COVID19 and other infectious disease concerns—here’s what fertility patients should consider

There is increasing concern over Corona Virus or COVID19 as this infection spreads. In perspective there are other infectious diseases that people seeking pregnancy should also consider. Here is a link to a videoblog we recently created to try to answer some of these questions and provide some practical advice:  COVID19




Starting a new video blog: Clinical Conversation

In our effort to remain relevant and provide you with current and relevant content–we’re starting a new YouTube Channel called Clinical Conversations. My partner in this project–Lisa White–is a licensed counselor that has actually gone through fertility treatment herself.

Introducing Fertility Chat

Our goal is to help support you by providing you with some short dialogues about topics that you find to be most relevant. Consider signing up or emailing us some suggestions for topics.

If you can’t find us at the link above just search “clinical conversations–fertility chats” on YouTube.

We hope to see you there!

Tea and Plastics: the most recent example of healthy food packaged/prepared badly

As fertility specialists we try to point out how diet/lifestyle can optimize your fertility efforts. Recently, I shared the latest information that coffee and tea can actually have some benefits—despite popular, but misguided beliefs. But it is always important to realize that it’s not just what we consume—but also how we prepare it that matters!

Fancy tea bags

Tea can easily become an example of a healthy drink gone bad if not prepared properly. A recent study from McGill University demonstrated that just one of the new fancy plastic tea bags can release 11 billion microplastic and 3 billion nanoplastic particles into your drink in as little as five minutes when prepared at standard temperatures. These tiny particles cannot be seen without a microscope. But because of their size they can enter your body much easier than they can ever leave. In fact, a study from the World Wild Life Fund found that it is not unusual for people to consume about 5 grams of plastic per week by eating sea food or drinking beer from cans lined with plastic. That’s equivalent to eating the amount of plastic in a credit card each week!

Although we don’t (yet) know of all of the potential health effects of micro-particles—we do know that plastics can have a negative impact upon fertility due to the chemicals that they contain. In fact, a direct link has been found between the ingredients used in plastics upon egg quality and maturation (their ability to be fertilized). More importantly, these plastic tea bags are not needed and have only recently been introduced.

Here are a few tips to consider:

  • Say “NO” to unnecessary plastics—as consumers you speak volumes with your purchases. Let companies know if you’re choosing to not use their products due to their packaging choices
  • Get a re-usable device to steep your tea
  • Support organizations like the Environmental Working Group that offer tips to minimize your exposure to plastics


As I said in my previous blog post, “these low calorie, plant based beverages may have some health and fertility boosting benefits.” But now I’ll modify my statement with a reminder that this is only true if packaged and prepared in a health way.

Stay informed and motivated,


Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Modern Family Building strategies for the LGBTQ Community

Many of us take for granted that having children will become a natural outcome of our current relationship. For members of the LGBTQ community—this is not the case. A recent survey conducted by the Family Building Council found that 33% of the LGBTQ respondents over age 55 either had children or were planning to have children. This was a sharp contrast to LGBTQ Millennials—age 18 to 35—for whom 77% are either already parents or planning to have children. Even more encouraging among Millennials, is that there are nearly as many members of the LGBTQ community planning to have children as their non-LGBTQ peers—48% vs 55%. However, the LGBTQ Millennials know that they are going to need some assistance to achieve their family.

Booth at Pride Fest

The Family Building Survey also revealed among LGBTQ Baby Boomers—those 55 and older—nearly 75% became parents through intercourse. Many of those were children conceived in former relationships and therefore were “blended families.” This was in sharp contrast to Millennials. Among the 18 to 35 year olds, more than half planned to use Assisted Reproductive Technologies, adoption or fostering to meet their family building goals. That amounts to an estimated 3.8 million LGBTQ Millennials considering expanding their families and 2.9 million that are actively doing so.


If you’re among those seeking to become parents, consider the following:

  • Learn what options are available rather than simply thinking about the simplest way to initiate a pregnancy
  • Consider what your ideal completed family would like before finalizing your plan—it can be very difficult to find the same donor years later if you want a sibling
  • Seek out providers in the healthcare community that will serve as your allies and advocates
  • As more insurance companies are covering reproductive technologies as a covered benefit—investigate how those options apply to you


Stay informed,



Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Vitamin B3: an emerging tool in reducing the risk of miscarriage

About one in four pregnant women will experience a miscarriage. At least two thirds of miscarriages are believed to be due to a genetic abnormality in the embryo. It can make it even more emotionally devastating if the pregnancy was initiated following an IVF procedure with an embryo that had already been genetically tested prior to transfer. That’s why it is so very important that we investigate other—possibly preventable—causes of early pregnancy loss. One emerging strategy is to optimize vitamin B3 intake.


Vitamin B3—also called niacin—serves as critical component of energy within cells to support growth and development. It also serves as a key signal for a group of chemicals that are necessary to repair DNA as well as regulate your body’s stress response. These are all critical functions to initiating and maintaining a successful pregnancy. Unfortunately not all pregnant women are getting enough vitamin B3.


Surprisingly, not all prenatal vitamins contain niacin / B3. One study that was following over 500 pregnant women found that despite following a healthy diet and taking daily supplements—a high percentage of women were vitamin B3 deficient. More recently, a study published in the New England Journal of Medicine demonstrated that giving a group of high risk pregnant women a high dose vitamin B3 supplement seemed to reduce the risk of both miscarriage and birth defects. Additional studies are on-going to see how this may translate into women with average risk.


While we await the results of future studies in this area, there are some safe and simple steps you can consider to help minimize your risk of miscarriage:

  • Eat fortified cereals and grains
  • Include blueberries and grapes as part of your healthy diet—they contain a chemical pterostilbene which can enhance Vitamin B3 activity
  • Check your prenatal vitamin to confirm that it has at least 20 mg of Vitamin B3
  • Talk to your provider about whether or not you should consider a Vitamin B3 supplement


Stay informed,


Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Giving your Embryo a Healthy Place to Grow: preparing the uterus for implantation

It is estimated that between 8 and 12% of women will develop endometrial polyps during their reproductive years. These represent outgrowths of the uterine lining that can vary in shape and size but reflect uneven development of the tissue that is responsible for promoting implantation of embryos to initiate pregnancy. Therefore, it’s not surprising that they seem to be more common in women with infertility. In fact, one study of 1000 women undergoing IVF found about 32% of them had endometrial polyps.

Endometrial polyps

In an attempt to estimate the impact of endometrial polyps on infertility, one study randomized 215 women with endometrial polyps to having surgery prior to starting Ovulation Induction with Insemination treatment vs not having surgical correction prior to starting treatment. They found that those that had surgery were twice as likely to become pregnant.   


Other studies have also looked at mechanisms for how polyps could interfere with implantation. Here the evidence is equally compelling. In addition to the mechanical interference; polyps have been linked to various chemical changes in the uterine environment—especially involving certain markers of implantation and inflammation.


At our center, we go through great lengths to create and identify the healthiest embryos possible to help our patients achieve the highest attainable live birth rate. Therefore we always take steps to make sure that we’re placing embryos into the best possible uterine environment. Timing is also important in considering when to remove polyps. At least one study found that 27% of polyps will go away on their own. So we don’t plan any such surgery until we know we have healthy embryos to transfer or our patient is ready to become pregnant.

Stay informed,



Robert Greene, MD, FACOG

Conceptions Reproductive Associates

Herbal Medicine and Supplement Use during Pregnancy: a cautionary note

Many women underestimate the potential negative impact of over-the-counter products. Herbal medicines are any plant derived product taken as a preventative or curative treatment. Dietary supplements are defined as products taken by mouth including vitamins, minerals and herbal or botanical products. Currently, the supplement industry is valued at over $133 Billion per year with a projected growth of 8.8% annually. Women of reproductive age make up a large portion of these consumers.

Think before you drink

Are you sure that your supplements are safe?

Estimates are that nearly half of women take dietary supplements during pregnancy and about 30% continue their use into the postpartum period while breastfeeding. Studies indicate that it is naïve to assume these products do not have a negative impact upon pregnancy. Yet it is only after concerning data has emerged that warnings for supplements are issued. Take for instance the recent recall of Periwinkle.


A supplement ingredient called vinpocetine, but also marked as periwinkle extract or vinca minor, has been advocated for many purposes including weight loss, boosting energy or improving memory—all common concerns of reproductive age women. Yet last week, the Food and Drug Administration issued a warning that based upon data from the National Institute of Health that this product has been linked to an increased risk of miscarriage. Some other potential problematic supplements include the following:

  • Almond oil—used topically to treat stretch marks—may increase the risk of preterm labor
  • Chamomile—may increase the risk of preterm delivery and low birth weight
  • Raspberry leaf—often used to induce labor—is associated with an increased risk of c/section
  • Licorice root (glycerrhizin)—increased risk of preterm birth and blood pressure problems as well as possible developmental issues


In closing, if you’re pregnant or hoping to become pregnant it’s best to discuss any supplements that you choose to use with your OB/GYN provider.

Stay informed,


Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

To Those Hoping to Celebrate Mother’s Day (Next Year)


As we prepare to celebrate Mother’s Day, I am reflecting upon the journey that my wife and I undertook to become parents. It may seem to an outsider that it was easy given that I’m a fertility specialist and I work in a top performing fertility center; but it wasn’t. In fact, my wife and I felt quite isolated. We didn’t openly talk about our efforts at the time because we didn’t want to invite the scrutiny of family and staff. So I understand how sequestered the process can feel. That’s why I so fully appreciate efforts like those of women like Lisa W. (in the photo above) that are not only willing to share their experience but also work to help others. I encourage you to check out her website and see if she can help support you in your efforts. It’s great to have someone you can talk to that’s been on the same path.

Identical Twins and IVF; here’s the latest information on “womb-mates”

As fertility treatment continues to help more women/couples achieve their family building goals, we have continued to see the risk of twins decline. IVF has helped drive up fertility treatment while also helping reduce the risk of twins. That’s occurred mainly through efforts to encourage Elective Single Embryo Transfer (ESET). At our center, nearly 90% of our patients agree to ESET and we feel that this strategy has actually helped us achieve among the highest live birth rates attainable.

Twins 3D image

Even with ESET however, twin pregnancies do occur. That is primarily due to a single embryo splitting. In fact, sometimes an embryo can split and become a triplet pregnancy. Whenever an embryo splits; the resulting babies are genetically the same and therefore referred to as “identical twins.” Identical twins are naturally conceived in about 0.45% of pregnancies. Recently a large analysis of 7 years worth of data helped clarify the incidence of identical twin from embryo splitting in IVF.

Japan performs the highest number of IVF cycles per capita than any other nation. In Japan, they have shifted to single embryo transfer in about 80% of their treatment cycles. This recently made it possible for a group of researchers to review 937,848 single embryo transfer cycles to determine how frequently embryos appear to split following IVF. Their conclusions were as follows:

  • The risk of multiple pregnancy after single embryo transfer is 1.60%
    • This results in a risk of twins that is 1.56% following single embryo transfer
    • The risk of triplets when one embryo is used is about 0.04%
  • About 1.36% of embryos appear to split while the remaining number of multiples are believed to be a combination of natural conception along with single embryo transfer—this is the reason that we discourage intercourse following an embryo transfer.
  • Embryos are more likely to split if they were created by eggs from younger women and those with unexplained infertility.
  • Pregnancies resulting from embryo splitting are at higher risk of miscarriage

In summary, with today’s improved technology for freezing embryos, it is safest to transfer one embryo at a time to optimize live birth rate and reduce the risk of multiple pregnancy.

Fertile thoughts,