Question about miscarriages

[Cat111]

Dr Roseff,
I will try to present my situation hoping that your great experience can make me understand more about my case.
I am 32 years old and had 2 miscarriages (at about 6 weeks, 7 months apart, one with heartbeat). I ovulate by myself every month, but sometimes too late or too early. The first pregnancy - ovulation day 25, second pregnancy - ovulation day 12. Day 3 fsh and estradiol - normal, Day 21 progesterone before pregnancies (no medication) was 14. HSG normal.
My husband's SA is normal.

After the 2nd m/c I did the following tests:
1. Factor V (Leiden) Mutation
2. Prothrombin Gene Analysis
3. Homocysteine, Cardiovascular
4. Mthfr, Dna Mutation
5. Protein S, Antigen
6. Protein C, Antigen
7. Antihrombin Iii Activ Wrfx
8. T4, Free, Non-Dialyis (astea sunt de tiroida)
9. Tsh, 3rd Generation
10. Lupus Anticoagulant Screen
11. Cardiolipin Ab (Igg, Igm)
12. Chromosomes, Blood

I just got my recurrent miscarriage panel results back. All seems to be normal except the MTHFR, which has only one gene abnormal (A1298C). The homocysteine is normal. My RE didn't prescribe anything more than Baby Aspirin and continuing with Prometrium 400mg daily after ovulation.. I know that other doctors advise on taking Folic Acid supplement (eg. Folgard).

I have 2 questions:
1. Can you please tell me, do you usually recommend high doses of Folic Acid (eg Folgrad) for your patients who have MTHFR (one mutation), while the homocysteine levels are being normal, after recurrent miscarriages? And if yes, how much (mcg)? I am taking Prenatal Vitamins (1mg folic acid) since January 2007.

2. I am thinking of doing the NK cell assay test. Do you find it helpful in my situation?

I apologize for the long post and I am hopping you can understand my general concern. Thank you very much for your time and support. Your help will be much appreciated.
Best regards.

[Scott Roseff MD]

Hi,

Thanks for your note. The MTHFR mutation is meaningless unless the homocysteine level is elevated. However, now that it has been done and shows a (clinically meaningless) mutation, given your history, it generally couldn't hurt to be on higher doses of folic acid (my patients take 5 grams/day in an Rx along with the prenatal vitamin and DHA).

The NK assay, IMHO, is of no clinical utility. What's measured in the peripheral blood (NK cells) is not necessarily reflective of what happens in the uterus (in or outside of pregnancy).

What did your husband's sperm DNA function testing show???

Dr. Roseff in FL - Specializing in Recurrent Pregnancy Loss

[Cat111]

Dr Roseff,
Thank you very much for your answer and advice. We are just waiting for my husband's chromosomes blood test. We didn't do a sperm DNA testing.

I will take Folic Acid supplement, too. My Prenatal Vit only have 1mg. Do you advise you patients to take 5 g/day or 5mg/day? Is Folgard ok?
Should I take it together with my prenatal vitamins or in the evening?

Thank you again for all your help. I apologize for so many question. Thanks for understanding. Best regards.

[Scott Roseff MD]

Hi,

My patients take 5 mg/day, and Folgard is one of the choices. The Folgard can be taken with the prenatal vitamins or separately - It doesn't matter.

Hope this helps,
Dr. Roseff in FL

[Cat111]

Thank you, Dr Roseff. I appreciate your answer and help more than you think. I hope you have a nice day. Best regards.