IÃ¢â‚¬â„¢m a 37y.o. G1P0. I developed severe preeclampsia and HELLP syndrome (Class 1) at 23w1d which immediately led to an emergency cesarean section (classical incision). My son died 4 hours after he was born. My husband and I are planning to try to conceive again; we were advised to wait until 6 months after my C/S.
For a bit of background information, my risk factors for preeclampsia were being a nulligravida, advanced maternal age (36y at time of conception), and donor insemination. We successfully conceived on our 3rd IUI with frozen sperm from a donor. The pregnancy was also complicated by new onset severe migraine headaches and an abnormal 2nd trimester screen suggesting a 1/29 risk for Down Syndrome; the amniocentesis results were normal. We have since consulted with an MFM specialist and the thrombophilia workup revealed a Protein C deficiency and heterozygosity for the MTHFR DNA mutation (A1298C). Otherwise IÃ¢â‚¬â„¢m a very healthy person; my medical history is only significant for the occasional bout of RaynaudÃ¢â‚¬â„¢s phenomenon and tension headaches.
I understand that you cannot provide specific medical advice about individual cases, but I would appreciate it if you would consider the following questions:
1.) Should the same or different sperm donor be used in future conception attempts?
The literature seems to suggest a possible immunological role of donor insemination and preeclampsia. And I would obviously like to reduce my risk for recurrence as much as possible. Unfortunately, I have heard mixed opinions regarding this issue. One OB/GYN has said use the same donor; another said use a different donor. And, the specialist indicated that there is not enough evidence to base an opinion for or against using the same donor. If Ã¢â‚¬ËœsomeÃ¢â‚¬â„¢ evidence suggests that increased exposure to a partnerÃ¢â‚¬â„¢s sperm decreases the risk of preeclampsia, should the same donor be used in future conception attempts?
2.) When should anticoagulation begin if you have an inherited thrombophilia?
It has been suggested that anticoagulation with Lovenox be initiated as soon as there is a positive pregnancy test. I am curious whether any evidence suggests benefits of anticoagulation at the time of or just prior to conception Ã¢â‚¬â€œ such as with low dose AspirinÃ¢â‚¬â€as compared to starting anticoagulation roughly 2 weeks later with a positive pregnancy test. Another approach I heard about it is a combination of the above: start ASA when you are trying to conceive and then switching to Lovenox once there is a positive pregnancy test. What does the evidence suggest?
Thank you for your time, dedication to this issue, and any information you can share!!