my chances ? Do you recommend it to your patients?
    Was it a mistake to take the pill for this 2 days and then stop it and could that compromise my chances for my next IVF mid march ?
    Should I delay the next IVF to april to Have better chances ?
    Could you give me any advice to improve my possibility to make this dream come true ?if you need any more info please do not hesitate to ask me.
    I am so happy i could find your web and being able to ask you directly.
    Thank you for your help





    Should I delay the treatment to april ?
    I am well aware that it will not be easy to to get pregnant, but I am not ready to give up for now.

    ReplyDelete
    Replies
    1. Hello,

      DHEA and OCP's do not interfere with eachother and are used together in IVF cycles. DHEA is one of those medications that many clinics try because they can and not because there is any medical evidence supporting its use. I do not use it. At this point in time, there is nothing proven that can increase egg quality. There has been a study showing that taking CoQ 10 600 mg per day increases egg quality in mice but human studies have not been done. However, because there are not side effects to CoQ10, I prescribe it to my patients.

      I think you need to find a BETTER doctor. Your chances of getting pregnant because of your age will be heavily depedent on the skill of the doctor, the laboratory you use AND the medication protocols, as well as, obtaning a good egg. Part of my reason for recommending this is I have not heard of ANYONE doing a D#2 embryo transfer for over 15 years! That makes me very skeptical of your doctors' credentials.

      You should always skip a month between IVF cycles because of the medications effects on the ovaries.

      Good Luck.

      Delete
  21. Hi Doctor, I'm 41 year old. I did two IVF so far, both with good embryos (grade 1 no fragmentation, 8 cell), put back in total 7 embryos, all BFN, not even a chemical. My RE said good looking embryos doesn't mean they are normal. So next time he wants to up my dose and get more eggs. Since I have never got pregnant (including no m/c), I feel my uterus may not be receptive to implantation even though my lining has always good at 11-12mm. So I did the Yale EFT, it came back mildly abnormal and I was told the only reasons could be either endometriosis or too much stress. I then did a laparoscopy and found 0 endo. In my case, do you think I have uterus problem? or just need to keep trying and find that golden egg that not only look good but is also normal? Thanks a lot, -CP

    ReplyDelete
    Replies
    1. Hello,

      Your doctor is correct in that the method that we use to "evaluate" embryos at this time is not complete. The "grade" that we give is based on external appearance. I tell my patients that it basically means "beautiful, normal, ugly". In reality it is not evaluating the most important parts of the embryos which are internal. We don't have the technology for that. Based on your age, you are at increased risk of egg and embryo problems, such as genetic defects, that could lead to a lack of pregnancy. What this means is that you are trying to find the one "golden" egg within a basket of bad eggs. Therefore, it can take several attempts before it is found.

      I don't necessarily think you have a uterine problem if it has already been evaluated by ultrasound and hysteroscopy. If the endometrium is not developing well enough (lack of b Integin) then the treatment is to increase the progesterone. I use both injectable and vaginal progesterone to cover this. If you have good embryos, then the only other factor to consder is transfer technique has this has a definite effect on pregnancy rates.

      There are other things that can be done but these are highly controversial and based on individual doctor preferences.

      Good Luck

      Delete
  22. Hello, Doctor,

    I am a 28 year old woman and I am currently going through my third miscarriage in 5 months. I have 5 children, ages 7, 5, 4, 2 & 1. Inbetween each full term pregnancy I had a chemical pregnancy (except between the last two full term pregnancies). Usually I have a cp, and 2-3 weeks later I get pregnant again and go full term. This past November I had a chemical pregnancy. A few weeks later, had a period, then found out that I was pregnant again in the beginning of January. I was 8w3d when I miscarried. About 5 weeks after miscarrying I am currently bleeding following a chemical pregnancy.
    My question is, what do my husband and I do now? Should we seek testing? We had 5 children just fine, why would I be having problems now? Is there anything we could do on our own without going to see a doctor to help me stay pregnant? If we go to a doctor, should we see a RE? Thanks so much for sny input.

    ReplyDelete
    Replies
    1. Hi,

      Based on your previous successes, I don't necessarily think that you need an evaluation as yet and would recommend you continue trying. Even in patients with recurrent miscarriages, studies show that the majority will eventually be successful.

      If it is of significant concern for you, of course you could have a recurrent pregnancy loss evaluation done. You would need to see a fertility specialist for that.

      Good Luck

      Delete
  23. Hello Doctor Ramirez,
    My Wife (32) and Me (33) are trying to concieve from 5 months and we have 3 chemical pregnancies all between 4 and 5 weeks. We have positive pregnancy test and the symptoms progress well the all of a sudden 2 days before the regular period would occur the symptoms reduce in intensity. My wife have 26 day regular menstural cycle, she is on the thin side and no known health issues for both of us. From your experience what would be the most often cause of these type of miscarriagies? Also do you expect the age and poor egg quality to be a factor in our case?
    Thank you very much and gongratulations for the great blog!

    ReplyDelete
    Replies
    1. Hello,

      The most common reason for recurrent miscarriages is because of a genetically abnormal embryo, but there are other causes as well. One of the causes is hormonal abnormalities. My recommendation is to see an infertility specialist and undergo an evaluation for recurrent pregnancy loss. Treatment might be as simple as using progesterone to provide enough supplementation in the luteal phase. I would suggest that she take 1 tablet of low dose aspirin (81mg) each day, in addition to prenatal vitamins with folic acid. There are other medications that can help as well, but these all depend on the cause of the problem.

      Good Luck

      Delete
  24. hi dr me 26 my husband 28 we had 1 chemical pregnancy in ths last september we are trying to concieve since 2ytears his all lab work normal but i had long cycles and altered fsh lh ratio on day2 3.6:7 and no mature follicle on day 12 scan follicle size max 12mm so i was put on clomid my ovaries responded on clomid 150mg one successful cycle ended in chemical pregnancy since then i have taken 3 other cycles but still failed i use to have hcg trigger on day 10 when my follicle is 20 or 25mm now what to do i also took hormonal support for possible luteal phase defect i am trainee at obs/gynae had stressed life and cant afford ivf and living in city with less facilities should i continiue same treatment or should bother for other options thanks in advance ........emotional girl from india waiting for reply

    ReplyDelete
    Replies
    1. Hello,

      If you had a chemical pregnancy using Clomid ovulation induction with timed intercourse then it showed that treatment can work. 1-4 treatments is probably not enough, but if you've done 6 or more and still not had a repeat pregnancy, then there is something else that is going on. At that point you would have the options of pursuing a completion of the infertility evaluation, such as laparoscopy, or move to the next level of treatment which is IUI. You or your doctor also can re-evaluate the current treatment strategy and maybe increase the stimulation to increase the number of eggs ovulated (up to 3). Keep in mind that the treatment you are using is not "magic". Rather, it is just enhancing your natural chances, so just like trying naturally, it can take time.

      Good Luck

      Delete
    2. thanks dr for your advise one other question in my mind is that how we count the cycles of clomid one cycle is equal to one menustral cycle or other please clear my idea about that my senior told me different one other thing that in this cycle i havent taken treatment and on day 12 i had my scan it showed follicle of 16mm not round so sonologist informed me thst ovulation may have taken place earlier so can it happen and i had 16mm size follicle without treatment so can this be possible for my conception

      Delete
    3. Hello Again,

      I didnt' quite understand you questions so I hope my answers will suffice.

      One clomid cycle is one menstrual cycle. That is, the period of time from one period to the next.

      The second piece of advice I can give you is to not believe what you hear from an ultrasonographer (ultrasound technician). If you have a 16 mm follicle and it was at the correct time of the cycle, then there is the possibility of getting pregnant.

      Good Luck

      Delete
  25. Dear Dr. Ramirez,
    Greetings from Toronto! I am a 43 year old female who is undergoing fertility treatments in the United States. I have had one chemical pregnancy and one blighted ovum through the use of donor eggs and IVF. My question is, are both these situations indicative of implantation? Am I implanting properly or is the chemical pregnancy and blighted ovum a result of implantation problems? What can be done to avoid a miscarriage again? I am in the process of doing immune testing and other tests have shown everything to be in "order" with me. With the blighted ovum, it was discovered that I had very low progesterone after my two week wait and positive test result. The first time with the chemical, my progesterone was never mentioned so I am not sure. Please let me know what you think and thank you so much for holding this forum!

    ReplyDelete
    Replies
    1. Hello from California,

      The fact that you had two pregnancies in two tries is a significant finding. Keep in mind that unlike popular impression, IVF CANNOT make you pregnant. . . it can only give you the OPPORTUNITY to become pregnant. This is because IVF only accomplishes 7 of the 10 steps required to get pregnant. The last three steps are "natural" steps in the hand of God. So your chemical pregnancy and blighted ovum are signs that the last three steps occurred. That means implantation happened and means that IVF can work!

      Now the question is WHEN you will be ultimately successful and is there something you can do to expedite that. Well, no one can answer the first question. As to the second question, that can't be really answered because we don't know what caused the two abnormal pregnancies. In most cases it is a genetic problem in the embryo. Was your donor genetically tested? In most cases it is a spontaneous genetic abnormality that occurred at the time of embryo division. We can help that by doing preimplantation genetic diagnosis (PGS) but I'm not sure I would recommend that. Nature can do the same thing although there is an emotional cost.

      I think that my recommendation is to keep trying and either continue to use the same donor or change donors. The progesterone level (blood test) is not that signficant but certainly one thing that you can do is increase the progesterone (injection plus vaginal). Lack of progesterone usually will cause the lack of implantation or a chemical pregnancy. "Blighted ovums" are an embryo development problem and not due to progesteron.

      Sorry for the long answer. There is more I could discuss but this is not the proper forum for that. If you want a more comprehensive second opinion, we can do that by an email, Skype or Telephone consult in my office and I would need to review your records.

      Don't give up.

      Good Luck

      Delete
  26. Hi Dr Ramirez,

    My husband and I had a successful IUI using 50mg of Clomid and progesterone support to conceive our daughter, now 2 years old. I was 26 at the time of pregnancy and am now 28. All tests were normal, sperm counts were good. We are trying again and have now been unsuccessful for 3 IUI attempts, now using 100mg of Clomid. I responded well with 2-3 mature follicles each time and sperm counts over 15 million each time. Last attempt was 69mill post wash, and on 11dpiui I had a positive home pregnancy test (I did take Ovidrel, but tested out the trigger and was negative by 8-9 dpiui. It was lighter on 12pdiui, and eventually I had a beta of <5. My question is should we continue with IUI? I know the success rate drops after 3 attempts. I am not opposed to doing IVF if we need it, I have just been hesitant since we had a successful IUI, no diagnosable fertility conditions, and now a chemical pregnancy. I would appreciate your thoughts. Thank you.

    ReplyDelete
    Replies
    1. Hi. In general, IUI should be tried up to four attempts to achieve success. This is because it is completely depenedent on the natural processes to achieve the pregnancy. Statistically, after four attempts the chances of pregnancy go from 25% per attempt down to less than 1%. This drop is attributed to other possible causes for the infertility. At that point, it is recommended to proceed to IVF. The other option is to complete the infertility evaluation, including doing a laparoscopy, if you want to continue trying by natural means.

      Delete
  27. Hello! I am 29 and just recently experienced my first chemical pregnancy last week. We have been trying for about 6-7 months prior and I was put on Clomid. I took that for 4 cycles and became pregnant. I was due to start period on 02/17/13, but it never happened. About a week after I started spotting and ended up in the ER where they told me to follow up with my DR on Monday. After going to the DR every other day for blood tests of beta hcg and progesterone I was informed my levels were dropping and expect a miscarriage. I was dismissed as having a chemical pregnancy. Im not sure where to go from here. Should I continue treatment with Clomid on my next regular cycle? Also, if I was treated earlier with progesterone would that have helped save the pregnancy? Soooo confused! When can we begin trying again. DR also said at lease we know I can get pregnant now?????
    Thanks for your time and expertise!

    ---confused

    ReplyDelete
    Replies
    1. Hello,

      The rule of thumb is to wait until your next natural period to begin trying again, whether with or without Clomid. The pregnancy has to resolve and the ovaries have to reset. Once that occurs, ovulation will occur and if you don't get pregnant, you will have a period. You can continue to have intercourse and sometimes a natural pregnancy will occur in the month following a miscarriage. Recent studies have shown that the fertility is heightened in the first six months after a miscarriage or pregnancy.

      Good Luck

      Delete
    2. In addition, normally Progesterone is used to supplement the Luteal phase when a Clomid cycle is done. You might want to read the section on how I do Clomid cycles to see how I recommend that it be done properly. If not done that way, not only could you be wasting time and money, but you are not optimizing your chances of getting pregnant per month. Make sure you find someone who has the knowledge and competence to give you the best care.

      Good Luck

      Delete
  28. I have been pregnant three times in my 6 months of trying. All biochemical. I have two naturally conceived term children with no complications. One at 32 and one at 35 years of age. I am now trying for a third at age 38. I have long 31-35 day cycles with an 11-12 day luteal phase. I ovulate on day 19-24. I did not have luteal phase PMS type symptoms when I first stopped bcp, but for the past three months, I have had strong symptoms, like sore breasts and nipples and crankiness. I also get yeast infections during the first part of the luteal phase only in months that I am pregnant. I don't know if that is coincidental or indicative of a hormonal issue. I also have diarrhea in the luteal phase in months where I am pregnant. I have symptoms prior to ovulation like sore breasts and crankiness. I have a short window of LH surge. I usually get no line on opk at all, not even faint. Then at ovulation, the LH will rise and peak and fall in about 24 hours. It is easy to miss the positive opk because it is so short lived. So can you tell from symptoms if I have a weak ovulation or hormonal problems associated with these early pregnancy losses. What is the likely cause, where should I begin with testing or treatment.

    ReplyDelete
    Replies
    1. Without doing a full evaluation for recurrent pregnancy loss, I can't tell you exactly what is going on but there are two possible issues I can see: (1) your age increases your chance of miscarriage (as high as 50%) and (2) since you lose the pregnancy so early, the possibility of a luteal phase defect must be considered (hormonal). You can't treat the age issue, but LPD can be treated with supplemental progesterone. I would recommend that you consult a fertility specialist for an evaluation and proper treatment.

      Good Luck

      Delete
  29. Dr. Ramirez,

    I'm 39 years old.

    1. I had a miscarriage last year from nature pregnancy. I saw hearbeat at first but the emproy stopped growing at 6 weeks. I had a D/C, the emproy tested as abnormal chromosome.
    2. Later last year, I had a chemical pregnancy again from a nature pregnancy. I got HPT positive from multiple test kits, but in a week, got my period, HPT tested negative.
    3. This year, my first IVF just ended a chemical pregnancy. I transfered 2 day 5 blasts--4BB and 3CC, day 9 after transfer, HCG tested 23, 3 days later, dropped to 10.

    My question is: did the implantation happen for the two chemical pregnancies, or they happened but didn't sustain? what tests should I do next, immue system related, or PGD/CCS on day 5 blasts if I do another IVF?

    Thanks a lot for your time!

    ReplyDelete
    Replies
    1. Hello,

      If you get a positive pregnancy test that is evidence that implantation occurred. If you don't have implantation, you won't get a positive bHCG.

      The specimen you got from the D&C showed what the main problem is and this is expected at your age. You have what we call the "age factor" which means that most of your eggs are now debilitated leading to poor embryo quality and increased risk of chromosomal breakage a the time of cell division. This leads to a genetically abnormal embryo that can't survive. Thus miscarriage occurs. IVF can help because you have more eggs to work with but there is no technology that can make bad eggs better. You have to just keep trying in the hopes of finding the perfect egg. You have shown that you can get pregnant. Now you just need to find the perfect embryo.

      Good Luck

      Delete
  30. This comment has been removed by a blog administrator.

    ReplyDelete
  31. Hi dr,
    I am from qatar. Dr we r trying to get pregnent for last 7 months.and i take clomid .I was pregnent in feb and i didnt know that i am pregnent . on time of my period i got spotting and i thought it was my period,i spotted for 4 days and i called my dr.and she told us to have home pregnancy test.. and it came out possitive..and i did a blod test and it was weakly possitve..and my doc ask me to do a beta hcg test and it came out possitive 186 and i reapet in two days and it was doubling 356 and after one week it go down to 2 .and we hve a tvs and found nothing....and she told we lose it. And after that i have 3.5. Weeks of bleeding which is told its normal.
    Dr, .my first question is...is this a chemical pregnancy?

    When my bleeding stops. After 2.5. Weeks i did a opk and it came out a strong positive result.

    Dose ovulation take place straight away after miscarriage?
    Is there any chance to concive straight after miscaariage?

    We want get pregnent again soon!!!

    We r eagarly waiting for ur vaulable reply..

    Thanks
    Nilufar

    ReplyDelete
    Replies
    1. Hello,

      What you just went through is called a "Chemical pregnancy." An ultrasound would not have shown anything because the pregnancy did not grow enough.

      In terms of the OPK, yes, once the pregnancy resolves completely, the ovary will reset and ovulation can occur. Many women have gotten pregnant soon after a miscarriage. In fact, a recent study showed that women have increased fertility in the 6 months following a pregnancy or miscarriage.

      Good Luck

      Delete
  32. I am 34 year old female. I will be 35 in three months. Four years ago I went to my obgyn and we started iui with hcg shot. The first iui I got pregnant right away and I lost my baby when I was seven in half weeks along. We try again but failed to get pregnant. My obgyn took a better job out of state and we was told to go see a ivf doctor. Four years latter we went to see a ivf doctor. We went to Ypsilanti MI Ivf docor. The office is out skirts of Ann Arbor MI. Doctor Shamma did a ultrasound and put me on Letrozole 2.5 mg for five days. The doctor toldd me he wasn"t going to give a hcg shot with my iui because he believe the hcg shot should be only use if I am doing ivf. I never herd not getting the hcg because it is use as a trigger to release eggs. I am wondering what are my chances to get pregnant doing iui without having hcg shot?

    ReplyDelete
    Replies
    1. HCG is often used to trigger ovulation for IUI, but that is not an absolute requirement. Since IUI is a "natural" treatment option, your body will often trigger on its own (called the LH surge). The HCG is justto make sure that there is a trigger for ovulation. I do ALL my IUI's with an HCG trigger just to make sure.

      Also keep in mind that Letrozole is similar to Clomid in how it works. One is not better than another. It is just an alternative.

      Good Luck

      Delete
  33. Hi,

    I am 28 years female, trying to conceive since past 2 yrs with my husband. In the beggining we tried 6 cycles with clomid. Although i ovulated with it but never conceived. Starting from July 2012 we tried IUI and faced 3 Chemical pregnancies till December 2012. In Jan 2013 I went for Laparoscopy and found my right tube was blocked(hydrosalpinx), thus got that removed. After that I tried naturally 2 cycles with no luck and another IUI. The IUI resulted a positive bHCG and in ultrasound as well we saw the sac which measured 4 weeks. But on the very same day when I had Ultrasound done, the bHCG got decreased and it again was a Chemical pregnancy. I fail to understand what went wrong in this cycle. Was it the egg, or endometrium or uterus or my immunity or what is it that is stopping the embroy to grow. I was on progestrone supplements. Also 2 days before i went for ultrasound i was having severe cold and cough and fever upto 99.5 deg. Could that be a cause of this Chemical preg. Please help me understand why this is happening with me and is there any hope for cases like me to have a baby?

    ReplyDelete
    Replies
    1. This comment has been removed by the author.

      Delete
  34. Hello Doctor,

    I am from India and 28 yrs of age. I have been trying to conceive with my husband since past 2 years now. We have been married since 3 yrs and i have been diagnosed with PCOS before marriage itself. Thus i was on Krimson 35 for 3 yrs.After marriage i took Krimson for 1 yr as we were not planning intially,
    After that i stopped taking it and for 2 months tried naturally without any medication. After that we I was on clomid for 6 cycles in which i ovulated but did not concieve. Then i went for 3 IUI with Ijectibles whjich were Menagon and Decapeptyl.
    All 3 IUIs resulted in Bio chemical pregnancy.After first bio chemical doctor analysed some blood reports and it was found that I had Hyperhomocysteinemia for which again some more injections were given and the level came to normal. But the next 2 IUIs again resulted in biochemical pregnancy.Thus in January 2013 we decided to go for Laparoscopy, in which we found that my right tube was completely blocked(hydrosalpinx). Thus a decision was taken and the tube was removed. My left tube and both ovaries are normal. After laparoscopy we tried naturally but with no luck. Then in April 2013 we went for another IUI which resulted in a positive blood test.In our first ultrasound we were able
    to see the sac which measured 4 weeks but on the very same day the HCG level dropped. We are very confused as to why this happened this time when everything seemed fine. What else could be the reason for another biochemical pregnany.We are not able to decide what to do next. Our doctor suggest to go for another IUI because we have moved one step further and saw the sac for the first time.
    Please suggest what should we do at this point and what possibly could be the cause of these multiple biochemical pregnany.
    Is IVF the solution for me or shall i again try my luck with IUI.
    Also my AMH is 3.8. IS this at the lower side and am I at a risk that my eggs will get exhausted due to the strong medicines and injections?

    Please help us. Your opinion will be of great help to us at this point.

    Thanks,
    Mrs. KD.

    ReplyDelete
    Replies
    1. Hello Doctor,
      Your suggestion and opinion will be of great help to me to decide what to do next. Hoping for a reply from your end.
      Thanks in advance.

      Delete
    2. Based on three miscarriages, you should undergo a recurrent pregnancy loss evaluation prior to proceeding with any other treatments. Miscarriages occur because of genetic, anatomical, immunologic, infectious disease and hormonal problems. Each of these need to be evaluated and there is specific testing for each.

      Delete
  35. Hello Doctor.I am 34 and we have been trying to get pregnant for the past 5 months.I had some hormonal testing done that showed LSH 12 and AMH 0.6.I had two faint positives this month just before my period was due and then two negatives.My period is delayed by two days.I think it could be a chemical one.Also should i seek professional help or is it too soon?

    ReplyDelete
    Replies
    1. I don't think it is too soon to see a specialist. I'm a little worried about the elevated FSH and decrease AMH which means that time may be an issue, but nothing more.

      Delete
  36. Hello Dr.
    I Just discovered that I had chemical pregnancy, I am 33 and am trying for second one. I'm tring since last 5 months but never got success. lately when I got it was not through. I am much worried becasue I could find no reason. I try to figure out was it becasue I used to workout? My cycle is ususally 24-26 days, So I tried early week too Please Help.

    ReplyDelete
    Replies
    1. Up to 50% of pregnancies end in miscarriage and chemical pregnancies are a form of miscarriage. Therefore, I would not worry about this one pregnancy and keep trying. Statistics show that you will eventually succeed.

      Delete
  37. Hi, I've had 2 chemicals in the past 2 months (April at 4 weeks 6 days starting and the other at 4 weeks 5 days just last week). TSH is normal x 1 year, on Synthroid 50 mcg daily (started initially 2 years ago due to subclinical hypothyroid w/ TSH running in the 4 range). Last time, OB tested antibodies (although not sure which ones) and were neg. Thyroid antibiodies negative in the past. I've never had an U/S. Do you think it is time to start additional testing? I'm 32 and healthy, hubby is 33 and healthy, on prenatals, normal weight, etc. No known genetic factors except hubby does not know any paternal history. I stopped birth control in November 2012, waited 3 cycles (advised to do this since I had no menses on it), got pregnant the 3rd month of trying resulted in first chemical, then waited one normal cycle as advised, then just got pregnant again this past month resulting in 2nd chemical. My OB appt is not until next week and I am just wondering what to expect and what the possible issues are and whether or not we should start to do some testing.
    Thanks!

    ReplyDelete
    Replies
    1. Hello,

      The answers to your questions are already posted within this subject post. At this point, we would not consider you to have a recurrent pregnancy loss problem so a complete evaluation is not yet required. Statistically, you will eventually be successful. You might want to ask your doctor to prescribe progesterone supplemenation vaginally to start after ovulation. It's a simple treatment, innocuous and could potentially solve the problem.

      Good Luck

      Delete
  38. Hi DOC,
    I have had my tube test back in 2009 and both my tubes were fine. We have been trying for a baby for last 6 years but no results. I have had 2 IUIs already done. My tests are all fine and no faults found so it is purely unexplained reasons. Should I go for laparoscopy and then try IUI, are the chances more with lap for IUI or should we go for IVF with Hysteroscopy

    ReplyDelete
    Replies
    1. Hello,

      I can't advise you on which is the better option with the limited information you've given. I don't know what tests have been done and what tests have not yet been done. If you look on this BLOG you'll see a post regarding the basic infertility evaluation.

      In general, if you don't get pregnant by four IUI attempts, then statistically your chances drop drastically. For that reason, we recommend proceeding to IVF after four attempts. Of course, you don't have to wait for four to proceed to IVF. You can decide to move on sooner. If you are going to do IVF, laparoscopy is not required, so some patients will skip the LSC because it is a surgery and they don't want to take the risk.

      Good Luck

      Delete
  39. Dear Doc,
    im from Africa 22years old n DH is 27.
    I have gone through 2 blighted ovums in the past 6 months,went through all testings(sugar,thyroid,toxoplasma,rubella)all came back negative.
    The doc jus said i should ttc immediately but i really want to know the cause that caused my previous miscarriages.
    i have not been tested for blood clotting disorder or genetic testing.
    im planning to take baby asprin 75mg from next cycle(i suppose it wouldnot hurt)
    im currently on prenatal(zincovit) 5mg folic acid everyday.
    i dont seem to have trouble getting pregnant..problem is maintaining the pregnancy past 12 weeks.
    you can also suggest protocols that i can try.
    im desperate to have a baby.
    thanks.
    Please advise

    ReplyDelete
    Replies
    1. Hello,

      I've comprehensively explained the protocol I use in this Blog post. Please review it again. I also explain the possible causes of miscarriage that need to be evaluated for.

      Good Luck

      Delete
  40. thanks doc.
    I forgot to say i have a cycle of 25-26.
    Please suggest a progesterone supplement.
    should i start taking the baby asprin from now coz im planning to ttc from my next cycle or do i wait to get my mp n then start taking the baby asprin??
    Regards

    ReplyDelete
    Replies
    1. You can start the aspirin now. I use Endometrin or Crinone for progesterone supplementation. There are other options as well and will be based on your doctor's preference. Some doctors use injectable progesterone in oil.

      Delete
  41. Hello Doc,
    Am 31 year old trying to concieve for more than a year now. I have been on clomid and HCG trigger shot last two cycles. First cycle ended with a bfn so I requested my doctor to order a HSG for me that revealed that my left tube was blocked. My right tube was ok. My doc was monitoring my follicles and in the first cycle I ovulated on the left side and after HSG results it made sense why I dint concieve that cycle. In my second cycle, I was monitored and showed a mature follicle measuring 21X16 right side. I was then given a trigger shot. I tested after 16 dpo and got a positive HPT. I had a blood test that revealed a HCG of 19 and Progesterone of 2.3. Nurse said that it is dangerously low. I was then put on progesterone vaginal suppositories 200 mg every day on 22 dpo. After 4 days, I took a blood test and that said a HCG of 64. I was ordered another blood test for 3 days later when my HCG remained the same at 64 and Nurse said it is a chemical pregnancy. Am 26 dpo now and still havent got my periods but I continue to take progesterone 200 mg every day. Do I still have a chance to save our baby this cycle? What other options do you think I can go with after this cycle? Also, this is the first time I ever got pregnant so am emotionally lost now. Your advice is greatly appreciated!

    ReplyDelete
    Replies
    1. The only way to know how the pregnancy is doing is to follow the bHCG levels and/or do an ultrasound. Considering that your bHCG did not rise previously, I would be worried that this is not a viable pregnancy and will end as a chemical pregnancy or miscarriage.

      If you are taking progesterone still, that could be the reason that you have not started your period yet. It is still supporting the pregnancy, whether a good pregnancy or bad pregnancy. The bleeding will not occur until you stop the hormones.

      Delete
  42. I'm 25 years old, a type 1 diabetic for 4 years now. My sugars were fine throughout my whole 5 week and 5 days pregnancy. I had severe constipation on Friday, called my nurse practitioner, he told me to drink 1/4 of a bottle of magnesium citrate plus a 100mg stool softener, if nothing changed, do it again in 4 hours. In an 8 hour time frame I had taken 1/2 of a bottle of magnesium citrate, and 200mg of the stool softener. It didn't help at all, and I miscarried the next morning. Could those OTC meds have possibly caused my miscarriage?

    ReplyDelete
    Replies
    1. Well, this is a question that I cannot answer. There is no way to know what caused the miscarriage. Could it have been the excessive amount of laxatives? It is possible. Could it have been the total lack of sufficient knowledge by a nurse practitioner that give you insufficient advice instead of referring you to a real doctor? It is possible. Could it have been something wrong with the pregnancy that had nothing to do with the above? That's most likely based on statistics.

      Delete
  43. hi dr, im an underground artisan electrician, i did ivf 3 months bag and i did my transplant yesterday n on clexane, i wanted an advise on how to care for my self till i do test and do u think underground work influenced my day 8 ivf transfer miscarriage, because this time im on 10 days sick leave due to my work condition of hard labor n walking to attend brake downs, and also doctor why isn't there any research done on woman working in the engineering field in mining. thank you for your response.

    ReplyDelete
    Replies
    1. Hello,

      I'm sorry, I don't have any specific advice to give you. All the studies done so far have not shown any specific behavior to influence implantation or pregnancy rates. A normal person (not undergoing infertility treatment), will have implantation without knowing it has occurred and most will do just fine. Although we recommend light activity or rest, it is more for psychological reasons than actual physiological reasons.

      In terms of why there are not specific studies on miners or persons working underground, I can't answer that but there are way too many job types for studies to be done on all of them. Are there no miners or underground workers getting pregnant? If that is the case, then maybe there should be studies to evaluate that.

      Delete
  44. Hi Dr. Ramirez, my husband and I have been trying to conceive. I took an early pregnancy test on September 1st and received a faint positive. My cycle was due to start on September 4th. I went to my doctor on September 4th and had a pregnancy test. On September 6th, I started bleeding. I called my doctor and he told me I had a chemical pregnancy. My cycle felt like it was coming but it never came. Two days ago, I felt like it was here but it was clear discharge (false alarm). I am now 2 days late. I took a pregnancy test and it's negative. My doctor wants to test my thyroid, prolactin, and progesterone on the 20th day of my cycle. Here's my question: is it common to have a late cycle after a chemical pregnancy?

    ReplyDelete
    Replies
    1. Since a chemical pregnancy is a pregnancy, the menses would be delayed until the pregnancy ends. If the pregnancy test was negative, then a period should have started. It does not make sense if the pregnancy test was negative and a period did not start. It makes me wonder about the diagnosis of "chemical pregnancy."

      Delete
  45. Hi Dr Ramirez,

    I want to thank you for your work on this blog - it seems you are helping a lot of women in understanding the reasons causing early miscarriages. It can be a very sad and frustrating event, it helps to have some answers or at least a direction to look into!

    I am writing to hear your advice on what I should do next. I've had 2 beautiful boys, aged 3 years and 18 months. I'm currently 37 years old and trying for a 3rd. Both pregnancies, I was very lucky at getting pregnant right away without any miscarriages or complications. Now, I am facing a very different situation. I have had 1 MC at 6 weeks and then 3 chemical pregnancies. For the 3rd chemical, we waited a few months before trying, but it didn't change anything. All times, I have my 'classic pregnant symptoms' and a positive test at 10 days past ovulation. Then symptoms go away and I start bleeding around 2 or 3 days later than my expected period. I have had the recurrent loss panel done with everything coming back normal. I have booked an RE and was wondering if I should address progesterone / lutheal phase questions with her? My thyroid has also been checked and it is in the normal range (tsh is low but t3 and t4 normal - been like that for years).

    Would you have any advice on what to do next? I was reading on vitamins and fertility, any advice on this also?

    Thanks again for your support!
    Marie

    ReplyDelete
    Replies
    1. Hello,

      First, you need to understand that beause of your age, you are at increased risk of miscarriage due to spontaneous genetic abnormalities that occur in egg division. The good news is that most women with this problem will eventually be successful.

      Second, your decision to see an RE is a good idea. They have more expertise in this matter than a regular gynecologist but be careful, because some RE's will automatically recommend IVF with preimplantation genetic screening (PGS).

      Finally, if you have not been tried on low dose aspirin 81 mg per day taken daily starting now and progesterone supplementation in the luteal phase, these are definintely two things I would recommend doing ASAP. There are other medictions as well but that will depend on your doctor's recommendations.

      Good Luck

      Delete
    2. Hi Dr Ramirez,

      I just wanted to let you know that following your message, I got results from a series of blood tests. I discovered that I have the MTHFR 677T mutation and V-Leiden factor that showed up abnormal. With this information, my RE decided to put me (as you suggested) on an aspirin a day + vaginal suppositories of progesterone after ovulation. I addition, I've been taking vitamins.

      I am crossing fingers but with these things, I am now 5 weeks pregnant! I am hoping that this one stays in. My Bhcg double time is very good and numbers are strong already.

      Thanks again for your help,
      Marie

      Delete
    3. Congratulations. With the positive MTHFR, I would also suggest that you increase your folic acid to 4 mg per day.

      My prayers are with you.

      Delete
  46. Hi Dr,
    I am 32 and I had a stillbirth 12 years ago at 8 months pregnant. Test and Post Mortems were done but the docs couldnt find out any rhyme or reason. and now Im actively trying to TTC , I have never used birth Control. My husband is 50 and he has had 3 kids from his 1st marriage, And hes done a sperm count test and they turned out good. My Menstrual Cycles are all over the place ranging from 28 days to 41days. I presumed that i never ovulated on those long cycles. However my menstrual will be heavy for 1-2 days followed by light ( clots as well) menstrual usually last 5 days. I am actively using OPKs and have never really gotten a true Positive, usually the test line is only 50percent as dark as the Control line. But this month I have been monitoring my BBT and Cervical Position, my pre O temps were 36.1 , however 2 days ago it went down to 35.8 and stayed at that for 2 days, I also checked my cervical position its was high Open and soft and not like the usually low position ,but this happened on CD 9 on a 28 day cycle. LMP came on 16th OCT and the recent one on 14th Nov . If i really did ovulate on CD 9 why is my OPKS not picking up anything?? after that dip in temp it has spiked to 36.3 , I am also worried of these low temps could be an underactive thyroid as Im overweight too but I had a thyroid test done a few months back and e doc told me not to test again till next year, I m really desperate, what are the measure then i can take to concieve , I have included 3-5 servings of veg daily to help in the reproduction, and have made healthy changes to diet...I feel age is catching up..

    ReplyDelete
    Replies
    1. You need to admit to yourself that you have an infertility problem. In addition, your ovaries are not functioning correctly as manifest by irregular menstrual cycles. Not only do you not have ovulation from time to time, but your hormones are probably out of sync. For these reasons, I recommend that you go see a qualified reproductive specialist.

      Delete
  47. Hello Doctor,

    I am 26 years old and trying to conceive from the past 4 years. I was tried with clomid, femera, IUI and had a laptroscopy identified as mild endometriosis with no success. My RE couldn't able to find any problem with me or my DH. We moved to IVF cycle and our first ivf cycle with 1 blast of day 5 transfer resulted chemical pregnancy. we have 5 blasts frozen with this cycle. I have thyroid and currently taking cynthroid 81mg. my first beta was 50 then 76 then it went to 66. My nurse was telling that they couldn't able to test anything since it is an early pregnancy. We are planning to move to FET cycle. What are all the tests you suggest us to make our next cycle successful and to avoid an emotional stress/rollar coaster? I am very much worried as my RE is going to move to next FET cycle without any testing/identifying the root cause.

    ReplyDelete
    Replies
    1. Your question requires a consultation and review of your medical records so it is not possible for me to give you a list of tests that I would recommend not possible treatment. Sorry. If you want ot proceed to a formal consultation, I can do this via emial, Skype or telephone consult. Please go to my website and contact me to set up a consultation appointment. You will then need to send m copies of your records to review.

      Delete
  48. Dear Doctor,

    I am 38 years old and trying for my second child. My first is now 4 years old. Since early 2013 I have had irregular periods and have had to have Provera to induce my period twice. I had my last period on Nov 5th, received 50 mg of Clomid and ovulated around day 19. My doctors think I am having a chemical pregnancy as my first Beta was around 10.3 then 30, 50, 70, 160, 89 last week and now 130. I've had bleeding for the last 3 weeks and during the first week it was heavy, with clotting and a constant cramp on my one side for 1 week. I was worried about ectopic but two u/s's have shown nothing in the uterus or tubes. The bleeding is much less but still there. I'm worried about why the hcg is taking so low to go down, why it has now increased and also how quickly I will be able to start trying to conceive again. Any thoughts?

    ReplyDelete
    Replies
    1. Certainly this is an abnormal pregnancy and, hopefully, it is a chemical pregancy with probably miscarriage. An ectopic is still possible but the proper course of treatment at this point is to follow you closely with bHCG levels. Even ectopic pregnancies can naturally miscarry and no intervention is required unless serious problems occur. Bascially, the bHCG will not go down until the pregnancy tissue either dies off or is expelled. If the bHCG's have not gone down yet, that means you have not yet miscarried. It can take a bit of time. Once the bHCG goes down completely, you can start trying again.

      Delete
  49. Hi Dr. Ramirez-
    I just turned 30 and am trying for my first child. I have had three chemical pregnancies in the three months that we have been trying. I had my salivary progesterone levels tested during my second CP and they were low (95 for a normal range of 120-150). On this third CP, I was on sublingual progesterone drops at 50mg per day after ovulation. My blood level was tested to be 37 ng/ml, which is in the second trimester range. However, the pregnancy did not stick. I am unsure of whether to try the suppositories at the higher dose or if this signifies that progesterone is not my problem. I have read literature that says oral progesterone does not transfer to the endometrial lining so it is ineffective in stopping recurrent early pregnancy loss. Any recommendations are greatly appreciated! I plan to start the 81 mg of aspirin this cycle, as well. Also, do you have an estimate of how long it take for your period to resume after discontinuing progesterone? Thank you so much! Your site is very helpful.

    ReplyDelete
    Replies
    1. Hello. All the studies done regarding infertility show that progesterone is most effective given by intramuscular injection or vaginally. Oral progesterone has been shown to be an ineffective method.

      Once you stop the progesterone, assuming you developed an adequate lining to slough, you should start a period within 7 days.

      Delete
  50. Hey doctor,

    My name is kathleen. I have been TTC since 2008. In February of 2008 I had a miscarriage at 7 weeks pregnant. Then august 2009 I had labroscopy surgery and found out I have endo and continued to try for 2 years with no success. I have very regular periods can tell when they are about to come. We tried everything clomid with iui gondel f shots with iui nothing worked. Went to a re and she was the one who recommended the go del f shots. Had labroscopy surgery again in February of 2012 was on the depo prover a shot from march to September 2012 did clomid in October and didn't do iui because I had a big size cyst. So November 2012 just tried intercourse and bam December 2012 found out after 5 years of trying I was pregnant. I was on cloud 9. Everything was fine with the baby. The march 10th I went to the er with horrible pain found out I had kidney stones and they would pass on their own. They did then March 27th I woke up to what I thought was me peeing my pants. Well it ended up being me loading all my amniotic fluid. Went to doctors found out I did loss the fluids. Was admitted to the hospital. Where I found out I had an infection and my son was OK he was moving around in what fluid I had left. Was hooked up to an ivf that didn't help raise my fluid. So I was in the hospital for a week . Where on April 4th 3013 I delivered my 20w still born son. What killed him I got ecoli from something. To this day I am still hurting. In June of 2013 found I was pregnant numbers weren't doubling like they should. My highest number was 56 a few days later I ended up having a chemical pregnancy. December 2013 did a cycle with clomid and intercourse found out on January 7th 2024 I was pregnant Again. My levels where slowly going up. My first was 118 then 172 then 182 and finally 282 doctor again told me I'm having another chemical pregnancy, I asked why and he said I was tested in 2011 for antibodies and it was negative. And sometimes new expose of antibodys because there are so many they didn't test for. So my question to you is why does this keep happening? Is there anything I can do or take. I have yet to pass this clot for this chemical pregnancy. No spotting some cramps. I do have itching going on up there need to tell my doctor. Could it be possible this pregnancy is still find just the numbers are slower than most. Doctor also told me to start taking baby aspirin when I start trying again and something about hemprin when I do become pregnant again. Thank you for listening to my story hope to hear from you soon.

    Kathleen

    ReplyDelete
    Replies
    1. Hello Kathleen. At this point you have the diagnosis of recurrent pregnancy loss (RPL) and should undergo an evaluation for this. This evaluation includes anatomical testing, genetic testing, immunologic testing, infectious disease testing and hormonal testing. You should see a reproductive endocrinologist or infertility subspecialist for this evaluation and treatment options. Obviously getting pregnant is no longer the problem, but keeping the pregnancy is. That requires a different evaluation and intervention than an infertility workup.

      Delete
  51. Dr. Ramirez,

    41 y/o female. Gravida 8, Para 7
    Spontaneous Abortion: 11/27/2013 dx: blighted ovum

    My Question: Should I start with; Aspirin 81mg now along with prenatal vitamins, following ovulation with a Progesterone Supplement?

    Time is against me and suggestions would be greatly appreciated.

    Thanks Dr. Ramirez

    -M

    ReplyDelete
    Replies
    1. Hello. The most likely reason for your miscarriage is embryo "aneuploidy" or spontaneous genetic abnormality. That is what we refer to as the "age factor." There is nothing that can help with abnormal embryos except trying over and over again until you find a perfect one. Hopefully, there is still a perfect egg present in your ovaries. If you want to add aspirin and progesterone to your protocol, there is certainly no problem with that, since they are not harmful. You can go ahead and start the low dose aspirin at any time and take the progesterone after ovulation, as you mentioned.

      Good Luck

      Delete
  52. Dear Khan,

    Thank you for contacting the Center for Human Reproduction.



    Hi Doctor . Myself wife and I have went through 2 failed IUI's and one failed IVF. Really frustrated and confused !!!!
    Our History: Semen analysis always showed good motility, count and morphology. My wife was diagnosed with fallopian tubes blockage (Both tubes) 2 years ago , for which we had a laparoscopic surgery last year to clear the blockage. we were told a small cyst was also found during laparoscopy. After laparoscopy doctor told us that they have opened the blocked tubes and every thing is OK now and pregnancy should occur if we try naturally. We tried naturally for one year but NO pregnancy!!! even two failed IUI's immediately after laparoscopy. Frustrated , we moved to different clinic for IVF a year later after laparoscopy. During IVF doctor told us that my wife Ovarian reserve very Poor. Hence they managed to produce a single embryo , which has success rate of 15 to 20%. That single embryo transfer went good. Everything looked good. The pregnancy tests were coming positive immediately after 5-6 days (don't know exactly )after embryo transfer. Later , after some days the pregnancy tests came Negative. Lost Pregnancy. My wife emotionally very much confused even me. As we still don't know what is actually causing the problem!!!!!!! we went through lots of pains, spent a lot without any results... After embryo transfer , doctor said the embryo reached the Blastocyst Stage and it actually failed during implantation. But my question is how did the doctor know embryo reached blastocyst stage after embryo transfer ??? Is it possible to know that?? the reason they say implantation failure could be because of endometriosis!!! Do you think that is true? Please let me know your views on this as we are in really confused and desperate state . Don't know what to do and where to go from here. Though my Sperm analysis was normal , do you think there is still any Sperm Issues?? Awaiting your highly valuable insight and advice.
    Regards..

    ReplyDelete
    Replies
    1. Hello, I don't know the meaning of the opening line but as to the rest, there is some good news that you have to realize. Without seeing the entire medical record, I can give too specific a response but given the fact that your wife had a chemical pregnancy (initial positive pregnancy tests that then went negative) is a sign that implantation occurred. In order for implantation to occur, the embryo has to develop to the blastocyst stage, hatch out of it's shell, attach to the uterine lining and the lining has to grow around the embryo. This also means that you wife can achieve pregnancy and it is just a matter of continuing to try before she is finally successful. One IVF cycle is often not enough because IVF is NOT perfect technology. It assists the natural reproductive process up to the last three steps.

      Implantation failure is not related to endometriosis. The only possible sperm issues, that cannot be tested, is if there was some type of genetic abnormality in the sperm that fertilized the egg leading to a genetically abnormal embryo. However, there is not way to prevent or treat that. I don't think it is an issue. You don't mention your wife's age, but a woman's age has a significant effect on the viable of an embryo which can lead to chemical pregnancies and recurrent pregnancy losses.

      My recommendation is to see this as evidence that you wife can get pregnant with IVF despite having a poor ovarian response. You need to keep trying.

      Delete
  53. Dear Dr. Ramirez,
    I am 35 years old, had a chemical pregnancy in late 2010 followed by a healthy pregnancy and live birth in 2011. Just started TTC again and got pregnant in the first month, but sadly it turned out to be another chemical. Is it likely at this stage, with two miscarriages but a successful pregnancy in between, that there is some underlying problem, or is it likely just embryo chromosomal abnormality, which I realize would be exacerbated by my age? Would you recommend taking baby aspirin and progesterone supplements at this stage? If so, when do I start the progesterone (I know it is after ovulation but how many days, and is that confirmed using a OPK or charting BBT or does it matter)? My dr said I shouldn't start progesterone until after a positive pregnancy test but that didn't seem soon enough to me given my losses have been 2-3 days after my missed period/positive test.
    Another question, I am currently nursing my two year old although she is down to a few minutes one time a day, and sometimes skips a day. I know the research generally shows that nursing doesn't contribute to miscarriage risk, but I wonder if in limited cases if a woman has borderline or low progesterone to begin with or other risk factors, if the hormonal changes caused by breastfeeding can contribute additional risk. On the other hand with nursing being so infrequent I don't feel that it is strongly affecting my hormone balance anymore. Any thoughts?
    thanks in advance!

    ReplyDelete
    Replies
    1. Hi. We don't consider a patient to have recurrent pregnancy loss until a patient has lost 3 consecutive pregnancies, not 3 total pregnancies. So at this point, I don't think you need any medical intervention. If you want to use low dose aspirin, that is fine. I would not recommend you take progesterone on your own without Physician direction or supervision.

      At this point, nursing should not be affecting your ability to get pregnant.

      Delete
  54. Hello, I am 35yrs old & trying to conceive for over a year. I had a daughter 9yrs ago no problem what so ever! I am 110lbs with a history of many kidney stones, but otherwise healthy. I have had 3 chemical pregnancies over the past year, the most recent occurring now. They all occurred about a week after receiving a positive hpt (4-5 weeks pregnant by lmp). This last cycle that just ended in a chemical was my first cycle on clomid 50mg. My OB prescribed the clomid. My progesterone was "normal" (they didn't tell me the exact number). Do you feel I should see a RE at this point? My OB seems to think we should just keep trying. Do you think it could be as simple as adding aspirin & progesterone to fix this? Also, do I have to wait another cycle before trying again? I can't imagine trying to prevent pregnancy this cycle, as long as we have been trying unsuccessful! If I had not of taken hpt I would of never known I was pregnant, which makes me wonder how many times this may of happened before that I don't know about. My cycles have always been irregular 29-43 days, usually ovulating days 19-20. However on this first clomid cycle I ovulated my earliest ever on day 14! Thank you in advance for any advice you may have.

    ReplyDelete
    Replies
    1. I think it is time for you to see an RE or fertility specialisty because I don't think your Ob/Gyn is helping you. I do think that progesgesterone supplementation is required and use it for ALL ovulation induction cycles. You also need to undergo an evaluation to make sure there is not another problem going on.

      Delete
  55. Hi doctor i done IUI today morning, doctor advised me to take miprogen vaginally for morning and night and aspirin orally.. But i wrongly kept aspirin tablet vaginally will it affect my IUI process, will i conceive this month.

    ReplyDelete
    Replies
    1. No. The aspirin can still be absorbed through the vagina. It will not affect your chances of pregnancy.

      Delete
  56. I have been trying for a child for about three years now,ive done 4 iui's and gone through several rounds of clomid and letrozole treatment.ive also had a failed ivf .i was diagnosed with sperm antibody issues and my husband has borderline poor motility..asthenopermatozoa something like that though his numbers are very high.im wondering what could be the cause of the failed ivf yet all my embryos were grade A and those that are frozen are grade A and B all in blastocyst stage.i produced 25 eggs using low protocol and almost got ohss my AMH is classified as optimal fertility and everything is normal.kindly assist.

    ReplyDelete
    Replies
    1. I can't tell you exactly what caused the failure. First, I would need to review your medical records to see if anything in the cycle affected the chances and second, not all IVF cycles work. In my practice. 60% of patients get pregnant on their first attempt. This means that there is still an element of chance with IVF because it is not a perfect technology. There is no 100% pregnancy rate. This is not only because there are so many factors that can influence a cycle, such as embryo quality, transfer technique, lab quality, etc.; but also because the last three steps in the reproductive cycle: embryo emerging from its shell, attachment to the endometrial lining and lining engulfment of the embryo, are still natural processes. They are in the hands of God or Nature.

      As a side note, however, there have been numerous studies that have shown that in high responder patients (more than 20 follicles and retrieval of more than 20 eggs), the quality of the egg suffers and pregnancy rates decline. That could be a reason as well. In the next cycle your doctor needs to reduce the stimulation.

      Delete
  57. Dear Dr. Ramirez,

    I am 28 years old, trying to get pregnant (naturally) for almost a year (no succesful pregnancies). I have had 3 (maybe 4, one could not be verified) chemical pregnancies, where bleeding always starts shortly after a positive home pregnancy test in early week 5. In the first two times hCG levels continued to increase until ~300, then dropped. Following a doctor's advice, in the third time, I took just one baby aspirin pill and one progesterone pill, both right after the positive result. This made a change in the sense that (while bleeding still started early), hCG levels continued to rise until 3000: but then dropped erubptly, and the ultrasound could still not show anything.

    What could this different course of events mean? Could it indicate that taking aspirin earlier would help? Or would the change be a result of the progesterone? Or just coincidental (I find this a bit hard to believe since it felt so radically different)? We're trying again now and wish to find the best course of action.

    Many thanks in advance


    ReplyDelete
    Replies
    1. By definition, you have recurrent pregnancy loss. Low dose aspirin and progesterone certainly are treatments for this and could help, but it may not be treating the cause of the problem. Recurrent pregnancy loss occurs because of five possible defects: genetic, hormonal, immunologic, infectious and anatomic. These need to be tested. I would strongly recommend that you see a competent infertility specialist for this.

      Delete
  58. Hi Dr Ramirez, I got married 5 months ago and have had a back to back m/c In March and May. First one being a chemical pregnancy..hcg 23 and started bleeding and the next 5-6weeks with the sac never seen on u/s.. hcg 3870. I am still in the process of miscarrying and I have been having fears on if I can ever have a baby. I am turning 25 next month and afraid of miscarrying again. What do you think I should do to prevent m/c? Everything looks normal in the ultrasound, I have a 23-30days period with premenstrual brown spotting 2-4 days before my period, my progesterone level is on the low normal and was on it during the second pregnancy and still could not save the pregnancy. I would really appreciate your advise. Thank You.

    ReplyDelete
    Replies
    1. By definition, you don't have recurrent pregnancy loss yet and the chances that you will have a successful pregnancy is still very high. There are three things you can do that might help: take a low dose (81mg) aspirin tablet each day, use a progesterone supplement vaginally beginning after ovulation and take a prenatal vitamin with at least 1 mg of Folate (folic acid).

      Delete
  59. hi dr ramirez,
    i am married since 7 yrs....and trying to concive since 1st day..never got pregnant...diagnosed as hypothyroidism with mild elevated anti thyroid peroxidase antibody,natural killer cells normal.. on eltroxin 100,tried several cycles of clomid... hsg both tubes patent.hysterescopy done in 2013...pcr for tuberculosis positive took ATT for 6 months, then hsg in jan 2014...normal study...then 3 cycles of iui with gonal f...no success...husband semen analysis normal....why i cant get pregnant...may be implantation problem because of antithyroid anti body...can i add prednisolone and aspirin in my next iui cycle...if yes what is the dosage and from which day to start....i would appreciate ur advise..thanks..dr sumi

    ReplyDelete
    Replies
    1. Since you have antithyroid antibody, using prednisolone and aspirin certainly can help. There are no other well established treatments for this, however. As to why you can't get pregnant, I can't answer that question in this venue as I don't have all the information required, nor can I evaluate whether or not the treatments rendered were done competently.

      Good Luck

      Delete
  60. thanks for ur reply...i am 32 yrs old ..and my husband 41...my question is when should i start prednisolone in cycle ,and what should be the dose and when to stop...thanks a lot sir...dr sumi

    ReplyDelete
    Replies
    1. In reality when you start and stop it depends on the procotol that your dcotor is using so you should consult him/her. I usually start with the start of the IVF cycle and use 16 mg per day. On the day of retrieval, I decreased the dosage to 8 mg per day and continue that until the second pregnancy test. I then stop it at that point. I only continue it in patients that have recurrent pregnancy loss. In those patients I continue it until they are 10 weeks gestational age.

      Delete
  61. I did iui about last week Friday 30th May, and have been asked to come for pregnancy test on the 14th June which seems to be a long wait for me. I noticed yesterday that stood up five times to urinate overnight and am having sore and tender nipples. Could it be that am pregnant? Honestly am afraid to do a home pregnancy test in case of a negative result. Thank you

    ReplyDelete
    Replies
    1. Certainly the symptoms you are exhibiting could be a pregnancy but I would not expect those symptoms until much later in the pregnancy. I usually wait 14 days when doing IUI's so your doctor is not waiting too long. A blood pregnancy test is the way to go.

      Delete
  62. Hello doctor
    I am 31 yrs old and my husband is 38. We have been trying to concieve for 8 months. We have had two chemical pregnancies and a missed miscarriage where the baby stopped growing at 9 weeks exactly. I miscarried rather naturally under the supervision of an RE I was perscribed misoprostol and monitored with ultrasounds to make sure I passed everything. We have a full work up scheduled for cycle day three once my period arrives. Our RE told us there is a good chance nothing will be found in our work up. We have already had a SA, my progesterone checked and a panel done on me that all came back normal. This past pregnancy I was put on baby asprin aswell as proestrogen as a precautionary. My question is is it safe for us to try again right away? I seem to before fertile after a loss and would hate to loose an opportunity of conceiving when there is no definite answer that anything wil be found in the work up. I only bled for six days on the misoprostol and my body seemed to bounce right back. My HCG is dropping drastically and 7 days ago it was at 62. Is there any high risk of concieving immedietly after a loss? Thanks in adavanced

    ReplyDelete
    Replies
    1. Hi,
      There is no reason why you can't begin trying immediately. In fact, there has been a study showing that a woman's fertility it heightened within the first 6 months of a miscarriage. My only concern is that you have now lost 3 pregnancies which puts you into the category of "recurrent pregnancy loss." For that reason, you should have a full RPL evaluation done. This includes the following:
      Anatomical evaluation - ultrasound, diagnostic hysteroscopy
      Genetic evaluation - Chromosome and DNA analysis in both partners
      Immunologic evaluation - blood tests
      Hormonal evaluation - ovarian, thyroid, pituitary
      Infectious disease

      Talk to your RE about this before trying for another pregnancy. Treatments that can be done include estrogen and progesterone supplementation, low dose aspirin, Medrol, heparin or lovenox. If a genetic abnormality is found, then your doctor might recommend preimplantation genetic screening in conjunction with IVF.

      Good Luck

      Delete
  63. Dear Doctor,
    It is so very kind of you to answer people's questions here.
    I wonder if you could clarify something please for my husband and I? I am 34 and have been TTC for the first time but I have just had a chemical pregnancy. I tested positive on the pregnancy kit at 4 weeks but I immediately started bleeding heavily, the same amount of blood as a typical period but more achy and it came a bit earlier than usual (my normal cycle is 4 1/2 - 5 weeks).
    My doctor has said to wait for a "normal" period before trying again but I am desperate to try again sooner. I saw your post above saying "Once your cycle returns, there is no need to wait to start trying again." What is the difference between this chemical pregnancy bleed, and a normal period and do you think that I need to wait for another bleed before trying again?
    Many, many thanks.

    ReplyDelete
    Replies
    1. Hi. There is no reason to wait for the period except that it helps with timing intercourse. It is important for you to begin trying again soon after a miscarriage because studies have shown that a woman's fertility is heightened (increased) in the first 6 months after a miscarriage.

      The difference between a miscarriage bleed and a period bleed is that you are not pregnant when you have a period bleed and therefore sloughing the lining, whereas you are pregnant with the miscarriage bleed and sloughing the uterine tissue (pregnancy tissue).

      Delete
  64. Hi doctor,
    My age s 27 and husband age s 30. I am trying to conceive for the past two years.. recently I had 2 times iui and both ended in chemical pregnancy. Now next step should I move to IVF or try once again IUI. My husband sperm has low motility and I have Pcos. Am totally devasted n vexed.. pls provide some positive feedback

    ReplyDelete
    Replies
    1. Hello.
      If you achieved a chemical pregnancy (2) by IUI, that showed that the IUI worked. The loss of the pregnancies was not due to IUI or getting pregnant, rather, it was something wrong with the pregnancy itself. I think you can still continue using IUI to try for pregnancy, but I would recommend that you undergo evaluation for recurrent pregnancy loss prior to the next attempt. RPL can occur because of anatomical abnormalities, genetic abnormalities, hormonal abnormalities, infectious disease and immunologic abnormalities.

      Delete
    2. Thank you very much doctor. We have given now for the above blood tests. After iui,I take susten progesterone tablet upto 400mg. Is that tablet enough or any other supplement tablet would be helpful? Pls suggest...

      Delete
    3. Susten is not a medication that I am familiar with because it is not marketed in the U.S., however I was able to find that it is a natural progesterone. The usual dose is usually 100 mg three times a day or 300 mg per day, used vaginally. Oral progesterone has been found to not be effective for the uterine lining. So the dosage you are using is adequate.

      Delete
  65. Hi Dr. Ramirez,

    I'm 38 and in the process of a first IVF cycle. We did a 6 day transfer with 2 blastocysts of 'fair' quality. 7 days after the transfer I had heavy bleeding like a regular period. We are thinking the IVF failed, but our first beta hcg test (8 days after transfer) was 7.5. We tested again (10 days after transfer) and it was 24.2. Then we tested again (12 days after transfer) and it was 95. We are set to test again on Day 16, but my husband and I are definitely feeling confused. Are our numbers considered low, even though they are increasing? And what are other explanations for our situation? I'm hesitant to think we are actually pregnant. Thanks so much for any possible feedback.

    ReplyDelete
    Replies
    1. Hello,

      As long as your numbers are going up in a normal fashion (approximately doubling every other day), then there is hope. When bHCG is low, goes up abnormally i.e. does not double or flattens, that could indicate an abnormal pregnancy such as an impending miscarriage or ectopic pregnancy.

      Technically, you are pregnant and the IVF was successful in as much as it can be.

      Congratulations.

      Delete

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