Having challenges getting pregnant? Laughter can help!

Most of us are goal oriented. As a result, any obstacle that interferes with us achieving an important result produces changes in our physiology that are referred to as “stress.” Sometimes stress can be a positive response. It can help us think creatively, remember details better and provide motivation to try harder. Unfortunately, the stress associated with trying to conceive is not helpful.

Whether trying to become pregnant naturally or with medical assistance; we work with our patients to help reduce the physiologic obstacles created by stress. One of the simplest ways to help reduce stress is to smile. Even when smiles are artificially induced; they can reduce the physiologic impact of stress. But we encourage people to go even further.

Baby Laughing

As a scientist and clinician, I love having data to further support recommendations. Research on how your body responds to laughter has shown improved immune function. In fact, that data focused in on a specific type of immune cell (NK cell) that we know impacts implantation and early pregnancy. But the best data comes from testing the hypothesis in real world situations like what has been done on patients going through IVF.

One well-designed interventional study followed 220 couples going through IVF. They had half of them randomly assigned to meet with a comedian around the time of their transfer to promote laughter. They found that the pregnancy rate in those exposed to laughter were almost double! Although this study has not (yet) been repeated; the results do make sense. We’ve all experienced serious situations where we have laughed—sometimes even apologizing for our laughter—only to feel better afterwards.

So as you proceed, consider the following advice: “Laugh often and smile loudly”

Mirthfully yours,



Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Metformin Reduces Miscarriage Risk

I have written previous blog posts about the various ways that metformin can improve fertility treatment. These studies typically focus on the influence that this medication seems to have on becoming pregnant. We now have compelling evidence that this medication can also optimize your chance of completing your pregnancy. In other words, metformin is associated with a reduction in the risk of miscarriage.

Mid Pregnancy Yoga

Most miscarriages occur in the first trimester. It is estimated that 80% of pregnancy losses occur within the first 6 to 12 weeks of pregnancy. Previous research has shown that use of metformin may help reduce this risk due to various ways that it seems to influence egg quality and by stabilizing first trimester hormone shifts. Now a study has found that continuing metformin reduces the risk of later miscarriage by 50%!


A very well designed study followed nearly 500 women in 14 difference centers as their pregnancies progressed. These women had been randomly assigned to take metformin based upon a previous diagnosis of risk due to either PCOS or concerns of potential gestational diabetes. Unfortunately, 10% of women taking the placebo lost their pregnancy after the first trimester. But the women taking metformin had less than half as many pregnancy losses! Since no other treatment has demonstrated a comparable ability to reduce the risk of second trimester loss—these results are pretty impressive.


So if you feel that you may be at risk of second trimester pregnancy loss or gestational diabetes; discuss with your provider whether or not you may be a candidate for metformin.

Stay informed,

Robert Greene, MD, FACOG

Conceptions Reproductive Associates

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

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: https://miraclestakealittletime.com/posts/  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: https://miraclestakealittletime.com/contact/ . 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