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? high risk

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  • ? high risk

    Dear Dr. Cusick,
    i need advice

    I am 36 yo, have one daughter born october 2010.
    At the time, the only problems i was aware of were tubal disease and decreased ovarian reserve (had low AMH and FSH as high as 12). Also tested positive for anti ovarian antibody. After I got pregnant, I was recommended to be an baby aspirin for no particular reason other then "it's good for you" and everyone was on it at the fertility clinic I used. However, after I had a small subchorionic hemorrhage at 13 weeks and per my ob's recommendations i discontinued it. The rest of my pregnancy was mostly fine (had 2 vessel cord, but that turned out to be fine, baby was born 6lb 5 oz at 36 weeks though not sure why so early, my water broke a few days after some painful contractions)

    i am currently trying to get pregnant again (frozen cycle) and had to switch fertility clinics for insurance reasons. My latest FSH was 9, but they also ran thrombophilia panel and it came up with heterozygous for MTHFR and Prothrombin mutation. So, my fertility specialist wants to put me on lovenox 30 mg once a day right after transfer and "until your ob takes you off". He believes that baby aspirin does nothing. I am also on extra folic acid (folgard)

    when i contacted my ob about how long he would keep me on lovenox, he felt it wasn't even that necessary and maybe only first trimester.
    Now that I know I have these mutations and from doing some research, I am nervous because I do want to prevent possible miscarriage, especially reading that with prothrombin mutation it can happen in 2nd or 3rd trimester, but I am also worried about possible subchorionic hemorrhage or any other problems during birth from lovenox.

    what would you advise me to do in terms of using lovenox and for how long after I get pregnant? Is extra folic acid necessary as well? and do you think I need to be under care of a high risk Ob now?

    thank you