So many of our readers are dealing with challenging fertility issues that are related to their MTHFR mutations. Today we have wonderful guest post from nutritionist Aimee McNew, who also has personal experience with pregnancy loss. She will share with you practical steps you can take to diagnose and overcome your challenges in getting and staying pregnant. This may include going beyond MTHFR.
Pregnancy loss is devastating no matter what the cause, but it’s especially difficult when it happens again and again. With so many factors that can contribute to miscarriage, it’s hard to nail the reason down to a single cause, although MTHFR can certainly be a contributing factor. So what do you need to know, as a patient, to help prevent future pregnancy loss?
As a nutritionist who specializes in fertility, I work with women who want to have kids. Sadly, I also work with a lot of women who haven’t been able to have children or who have suffered miscarriage. I wish I could say I didn’t know what it’s like firsthand, but I can’t, because I recently lost my seventh pregnancy. I’m compound heterozygous MTHFR, along with other genetic and autoimmune factors. While no two women may face the exact same set of genetic or health factors when they’re trying to assess what’s causing their miscarriages, there are a number of ways that patients can advocate for themselves. I know, because I had to do my own research and make special requests from my doctor. I wasted many months, and lost several pregnancies that may have stood a chance if I’d only known more before I’d gotten pregnant. Either way, I want to give you the best chance to discover why
you’re having miscarriages, and how you can move forward armed with the best odds for success.
If you’re a regular reader of this blog, you’re well aware of how MTHFR can affect the body, including being a contributor in recurrent miscarriage, infertility, and birth defects. But you’re also probably somewhat aware of how to address it: methylfolate, methylcobalamin, a whole foods diet, etc. Typically these are the first things to be changed when a patient discovers that MTHFR could be contributing to their pregnancy loss. When I learned I was compound heterozygous, I tossed all supplements that contain folic acid, figured out an appropriate supplement program for me, and started on baby aspirin at my doctor’s suggestion. That, my doctor thought, was more than enough to “fix” my MTHFR problem. And then I had another miscarriage.
More Than MTHFR
While MTHFR gets a lot of buzz, there are a lot of other genetic mutations that can wreak havoc on the body’s ability to successfully carry a pregnancy. This is still a relatively new field of research, so sometimes the volume of information isn’t readily available. I started by getting a 23andMe test done, and then plugged it into the Livewello app to get some feedback on my genetic mutations. Since I’m a nutritionist, I was able to delve even further into my research and then spoke with my doctor about my findings. Not only do I have MTHFR, but I also have more than a dozen other mutations that deal with methylation. I have several mutations that are related to excessive clotting within the body, too. I spoke with my doctor about my concerns and my research, and she agreed to run some additional tests that 23andMe didn’t cover. These included Anticardiolipin antibodies, Lupus Anticoagulant, and PAI-1 4g/5g. While I didn’t test positive for the Lupus Anticoagulant, I did for all the others.
If you’ve had one or more miscarriages, I recommend getting the same testing done
that I did, as well as a full thyroid panel (including free T3, free T4, and Reverse T3), homocysteine, glucose, prolactin, and the standard cycle day 3 bloodwork to assess reproductive hormone health (estradiol, LH, FSH, and AMH). Progesterone should be checked around 7 days after you have ovulated. On that same note, I highly recommend tracking your cycle with a fertility app or calendar (I use Fertility Friend) so that you can give your doctors as much knowledge as possible when they’re trying to help you. You can use ovulation predictor kits, but you don’t have to. The book Taking Charge of Your Fertility is the gold standard for learning how to chart, and I highly recommend it. I didn’t start paying attention to any of these things until after my second miscarriage when I started to deduce that there was a problem. Get ahead of the curve because, in fertility, knowledge is most definitely power.
What Should Your Doctor Know?
As I said before, I had to approach my doctor with my concerns after doing a substantial amount of research. Some doctors will be very proactive and will order these tests before you can request them, but the majority aren’t going to consider miscarriage a problem until you’ve had at least three clinically documented ones. Early losses often don’t “count” to the medical world, since they can’t be verified by ultrasound, and yet, a large majority of miscarriages happen before six weeks gestation.
Not all doctors are created equal when it comes to addressing fertility problems or
even MTHFR, so you’ll want to find a doctor who (1) understands the connection between MTHFR and pregnancy loss and (2) has a game plan that involves more than baby aspirin. Yes, baby aspirin alone can work for some, but in many cases more intervention is necessary. I read study after study that showed correlation between heparin injections and a 54% reduced risk of miscarriage in patients with a history of recurrent pregnancy loss. I pressed my doctor, an OB, to give me the heparin along with the aspirin, but she was reluctant to prescribe it due to my history of miscarriage (fearing that I would hemorrhage if I had another miscarriage). I was frustrated, thinking that I was sure to have another miscarriage if I didn’t get the heparin, but she persuaded me that my odds were good on baby aspirin and progesterone alone. Even so, I had another miscarriage.
It’s important to find a doctor who will be proactive, not reactive. I began seeing a new doctor who laid out an entire plan and gave me his personal success rates with patients who had similar genetic and autoimmune disorders like mine. I didn’t have to request anything, including heparin, progesterone, and prednisone (a steroid medication thought to help calm autoimmune reactions that can terminate pregnancies). While not every doctor is going to immediately lay out a plan, you should feel confident that your doctor will do everything that he or she possibly can to help prevent future losses. This largely boils down to philosophy and how up-to-date they are on current research.
Self-Care Tips For Surviving Miscarriage
Whether you’ve had one or many miscarriages, they’re traumatizing and heartbreaking. Even if you find a doctor who can help to prevent future losses, to the best of their ability, it’s still going to take time to heal from what you’ve already gone through. Finding a new treatment plan often isn’t enough to heal the wounds or grief.
After going through seven different miscarriages, all of them somewhat different from the last, I have nailed down a few key areas where I now know how to take better care of myself.
Right after I’ve gone through a miscarriage, diet is the furthest thing from my mind. I tend to indulge in things I don’t normally allow myself on a fertility diet (read: lots of sugar), and generally give up on caring how many vegetables I eat. But this can only go on so long before it starts contributing to depression and other negative factors. I always give myself grace after a loss for a few weeks, sometimes even a month, but after that I pick myself back up and the first thing to prioritize is nutrition. Miscarriage wreaks havoc on hormonal balance, and the fastest way to overcome depression and rebalance the reproductive system is to support it with the proper nutrients. This is best done by eating plenty of green vegetables, fruits rich in antioxidants (like berries and apples), nuts and seeds (for minerals), and salmon (for good quality fat). Your diet doesn’t have to be pristine to make a difference, either, so just start adding one or two good-for-you items each day. Drinking plenty of water is essential, too, as it’ll help your liver flush toxins from your body and break down hormones.
Of course miscarriage traumatizes much more than the body, and I have found it essential to address all areas of my mental and emotional wellbeing after a pregnancy loss. For me, this has meant regularly seeing a counselor who understands infertility and writing in a journal. I’m a writer, so naturally, I express myself in words, but even non-writers can greatly benefit from putting their thoughts on paper (or the computer screen). Miscarriage can attack a woman from every direction, including self-worth, work life, personal relationships, and even spiritual relationships. It’s essential to realize that you’re not alone in what you’re feeling. One of the greatest things I could have done for my mental and emotional health after pregnancy loss was to reach out to others who had gone through it. This primarily happened via social media, and I’ve since developed strong friendships with women who really get the difficult walk that pregnancy loss and infertility really is.
It’s easy to want to forget exercise in the wake of a loss, and again, for a few weeks or a month after a miscarriage, I wouldn’t do much of anything. But choosing to prioritize physical health can help to stave off depression, rebalance hormones, and perhaps most importantly, release endorphins. Endorphins are chemicals in the body that connect with receptors in the brain to help reduce a person’s perception of pain. So exercise can actually lessen the impact and severity of post-miscarriage grief and can speed the time to healing. Exercise doesn’t have to be long or intense to be beneficial, and in fact, I’ve found the greatest post-miscarriage benefits from taking brief walks (15 minutes or less) and doing 15-20 minutes of yoga or Pilates. Whether you do something once a day, or a few short workouts throughout the day, you’ll be contributing to your physical, emotional, and mental wellbeing.
Nothing really can make miscarriage easier, but knowing how to advocate for yourself through the process can restore a sense of hope, as well as support the healthy process of grieving.
If you’ve suffered a miscarriage or many, consider asking your doctor to run the
tests I mentioned above, listed here for your convenience:
Thyroid panel including free T3, free T4, and Reverse T3 – Homocysteine
Cycle Day 3 Bloodwork: Estradiol, LH, FSH, AMH
7 Days Past Ovulation Bloodwork: Progesterone
Depending on your results, it may be appropriate to ask your doctor to prescribe heparin, baby aspirin, prednisone, progesterone, or one of many other supportive medications or supplements. You should find a doctor who you trust to be proactive for your health. Track your cycle with a fertility chart, and ultimately: don’t lose hope. Even when odds look grim because of genetics or autoimmune disease, there are still many out there who defy the odds. Living a lifestyle that supports your own set of genetic and health needs, and keeping a positive outlook, will give you the best chance possible to conceive and carry a healthy pregnancy.
About Aimee McNew