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lyly14 - October 23rd, 2007 1:32 PM

Hi Dr. Jacobs,

I just want to start off by telling you how much I appreciate all the time you take to read these posts and offer your advice. Now here is my question:

I was recently approved to start IVF and went in for a consult with my RE. He was hesitant to put me on birth control because I have two copies of the MTHFR gene and have had positive antiphospholipid antibodies in the past (recently tested negative 2X's after years of positive results). However, he said that since I have a hard time using OPK's it would be hard to determine when to start meds without some manipulation of my cycle. Anyway, he prescibed me the birth control pills and advised me of the risks. He also told me that these risks were also present once I stopped the birth control because of the high levels of estrogen during IVF stimulation. My question is :

1. Would you recommend some type of blood thinner (lovenox, heprin) while I am on birth control and throughout the IVF cycle?
2. Or is 2mg of folic acid twice daily and 1 baby asprin sufficient as a precaution?

I really appreciate your time. Thanks so much
-Lyly

B. Jacobs, M. D. - October 23rd, 2007 6:04 PM

If there is a genuine concern about blood clotting in your veins ono pills and with your high estrogen levels during stimulation, I might consider using Lovenox. Also, if you really do have a phospholipid syndrome, you should probablv be on Lovenox, anyway, to help decrease your risk of miscarriage.
Goodluck.


lyly14 - October 23rd, 2007 9:01 PM

Thank you so much for your response.

I have one daughter who will be 9 (complications of preclampsia during pregnancy ) and have had one chemical pregnancy (2005) and one miscarriage at 11 weeks (March 2006). I have not been able to conceive since. After the miscarriage I was told that lovenox would be used if I got pregnant again but not until pregnancy was confirmed with a fetal heartbeat. Now that I have been seeing the RE he has retested the phospholipid panel twice and was negative. So he did not feel the phospholipids were a major issue, however was concerned about the MTHFR. I think I will call him tomorrow before I start the pills and discuss this with him. However, I am just curious: I know you are not the one treating me , but with a past history like mine would you be concerned with the phospholipids considering they have recently been negative ?

B. Jacobs, M. D. - October 26th, 2007 6:45 PM

If the phopho lipid antibody panel was done by a reliabel laboratory,, and is negative, I doubt that it is an issue.
Good luck.


lyly14 - October 29th, 2007 9:35 AM

Thanks for all your input.

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