The Best Prenatals for MTHFR Mutations

My top recommendations for prenatals containing methylfolate are:

Deciding between the options

The suggested dose of the Thorne Basic Prenatal and Naturelo is three tablets per day, whereas Mama Bird Prenatal + is just one tablet per day.  Some nutrients may be absorbed slightly better if divided over the course of the day, but for those who are likely to forget some of the doses, taking the full dose once per day is a better plan.  In addition, some people have trouble sleeping if they take B vitamins later in the day.

Both the Mama Bird and Thorne prentals are approximately $25 for a one month supply in the U.S. The difference between the two brands really comes down to higher amounts of certain vitamins in the Thorne Basic Prenatal, namely slightly more methylfolate and a much higher dose of B12.

B12 is very helpful for fertility, particularly for those with MTHFR mutations, but excessive amounts can cause side effects such as itching skin and anxiety.  For this reason it might be better to choose the Mama Bird Prenatal unless you are B12 deficient.  The Thorne prenatal does however have a superior form of iron that is less likely to cause digestive problems, so may be more suitable for those that experience side effects from iron supplements.

Another good option is Naturelo’s Prenatal, which contains 800 mcg methylfolate. ($40 for a two-month supply). It contains the standard form of iron, not the gentler form found in Thorne prenatal. It is, however, one of the few methylfolate-containing prentals that is readily available outside the U.S.

Thorne Basic Prenatal Supplement Facts: 

Thorne basic prenatal

Best Nest Wellness Mama Bird Prenatal + Supplement Facts

mama bird

Why is Methylfolate Beneficial for Fertility?

If you have a history of recurrent miscarriage or failed IVF cycles, there is a good chance that a genetic variant in the MTHFR gene is one contributing factor.  The MTHFR gene encodes an enzyme that converts other forms of folate to the biologically active methylfolate. If you have one of several common variants in this gene, you may not be able to efficiently convert folate from food or supplements into methylfolate, creating a deficiency in this important vitamin.

Researchers have known for many years that MTHFR mutations are a common culprit in women with recurrent miscarriage. A study published in May 2016 also found that MTHFR mutations are much more common in women with failed IVF cycles and chromosomally abnormal embryos.  (To find out whether you have one or more variants, your Doctor can order an MTHFR blood test or you can order DNA analysis yourself through 23andme and have the data analyzed through the free website Genetic Genie.)

How Do MTHFR Mutations Contribute to Infertility and Miscarriage?

Folate plays an essential role in the production of DNA and in detoxification. Both functions are absolutely critical to early embryo formation.  If you have a genetic variant that compromises your ability to produce methyl-folate when needed, toxins such as homocysteine can accumulate.  High homocysteine and low folate appears to increase the risk of chromosomal abnormalities in embryos. These abnormalities are the primary cause of early miscarriage and failed IVF cycles (read more on miscarriage and chromosomal abnormalities here).  High homocysteine may also contribute to miscarriages by raising the risk of blood clots, although this is more controversial and some studies have found no effect.

To solve these problems, the first step is to supplement with more folate, in order to support DNA production and the detoxification of homocysteine.

Folate Supplements for MTHFR Mutations

In years past, those with MTHFR mutations and either a history of miscarriage or neural tube defects were advised to take 4000 micrograms of synthetic folic acid to get around impaired folate metabolism.  It is now clear that a better approach is to supplement directly with methylfolate. Those with MTHFR mutations typically need at least 800 mcg per day of methylfolate.

Recommended prenatals containing methylfolate include: Thorne Basic Prenatal and Mama Bird. (For those the UK, I recommend Naturelo Prenatal)

Troubleshooting Methylfolate Supplements & Side Effects

The only problem with supplementing directly with methylfolate is that it can sometimes cause side effects such as mood changes and joint pain, particularly when taken in higher doses and if vitamin B12 is low.

If you are taking a prenatal that contains 800 mcg or more of methylfolate and find that it bothers you,  consider switching to a multivitamin that contains 400 micrograms of methylfolate (such as Thorne Basic Nutrients 2/day), and then add 400 to 1200 micrograms of folinic acid and perhaps some additional vitamin b12.

Folinic acid is another form of folate that is naturally found in foods. It is more readily converted to methylfolate than synthetic folic acid. I recommend Seeking Healthy Folinic Acid Lozenges, which come in two versions: one with hydroxo B12 and one that is folinic acid alone.  Another good quality product is Kirkman Labs Folinic Acid

 The Bottom Line

Most people will not have any problems with a prenatal containing 800-1000mcg of methyl-folate, and chances are if you have an MTHFR variant, you may actually start to feel much better overall.  You will also be taking an important step towards getting pregnant more quickly and preventing miscarriage.

Recommended prenatals containing methylfolate include:

There are of course many other strategies to further improve fertility and reduce the risk of miscarriage for those with MTHFR mutations, as I explain in It Starts with the Egg.

The Second Edition of It Starts with the Egg will be released in February/March 2019!

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