a lot of blog traffic is coming this way via google searches about folic acid levls and how much is enough. obviously i don’t know, but i recommend this resource:

http://www.healthline.com/blogs/pregnancy_childbirth/2007/04/recurrent-early-pregnancy-loss-10.html

and for related questions about meds and appropriate dosages, visit here:  http://motherisk.org/women/index.jsp

the usual caveat: i am not a doctor. i know jack-sh*t that will actually be useful to you in any kind of medically proven scientific way. i may sound certain of things i say but that should not be mistaken for accuracy (or frankly even for certainty.) i am most definitely not dispensing medical advice.  don’t forego conversations with your own doctor.  if you can’t talk to your doc about this stuff, you might want to start working with somebody else, someone you can talk to.

dr l is pretty adamant that i need to wait three cycles before trying again. i am pretty adamant that one (now passed) is plenty. he has research on his side. i have nothing much on mine. except, perhaps, a little more control (!?) over when to get on with it.

so we agreed to wait for divine intervention another opinion: dr s, the not-so-researchy, has-a-few-people-skills perinatologist that i have now been referred to. i have promised to abide by what he says. ( if for some reason he thinks three cycles is NOT enough, i will quickly forget i ever made such a promise.)

dr l thought this was a great compromise, since he figured i wouldn’t get in to see dr s for at least a month, which would put me close to my third cycle anyway. but crafty me: i got an appt for december 4. which would be in time to catch cycle #2. which would make me very, very, happy.

in the meantime, i have been ok’d to dose up on 400 IU vitamin e; 1000 mg vitamin c (no linus pauling prescription doses for me, i guess); and whatever i want to take for folate. that one, really, just cracked me up. the difference between 400 mcg and 4 mg — that is, the difference between a standard prenatal dose and a megadose for mthfr patients — is pretty big, at least the way i do the maths. but the difference between 400 mcg and 1 mg — the difference between what i took with ruby and what i took with mairin — is, according to dr l, “clinically insignificant,” especially since i’m not starving to death on non-folate-supplemented food. “for all i know,” dr l smiled at me, “you get way more than you need just from your diet.” it’s true that we eat pretty well in our house, but still. that seems more sunnily optimistic than medically reasoned. oh well.

duirng our chat dr l did focus a bit on the “clinical insignificance” of my ruby-dose, though, which is about as reassuring as anything can be. (that is, not reassuring at all, but still recognizable as an attempt at reassurance, and also recognizable as information that should be reassuring, so there is something nice-if-not-reassuring about his having said it.) so i’m taking about 1.6 mg, which everybody agrees is low enough to be safe but high enough to help me feel better.

in the meantime, as we prepared our house for guests over the weekend and dug through still-unpacked boxes of bathroom linens and toiletries, i found two unused hpts. we’re set. for whenever.

many women in situations like mine — all of the various situations that can be considered “like mine” — find themselves glued to keyboards and screens looking for answers. and it’s wonderful, and it’s hard, because the beauty of having so much information at your fingertips is countered by the sheer ugly bulk of too-much-mis-information popping up in the search engine. but we keep at it. at least i do. (it’s part of the addictive personality, i guess.)

my latest forays have left me wondering whether i have the homozygous MTHFR mutation.

now, like most of my self-diagnoses, this one is lousy and uninformed. but i cling to anything that looks like a reason for recurrent pprom, and if i find anything that resonates with my experiences, well, then, i hang on all the tighter.

the one that gets me about this possibility is something my last ob said (before we moved out of state and so had to change docs). it went something like this:

“you know, i was at a conference recently and heard a talk about a genetic mutation that can cause prom. it’s expensive to test for, but the treatment is a megadose of folic acid. and since folate is good for you while pregnant anyway, why don’t you dose yourself up. take 1 mg a day.”

well, i thought this was a big deal, since 1mg is so much more than the 400 mcg typically recommended (even though many prenatals have higher doses). and i really thought it was a big deal when i went to buy 1mg pills and found out that that is considered a prescription strength. (i got around that by buying 400 mcg tablets and cutting a bunch of them in half.) and i took those extra pills faithfully, every damn day i was pregnant with mairin. and voila.

when slim came along and i met my new doctor, i gave him my shorthand version of my old ob’s prescription. new doc (dr. l) told me that 1mg isn’t really that much of a megadose, but sure, i could go ahead and take it. stupid me — i read into this that it wasn’t that essential. so sure, i took my folic acid like a good little mommy-to-be, but i didn’t go out of my way to dose myself up.

one of the sickest aspects of grieving is guilt. and guilt i’ve got by the gulletsful over this one. if i’d taken all that extra folic acid would ruby still be with us? i’ll never know. but i thought mr. google might be able to help me find out.

so it is that after many searches and links and related hits i ended up learning about mthfr.

like all my medical knowledge, i know about mthfr only enough to be a danger to myself. most interesting to me, though, is that some women who are prescribed folic acid for it take up to 4 mg a day. that’s a whole lotta folate. is there a toxicity level? what happens to a non-mthfr woman who takes this much? and even without the mthfr mutation, could such a high level help prevent pprom?

and the $10,000 question: how do i muster the courage to call dr. l and say, yet again, “so, i’ve been reading, and have this really wacky idea…”?