Sunday, July 11, 2010

Lovenox / Heparin Question

After losing two babies in 2007, both at 5 months gestation, I was advised to use Lovenox in any subsequent pregnancy. I still haven't had the chance to try it, but I'm about to do IVF. The trouble is that my RE refuses to let me have Lovenox to start after retrieval, saying we'll see about it after (if) I have rising betas. Also, the dose would be low - a prophylactic dose of 40 mg/day rather than a therapeutic dose of 60-80 mg/day.

So I have a question for anyone out there who has used Lovenox/heparin in absence of definite proof of thrombophilia: When did you start and at what dose? And why exactly did you use it? With what outcome? I'm looking for personal experiences and also any references to studies/articles about any advantage to starting Lovenox before pregnancy is confirmed.

After my losses I was tested for everything under the sun. All results were negative except the following:

First Loss - Jeremiah (January 2007 at 21w 3d) cord hypercoiling
Moderate positive result on anticardiolipin antibody IgG, which we're told is not significant; after six weeks this was retested and the level was "inconclusive"

Normal chromosomes (except a pericentric inversion of chromosome 9 [inv(9)(p12q13)] inherited from mom - we're told this is insignificant

Second loss: Miles (July 2007 at 18w 5d) cord stricture
Additional testing on me showed I am heterozygous for MTHFT mutation C677T, which we're told is "not clinically significant"

I took baby aspirin from 6 weeks onward

Anticardiolipin was normal this time

I do have two living children, a son born 2003 and a daughter in 2005. They also had placenta/cord issues (esp. my son). I don't know if we're on the right track at all with the thrombophilia hypothesis. Maybe it's genetic? Something else? Any thoughts are appreciated.

Up until a few days ago, my time and energy went into fighting for the chance to even try IVF and then into arranging all the details (getting drugs, paying, etc.). Now the stress is really hitting me. I think my chances of getting pregnant are decent, but what about staying pregnant? I think with my terrible track record it's best to be aggressive with the Lovenox, but how can I when my RE refuses because the "cord isn't even formed that early". I wonder if my babies' cord problems are just a symptom of a larger implantation problem caused by thrombophilia. I'm terrified of having another dead baby.


Nick and Kristi said...

Hello....Well let me first start off by saying that I have MTHFR Hetero but two copies and also Factor XII Hetero...I had IVF last June and got overstimulated and ended up with a Pulmonary Embolism in my lung...this is of course prior to me knowing that I had the two clotting factors...however I was on Baby Aspirin...So for all future tx/pregnancies they always put me on Lovenox 40mg one time a day....In my 2 pregnancies that mad it to an US both had subchorinic Bleeds(can be caused from blood being to thick)...So with my last miscarriage when I went to the Reproductive Immuniologist she did a doppler blood flow study to my uterus when I was just on baby asprin and said that I wasnt getting enough blood pre IVF cycle she put me on Lovenox 40mg 2 times a day when I started my stimulation medications...then pulled me off the Lovenox for two days prior to Egg Ret...and then I went back on one day later...A couple of days past Egg Ret she did another doppler flow study and my blood flow was within a good range so she just kept me on the 40mg two times a day...I go weekly to get this doppler flow study the week I found out I as pregnant we did the study again and my blood flow was down...Dr. said this is common during early pregnancy so she increased my Lovenox to 60mg in am and 40mg in the pm and that is what I have been taking since....and now this is my first pregnancy where I have not had any subchorinic bleeds(crossing my fingers that I wont) and our pregnancy is going even though I know some Dr.'s dont think it is a big deal I would def have to disagree because clearly in my case it has helped....Better safe than sorry in my opnion...Oh also I did have a little spotting one day and my Dr. had me discontinue the Lovenox for 24hrs but started back up again when it stopped...Hope this helps:)

Katie said...

I just want to say that I am sorry for the loss of your two babies. I had unexplained recurrent miscarriage (total of 7 prior to my first term pregnancy). We eventually did IVF with PGD and the Lovenox.

For me, my RE started me at what would have been 3 DPO (so 3 DPR) at 80 MG per day. I did that through the first trimester. Again, this was for no other reason than my sanity. To be honest, I don't know that it made a difference, since there were obviously other things we did differently.

But if a doctor TOLD you to do Lovenox, then I would do it. It's kind of expensive (but insurance should cover if if it's coded correctly), it's a once a day thing (heparin would be multiple times a day), and it didn't give me any side effects other than some interesting bruises on my tummy.

Can you get the records from the doctor who advised you to take the Lovenox and have them faxed to your RE? Can you have that doctor consult with your RE? If all else fails, can that doctor prescribe you the Lovenox?

Good luck.

Jenn said...

I also have MTHFR like the first commenter, with RPL (7). After my diganosis, they had me do my trigger shot, then my husband and I's 'date' and the next day I started Lovonox until either a negative pregnancy test, or in my case, until it was a confirmed miscarriage. They still don't know whats wrong, because I lost 2 after doing Lovonox, but they are thinking it's my eggs... so we moved up to adoption now. Good luck. My doctors said that 1/2 doctors will do Lovonox, 1/2 won't, depending on which reasearch they follow... but he told me it wasn't going to hurt me, and if it took a bit of the edge off of the worry, he had no problem prescribing it for me.

G$ said...

I don't have any thromb diagnoses, but we added Lovenox to my protocol. My doctor was of the mindset that "it couldn't hurt" and agreed after I brought it up. But he wanted to start with the positive beta. I arm wrestled him a bit and got him to agree to let me start the day after transfer. After everything I had already been through, it wasn't much of an arm wrestle and we both knew this was the last cycle for us to have a bio child.

Also, even though the cord isn't even doing much by there, there is some talk in the industry that the blood flow is better. Considering how this current pregnancy started (good beta, then doomed, then no miscarriage, then Um, wow, you're still pregnant but no heartbeat, then heartbeat and now 1 week from delivery) I am 100% convinced this kid wouldn't have had a chance without it. There are so many clotting issues they don't even know about yet.

So my advice, break down in tears and tell your doctor you just want to know you gave it your all before you gave up, that you don't want to feel like it may have worked if you had been on Lovenox. (I had that breakdown via email to my doctor in the middle of the night - he agreed by 7am). Hopefully your doc goes with the "what can it hurt" attitude if you push it.(yes, there are side effects but not that big considering everything you have been through). Good luck.

Dora said...

So sorry for your losses.

I had 30mg of lovenox added to my protocol for my 2nd donor FET. Everything looked perfect for my first FET, but I didn't get pg. I have a single hetero MTHFR and have mild Reynauds. My RE felt it couldn't hurt. 30mg per day was started on transfer day. My OB had me stop at 8 weeks, when she saw me for my first OB appt. She had me retested for all the risk factors, and felt it wasn't necessary. I had an uneventful pregnancy. The best kind.

Good luck!

areyoukiddingme said...

I have elevated ANAs, which is essentially nothing, but probably the cause of my two miscarriages. I had heparin (5000 units twice a day) which I started after getting a decent beta number. But, I also started low dose aspirin before attempting to conceive. Since they both have blood thinning effects, I would guess that the milder aspirin keeps clotting issues in check until lovenox/heparin can be started. But, my doctor had me testing at 10-11 dpo, too. That way, I could get the heparin going as soon as possible after the blood flow became established. Anyway, successful effort - now dealing with obstinate 3 year old. :)

Jana said...

I hope you are able to talk with your doctor and get things sorted out correctly. I would ask him why he won't let you do it beforehand. Is it just because there is "no cord" as he says, or is he concerned about other risks? or just being stupid? What matters is the baby, if it could help your baby, there is no reason to not do it.

Also, can you take baby aspirin from the get go as well?

I will be thinking of you. Sorry you are feeling stressed out, this stuff is not fun. You can do it though, hang in there.