Your standard prenatal vitamin might not be enough

 I still remember feeling completely overwhelmed the first time I shopped for prenatal vitamins when I was ready to try to conceive. I’m sure I was putting too much thought into it, but like many others, I was going to take my fertility seriously and I wanted the BEST option. So why did my drugstore have over 5 different types of prenatal vitamins, all with a different concoction of what they claimed was “best?” Some of my friends reported using “prescription prenatal vitamins” and swore they were worth the cost.

I ultimately ended up buying prenatal vitamins that contained docosahexaenoic acid (DHA) since they were advertised as “supporting neurodevelopment” and who wouldn’t want a smarter baby? DHA is an omega-3- fatty acid that is important for brain development.  It has been recommended to eat foods which are high in omega-3 fatty acids for women who want to become pregnant or when nursing.  Although vegetarian sources are now available, fish and fish oil are often utilized for DHA supplementation. For months, I endured gross fishy tastes in my mouth and a fishy odor to my breath; all in the sake of helping my baby’s brain develop. Was it worth it?

The sale of prenatal supplements with DHA continues to increase, despite limited evidence that it actually helps brain development. A recent study suggests that DHA may not be all that it was chalked up to be. This group evaluated pregnant women who took DHA supplements and compared them to women who didn’t. There was no difference in cognitive, language, or motor development in the children from moms who took DHA compared to those that didn’t at 18 months, and 7 years- DHA doesn’t seem to result in smarter kids.  This data is strong enough for me to recommend that you can skip the DHA supplement in your prenatal vitamin, especially if you are having undesirable side effects like gross fish burps.

So what does a good prenatal vitamin need, anyway?

  • Folic acid- at least 400 micrograms; some patients require higher doses of folic acid
  • Iodine

Although a prenatal vitamin will help supplement your diet with extra amounts of vitamins and minerals, your diet should be the primary source. Iron, calcium, and vitamin D are particularly important in pregnancy.

My advice to anxious patients (like myself a few years ago) is simple: eat a well-balanced diet, stay healthy, and find an inexpensive prenatal vitamin that you like so that you remember to take every day.

Atypical PCOS: new insights for patients with fertility problems that don’t have other symptoms

Women with Polycystic Ovarian Syndrome (PCOS) can have a variety of symptoms including irregular/infrequent menstrual cycles, skin problems and weight gain. This creates a diagnostic challenge as many healthcare providers rely heavily upon these symptoms to make their diagnosis. New discoveries over the last two decades have demonstrated that PCOS is not a simple cluster of findings.  Instead it is a spectrum of conditions with a variety of presentations. New information has provided greater understanding why some PCOS patients may present primarily with infertility alone and none of the other commonly associated symptoms.

 

PCOS is essentially a hormone imbalance. One of the most important hormones that is typically involved is one called Anti-Müllerian Hormone (AMH). What’s disappointing is that some physicians either don’t measure this hormone or don’t understand its implications. Many women with PCOS have very high levels of AMH. Having too much of this hormone may be their greatest obstacle to becoming pregnant.

 

A new study shows that AMH (referred to as Müllerian Inhibiting Substance or MIS in this article) can inhibit the maturation of eggs. In fact, it can be so potent that it may someday be used as a contraceptive. But most importantly, having a high AMH level can make a woman’s ovaries behave like a woman that has PCOS; even if she does not have any of the other common symptoms. Regardless of what we call this hormone imbalance; women with a high AMH often benefit from similar treatment recommendations as women with PCOS.

 

Stay informed,

~Robert

 

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Thyroid Hormone for Women Trying to Conceive; why extracts and T3 can be harmful to your developing baby

Many patients that present to fertility centers are on thyroid supplements that are extracts from pig thyroid gland. Unfortunately, they have often embraced this treatment because it is presented as more “natural” then  the synthetic thyroxine often prescribed by most healthcare providers. In reality, the human thyroid gland converts T4 (thyroxine) into T3 (the active form) very efficiently. The typical ratio of T4:T3 in humans is about 14:1. By contrast, pig thyroid extracts have a 4:1 ratio so that there is much more active T3 in the preparation. The problem with this high level of T3 is that the developing baby needs the T4 from a pregnant mom’s blood; not T3. High T3 levels during early pregnancy can impair healthy brain development. So I recommend the following: 

          –take a stable dose of thyroxine. 

          –If you still feel challenged; consider meeting with an endocrinologist to see if you might be a candidate for small supplemental dose of T3; two or three times per day. 

http://endocrinenews.endocrine.org/controversy-continues-combination-treatment-hypothyroidism/

Selective dietary supplementation in early postpartum is associated with high resilience against depressed mood

Much of modern psychiatry is about using medications to try to normalize brain chemistry as a tool to help resolve mood disorders. Having been involved in considerable research on how hormonal shifts can cause changes in brain chemistry–I am always interested in trying to help my patients understand what may occur and what they may be able to do to take preventive actions. Here is a study that suggests that using a dietary supplement containing tryptophan (2 grams) and tyrosine (10 grams) may prevent postpartum blues without changing breast milk contents. Better still, this might interrupt the spiral to postpartum depression! Check out this link and then talk with your doctor before starting any program.

http://www.pnas.org/content/114/13/3509.abstract

Tens of Millions Lack Local Assisted Reproductive Services | Medpage Today

The lack of quality treatment has been something that we have taken on aggressively this year through our tele-medicine campaign. Since the new law was enacted in Colorado-making telemedicine fully reimburseable–we have been actively building our internet based services. If you’re one of the millions lacking care in your area, consider setting up a consultation. We’d love to meet you.

http://www.medpagetoday.com/Endocrinology/Infertility/63901?xid=nl_mpt_AACE_Daily_2017-03-17&eun=g7126400d9r

PCOS and AGE; how the foods you eat effect your chances for a successful pregnancy

Women with Polycystic Ovarian Syndrome (PCOS) are faced with a dual challenge. First, their inherent hormone imbalance makes it more difficult for an immature egg to become a mature fertile one. But less often appreciated is that they also tend to produce eggs that are less likely to fertilize or can be more likely to miscarry if they do conceive. This second problem is believed to be linked to poor egg quality. New research suggests that the impact of this second problem may be reduced by decreasing exposure to dietary toxins.

Advanced Glycation End products or AGE’s are formed when proteins or fats are exposed to sugars—especially when prepared by high heat cooking methods. These glycotoxins have been linked to aging, heart disease, cancer and infertility because they promote inflammation, reduce blood flow and promote the production of free radical formation. In fact, there are specific receptors (RAGE or “receptors for advanced glycation end products”) for these unhealthy chemicals that are concentrated on the surface of the ovary and have been linked to ovarian aging and reduced egg quality. Women with PCOS seem to have at least two times the levels of AGE’s and more concentrated RAGE on their ovarian surface; linking the reduced egg quality in PCOS to diet.

Importantly, there are steps you can take to reduce the impact that AGE’s are having upon your ability to become pregnant. It has been demonstrated that some simple dietary changes can profoundly reduce your AGE levels and start improving the quality of the eggs that you’re producing. Here’s list of helpful suggestions:

  • Dietary Recommendations:
    • Reduce consumption of meat, poultry, fish and dairy—all rich sources of AGE
    • Increase consumption of brown rice and mushrooms—which have been shown to help sequester these damaging chemicals after they already entered your body
  • Lifestyle Recommendations:
    • Adjust your cooking methods to reduce the production of AGE in your food before you eat
      • High heat and drier cooking methods like broiling, searing, grilling and deep frying all dramatically increase the formation of AGE
      • Lower heat and moist cooking methods like stewing, boiling and steaming minimize AGE production
    • Stay away from tobacco smoke—a potent source of AGE
  • Supplements to consider:
    • Resveratrol—a chemical found in red wine and now available in supplement form, has been shown to reduce the effects of AGE
    • Curcumin—a key product in the ginger-like spice turmeric—has also been shown to dramatically reduce the effects of AGE.
  • Medications that might help:
    • Metformin—a drug commonly given to women with PCOS and associated with higher pregnancy rates—has been shown to inhibit the activity of AGE
    • Aspirin—has been shown to help reduce AGE attachment

Daylight Savings Time May Lower Chances of IVF Success for Some: Study

At our center, we have long held that your circadian rhythm–how your biology responds to the day-night cycle–impacts your fertility. This is one of the many reasons we focus on optimizing vitamin D levels, melatonin (when necessary) and paying careful attention to our embryo transfer schedules. In case your fertility center hasn’t figured out how important that this is, check out the following recent study on miscarriage risk associated with time shifts.  https://consumer.healthday.com/infertility-information-22/infertility-news-412/daylight-savings-time-may-lower-chances-of-ivf-success-for-some-study-719514.html