lovenox and mthfr gene

[Anonymous]

Hello,
After having two very early pregnancy losses I was diagnosed with mthfr gene mutation
My Dr wants to put me on s lovelox once I become pregnant again.

If you ever used lovelox please tell me what was your condition andif insurance covered the shots.
For how long have you been using lovelox?
any other info is appreciated.

[Anonymous]

I took blood thinners for PAI-1 and anti-phospholipid antibodies. Also tested heterozygous for MTHFR, but my doctor considered that a minor issue. It was covered by insurance with a small co-pay and I took it from 2 weeks pre-transfer to 6 weeks post-partum.

[Anonymous]

Anonymous wrote:I took blood thinners for PAI-1 and anti-phospholipid antibodies. Also tested heterozygous for MTHFR, but my doctor considered that a minor issue. It was covered by insurance with a small co-pay and I took it from 2 weeks pre-transfer to 6 weeks post-partum.

Did you get an epidural?

[Anonymous]

mthfr is really common and doesn't usually require lovenox. mthfr may cause elevated homocysteine which may lead to increased clotting. however, if you have mthfr but your homocysteine levels are normal, you don't need lovenox. pretty sure that's how it works, but i'm not a doctor.

[Anonymous]

Regardless of if you take lovenox or not, be sure you take Metanx- a prescription strength folic acid. With the MTHFR gene, your body has a hard time converting folic acid into its usable form, L-methylfolate. Metanx is folic acid already in the L-methylfolate form so your body can absorb it. Taking extra regular folic acid does not help. Many doctors will prescribe a similar prescription strength folic acid, Folgard, but anyone who really specializes in this says that Metanx is definitely the way to go. Without it, you run the risk of increased down syndrome and other neural tube defects (there have also been some recent studies showing a link between MTHFR and autism if not properly treated during pregnancy). Insurance usually doesn't cover it and its like $60 a month. In case your doctor hasn't prescribed it, definitely ask them to!

My insurance covers my lovenox and I also take a baby aspirin among other things. I have MTHFR plus one other blood clotting disorders plus immune issues. (Often immune issues and blood clotting disorders come hand in hand). Lovenox helps both because it is an anti-inflammatory and when you have immune issues, your body will send small blood clots to kill the fetus- something that is made easier when you have a blood clotting disorder.

After your two losses, I wouldn't take the risk and would go ahead and use the lovenox. It can help so much with implantation issues which could likely be the cause of your early miscarriages. You might only need it for the first trimester and if you do need it throughout the pregnancy, some doctors switch you to heparin in the last month- which leaves your body quicker so you can still do an epidural or will schedule you for induction and you stop the lovenox 24 hours before delivery.

A high risk OB who specializes in blood clotting disorders in the area is named Dr. Hamersely. She is based in Rockville with Maternal Fetal Medicine Associates of Maryland. She accepts most insurance so you may want to get a second opinion from her. She is one of the top specialists in blood clotting disorders in pregnancy in the country and writes most of the standard protocols.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I took blood thinners for PAI-1 and anti-phospholipid antibodies. Also tested heterozygous for MTHFR, but my doctor considered that a minor issue. It was covered by insurance with a small co-pay and I took it from 2 weeks pre-transfer to 6 weeks post-partum.

Did you get an epidural?

Yes, but I had an induction at 38 weeks and went off the Lovenox 3 days beforehand so it was out of my system pre-delivery.

[Anonymous]

Yes we have this, started folgard and it stopped miscarriages, we have two healthy ones. Only took lonvenox when traveling by air for work.

[Anonymous]

Anonymous wrote:Regardless of if you take lovenox or not, be sure you take Metanx- a prescription strength folic acid. With the MTHFR gene, your body has a hard time converting folic acid into its usable form, L-methylfolate. Metanx is folic acid already in the L-methylfolate form so your body can absorb it. Taking extra regular folic acid does not help. Many doctors will prescribe a similar prescription strength folic acid, Folgard, but anyone who really specializes in this says that Metanx is definitely the way to go. Without it, you run the risk of increased down syndrome and other neural tube defects (there have also been some recent studies showing a link between MTHFR and autism if not properly treated during pregnancy). Insurance usually doesn't cover it and its like $60 a month. In case your doctor hasn't prescribed it, definitely ask them to!

My insurance covers my lovenox and I also take a baby aspirin among other things. I have MTHFR plus one other blood clotting disorders plus immune issues. (Often immune issues and blood clotting disorders come hand in hand). Lovenox helps both because it is an anti-inflammatory and when you have immune issues, your body will send small blood clots to kill the fetus- something that is made easier when you have a blood clotting disorder.

After your two losses, I wouldn't take the risk and would go ahead and use the lovenox. It can help so much with implantation issues which could likely be the cause of your early miscarriages. You might only need it for the first trimester and if you do need it throughout the pregnancy, some doctors switch you to heparin in the last month- which leaves your body quicker so you can still do an epidural or will schedule you for induction and you stop the lovenox 24 hours before delivery.

A high risk OB who specializes in blood clotting disorders in the area is named Dr. Hamersely. She is based in Rockville with Maternal Fetal Medicine Associates of Maryland. She accepts most insurance so you may want to get a second opinion from her. She is one of the top specialists in blood clotting disorders in pregnancy in the country and writes most of the standard protocols.

I second the rec for Dr. Hamersly. She is an amazing doc and she specializes in clotting disorders. I've had two sucessful pregnancies under her care and I have MTHFR and PAI-1 mutation along with lupus. She will see you right away if you tell the receptionist that you are newly pregnany after two losses and have a confirmed clotting disorder. I would let her make the determination on your treatment plan.

[Anonymous]

To pp17:09

Did you take anything else for your immune issues?
At what point did you start taking lovenox?

I have to take it 3 days after an LH surge using a OPK, I am ttc naturally.

[Anonymous]

Anonymous wrote:To pp17:09

Did you take anything else for your immune issues?
At what point did you start taking lovenox?

I have to take it 3 days after an LH surge using a OPK, I am ttc naturally.

I started taking lovenox at ovulation (this is very important for implantation...one of my pregnancies I didn't start until a positive pregnancy test, and that one made it further than any of the others, but I lost it at 13 weeks, most likely due to early implantation issues that eventually caught up with me).

I started neupogen and prometrium a week after ovulation. Neupogen is an off-label use drug that has only recently been used to treat immune issues, but with amazing results so far. Dr. Braverman in NY is one of the few doctors in the US that prescribes it, and insurance usually won't cover it, but it is often used when ivig/intralipids fail or sometimes in their place (I had a bad reaction to IVIG so didn't want to use it again). It is completely safe to take during pregnancy and I took it up to 9 weeks. (Its a daily injection, but much easier than lovenox). I started prednisone, a steroid, shortly after I was confirmed pregnant based on my immune results. I also took baby aspirin, metanx and fermented cod liver oil even before I started trying. And a prenatal called Neevo that is meant for women with the MTHFR gene (same makers at Metanx, but my insurance actually covers this one).

I think lovenox is a wonder drug for women with recurrent pregnancy loss and I don't think you have much to loose. I hate it when docs think you have to have 3 miscarriages in a row before looking into any interventions, so if you have a doc on board to help you after 2, that is great! But I do recommend a consult with Dr. Hamersely. She can help coordinate care with your doc, and we are lucky to have one of the top specialists for this in our area, so might as well take advantage!

Good Luck!

[Anonymous]

OP here.

Thanks for the info, guys.

[Anonymous]

To pp 15:27

Thank you for taking the time and answering my questions.
Did you do ivf or natural?
And if natural how long did it take you to conceive?

[Anonymous]

I'm currently 16 weeks pregnant and like one of the PPs I conceived on Neupogen (naturally and on the first attempt) prescribed by Dr. Braverman after I miscarried twice with IVIG. I started lovenox and Neupogen at the same time, right after ovulation.

I am on lovenox for PAI-1, MTHFR, and FVL (also elevated APS, but not diagnosed with APS). I also see Dr. Hamersley who has FVL and has also had miscarriages (I've had 8). My insurance had no problem covering lovenox with my specialty med co-pay. I'm guessing it's because I have FVL though. They ship me 3 months at a time along with sharps containers and alcohol swabs.

MTHFR itself does not cause a problem itself like another PP mentioned, but many REs will treat with lovenox empirically if they uncover something with your RPL panel. You could also have something else undiagnosed that lovenox will treat, especially if you have not been tested for immune issues.

Dr. Hamersley is great and so is Dr. Braverman

[Anonymous]

I forgot it puts a shaded smiley face in when I write 8 followed by ")", but it's certainly not meant to have a smiley face beside it...

[Anonymous]

Anonymous wrote:I'm currently 16 weeks pregnant and like one of the PPs I conceived on Neupogen (naturally and on the first attempt) prescribed by Dr. Braverman after I miscarried twice with IVIG. I started lovenox and Neupogen at the same time, right after ovulation.

I am on lovenox for PAI-1, MTHFR, and FVL (also elevated APS, but not diagnosed with APS). I also see Dr. Hamersley who has FVL and has also had miscarriages (I've had 8). My insurance had no problem covering lovenox with my specialty med co-pay. I'm guessing it's because I have FVL though. They ship me 3 months at a time along with sharps containers and alcohol swabs.

MTHFR itself does not cause a problem itself like another PP mentioned, but many REs will treat with lovenox empirically if they uncover something with your RPL panel. You could also have something else undiagnosed that lovenox will treat, especially if you have not been tested for immune issues.

Dr. Hamersley is great and so is Dr. Braverman

Thank you and good luck to you.