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

From One Fertility Patient to Another; inside advice and guidance from someone that’s been there

Typically, my blog posts are about sharing the latest research studies or insights into some treatment options or they focus on busting a popular myth. However, every now and then I have an opportunity to introduce someone that I feel has something very important to say. This is one of those posts.

Ambers blog

I want to introduce you someone that I consider a true hero. Amber has been through fertility treatment. What makes her someone that I admire is her desire to help others on the same path. In her blog:  she very eloquently shares her own experience. But she even goes one step further. She offers support to others beyond the information and experience of her journey.

If you need to reach out to someone, she is an articulate and engaging woman willing to provide you with some insights: . You are not alone.

In kindness,



Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Planning your family: guiding thoughts when considering your options

As a fertility specialist for over 20 years, I have seen our treatments evolve from “hoping to achieve a pregnancy” to effectively assisting people to have the family of their dreams. Whether you are in a stable relationship or single; same-sex, hetero or even gender-fluid—there is a strategy available to assist you in achieving your reproductive goal. The first step is to define your vision of your ideal family.


Fertility rates in the U.S.A. are at a record low; but not for those with a plan! A new analysis has found that birth rates are up for women that have delayed childbirth. Today, 86% of women between age 40 and 44 are mothers; that is up from 80% in the same group only 10 years ago. With the new treatment options available, family size is increasing as well. Most notably, the women that are driving this trend are women that had traditionally delayed having children for career purposes, educational pursuits or lack of a male partner.

Pew 2018 after decades of decline family size is ticking up

That’s why it is more important than ever to start planning your family early in your journey. For instance, one study found that healthy women attempting to conceive through donor insemination had about a 70% chance of success; but that it typically took four attempts. Today we can do much better.


Now that we understand that a woman’s ovarian reserve and egg quality are the most limiting factors to success; we have shifted our focus to creating and identifying healthy embryos. With the process of in vitro fertilization (IVF), we are able to optimize the number and quality of eggs that woman can produce at any given time. Then through the process of Intracytoplasmic Sperm Injection (ICSI), we can be certain that each egg is entered by only one perfect looking sperm. Each egg that fertilizes and then develops properly can undergo genetic testing (CCS) and then be frozen (vitrified) for later use. Once frozen, we now know that embryos can remain viable for over twenty years!


At our center, we find that each individual embryo that passes the genetic testing provides women with a greater chance of a livebirth than four attempts at more traditional treatments. That’s why we now encourage our patients to think of their last pregnancy at the same time that they are considering their next one. By shifting treatment paths, women can reduce frustration and cost while optimizing their chance of completing their ideal family.


Fertile thoughts,



Robert Greene, MD, FACOG

Conceptions Reproductive Associates

Successful Fertility Treatment


Defining goals is a key feature shared by people that we describe as “successful.” It is also a practical approach for those of us that diagnose and treat fertility challenges. So what is the best way to define successful fertility treatment?

Many patients present to us with the question of “why?” They want to know why they haven’t conceived. My first goal is to redirect them to thinking of “what?” What do they want their completed family to look like? This may seem like a small shift in focus; but in reality is a huge leap towards achieving that goal.

“Why-focused thinkers” tend to focus on the past. They often want to spend a tremendous amount of time and effort in diagnosing what their obstacle has been and what could they have done differently. Once they effectively become “what-focused-thinkers,” their momentum has already shifted forward. That simple shift in thinking dynamically places them on a path forward to actually achieving that goal.

At our center, we focus on Live-Birth-Rates because we know that is the only marker that really matters to our patients. With that in mind, we work towards minimizing obstacles to efficiently reach that goal—one (or occasionally two) babies at a time. But considering the answer to the “what” question—we often have to plan for subsequent pregnancies at the same time that we plan for the first/next one. Applying this approach, we became one of the elite centers that truly have the highest reportable success rates.

Our goal for the coming year is to not only stay in this elite group. But to continue to find ways to help push those rates higher—while continuing to share what we learn along the way. So thank you for checking in. Let’s focus on the future!

With dedication and humility,

~Robert Greene, MD

On behalf of the team at Conceptions Reproductive Associates

Common chemicals in shaving cream and soaps tied to poor semen quality


Men are often unaware of how their personal care products may be limiting their fertility potential. Several studies have focused in on a common ingredient called parabens. This is a commonly used preservative in shaving creams, soaps and cosmetics–and is known by a variety of names including “methyl-parabens and propyl-parabens.”

Another study has now found that this chemical can not only disrupt healthy hormone levels but actually contribute to potential sperm damage. Specifically, they found a higher incidence of sperm with abnormal shapes (called teratospermia”) as well as a higher incidence of sperm DNA damage.

Since shaving involves scraping the skin–this daily activity provides a very unhealthy opportunity to absorb this hormone-disruptor. So consider switching to products that are “parabens-free” or certified organic.

Coffee, Tea and Fertility: time to re-evaluate an outdated concept


As both a physician and researcher, I have come to realize that it is much more difficult to dispel a popular belief that is wrong than it is to prove a new finding. A classic example is the popular notion that coffee and tea are harmful for women trying to conceive. Both are drinks created from small trees/shrubs—coffee is made from the seed (not bean) of the plant Cofea Arabica whereas tea is made from the leaves of the plant Camellia sinensis. Interesting, both are now known to have a growing number of health benefits. In fact, both—when served unsweetened—regularly appear after water as the “second healthiest beverage” to consume in moderate quantities of 3 to 4 cups per day.

Both coffee and tea contain various plant produced antioxidants as well as health promoting polyphenols and flavonoids. Coffee has been shown to reduce the risk of diabetes and tea is linked to a reduced risk of heart disease. Both are linked to a longer life expectancy. In fact, in 2016 the Nurses Health Study demonstrated that moderate coffee consumption may even protect DNA—potentially slowing the effects of aging and possibly even optimizing fertility. So where does the negative reputation of these beverages come from? I link this myth to obsolete observational studies and the concerns that they raised about caffeine consumption.

Here’s what the current information shows:


Bottom line is that these low calorie, plant based beverages may have some health and fertility boosting benefits. Any risk from them is not associated with mild to moderate daily consumption.

Stay informed,


Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

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.