PAI+ and MTHFR

[Anonymous]

I'm wondering if anyone can shed light on an issue. I apologize for "posting while pregnant" but it's related to my history of infertility.

I had secondary infertility and did IVF, succesfully, to conceive #2. The IVF protocol I was on included baby aspirin, which I haven't stopped taking (there is a history of autoimmne issues in my family, I had a very high positive ANA at one point, and I figured it couldn't hurt).

At 18 weeks my OB reviewed my records from the ferility specialist (Abassi at Columbia) and noted that I had a positive PAI test (heterozygous) and MTHFR double herteozygous.
Has anyone else had similar issues? If so, what did you do about them?

[Anonymous]

I'm homozygous for PAI-1 (4G/4G) and Abbasi prescribed Lovenox, pre-conception. I'm also on Folgard for MTHFR (heterozygous) and baby aspirin, but I think the aspirin is more because I was borderline for APA's.

[Anonymous]

I also have PAI and MTHFR. My Hematologist recommended Lovenox if I got pregnant again.

Also, Dr. Sherri Hamersley is a MFM Specialist who specializes in clotting disorders. She's in the office building right next to the Shady Grove office. I would definitely recommend having a consult with her. She monitors patients with clotting disorders differently and more frequently. You definitely should be seeing a specialist along with your OB/GYN.

[Anonymous]

Anonymous wrote:I also have PAI and MTHFR. My Hematologist recommended Lovenox if I got pregnant again.

Also, Dr. Sherri Hamersley is a MFM Specialist who specializes in clotting disorders. She's in the office building right next to the Shady Grove office. I would definitely recommend having a consult with her. She monitors patients with clotting disorders differently and more frequently. You definitely should be seeing a specialist along with your OB/GYN.

I also wanted to mention that in my opinion it was negligent that your RE didn't advise you about the clotting disorders. It put your pregnancy at risk. Dr. Hammersly likes to see patients with clotting disorders as soon as they fall pregnant.

[Anonymous]

This is the OP. THANK YOU to the other posters. I actually wound up switching from Abassi to Shady Grove because I had the sense she wasn't paying full attention. Now I am wondering 1) how much my current pregnancy was/is in danger as a result of the lack of attention to this and 2) how my fertility treatment(s) would have been altered if this had been paid attention to.

I'm glad my OB caught it. I sent the records to McClaren, the high-risk specialist doing other tests for me today. I truly appreciate the reference to Dr Hamersley and will call first thing in the morning. Hopefully I'll get an appt with her quickly (is this difficult)?

Thanks again.

[Anonymous]

Anonymous wrote:This is the OP. THANK YOU to the other posters. I actually wound up switching from Abassi to Shady Grove because I had the sense she wasn't paying full attention. Now I am wondering 1) how much my current pregnancy was/is in danger as a result of the lack of attention to this and 2) how my fertility treatment(s) would have been altered if this had been paid attention to.

I'm glad my OB caught it. I sent the records to McClaren, the high-risk specialist doing other tests for me today. I truly appreciate the reference to Dr Hamersley and will call first thing in the morning. Hopefully I'll get an appt with her quickly (is this difficult)?

Thanks again.

You are very welcome. I think you got lucky and your pregnancy is fine. It's awesome you decided to stay on the baby aspirin. I'm no expert but I believe clotting disorders can cause a much higher rate of miscarriage early in pregnancy. Later in pregnancy it can cause other issues. I think any problems would be acute or picked up by ultrasound (like slow growth). Again, this is just my layman's understanding so don't take it too seriously.

I think when you call Dr. Hammersly you definitely need to let the receptionist know that you have a confirmed clotting disorder that's not being treated and need to be scheduled right away....you can explain the situation. With situations like this I've found they'll fit you in quickly. Just make sure they know. Also, try to make your appointments either first thing in the morning or right after their lunch to avoid long waits. She spends a great deal of time with her patients so can get backed up.

[Anonymous]

Just wanted to share my experience. I am homozygous for PAI-1 (4G/4G) & heterozygous MTHFR. I have one DC, conceived naturally (by accident actually) and delivered after an uneventful pregnancy. This was before I knew about the PAI-1 & MTHFR. I discovered the PAI & MTHFR after a missed miscarriage and no luck TTC #2 when I went to Dr. Abassi. She recommended the tests right off and when I found out about the PAI & MTHFR insisted that I see a hematologist before moving forward with any treatment. The hematologist ran more tests and based on those tests concluded that while I did indeed have the genetic markers that indicate a predisposition for clotting disorders- my bloodwork indicated no such disorders - he did not recommend any special treatment. I would certainly not discourage anyone from alerting their ob/gyn about the findings - and seeking additional medical advice (Dr. McLaren did my NT & amnio b/c of AMA) but I did want to say that just having the genetic mutations does not automatically mean you will have problems or require treatment.