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

Is going low carb dangerous?

At the initial patient visit, I try to learn about any special dietary restrictions my patients may have. A common diet is going “low carb” in an effort to lose weight. Emerging research, however, suggests that this could be dangerous when trying to conceive.

Folic acid is a vitamin that reduces the risk of having a child with a problem with it’s spinal cord, known as a neural tube defect. Folic acid is added to many common meals, like cereal, in order to fortify the food. Women who intentionally avoid carbohydrates, thereby consuming fewer fortified foods, may not have adequate dietary intake of folic acid.

This study found that women eating low carb had significantly lower dietary intake of folic acid. Women eating low carb were 30% more likely to have an infant with a severe neural tube defect such as anencephaly or spina bifida.

What you should do:

  • Talk to your doctor about any special diets you have before trying to conceive
  • Women should take a daily prenatal vitamin in addition to having a well-balanced diet while trying to conceive

Iodine deficiency may reduce pregnancy chances

A common question asked in a new fertility evaluation is: “Which prenatal vitamin is best?” We have previously tried to provide some guidance in choosing the best vitamin.  The ingredient list in your prenatal vitamin needs to be considered.

In particular, iodine is an often-overlooked but extremely important component that should be considered in a prenatal vitamin. Iodine is a mineral used by the body to regulate metabolism; it is also very important for brain development in children. It is often found in seafood, iodized salt, dairy, and some fruits and vegetables.

A new study shows that women who have low iodine levels take longer to get pregnant than women who have normal iodine levels.

Take home points:

  • Iodine is important in pregnancy and when you are trying to conceive
  • Boost your fertility naturally with iodine
  • Make sure you are on a good prenatal vitamin
  • Talk to your doctor about what levels of iodine are best for you

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

Worried about BPA? Your diet might help!

Bisphenol A (BPA) is commonly found in plastics and the majority of us are exposed to this hormone disruptor multiple times daily. We previously introduced BPA and the negative health impacts here. We know that BPA exposure when trying to conceive can negatively impact multiple aspects of your health, including your fertility and the likelihood of your children having health problems.

New data suggests that something as simple as getting enough folate through your diet can help protect you from the damaging effects of BPA. This study looked at the dietary habits of couples with infertility who were going through IVF treatment. They found that women with high urinary BPA concentrations had lower pregnancy rates and live birth rates if they didn’t consume enough folic acid (<400μg/day of food folate) compared to similar women with high BPA exposure but adequate folic acid intake. They found that women who ate enough folate in their food had higher pregnancy rates, despite the fact that they had high BPA exposure. This suggests that folate intake may somehow protect women from the negative impact of BPA on fertility.

Take home points:

  • Avoid BPA as much as possible
  • Make sure you are eating a well-balanced diet to get adequate folate intake while trying to conceive

Workout supplements in 2018


With the coming of every New Year, many make resolutions. One of the most common resolutions relates to health and fitness. Many people consider the use of supplements to boost their workout or diet regimens.

The National Institutes of Health (NIH) compiled fact sheets of the most common supplements used to boost exercise and athletic performance and weight loss. We share them with you as a trusted resource for more information.

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