Secondary infertility & APS

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Secondary infertility & APS Posted on: Aug 2, 2011 at 3:20am
Greetings,
I would like your opinion... I am 40 years old. I have a 9 & 6 year old. We have been trying for a 3rd child for the past 3 yrs. I have had 5 losses-6 wk m/c, 7 wk m/c, 9 wk blighted ovum, 7 wk m/c, & 6 wk ruptured eptopic. We had heartbeart for 1st, 2nd, & 3rd m/c. I researched RPL after 4th pg, & asked to be tested for APS. My result was a 6. My OB prescribed baby aspirin & Lovenox. I did get pg again however it was an etopic. With the ruptured etopic & blood thinners, I lost 8 units of blood & almost lost my life. I was helicoptered to a major hosptial, & had emergency surgery to have right tube removed. Needles to say, we decided to try again, after 6 mos. I had a histoslingogram (sp), it showed right tube was clear. Then my OB retired, & I decided to see an RE. He referred me to a hematologist.

My new plan is: 1)BA for life 2) clomid & self-injecting ovulation inducing shots & 3) on the 10th day of my cycle I begin Lovenox. My MTHF test was positive for one (cant remember if hetero or homo), but hematologist said it is not a factor with my RPL. I have always gotten pg on 1st try. However, I have another issue.... with fertility meds, the ultrasounds show I have a 3mm cyst on left ovary that is probably interfering with pg. I have had 2 rounds of clomid, & no pg. I am scared to get pg again for fear of etopic rupturing again while taking BA & Lovenox.

One question I have is, can I just take BA until confirmed pg shows ultrasound with implantation in uterus? Or will I need Lovenox to prevent m/c & clotting issues? Also, is there anything else I need to do as far as testing? I am very nervous getting pg & about having another m/c? I do hate the Lovenox shots, & ended this last cycle with a purple belly. However, I am willing to do it for the eventual outcome of a baby.

Dr. Braverman

2004 Posts
Re: Secondary infertility & APS Posted on: Aug 3, 2011 at 9:10pm
well a couple of things, IVF would of course markedly reduce your risk of ectopic have you considered this with your RE? Also there may be other issues other than hematologic and you should be worked up for this such as immune related issues, which I would be happy to help guide you with. good luck!
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.