After being on the receiving end of repeated episodes of negligence on the part of Dr. Ramirez and his staff, I have finally become inspired to jot down my experiences with the Fertility and Gynecology Center in Monterey. Hopefully this will serve as a cautionary notice to prospective patients of Dr. Ramirez.
I will begin with the good, because it’s short and sweet! I conceived on two of the three ovulation induction cycles I underwent with Dr. Ramirez. He clearly had the formula down for me. (Unfortunately, both pregnancies ended in miscarriage, though I do not blame this on the doctor.)
Now for the full story…
I started seeing Dr. Ramirez for ovulation induction treatments at the beginning of this year, in an attempt to shorten my excruciatingly long (48-day) cycles. I had previously undergone one round of Clomid with my OBGYN, which had resulted in an extremely thin endometrial lining and disturbingly heavy bleeding, among numerous other unpleasant side effects. Dr. Ramirez suggested I try Femara, instead, which I was very grateful for.
He prescribed 2 Femara 2.5 mg tablets (5mg) on days 3-7 of my cycle. I came back for an ultrasound scan on day 10, at which point he prescribed Enjuvia (estrogen), as my endometrial lining was not of sufficient thickness. I had a second ultrasound scan around day 12, at which point he administered an HCG trigger shot. For the first time in my life, I had a timely ovulation on about day 15! I began taking progesterone supplementation a couple days after ovulation occurred, as prescribed. (The doctor never monitored my progesterone levels thereafter, so I’m not sure how he could know if the prescription was effective/being absorbed/etc.)
A few days before I was scheduled to test for pregnancy, I experienced period-like bleeding with clots and phoned the office to notify the staff. I assumed I was not pregnant and that my period had arrived a bit early. The doctor told me to discontinue the progesterone (on Saturday), and come in on Monday (Day 3 of the cycle), at which point he would perform the standard quantitative blood HCG pregnancy test, so that I could prepare for a second ovulation induction cycle. He mentioned that we could bypass the test if I wanted, as the bleeding indicated that the previous cycle had not been successful. I chose to confirm with the blood test.
After drawing the blood and completing my Day 3 scan, Dr. Ramirez confirmed that my pregnancy test was negative, waving the result sheet at me briefly. He instructed me to start the next dose of Femara that evening, at a higher dosage (7.5mg), since this cycle was deemed “unsuccessful”. However, in the brief moment that he waved the result sheet at me, I had noticed that the number next to “HCG” was 5.0. This surprised me, as my HCG levels had always registered under 1.0 when I was not pregnant. Not wanting to mention it without doing some research, I left the office and reflected over the discrepancy on my way home.
Once home, I Googled “HCG levels”, and found that HCG levels of 5-25mIU/ml are considered “equivocal” early in pregnancy, and a re-test was in order. I decided to forgo beginning the Femara as directed, and took a home pregnancy test the next morning. Femara is a Category D drug in pregnancy and has been associated with SEVERE birth defects if taken while pregnant.
When I performed the urine test the next morning, the faintest of faint positives appeared! I immediately phoned the office and explained that I had a positive urine test, had not started the Femara, and that I wanted a repeat blood test drawn the next day. I was told by the nurse that the blood tests were much more sensitive than urine tests, the urine test must be inaccurate, and that I needed to start the Femara right away, as the blood test from the day before was negative! I told her that I was not comfortable taking a Category D drug if there was any chance whatsoever that I might be pregnant, and I would skip the medicated cycle completely if I was not provided with a second blood test which confirmed that I truly was not pregnant. I also pointed out that my results were 5.0 on the initial test, which surprised her. She said she would double check with Dr. Ramirez. A few minutes later, she called back and told me that I must have seen incorrectly: my results were not 5.0, the doctor would not perform a repeat test, and I should go ahead and start the Femara. Outraged, I told her that I was not going to start the Femara and demanded a repeat test. She put me on hold and spoke with the Doctor, who apparently tried once again to convince her that a repeat test was not necessary and that I was definitely NOT pregnant, but he’d be willing to humor me if I absolutely insisted.
The next day, I went in to the office for the repeat HCG test. The doctor ONCE AGAIN tried to persuade me not to take the test; he said my urine test was surely a false positive and that it was unnecessary for me to get poked. I insisted. 30 minutes later, the nurse called me, obviously startled, telling me not to start the Femara: my HCG levels were now at 12! She said that she looked back on my paperwork, and I had actually been correct: my first test result was 5–and that I was indeed pregnant, with properly doubling HCG levels! WHOOPS. How was it that when I brought this up originally, neither nurse nor doctor double-checked my results–and instead assured me that I had seen incorrectly and was certainly not pregnant? I was very glad I trusted my instincts and did not take the Category D Femara prescription (at the highest dose, no less!). I came back two days later, and my tests had more than doubled again–there was no question that I was indeed pregnant.
This shook my confidence in Dr. Ramirez and his team, but I was willing to forgive and forget–as he had helped me to conceive in the first place–and perhaps had just made a SERIOUS mistake, which he did apologize for. However, a couple of weeks later, I began experiencing additional bleeding with abdominal and back pain, and asked for an ultrasound or HCG level to get a sense of what was happening. Both were denied to me. I had no idea what was causing the pain. My HCG levels were no longer being tracked, even though I had a history of miscarriage. I became concerned that I might be experiencing an ectopic pregnancy. The doctor basically told me to just deal with it–that there would be nothing visible on the ultrasound at that point in time. I argued that if the HCG levels were doubling as they should have, they would be over 1500 by then, and there should in fact be something visible. Again, the doctor did not agree to check either the HCG or follow up with an ultrasound. I was at my wit’s end. I threatened to go to the ER if he would not at least perform a repeat HCG. (I should note that these interactions were all through his nurse, via the phone. I was not able to speak to the doctor directly, outside of my appointments.) Finally, he agreed (via the nurse). The test revealed that the HCG levels were still extremely low–and so he seemed victorious that he was validated in saying that nothing would be visible on the ultrasound. I couldn’t believe he didn’t get it–if my HCG levels were that low at that point in the pregnancy, it was clear that I was in the process of miscarrying–and instead of informing me that I was miscarrying, he was trying to justify why he wouldn’t give me an ultrasound! I had to explain to him that based on my previous numbers, my levels should be much higher by now. Only then did he agree to perform a repeat blood test a couple days later. My numbers continued to increase, but not double. By now, I was having pronounced discomfort and kept begging for an ultrasound. He finally relented, even though my HCG levels were still not high enough. The ultrasound instantly revealed a 5cm ovarian cyst!
Why wouldn’t the doctor grant me the requested ultrasound earlier, with the problems I was experiencing? Ovulation induction treatments carry the risk of OHSS, and surely he must have known there was a potential to develop cysts? All throughout this pregnancy, I was terrified I might be having an ectopic. Had he performed the scan, he could have assured me that the pain was most likely the result of the cyst, as opposed to an ectopic. Instead, he just kept telling me that ectopic pregnancies were rare (which is true, but which did not explain my pain). After discovering the cyst, he did no further monitoring to ensure it resolved–which upset me. Although cysts generally resolve on their own, there is also a potential for extreme/permanent damage to the ovary. Monitoring for peace of mind did not seem like too much to ask. I even mentioned that I’d be willing to pay for further monitoring of the cyst out of pocket, if he was concerned about the insurance companies rejecting coverage.
Sadly, I miscarried at almost 8 weeks, and needed to try again. As there were no other fertility specialists in the area, I had no choice but to return to Dr. Ramirez–even though by now I was less than impressed with his responsiveness, attention to detail, and professionalism.
For the second cycle, the Dr. prescribed a higher dose of Femara: 7.5 mg. I told him that I had conceived with two follicles on the 5mg dose, and didn’t understand why he would increase the dosage when we had already had success with a smaller dose. I was now concerned about OHSS and multiples. He told me that his records showed that the last prescription was for 7.5mg, not 5mg. I pointed out that this was the dose he prescribed when he thought my last (pregnant) cycle had failed; it was not the dose I conceived on for the first cycle. He realized this was correct, and agreed to proceed with the 5mg dose. (I couldn’t believe he had already forgotten that he insisted I take a Category D drug when I was pregnant!)
Again, I developed a mature follicle as a result of the Femara, and in two weeks’ time, confirmed success with a positive blood pregnancy test. I miscarried again shortly thereafter–though I don’t blame the doctor for either of my losses.
I began a third Femara cycle with Dr. Ramirez, this time at 7.5mg. On my day 13 scan, it was apparent that my endometrial lining was too thin (5mm), so the doctor prescribed a different, higher dose estrogen patch to be used. He gave me expired samples instead of writing up a prescription, and told me that the expiration date is arbitrary and they would be fine. When I got home, I couldn’t remember if the doctor had prescribed 2 patches or 1 patch daily, so called to verify with the nurse. She said she’d check with the doctor and get back to me. She never called back, so I started with a single patch. I called the office the next morning, reporting headaches, exhaustion, and depression (I am also taking thyroid medication and was concerned that the Estrogen could be impacting my meds)–furthermore, I still wanted to confirm how much estrogen I was supposed to be taking. The nurse apologized for not getting back to me, and confirmed that I should use two patches. She told me she would check in with the doctor on the exhaustion/depression and get back to me. Again, she never called back. I began taking the two patches wearily, as I was already having said symptoms and was a little nervous about increasing the dose.
Over the weekend, three days after my HCG trigger shot and beginning the estrogen supplementation, I began bleeding and experiencing stabbing pains, backache, strong headaches, hair loss–you name it! The bleeding persisted throughout the weekend, and increased to a heavier flow on Monday morning. I called the office as soon as they opened, explaining that I was having abnormal vaginal bleeding and pain similar to the pain I experienced with my cyst, and wanted to know whether they could monitor me to determine if 1) I was overdosing on the Vivelle Dot estrogen patch, and 2) if they could provide an ultrasound scan to determine if I was developing a cyst. The nurse did not apologize for not getting back to me on the exhaustion bit, and sounded very irritated that I was calling again with additional concerns. (The patient information sheet for Vivelle Dot clearly specifies that if abnormal vaginal bleeding occurs with use, it’s likely that the patient is experiencing an overdose, and should see the doctor immediately!) She condescendingly explained to me that the pain I was experiencing couldn’t be similar to the pain I had when I had the cyst, as I was only a few days past the HCG shot and what I had were follicles, not cysts. I explained that this was an analogy: I wasn’t TELLING her I had a cyst, I was just saying the pain was similar to what I experienced with my cyst, and I’d appreciate some sort of monitoring (Estradiol levels to ensure I was not overdosing on estrogen, and/or an ultrasound to determine if all was as it should be). This was denied even before I got the words out! She put me on hold to check with the doctor, who confirmed he would not provide me with an ultrasound or any blood monitoring: that I needed to follow “the protocol” (oh god, the PROTOCOL again!)–and continue taking my meds. I told them I was completely on board with taking the meds, but as I was experiencing pain and bleeding, I simply wanted to be monitored–so as to know whether I was taking an appropriate dosage!
Now feeling utterly hopeless, defeated, and helpless (not to mention being in pain and bleeding abnormally!)…I ended the conversation with the nurse saying that I intended to follow up with a different doctor. She told me that I could stop taking the estrogen if I was concerned, but that Dr. Ramirez recommended I continue with the med. I repeated that I’d prefer to continue with the med, and that I only wanted to be seen/monitored! Again, I was refused. I gave up.
After I got off the line with the nurse, I called my OBGYN, who was horrified that the Fertility and Gynecology Center refused to see me based on my symptoms, and scheduled an appointment for me to come in immediately. I was prescribed additional progesterone to balance out the unopposed estrogen, which stopped the bleeding and pain in its tracks within a day’s time. I then called Doctor Ramirez’s office and requested that they call in a legit (unexpired) prescription for the Vivelle dot. When I picked up the prescription, the label specified only “take as directed”–with no specifications as to what “as directed” was. (How convenient for them to not have any written “proof” that they had instructed me to overdose on this medication!)
For the record, I very much liked Dr. Ramirez in person: he has an excellent bedside manner in the office and was a very pleasant person in general. The ladies on his team are also quite likable. In fact, I feel somewhat guilty sharing my negative experiences with them on the web, but I feel obligated because they just seemed to “check out” whenever I had a problem. Frankly, I was surprised that with such a warm personality Dr. Ramirez could seem so unconcerned about my complaints, which seemed valid. I really wanted to believe in him, and only after my last experience with him did I decide that I will never go back to see him. Please take this to heart when deciding whether to pursue treatments with Dr. Edward Ramirez and his team–I hope through this post I may spare someone else similar negative experiences. I’ve actually recommended him to two people (since he did help me to conceive), but with the disclaimer that they should always seek a second opinion when in doubt (or when he refuses to see them in person)! I did not pursue a more aggressive IVF treatment with Dr. Ramirez (as ovulation induction was successful), but know that many seeking his assistance will be interested in IVF. My advice is to be very cautious before (and while) undergoing an aggressive treatment such as IVF with this doctor, should you choose to do so after reading this post–as my treatments were much less invasive/potentially dangerous than IVF would be.
All the best.
