Adding Heparin or Prednisone in a miscarriage preventative?

Hello-
I have had 3 early miscarriages(4-6weeks) and am getting ready for an FET. I have been scouring the internet and books in the last few months looking for any answers to why I am losing these pregnancies.
Doing so I have heard alot about Heparin and Prednisone treatment, and the wonderful stories of success. When I asked my RE about adding these in to my protocal he was not very receptive as blood tests have shown no problems and my miscarriages were so early, that they really are not "counted" in his words.
Anyone out there have an RE that let them add this in as a "won't help/won't hurt" method?

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Hi,
I have also had 3 miscarriages. All of mine were around 7-8 weeks. My RE tested me for some clotting disorders and they came back negative. I recently found a new OB-GYN who specializes in IF. She tested me for 7 more clotting factors-1 came back low but on the retest was fine.
Anyhow, the OB wants to have me go on 20 mg of prednisone after a confirmed pregnancy as well as 1 baby aspirin/day. There are theories that immune reactions can cause miscarriage. Also, there may be a clotting factor that they don't know to test for yet so, hence, the baby aspirin.
DH and I both met with the OB nurse practitioner to ask a bunch of questions about the risks vs benefits. We have decided to try the new meds with any further pregnancies. I am waiting to hear back from the office on info where they have found their empirical evidence for this.
RE is NOT in favor of prednisone but really can't stop me from taking it or not taking it. The OB said this was common-she said most REs don't use it. OB said it is fairly commonly used in recurrent miscarriages and the pregnancy rates increase.

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Wow- thanks for the info. I wonder if I should make an appt with my GYN and ask for this? I have not been to him in 2 years though as I never made it to the point of getting released from the RE.
Did they mention Heparin at all?

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I took Dexamethasone (I think SIRM routinely prescribes it) and Heparin (which I insisted on) on my successful cycle.

The first thing you need to do if find a new RE. No matter how early your loss is it counts! Implantation failure is widely accepted and although treatments very there are options and ou shouldn't have to suffer another loss before some trys to prevent it.

Many Dr's agree tha implantation failure is often caused by one of 2 (or perhaps both are related) factors. A clotting issue or the immune system mistakenly attacking the embryo as it tries to implant. Both of these can be hard to Dx, but if you have an autoimmune disease (I have hypothyroidisim) you are more likely to have implantation failure. Many Dr's even miss this because they test so late. I was told I had a negitive pg test, but when I asked for my medical records I discovered that it was really an early loss. That Dr just didn't "count" it. Dr Fisch at SIRM does an early pg test to catch even the earliest losses, because he believes that sometimes that can lead to a success later.

The steriods tame your immune system just incase an over active one is the problem. The heparin thins your blood a bit and makes it easier for the embryo to implant. It also makes it harder for the immune system to use clotting as a means of keeping the embryo from implantating.

I refused to do my second IVF without heparin and I wish I'd insisted with the Dr who did the first one. My feeling was that as long as I didn't have bleeding issues there wasn't any real danger in trying.

The clotting discussion makes me wonder about something. I always had a really light AF even with great linings. I wonder if that could be a clue, that things down there clotted too easily. I'll have to ask my Dr what he thinks. Maybe we should do an informal poll.

When it comes to Dr's: Go armed ~ If you know what you want don't ask, tell! ~ and research is your friend. Dr's are not God and there are just as many bad ones as there are good ones. Sadly in IF for many it's a numbers game. Or worse a money game, where onesize fits all and they don't care enough to try anything else, because they it works often enough and they are getting paid either way.

Good luck. Patti

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Thank you. Can you tell me what SIRM is?
Also- Did you have testing for auto immune issues?
I recently had a whole work up up bloodwork done and according to them everything was"normal"
THe only thing they added was thyriod meds because I was a "bit hyp" as the nurse desribed it. My level was 4.
Are you taking Levothyroxine?

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You may want to consider discussing your concerns with a hematologist. I got my lovenox from one after 2 m/c. They are the specialists rather than the REs when it comes to blood.
Nicole

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Ok- thanks!
Do i just call one and make an appt? When you went did you tell them you were seeing them for infertility?

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I asked about it since some have no clue. I did tell them it was for infertility. The receptionist was so nice at the one place and said she had IF problems too. The only thing that popped up on my recurrent m/c panel was homozygous MTHFR which they did not want to treat so it took some convincing. They pointed out the risks of blood thinners and I pointed out the risks of multiple IVFs followed by D&Cs.
Nicole

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If my clotting factors had come back abnormal, I would have gone on lovenox, which is a low molecular heparin. Since I passed the assortment of blood tests in this department, they are thinking no lovenox or heparin is needed. Aspirin thins the blood and I will start 1 baby aspirin/day.
If you do approach your OB-GYN about this, I would not be surprised if they are hesitant to offer the prednisone. If so, perhaps look into finding one who works with IF patients, too.
Good luck to you. I will let you know what empirical evidence we find to support this intervention when we hear back from OB.
Take care,
Kathy

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I'm taking 5mg Prednisone twice a day since I started my stims. I'm hypothryoid with Hashimoto's which is an autoimmune disease. The Prednisone is supposed to suppress my immune system to allow implantation. Based on having MTHFR, I'm also on a baby aspirin a day starting on ET. If the embryo's look good and promising, we will start Lovenox.

I agree with what others have said, go armes with your research, print out the articles and don't let the doctor stop listening to you. I've also seen multiple times that for TTC your TSH should be below 2. My last test was 2.62 so I just had my Synthroid increased. If your level is 4, that might be normal for most people but high for TTC. Discuss all this with your doctor and insist on him/her going outside the "normal" protocol if needed.

- Lisa Z

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Hi,

My first RE had me on steroids after transfer and he also had me on one aspirin a day. I has a miscarriage and three chemical pregnancies. Once they tested me for blood problems they found I had MTHFR but the homozygous kind that supposedly doesn't hurt you. I asked that RE to write me a prescription for Folgard so I would be sure to get the right amount of folic acid. He said NO. He would not put me on heparin or lovenox either. He was a jerk and I could no longer trust him.

I then went to a new RE in LA. Dr. Boostanfar wrote me a prescription for Folgard and he accepted me into a study where I did not pay for IVF. He was a God send. He would have put me on Heparin and he would have done a different protocol called antagonist but I got in the trial which was really strict. I could not do accupuncture or take aspirin...but I was allowed to take the Folgard and supplements. It worked and I'm now pregnant with a singleton. As soon as he confirmed pregnancy he had me start a baby aspirin which I've been taking every day.

There is hope after miscarriages and I'm sorry you have suffered so many. It makes me so mad that docs have a "wait and see" attitude when they could be proactive and test earlier for these problems.

Jamie

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Hi Jaime!
What Supplements did you take?
Also- what is in Folgard?
Thinking of making a visit to my local gnc and coming up with a homemade concocktion! LOL

Thank you!

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I'm also on Folgard. I went on it because of my MTHFR. It's really just megadose of Folic Acid, B6 and B12 vitamins. With the MTHFR, my body doesn't absorb folic acid so this is in addition to pre-natal vitamins.

- Lisa Z

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