Infertility/Fertility/PAI-1

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Question
Hi,
I am about to start my first IVF cycle. I am currently on the mini pill. Although I have PAI-1 my fertility doctor states that I should be able to carry to full term with blood thinner injections such as lovenox. He would also like for me to take baby aspirin, however, my body does not tolerate baby aspirin. I get awful chest pains when taking any type of Nsaids. My doctor says I should be fine without aspirin, but everywhere I read it seems everyone recommends taking aspirin in additions to injections. My question is do you know if Lovenox or Heparin is like an Nsaid? I am wondering if I could have the same bad reaction and not tolerate those drugs too. I am afraid to spend all this money on IVF and then not be able to go through with blood thinner injections. Also, do you think I should worry with not taking baby aspirin in addition to Lovenox? Would there would be a higher chance I could miscarry? My doctor recommends I start Lovenox day after embryo transfer.

I have already miscarried at 9-1/2 weeks a year ago (natural pregnancy), but I was not on baby aspirin or blood thinner injections.

Thank you for you advice. I would just love a second opinion!!

Answer
Hello Linda from the U.S. (California),

Aspirin is not considered an NSAID and low dose aspirin is only 81 mg vs the 326 mg in full dose aspirin.  I don't know if that makes a difference for you, but you might want to give it some thoughts.

The blood thinners Heparin and Lovenox are also not NSAID's.  In low doses they have been shown to help with recurrent pregnancy loss.  Even if you can't take the low dose aspirin, I would strongly encourage you to take the Heparin or Lovenox.  That should help.  The typical protocol is to start the blood thinner at the beginning of the cycle, but every doctor has their own preferences so I guess you'll have to go with your doctor's recommendations/protocol.

As to whether or not you would be helped with only the blood thinners and not the aspirin, that is an unknown.  All the studies used both.

Good Luck,

Dr. 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 twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate  

Infertility/Fertility

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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