Since deciding earlier this week that I would start the injections tomorrow (TOMORROW? Already? Eek!), I’ve been in contact with Dr. Google quite regularly. I’ve found that it’s hard to get a straight answer ANYWHERE about whether taking Lovenox before/during/right after ovulation can help or hurt. Some doctors say not to do it because it can cause bleeding at the ovarian ovulatory site or at the implatation site. (I’ve found that this is most common with women who are on a higher dose of Lovenox.) Others say that’s not true, that healthier blood flow to the uterus can do nothing but help the implantation, and in turn, development, of the egg.
Today I found a Q&A between a woman and a doctor that finally made me feel better about my decision.
Q: Dr. T – what are your thoughts on starting lovenox prior to implantation – either right before, or right after ovulation? And is your opinion the same in regard to a natural cycle as opposed to an ovulation induction cycle in which ovulation is then triggered with HCG? Also – does the patient already being on a daily baby aspirin have an impact one way or the other?
It has been suggested to me that being on both baby aspirin and lovenox (40mg/once a day) could actually inhibit implantation by causing a bleed at implantation site.
Others have said this is not the case at all – and in fact the opposite is true – healthier blood flow to uterus will assist with implantation (that may have been prevented in the past by diagnosed clotting disorders – homo MTHFR C677T and hetero Factor V.)
A: Personally, I rarely will start lovenox or heparin before midway through the luteal phase after spontaneous ovulation or ovulation induction (about day 20-21) unless you have documented antiphospholipid syndrome or another condition that requires chronic anticoagulation. The reasons for that are it may increase bleeding from the ovarian ovulatory site (and, personally, I have taken two young women, who were not even on lovenox or aspirin, to the operating room in the past month with bellies full of blood from that very thing) and I sincerely doubt it does much good until the embryo has reached the uterine cavity and attachment has actually taken place. With all that said and done, on prophylactic doses of lovenox such as you are taking, it probably would not hurt or put you at much risk.
It’s that last line that got me — on prophylactic doses of Lovenox such as you are taking, it won’t hurt or put you at much risk.
And that’s really how I feel about it. I don’t feel like I’m at risk for a major bleed or anything like that. I trust my OB, I value her opinion, and if I can do ANYTHING, even just a very little thing, to improve my chances of sustaining a viable pregnancy, then I’m going to do it.
Tomorrow is the day. My stomach’s been turning all day just thinking about it, but I’m just psyching myself out. I know it’s not that bad.
Now, lets hope for an earlier ovulation this month. CD14 would be nice!