I've been getting lots of email lately from awesome women going through the devastating pain of miscarriage loss, and they are all asking me for advice in terms of what to take, what to test for, etc.
Clearly, I'm not a doctor and all I can really do is to convey what I was given. And I have to admit I have no idea what actually worked or what is working now. Still, if it provides someone with additional information to bring to their care providers, here is a summary of what I've done and what I am doing.
Monotoring is Crucial
For this pregnancy, my hCG and progesterone were monitored every other day from the time I knew I was pregnant until the 13th week. This was not true of Pregnancies 1-4, even when I asked (begged, pleaded) to have my progesterone monitored along with the hCG. One doctor did it once and said everything was okay. He told me progesterone has "nothing to do with it." (Wrong!)
I was put on progesterone 2x a day at first - standard 200mg Prometrium - then was upped to 3x a day probably around 6-7 weeks (I always miscarried at 7 weeks although my scientist husband calculated that the hCG began to slow down and not really double around 5-6 weeks each time).
Then my doctor put me on progesterone shots 3x a week because the numbers kept falling. Anything over 20 is considered okay. Anything over 30 is considered great. I think I went from high 20s to very low 20s including a lab error under 15 which would have been bad if it were true. So going on the shots was our way of replacing the progesterone instead of supplementing it with pills and having a much greater comfort level that I was getting enough progesterone no matter what.
(That first doctor who measured my progesterone only once said my levels were above 50 at that time. We never knew when they dropped, but I swear they did around Week 6 or so).
Take It Up Your Yoni
Yes, I was taking the Prometrium intra-vaginally. My RE (reproductive endocrinologist) warned me not to mention this to the pharmacist because he'd have a cow, so I spared myself the unnecessary lectures and just did it. Remember to put a drop or two of water on the gelcap to help it dissolve.
This is not a messy procedure although for anyone who is too squeamish to stick a finger up their vaginal canal to position the gelcap closer to the cervix, get over it. I have to admit, learning how to use OB tampons in my 20s was a lifesaver in the "oh my god, do you mean I have to touch myself" department.
Prophylactic Doses of Blood Thinner
My RE put me on Lovenox - non-therapeutic levels at 40mg - as soon as we confirmed I was pregnant. A shot in the belly 1x a day. Therapeutic levels are twice that amount ie. 2x a day or more. Many women are commonly put on Heparin instead of Lovenox so there are different schools of thoughts in terms of which is ideal to use. See section below on Labor Issues to understand a key difference.
I've also been on baby aspirin for almost 3 years now and still am on it with the Lovenox even though the instructions for Lovenox say "Do Not Take Aspirin." According to a perinatologist I consulted regarding this issue, she said as long as your doctor is aware and monitoring you, you should be fine.
Also, depending on the dose you are getting - and WHY you are getting it - you may also be monitored regularly for blood platelet levels. I have been anemic since my 9th week screening but then again, I have been borderline anemic all my post puberty life so there is no way of telling if the Lovenox had anything to do with it. I'm not being monitored as closely but also am not on therapeutic doses.
FYI - therapeutic doses of blood thinner are usually administered to women with proven blood clotting or autoimmune disorders. I have been diagnosed with neither. The thinking is that this was a "last ditch effort" to hold onto my pregnancy and maybe counteract some disorder that just hasn't shown up in any test I've had.
Blood Thinners and Labor
My biggest concern is bleeding during labor and birth. I was told that I can stop the Lovenox about a week before my due date and this is only if I want the option of getting an epidural. Seems that anesthesiologists will not administer epidurals if you are on Lovenox but they will if you are on Heparin.
So I also have the choice of switching over from Lovenox to Heparin a few weeks prior to my due date and then I'd be on a blood thinner during labor. I'd prefer not to do that.
I must also stop baby aspirin at least 1 week before due date.
There are reverse agents for both Lovenox and Heparin as in drugs they can adminster if either causes excessive bleeding. There are NO reverse agents for aspirin so that needs to get out of my system.
In Summary...
I don't know if it was the Lovenox or the progesterone that held onto this pregnancy, and of course, I still have 10 weeks to go. While I stopped the progesterone at 13 weeks and felt okay about it since my placenta had taken over progesterone production from my aging ovaries, I refuse to stop the Lovenox right now because we just don't know for sure.
Have I had side effects? Other than the occasional nosebleed that is a little harder to stop, I don't notice anything. Since I've had anemia off and on forever and also because I'm taking baby aspirin, chances are any extra bleeding I might have from a cut is not directly related to Lovenox at the low doses I'm taking and more related to those other factors.
But, knock on wood, I haven't had any scary things happen because of the Lovenox. Unless you count the nightly ritual of needle poking belly which is becoming creepier as baby is pressing herself up against the wall of my abdomen and seems too close to the needle for my comfort. Granted, I'm still able to pinch an inch of skin/fat and the needle is quite short and just going in subcutaneously, not piercing through to the amniotic sac, but still the thought of it gives me the heebies.
Post Script
The interesting/ironic thing about the Lovenox is that I was told it probably helped with the blood lakes or pools in my placenta caused by my accidental/continuous exposure to carbon monoxide - that it helped keep the pooling to a minimum. Truth is stranger than fiction. There are no coincidences.
I don't know what else to tell you other than hang in there, find a practitioner who is aggressive and responsive, and don't take no for an answer.
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