Opinions needed! Especially from Dr. B girls or those who've used Lovenox...LONG

hi girls.....this is probably going to be long so TIA to anybody that sticks with it!

on thursday, we met with Dr. B to go over all my immunology/thrombo bloodwork. the most amazing thing is that Dr. B only considers me as having ONE loss. that blew my mind b/c in my head (and heart) i've had 3!! the first pregnancy which we had to terminate for medical reasons is not a loss to him and the ectopic is not a loss to him because technically the baby was healthy, just grew in the wrong place. only the 3rd loss, a chemical, is considered a miscarriage. i get it but it still blows my mind.

so this is what we learned from the testing:

thrombo testing all ok. in his words "nothing significant" showed up. i do have a heterozygous copy of MTHFR which he said i can just take a baby aspirin and metanx for.

immune testing: mostly ok except for elevation in one cell (i THINK he called it cd195b) which produces antibodies that can attack placental tissue. he didn't feel this was of huge concern but said he would treat it with lovenox if i chose that route.

vitamin D is low so i need a supplement--no biggie

thyroid is hypoactive so i should see an endocrinologist and see what they suggest for treatment

and also what i found out previously is that i am insulin resistant and he started me on metformin about 3 weeks ago. he did say that my insulin level was very high

so......these are the options he gave us:

1: take baby aspirin, metformin, metanx, my prenatal, vitamin d and whatever (if anything) the endo puts me on for my thyroid and go on my merry way. call him when i'm pregnant.

2: all of the above, but in addition, i could go in mid cycle and he could stimulate my ovaries so that i would hopefully ovulate on my left side (lost my right tube from the ectopic)

3: same meds as #1 but add in the lovenox from ovulation onward. he considers this option VERY aggressive and didn't seem to think it was 100% necessary at this point b/c to him, we've only lost one baby.

4. same meds as #1 with or without lovenox plus an IUI

he really feels that the MAIN cause for my losses and difficulty holding onto a pregnancy is the insulin issue. he feels that getting it under control by taking the metformin and adjusting my diet with help with my ability to stay pregnant. so he was leaning toward the most less aggressive approach of option 1.

he did say that how aggressive we want to be is completely up to us. and he'll go with whichever we choose.

so here is my question........i left there thinking we would try option 1 for a couple of months and see what happens. but now that i keep thinking about it, i wonder if i'm making a mistake?? should i add the lovenox in?? he said there's no harm in doing it, but it's tedious. plus, im scared to death of needles. but, if it gives me a healthy pregnancy then i'll suck it up.

option #2 is completely out for us b/c DH has a history of performance anxiety around O time and i think just the knowing that Dr. B stimulated my O would make him a nervous wreck.

option #4 was actually my idea. i mentioned it before Dr. B b/c of DH's past performance anxiety and b/c it does up our odds slightly. but, i don't think we'd jump right into an IUI. maybe if a few months pass by with no luck we'd give it a go.

so i guess my main question is about the lovenox. do you girls think i'm making the right decision by only doing option 1 or am i being stupid by not adding the lovenox? i know ultimately it is up to me but i think it would help to hear other experiences/opinions.

sigh. this is all so overwhelming. i just want to be a mom. i'm soooooooo tired of ttc. thanks

Re: Opinions needed! Especially from Dr. B girls or those who've used Lovenox...LONG

i think if dr. B thinks lovenox is not 100% necessary then you will be fine with option #1. baby aspirin does the same thing as lovenox to a lesser extent so if your issue is minor and dr. B isnt saying lovenox is necessary, than #1 is fine. however if you want to be super aggressive, then you would do the lovenox and the IUI. it's really up to how aggressive you want to be.

i would think if your DH is known for performance anxiety that IUI isnt an option at all. for an IUI he'd have to give a sample an hour or two before the procedure and unless you live VERY close to Dr. B he'd have to do give the sample in the office. which IMO would be much more performance anxiety than just around O time.

i dont think you should necessarily rule #2 out either though. to be honest, if your DH can around O time regularly, there really shouldnt be that much more pressure to do it if you are stimulated. keep in mind though that "stimulating your ovaries" usually involves injectable meds.

i promise you no matter how scared you think you are of needles, if you NEED to do injectables to get pregnant, you will get over your fear VERY quickly. anyway good luck with whatever you choose! i do agree with dr. B that other than the chemical your losses prob dont have that much to do with immune or thrombo issues, although i am sure to you they are devastating losses.

anyway, good luck with whatever option you choose!!

Re: Opinions needed! Especially from Dr. B girls or those who've used Lovenox...LONG

Posted by FlowerWife

i think if dr. B thinks lovenox is not 100% necessary then you will be fine with option #1. baby aspirin does the same thing as lovenox to a lesser extent so if your issue is minor and dr. B isnt saying lovenox is necessary, than #1 is fine. however if you want to be super aggressive, then you would do the lovenox and the IUI. it's really up to how aggressive you want to be.

i would think if your DH is known for performance anxiety that IUI isnt an option at all. for an IUI he'd have to give a sample an hour or two before the procedure and unless you live VERY close to Dr. B he'd have to do give the sample in the office. which IMO would be much more performance anxiety than just around O time.

i dont think you should necessarily rule #2 out either though. to be honest, if your DH can around O time regularly, there really shouldnt be that much more pressure to do it if you are stimulated. keep in mind though that "stimulating your ovaries" usually involves injectable meds.

i promise you no matter how scared you think you are of needles, if you NEED to do injectables to get pregnant, you will get over your fear VERY quickly. anyway good luck with whatever you choose! i do agree with dr. B that other than the chemical your losses prob dont have that much to do with immune or thrombo issues, although i am sure to you they are devastating losses.

anyway, good luck with whatever option you choose!!

Re: Opinions needed! Especially from Dr. B girls or those who've used Lovenox...LONG

If you don't need the lovenox, I wouldn't use it. You can always add it if they see any clotting or a poor placenta once you get pregnant. The needle of the lovenox is different than the other needles you have used. I wouldn't do it unless you had to and this is coming from someone who used it twice a day the entire pregnancy.

Re: Opinions needed! Especially from Dr. B girls or those who've used Lovenox...LONG

i think a lot here depends on how much patience you have If you are willing to try on your own under dr B's guidance, that might be a good option, If you are eager to have this baby sooner than later, I would think that IUI + option 1 is the way to go.

GL!

Message edited 1/31/2011 11:01:35 AM.

Re: Opinions needed! Especially from Dr. B girls or those who've used Lovenox...LONG

regarding the immunology i would go with his recommendation.. however wtih the clotting issues- i dont like his wishy washy option to u.. hes supposed to be the expert... so i would take ur bloodwork results and have a consult with a hematologist. - they are the experts in blood disorders. i have an autoimmune clotting issue and other autoimmune issues and bc its autoimmune the re sent me to a rheumatologist (i have other autoimmune issues and a pretty extnsive autoimmune issues in my family).
i was also sent to a hematologist to review my bloodwork.
the RE did recommend lovenox and 81mg asprin but did send me to a hematologist and rheumatologist for a second and third opinion.
all 3 drs agreed lovenox and 81mg asprin was the way to proceed. i still see a rheumatologist once a year to run tests and make sure everything is status quo

good luck

Message edited 1/31/2011 1:27:15 PM.

Re: Opinions needed! Especially from Dr. B girls or those who've used Lovenox...LONG