The Role of Homocysteine Levels in Preconception Health

If you’re planning to have a baby, you may already be eating better, staying active, or taking vitamins. But there’s one more thing that might affect your chances of getting pregnant and having a healthy baby: your homocysteine level.

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High levels of homocysteine in the body can sometimes lead to fertility problems, miscarriages, and complications during pregnancy. This blog explains what homocysteine is, how it can affect your chances of getting pregnant, and what you can do to keep it under control.




What Is Homocysteine and Why Should You Care?

Homocysteine is a substance your body makes when it digests a protein called methionine, which is found in many foods. Normally, your body uses certain vitamins, B6, B12, and folate (B9), to break down homocysteine and keep its level under control.

But if you don’t have enough of these vitamins, or if something isn’t working properly, your homocysteine level can rise. That’s a problem, especially when you’re trying to get pregnant, because it can cause:

  • Trouble conceiving
  • Early pregnancy loss
  • Poor egg or sperm quality
  • Health risks during pregnancy, like high blood pressure (preeclampsia)


How Homocysteine Affects Female Fertility?

If your homocysteine level is high, it can affect your eggs, your hormones, and even the lining of your uterus. Here’s how:


1. Reduced Egg Quality

Homocysteine can produce oxidative stress, so when it's excessive, it can damage your cells. The development and maturation of eggs in the ovaries may be affected by oxidative stress, which can impair fertility and increase the difficulty of conceiving.


2. Impaired Follicular Environment

Excess homocysteine present in the follicular fluid may lead to hormonal imbalances and nutrient deficiencies, which can impact the maturation of your eggs.


3. Increased Risk of Miscarriage

Higher homocysteine levels increase a person's risk of developing blood clots. Suppose you're trying to conceive or are pregnant. In that case, having an irregular heartbeat may make it hard for your body to supply the placenta with enough blood, raising the chance of miscarriage and other issues.



How Homocysteine Affects Male Fertility?

Your partner's homocysteine levels matter, too. In men, high homocysteine has been linked to:

  • Reduced sperm count
  • Poor sperm motility (how well sperm move)
  • Increased DNA fragmentation in sperm

The Role of Genetics: MTHFR Mutation

Some people may have heard that a mutation in the MTHFR gene can change the way your body uses folate. If the genetic variant is present in you or your partner, your body can have trouble changing folate into its proper form (methylfolate). Thus, levels of homocysteine may rise in your blood.

Understanding the effects of the MTHFR gene can inform your decision about supplements. If you have the mutation, your body may respond better to methylated folate and B vitamins for reducing homocysteine levels.


Testing Your Homocysteine Levels

You can consult your healthcare provider to have a simple blood test to find out your homocysteine level. To prepare for pregnancy, it is ideal to keep your blood glucose level below 10 µmol/L; however, some experts recommend a level below 8 µmol/L.

A doctor may run additional tests if your results indicate that your homocysteine level is high to rule out the presence of a related condition.

If your homocysteine is high, your doctor may investigate further to rule out underlying conditions like:

  • Vitamin B deficiencies
  • Poor diet
  • Kidney problems
  • Hypothyroidism

How to Lower Homocysteine Levels Before Conception?

You can take proactive steps to reduce your homocysteine and support fertility. Here's how:


1. Prioritise B vitamins

Taking 5-MTHF forms of folate, methylcobalamin B12, and P-5-P B6 may be beneficial, especially if you have the MTHFR mutation. The body readily absorbs these types of vitamins, which help break down homocysteine.


2. Eat a nutrient-dense diet

Focus on foods rich in natural B vitamins, such as:

  • Leafy greens (spinach, kale)
  • Eggs
  • Liver
  • Legumes
  • Whole grains
  • Salmon and other fatty fish

3. Limit processed foods and alcohol

Homocysteine can't be metabolised well by the body because processed foods typically lack the necessary nutrients. Drinking alcohol can stop the body from absorbing some vitamins, and for this reason, it's a good idea to either limit or quit drinking before pregnancy.


4. Address gut health

If you suffer from IBS, leaky gut, or always have inflammation, you might not be able to use B vitamins well. Consulting with a functional medicine practitioner can be helpful if you have any concerns.


Homocysteine and Pregnancy Complications

Even after you conceive, elevated homocysteine remains a risk factor for several pregnancy complications, including:

  • Preeclampsia
  • Placental abruption
  • Preterm birth
  • Neural tube defects in the baby

Should You Supplement Even with Normal Levels?

If your homocysteine level is within the standard range, consider whether you should continue taking supplements. Many factors about a person influence the decision, and taking supplements may still be beneficial, even when vitamin D levels are adequate. Here's why:

  • Genetic Variants (e.g., MTHFR Mutation): If you do not have high homocysteine levels yet, a MTHFR genetic mutation can hinder your body's ability to process folate.
  • Dietary Gaps: Diets that lack sufficient folate, B6, and B12 vitamins may lead to unhealthy homocysteine metabolism over the long term. Vitamins and minerals in these supplements help you obtain all the necessary nutrients and promote regularity.
  • Environmental and Lifestyle Factors: B vitamins can be less absorbed and used properly if people are often stressed or use alcohol, smoke, take certain medicines, or use oral contraceptives.
  • Support for Early Pregnancy Needs: During early pregnancy, the demand for B vitamins increases rapidly. Maintaining optimal levels through supplementation ensures your body is prepared to support fetal development from the moment of conception.
  • Prevention Over Correction: Catching a deficiency early and addressing it with supplements usually works better than trying to fix it after it occurs. Taking care of homocysteine and methylation in advance can stop fertility or birth complications from developing.
Knowing your homocysteine levels offers you another way to take good care of your body in preparation for pregnancy. Although vitamin B12 is not often discussed, studies have confirmed its crucial role in fertility and pregnancy outcomes.

When you test for homocysteine, provide your body with suitable nutrients, and address any underlying issues, your chances of having a healthy baby increase. Although it may seem insignificant, it can have a significant impact and help you manage your reproductive health.


FAQs on The Role of Homocysteine Levels in Preconception Health

  1. Can I lower my homocysteine levels naturally without taking supplements?
    Yes, you can support healthy homocysteine levels through a balanced diet by consuming foods rich in folate, such as leafy greens, legumes, eggs, and whole grains. However, if your levels are significantly elevated or if you have the MTHFR mutation, targeted supplementation with methylated B vitamins is often more effective.
  2. Is it necessary for both partners to have their homocysteine levels checked?
    While women's levels are often prioritised, both partners should ideally be tested for the same condition. Elevated homocysteine in men can affect sperm quality and DNA integrity, potentially impacting fertility outcomes and embryo health.
  3. How long before conception should I test and manage my homocysteine levels?
    It's best to test and address homocysteine at least 3 to 6 months before trying to conceive. This gives your body enough time to respond to dietary or supplemental changes, creating a more favourable environment for pregnancy.
Disclaimer: Medically approved by Dr Ranjana Dhanu, Consultant, Gynaecology & Obstetrics at P. D. Hinduja Hospital & Medical Research Centre, Mumbai