Monday, June 2, 2014


Dear Readers,

It has been a while since I last posted to this blog, and to my readers I apologize.  Things have been quite busy, hectic and stressful this year.  As you know, we are still in a recession here in the U.S. (not officially of course) which has placed a great deal of stress on my practice.  Although I have continued to answer questions that come in daily in the comment sections, posting in this blog is one of my duties that I have neglected.  I'll strive to do better from here on out!

This post is a little different and a little off subject, but something important that I want to request from my readers. Yes, instead of you asking something from me, I'm asking something from you this time.  As you know, the internet has become the biggest driving force for information and patients also use this to choose their doctors or clinics.  This is a good thing, as anyone who has ever looked for a doctor, plumber, contractor, etc. realizes, but at the same time, the current sites that rate are flawed and often unreliable which make it a bad thing.  It also can be used as a weapon against competitors.  This latter point is something that I've only recently come to realize.  I usually don't pay any attention to the rating sites, such as "Yelp" but just by chance, while looking for something else, I came upon it and saw some ratings of me "Edward J. Ramirez MD".  My overall rating was a 2 (out of 5) based on four reviews, three of which were terrible!  Interestingly, all three were within 1 week of each other so I decided to see if I could recognize who these "former patients" were and figure out why they hated me.  The site had the first name and the initial of the last names listed so I thought I would look them up using that criteria.  I have electronic medical records so it is not a difficult thing to do.  I also had the time period (April 2014) to help with the search.  Interestingly, I could not find any patients with the first names and last name initials to match these three patients.  I also found the exact same texts in reviews on two other review sites!  What I concluded is that these three "patients" were not actual patients but could only have been staff from a competing clinic that is trying to drive patients away from me by using these review sites.  Why do I suspect a competitor?  Because each of the reviews mention going to a "bigger Bay area clinic or another doctor".   Of course they wouldn't state the clinic or doctor by name because that would them reveal who was placing these malicious reviews.

Many of you, my readers/followers, have never met me and don't know me personally.  However, from my writing, I hope that you can see my devotion to patients and to treating them properly and respectfully.  My consultations are 1+ hours long, and I don't limit the number of questions, how much time spent with the patients or tell the patient what to do.  I also give my patients my email address in order to have almost immediate access to me for additional questions. I always try to make sure that the patient(s) understand everything that I have explained fully and clearly, even drawing diagrams and giving handouts regarding the topics.  At the end of the consult, I give each patient a "consultation diagnosis and treatment" summary with a written explanation of their options.  As you have read here in this blog, I believe that patients should be given options and should understand the pros/cons, risks/benefits, approximate costs and approximate pregnancy rates for each option; and I believe that this is a personal problem that they need to decide for themselves.  Each patient has different priorities and needs and therefore, the decision will be different for each.  As such I DO NOT TELL PATIENTS WHAT TO DO!  I give them options.  My role, as I explain to each new patient, is to be their consultant, adviser, advocate and therapist to help them reach their goal.  I am here to help them to the best of my abilities via the path that they choose, even if it is against my recommended path. Some patients can't afford IVF so prefer to try IUI or prefer it because it is more natural, whereas other patients want to be pregnant immediately so want to  bypass the easy treatments like ovulation induction or IUI and go straight to IVF.  I believe that is THEIR choice, not mine.  I'm there to help them in whichever path they choose.

So as you can see, when reviews show up that state that "I don't spend time answering questions" or "push them into IVF" or "don't explain things to them", you can bet that it is NOT a real patient writing that review, because that is exactly the opposite of what I really do.

After these many years of writing these blogs, answering questions through All Experts and responding to questions in the comments on this blog, I am asking for assistance from you, my readers and followers.  The best way to overcome these false reviews is to put REAL reviews on these sites.  If you have found me to be helpful to you, despite the fact that you have never seen or met me, but you feel that I've spent time on your questions, given you proper and reliable answers, given you hope, or helped you understand what you are going through, I would greatly appreciate it if you would call up one of these rating sites like YELP and put in a good word for me.  Give me a rating that you feel I deserve and comments that you feel reflect what you feel about me.  In this way, not only will you be helping me, but more importantly, you will be giving potential patients searching for a doctor a VALID review upon which to base their opinion and choices.  I hope that you will go to a review site (type in Edward J. Ramirez MD or Fertility and Gynecology Center or Monterey Bay IVF or all three) and file a review of your experience in return for the information, response or advice that I have given you.

I would greatly appreciate your help in this matter.

Edward J. Ramirez, M.D.
Monterey Bay IVF
Monterey, California


  1. Hello Dr. Ramirez,

    I would first like to start by sharing my appreciation for all that you do. Struggling to get pregnant is an amazingly emotional journey and from my personal experience it is often plagued with utter lack of knowledge and information. I appreciate your willingness to freely share the information that you have and in doing so better educate people and equip them to advocate for themselves. Secondly, I have read your recent request to contribute to your Yelp reviews and I am willing to help you with this request. While I expect that I will not have an opportunity to visit your practice directly, I would hate to think that someone that is so generous with their time and information is so negatively impacted by anonymous culprits.

    I am 32 years old and have two amazingly beautiful children that were conceived very quickly (1 was conceived in our first cycle, the 2nd was conceived in 2 cycles) and both were easily and born via scheduled c-section after uncomplicated pregnancies (planned c-section was due to unrelated medical issues).

    My challenges began when we decided that we wanted one more child to make our family complete. I have been trying to conceive since I had Mirena removed in February 2013. During this time I have had 1 miscarriage (and subsequent D&C), a chemical pregnancy (not clinically confirmed: several + home pregnancy tests but by the time my beta was drawn levels were at 5). An ectopic pregnancy (ruptured at 8w3d - lost my right tube) and just last week I had another chemical pregnancy (Betas: 17, 13, 2 over several days). I should also mention that since the Mirena removal, my periods have been regular (ovulation confirmed via OPKs and temping) but very light - I have light bleeding for 2 days at the most. Some cycles I'll have one additional day of spotting between cd 7-9. All of the doctors I've asked about this seemed to be unconcerned about this.

    After the ectopic (which occurred almost a year after we started trying) I was referred to an RE by my surgeon who did the salpingectomy because I had a lot of questions. The RE basically told me that I need to try to conceive for a whole year from that point and then come back if I wasn't pregnant within a year. Obviously this was frustrating as we had already been trying to conceive for a year and he was essentially resetting the clock before we could seek help.

    My question for you is that now that I have had yet another chemical pregnancy should I push for more tests or answers? Or should I just accept that all of the events are likely unrelated and just continue to try to conceive a viable pregnancy until I reach a year from the ectopic and then request to be seen? I recognize that this is an emotional situation and I would appreciate your insights into if I should be willing to consider these losses and amount of time it has taken to conceive as normal and not collectively concerning or if I am right in thinking I need to push for more answers? If it is time to start asking for additional tests or screening, what would you recommend that I ask for?

    Again, my appreciation for the wonderful information that you provide! I hope to be able to hear back from you.

    1. Hello. A chemical pregnancy is a form of miscarriage and may indicate that there is some type of problem going on. It could be a simple as a progesterone deficiency or as complex as an immune problem. I think that maybe you need to have another discussion with your RE or find a better one. The good thing is that you don't have a conception problem. One easy thing that you can do is take a low dose aspirin tablet each day (81 mg tab). You can purchase these at Costco and it is the heart disease protection version. This is one of the treatments for recurrent miscarriage. Other treatment would include progesterone supplementation, prednisone or Medrol and sometimes heparin or lovenox. These medications are all prescription so your doctor would need to decide if they are appropriate. Even if you did nothing, however, statistically speaking, you will eventually be successful if you kept trying on your own. But, that would be a lot of emotional let=downs you would have to go through.

  2. Hi Dr. Ramirez,

    I am 38 years old. I have just undergone my first IVF. Day 1 of cycle was on Jan. 26th. Retrieval on Feb. 5th and Day 3 transfer on Feb. 8th. My cycles are normally about 25 days. Blood test done on Feb. 19th and results were disappointing, negative, <1. I was due to start period on Feb. 19th, would Progesterone prevent me from getting period? Would you recommend a re-test or should I assume I am not pregnant? I am taking 100 mg, 3 times a day. I have since decreased the dosage because of the negative blood test result, but hesitant to stop completely if there is still a chance. I don't know what to do. What are your thoughts?

    1. My protocol is to do two tests to confirm. They are done 48 hrs apart. I have had patients have a negative 1st test and subsequent positive tests due to late implantation. If would recommend that you now have a second test and if it is negative then stop the progesterone. Yes, progesterone can delay the period because there is still hormone pregnant. The period occurs because the hormones drop.

  3. I am 35 years after my 3rd child 10 yrs ago I had a tubal ligation. I normally get my cycle for 5-7 days,however last month it was only 3 days with one full day of flow. I ovulated just a week later with a lot od lower abdominal pressure which never happen. Then this month I only had a one day cycle. Is there's some major going on in my body to I need to go see a doctor or is this normal.



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