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Thread: Lupus anticoagulant Infertility

  1. #1
    Join Date
    Dec 2013
    Posts
    3

    Default Lupus anticoagulant Infertility

    Dear Dr. Carolyn,

    Greetings of the day. I would be very grateful to you if you could advise me with regard to my case as detailed below.

    We are trying for a baby since last two and half years. After trying naturally for one year, we consulted one gynecologist. He asked for routine blood check up, ovulation study, USG, semen analysis. All these test were normal. After that my wife had undergone diagnostic laproscopy, findings of which were normal. After this he diagnosed us as a case of unexplained infertility and advised IUI. We had undergone three IUI cycle without success.
    After this we consulted another doctor. After studying reports and after examination he diagnosed her as a case of galactorrhea and prescribed Cabergoline. Within one month of Cabergoline treatment my wife was conceived. At six week USG doctor noticed very tiny sac and advised to have follow up USG after 10 days. On next USG there was no growth. Missed abortion was confirmed through B hcg and she had undergone MTP. After routine test she was found to be Lupus anticoagulant positive. (beta cardiolipin antibody positive)

    AS per doctors opinion, due to lupus anticoagulant, there is problem in implantation which leads to loss of pregnancy, most of the time even without the knowledge of the patient and this is the cause of infertility in our case. He has advised daily aspirin and once pregnancy is confirmed he advised LMWH. My wife is on daily low dose aspirin since last five months however there is no conception.
    My question is whether lupus anticoagulant has any role to play in infertility? Will starting LMWH from fifth day of menses would help in successful conception and implantation? What line of management would you suggest in our case?

    Eagerly waiting for your reply. Thank you.
    Sandy

  2. #2
    Join Date
    Sep 2008
    Posts
    677

    Default

    Yes lupus anticoagulant has been associated with implantation failure as well as recurrent pregnancy loss. Dr. Coulam

  3. #3
    Join Date
    Dec 2013
    Posts
    3

    Default

    Thank you Dr. Carolyn.

    I was wondering whether she can be started on LMWH from fifth day of menses so as to improve chances of implantation. Although I did not come across any literature about prophylactic use of LMWH in lupus anticoagulant patient before confirmation of pregnancy, I did come across few studies where LMWH was used to increase chances of implantation in lupus anticoagulant patient undergoing IVF.

    Do you think starting LMWH from fifth day of menses would help in our case?

    Thanks and Regards,
    Sandy

  4. #4
    Join Date
    Sep 2008
    Posts
    677

    Default

    We have not found heparin/lovenox to be helpful in treating implantation failure in contradistinction to treatment of recurrent pregnancy loss. In fact Vicki Abrahams has shown not effect on implantation in her mouse model. This is probably related to the targets of heparin being on the endothelial cells of the placental vessels which have not as yet formed at the time of implantation. We have found success with the use of IVIg in enhancing implantation as its mechanism of action is different. It provided the anti-idiotype to the APA antibody. I hope this information is useful. Dr. Coulam

  5. #5
    Join Date
    Dec 2013
    Posts
    3

    Default

    Thank you Dr. Carolyn for prompt reply. This is indeed very useful.

  6. #6
    Join Date
    Sep 2008
    Posts
    677

    Default

    You are very welcome. Dr. Coulam

  7. #7
    Join Date
    Mar 2018
    Posts
    2

    Default

    I was wondering whether she can be started on LMWH from fifth day of menses so as to improve chances of implantation. Although I did not come across any literature about here prophylactic use of LMWH in lupus anticoagulant patient before confirmation of pregnancy

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