Did going off of Lovenox CAUSE HELLP Syndrome to occur?


2 Posts
Reply Posted on: Nov 21, 2012 at 9:53pm
Dear Dr. Braverman,

I tried to conceive for ten years (starting at age 35), undergoing many failed IUIs and 2 failed IVFs with my oe. I was diagnosed with AMA/high FSH and told that I had endometriosis that I should get removed. I had lap surgery to remove it and was told that I had a good chance of getting pregnant if I did IUIs ASAP. I did 6 IUIs, making between 6-9 follicles each time, but never succeeded in getting pregnant. I then moved on to IVF but on double the dose of stims made only half the number of follicles. Two attempts at IVF with my own eggs never made it to transfer. (The embryos--3 in number--didn't grow well enough by D3 and I was sent home with no ET performed.)

I began to consider DE IVF but got pregnant, naturally (through intercourse with my husband) and I asked my RE to monitor me since no OB will take a patient that early and I wanted to give the pregnancy the best chance of success, having already lost one. I had two good u/s with a h/b and then on the third u/s found out the pg had ended.

I started looking for an egg donor and then...found myself pregnant again. This time (age 41) was a total surprise as I hadn't even known that I was ovulating and had given up "trying" though I had continued acupuncture and herbs. Again, after two good u/s with h/b sadly there was no h/b on the third u/s.

At this point I committed to finding an egg donor since I finally accepted that my eggs must be "bad." I went on the b/c pill to avoid "accidentally" conceiving again while I looked for a donor. I also consulted a therapist to help me deal with the grief. She referred me to Dr. William Matzner of Van Nuys, CA (now retired I believe) whom she said had helped HER carry her daughter (conceived via IVF) to term after multiple PG losses.

Dr. Matzner recommended a long list of expensive tests that weren't covered by insurance so I took his list to my RE (in whose care I'd lost the last two pregnancies.) I asked him which tests on the list (if any)had merit and he replied: "APA, ANA, and NK Count." He sent a sample of my blood off to West Coast Labs, an outside, independent lab, for testing and the results came back positive for APA with elevated NK Count. He put me on low dose prednisone and retested the NK Count. He said that due to the prednisone the NK count was now within "acceptable" limits and that if I were to conceive again I should take low dose prednisone once a day during the first trimester. To treat the APA, he said I should inject lovenox daily while pregnant.

So with my DE IVF conceived pregnancy (age 44 after two prior attempts at DE had to be cancelled due to problems with the donors' health histories and/or response to stims) I did both. I had a blissful, medically uneventful pregnancy until two weeks before my due date (one week before the medically necessary scheduled C-Section)when my OB instructed me to go off of lovenox. Two days later I suddenly came down with the worst class of HELLP Syndrome (a rare, extreme form of eclampsia.) HELLP ruptured my liver and gave me a stroke that put me in a six week long coma. I needed a tracheotomy, craniotomy, emergency C-section, $11,000 of blood transfusions, 6 months in hospitals & 18 months of cognitve and physical therapies. I was BLESSED to receive such excellent care and make a great recovery yet of course I grieve the illness and injury and time I lost with my husband and infant daughter.

What I want to know is: was there a male genetic component to HELLP and my prior losses? Did injecting lovenox keep my pregnancy going? (I believe it did but am only guessing.) and did going off of lovenox trigger HELLP? I know many women inject lovenox while pregnant and suffer no ill affect when they cease it but I can't help but wonder if there was a connection.

My other question is: would a surrogate be at risk for getting HELLP if I were to hire a surrogate to carry a pregnancy (attained with one of the frozen embryos?) I have some frozen embryos in storage but would not want to place a surrogate at risk.

Thanks ahead of time.

Dr. Braverman

2026 Posts
RE: Did going off of Lovenox CAUSE HELLP Syndrome to occur? Posted on: Nov 22, 2012 at 7:22am
First I am grateful that you came through such diffiucult situation and are back with your family . HELLP is a very complicated syndrome where we still do not understand completely the cause. Clearly it does have to do with an immune attack on the placenta from early in the pregnancy. It is unlikely that simply stopping the lovenox late in the pregnancy played a part in developing the syndrome , it was probably brewing for sometime. In my opinion I think it was coincidental with the timing of coming off the lovenox.
this is 100 percent an issue with you and implantation and a surrogate would not have any increased risk over the general population if you so choose to have another child through surrogacy I see no problems.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.