QuestionHi Dr. Ramirez,
My husband and I have been trying to conceive for 6 years now. We are both 36 years old. We have had 7 IUI's and 4 IVF's, along with many other methods of trying to conceive (clomid cycles, letrozole cycles, etc). I have had 3 miscarriages - the first two were chemical pregnancies. The last one we did see a heartbeat at 6 1/2 weeks, but the baby died sometime around 7 1/2 weeks. They did a D %26 C and found the fetus to be chromosomally normal.
Because of the normal report from the D %26 C, a hematologist suggested to me that maybe I have a blood clotting disorder that caused the placenta to clot and suffocated the fetus. He tested me for blood clotting disorders (lupus anticoagulant, antiphospholipid screening, etc). All these tests came back normal.
In our 3rd IVF, we did PGD testing to the embryos and they ALL came back completely abnormal - none to transfer. With that info, plus 6 years of no success, we decided to use donor eggs with our 4th IVF. The hematologist suggested that I also go on heparin injections (10,000 units per day) even though all of my tests for blood clotting disorders were normal.
I went on heparin injections, we used donor eggs and I am now 12 weeks pregnant!!!
My question to you is this...
Should I stop the heparin injections? My OB would like to see me stop them, but the hematologist has scared me into thinking that the baby will suffocate due to clotting in the placenta, if I should stop the injections.
We are so happy that we are finally pregnant, and don't want to do ANYTHING to hurt this pregnancy. But, I know that staying on heparin if I do NOT have a blood clotting disorder can be risky for me and possibly the baby.
On a side note, we had another ultrasound on Tuesday (the day I turned 12 weeks), and had the nuchal scan - the baby looks great and is measuring right on target. The heartbeat has been between 169 - 176 bpm for the last few weeks.
Please let me know your thoughts. Thank you so much!
Heidi
AnswerHello Heidi from the U.S.,
I am glad to hear of your success. I do use heparin (microdose) in my patients that fail their IVF cycle. The dose I prefer is 2000U twice per day. 10,000U is therapeutic levels and probably over-kill for your problem. I stop the heparin at 10 weeks gestational age. Some clinics/docs will go to 12 weeks to get the patient out of the first trimester. That is okay too. It is just being careful. I think you should stop the heparin. There is no need to continue it and there is no incidence of "clotting" in the placenta if your hematological screening was all normal. I think if you want another opinion, it might be a good idea to have a consult with a Perinatologist, who is an Obstetrical sub-specialist that specializes in high risk pregnancies and disorders.
Again, congratulations and I hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf
