Help! Got some of my blood work back

[scoobers]

(x-posting to TTC)
Help!
I got a call from my OB's office today. They have some of my blood work back and they found three "areas of concern". I talked to the nurse, not the OB, and she was nice but didn't have much in the way of helpful info or explanation. They've set up three follow up appts. for each issue. Anyone deal with any of these? Any words of comfort or advice?

1. Positive for MTHFR Gene mutation
2. Thyroid level high - optimal for fertility/conception is 2 and I have 3.3
3. Seratonin Level is low

For issue #1, apparently I have to come in to get instruction on and a prescription for a daily injectable medicine. This one really freaks me out. What does this gene mutation do?

Issue #2, some kind of medication, she didn't know what.

Issue #3 - Lexapro. WTF? Isn't that for depression?

[lifeguard]

Lexapro is generally used for depression but as it targets your serotonin receptors I suppose they may be able to use to help correct a serotonin deficiency.

[biomama]

I would write down all your questions and ask to speak to the doctor about them. I am pretty surprised they gave you all this info over the phone without being able to respond to your questions! That's terrible!

from a little bit of reading, I found out that the MTHFR gene normally is involved in making folate, and if you have a mutation, you may not be as good at making folate. Obviously babies need a lot of folate to develop properly, so there is an increased risk of problems during pregnancy with this mutation. The shot is probably folic acid...
a very science-y cite here

I'm curious why they tested you for this? Do you have a history of complicated pregnancies?

Certain medicine for depression, the SSRIs (selective serotonin reuptake inhibitors) can help increase the levels of serotonin in your brain. How did they measure your levels? Was that a blood test?

GL dealing with all of this! We are here to help you get through it. And good luck dealing with the doctors and getting your questions answered.

[scoobers]

Hi Ladies, thanks so much for all your responses.
I couldn't sleep and have been up for hours googling and reading. (How did I ever survive before the www???)
MTHFR- (I've already got a name for this...what does it look like it's an abbreviation for? Yep. That's what I'm calling it.) So, it sounds like this mutation can interfere with the metabolization of folate among other things. From this article:
"Normal MTHFR activity may help maintain the pool of circulating folate and methionine and possibly prevent a buildup of homocysteine." Obviously anything that interferes with your folate levels is of concern to women trying to get pregnant. However, the other thing that freaks me out about this is that I had a pancreatic cancer scare in the year after DS was born. Lower methionine levels are also linked to elevated pancreatic cancer risk. I got the all clear a couple years ago but...UGH. My Dad died in his 40's of pancreatic cancer. ALSO, we're mostly vegan so elevated homocysteine is of concern as well as it can be a sign of B12 deficiency. We supplement but now I'm wondering if it's enough? I did ask them to check homocysteine and MMA but they didn't say anything about that.

Thyroid level high - From this article:
"Hypothyroidism and hyperthyroidism are among the many different causes of infertility by preventing ovulation, or the release of an egg. Despite the absence of ovulation, menses may appear normally, so infertility may be the only symptom of an underlying thyroid problem.

If you are hypothyroid, you may not ovulate, and it may be difficult for you to become pregnant. Hypothyroidism has also been associated with an increased risk of having cysts forming on the ovaries, or polycystic ovaries, which is also associated with decreased fertility. In women with severe hypothyroidism, the level of a pituitary hormone called prolactin may also be increased, causing milk production (galactorrhea) unrelated to pregnancy and childbirth. The high prolactin level may prevent normal ovulation, causing decreased fertility, sometimes with irregular or absent menses. In addition, some researchers believe that women with untreated hypothyroidism who do conceive are at increased risk for their children to be born with physical abnormalities as well as mental retardation. Spontaneous abortion and fetal death are two other potentially serious complications of untreated hypothyroidism. Diagnosing your hypothyroidism and treating you with thyroid hormone medication will cure you of your thyroid disease."
Only...I'm pretty sure I'm ovulating. I use the CBEFM and get an LH surge like clockwork and FF says I ovulated. One interesting thing is from this article which mentions that a hypoactive thyroid can cause luteal phase shortening. I seem to have a shortened LP of only 11 days so maybe treating this will help that?

Serotonin - From this article: Serotonin appears to affect Prolactin levels which can in turn affect ovulation. Again, as far as I can tell I'm ovulating so not sure this is a problem. This blog mentions that low serotonin can cause you to have a too thin uterine lining which could very well be a problem for me. It also has a scary link to a BBC article on a study which SSRI's (which is what Lexapro is) have been linked to stillbirth, premature birth, and low birth weight.:

I definitely have a lot of questions for my OB. Unfortunately I'm only going to be seeing the nurse for my next 4 appts. I don't see my OB until Aug. 5. I think I'm going to call the office on Monday and ask if he can call me though. I'm not comfortable starting treatment for this stuff without asking for more info. I guess if the shots are folic acid I'd be ok with that but I'm not sure about the Lexapro or Thyroid medication. Also, there's a chance I could be preggo, I'm in the 2WW so I'd want to make sure anything I take is ok during pregnancy.

Sorry, I know this was really long. If you made it this far, thanks!!!

[biomama]

looks like you got a lot of information! That's great. I agree that you should insist on seeing or talking to your doctor before starting any of the medications. It is completely reasonable to want to ask your questions first. If they aren't cooperating, you may want to find another doctor!

GL, and keep us posted!

[soulshine]

it is possible to be positive for one copy of the mthfr mutation. if that is the case, most peri's/o.b's will prescribea combination pill of vit.'s b-6, b-12, and folate, in higher than normal dosage. pills are called foltx or folgard or folbee.

the injections are probably NOT folate. when you have a + copy of mthfr, it is for a very specific gene, and it will make your homocystine levels high. this is where blood clots come into play, and the injections you take for this are either lovenox or heparin.

i don't know anything about the thyroid or the seratonin. but for mthfr, it is pretty common to have one + copy of this mutation, and if you have 2 copies, it is only when it is the specific gene that you have to treat with lovenox/heparin.

i know there is a thread on mdc for blood clotting disorders, and there is alot of info there.

i have the one copy of mthfr, and i take daily foltx.

your ob will know what specifically you have as far as the mthfr, and it sounds like if they want you to come in for an rx, well, it sounds like you have the kind that is treated with lovenox/heparin.

i hope you can get more information and direction from your doctors. its hard to get a dx and then be left wondering what the heck it all means.

edited to add link... this is a good link someone from mdc showed me the other day. it explains mthfr very well, see question/answer #4 http://www.fvleiden.org/ask/51.html

[scoobers]

biomama I'm definitely going to insist on talking to my OB before starting any of these treatments. From the other thread...I should add a few words about my OB. He's not your typical OB. He specializes in fertility issues and definitely handles lots of high risk pregnancies. He's been around in the Bay Area for a long time and comes VERY highly recommended from 3 women I know, two of whom had fertility problems and now have babes. I also checked him out on yelp for what it's worth and every single rating raved about him. So, I do feel pretty good about him overall. He's very aggressive about treating fertility issues which may not be for some people but I'm 41 (soon to be 42) so I'm feeling like it's probably good to not take a wait and see approach. I definitely plan on calling and asking to talk to him on Monday so I can get some questions answered before starting any treatment though.
soulshineThanks!! That's really helpful and thanks for the link!!

[LisaG]

Scoobers - I have #1 and #2

You've probably read this already in your time with Dr. Google , but just in case, double check which gene mutation you have and whether or not you're homozygous or heterozygous. I'm homozygous for the one that doesn't raise homocysteine levels. My doc didn't read the lab report closely and has me taking high levels of folic acid, B6 and B12. I figure it can't hurt, might help, why not. Sometimes they'll have people do injections of heparin or lovenox to keep the blood thin.

As for your thyroid - my resource of choice is here. They have a ton of information on thyroid and fertility. This article is especially good.

"The normal TSH level for the control group of pregnant woman without autoimmune thyroid disease? 0.9. A TSH of .9 is a far cry from the so-called "normal" TSH levels of 3 or 4 or 5 that some doctors feel are no impediment whatsoever to getting -- or staying -- pregnant. "

That's great your doc recognizes that it should be lower than 3 - most docs just see that it's within "normal" range and leave it at that.

Good luck!

[scoobers]

Thanks, Lisa! I do remember reading somewhere about the specific gene mutations but didn't write them down. That's a very good point, I'll go back and check and ask him about that.

Do you mind if I ask what you are taking for your thyroid and whether it's helped?

Thanks!

Originally Posted by LisaG

Scoobers - I have #1 and #2

You've probably read this already in your time with Dr. Google , but just in case, double check which gene mutation you have and whether or not you're homozygous or heterozygous. I'm homozygous for the one that doesn't raise homocysteine levels. My doc didn't read the lab report closely and has me taking high levels of folic acid, B6 and B12. I figure it can't hurt, might help, why not. Sometimes they'll have people do injections of heparin or lovenox to keep the blood thin.

As for your thyroid - my resource of choice is here. They have a ton of information on thyroid and fertility. This article is especially good.

"The normal TSH level for the control group of pregnant woman without autoimmune thyroid disease? 0.9. A TSH of .9 is a far cry from the so-called "normal" TSH levels of 3 or 4 or 5 that some doctors feel are no impediment whatsoever to getting -- or staying -- pregnant. "

That's great your doc recognizes that it should be lower than 3 - most docs just see that it's within "normal" range and leave it at that.

Good luck!

[LisaG]

Scoobers, I take naturethroid - it's similar to armourthyroid, different brand name. Originally I was on synthroid because my endocrinologist told me that it's the only one that's reliable, blah, blah, blah. Since then I've read that a lot of people don't do well on synthroid - their levels may improve, but they don't feel better. I found a doc who would switch me and I feel a lot better on the naturethroid. Here's more info on it too.

It has definitely helped. I went off my synthroid for a few weeks a couple years ago because I wanted to see how if I really felt worse off of it. My TSH went up to 10 I then went on the naturethroid and my levels before going on the pill for IVF were around .3

[scoobers]

Thanks, Lisa I checked out the site and, unfortunately for me, it looks like it's made from pig thyroid? I'm vegetarian so that won't work for me. Synthroid sounds synthesized? Do you mind me asking what specifically got better on the Naturethroid?

Thanks!

Originally Posted by LisaG

Scoobers, I take naturethroid - it's similar to armourthyroid, different brand name. Originally I was on synthroid because my endocrinologist told me that it's the only one that's reliable, blah, blah, blah. Since then I've read that a lot of people don't do well on synthroid - their levels may improve, but they don't feel better. I found a doc who would switch me and I feel a lot better on the naturethroid. Here's more info on it too.

It has definitely helped. I went off my synthroid for a few weeks a couple years ago because I wanted to see how if I really felt worse off of it. My TSH went up to 10 I then went on the naturethroid and my levels before going on the pill for IVF were around .3

[LisaG]

Scoobers - yes, I think both armourthyroid and naturethroid are derived from pig. Synthroid is just T4 and it is synthetic. The challenge with something that contains just T4 is that your body has to convert it to T3 in order to be able to use it and sometimes the body has difficulty making the conversion. That's why people can absorb the amrouthyroid and naturethroid better - it contains both T3 and T4 and various cofactors. However, I know that it's possible to get synthetic T3 and T4 together, the challenge is that most docs don't think it's necessary. But there are definitely people who don't want animal derived products or who are allergic to pig and need an alternative, so that's not your only option. The about-thyroid site should have some information on this.

In terms of what I noticed - when I was on the synthroid it worked well for me for several months, then I started noticing that I was dragging in the mornings, feeling sluggish, low energy, etc. and my blood levels were still in a good range. When I switched to the naturethroid, I felt much better energy wise, less sluggish, clearer headed, etc.

[scoobers]

Thanks, lisa. That's super helpful. I'll ask my doctor about T3 and T4 levels as well and check out the site.