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MTHFR and Fertility: What Your Genotype May Mean for Ovarian Reserve and Reproductive Health

Infertility is commonly defined as the inability to conceive after one year of regular, unprotected intercourse. Many factors can affect fertility, including age, environment, medical conditions, and genetics. One gene that plays a role in reproductive health is MTHFR. This gene helps the body convert folate from food and supplements into methylfolate, the active form needed for DNA synthesis, cell division, hormone metabolism, and the methylation process that supports egg quality and early pregnancy.

Variations in MTHFR can reduce how efficiently the enzyme works, which may influence ovarian reserve and other aspects of reproductive function. The information below explains how this variant may relate to fertility and offers practical, evidence-informed steps to support reproductive health. PlexusDx does not provide medical advice. Always consult your healthcare provider before changing supplements or making major lifestyle changes.

How MTHFR Can Affect Fertility

  • MTHFR converts dietary folate into methylfolate, the form your body uses for critical cellular processes.
  • Methylation supports DNA synthesis, cell division, and hormone metabolism, all central to healthy egg development and early embryo growth.
  • Certain MTHFR variants can lower enzyme efficiency, which may contribute to lower ovarian reserve or reduced reproductive potential in some people.
  • Genetic risk is one piece of the fertility puzzle. Age, lifestyle, medical history, environmental exposures, and partner factors are also important.

Practical Recommendations to Support Fertility

Diet

  • Eat folate-rich foods daily: leafy greens like spinach and kale, broccoli, Brussels sprouts, asparagus, and legumes such as lentils and chickpeas.
  • Include a variety of whole foods to support B vitamin status: eggs, dairy or fortified plant alternatives, lean meats, nuts, seeds, and whole grains.
  • Focus on antioxidant-rich fruits and vegetables to reduce oxidative stress, which can affect egg quality. Examples include berries, citrus, dark leafy greens, and colorful vegetables.
  • Maintain healthy body weight. Both underweight and overweight can impact hormonal balance and ovulation.

Supplements

  • Prefer methylfolate (5-MTHF) over synthetic folic acid if you have an MTHFR variant that reduces conversion. Typical preconception doses range from 400 to 800 mcg of methylfolate, but follow your provider's guidance.
  • Ensure adequate vitamin B12, ideally as methylcobalamin if absorption is a concern. B12 supports methylation and works closely with folate.
  • Include riboflavin (vitamin B2) to support MTHFR enzyme function. B-complex supplements can provide balanced support.
  • Standard prenatal supplements that include iron, iodine, vitamin D, and DHA remain important when planning pregnancy, unless your provider advises otherwise.

Lifestyle

  • Avoid smoking and limit alcohol consumption, as both can impair fertility and increase oxidative stress.
  • Manage stress. Chronic stress can disrupt hormone balance. Consider stress-reduction techniques such as mindfulness, yoga, moderate exercise, and adequate sleep.
  • Engage in regular, moderate physical activity to support metabolic health and hormonal balance. Excessive high-intensity exercise may negatively affect ovulation in some people.
  • Avoid environmental toxins when possible, including excessive heat exposure, certain household chemicals, and endocrine disruptors found in some plastics and personal care products.

Testing and Medical Evaluation

  • If you are concerned about ovarian reserve, discuss testing with your provider. Common assessments include serum anti Mullerian hormone (AMH), antral follicle count (AFC) by ultrasound, and day 3 FSH and estradiol levels.
  • MTHFR genotyping is one element of reproductive evaluation. Use results to guide discussions about supplementation and monitoring with your healthcare team.
  • If you have a history of recurrent pregnancy loss or clotting issues, talk with your provider about comprehensive evaluation, because multiple factors can contribute to these outcomes.

Genetic Interpretations

Two effect alleles (AA) for rs868014

If your genotype is AA, you carry two copies of the effect allele for rs868014 in MTHFR. This pattern is associated with a higher likelihood of reduced MTHFR enzyme efficiency. Reduced activity may impair conversion of folate to methylfolate, which can affect methylation, DNA synthesis, cell division, and hormone metabolism. These processes are important for egg development and early embryo support. As a result, AA is associated with an increased risk of low ovarian reserve, meaning fewer available eggs and potentially reduced reproductive potential.

Recommended actions

  • Prioritize methylfolate supplementation rather than folic acid. Typical preconception doses are 400 to 800 mcg of methylfolate, tailored by your healthcare provider.
  • Ensure adequate vitamin B12, preferably methylcobalamin, and include riboflavin to help support methylation pathways.
  • Emphasize folate-rich foods: leafy greens, legumes, asparagus, and fortified whole foods when appropriate.
  • Consider evaluation of ovarian reserve with AMH and antral follicle count if you are planning pregnancy or experiencing difficulty conceiving.
  • Work with your healthcare provider to design a personalized preconception plan that includes nutrition, supplements, and lifestyle strategies.
One effect allele (AG) for rs868014

If your genotype is AG, you carry one copy of the effect allele. This genotype may be associated with a likely increased risk of reduced MTHFR enzyme activity compared with GG, but typically the effect is less pronounced than with two effect alleles. This may translate to a modestly increased risk of lower ovarian reserve or subtle impacts on methylation that could influence egg quality and early pregnancy support.

Recommended actions

  • Consider methylfolate supplementation at a preconception dose of 400 to 800 mcg, under guidance from your provider.
  • Support B vitamin status with adequate B12 and riboflavin through diet or a B-complex supplement.
  • Maintain a folate-rich diet and overall nutrient-dense eating pattern to support reproductive health.
  • Monitor ovarian reserve with AMH and antral follicle count if you have fertility concerns or are of advanced reproductive age.
  • Discuss a personalized plan with your healthcare provider that balances supplements, nutrition, and lifestyle measures.
No effect alleles (GG) for rs868014

If your genotype is GG, you carry two copies of the non-effect allele. This is the most common pattern and is associated with typical MTHFR enzyme function. Efficient conversion of folate into methylfolate supports normal methylation, DNA synthesis, and hormone metabolism. With this genotype, you are not at increased genetic risk for low ovarian reserve from this specific variant.

Recommended actions

  • Continue eating folate-rich foods such as leafy greens, legumes, and fortified whole foods.
  • Use standard prenatal or preconception supplements that include folate, B12, and other essential nutrients unless your provider recommends methylfolate for other reasons.
  • Maintain healthy lifestyle habits that support fertility: balanced diet, regular moderate exercise, good sleep, and reduced exposure to toxins.
  • If you have fertility concerns or risk factors, discuss ovarian reserve testing and individualized care with your healthcare provider.

Final Notes and Disclaimer

Genetic information can help guide conversations about fertility, but it does not determine outcomes on its own. The MTHFR variant described here is one factor among many that may influence ovarian reserve and reproductive health. Use these insights to support informed discussions with your healthcare provider and fertility team.

PlexusDx does not provide medical advice. This information is educational only. Always consult your healthcare provider before starting or stopping supplements, changing medications, or making major lifestyle changes. Your provider can help interpret your genotype in the context of your full medical history and recommend testing or treatments tailored to your needs.