MTHFR & Folate: How to Support Fertility and Pregnancy Naturally

Folate is one of the most critical nutrients for fertility, pregnancy, and hormone health, but if you have an MTHFR gene variation, your body may struggle to process synthetic folic acid efficiently. Since folate plays a key role in egg quality, methylation, and fetal development, ensuring you get the right form of supplemental folate is essential for preconception health and a healthy pregnancy.

In this article, we’ll break down what the MTHFR gene does, why folate is so important, and how to optimise your intake through food and supplementation.

What is the MTHFR Gene & Why Does It Matter?

The MTHFR (Methylenetetrahydrofolate Reductase) gene is responsible for converting folate into its active form (5-MTHF), which is essential for:

• Methylation – A key process for hormone balance, detoxification, and neurotransmitter function.

• DNA synthesis & cell division – Crucial for egg and sperm health, implantation, and fetal development.

• Oestrogen metabolism – Supports the clearance of excess hormones to maintain balance.

• Neural tube development – Essential for preventing neural tube defects in early pregnancy.

If you have an MTHFR gene variation, your ability to convert folic acid into active folate is reduced, making it harder for your body to use this nutrient efficiently.

Why Synthetic Folic Acid Isn’t the Best Choice for MTHFR

Many prenatal vitamins and fortified foods contain synthetic folic acid, which needs to be converted into 5-MTHF (methylfolate) to be used by the body. For those with an MTHFR mutation, this conversion process is impaired, leading to a buildup of unmetabolised folic acid (UMFA) in the bloodstream.

Potential Issues with Unmetabolised Folic Acid (UMFA):

• Blocks natural folate absorption – Can prevent the body from properly using folate from food.

• Affects methylation – Impacts detoxification, hormone balance, and brain function.

• May increase pregnancy complications – Some research suggests high UMFA levels could interfere with neural tube development and immune function.

For this reason, choosing the right form of folate is essential for fertility and pregnancy health.

How to Get Enough Folate if You Have MTHFR

1. Prioritise Natural Folate-Rich Foods

Folate in whole foods is already in its natural form, making it more bioavailable and easier to absorb. The best sources include:

• Leafy greens – Spinach, kale, Swiss chard, rocket

• Liver – One of the richest sources of bioavailable folate

• Legumes – Chickpeas, lentils, black beans

• Avocado & asparagus – Great plant-based sources

• Egg yolks – Also provide choline, another essential nutrient for pregnancy

Eating a variety of folate-rich foods daily supports cell division, hormone regulation, and fetal neural development.

2. Avoid Synthetic Folic Acid

Since many processed foods and prenatal vitamins contain synthetic folic acid, those with an MTHFR mutation should avoid:

• Fortified cereals, bread, and processed grains

• Supplements containing folic acid instead of active forms of folate

• Highly processed foods with added folic acid

Instead, focus on natural food sources and the right type of supplementation.

3. Choose the Right Folate Supplements

If you have an MTHFR variation, look for methylation-friendly forms of folate in prenatal or fertility supplements:

• 5-MTHF (Methylfolate) – The most active and bioavailable form of folate.

• Folinic Acid – A non-methylated form that is still well-absorbed and supports methylation without overloading pathways.

Taking the right type of folate supports fertility, pregnancy, and hormone balance without the risks of unmetabolised folic acid buildup.

4. Support Methylation with Other Key Nutrients

Since methylation involves more than just folate, ensuring you have other supportive nutrients is essential:

• Vitamin B12 (methylcobalamin or hydroxocobalamin) – Works alongside folate for red blood cell production and nervous system health.

• Choline (found in eggs, liver, cruciferous vegetables) – Very important for fetal brain development and also supports methylation.

• Magnesium & Zinc – Essential for methylation and hormone balance.

Supporting methylation pathways helps with oestrogen detoxification, fertility, and overall reproductive health.

Should You Get Tested for MTHFR?

If you have a history of:

• Recurrent pregnancy loss

• High homocysteine levels

• Family history of MTHFR variants

Testing for MTHFR may provide insight into how your body processes folate. However, most people can benefit from following methylation-friendly nutrition strategies, regardless of genetic status.

Optimising Folate for Fertility & Pregnancy

Folate is essential for preconception health, hormone balance, and fetal development, but if you have MTHFR, getting the right form of folate is key.

• Eat natural folate-rich foods like leafy greens, liver, and legumes.

• Avoid synthetic folic acid in processed foods and standard prenatals.

• Choose bioavailable folate supplements like methylfolate (5-MTHF) or folinic acid.

• Support methylation with B12, choline, magnesium, and zinc.

Making these adjustments supports healthy fertility, pregnancy, and long-term hormone balance.

Need some personalised preconception and fertility guidance? Book an appointment here.