Metformin and PAI-1 or MTHFR?

triple-j · 01-18-2008, 07:51 AM

Hi,

Has anyone heard of using Metformin to help prevent m/c with PAI-1 or MTHFR issues? My high risk OB just prescribed this. I've seen it used for PCOS but nothing else? Any insight would be greatly appreciated.

If you need more history:

My mutations:
Heterozygous MTHFR (A1298C)
Homozygous PAI-1 (4G/4G)
Heterozygous Factor XIII V34L

I'm 36 and had one m/c at 5 weeks. I've been to a RE, a hematologist and a high risk OB. The collective group does not think the thrombophilia risk factors caused the m/c. (Mostly due to how early it was and that it was my first pregnancy.) Hematologist ran a bunch more tests and all came back OK. His reco was a baby aspririn and extra folic acid for rest of my life, and he deferred to the high risk OB with regards to treatment while TTC and pregnant.

LOVED my high risk OB. He too was fine with just the baby aspirin and folic acid. He gave me an Rx for Foltex. However, because I was concerned regarding my age (36) and didn't want to risk time with another m/c, he suggested Metfrormin. He thought Lovenox was too extreme at this point and I am willing to take his advice. Just wanted to see if anyone else had any experience with this.

Thanks!

henypeny · 01-26-2008, 06:37 AM

I too have beta-fibrinogen 455G/A Gene Polymorphism Homozygous and
PAI-1 4G/5G Gene Polymorphism Heterozygous

Someone also mentioned to me about taking metformin for PAI-1 but I have not talked to any RE yet or ob/gyn yet. I do not seem to have PCOS based on my bloodwork done in May last year so I do not know how to approach my RE or ob/gyn on this as they may not be familiar with these tests since they are immune related tests.

wanabmom · 02-13-2008, 07:16 PM

I am positive for PAI-1 and have 2 copies of the MTHFR gene. I had 5 miscarriages before I found a repro immunologist that put me on Metformin, Folgard, BA, & Lovenox among other scripts that were needed. I am now 31 weeks pregnant. I don't think we would ever be where we are at now unless we had gone through this Dr. and had been given these prescriptions, along with other treatment that we have had to do along the way.

Good luck!

triple-j · 02-20-2008, 11:51 AM

Thanks ladies for your feedback! I've been doing the Metformin and extra folic acid for a month now and we are going to try again next cycle. It's nice to hear that others have been successful with this treatment. (Won't be going so far as the Lovenox unless we have another loss.)

vl1 · 04-11-2008, 12:07 PM

Hello, I am new to the site but have something in common with a lot of you. I am 37 and pregnant for the 4th time although the last 3 ended in miscarriage. I am heterozygous for MTHFR and homozygous for PAI 1 too.

I have been prescribed 5mg folic acid, 75mg asprin, 20mg clexane and 800mg progesterone (for the first 12-14 weeks) by the fertility clinic where I had my IUI and I am now 11 weeks pregnant. The fertility clinic have now discarged me to the NHS.

I am a bit concerned with a few things. I had a large bleed at week 8 where a pouch of blood burst which was very near to the baby. Anyone had anything similar?

No-one seems to want to take ownership of me either.. the midwives are not really interested about my questions about blood tests and if I should up my dose of clexane or when to stop clexane, or do I need doppler flow scans later on to see if the placenta is ok?

My GP has only met me once and doesn't know about the clotting disorders at all! I have yet to meet anyone else and only have another midwife appt at week 15.

Is there anything I should be getting done right now that anyone can advise me on. Any advise would be greatfully received.

poohbear · 04-11-2008, 02:41 PM

Hello,
I tested heterozygous for both the mthfr C677T mutation and PAI-1. I'm seeing a hemo in May but the RE's didn't think it was a big deal and to take the extra folic acid, baby aspirin and possibly lovenox if pg.

Wanabee do you have one or two copies of the PAI-1. I do not have PCOS or any issues with diabetes in my family. I still don't get what this PAI-1 means.

triple-j · 04-14-2008, 08:05 AM

OK ladies, cross your fingers for me! I got a BFP yesterday. It's still early. My cycles have been fluxuating from 21 to 28 days, so I am "late" for the 21 day but not late for a 28 day. Not sure if I should call the doctor for a blood test verification? I have had 2 mc's. One was my first pg and the second was the next cycle -- which could have been due to our getting pg too soon after first mc. So I am hoping that the drug mix (ba, folic acid, and metformin) is working! If this one fails, I'm going to push for the Lovenox.

Vl1 -- can you share what the 20mg clexane and 800mg progesterone are being prescribed for? These are new to me with regards to MTHFR and PAI-1?

Thanks!
JJJ

poohbear · 04-14-2008, 08:16 AM

Congrats JJJ!
The clexane is a type of low molecular weight heparin I think, probably similiar to lovenox. Good luck!

lw962 · 04-14-2008, 02:04 PM

hi ladies...

i have had 3 m/c, conceived naturally.

i have pai-1 4g/5g. my doc only wants to treat me with lovenox and prednisone.

is this protocol enough? what other methods of treatment should i consider?

i also have lipoprotein a = 177. i think this should be less than 35 if normal. this means that i have a higher propensity to clot. anyone else have this? treatment?

thanks
lyn

triple-j · 04-21-2008, 07:30 AM

lw962

i'm not familiar with the lipoprotein issue so i'm afraid i can't be much help there! my cousin has the worst form of MTHFR and is on coumadin for the rest of her life. when she was TTC and pregnant, they moved her to lovenox. i think that's all she was doing and she had a healthy, full term baby boy.

so my betas came back looking good! not sure how many dpo i was at last week, but the first one was 78 and the second was 166. (keep in mind that i was VERY early! just 25 days past my last period -- i have a 21 - 28 day cycle -- very irregular.) my nurse was pretty excited and the doc said no lovenox. so now my protocol is baby asprin, extra folic acid (pretnatal plus 2 folgard), and the metformin.

have my first U/S on May 21. the waiting is the worst! today is day 33 which is the day i lost my first one, so i think once i get through today i'll feel better!

best of luck to you!
jennifer

01-18-2008, 07:51 AM	#1 (permalink)
triple-j Registered User Join Date: Nov 2007 Location: usa Posts: 12	Metformin and PAI-1 or MTHFR? Hi, Has anyone heard of using Metformin to help prevent m/c with PAI-1 or MTHFR issues? My high risk OB just prescribed this. I've seen it used for PCOS but nothing else? Any insight would be greatly appreciated. If you need more history: My mutations: Heterozygous MTHFR (A1298C) Homozygous PAI-1 (4G/4G) Heterozygous Factor XIII V34L I'm 36 and had one m/c at 5 weeks. I've been to a RE, a hematologist and a high risk OB. The collective group does not think the thrombophilia risk factors caused the m/c. (Mostly due to how early it was and that it was my first pregnancy.) Hematologist ran a bunch more tests and all came back OK. His reco was a baby aspririn and extra folic acid for rest of my life, and he deferred to the high risk OB with regards to treatment while TTC and pregnant. LOVED my high risk OB. He too was fine with just the baby aspirin and folic acid. He gave me an Rx for Foltex. However, because I was concerned regarding my age (36) and didn't want to risk time with another m/c, he suggested Metfrormin. He thought Lovenox was too extreme at this point and I am willing to take his advice. Just wanted to see if anyone else had any experience with this. Thanks!

02-13-2008, 07:16 PM	#3 (permalink)
wanabmom 100-199 post 3 of hearts Join Date: Sep 2007 Location: Arizona Posts: 104	I am positive for PAI-1 and have 2 copies of the MTHFR gene. I had 5 miscarriages before I found a repro immunologist that put me on Metformin, Folgard, BA, & Lovenox among other scripts that were needed. I am now 31 weeks pregnant. I don't think we would ever be where we are at now unless we had gone through this Dr. and had been given these prescriptions, along with other treatment that we have had to do along the way. Good luck! __________________ Me (29) DH (31) Dx immune & clotting issues 5 x 6.5 weeks, 5 weeks, 9 weeks, chemical preg, 8 weeks Hanna Skye arrived 03/27/2008 5lbs 3oz, 17.7 inches

04-14-2008, 08:05 AM	#7 (permalink)
triple-j Registered User Join Date: Nov 2007 Location: usa Posts: 12	Update from triple-j (PG and MC mentioned) OK ladies, cross your fingers for me! I got a BFP yesterday. It's still early. My cycles have been fluxuating from 21 to 28 days, so I am "late" for the 21 day but not late for a 28 day. Not sure if I should call the doctor for a blood test verification? I have had 2 mc's. One was my first pg and the second was the next cycle -- which could have been due to our getting pg too soon after first mc. So I am hoping that the drug mix (ba, folic acid, and metformin) is working! If this one fails, I'm going to push for the Lovenox. Vl1 -- can you share what the 20mg clexane and 800mg progesterone are being prescribed for? These are new to me with regards to MTHFR and PAI-1? Thanks! JJJ

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01-26-2008, 06:37 AM	#2 (permalink)
henypeny 0-99 post 2 of hearts Join Date: Jul 2007 Location: USA Posts: 65	I too have beta-fibrinogen 455G/A Gene Polymorphism Homozygous and PAI-1 4G/5G Gene Polymorphism Heterozygous Someone also mentioned to me about taking metformin for PAI-1 but I have not talked to any RE yet or ob/gyn yet. I do not seem to have PCOS based on my bloodwork done in May last year so I do not know how to approach my RE or ob/gyn on this as they may not be familiar with these tests since they are immune related tests.

02-20-2008, 11:51 AM	#4 (permalink)
triple-j Registered User Join Date: Nov 2007 Location: usa Posts: 12	Thanks ladies for your feedback! I've been doing the Metformin and extra folic acid for a month now and we are going to try again next cycle. It's nice to hear that others have been successful with this treatment. (Won't be going so far as the Lovenox unless we have another loss.)

04-11-2008, 12:07 PM	#5 (permalink)
vl1 Registered User Join Date: Apr 2008 Location: Surrey, England Posts: 1	Hello, I am new to the site but have something in common with a lot of you. I am 37 and pregnant for the 4th time although the last 3 ended in miscarriage. I am heterozygous for MTHFR and homozygous for PAI 1 too. I have been prescribed 5mg folic acid, 75mg asprin, 20mg clexane and 800mg progesterone (for the first 12-14 weeks) by the fertility clinic where I had my IUI and I am now 11 weeks pregnant. The fertility clinic have now discarged me to the NHS. I am a bit concerned with a few things. I had a large bleed at week 8 where a pouch of blood burst which was very near to the baby. Anyone had anything similar? No-one seems to want to take ownership of me either.. the midwives are not really interested about my questions about blood tests and if I should up my dose of clexane or when to stop clexane, or do I need doppler flow scans later on to see if the placenta is ok? My GP has only met me once and doesn't know about the clotting disorders at all! I have yet to meet anyone else and only have another midwife appt at week 15. Is there anything I should be getting done right now that anyone can advise me on. Any advise would be greatfully received.

04-11-2008, 02:41 PM	#6 (permalink)
poohbear 5000-9999 post king of hearts Join Date: Jan 2002 Location: NYS Posts: 6,330	Hello, I tested heterozygous for both the mthfr C677T mutation and PAI-1. I'm seeing a hemo in May but the RE's didn't think it was a big deal and to take the extra folic acid, baby aspirin and possibly lovenox if pg. Wanabee do you have one or two copies of the PAI-1. I do not have PCOS or any issues with diabetes in my family. I still don't get what this PAI-1 means.

04-14-2008, 08:16 AM	#8 (permalink)
poohbear 5000-9999 post king of hearts Join Date: Jan 2002 Location: NYS Posts: 6,330	Congrats JJJ! The clexane is a type of low molecular weight heparin I think, probably similiar to lovenox. Good luck!

04-14-2008, 02:04 PM	#9 (permalink)
lw962 1000-4999 post queen of hearts Join Date: Oct 2007 Location: Miami, FL Posts: 3,774	hi ladies... i have had 3 m/c, conceived naturally. i have pai-1 4g/5g. my doc only wants to treat me with lovenox and prednisone. is this protocol enough? what other methods of treatment should i consider? i also have lipoprotein a = 177. i think this should be less than 35 if normal. this means that i have a higher propensity to clot. anyone else have this? treatment? thanks lyn

04-21-2008, 07:30 AM	#10 (permalink)
triple-j Registered User Join Date: Nov 2007 Location: usa Posts: 12	lw962 i'm not familiar with the lipoprotein issue so i'm afraid i can't be much help there! my cousin has the worst form of MTHFR and is on coumadin for the rest of her life. when she was TTC and pregnant, they moved her to lovenox. i think that's all she was doing and she had a healthy, full term baby boy. so my betas came back looking good! not sure how many dpo i was at last week, but the first one was 78 and the second was 166. (keep in mind that i was VERY early! just 25 days past my last period -- i have a 21 - 28 day cycle -- very irregular.) my nurse was pretty excited and the doc said no lovenox. so now my protocol is baby asprin, extra folic acid (pretnatal plus 2 folgard), and the metformin. have my first U/S on May 21. the waiting is the worst! today is day 33 which is the day i lost my first one, so i think once i get through today i'll feel better! best of luck to you! jennifer