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However, you might suspect an MTHFR mutation if you: Have a family history of heart disease, stroke, or blood clots Experience multiple unexplained symptoms across different body systems Have elevated homocysteine or low B12/folate levels on blood tests Struggled with infertility, miscarriages, or pregnancy complications Don’t respond well to standard treatments for anxiety or depression Have chronic health issues that improve with methylated B vitamins The most definitive way to know is through genetic testing (blood test or saliva test) that identifies MTHFR variants like C677T or A1298C