MTHFR mutations and lovenox

sophie

12 Posts
Reply MTHFR mutations and lovenox Posted on: Nov 30, 2011 at 3:26pm
Hi Dr. Braverman,

I have a history of early pregnancy loss and and am compound heterozygous for MTHFR (C677T and A1298C).

From ages 35 - 37, I had two chemical losses and one clinical loss (with heartbeat) at 7 weeks.
At 38, had a live birth with no RPL treatment.
From 40 - 42, had one chemical loss and one clinical loss (again, at 7 weeks after seeing heartbeat).

My question is, would you put a patient with my history on lovenox, and if so, starting before or after ovulation?

Thanks so much,
Sophie

Dr. Braverman

2005 Posts
Re: MTHFR mutations and lovenox Posted on: Nov 30, 2011 at 3:29pm
I would require much more information to give you a correct treatment plan. I dont think the compound hetero C677 MTHFR is your problem however. I would be happy to assist you , feel free to call my office and schedule a consultation. did you ever have karyotyping(genetic studies performed?).
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

sophie

12 Posts
Reply Re: MTHFR mutations and lovenox Posted on: Dec 4, 2011 at 3:32pm
Thanks for your reply. We have had kareotyping done-- all normal. Only other issues are 3 partial DQ alpha / HLA matches and "borderline" elevation of natural killer cells. We are currently doing dexamethasone, intralipids, and lovenox. I'm just wondering if the lovenox is doing us any good / is necessary, and what part of the cycle it should be started in. I've seen two doctors with two differing opinions on this.

Thanks again,
Sophie

Dr. Braverman

2005 Posts
Re: MTHFR mutations and lovenox Posted on: Dec 5, 2011 at 7:52pm
The types of HLA mathces you have are important as well as which ones you alone have as certain combinations are also associated with pregnancy loss. Your immune profile is also insufficient to determine if your management is correct both in regards to timing , frequency and dose. It is critical to know how the change during the course of treatment as well so doses can be modified correctly.
I need to see a full immune profile before I can best tell you when to start the lovenox. Most times however I do start it with ovulation on an IUI or natural cycle, and with stimulation with an IVF cycle as long as you stop it 48 hours prior to retrieval.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

sophie

12 Posts
Reply Re: MTHFR mutations and lovenox Posted on: Dec 5, 2011 at 9:38pm
Thanks very much for the reply. I'm honestly about done with trying for -- 2 (I'm 43), so planning to use the last few cycles insurance will cover and then give up.

I'm very appreciative of the time you take to answer questions on this board. We are confronted with so much conflicting info. Sometimes it just helps to have an informed second opinion (or third!) opinion-- thank you for doing this!

Sophie

Dr. Braverman

2005 Posts
Re: MTHFR mutations and lovenox Posted on: Dec 6, 2011 at 4:29am
you are quite welcome, let me know if I can be of any further assistance to you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.