There is no doubt that MTHFR and recurrent pregnancy loss are linked.
This is especially true if you have:
- 1 or more copies of the C677T MTHFR mutation or
- 1 copy of each (1298 and 677) or
- 2 copies of A1298C or
- A single copy of A1298C MTHFR mutation may not be related – however, I am still on the fence about this for various reasons.
I recently came across an article regarding a 31 yr old woman who had 3 recurrent pregnancy losses in 12 months. She was tested positive for 1 copy of a MTHFR variant (which form is not clear).
She was inappropriately prescribed high amounts of folic acid.
What should have been done?
In my experience, doctors should prescribe methylfolate and folinic acid to pregnant women.
It depends on the MTHFR variant, lifestyle, diet and symptoms. There is no set guideline to how much. One must taper up or check their blood levels for various forms of folate.
The point I want to make is there are certain guidelines for recurrent pregnancy loss and MTHFR.
I am not an OB/GYN or a specialist in recurrent miscarriage so in order to provide you the best information, it is best that I find someone who is.
I’ve done that.
1. Edward Ramirez, MD, FACOG
2. Reproductive Immunology Associates
You ask: What is FACOG?
FACOG = The initials FACOG after a physician’s name indicate that he or she has met additional criteria to qualify as a Fellow of The American Congress of Obstetricians and Gynecologists. By choosing an ACOG Fellow as your physician, you can feel confident that you will receive the highest quality health care. Choosing an ACOG Fellow as your physician ensures that your ob-gyn is being kept abreast of the latest medical guidelines, treatments, and techniques in women’s health care today.
To make this as clear as possible, I am going to now provide you the Q and A that occurred between D from Boston and Dr Ramirez:
Dear Dr. Ramirez,
I am 31 years old and have had 3 chemical pregnancies in the past 12 months. They have run a slew of genetic testing and a RPL (recurrent pregnancy loss) workup and all has come back normal with exception to the MTHFR test. I have tested positive for 1 copy of the MTHFR mutation. The nurse told me that because I was considered heterozygous that this was not a big deal. They prescribed me with a high dosage of Folic Acid. She said that it was likely not contributing to the repeat losses. I have been reading online and while the homozygous mutations seem to be more serious, there seem to be mixed reviews on whether this can contribute to early miscarriage.
Do you prescribe Lovenox or Heparin in this type of situation (only 1 copy?) Should I be concerned about this and demand that they treat it somehow? It doesn’t seem like they are planning on doing anything besides the folic acid.
Also, given that this test has come back as it did, is there any other testing that you would reccommend that may be related to this? I am a little frustrated because this test was not originaly included in the work up and I had heard about it from online research and specifically requested it.
I just want to make sure that I am not missing anything.
D. from Boston
Hello D. from the U.S. (Massachusetts),
The treatment for MTHFR (Methylenetetrahydrofolate reductase), is increased Folic acid (for more information MTHFR.net). But with your history of recurrent pregnancy loss or RPL, I usually will add the following to my patients, although there is not clear research backing it up if you are immunologically negative:
1. Low dose aspirin 81 mg starting with the start of the cycle
2. Low dose heparin 2000 units bid starting with the start of the cycle (you can substitute lovenox but it is more expensive).
3. Medrol 16 mg starting with the beginning of the cycle until ovulation then decrease to 8 mg
4. Increase progesterone supplementation of either Crinone 8% per day or Endometrin 100 mg three times per day starting after ovulation.
This cocktail has been shown to be effective in recurrent miscarriages (see Reproductive Immunology Associates for further information regarding immunological causes of miscarriage). My presumption is that you have had immunological testing, specifically antiphospholipid antibodies?
I hope this helps!
Dr. Edward J. Ramirez, M.D., FACOG
You may have noticed Dr Ramirez stating that the treatment for MTHFR is high dose folic acid. Well – it is – unfortunately. This is the standard of care which physicians are forced to abide by. You notice that Dr Ramirez mentioned to visit MTHFR.net for more information. That is all I’ll say about that.
Proactive doctors who are ahead of the standard of care know that high dose folic acid is cause for concern. Not only that, but folic acid is not the active form of folate that is needed for a developing baby. The forms of folate that are needed for a developing baby are folinic acid and methylfolate.
Why would Dr Ramirez provide aspirin and heparin (or lovenox) for a woman with 1 copy of a MTHFR variant?
Because this woman had recurrent miscarriages. Period.
We know that D from Boston had recurrent miscarriages and the ‘only’ thing that showed up in her bloodwork was 1 copy of a MTHFR variant.
What we don’t know is:
- What other relevant blood tests were not done?
- What tests should have been done on her partner? It is not only the woman’s genetics that can cause miscarriage. The man may donate genetics which can recurrent pregnancy loss.
- What is her lifestyle and diet like?
- What is her occupation?
- Are her environmental exposures partially at cause here?
To understand my point in detail, one must read this article on recurrent pregnancy loss and how it is important to identify the genetics of the man also – not just the woman.
If your doctor is not being proactive in addressing the known (and unknown) causes of recurrent pregnancy loss, then it is time to educate them on it and/or find a new doctor.
Resources for Recurrent Pregnancy Loss:
Please comment below your experiences of recurrent pregnancy loss
- How your doctor has been either proactive – or – underactive.
- If your doctor was proactive and you successfully carried to term, please do share who your doctor was.
- What was done medically and nutritionally for you in order to carry to term?