Metformin and Fertility Treatment: the expanding uses for an age-old drug

We all get excited about new things. But most people remain skeptical when you suggest that something old may be better. In fact, what if something VERY old may be one of the hottest developments in a high tech field like fertility treatment? That’s what has been quietly happening with the medication known as metformin.

Galego officianalis

Metformin has been used since the time of the pharaohs (around 1500 B.C.E.) but it was extracted from the plant Galega officinalis (see image). From then until the discovery of insulin; this was the primary treatment for diabetes. Unfortunately, like many plant extracts there were many other compounds present as well—some with serious and/or troubling side effects. The modern synthesized version of metformin has been purified making it safer and easier to study.

 

The best known use of metformin in reproductive medicine is in the treatment of women with polycystic ovarian syndrome (PCOS). But we’re now learning that there are many other ways that his modern version of an herbal remedy can help improve the outcome of fertility treatment. Although I’m not a fan of lists, the complexity of this treatment is beyond a simple blog post. So here is what you may want to consider when planning your treatment with your doctor:

 

 

In summary, pregnancy is a very multifaceted process. Sometimes, we still have a lot to learn about something that has been around for a long time.

Excited to Join the Team!

I’m THRILLED to report that I have officially started accepting new patients at Conceptions!

If you have read the blog before, you may have already caught on to my passion for enhancing fertility through diet & lifestyle changes. If you are new to the blog, welcome!

I joined the field of reproductive endocrinology & infertility because of my love for science and applying the newest findings to clinical medicine. I joined Conceptions because I have the opportunity to practice individualized medicine and boutique-style care in one of the best IVF labs in the country.

I cherish the relationships that I develop with my patients and their families. In fact, I provide my patients with my direct email information and I welcome them to contact me directly with any questions or concerns. I enjoy having open discussions with patients about options and alternatives. I encourage my patients to choose the treatment best suited for their individual family.

As a physician and a mom, I get it. I understand how stressful it is to balance work and life. I also understand how challenging it can be as a patient. By offering to meet with patients online via WebEx or Skype, my goal is to make the process of obtaining care as easy and stress-free as possible.

Fertility is a challenging and complex life event. I’m here to help by discussing all your options, encouraging you and your family to optimize your health, and cheering for you along the way of any treatment you may need. I look forward to meeting you and your family!

Are Low-Calorie Sweeteners Making Your Baby Fat?

Obesity is a major risk factor for problems conceiving and pregnancy complications. Obesity is a potentially modifiable risk factor, meaning this is something that you can change to improve your chances of getting pregnant, having a healthy pregnancy, and having a healthy kiddo. This subject is so important that I thought I would blog about it again.

 

In December, our blog brought you new data that revealed that people that used low-calorie sweeteners in their lifetime were more likely to be obese than those who didn’t use these sweeteners.

 

Today, we want to caution you even more about using these sweeteners. Researchers have found that women who drank at least one artificially sweetened beverage per day during pregnancy had children who were more likely to be obese by the time they turned 7 years old. These findings suggest that artificially sweetened beverages during pregnancy are not likely to be any better at reducing the risk for later childhood obesity than sugar sweetened beverages! So these patients may have been drinking the diet version without any measurable benefit for their children; diet versions may have actually lead to harm! Interestingly, substituting a glass of water for a sweetened beverage reduced their children’s obesity risk by nearly 20%!

 

I am always cautious in interpreting data, particularly when it comes to weight because we know that so many other factors could influence children’s weight gain (Ex: physical activity, etc). Although the data doesn’t prove that maternal artificially sweetened beverage consumption caused children to gain weight, the data is strong enough for me to counsel my patients to avoid drinking any drinks with artificial sweeteners when pregnant.

 

Take home points:

  • Limit using artificial sweeteners during pregnancy
  • Consider trying some of these more natural sweeteners; note that there are limited long-term studies of these alternatives in pregnancy.
  • If all the natural sweetener options are overwhelming, stick to the basics: a cold glass of water!

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.