mthfr and early pregnancy?

[laurelavenue]

Some background: I am 41 years old and have experienced 7 miscarriages in the past 3 years. I did also have one successful pregnancy (yay!) in 2007, and I have three much older children. We would love to have just one more baby.

After three early miscarriages in 2006, I was diagnosed as compound heterozygous for the MTHFR genetic mutations C677T and A1298C.

I also carry the PAI (-675) 4g/5g genotype.

After this diagnosis, I was put on prometrium, Metanx (extra folic acid) and baby aspirin. Taking these meds, I was able to carry my next pregnancy to term. Since giving birth to my daughter in 2007, I have had several more early miscarriages.

I am now newly pregnant again (4 weeks and 2 days) and am taking the oral progesterone, Metanx and baby aspirin, but I am really wondering whether I should be more aggressive in treating my immune issue to try to sustain this pregnancy. My perinatologist told me I do not need lovenox or heparin, and he doesn't even want to see me for a regular office appt for 10 days, although they are having me come in for HCG/progesterone blood draws every few days.

I welcome any and all feedack on my situation. I feel very resigned to miscarrying yet again, and it's a very depressing place to find myself.

Thanks

[DaisyMae08]

Originally Posted by laurelavenue

Some background: I am 41 years old and have experienced 7 miscarriages in the past 3 years. I did also have one successful pregnancy (yay!) in 2007, and I have three much older children. We would love to have just one more baby.

After three early miscarriages in 2006, I was diagnosed as compound heterozygous for the MTHFR genetic mutations C677T and A1298C.

I also carry the PAI (-675) 4g/5g genotype.

After this diagnosis, I was put on prometrium, Metanx (extra folic acid) and baby aspirin. Taking these meds, I was able to carry my next pregnancy to term. Since giving birth to my daughter in 2007, I have had several more early miscarriages.

I am now newly pregnant again (4 weeks and 2 days) and am taking the oral progesterone, Metanx and baby aspirin, but I am really wondering whether I should be more aggressive in treating my immune issue to try to sustain this pregnancy. My perinatologist told me I do not need lovenox or heparin, and he doesn't even want to see me for a regular office appt for 10 days, although they are having me come in for HCG/progesterone blood draws every few days.

I welcome any and all feedack on my situation. I feel very resigned to miscarrying yet again, and it's a very depressing place to find myself.

Thanks

I don't have much in the way of helpful information. Having never been pregnant, I haven't had the awful experience of miscarriage. I will be thinking about you and pulling for you though. I think if you're that worried it's okay to discuss it with your doctor and be a little pushy if you have to in order to get what you need. You will be the best advocate for yourself and your baby.

[by-the-lake]

Advocate for yourself. You seem to have a handle on what you need/want. Good luck

[Sotevenn]

Hi - I found some good info in the book "is your body baby friendly" and on the fertilethoughts forum, specifically genetic & immune issues sections. My first pregnancy I was on just the baby aspirin & progesterone (in the early weeks). Then two losses & for my last pregnancy I really felt I needed to be on lovenox. I got a referral to a peri who agreed I should be on it my entire pregnancy & until 6 weeks pp (high risk to the mother of a blood clot pp). It was something I felt so strongly I needed & so my ob referred me to a peri that she thought was more agressive towards treatment of clotting issues compared to some others. He tended to treat things aggressively but that was what I felt I needed at that point. If your ob isn't willing to give it to you but you feel you need it, can you ask for a referral to a peri & specify what type of doc you want? My first pregnancy my referral was to a peri who was much more hands off, but in that pregnancy the baby aspirin was just what I needed. I hope you can find what you need.

[Happily Blessed]

I also have MTHFR (side note - I read somewhere somebody kept thinking Mother f'er everytime she read this so it stuck in my head.) But thats beside the point. I also have Antiphospholipid antibodies. When we carried our son to term, I was on Metanx, baby asaprin, and Lovenox. I don't remember if the lovenox was for the mthfr or the APA. So sorry.

I would see if you could get a referral to another peri or even an hematologist to follow through with the lovenox.

Good luck and let us know how you are doing.

laural

[LisaG]

I also have MTHFR but I'm homozygous for the version that doesn't increase homocystine levels (I think that's A).

Typically hetero doesn't have any impact on increased blood clotting and homocystine levels, at least from the reading I've done. Did they check your homocystine levels and are they in normal range (did you get the actual number?)?

My doc has me on increased B12, B6 and folic acid, as well as baby aspirin although from the reading I've done this really shouldn't be necessary, but what the heck.

I'm not familiar with the PAI genotype you mentioned or the affect it has.

Given the number of m/c you have had I would want to rule out immune issues. Not very many docs test for this unfortunately. The ones that do are typically reproductive immunologists. Someone else mentioned "Is Your Body Baby Friendly?" and that's a great albeit somewhat overwhelming place to start. Personally, I wouldn't read the book if you're pregnant. No sense adding to the worry if you don't need to.

Also, I would assume you've had a hysterosalpingogram done (HSG)? This would help rule out any fibroids, polyps or septum in the cavity. Uterine septums can cause repeated miscarriages and are pretty easy, in the right hands, to correct.

Best of luck to you - I hope that your pregnancy continues and you are pleasantly surprised

[railyuh]

Originally Posted by LisaG

Typically hetero doesn't have any impact on increased blood clotting and homocystine levels, at least from the reading I've done. Did they check your homocystine levels and are they in normal range (did you get the actual number?)?

From what I've read compound heterozygous is a different situation (I am also compound hetero for MTHFR). Compound hetero means you have one of each of the genes instead of just one of them, and from my reading it is almost as bad as being homozygous for the C gene.

I take foltx/folbic instead of metanx and it contains folic acid along with B6 and B12. I'm not sure what is in the metanx though so maybe it contains the B6 and B12 as well? My RE didn't think the lovenox or heparin was necessary for my situation, but MTHFR was the only thing that popped up on my tests. I'm not sure if the PAI genotype you mentioned has an affect on that or not since I'm not familiar with it. I know that if I had come up with another blood clotting related disorder we would've considered heparin or lovenox.

[railyuh]

Originally Posted by Happily Blessed

I also have MTHFR (side note - I read somewhere somebody kept thinking Mother f'er everytime she read this so it stuck in my head.)

Ha, that's how I think of it in my head too, wrote about it on my blog a while back when I first found out I had it.

[LisaG]

Originally Posted by railyuh

From what I've read compound heterozygous is a different situation (I am also compound hetero for MTHFR). Compound hetero means you have one of each of the genes instead of just one of them, and from my reading it is almost as bad as being homozygous for the C gene.

Ah, I didn't realize this. Thanks for correcting me

[momoftworedheads]

I carried my son to term with MTHFR (the same way you have it) by taking 4 mg of folic acid and 2 shots of lovenox every day from the 10th week until the 34th week. Then I took folic acid and baby aspirin until I delivered him at 39 weeks.

I have had 3 early losses, and one second tri loss and we really feel we had the second tri loss because the MW did not start the lovenox soon enough.

I would request getting your homocysteine level checked and if it is normal, then you will not have to take Lovenox. If it is high, I would advocate for lovenox.

Sending your lots of sticky baby dust! Please take care!

Jen

[Pookietooth]

Originally Posted by Happily Blessed

I also have MTHFR (side note - I read somewhere somebody kept thinking Mother f'er everytime she read this so it stuck in my head.)

Me too! I don't think I have it, but I've known others who did (it's common in women with PCOS, and I've been on PCOS boards for 13 years now). I would think that anything that would be an anti-inflammatory, including natural stuff like CoQ10, would be helpful, but I'm no expert.