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What is the role of lupus anticoagulant in infertility problem and will starting LMWH from fifth day of menses help in implantation?

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I am married since last six years and 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. Everything was 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 anothe rdoctor. 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 sonography doctor noticed very tiny sac and advised to have follow up Sonogrphy 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. Doctor advised us not to try for conception for next three months and after this try for conception with daily Aspirin and Folic acid. AS per doctors opinion, due to lupus anticoagulant, there is problem in implantation which is the cause of infertility. He has advised daily aspirin and once pregnancy is confirmed he advised LMWH. My question is whether lupus anticoagulant has any role to play in infertility? will starting LMWH from fifth day of menses would help in implantation and successful conception? is there any alternative line of management?
Posted Sun, 12 Jan 2014 in Infertility Problem
Answered by Dr. Mahesh Koregol 14 minutes later
Brief Answer: repeated abortions Detailed Answer: Hi, 1) Positive lupus anticoagulant thickens the blood and prone to form small blood clots which result in giving less nutrition to baby and end up in miscarriage. 2) Hence in patients with repeated abortions ( 3or more) LMWH is advised that after confirming heartbeat of the baby. Otherwise there in no much use. LMWH actually thins blood and improves blood circulation to fetus. 3) There is no need to take LMWH during menses or for ovulation as lupus anticoagulant has nothing to do with ovulation. So dont take when you are not pregnant. 4) I think your ovulation is normal since you have already conceived once. So probably ovulation seems fine. Let me know if there are any more doubts. Regards, Dr. Mahesh Koregol IVF & infertility Specialist
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Follow-up: What is the role of lupus anticoagulant in infertility problem and will starting LMWH from fifth day of menses help in implantation? 7 minutes later
What line of management would you like to suggest to increase chances of conception and successful outcome? She is taking mefanemic acid anddrotaverine (Drota M) for dysmenorrhea since last five years during initial two days of menses? does mefanemic acid interfere with conception? if so what alternative is available for treatment of dysmenorrhea?
Answered by Dr. Mahesh Koregol 11 minutes later
Brief Answer: IVF Detailed Answer: Hi, Since your age is increasing and you have already tried IUI next step would be to go for IVF. Try another 2 or 3 cycles of IUI at an IVF centre. If you dont conceive opt for IVF to save time. Meanwhile she can continue the same medicines for dysmenorrhea and they dont cause infertility. There is no need of alternatives. Regards
Above answer was peer-reviewed by
Follow-up: What is the role of lupus anticoagulant in infertility problem and will starting LMWH from fifth day of menses help in implantation? 12 minutes later
Thank you Sir. What is the success rate of IVF in lupus anticoagulant patient? How many cycles of IVF patient can go? what is the approximate cost of IVF per cycle?could you please suggest good IVF centre in Pune?
Answered by Dr. Mahesh Koregol 24 minutes later
Brief Answer: Good Success Detailed Answer: Hi, The success depends on each patients and also IVF centre excellence. It is between 30 to 70 percent. There is no limit on no. of cycles as of now. But you will come to know about problems in frist cycle itself seeing egg, sperm or embryo quality. Cost is approximately 1 to 1.5 lakh for cycle including injections used. I am not sure about pune centres as i am in bangalore. You can take opinion from few gynecologists there. Regards
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