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During gametogenesis, methylation patterns are erased and reset, a process that requires adequate folate availability. Methylfolate (5-MTHF) is the bioactive form and is recommended over synthetic folic acid, particularly for the significant proportion of the population who carry MTHFR variants (such as C677T) that may reduce their ability to convert folic acid to its active form

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This is not an issue with an injection (since IM/IV bypasses the gut), but if a patient is also taking oral supplements, they should separate them from tetracycline dosing