Monday, June 4, 2012

Recurrent Pregnancy Loss (RPL) Workup Shows MTHFR: What Next?


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.

Thank you,

D. from Boston


Hello D. from the U.S. (Massachusetts),

The treatment for MTHFR (Methylenetetrahydrofolate reductase), is increased Folic acid (for more information 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!

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A


  1. hello,
    i am in my first and last cycle of ivf (i will not repeat it) and my dr. has suggested heparin too.
    i would like to ask, whether taking higher doses of fish oil, garlic, ginger, bromelain could be used instead of heparin. im not comfortable taking many drugs
    thank you!

    1. No, these are not substitutes. Why have you limited yourself to one IVF attempt. IVF is just like trying on your own for one month because it just replicates the natural process for you (minus three steps). If you were trying naturally, would you tell your husband, "we are only going to have sex this month and if no pregnancy occurs, then we'll never try again"? Of course not because everyone knows it may take more than one month to get pregnant. The same is true of IVF. It is not a perfect technology and only 50% get pregnant on their first try.

      Good Luck

  2. Dear D. from Boston,

    I am in the exact same situation that you have described (same age, multiple CPs, positive only for hetrozygote MTHFR). I would be extremely grateful if you could share your experience and what worked for you eventually.

    Many thanks
    A. from NY

    1. Hi. I think I put all my recommendations in this article. I recommend Folic acid 4 mg per day and have had success with this treatment for RPL in patients with MTHFR as the only possible cause.



Related Posts with Thumbnails