Boxers vs. Briefs; another popular myth falls to scientific investigation

There are many common health related beliefs that are popular in our culture today. The field of fertility medicine probably has more than most; for instance check out this excerpt from the popular sitcom Seinfeld. These recommendations are often driven by an idea and maybe even a theory that sounds valid. But rarely are they ever challenged by good investigation. Through time, these suggestions can even become recognized as facts despite the lack of supporting data. This has been the case in how men are advised to help their partner conceive more quickly. “Boxers over briefs” has been the unchallenged advice for underwear for decades…until now.

Boxers v Briefs

The best study to date was recently published in the journal Andrology. They tracked over 500 couples for a year to see if there was a correlation between time to pregnancy, conception delay or infertility in men who wore boxers vs. briefs. They even tracked daytime vs. nighttime habits as well. Although there some changes in sperm counts and other parameters; this did not impact their true goal of having a baby. So it’s best for men to focus on other helpful instructions to optimize their sperm quality and count.


Here are few helpful tips:


Stay informed,


Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Women are Having Fewer Children Than They’d Like

recent article in the New York Times caught my attention and I thought it would be worth sharing.

In summary: evidence from the CDC suggests that America’s fertility is in precipitous decline.

What you can do:

  • Be an informed patient. Know your fertility status to help plan your life and family goals.
  • Schedule an appointment with a REI for more information.

Doing an IVF cycle? A Mediterranean diet can help!


Couples often ask me: “What else can we do to make this IVF cycle successful?” The first answer, is to pick the right lab. I’m fortunate to work with an amazing group of embryologists so I encourage my patients to consider the next step: using your diet and lifestyle to stack the odds in your favor. As we have discussed before in the blog, what you eat and what you do can absolutely impact your fertility and overall health. New research demonstrates that your diet, in particular, can impact your success with IVF.


As many of my patients know, I encourage a plant-based diet to enhance your fertility naturally. The problem with many of these studies that we have previously reviewed is that people who eat a plant-based diet are more likely to be thin and the following question emerges: “Is diet really impacting your fertility or does this have to do with your weight?” A new study helps us address this question.


In this study, women who had a normal weight (BMI < 30 kg/m2) underwent IVF in Greece. Women who ate a Mediterranean diet were more likely to get pregnant and bring home a healthy child compared to women who did not eat a Mediterranean diet. Women who ate better were almost 3 times as likely to bring home a child than women who did not eat a Mediterranean diet! The results suggest that dietary modifications may help increase the chances of a successful pregnancy and delivering a live baby for women undergoing IVF treatment.


What this study doesn’t answer, however, is when these dietary changes need to be implemented in order to have the full benefits on your fertility. My advice is simple: the sooner the better. The healthier you are when you start an IVF cycle, the more likely you are to get the full benefits of diet on your fertility. However, if you have a time crunch with regards to your fertility, with diagnoses such as diminished ovarian reserve, it may not be in your best interest to delay starting treatment. Talk to your doctor for more information about what the best next steps are for you.


Take home points:

  • Your diet can impact your chance of having success with IVF
  • Consider implementing a Mediterranean diet
  • Talk to your doctor for more information to help select the best diet for your goals

You are what you drink- continued

We have previously discussed in this blog the impact of the beverages we drink on fertility.The old saying of “You are what you eat” couldn’t be more true- what you eat absolutely impacts how we feel and our overall health.


New research is adding to this old saying- what you drink may be just as important as what you eat, when it comes to fertility. Similarly, we also discussed that the beverages you consume now can impact the health of your future children: women that drank beverages with low-calorie sweeteners are more likely to have obese children.

New research adds to these concerns. In this large study, the dietary habits of men and women were evaluated while they tried to conceive. Drinking sugary beverages was associated with decreased fertility for both men and women. Similarly, participants who had consumed the most sugary drinks (>7 servings/week) were found to have the lowest odds of fertility for both men and women.

This study looked at what couples drank during an IVF cycle and monitored their outcomes. They found that couples that drank more sugary drinks like soda did worse in IVF, when compared to couples who don’t drink sugary drinks: fewer eggs and fewer good quality embryos.

Take home points:

  • Men and women should avoid sugary drinks when trying to conceive, but particularly if they are using IVF
  • Using artificial sweeteners is not necessarily a safe alternative to sugary drinks
  • If you can’t completely eliminate sugary drinks, consider limiting your intake to <1 beverage a day.

Supplement that may optimize egg quality in women with diminished ovarian reserve (or PCOS)

Many of the supplements that we recommend for our patients to use are based upon theory or observational studies. That’s why when we have additional research to support a recommendation; it creates even more excitement and promise. That’s how we currently feel about inositol.

Inositol is a naturally occurring vitamin-like chemical that is common in fruit. It occurs in two forms; myoinositol and its alternate form D-chiro-inositol. It is not considered a vitamin because your body is capable of making this vitamin B-like substance. Unfortunately, some women might not make enough to insure the health of their immature eggs. Disappointingly, studies suggest egg quality correlates with the presence of this important substance.


Inositol has been classified as an insulin sensitizing agent like metformin. Also like metformin, it has been shown to have other important effects that seem to benefit outcomes for women undergoing fertility. Additionally, inositol improves responsiveness of the immature follicle (developing egg and its hormonal support team) to the hormone FSH for women going through IVF.


A recent review of studies performed on women taking this supplement during IVF treatment suggested that there may be several other benefits. They found that the women with a predicted low response required less medication to stimulate their ovaries if they were on this supplement. More importantly, they appeared to produce higher quality embryos and had a higher pregnancy rate.


As a note of caution, since this supplement seems to have similar actions to metformin—it is not recommended to use both during the same treatment cycle. This information seems very reassuring that women that have not tolerated metformin or choose not to take that medication—a supplement containing both myoinositol and D-chiro-inositol may provide some (or possibly all) of the same benefits.

With compassion,


Robert Greene, MD, FACOG

Is going low carb dangerous?

At the initial patient visit, I try to learn about any special dietary restrictions my patients may have. A common diet is going “low carb” in an effort to lose weight. Emerging research, however, suggests that this could be dangerous when trying to conceive.

Folic acid is a vitamin that reduces the risk of having a child with a problem with it’s spinal cord, known as a neural tube defect. Folic acid is added to many common meals, like cereal, in order to fortify the food. Women who intentionally avoid carbohydrates, thereby consuming fewer fortified foods, may not have adequate dietary intake of folic acid.

This study found that women eating low carb had significantly lower dietary intake of folic acid. Women eating low carb were 30% more likely to have an infant with a severe neural tube defect such as anencephaly or spina bifida.

What you should do:

  • Talk to your doctor about any special diets you have before trying to conceive
  • Women should take a daily prenatal vitamin in addition to having a well-balanced diet while trying to conceive

Iodine deficiency may reduce pregnancy chances

A common question asked in a new fertility evaluation is: “Which prenatal vitamin is best?” We have previously tried to provide some guidance in choosing the best vitamin.  The ingredient list in your prenatal vitamin needs to be considered.

In particular, iodine is an often-overlooked but extremely important component that should be considered in a prenatal vitamin. Iodine is a mineral used by the body to regulate metabolism; it is also very important for brain development in children. It is often found in seafood, iodized salt, dairy, and some fruits and vegetables.

A new study shows that women who have low iodine levels take longer to get pregnant than women who have normal iodine levels.

Take home points:

  • Iodine is important in pregnancy and when you are trying to conceive
  • Boost your fertility naturally with iodine
  • Make sure you are on a good prenatal vitamin
  • Talk to your doctor about what levels of iodine are best for you