2nd visit with MFM after tests?

[ellemoon]

My husband and I are going to start trying for #2 in March. I've already met with 2 MFMs and gathered information, formed a plan, etc. BUT since I met with the last one, I was diagnosed with homozygous C677T MTHFR (apparently the worst one). I know there are varying opinions on this but given my history of early severe pre-e, partial placental abruption, IUGR, superficial DVT postpartum and chronic high blood pressure...I've decided I definitely want to do Lovenox injections. This article definitely sealed my decision. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407628/

I know my OB will not be experienced in this and will want me to talk to the MFM. Since I didn't know I had this when I met with the MFM before, Lovenox was not discussed. My question is...should I schedule another appt with him to discuss a plan for Lovenox BEFORE I get pregnant again? or should I wait until I am pregnant? If I wait until I am pregnant, Then I risk running into problems with the MFM maybe not giving me Lovenox and then I will have to find one that will give it to me. I've researched the risks vs. benefits and I know that I want to do it, without a doubt. What would you do?

[sam10]

I would see the MFM to clarify. For me it was important to have all questions answered and all doubts/worries dealt with in the best possible way. From your post it sounds as though you would want to have this clarified.
I have also the homozygous mutation, however my homocysteine levels are normal. I was not taking lovenox during my last pregnancy.

[ellemoon]

Thank you for your response! I'm so happy to hear you made it almost full term! That's great!

I know that the use of Lovenox for this is controversial and it may not even make a difference. But I feel like if I don't do it, then I will regret it. I've researched this A LOT and I feel like the potential benefits outweigh the risks to me. I will definitely schedule another appointment with them. What should I say when I call? I want to discuss results? I've only seen this person once and it was a consult.

[sam10]

I would ask for another consult, especially since your medical background information has changed. I think it depends how the mutation manifests (e.g. I don't have abnormal homocysteine levels) which might be a deciding factor or individual pregnancy care (lovenox or not). I do remember I came across an article that excluded MTHFR as a clotting disorder per se. I tried to find it, but am still looking.