Q. I have a history of recurrent miscarriages. Is my estradiol good enough?

Answered by
Dr. Dattaprasad Balasaheb Inamdar
and medically reviewed by iCliniq medical review team.

Hello doctor,

I am a 29 year old woman with a history of recurrent miscarriages (3 losses, all in 5-6 weeks). I was recently diagnosed with Grave's disease (I had overt hyperthyroidism with my last miscarriage). Now my levels are in check. I had APS, ANA and thrombophilia panels, all perfect except for heterozygous MTHFR A1298C. I have added more folate to my diet (2mg instead of 0.4mg). I am now 4 weeks and 1 day with my 4th pregnancy. I am taking PTU 75mg, Progesterone 400mg (300 orally, 100 vaginally), Prednisone 10mg and Folate 2mg.

Yesterday at 4 weeks (2 weeks since conception) I measured my estradiol since I had never measured it with my other pregnancies. It came out at 186 pg/ml. Is my estradiol good enough? I have read studies that say estradiol levels are prognostic for a viable pregnancy but did not specify the numbers. With my last pregnancies, I lost them by bleeding and I have read that estradiol prevents that. Should I supplement with 1-2mg/day? Is there anything else I should be doing?

Dr. Dattaprasad Balasaheb Inamdar

Infertility Obstetrics And Gynaecology


Welcome to icliniq.com.

Your estradiol level appears to be fine if pregnancy happened naturally (that is not through treatment like ovarian stimulation). Though studies associate low estradiol levels with viability, the association is indirect (indirectly indicating defective egg formation/folliculogenesis, with resultant defective corpus luteum). Estrogen supplementation to improve viability in natural pregnancy is not studied well.

In fact, it is only the health of embryo, which determines viability (and it cannot be altered through medicines), second hypothesized intervention being progesterone support (which you are already taking).

As other causes like APA, thrombophilia is already ruled out, you do not need medicines for that.

Regarding MTHFR mutation, if your homocysteine levels were high, it is better to take Vitamin B6 and B12 supplements along with Folate. If levels were normal, those supplements are not normally needed. If levels were not checked, you can get it checked or start supplements, as there is no harm in taking water-soluble vitamins.

So, in summary, estrogen supplementation is not known to improve viability/prolong pregnancy, and is not needed. Vitamin B6 and B12 supplementation may be helpful if you had elevated homocysteine levels.

Wish you good luck.

Thank you doctor.

I did get pregnant naturally, so is this a good level? What is regarded as a good level at 4 weeks and what is too low? I did not check my homocysteine. I wanted to supplement with vitamin B12 and B6 but got pregnant before that. Do you think I can add them to my medication now and if so, in what dosage? I am already taking a multivitamin supplement with 1.9mg B6 and 3.5mcg B12. Is that enough or should I supplement more?

Dr. Dattaprasad Balasaheb Inamdar

Infertility Obstetrics And Gynaecology


Welcome back to icliniq.com.

For natural pregnancy, estradiol level is fine. At 4 weeks, the expected level is around 200pg/ml (though there can be varied depending on the calibration of lab analyzer). Normally we do not test estradiol levels during pregnancy.

Regarding vitamin dose, in hyperhomocysteinemia, the prescribed dose of vitamin B6 is between 10 & 25mg, and that of vitamin B12 is 0.5 to 1mg. (Normally we titrate dose to keep homocysteine in the normal range). You can safely start with 10mg of B6 and 0.5mg of B12. Even higher dose will not harm, as both are water soluble vitamins and any excess which is not required by body gets excreted in urine.

Ask a QueryAsk a Query Consult by PhoneConsult by Phone Video ChatVideo Chat
Also Read Answers From:

Related Questions & Answers

How much Folic acid is required during pregnancy in Crohn's patient?

Query: Hello doctor, I have Crohn's disease and am pregnant. The first day of my last period was before 40 days and I have been taking multivitamins which includes 400 micrograms of Folic acid for the past four months. I am now pregnant. The doctor said that I need 5 mg of Folic acid due to the Crohns whi...  Read Full >>

Dr. Donalyn S. Barcial
Obstetrician And Gynaecologist

Answer: Hi, Welcome to icliniq.com. I have read your concern. You need not worry or be anxious about it. Although absorption of Folate may be disturbed because of your Crohns, taking 400 mcg for four months will be good enough. Meaning, you are not deficient from it from the very start but since you are ...  Read Full

I had miscarriage and ectopic pregnancy in the last six months. Is it endometriosis?

Query: Hi doctor, I am recently trying to get pregnant and in the past six months, have had a miscarriage and an ectopic pregnancy. I am wondering if there is a chance I have endometriosis. I am wondering this because I have no other risks/causes that could have caused the ectopic. There is no chance I co...  Read Full >>

Dr. R Balakrishnan Menon
Obstetrician And Gynaecologist

Answer: Hi, Welcome to icliniq.com. How are you doing? From your history, the only problem I feel is the problem which could happen to the tube. Your history of having a tubal pregnancy and severe pain during sex, that is dyspareunia, means that there is some problem which is happening around the uterus ...  Read Full

Will high LH impact ovulation and healthy pregnancy in a PCOS patient?

Query: Hello doctor, I am 32. I have PCOS for past seven years. Now planning to conceive with Gonadotropin injection and timed intercourse. But my day two blood work shows FSH 4.7, LH 11.2 and prolactin 9. Due to high LH will I get ovulation and if so, how will be the chances of having a healthy pregnancy?...  Read Full >>

Dr. Sameer Kumar
Family Physician, Obstetrician And Gynaecologist, Infertility Specialist

Answer: Hello, Welcome to icliniq.com. The LH levels are more than 10 as expected in PCOD, ideally should be less than 7, but still on the lower side. You can continue with the protocol and ideally LH surge occurs at 20 and usually the follicle is matter at 18 mm size. So, pertaining to your query that wh...  Read Full



Ask your health query to a doctor online?

Ask a Doctor Now

* guaranteed answer within 4 hours.
Enter Your Health Query
You can upload files and images in the next step.