There are 23 million miscarriages worldwide each year. The vast majority of these happen for unknown reasons. Structurally there is nothing wrong, however women that miscarry are often told to just keep trying and that it's a numbers game. This is not only emotionally devasting but financially difficult, when many are having IVF treatments.

We learnt last month the importance of avoiding unmetabolised folic acid but how do we understand that genes that our fertility patients have and how do we explain to them that there may be a better option than folic acid for fertility patients, particularly those who have recurrent miscarriages.

There are two active forms of folate: folinic and methyl folate. What do we use? Do we combine? Do we just use one over the other? What is the optimum dose?

As practitioners, we need to guide our patients at a very early stage and help them to understand why folic acid may not be the best choice for them.

The conversation needs to commence long before they are even considering pregnancy.

Here's some of the best bits we covered:

Re-cap on folate metabolism.
Genetic polymorphisms affecting folate metabolism:

• DHFR
• MTHFS
• MTHFD/1
• MTHFR
• SHMT

Vitamin B12 in fertility - how much do we need and why is it important?
Learn the key markers in pathology testing to give you clues as to folate and B12 deficiency.
Folate and folate dosing particularly those with MTHFR polymorphisms and previous pregnancy loss.

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