A Brief Note About Farmer’s Markets!

Don’t forget that it is a great time of year to eat from the Farmer’s Markets.  The ancients believed that the energy we get from foods recently in the ground and alive is really good for us. I know it is not always possible, but try to avoid pesticides by choosing organic when you can.

StartART Nursing Congress

On August 1st, I went to Baltimore to attend the StartART Nursing Congress. My fellow attendees were primarily nurses who work in reproductive health and IVF clinics. The presenters were MD’s (reproductive endocrinologists), geneticists, and ethicists from Harvard, Stanford, Weill Cornell, Yale, Vanderbilt and other prestigious centers.

Way too many words and stats appeared on their Power Point slides, but I would like to share some highlights, based on common questions from my patients. 

  • Letrazole appears to be more successful than Clomid in women with poly cystic ovaries but not for those with unexplained infertility.  Adding Metformin may help pregnancy rates and lower miscarriage rates. 
  • Inositol (a member of the Vitamin B family) can help ovulation. No solid data on whether it increases pregnancy rates.
  • Weight gain can induce the development of Polycystic Ovaries. This association was seen when college women who were studied after gaining weight after starting college. From the lecture of Dr. Elizabeth Ginzburg, Harvard Medical School

Embryos with evidence of mosaic cells (chromosomally abnormal cells) can become normal babies. However, the higher the percentage of mosaic cells, the more likely there is to be a problem. From the lecture of Marcus Hughes, Clinical Molecular Geneticist

  • There is a higher miscarriage rate for women who consumed over 4 or 5 drinks per week, during the months leading up to pregnancy.
  • There is some evidence that Progesterone is helpful in recurrent pregnancy loss.
  • In the event of a second miscarriage, a woman should try to preserve some of the “products of conception” to have them tested.  Dr. Kutteh stated that 95% of the time, the reasons for recurrent pregnancy loss can be determined.
  • There is NOT good evidence that treating the MTHFR, Protein Z, or Factor V , is at all helpful unless a woman or a lot of her first degree relatives have had a history of blood clots. From the lecture of Dr. William Kutteh, Reproductive Endocrinologist, Vanderbilt University.

What the future may hold:

Making eggs and sperm from a person’s skin cells will probably be possible in 15 to 30 years, or 20 to 40 years, depending on which researcher you talk to.  It is already being done successfully in mice. From the lecture of Henry T.  Greely, Professor of Law and Genetics, Stanford University.

Cells for genetic testing of embryos will be able to be taken from the culture medium that the embryo is living in rather than the embryo itself, which will be less invasive for the embryo. From the lecture of Marcus Hughes, Clinical Molecular Geneticist.

Stem cells from bone marrow or embryonic stem cells can help women who have a history of a thin endometrial lining. They migrate to the uterus and help it proliferate. From the lecture of Dr.Hugh Taylor, MD, Professor of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine.

If you choose to ask your doctor about this research or any information you find on the internet, remember that one study does not mean that protocols or standard treatments should be changed. Results can change when studies are repeated. In addition to this , not everyone agrees with the interpretation of data from a given study. And know that when medical journalists profile a study or research they extracted from a journal and published in the mainstream media, they sometimes “distill” the information in a way that may be misleading, or incomplete. There are some fine medical journalists out there, but be aware.

I enjoy bringing my patients information about current research and what things may help them in the future. I am hoping to attend the American Society of Reproductive Medicine Conference in October, and will plan to bring you some of the “pearls” from that.


Midwest Reproductive Symposium

Me with Elizabeth Brown, the first “Test Tube Baby”

Midwest Reproductive Symposium International, June 6-9.

My goals in attending this conference were to:

  • Gather information helpful to my patients.
  • Meet attendee Elizabeth Brown, who was the first IVF baby (born in 1978).
  • Learn about Dr. Ali Domar’s latest research.
  • Pick up cool give always from vendors and exhibits.


Fertility Apps: Although I often feel that my patients are too reliant on fertility apps and on-line “support” groups, Dr. Ali Domar’s new apps for self-help fertility support are awesome. They are based on her many years of experience using Cognitive Behavioral Therapy (a form of talk therapy) with couples struggling with infertility. The app for women is called FertiCalm and the one for men is FertiStrong. They are fee and can be downloaded at www.FertiCalmApp.com. I tend to favor in person counseling, but these apps are truly impressive.

Genes and genetic testing: While science is racing ahead in this arena, there are differing views on the value of and indications for pre-implantation screening of embryos, based not so much on conflicting data, but interpretation of the data. Reproductive endocrinologists Dr. Richard Paulson and Dr. Richard Scott had a lively debate that included a discussion of the so called “mosaic embryos”, which have a mixture of normal and abnormal cells. If I understood them correctly, the decision to transfer a mosaic embryo should probably be done on a case by case basis.

Genetic Counselors: There were several “shout outs” to genetic counselors and how important they are in view of the increase in testing. For anyone looking for a career, as one doctor stated, “We don’t have enough genetic counselors”.

Interesting dessert!

Sperm quality and miscarriage: Research shows that sperm quality can adversely affect miscarriage rate, and sperm quality does decrease starting at age 45 or 50. A tool on the wish list for RE’s would be a microscope that could visualize the DNA in a sperm without having to open it up and therefore render it unusable. It was one speaker’s opinion that sometime in the future this microscope will be invented.


I often ambush speakers after their presentations to ask them questions that are related to their area of expertise and involve information I often discuss with my patients.

Can endocrine disruptors such as BPA which we are exposed to through plastics, influence the development of endometrioses ? Is there any point in trying to avoid exposure ?

For this question, I ambushed Dr. David Adamson, a reproductive endocrinologist from Stanford who has special expertise and experience in treating endometrioses. He was totally on board with the idea that the endocrine disruption of plastics could be a contributing factor in endometrioses for some individuals. It was good to hear his answer, since as my patients know, I have been preaching for years about the importance of cooking with and eating from glass and stainless steel, as well as avoiding personal care items that contain harmful chemicals.

Why aren’t more of my male patients with varicoceles referred for corrective surgery since it has been shown that many men go on to father children after the problem is corrected? (A varicocele is like a varicose vein in the scrotum that can negatively affect sperm quality)

I didn’t have to ambush Dr. Rodrigo Pagani for this answer as I attended his workshop which was a small group. As a urologist at the University of Chicago and team member at INVIOS, he indicated that he has the same question. He is supportive of “working up” the man when there are male issues rather than going straight to IVF. He said that there probably are men who should be evaluated for surgery if there is a varicocele, and are not being referred. There is even some evidence that correcting the varicocele could positively affect a man’s future health. But he added that unless the varicocele is palpable on exam or painful, surgical correction is not suggested. I also asked him:

Does marijuana have a negative effect on sperm health ?

Dr. Pagani was quick to say YES. Marijuana can cause DNA fragmentation in sperm. It also converts a man’s testosterone to estradiol, which can disrupt endocrine function. With the increasing legalization of marijuana, it will be interesting to see if fertility rates are indeed impacted in users.

Another interesting dessert!

Is CoEnzyme Q10 helpful for enhancing egg quality ?

Dr. Doody said “yes”, probably because this body enzyme increases “ATP” which facilitates the movement of chromosomes between cells as they divide. He said that women under age 36 probably do not need this help. A 400-600 mg dose per day is good, although divide it, because only 200mg can be absorbed at once. Sperm parameters seem to improve with the CoQ10 as well. I was impressed with one of the CoQ10 vendors at the meeting if anyone wants to contact me about that info.

It was nice to hear again that:

Anti-depressants in the SSRI category seem to be generally safe in pregnancy, although some data show there may be some issues. However, Paxil was an exception however and is considered unsafe in pregnancy so it is best to talk with your doctor about switching to a different medication before conceiving if you are taking Paxil (Dr. Marcelle Cedars, UCSF).

Vitamin D levels, pre-conception Vitamin D levels, of greater than 30ng/ml may help to increase pregnancy rates and decrease miscarriage rates. (Dr. William Kutteh)

The National Fertility Support Center, which seeks to educate people about donation of embryos currently has a grant to help with some of the costs of adopting an embryo. Debra Peters, the executive director, said that they are unsure about how long the money will last.


I left the conference with the same feeling I always leave these conferences with—a sense of sadness at the huge industry that has grown up around the need for fertility services. The large hall of exhibitors and vendors offering eggs, sperm, medications, options for genetic testing, financing, equipment needed for IVF, etc. is overwhelming. I am sad because I think of how my patients grew up assuming when they were ready to start a family it would not be this hard, expensive, and complicated. But given the reality of fertility challenges, I am happy that knowledge and options are increasing.

Recipe for Best Purple Food You Will Ever Eat!

Best Purple Food You Will Ever Eat !

Purple Glutinous Rice Pudding

(Khao Neow Dum Ptag)


Similar to the Western Rice Pudding this is a Thai dessert that is very nourishing. In Traditional Chinese Medicine, rice congees are prepared for people when they are recovering from an illness. It is also used to nourish a new mother after she has given birth. Congees are basically overcooked, soupy rice that nourishes because the overcooking of the rice makes it easily digested. Although Thai in origin, this  pudding is similar to a congee.
1 cup purple glutinous rice (not black rice). Ingredients:

Can be found at Asian grocery stores and Larry’s Brown Deer Market.

6 cups water

1/2 cup palm sugar

2 cups coconut milk


Reduce heat to a slow simmer and cook for 45 minutes, until rice is very soft and soupy. Stir occasionally.



1/2 cup coconut cream

1/2 tsp salt

1/4 cup palm sugar

(I sometimes skip making the topping and top with fresh mangoes)


Rinse and drain rice. Place rice in medium saucepan, add water, and heat to boiling.

Add the palm sugar and coconut milk. Stir well and simmer for another 10 minutes.

Combine topping ingredients and pour a small amount over each serving.

Serves 4

Note: Use of Palm Sugar is important. When I have substituted regular white sugar, it does not have the same flavor. An added advantage of palm sugar is tht it has a low glycemic index, meaning it will keep your blood sugar and insulin more even.



High Fructose Corn Syrup and Infertility

We haven’t heard about it in awhile, as its reputation has moved from OK to bad, and now to “controversial”. HCFS as it is known, is sugar that has undergone enzymatic processing to convert some of the glucose in sugar to fructose for added sweetness. Some scientists believe that it can affect the body’s metabolism, which can indirectly affect our metabolism, weight and fertility. The Corn Refiners Association refutes this and claims that HCFS is metabolically no different than plain sugar.  But none the less the association applied to change the name of HCFS to “corn sugar” on food labels. Fortunately the FDA denied this request in May 2012 , stating that “sugar is a solid crystallized food, not a syrup”.

While the food industry often tries to confuse consumers, and researchers cannot agree on the potential negative impact, it is in the best interest of fertility and general health to avoid products made with high fructose corn syrup. If you might be having some infertility problems or will be starting a family soon, read all food labels for the words high fructose corn syrup and avoid them if possible. Note: HCFS can be found in breads, pastas, beer, salad dressings, etc. In products made in Europe, it is legal to list it as “glucose-fructose syrup”.