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

Hi,

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

Hi,

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.

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