Not sure if this is the right place to ask this question...

I was blessed with a beautiful DD 16 months ago. Our miracle came during a cycle where I was "taking a break" before starting a protocol that Dr. Braverman put in place for me.

With that said, I am thinking about TTC for #2 and wanted to know if any of you that have the following issues have started to TTC for #2 and if you did what were the first steps that you took. Did you go back to Braverman? Did you skip Braverman and just go to your OB & Perinatologist?

My Issues:
-Anti-Prothrombin antibody, this interferes with the bodies normal mechanisms of breaking up spontaneous clots therefore predisposing you to lingering clots that can "clog" the early capillary formation of the embryo.

-Enzyme defect you were born with that is not uncommon called MTHFR the type of defect and when present on both of your MTFHR genes is what makes it more significant and you have 2 copies of the C677T so this is associated also with spontaneous clot formation.

-Defect in your plasminogen activating inhibitor enzyme called the 4G/5G and this is associated with higher levels of PAI-1(abbreviated) and along with high insulin levels can also lead to clot formation.

-Elevated NKT Cells which was treated with Intralipids

I saw Pillitteri and Kofinas my entire Pregnancy once released from Braverman.

Re: Not sure if this is the right place to ask this question...

I have all of the above too, as well as a ton of other thrombo and immune related issues.
I've been with Braverman for a bazillion years and needed IVF to get pregnant but decided to consult with Kofinas right before my retrieval for IVF and he started me on a higher dose of Lovenox for the thrombo issues where as Dr. B would've waited until after.
If you were able to conceive naturally, I'd still see Kofinas for a consult. He might start you on meds, Lovenox, etc. before ovulation to help with implantation. Like Dr. B he'll still follow your NK level and may even consult with Dr. B. if your levels were still high with Intralipids. IMO, they all work very well together. Dr. B is still involved in my treatment and speaks to Dr. K about my case.

and hope you are blessed with another miracle very soon!

Re: Not sure if this is the right place to ask this question...

Thank you so much for your response!

I was thinking of starting with Kofinas and Pillitteri and going from there.

Not sure if this is the right place to ask this question...

i have PAI1-4g/5g polymorphism and elevated NK as well as a partial HLA match with my husband. i was on lovenox for most of my IVF and throughout my pregnancy until it was switched to heparin in the hospital at 32w and i delivered at 33w. i did intralipids every 3-4 through the first tri for the NK. do know that any clotting or immune issues can lead to early miscarriage or third trimester issues. for me, it took a few tries before i didn't have chemicals. then once i got pregnant with my DD (first IVF) it seemed to be smooth sailing. however i developed pre-eclampsia and HELLP at 32w and delivered at 33w. from the research i have done, most of which i confirmed with Dr. B, inflammation at the time of implantation can result in abnormal irreparable damage at the placental uterine connection. this damage sometimes causes miscarriage (ie via clotting or NK antibody cause/effect) but my DD and I are living proof that you can bypass miscarriage but still be heavily effected by this damage at the site of implantation. i did not see a peri during my pregnancy.

all of that being said, when i am ready for #2 i will try on my own since i now ovulate regularly (i didn't before due to PCOS but it has regulated a bit post partum). if it doesn't happen, i will go to Dr. B and use my frosties. i have confirmed with dr. B that if i were to get pregnant and we started meds immediately, we can still effectively manage my issues. at this point i doubt there is any control over how effective implantation will be if there is any inflammation (ie NK activity or clotting factors, etc). so we will TTC on our own but i am tracking my cycle so i can have a good idea of ovulation in the case that i do get pregnant (we are not TTC right now but marginally preventing with PNP). i will prob see a peri next time around (didn't the first time around), especially one that deals with placental issues like Kofinas (if i can afford him).

good luck!!

Re: Not sure if this is the right place to ask this question...

same for me...
I am just 6 weeks pg now with #2. I saw Dr. B and spoke to Dr. Kofinas. He said I can wait to see him until Dr. B releases me. That being said, Dr. B has already upped my lovenox dose and b/c my NK cells came back elevated again, I am doing another round of intralipids this week!

I'd say do whatever you feel most comfortable with. I felt going back to Dr. B right away was best for me...getting pg on my own would be so stressful not being on all the right meds bc I have a history of losses!


Good Luck!!

Re: Not sure if this is the right place to ask this question...

I would ttc naturally for a few months and ask kofinas to prescribe intralipids. I'm not sure if he does them sole for nk but might since you were on them before. But as long as you are with kofinas he will keep an eye on you.

Not sure if this is the right place to ask this question...

Thank you all again for your responses!

I was on lovenox, metanx, calcium, vitamin d, baby aspirin and pre-natals my entire pregnancy so I am thinking that kofinas may start me on lovenox & metanx again while we are ttc.

Re: Not sure if this is the right place to ask this question...

i just wanted to wish u all the luck in the world!

Re: Not sure if this is the right place to ask this question...

Posted by gina409

i just wanted to wish u all the luck in the world!

Re: Not sure if this is the right place to ask this question...

Posted by nraboni

Posted by gina409

i just wanted to wish u all the luck in the world!

Thank you Gina!!! I am so happy that you finally got your wish. Those babies are very lucky to have you as their mommy!