Joyfully Assisting the LGBT Community in achieving their reproductive goals

Pride 2017

As Denver celebrates Pride Week; we wanted to reach out and extend our gratitude to our LGBT patients for accepting our invitation to help them create the family of their dreams. We realize that you haven’t always received compassionate care from the medical community and that you—like everyone else—want building your family to be as exciting and as efficient as possible. In fact, some of you have traveled to us from other states and even across oceans seeking such a setting. We’re proud that you chose us. Here’s to all of you!

In deepest gratitude,

The TEAM at Conceptions Reproductive Associates of Colorado

Another reason to eat whole grains

I spend a significant amount of time with each of my patients reviewing their lifestyle and dietary habits. Ultimately, we all have the same goal: happy healthy families. I strongly believe that part of my job as a reproductive endocrinologist and infertility physician is helping build healthier families. As I reviewed in previous posts, we believe that our habits before and during pregnancy can program many diseases in childhood and later in life.

 

I previously discussed the importance of whole grain diet as it relates to fertility. New research suggests yet another reason why you should consider whole grains, and stick with it throughout a pregnancy. Researchers found that children born to women with gestational diabetes who consumed the most refined grain (more than 156 grams per day) were twice as likely to be obese at age 7, compared to children born to women with gestational diabetes who ate the least amount of refined grain (less than 37 grams per day).

 

Take home point: eating refined carbs in pregnancy could increase the risk of your child being obese at a young age.  “You are what you eat” … and based on this study, your future child will be too.

 

What you can do:

  • Substitute one meal a day for something with more whole grains.

Summer is here and mosquitos are back

My neighborhood pools opened this week for summer and my family couldn’t be more excited. Unfortunately, mosquitos are popping up again and reminding me of the importance of discussing insect repellants with my friends, families, and patients.

 

Many women who never wear insect repellants have recently become interested in these products because of the news coverage of the Zika virus. The Zika virus was introduced to the world during the most recent Olympic games in Brazil. Mosquito bites were linked to severe birth defects and the Zika virus was identified.

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The number of pregnant women with laboratory evidence of possible recent Zika virus infection and the number of fetuses/infants with Zika virus–associated birth defects continues to increase in the United States. About 1000 pregnant women in the US were diagnosed with Zika virus infection last year. Of these pregnancies, birth defects were reported in 15%. Congenital microcephaly, or severely small head in the affected child, has been a hallmark of intrauterine infection with Zika virus. However, the full clinical spectrum and severity of Zika remains unknown. Others have recently reported much lower rates of confirmed Zika virus in other parts of the US and no confirmed fetal or neonatal infections, which puts some doubt on the true prevalence of this widely publicized virus. The field of perinatal Zika virus infection is evolving and we continue to learn more about the virus as well as the risk of disease.
Insect repellants can be a good option for reducing your exposure to mosquitos and tics. The EWG has published excellent resources for consumers to learn about what is in their bug repellent.

 

My family uses DEET. It protects you against tics and mosquitos. DEET is the only insect repellant that has been tested on pregnancy women. The children of mothers who used DEET in their second and third trimesters showed no birth defects, changes in body size or developmental problems. No studies have examined the children of women who applied DEET during their first trimester. However, at toxic doses, DEET has been associated with seizures and neurological damage. Although this risk is scary, The EPA reports that this risk is very low- 1 per every 100 million persons. As with medications, I tend to recommend limiting the use of multiple products in order to limit exposure to multiple chemicals. Choose one insect repellant and stick with it.

 

A more natural alternative is also available as oil of lemon eucalyptus. The tree extract is refined to intensify the concentration of the naturally occurring substance para-menthane-3,8-diol (PMD) from 1 to 65 percent. The resulting oil is very different from unprocessed tree oil. Some testing shows that concentrations of 20 to 26 percent PMD may perform as well as 15 to 20 percent DEET against both mosquitoes and ticks (Barnard 2004, Consumer Reports 2010). I think it is important for us to recognize the limited safety data available on essential oils in pregnancy and in children. Refined oil of lemon is classified as a possible biochemical pesticide. Oil of lemon eucalyptus and essential oils have disadvantages but is a good choice for people who want a botanically based bug repellant. EWG recommends that consumers who are in high-risk areas for bug-borne disease or need long-lasting, effective bug protection avoid botanically-based bug repellents, aside from Oil of Lemon Eucalyptus. In other cases, you may find it worth your while to try botanical repellents to identify one that works well for you.

 

What you can do:

  • Avoid exposure to mosquitos: use insect repellants with <50% DEET when trying to conceive and during pregnancy. More is not better. My family uses 30%.
  • Wash your hands well after applying insect repellant. Wash repellant-coated skin at the end of each day.
  • You and your partner should avoid travel to areas with Zika virus when trying to conceive and during pregnancy. Discuss your travel plans with a physician if there is any question about the safety of travel. Talk to your physician if you or your partner are concerned that you have been exposed to the Zika virus.

 

For more information:

 

 

“Just the Tip of the Toxic Iceberg”

cosmetics

The terrifying association between consumer products and health problems is described in this recent article found in Time Magazine. Wow. What a headline. This article was written as a result of a large lawsuit for baby powder being associated with ovarian cancer. Yep, you read that right.

 

I’ll leave the rest of the reading up to you if you are interested but just had to share one more quote from the article:

 

“But it’s actually not surprising. The fact is, many personal care products on store shelves—products we lather in our hair, rub on our skin, and put in our babies’ bathtubs—contain chemicals with known links to health problems, with no warnings at all to consumers.

Many of us assume the companies are using the latest science as a guide to choose the safest ingredients, especially for products used on babies.

 

We should be able to expect that.

 

Unfortunately, nobody is watching the store. Companies in the U.S. are allowed to put ingredients into personal care products with no required safety testing, and without disclosing all the ingredients.”

 

What you can do:

  • Keep reading our blog to stay current .
  • Be an informed consumer
  • Check out the Environmental Working Group to check the safety of the products you already use.
    • I use this website every time I need to buy a new product so that eventually I will only have the safest products in my house and in my life. For example, I needed to re-stock on hand soap this week and used the EWG app to ensure I purchased the best rated kind.

Why you should opt for the whole-grain option

Whole-Grains

I know- whole grains take some getting used to. New IVF data, however, suggests that you should hear me out and give that whole grain bagel and pasta a try.

 

In a recent study, investigators took a very close look at the dietary habits of people undergoing fertility treatments. Women who ate more whole grains (>52.4 g/day) had higher pregnancy rates than women who ate less whole grains. We have mentioned this whole grain study in our blog before: at least one serving of whole grains per day boosts the odds of success by 33%! It may even benefit women who have problems developing the lining in their uterus (endometrial lining): increasing whole grain intake by 1 serving a day was associated with an increase in endometrial thickness!

 

What you can do:

  • Make the healthier choice: substitute one meal a day for something with more whole grains

Dads- pay attention too!

In my fertility clinic, much of the discussion about pre-conception counseling, or what should be done to prepare for a healthy pregnancy, focuses on the female. We discuss a woman’s diet, vitamins, immunization status, supplements, exercise habits and more. New research is suggesting that dad needs to be involved in this health optimization before starting a family.

Epigenetics is a new hot term in science. We all have DNA, which is a roadmap of genes that encode the proteins that are expressed that make our bodies work. To describe it simply, epigenetics is the field that ensures that these genes are expressed at the right time, the right place, and the right amount. My research over the past three years has focused on epigenetics.

I am passionate about learning how our environment impacts our fertility. Epigenetics is an emerging link  to learning about your environment and how it may impact your genetic health: most toxins in our environment are not strong enough to cause DNA damage and mutations, but are able to impact gene expression, and ultimately the health of an individual, by altering epigenetic profiles. Exposure to endocrine disrupting chemicals in our environment, like those commonly found in plastics, induce epigenetic changes in sperm. Worse yet, these changes can be transmitted to future generations.

Recent studies suggest that epigenetic changes may be the key mechanism by which paternal factors such as age and weight contribute to health outcomes in their kids. For example, dads who smoke have children that are more likely to be overweight. Similarly, dads that are obese are more likely to have obese children as a result of epigenetic changes.

Dads- don’t lose hope. There are early indications that some paternal lifestyle-associated effects on sperm can be reverse through exercise, diet, and/or surgical weight loss. In my practice, I like to focus on the couple becoming the healthiest they can be before conceiving. Because ultimately, our goal is similar: we don’t just want to help you get pregnant, we want to help you be a healthy and happy family for generations to come.

If you’d like to take some steps to reduce the impact of your environment on your fertility, consider the following:

 

Your standard prenatal vitamin might not be enough

 I still remember feeling completely overwhelmed the first time I shopped for prenatal vitamins when I was ready to try to conceive. I’m sure I was putting too much thought into it, but like many others, I was going to take my fertility seriously and I wanted the BEST option. So why did my drugstore have over 5 different types of prenatal vitamins, all with a different concoction of what they claimed was “best?” Some of my friends reported using “prescription prenatal vitamins” and swore they were worth the cost.

I ultimately ended up buying prenatal vitamins that contained docosahexaenoic acid (DHA) since they were advertised as “supporting neurodevelopment” and who wouldn’t want a smarter baby? DHA is an omega-3- fatty acid that is important for brain development.  It has been recommended to eat foods which are high in omega-3 fatty acids for women who want to become pregnant or when nursing.  Although vegetarian sources are now available, fish and fish oil are often utilized for DHA supplementation. For months, I endured gross fishy tastes in my mouth and a fishy odor to my breath; all in the sake of helping my baby’s brain develop. Was it worth it?

The sale of prenatal supplements with DHA continues to increase, despite limited evidence that it actually helps brain development. A recent study suggests that DHA may not be all that it was chalked up to be. This group evaluated pregnant women who took DHA supplements and compared them to women who didn’t. There was no difference in cognitive, language, or motor development in the children from moms who took DHA compared to those that didn’t at 18 months, and 7 years- DHA doesn’t seem to result in smarter kids.  This data is strong enough for me to recommend that you can skip the DHA supplement in your prenatal vitamin, especially if you are having undesirable side effects like gross fish burps.

So what does a good prenatal vitamin need, anyway?

  • Folic acid- at least 400 micrograms; some patients require higher doses of folic acid
  • Iodine

Although a prenatal vitamin will help supplement your diet with extra amounts of vitamins and minerals, your diet should be the primary source. Iron, calcium, and vitamin D are particularly important in pregnancy.

My advice to anxious patients (like myself a few years ago) is simple: eat a well-balanced diet, stay healthy, and find an inexpensive prenatal vitamin that you like so that you remember to take every day.