MTHFR Compound Heterozygous and recurrent miscarriage


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Reply MTHFR Compound Heterozygous and recurrent miscarriage Posted on: May 8, 2011 at 10:40pm
Dear Dr Braverman,

I have filled out the patient questionnaire, and may be calling for a consult this week. We have an appointment with our RE this week, and are hoping he'll know what direction to go from here, but we are unsure.

I have a hx of PCOS, compound heterozygous mthfr mutation, and a borderline immunglobulin that I take asa 81mg for (not sure what details are on it). I take 1500 mg metformin daily, baby asa, folgard RX, and prenatal vitamins. In the course of trying to conceive with the RE we also discovered my right tube is slow to clear, but the right ovary is the only one that produced mature follicles with femara alone. I am an active 31 y/o, 125 lbs, and5 ft 7. I am also a nurse so I try to research all of the crazy stuff that has termed me less fertile.

Anyway, we conceived our daughter after 3 years of trying, while taking femara and our first time with menopur. She was born Oct 2009. In Sept 2010 we returned to the RE and got pregnant our first cycle with femara and bravelle, unfortunately I miscarried at 8 weeks had d & e and found XX trisomy 3. Since that miscarriage we have done 3 more cycles with the same protocol and had chemical pregnancies 2 of them. Then we tried menopur with femara this last cycle thinking it would make a difference, and again chemical pregnancy. They all seem to happen right around the same time. I respond well, maybe too well to the meds, with up to 4 follicles on the left ovary. I also seem to get mild ohss easily.

My question is do you think this is immune related? Or do you think I need more treatment, heparin or lovenox, for the mthfr mutation? Would this be something of trial and error to figure out tne answer? We have spent thousands of dollars because of my right tube not working, knowing I tend to get pregnant easily from the left. We didn't expect to run into this extra more complex problem of miscarriages though. Thank you so much for taking the time to read this.


Dr. Braverman

2026 Posts
Re: MTHFR Compound Heterozygous and recurrent miscarriage Posted on: May 9, 2011 at 3:24am
This is a common presentation for immune issues. The MTHFR is not likely the reason for all of these losses. Im sure a full immune workup will show the problem. Had it been thrombophilic(MTFHR) you would have seen evidence in the first pregnancy as these problems are inherited where as the immune issues most of the time are aquired. Please call me and schedule a consultation , I would be happy to guide your workup and management along with your current RE.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.