IVF & when to take blood thinners

[Tlove]

Hi there,

So after 2 miscarriages in 2013 / 2014, I was diagnosed with APS. I went on aspirin and heparin for my next pregnancy that happened very quickly after the 2nd mc. The doctors wanted to wait for a scan before starting the blood thinners to be sure I was not ectopic. We got as far as a heartbeat and I started taking the medicine at 6/7 weeks but I miscarried shortly after. The doctors then said that for my next pregnancy I should take the medicines from a positive test result, before any scan. This happened a year ago and I couldn't get pregnant since then.

I found out earlier this year that my AMH is low, indicating low egg quality, which was likely also a factor in the mc. It was suggested that APS may have been less of a factor than this. I was recommended to a fertility clinic and I have just completed IVF, having had 2 embryos transferred today. We were discussing the heparin and aspirin today and they said to start taking them from positive test, like the pregnancy loss clinic had recommended. But one of the nurses at an earlier appointment had mentioned taking them 8 days after egg collection. The doctor was almost giving me the choice today of which I'd prefer and said there is little benefit to me to take them from 8 days.

I just wondered if anyone here had any thoughts on this? The only time APS affects me is when I'm pregnant, I haven't had any blood clots or other significant symptoms otherwise.

[MaryF Administrator]

Hi there, first of all I want to wish you the best of luck with your venture. I can't comment on the timing, but presumably heads have been put together in that clinic to try for the best outcome for you. I know some women on here who have had successful pregnancies have also been guided very accurately from fertility clinics including with in some cases progesterone also, alongside Heparin and or Aspirin. I guess they are checking also your levels of D, B and iron and your Thyroid?

If there is some concern that you should start on Heparin as early as possible, go with the majority decision, everybody is different. Please ring that doctor and talk it through and do explain any concerns you have, you need to be as relaxed as possible, they are there to help you. MaryF

[Tlove in reply to MaryF]

Thanks MaryF. I feel reassured by your response. I'm just so nervous about the whole thing! It's gone well so far, so I'm really hopeful it all works out first time!!

Haven't had vitamin D, B or iron checked yet....I know they definitely don't check vitamin D, I asked my GP about it a while ago and she just recommended what foods to eat to get it in my diet and told me it's not one that gets checked. I was with a haematologist recently and had been waiting so long for that appointment that I'd forgotten to ask everything I wanted to ask about vitamin D, etc. I am taking Pregnacare, so that seems to have everything I need, and I am on high dose folic acid for the past year too. My thyroid is checked every 3 months or so routinely by my GP. And I am still on progesterone for a few weeks too. It does seem like they're doing all they can for me.

Thanks again, I think I just needed some reassurance!!

[MaryF Administrator in reply to Tlove]

You can sneak a vitamin D request in at the Fertility Clinic.... I am sure if you asked they would do it. MaryF

[Tlove]

I'll give it a go! I think the hospital that tests for vitamin D may be a different one that is not linked to the clinic but always worth asking.

[Tlove]

Also, I am just curious about vitamin D - what makes it so important in APS? I always thought it was linked to bones, rather than blood.

[MaryF Administrator in reply to Tlove]

Low vitamin D is not good full stop, whether pregnant or otherwise. The hospital will be keen to help as will your GP: Info: bmj.com/press-releases/2013...

MaryF

[Fusch]

If you were taking oestrogen as part of the ivf cycle you should have started on heparin then, to protect against dvt

[sum1sweeta]

Hi, sorry to hear you have suffered 2 miscarriages. I also have had 2 miscarriages and then was diagnosed with APS so I understand what your going through - although I am not starting my next round of ivf until next. I was told I will start taking aspirin from positive pregnancy test, and will start taking a high dose of folic acid when ivf starts.

I wouldn't see any harm in starting aspirin/heparin at egg collection as it's better to be safe than sorry. Try and get lots of info and make a decision based on that. But it's a bit scary that you've been left to make the decision.

I saw my GP and asked to be referred to a haematologist, he said he won't refer me because I don't need to be as I will receive aspirin when I'm pregnant- I was furious when I left. After reading you have seen a haematologist I am going back to the doctors to see a different GP.

I hope everything goes well for you.

Keep me posted x

[Tlove]

Hi sum1sweeta,

Sorry to hear about your miscarriages - it is one of the most devastating things that can happen to a couple. It still affects me occasionally, even though for the most part I feel I have moved on and I am trying to feel positive about this progression to IVF.

I have actually been taking high dose folic acid for the last year, as we were still trying to conceive naturally. I thought you would need to have it built up in your system for a few months before conception.

Did they mention anything at your clinic about taking heparin? I was told to take heparin with the aspirin. I believe that some doctors think it is more effective with both.

I was referred to a haematologist by the pregnancy loss clinic after I had a 3rd mc and had been on the blood thinners for that pregnancy. It was just to tie up the loose ends but the haematologist agreed with the clinic that it is pregnancy that triggers my APS and only to take the thinners then. He just asked me some questions about whether I'd had clots, did I smoke, etc. I was on the pill for many years without a clotting incident, so he wasn't overly concerned about me apart from when I'm pregnant. He said that when I do become pregnant, I will be treated in the high risk clinic and that I will also see the haematology dept fortnightly. Just hearing that gave me some reassurance.

It was reassuring to have that appointment because APS was new to me and when you read people's experiences here, you wonder about yourself and how it affects you and whether you should be on daily aspirin. So it did tie up the loose ends for me and they took my case seriously as they will see me again in 6 months and have asked for 2 further tests to be done prior to that appointment.

I should say I am based in Ireland, so this was not done on NHS but it was through the public system here so I would assume you would have the same level of care in the UK. It wasn't quick to get that appointment and I did have to remind the hospital that they had promised me a referral. If you do get an appointment, make sure you write down what you want to ask! I had so much going on at the time that I didn't properly prepare for it and didn't ask everything I wanted to.

[designer16]

I also had miscarriages & a ruptured ectopic. I went through IVF. Once I had the pregnancy test & it was positive I was on Progestrone injections & heparin. I was monitored very closely. If I were you I would stay on top of this & tell the Drs. You don't want to take any chances. Best of luck. Designer16