APS antibodies - clexane dose?

[Endofitall]

For those who’ve tested positive for Antiphospholipid antibodies (I’ve had two samples 12 weeks apart with raised IgM cardiolipin), what dose of clexane/inhixa/enoxaparin were you prescribed?

My new clinic seem to be keen on 20mg but my old clinic only used 20mg when it was empirical (best guess) treatment for recurrent implantation failure, and once they knew I tested positive for APS they increased the dose to 40mg from transfer. My new clinic are mainly private fertility specialists whereas my old clinic did have working obstetricians who I suspect had more experience with managing APS in actual pregnancy. I don’t want to risk bleeding but equally don’t want to be under treated.

[Chel91]

It's actually weight based so it depends on that. Most ladies fall into 40mg or 60mg depending on weight. 20mg would only be suitable if you were extremely petite.

[Endofitall in reply to Chel91]

Thank you that’s super helpful. I am quite light but probably with lots of unsuccessful IVF rounds and courses of pred under my belt have gained weight from when I started this process. I think my current clinic are just doing a 20mg standard empirical dose and not factoring in properly fact I’ve tested positive for APS. Will have to raise again with them. Thanks 🙏🏼

[Mercury363]

I have only been given hydroxichloriquin and not clexane/ hibor until a positive test. I had been self medicating with aspirin but told to come off that as it can affect implantation. This is contrary to my previous clinic but I have nothing to lose at this stage. My dose of clexane would be 40mg if I ever got a natural pregnancy test and it had been this throughout my last ivf pregnancy. Hope that helps.

[Endofitall in reply to Mercury363]

Thank you I hope this works for you. In a natural conception (which has only happened once and sadly been ectopic) I was started on 40mg from positive test too. I am going to make sure I’m on 40mg from transfer. Thanks and best of luck.

[Nes1005]

Hello,

I was formally following diagnosed by a Haemotologist, Dr.Robinson from St.Thomas hospital London very early this year. I was gutted to have ‘another thing’ to deal with but happy to get the right treatment. Dr.R wrote a protocol for my clinic in Cyprus and they were happy to follow her guidance. I was on 40mg From the beginning of Stims right up until 2 weeks after egg collection (the direction was stop Clexane two weeks after collection if having a frozen transfer. Alongside this on the protocol I was on Hydroxy for 8 weeks before starting the stims cycle.

The following month back on 40mg at the start of the frozen transfer cycle ie at the start of my period (mine was a natural modified cycle so no estrogen or drugs).

For both the collection and transfer I had to stop the Clexane for 12 hours before and resume 6 hours after.

I was also on Aspirin throughout and directed to start Predislone straight away if I got a positive test.

I am currently 24 weeks and 2 days pregnant and hopefull although such a long way to go.

I only wish I’d been diagnosed sooner in my journey, but I am so glad I found Dr.R and I do believe the protocol made all the difference with the timing of the Clexane and Hydroxy.

Sending huge good luck and positive best wishes with your next steps.

xxx

[Endofitall in reply to Nes1005]

That’s wonderful news and thanks for sharing. I’ve had a chat with my old consultant and he’s happy to do a private prescription of 40mg and I’ll start that post egg collection in prep for embryo transfer. I’m increasing pred from 10mg to 20mg after egg collection too. I’ve never been prescribed hydroxychloroquine but maybe something I need to explore if this round doesn’t work. Wishing you all the best ❤️

[Nes1005 in reply to Endofitall]

Ah glad you managed to get the prescription. Hopefully you won't need to explore anything else and this will be your time, huge good luck.xxx

[Sharbertn in reply to Nes1005]

His Nes1005 did Dr R explain why you were on the protocol before and during egg collection too? I've not experienced this, only having stuff like clexane/hydroxy/aspirin for pre and post transfer? Thanks

[Nes1005 in reply to Sharbertn]

I’m not 100 percent sure but it was very specific and I do beleive her protocol made the difference. She’s really very good and experienced and I am lucky to have found her. I’m still going to that clinic, even though my antenal care is at another hospital. My last 3 cycles at 42 and 43 didn’t work and this time with the changes a different result. I did get pregnant on my first ivf at 41 with none of the above and hadn’t had the APS diagnosis then, Although it ended sadly. I do wonder if my natural pregnancy last year ended in miscarriage because Of the APS and I wish I was diagnosed sooner but we can’t turn back time and I am grateful for this glimmer of hope we have been given. I’ve attached the written protocol as a photo with the detail that I had if that helps. Xxx

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[Endofitall in reply to Nes1005]

Thanks for sharing this that’s really helpful about timings. Did you take your clexane in the evenings then usually if you had to ensure a 12 hour window before embryo transfer and 6 hours post?

[Nes1005 in reply to Endofitall]

Yes I think I took my last dose of clexane in the evening before both egg collection and embryo transfer.

[Endofitall in reply to Sharbertn]

I think it’s about reducing the actual number of antibodies in preparation? - I am usually prescribed pred and clexane from early on in stims. Then an increased dose from straight after egg collection.