Hi Dr. Sher,

I am 41 years old and I am currently 8 weeks and 5 days pregnant through IVF and I need a second opinion when to stop Lovenox. Just to provide some background, I had two failed embryo transfers with AA euploid blastocysts. Then I was diagnosed with endometriosis and had excision surgery in March 2023. Also, I have these gene mutations:
PAI-1 (675 5G>4G) Homozygous
MTR (2756 A>G) Heterozygous
MTHFR (1298 A>C) Heterozygous
MTRR (66 A>G) Homozygous

I had test for homocysteine on 06/2023 – 5.8 umol/L
Test for PLASMINOGEN ACTIVATOR INHIBITOR 1 in 2021 – 5ng/ml
I am taking methylfolate form of folic acid.

Currently as part of IVF protocol besides progesterone/estrogen I am taking these medications since I had slightly elevated Th1/Th2 ratio and to reduce inflammation:
Prednisone 20mg/day
Tacrolimus 1mg/day
Lovenox 40
Aspirin 81

The doctor recommends stopping lovenox and tacrolimus at the end of week 9 and starting weaning down prednisone. I noticed that most people stop lovenox at the end of week 12 and want to ask what you would be recommendation. Also want to ask if there any pregnancy risks associated with gene mutations I have and do I need to do any specific bloodwork related to them?

Thank you,
Lena