BFP after 13 months TTC and 2 m/c -- it looks like i was folic acid resistant

[cjmullin]

Hello Ladies,
I wanted to share my story – knowing, of course, that it’s not necessarily anyone else's story and knowing mine’s far from complete as I write this. But I’m pretty awed at the events of the last few months and the power of getting the right support!  I just received a positive pregnancy test on July 31, 2011 – I’m five weeks tomorrow – my hcg’s are really strong. I’m shocked and thrilled.

My fertility history:
I’m 38

• Aug. 09 - Pregnant second month we tried – ends in chemical pregnancy

• Sept. 09 --Pregnant again – Learned at 10 week apt. that embryo died at 7.3 weeks (took until 12 weeks to miscarry)
• 
take six months off of trying to heal ( I got off ALL my supplements)
• 
get back on supplements and begin trying in June of 2010 

• by March of this year we see RE for fertility testing – All tests normal. 

• IUI during the clomid challenge test – negative

•  we decide we don’t want to do further fertility treatments, at this time and decide to take the summer to “be” with each other and see what happens.
• 
 In May of this year my ND requests that my RE do a recurrent miscarriage blood panel.  (SO much blood : ) 
    
• All tests come back normal except for my MTHFR gene – I have two copies (mutations) for A1298C, which is related to Folic Acid resistance.

My RE’s office says that he falls into the camp of believing that this has "no connection to your miscarriages” and tells me to “increase my dose to 1 mg of Folic Acid a day, because it "can’t hurt anything”

I called my ND’s office that day and at that apt. I learned much, much more:
This gene is important in the metabolism of homocysteine, an important amino acid.  Having two variants/mutations in the MTHFR gene, such as A1298C, can cause elevated homocysteine levels. Elevated homocysteine levels have been implicated in many health issues including pregnancy loss and other pregnancy-related complications, as well as restless leg syndrome (the list goes on).  My current test results showed normal homocysteine levels.

My ND recommended that I begin 1 mg of Methyltetrahydrofolate --- HUGE distinction from the folate found in prenatal supplements or OTC folate that my RE had recommended.  This is folate that is already converted – taking over the role that my mutations have been preventing. In combo with the folate you need to take a B vitamin complex. She put me on B 12 complex. The series of B vitamins work together for best absorption/results.  Her theory was that my body in 2009 had some folate reserves enough to get pregnant but not enough to sustain the pregnancy. Get my reserves back up and see what happens. That was May 12 of this year. I got my positive pregnancy results on July 31, 2011!!

Another change I made back in November of 2010 was to go off gluten entirely (my father and sister have Celiac and I noticed my own sensitivity to wheat and gluten). I continue to stay off gluten, and I’ve increased my intake of the MTHF folate and B-12 to two a day since I got pregnant.

I think the biggest thing I want to share with this community is to keep seeking support, however you need it. I’ve been seeing a lot of people who have wonderful intentions for helping us reach our goal of my goal of having a baby. I don’t fault my RE, but I believe I’d still be trying if I didn’t have my ND in my corner, with her interest and understanding of this issue.

Best to all,

Christina
 

[blueyezz4]

Thanks for sharing and Congrats!!!  That is great that you were able to correct the issue w/ such an easy fix.  I also have MTHFR, but it is only one gene I guess, so they just told me to take a baby aspirin and my RE says he doesn't think it has caused any of our issues, but says it can't hurt.  The folic acid that you are taking is that over the counter or prescription?  Hope you have a happy and healthy 9 months.

[cjmullin]

This is the brand I take: http://www.thorne.com/Products/Vitamins/prd~B129.jsp  and i buy it at my ND's office. It looks like Thorne products are sold through vitamin and supplement stores on the Web. I just can't find it at any of our local health food stores around town.  As it's been explained to me there are two mutations of the MTHFR gene -- the one i have and also C677T, which is related to blood clotting. Sounds like that might be the one you have if they recommended baby aspirin?  Although I've seen some women with the A1298C on message boards taking aspirin and folic acid so i should check that option out too.

Take good care.

[Holly TH]

Christina,

Thanks for sharing your story.  I work with NeevoDHA.  NeevoDHA is indicated for women who have MTHFR polymorphism.  Women with this mutation have a compromised ability to process folic acid.  NeevoDHA contains L-methylfolate which bypasses the polymorphism.  It is 7 times more bioavailable than folic acid.  NeevoDHA also reduces homocysteine levels better than folic acid.  I admire the proactive role you are taking in your health care and wish you the best of luck.  

[gozal]

Congratulations! I'm so happy your story has such a happy ending!

Thank you for sharing this. I recently learned about the distinction between folic acid and folate after I needed treatment for an ectopic pregnancy. I was given a methotrexate injection, which is a low dose of a chemotherapy drug that acts as a folate agonist (it prevents metabolism of folate which means embryonic cells cannot divide). Naturally, I wanted to know what I could do to restore my body's store of folate. It was really shocking to me to learn that the synthetic folate that is in almost all prenatals can harm fertility for a relatively large minority of women. I don't know if I'm in that minority but I do not take any supplements with folic acid (i.e., the synthetic kind) in them for that reason.

[cjmullin]

Originally Posted by gozal 

Congratulations! I'm so happy your story has such a happy ending!

Thank you for sharing this. I recently learned about the distinction between folic acid and folate after I needed treatment for an ectopic pregnancy. I was given a methotrexate injection, which is a low dose of a chemotherapy drug that acts as a folate agonist (it prevents metabolism of folate which means embryonic cells cannot divide). Naturally, I wanted to know what I could do to restore my body's store of folate. It was really shocking to me to learn that the synthetic folate that is in almost all prenatals can harm fertility for a relatively large minority of women. I don't know if I'm in that minority but I do not take any supplements with folic acid (i.e., the synthetic kind) in them for that reason.

oh wow! that is really interesting. I've been using the terms interchangeably. It is pretty strange that there wouldn't be at least a significant number of prenatals with the folate. I'm not even taking a prenatal, pretty much for that reason. Best to you.

[blueyezz4]

CjMullen -So I went to that website you posted, but it looks like you can't just order the vitamins online. You have to be more of a distributor like someone like your ND.  So I'm kinda stumped, but I'm interested in trying to find someone that would sell it around me.

Holly TH - do you have any suggestions on how I find a distributor????

[blueyezz4]

Disregard that post above.... I found it online!!!!  Thanks anyways!!!

[cjmullin]

Originally Posted by blueyezz4 

Disregard that post above.... I found it online!!!!  Thanks anyways!!!

Oh good! Do you mind sharing the link? Thanks.

[blueyezz4]

No problem at all.... here it is.      http://www.pureformulas.com/
 

Originally Posted by cjmullin 

Oh good! Do you mind sharing the link? Thanks.

[monkeyscience]

gozal - Could you elaborate more on the distinction between folic acid and folate? And why is folic acid bad for fertility?

[gozal]

Sure - sorry I didn't get back to this thread sooner! Here is what I have from my reading (or as I like to call it, my medical degree from the University of Google). Basically, folate has to be converted first before the body can use it for proper cell division. Our bodies don't have any trouble converting folate, which is found in nature. Incidentally, folate is absorbed in the gut, which will end up being important. Folic acid, on the other hand, is a synthetic form of folate. It is manufactured for the purposes of food supplementation and is absorbed in the stomach. For about 60% of the population, it's totally fine. The body can convert it to usable form. For an estimated 40% of the population (who are carriers of the MTHFR mutation, without necessarily being affected by it), folic acid isn't fine. For one thing, people with this mutation can't convert folic acid correctly for use. Worse than that, because folic acid is absorbed in the stomach, the body takes it in first. It then thinks that it's all stocked up and doesn't bother to collect folate from food sources in the gut. So not only does supplemental folic acid not reach this large minority of people, it actually prevents them from absorbing naturally-occuring folate. Very bad. Especially for fertility. In my opinion, it is a public health scandal that manufacturers of prenatal vitamins are not required to place a warning on their prodcuts to this effect if they use the synthetic. I found out about this because  my friend in another country was seeking help with infertility and her doctor told her to stop taking folic acid, as it could cause a problem, and I went off to search for why. There are actually lots of food-based prenatals that don't have this problem.

Of course, I only play a scientist/doctor on the internet so I do hope if I am mistaken in my understanding, that someone more knowledgeable will correct me...

[Holly TH]

Hey Girls!  

Gozal, LOL, you are a very convincing scientist/doctor on the internet and have a lot of good information.  :)  I thought I subscribed to this thread but, for some reason, haven't seen any of your follow-up posts until today.  

Christina, how is your pregnancy going?  Has it been uncomplicated so far?

Blueyezz, I am so sorry for your losses.  Are you on L-methylfolate now?  I am crossing my fingers for you.     

Individuals with the MTHFR polymorphism have an inhibited ability to break down folic acid into its usable form, L-methyfolate, thereby increasing their risk for folate deficiency induced pregnancy complications such as pre-term delivery and low infant birth rate as well as neural tube defects.  Individuals with MTHFR have also been shown to have an elevation of homocysteine concentrations of approximately 20%.  An elevated homocysteine level is an independent risk factor for the development of occlusive arterial disease in the coronary, peripheral and cerebral vessels as well as peripheral neuropathy.  

Nearly all cases of elevated plasma homocysteine will be reduced with an adequate combination of L-methylfolate (found in NeevoDHA, Metanx, Deplin, Cerafolin & Metafolin), Vitamin B12 and vitamin B6.  L-methylfolate is the only natural, active form of folate that is immediately and completely bioavailable and is unaffected by the MTHFR mutations.  Folic acid is synthetic and must be converted, in a four-step process to its active form, L-methylfolate.

The role of MTHFR in RPL is a controversial subject that obviously needs to be further studied.  But it is a fact that if you have the polymorphism, you are not metabolizing folic acid effectively and you are at risk for folate deficiency which has huge implications for trying to conceive and pregnancy.  L-methylfolate is the preferred and natural form of folate for women with MTHFR and, in my opinion, should be the preferred form of folate supplementation for all women. 

I wish you all the best of luck.  I am so sorry that you have so many struggles to have babies.  It doesn't seem fair.  You guys are in my prayers.  

[blueyezz4]

Originally Posted by Holly TH 
s it been uncomplicated so far?

Blueyezz, I am so sorry for your losses.  Are you on L-methylfolate now?  I am crossing my fingers for you.     

Holly -   Sorry I just realized I never answered your question.  Yes, I have been on it now for a little over a month and we have our Beta on 11-11-11 so I'm hoping that between the IVF and switching to 5-MTHF we will have a little more luck.  I also plan to stay on it if we get pregnant b/c from the info you shared it makes me wonder if this also might have been part of our problem w/ our pre-term labor loss.  Thanks for sharing   Do you know if this is also a case if you only have one gene issue with the MTHFR???

[Holly TH]

Blueeyezz,

Whether you are homozygous or heterozygous for the MTHFR mutation, you still have a limited ability to metabolize synthetic folic acid.   I absolutely think you should be on L-methylfolate while trying to conceive and when pregnant.  Women with the MTHFR polymorphism are at risk for folate deficiency related pregnancy complications such as pregnancy-induced hypertension, preeclampsia, placental abruption, intrauterine growth restriction and preterm delivery as well as neural tube defects.  I am so glad you are on it now.  That way you can be sure that inadequate folate status is not an issue. 

You are in my prayers and I hope you have good news in the near future!

[cjmullin]

Holly TH -- I'm 18 weeks this coming Monday and so far things have been progressing very well. I had the normal first trimester blechs but nothing out of the ordinary. I've been making a good effort to walk frequently and starting yoga and i continue to take 2 mg. of L-5-Methyltetrahydrofolate and a b-12 complex every day (along with a myriad of other supplements). I will have my anatomy scan in the next couple weeks and hope to get reassurance about the baby's neural tube health, etc.

Blueyezz -- You're in my thoughts these weeks as you wait for your results!

[Holly TH]

CJ,

I am so happy to hear that your pregnancy is going so well.  Have you ever made it this far before?  

[cjmullin]

Holly -  Nope. I've had one chemical and one that ended at 7.5 weeks. In just the last few weeks i've begun to believe that the odds are in my favor!

[Holly TH]

I believe it too!  I am so surprised that your RE sees absolutely no connection between your limited ability to metabolize folic acid and your RPL.  I am so glad you found someone who listened to you.  Doing something (that has no risks) has to be better than doing nothing.   

[blueyezz4]

CJ - congrats!!!  Here is hoping for a happy healthy continued pregnancy!!! Keep us posted please!!

Holly - After our loss of our twin boys at about 6 months I had been told by my perinatologist that I should be taking Vit B complex, but when i was reading the bottle it says it has folic acid in it and now i feel like I want to avoid added folic acid, other than the 5- MTHF Folic acid b/c now the added stuff scares me.  Not knowing that it could be part of our problem or not, I'm just trying to avoid any other folic acid added to things in general.  Is this important at all, do you know?  I was trying to figure out if they make a Vit B complex w/o folic acid, but I wasn't having much luck.  I'd love to hear your opinion/knowledge on this or if you have any insight at all!!!  Thanks.  I'd ask my drs, but they both didn't even feel that the folic acid was an issue to begin w/ and just put me on baby asprin b/c it can't hurt anything, so I kinda feel like I have taken on this folic acid issue myself b/c I believe  that it can't hurt and might actually help.  After almost 6 yrs of ttc I'm willing to do anything, especially if it is natural.