For many women, getting pregnant is not the problem, rather, carrying to term is. Miscarriage and recurrent miscarriages are more common than most people realize. Miscarriage leaves a wake of heartbreak after a period of excitement, joy and baby dreaming. When a woman experiences multiple miscarriages, typically testing is performed to find a cause for the pregnancy loss. Sometimes though, doctors can’t find a reason for the losses. If this sounds familiar to you, keep reading…
Have you had one or more miscarriages that your doctor is unable to attribute to a detectable cause? Have you been diagnosed with unexplained infertility and experienced one or more miscarriages? If you answered yes to either of these questions, it may be worth talking to your doctor about testing for factor V Leiden.
According to Dr. Alan E. Beer, “Studies have shown that women with a history of recurrent miscarriage only have a live birth rate of less than 40% (compared with 70% in the unaffected population) when this [factor V Leiden] clotting disorder is left untreated.”
Ruling out factor V Leiden is going to be important for those struggling to achieve a healthy term pregnancy, but why? First let’s learn more about how factor V can affect pregnancy…
What is factor V Leiden?
Factor V Leiden (FAK-tur five LIDE-n) is a genetic mutation which is either:
- heterozygous, meaning only one copy of the defective gene was inherited, or
- homozygous, meaning two copies of the defective gene were inherited, one from each parent (a more rare event)
This gene mutation causes the blood-clotting protein factor V to slowly respond to anti-clotting proteins which work to deactivate the factor V protein. The slow anti-clotting response caused by factor V Leiden can result in thrombophilia. In the context of thrombophilia in pregnancy, the increased risk of forming blood clots may not only occur in the veins, but in the smallest arteries and blood vessels – the very lifelines for a developing fetus.
“In the normal clotting process, anti-clotting proteins combine to help break up factor V to keep it from being reused and forming clots when clotting isn’t needed. However, the factor V Leiden mutation keeps the anti-clotting proteins from breaking down factor V, which keeps it in the blood longer and increases the chance of clotting.” (Mayo Clinic)
Carriers of factor V Leiden Genetic Mutation
The factor V Leiden genetic mutation can occur in men and women, but is most often found in women of European descent and/or a family history of the gene mutation. Factor V Leiden is most commonly discovered during pregnancy due to routine testing, or after health complications arising from oral contraception medications (birth control) containing synthetic estrogen.
Possible Fertility-Related Complications
While factor V Leiden is most frequently tested for in cases of deep vein thrombosis (DVT), one study in the Australian and New Zealand Journal of Obstetrics and Gynaecology reports that “More recently it has been found in a significant number of cases of obstetric complications attributable to placental thrombosis…” and that out of 128 factor V Leiden genetic mutation carriers, the number of women experiencing miscarriages, intrauterine fetal deaths, or problems with infertility was statistically significant.
Several studies have been done that have found an increased risk of deep-vein thrombosis in young women using oral contraceptives who also have the factor V Leiden gene mutation. One study of 155 premenopausal women, ages 15 to 49, who had no underlying diseases, yet had developed deep-venous thrombosis determined “…that the absolute risk of venous thrombosis in young women who use oral contraceptives is much larger when they carry the factor V Leiden mutation.”
The following factors may increase the likelihood of developing a blood clot due to factor V Leiden:
- use of birth control pills and/or hormone replacement therapy
- being overweight or obese
- leg injuries
- traveling for extended periods of time without movement (e.g. air travel and bed rest)
- having surgery, or as a result of invasive medical procedures
How factor V Leiden Can Affect Pregnancy Outcome
It is not known if factor V Leiden can contribute to a woman’s inability to conceive, or hinder conception efforts, but it has been found to cause several pregnancy complications due to the development of thrombophilia, which are:
- possible implantation failure
- unexplained pregnancy complications
- increased risk of recurrent miscarriage (often second or third trimester loss)
- slow fetal growth
- placental abruption (early separation of the placenta from the uterine wall)
- low amniotic fluid level
- intrauterine fetal death
- incompetent cervix syndrome
- preterm birth
Complications for the mother:
- Thrombophlebitis (blood clots in the veins or arteries)
- deep vein thrombosis (clots within veins)
- pulmonary embolism (blockage of a major blood vessel in the lung)
- blood clot in the brain
- Anemia (low red blood cell count)
- Autoimmune thrombocytopenia (low platelet count)
- TIAs (transient ischemic attacks also known as “mini strokes”)
If you have unexplained infertility or recurrent miscarriages and have not been tested for factor V Leiden, schedule an appointment with your doctor for this test as soon as possible, prior to trying to conceive.
“Couples are strongly encouraged by me to have testing before attempting to conceive and certainly during early pregnancy if not tested previously. Testing for acquired and inherited thrombophilia when planning for a family will soon be standard practice.” – Alan E. Beer, M.D.
Trying to Conceive with factor V Leiden
Women with factor V Leiden should share any intention of getting pregnant with their healthcare provider. Women with factor V Leiden thrombophilia can and do have normal, healthy term pregnancies. Carrying the genetic mutation doesn’t automatically mean there will be pregnancy complications, it’s simply something to make sure your healthcare provider is aware of prior to pregnancy for proper monitoring throughout pregnancy.
Medical Treatment of factor V Leiden in Pregnancy
Anticoagulant medications, the most common of which are warfarin and heparin, may be prescribed if you carry factor V. Heparin and low molecular weight heparin are known to act quicker than warfarin and are considered safe for use in pregnancy. Talk to your doctor about the risks for use of these medications in pregnancy.
Diet, Exercise, and Lifestyle Choices
Herbs, nutritional supplements and natural therapies will not alter one’s genetic make-up. There are, however, ways to work to support the body in hopefully preventing blood clots from forming that also happen to support overall health and fertility:
- work to reach and maintain your healthy body mass index (BMI)
- eat a nutrient-dense, nourishing Fertility Diet
- exercise daily – 30 minutes five times a week
- avoid prolonged periods of immobility
- quit smoking
- consider alternatives to oral contraceptive use
- ➞ Fertility Awareness Method is a great alternative to pregnancy prevention.
➞ There are a variety of natural therapies to help a woman to avoid the use of oral contraceptives for management of reproductive health issues.
Systemic Enzyme Therapy
Naturally present in the body are a variety of enzymes. Enzymes are catalysts for chemical reactions necessary to the innumerable actions that maintain the function of the body. A subclass of enzymes known as Systemic Enzymes work to help support the body when there are genetic, immune system or inflammatory health issues present. Supplementing with Systemic Enzymes may help assist the body in promoting proper immune system response and gene signaling. We specifically like working with the systemic enzyme blend Wobenzym N.
Systemic Enzyme Therapy using Wobenzym N (the most scientifically studied systemic enzyme blend), in part works to help the body manage chronic inflammation, and according to Natural Fertility Company Founder, Hethir Rodriguez, “reduces the substances in the blood that trigger a hyper-autoimmune response, and improve blood flow by increasing the flexibility of red blood cells, inhibiting the aggregation of platelets, and helping to prevent abnormal blood clotting.” All of these actions have been found to be supportive of the body in managing many fertility health issues, including recurrent miscarriage, autoimmune related infertility, and inflammatory fertility health conditions.
Progesterone – The Pregnancy Hormone
Make sure your progesterone levels are adequate to achieve and sustain pregnancy, prior to trying to conceive. This will help to avoid miscarriage or pregnancy complications for the following reasons:
- progesterone is essential for a healthy uterine lining to support proper implantation
- may potentially reduce the chance of blood clots in pregnancy
- may reduce an overactive immune-system response to a fetus (making the body react to the fetus as a foreign invader potentially causing miscarriage)
In summary, if you have experienced recurrent miscarriages, or later-term pregnancy loss talk to your healthcare provider about the potential for factor V Leiden being a culprit. It is important to do so prior to trying for another baby. Work closely with your healthcare provider to determine the best course of action for your individual needs if the factor V Leiden gene mutation is discovered.
Diet, exercise, and lifestyle changes are known to positively impact circulation, vein and reproductive system health which are also important for a healthy pregnancy.
– Baré, S., Póka, R., Balogh, I., & Ajzner, É. (2008, February 13). Factor V Leiden as a risk factor for miscarriage and reduced fertility. Retrieved April 3, 2015, from http://onlinelibrary.wiley.com/doi/10.1111/j.1479-828X.2000.tb01144.x/abstract
– Learning about Factor V Leiden Thrombophilia. (2011, December 13). Retrieved April 3, 2015, from http://www.genome.gov/15015167
– Management – Condition Specific Fact Sheets/ FVL. (2012, July 18). Retrieved April 7, 2015, from http://genefacts.org/index.php?option=com_content&view=article&id=538&Itemid=720
– Mayo Clinic Staff. (2012, September 6). Factor V Leiden. Retrieved April 3, 2015, from http://www.mayoclinic.org/diseases-conditions/factor-v-leiden/basics/definition/con-20032637
– Rodriguez, H. (n.d.). 5 Steps To Decreasing the Chance of Recurrent Miscarriages. Retrieved April 7, 2015, from http://natural-fertility-info.com/preventing-miscarriage
– Rodriguez, H. (n.d.). How to Use Systemic Enzyme Therapy to Increase Your Fertility…. Retrieved April 7, 2015, from http://natural-fertility-info.com/fertility-enzyme-therapy
– Beer, Alan E., M.D. (2006). Is Your Body Baby Friendly? “Unexplained”, Infertility, Miscarriage and IVF Failure Explained. AJR Publishing.