Conceptions Reproductive Associates of Colorado
| Littleton, CO:303-794-0045    Denver, CO:303-720-7887    Lafayette, CO:303-449-1084    Sky Ridge:303-586-6598 
Fertility Clinic & IVF Doctors near Denver, CO - Conceptions Reproductive Associates of Colorado
Home Page
About Conceptions
Getting Started
Out of Town
Diagnosis & Treatment
IVF Program
Success Rates
Insurance & Financing
Fresh/Frozen Donor Egg
Mind/Body Wellness
Fertility Resources
Contact Us / Maps

Web Part Page Title Bar image
Fertility Resources
Conceptions IVF & Fertility Blog

 NEW BLOG! Greene Guide

Dr. Robert Greene

Egg Freezing 2.0: What Has Changed in Two Years?
How that JAMA study lines up with what we now know. more
Egg Freezing: The Latest Twist on 'Family Planning'
Technology is reshaping the American family. more
Women Getting Pregnant Later AND Aging at a Slower Rate; a review of the data
Most women are aware that their fertility declines more rapidly than other—often more visible—signs of aging. more
Hormone Happenings: Greene Guide's News Recap
Woman gives birth after having ovarian tissue frozen as a child, and more reproductive news. more
Greene Guide: When Patients Misunderstand Miscarriage
Sharing the latest research on miscarriage with our patients is critical. more
Double Embryo Transfer & Two Single Embryo Transfers
Its time to refine our definition of treatment success. more
GreeneGuide: Reducing Ectopic Pregnancy Risk
The pregnancy complication could have a simple solution. more
GreeneGuide: Functional Fertility Foods
Eating soy foods is associated with higher IVF success rates. more

Hormone Happenings: Greene Guide's News Recap
Robert Greene, MD, reviews the latest studies in hormone health. more

Greene Guide: How to Answer Questions About Boosting Fertility
Discussing the impact of diet and lifestyle on achieving healthy pregnancy.  more

Hormone Happenings: Greene Guide's News Recap
Robert Greene, MD, reviews the latest studies in hormone health.  more

Greene Guide: Mining the Latest Fertility Data


This year's CDC/SART report shows a reduction in twin and triplet rates. more

Hormone Happenings: Greene Guide's News Recap


Robert Greene, MD, reviews the latest studies in hormone health. more

Greene Guide: State of the ART


Assisted reproductive technologies are safe and increasingly effective, expert says. more

Be notified about new blog posts by liking us on Facebook: 
Discuss / Ask Questions on:

Provide Comments / Questions directly through our Contact Us Email Form

 Blog - Women's Health & Fertility

FAQ #16 - Weight and Infertility
Obesity is an increasing problem in the United States. It is estimated that approximately 31% of white women, 38% of Hispanic women, and 49% of black women in the U.S. are overweight or obese. Many people are aware of the medical problems that obesity can cause (ie, high blood pressure, diabetes, heart attack to name a few), but many are not aware of the reproductive consequences.

Body mass index, or BMI, is an index of a person's relative "skinniness or heaviness". BMI factors in a person's weight and their height to give an overall "index".

• A standard medical definition of "normal" body weight is a BMI of about 18.5 - 24.9
• A BMI under 18.5 indicates that the person is "underweight"
• A BMI of 25.0 - 29.9 indicates that the individual is "overweight
• A BMI over 30 indicates obesity
• A BMI over 40 indicates morbid obesity

Infertility in obese women is often caused by ovulation problems. Ovulation may be occurring infrequently or not at all. Thus, women may have increasingly irregular, or erratic menstrual cycles or no menstrual cycles at all. However, there is some evidence that this is not the only way that fertility can be affected. Although it is not known for sure, some research suggests that elevated levels of insulin (the hormone that allows the body to use glucose effectively) in overweight and obese women may be another factor which reduces fertility.

Some recently published studies have shown a relationship between BMI and in vitro fertilization success rates. Studies done on women who have undergone IVF have, in general, shown there to be an adverse effect of carrying extra weight on the success of treatment. These studies also indicate a higher risk of early pregnancy loss for overweight or obese women undergoing IVF.

What is known for sure is that obesity increases the risk of many complications of pregnancy, such as preeclampsia, gestational diabetes, and the need for a Cesarean section. These risks increase with increasing BMI. Also, obesity has been linked to an increased risk of birth defects. In addition, there are concerns about the impact that maternal obesity may have on the subsequent development and health of the child.

Women should try to achieve a BMI of

Men are not immune to the impact of obesity on fertility. The greater the BMI, the higher are the chances of low sperm count and decreased motility (movement) of the sperm. Obese men often have higher than normal estrogen levels. Also, the scrotum remains in closer contact with surrounding tissue, thus raising scrotal temperature and abnormalities with sperm. In addition, there is concern that genetic abnormalities that are associated with obesity can also cause infertility in men.

Long story short…there are many reasons, fertility included, to try to maintain a healthy weight. In contrast to many aspects of infertility that you may not have control over (e.g. decreased ovarian reserve or fallopian tube blockage), you CAN take charge of your general health. It is optimal to achieve a BMI of 19-25 prior to pregnancy; however, even small changes in the right direction can have a large impact. Don’t be discouraged by thinking that you have to achieve a large amount of weight loss all at once – every little bit helps.

If you are wondering what your BMI is, ask your nurse (who can calculate it from your height/weight). Or consider looking on the internet for a ‘BMI calculator’ which will give you the answer. If your number is not where you would like it, consider it a potential aspect of health and fertility that you can take charge of!

If your general health and potential pregnancy health are not strong enough motivators, realize that it takes longer for women who are overweight and/or obese to achieve pregnancy. Obese women may require higher doses of more expensive medications and treatments to get there. You may be able to significantly save on the costs of fertility treatment by getting your weight in a good range.

Certainly, lifestyle changes involving a diet and exercise program are the first-line treatment for obesity. If you have questions about where to start, consider asking your doctor for strategies. For those people with a BMI > 30 who are not achieving results with lifestyle changes alone, some medications may be helpful in enhancing weight loss. For people with a BMI >40, weight loss surgery may be a better and more efficacious option.

Addressing weight issues is never easy. Many folks may have already tried weight loss in the past with mixed results. However, the potential benefits for reproductive health are significant. Now is the time to make changes for a healthier you and a healthier pregnancy!
Contact: Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
FAQ #16 - What is Comprehensive Chromosomal Screening (CCS)?
What is pre-implantation genetic screening?

Pre-implantation genetic testing (PGS) or comprehensive chromosomal screening (CCS) analyzes each individual embryo to determine if it has the correct number of chromosomes.

How is CCS / PGS testing accomplished?

To take advantage of CCS, in-vitro fertilization (IVF) must be performed to allow our embryology team to analyze your embryos. Briefly, the ovaries are stimulated with medications and then a retrieval procedure is performed where on average, about 10-15 eggs are retrieved. These eggs are then fertilized and cultured (grown) in the lab for 5 (and sometimes 6) days. Embryos that develop into a high quality day 5/6 blastocyst are then analyzed. To analyze each embryo our embryology team removes a few of the cells (usually about 5) from each embryo’s early placenta, also known as the trophectoderm. These cells are then sent for analysis and testing at an outside company (e.g. Natera© – or IVIGen© – while your embryos remain at our Littleton IVF laboratory.

What are the benefits of CCS testing?

First and foremost higher CCS testing usually means higher live birth rates as demonstrated by a groundbreaking randomized controlled trial in 2013 (Scott R et. al., Fertility and Sterility, 2013). Second, patients who complete CCS testing typically have lower miscarriage rates. Third, CCS embryos have been screened to reduce their risk of having an incorrect number of chromosomes – a phenomenon known as aneuploidy. This means patients who complete CCS testing have a lower (but not zero) risk of diseases related to aneuploidy such as Down’s Syndrome (trisomy 21 or having 3 [instead of the normal 2] number 21 chromosomes. Finally, CCS is cost-effective for both patients with poor egg health (diminished ovarian reserve and /or advanced maternal age status), and conversely, those with high egg health parameters. Patients who are older are at greater risk of aneuploidy (figure 1) and therefore benefit from the testing. Younger women may grow several embryos to the blastocyst stage that appear visually normal but are genetically abnormal.

40 years + 35-39 years 30-34 years
Probability of each
embryo to be aneuploid
73% 48% 35%

Figure 1 – The percentage of day 5 embryos with aneuploidy (an abnormal number of chromosomes) increases with age.

CCS testing often saves most patients the time, expense, and emotional anxiety associated with a negative pregnancy testing or an abnormal pregnancy that results in a miscarriage and then possible surgery. CCS testing also provides couples with an explanation for why previous infertility treatment(s) may not have been successful. Lastly, and most importantly, CCS tested embryos have a very high implantation rate and therefore, a very high pregnancy rate (70-75%). This high implantation rate allows us to transfer a single embryo most of the time which means a low multiple gestation rate (about 1% or less). Because pregnancies with multiple gestations (e.g. twins) have more obstetrical complications this means more healthy babies in our patients’ arms.

What are the risks of CCS testing?

CCS testing, like all other tests is not perfect. For example, when we analyze the early placenta cells (trophectoderm), we assume these cells are identical to those of the actual baby (also known as the inner cell mass). This is true more than 95% of the time but in a few cases, there are exceptions and this is known as cellular mosaicism. Although uncommon, there are both false positive and false negative results associated with all forms of CCS testing. Also CCS testing tells us only about the number of chromosomes, providing no information about individual genes. We encourage all of our patients to take advantage of pre-natal testing guidelines as recommended by the American College of Obstetricians and Gynecologists. Lastly, removal of the trophectoderm cells, when performed on day 5 (blastocyst) embryos does not appear to directly harm the embryo or impair implantation or pregnancy rates. Although possible, it is rare for an embryo to not survive the biopsy process and most experts believe this is a consequence of an abnormal embryo and not the biopsy process.

How is an IVF cycle with CCS testing different from a conventional IVF cycle?

An IVF-CCS cycle takes about 4-6 months to complete from start to a positive pregnancy test. CCS testing of your embryos requires that we freeze the embryos because the testing and results take several days to accomplish and obtain. This separates or de-couples the embryo transfer process from the egg retrieval and lab aspects of IVF. This is positive for several reasons. First, it eliminates the risk of late-onset ovarian hyperstimulation syndrome which makes IVF safer. Second, it allows for more scheduling flexibility – remember: frozen or cryopreserved embryos are essentially in suspended animation and therefore, pregnancy rates do NOT decrease as you age. Lastly, new (and still preliminary and observational) data seems to indicate babies born from frozen embryo transfer cycles have lower rates of pre-eclampsia and small for gestation age (SGA) diagnoses.

What’s The Bottom Line? –

In my opinion CCS testing represents a significant advancement in the treatment of infertility and I strongly encourage you to discuss this with your provider. As always, your treatment and testing should be individualized to your specific situation but it appears that for most patients, CCS translates in to higher live birth rates and more happy families!
Contact: Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
FAQ#15 - What is a Miscarriage?
What is a miscarriage?

A miscarriage is the loss of a fetus before the 20th week of pregnancy. The medical term for a miscarriage is spontaneous abortion. As many as 60% of all pregnancies end in miscarriage; most often before a woman even knows she is pregnant. Greater than 80% of miscarriages occur within the first three months of pregnancy. Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage. Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of the expected period.

What Are the Symptoms of a Miscarriage?

Symptoms of a miscarriage include vaginal bleeding, abdominal/uterine cramping, and either abdominal or back pain.

What Causes Miscarriage?

Most miscarriages that occur in the first trimester are caused by chromosomal abnormalities in the baby. Chromosomes are tiny structures inside the cells of the body which carry genes. Our genes determine all of a person's physical attributes, such as sex, hair color, eye color, and blood type. Most chromosomal abnormalities are the cause of a damaged egg or sperm cell, or are due to a problem at the time that the zygote went through the division process.

Miscarriages can also be caused by infections; lifestyle factors such as smoking, drinking alcohol, excessive caffeine use, and using illegal drugs; environmental exposures to chemicals in the workplace; hormonal problems; uterine abnormalities; and several medical conditions (i.e. Immunological, diabetes, kidney disease, thyroid disease).

In addition, women may be at increased risk for miscarriage as they get older. Studies show that the risk of miscarriage is 15% for women in their 20s and increases to approximately 40% for women at age 40. The increased incidence of chromosomal abnormalities contributes to the age-related risk of miscarriage.

MYTH: Miscarriages can be caused by stress, physical activity (exercise/heavy lifting), or sexual activity. There is no scientific literature that these things will cause miscarriage.

Can I prevent a miscarriage?

Since the cause of most miscarriages is due to chromosomal abnormalities, there is not much that can be done to prevent them. Currently there is no known way to prevent an impending miscarriage. Identifying the cause of the miscarriage may help prevent it from happening again in a future pregnancy. One vital step is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur.

What are my options for treatment?

Unfortunately, there is no way to stop most miscarriages once they have started. When a miscarriage is inevitable or is already occurring , several options are available, depending upon the stage of the miscarriage, the condition of the mother, and several other factors. The three main options are: observation, medical treatment, or surgical treatment.

Observation — Some women having a miscarriage require little treatment. In addition, women who miscarry at less than 12 weeks of pregnancy and have stable vital signs and no signs of infection can often be managed without medical or surgical treatment. An ultrasound should be performed to ensure that the miscarriage is complete.

Medical treatment — In some cases, medications can be given to stimulate the uterus to pass the pregnancy tissue. The medicine can be given by mouth or vaginally, and works over several days. An ultrasound should be performed to ensure that the miscarriage is complete.

Surgical treatment — The conventional treatment for early miscarriage is a surgical procedure called dilation and curettage, or D&C. The cervix (the opening to the uterus) is dilated, and an instrument is inserted that uses suction and/or a gentle scraping motion to remove the contents of the uterus. D&C is generally recommended for women who do not want to wait for spontaneous passage of the pregnancy, and in women with heavy bleeding or infection.


As always, you should contact your physician and discuss your specific causes of miscarriage, chances of miscarriage, and how to have a healthy, successful pregnancy. I hope this information helps!

Sources:,, American Pregnancy Association
Contact: Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
FAQ#14 - Is there a relationship between Stress & Infertility?
It makes intuitive sense that stress should lead to decreases in fertility. It has certainly been observed in the animal model. If you stress animals by crowding them or limiting their access to food, their fertility rates decrease. When you put them in more comfortable surroundings or give them more food, they quickly begin to reproduce normally.

Until recently, there was less evidence about this relationship in humans. A recent study published by Courtney Lynch, Ph.D, and her colleagues at Ohio State University, for the first time documented that stress levels in women were in fact related to how long the women took to get pregnant. The women who had the highest levels of a stress-related hormone when they tried to conceive were twice as likely to experience infertility compared to women who had the lowest levels.

What about women who are not simply trying to get pregnant but are already experiencing infertility (defined as 12 consecutive months of unprotected intercourse without a pregnancy)? Most of the research does show that the more stressed the woman is when she begins treatment, the less likely she is to conceive. It is a difficult field to research however, since there are so many contributing factors. For example, a 26 year old female with normal hormone levels will likely report far less stress than a 42 year old whose hormone levels indicate that she is approaching menopause. The 26 year old is also more likely to get pregnant from treatment since in most cases, her eggs will be healthier. So if the 26 year old reports less stress and then gets pregnant, did she get pregnant because she was less stressed or did she get pregnant because she had more normal eggs? I don’t think there is an answer to this question.

It doesn’t really matter, since reducing stress is a good idea for several reasons. First, infertility is incredibly stressful. Women who are experiencing infertility report the same levels of anxiety and depression as do women with cancer, HIV+ status, or heart disease. It is a very challenging time; the infertile couple is surrounded by fertile family and friends who get pregnant easily and talk nonstop about their pregnancies and babies. These women likely don’t feel comfortable telling their employers and therefore make up constant excuses to explain frequent work absences to make it to doctor’s appointments. Their sex life suffers since they are basically told by their doctor when they should and should not be having intercourse, and many begin to associate sex with failure. Finally, infertility treatment is not covered by many insurance companies, is only mandated in a handful of states, and treatment can cost thousands of dollars per cycle. It is no surprise that most individuals have depressive feelings as they pursue fertility treatments, contributing to more stress.

Reducing stress not only can make the whole process more bearable, but may help couples cope far better with the rigors of treatment. Women who are depressed before they start infertility treatment are far more likely to drop out of treatment after only one cycle, thus limiting their chances of getting pregnant. In addition, there have been numerous studies which have shown that women who learn specific stress-reduction skills become less anxious and depressed, but also have increased pregnancy rates.

Some of the best ways to relieve stress during infertility are to increase social support and learn specific ways to cope. Infertility can be so isolating, which tends to happen since most people don’t tell anyone they are going through it. Connecting with other women in a similar situation is incredibly helpful. One of the best ways is through Resolve, the National Infertility Organization. Resolve offers support groups throughout the USA as well as an incredible amount of online support via their website. At Conceptions, we offer fertility support groups sessions if you are looking to connect on a more personal level. It might surprise you how much better you can feel after simply hearing someone else voice the feelings you thought only you were experiencing.

Another important way to feel better is to learn specific skills, designed to decrease stress and increase a sense of control. There is a lot of research on mind/body groups, which combine social support as well as very specific skills acquisition training on stress reduction. Research shows that women who attend a mind/body group not only see their level of depression and anxiety return to normal, but also double their chance of pregnancy.

Remember: most couples don’t handle the emotional aspects of infertility in the same way. Don’t try to convince your partner to feel the way you do. You are each coping in the best way for you. Respect each others’ coping style. Infertility is not a permanent crisis. Most people who receive treatment do indeed conceive a healthy baby. Infertility will not have a permanent negative impact on your quality of life, believe it or not.
Contact: Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
FAQ#13 - What is Tubal / Pelvic Adhesive Disease?
Pelvic adhesive disease (scar tissue in the pelvis) and problems with the fallopian tubes are a cause of infertility in about 25% of patients seeking care at fertility clinics. These conditions contribute to / cause infertility because they prevent normal transport of the egg, sperm, and embryo through the fallopian tubes.

There are many causes of pelvic adhesive and fallopian tube disease but pelvic infections, endometriosis, and scar tissue / damage from prior surgery explain most causes. Pelvic infections arise from a number of causes including sexually transmitted disease, appendicitis, and inflammatory bowel disease such as Crohn’s disease or ulcerative colitis. It is important to note that about 1 in 3 women who have had a sexually transmitted infection were not aware of the infection and therefore, may not be aware they at risk for fallopian tube problems. Endometriosis, discussed in a separate post, causes inflammation in the pelvis and disrupts normal tubal anatomy.

Assessment of the fallopian tubes can be accomplished via three methods: 1) hysterosalpingogram (HSG) 2) hysterosalpingo-contrast sonography (ultrasound) and 3) laparoscopic surgery. The most common method to assess tubal patency is the HSG which uses contrast dye and an X-ray to evaluate the fallopian tubes. In a similar manner, using air bubbles, ultrasound can evaluate the fallopian tubes. Lastly, surgery along with the instillation of colored dye (chromopertubation) through the fallopian tubes can assess not only the fallopian tubes but also evaluate the pelvis for endometriosis and the presence of scar tissue. HSG is rarely useful for the detection of scar tissue and / or endometriosis. If a tubal obstruction is noted, it is important to identify the size and location as obstructions close to the uterus (proximal) are often due to tubal spasm or mucus and are not “true” tubal blockages. Obstruction farther away (more lateral, distal) from the uterus tends to represent concerning tubal problems.

Treatment for tubal disease depends on a number of factors including severity and location of disease. IVF is by far the most effective therapy for tubal disease as it eliminates the need for fallopian tubes. In fact, the first attempted IVF cycle in the United States was a patient with bilateral tubal disease. Surgery and ovulation enhancement (assuming at least one fallopian tube is open) are less effective but also reasonable treatments that may be considered under some circumstances. Lastly, patients with tubal disease are at increased risk for an ectopic pregnancy within the fallopian tubes. Patients with tubal problems who become pregnant must be followed closely early in pregnancy until the location of the pregnancy can be confirmed.
Contact: Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
FAQ#12 - What is Male Factor Infertility?
Male factor infertility represents 35% of all infertility cases and the diagnosis is made by the presence of abnormal parameters on a semen analysis. A semen analysis has four main parameters, which include the volume 1.0-5.0 mL), count (≥ 20 million/mL), motility (active/forward moving sperm ≥50%) and morphology (normal appearance ≥14% by Kruger’s criteria and >30% by the old WHO criteria). Male infertility can be divided into three major categories that include: abnormalities of sperm production, abnormalities of sperm function, and obstruction or absence of the ductal system. Unfortunately, majority of male factor infertility is idiopathic (cause unknown).

Abnormalities of the sperm production can be due to testicular failure (Y chromosome microdeletions or Klinefelter’s syndrome), damage to the testes, toxins, radiation, infections, insufficient hormone production from the pituitary gland (FSH and LH) and use of androgenic compounds such as testosterone. Abnormalities of sperm function can be due to an infection of the genital tract (prostatitis), varicocele (an enlargement of the veins in the scrotum), anti-sperm antibodies, failure of sperm to attain fertilization potential ( commonly known as the ‘acrosome reaction’) and failure of sperm to bind and penetrate the egg. Obstruction of the ductal system includes prior vasectomy, blockage of the ejaculatory or epididymal ducts and absence of the vas deference from birth.

A semen analysis should be done after 2-5 days of abstinence. If abnormal, it should be repeated for confirmation of the abnormal parameters and in the absence of sperm (azoospermia), urological evaluation is recommended. Semen analysis provides quantitative information about the sperm, and in some men with normal semen analysis, quality of the sperm may still be compromised.

A recently developed test called the sperm DNA integrity assay (SDIA) or sperm chromatin structure assay (SCSA) has been used to diagnose those cases of possibly unidentified male infertility with normal semen analysis. SDIA is a helpful tool for measuring clinically important properties of sperm nuclear chromatin integrity. There are two components to this test, including the DNA Fragmentation Index (DFI) and high DNA stainability (HDS). Less than 15% of fragmentation and stainability are considered normal for either component and levels above 30-40% have been reported to rarely result in a live birth. SDIA has been shown to predict infertility and poor reproductive performance as it measures DNA damage. The DNA damage analysis may reveal a hidden abnormality of sperm DNA in infertile men classified as unexplained based on apparently normal standard sperm parameters.

If a man has a low sperm count, an endocrine evaluation is recommended. Hormones that are typically tested include FSH, LH, estradiol, testosterone, prolactin and TSH levels. Any abnormality in the levels of these hormones requires further assessment and patients are commonly referred to an urologist who specializes in male infertility for further work up and management. Genetic evaluation of men with low sperm count is also recommended after an initial evaluation to rule out any obstruction in the male genital system. Once an obstructive cause is ruled out in a patient with less than 5 million sperm per milliliter, a full chromosome analysis and testing for the Y chromosome microdeletions is warranted.

Although most men with abnormal semen parameters have a normal workup and the cause is unknown, some may have hormonal abnormalities for which medical treatment may be beneficial. One of these endocrinological disorders presents with low FSH, LH and testosterone levels suggesting that the gland in the brain called the pituitary gland is not releasing FSH and LH hormones that are necessary for sperm production. This is a condition called hypogonadotropic hypogonadism and such cases can be treated with clomiphene citrate to increase the production of LH, GnRH administration, gonadotropins, and HCG. In men with elevated levels of prolactin, a magnetic resonance imaging (MRI) of the brain is necessary to rule out a tumor. These cases are typically treated with medications called bromocriptine or cabergoline. In men with thyroid abnormalities, thyroid function is normalized with medications and reproductive hormones are also expected to improve with adequate sperm production. Testicular failure may be diagnosed by elevated levels of FSH and/or LH along with low levels of testosterone. Medical or surgical treatment is generally not successful and donor sperm is often times utilized to achieve a pregnancy. Alternatively, sperm can be obtained from the testicles by a biopsy and used in conjunction with an IVF and ICSI (intracytoplasmic sperm injection) procedure, although if there is no sperm found at the time of the biopsy, donor sperm becomes the only option.

Varicocele (dilation of the veins in the scrotum) can be associated with male infertility and poor semen parameters. In the general population, the prevalence of varicocele is approximately 15% (and about 40% in infertile men). Varicocele repair is indicated in men with large varicoceles that are apparent on physical examination with abnormal semen parameters who also desire fertility. Semen quality generally improves with surgical treatment especially in cases of large varicoceles, but the results achieved with varicocele repair vary greatly and significant evidence for improved fertility is still lacking. Other treatment options for men include intrauterine inseminations (IUI), IVF with or without ICSI.

In vitro fertilization (IVF) along with intracytoplasmic sperm injection (ICSI) offers the best treatment option for all male factor infertility cases regardless of the severity, but should not suggest that all male factor infertility cases be treated with IVF. In mild forms, IUI treatment is acceptable especially in early infertility cases with no other identifiable cause. This is a relatively inexpensive treatment method for mild cases, but it is not beneficial in cases of moderate to severe male factor.

When sperm cannot be collected through ejaculation or there are few or no viable sperm, a variety of sperm retrieval techniques can be used to obtain sperm for IVF/ICSI. Microsurgical epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) are procedures involving the introduction of a thin needle directly into the epididymis or the testicle under anesthesia to obtain sperm for IVF/ICSI procedure. Sperm are extracted from the tissue and each egg is injected with a single sperm using the ICSI technique. It is most commonly utilized in cases of spermatic duct occlusion or absence, but can also be performed in cases of ejaculatory dysfunction, such as spinal cord injuries, after prostatectomy or in cases of intractable male impotency. TESE or MESA is simple, relatively low-cost and offers fast recovery.
Contact: Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
Endometriosis is the presence of endometrial tissue (glands and stroma) outside of the uterus.   Although several theories exist to explain this finding, most experts believe endometrial tissue flows in a retrograde (reverse) direction from inside the uterus, through the fallopian tubes, and into the pelvis and abdomen.
Patients with endometriosis have variable symptoms.   For example, many patients with endometriosis have no symptoms and are therefore unaware that they have the condition.  However, many patients do have symptoms of endometriosis - commonly patients suffer from pelvic pain and infertility.  Endometriosis can be found practically anywhere but is often found on the ovaries, fallopian tube(s), bowel, and on the surfaces within the pelvis.  Interestingly, endometriosis has even been found in the lungs and brain.
Endometrial tissue outside of the uterine cavity remains hormonally receptive and active.   As women experience menstrual periods, the endometrial tissue, commonly referred to as implants grows, secretes fluid, and often causes inflammation and the development of scar tissue.   Scar tissue development can interfere with pregnancy by limiting the mobility of the pelvic structures such as the fallopian tubes and ovaries.   Endometriosis can damage one or both fallopian tubes due scar tissue formation or the deposition of endometrial implants on or near the fallopian tubes.   Endometriotic implants, inflammation, and scar tissue formation also often cause pelvic pain and painful menstrual periods.
Technically, endometriosis is diagnosed using a microscope by a pathologist after examining a small tissue biopsy obtained by your doctor during surgery.   However, many patients do not undergo surgery or do not have a biopsy performed.  Often, endometriosis is diagnosed by surgical visualization and evaluation of your pelvis; surgery also allows your doctor to attempt to "treat" endometriosis at the time of surgery.   Although endometriosis has a variable appearance, it is often dark and is often described as having the appearance of gunpowder in medical textbooks.   Occasionally, endometriosis will cause the development of a cyst filled with endometrial tissue on or within the ovary referred to as an endometrioma.   

As always, treatment(s) should be individualized and we recommend you discuss treatment options and considerations with your doctor.   Mild to moderate endometriosis may be treated with laparoscopic surgery that attempts to address abnormal scar tissue and restore normal anatomy.   Although studies are limited, most patients will receive a modest improvement in pregnancy rates (3-6 % per month) after surgical treatment of mild endometriosis.   Unfortunately, surgery can cause new scar tissue formation and/or the development of new endometriosis can occur.  By far, the most effective treatment for endometriosis is in-vitro fertilization (IVF).   Patients with severe endometriosis may want to consider IVF as an early treatment option due to its effectiveness in helping patients with endometriosis achieve pregnancy.
Contact: Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
FAQ #10 - Ovarian Reserve & Egg Health
As women age, the number and quality of their eggs (oocytes) naturally declines.   In fact, the ovaries are populated with the highest number of eggs at about 28 weeks gestations – months before birth occurs.  Over time, eggs are lost through a normal process called atresia.  By the time females experience their first menstrual period, the majority of their total egg count is depleted from about 6 million to several hundred thousand.  When menopause occurs only about 1000 total eggs remain.
The age of each patient, their social habits (smoking for example), medical and surgical history, and most importantly their “genes” determines their overall egg health.  Although fertility specialists don’t always agree, most of us define egg health (technically called ovarian reserve) as a combination of potential egg quantity (How many eggs can be obtained in an IVF cycle, for example?) and egg quality (How likely will the eggs combine with the sperm to produce a genetically normal embryo and then a healthy baby?). 
Egg health can be estimated in a number of ways and in general, more than one method should be applied to each patient.  Overall, maternal age continues to be the best predictor of each couple’s chances of success. However, within age groups, significant variations in ovarian reserve do occur - not all 38 year old females have the same chance of success with a given fertility treatment each month.  Hormone testing and ultrasound evaluation are the most practical and accurate methods for the estimation of each patient’s egg health.  Anti-Mullerian hormone (AMH), which is relatively stable throughout the menstrual cycle, has the best performance characteristics for the prediction of live birth and is convenient for patients since it can be drawn at any time.  FSH (follicle stimulating hormone) and estrogen levels are also hormone tests used to estimate egg health.
Ultrasound is also often used to evaluate ovarian reserve.  Ultrasound visualization of each ovary allows small, early follicles (each small follicle contains an egg) to be counted.   This is often referred to an antral or resting follicle count.  Higher numbers usually indicate overall better egg health and a more significant potential response to fertility treatment(s).  Please, be aware that the antral follicle count is reflective of your egg health and does not accurately predict the exact number of eggs that remain in each ovary (an antral follicle count of 12 does NOT mean only 12 eggs remain to achieve pregnancy). 
Patients with diminished ovarian reserve or poor egg health are often treated with medications that “encourage” the ovaries to produce more than one egg.  IVF, for example, utilizes injectable medications that act on each ovary to facilitate the aspiration (collection) of multiple eggs at the time of egg retrieval.  IVF also allows for the genetic testing of each embryo to determine that it has the correct number of chromosomes.  Some supplemental vitamins are being studied with regard to their potential effect on egg health.  Androgens such as DHEA and testosterone as well as the vitamin CoQ10 may help “fortity” the eggs within the ovaries.
Measures of ovarian reserve and egg health are not perfect but they are useful for determining why some couples struggle to conceive, counseling patients regarding treatment outcomes, and designing optimized, cost-effective and safe treatment plans.
Contact: Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
FAQ #9 - Infertility and Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is arguably one of the most common causes of infertility in our patient population - about 10% of the patients carries the diagnosis of PCOS. Patients with PCOS often suffer from infertility, unwanted hair growth and acne, sleep disorders, diabetes, and irregular menstrual periods.

Diagnosis of PCOS is done with 2 or more of the following findings: irregular menstrual periods (a sign of lack of ovulation), unwanted hair growth and acne (technically known as hirsutism) and abnormal ultrasound findings which demonstrate enlarged ovaries and /or ovaries filled with small follicles which contain “trapped” eggs.

Treatment for PCOS should be individualized and depends on the goal(s) of the patient. Diet and exercise improve the frequency of ovulation, improve fertility, lower the risk of diabetes, and decrease androgen (male hormone) levels. Patients who desire fertility often benefit from oral and injectable medication(s) to promote egg development. These medications are usually well-tolerate but can, especially in the case of injectable therapy, increase the risk of multiple pregnancy. Insulin sensitizing agents such as Metformin (Glucophage ®) are oral medications that also may improve ovulation.
Contact: Schedule Appt or Ask Questions at 303-794-0045 or Email Us on our Contact Us page
FAQ #8 - What Happens at your Initial Infertility Consultation?
Because there are many causes of infertility getting to know you and your partner’s medical and fertility history along with some testing is critical.  Each patient’s / couple’s clinical situation is unique so testing and then treatment must be individualized to your unique circumstance(s).   In general, we usually evaluate 1) the ovaries 2) the fallopian tubes and 3) the sperm.

Eggs and ovulation – Because an egg must be available to combine with the sperm it is important to determine if you are ovulating.  Secondly, using a number of methods, we will often assess your overall “egg health”.  This is usually accomplished with blood tests and an ultrasound evaluation of the ovaries.

The fallopian tubes – Your physician may want to determine if your fallopian tubes are open, also known as patency.   The most common test to evaluate the fallopian tubes is the hysterosalpingogram which uses contrast dye and an x-ray machine to assess the contour of the uterine cavity and the patency of the fallopian tubes.

The sperm – A semen analysis is perhaps the most cost-effective component of the fertility tests as about 40% of couples present with some form of male infertility.   Analysis of the sperm using a microscope and computer evaluation will assess many aspects of the semen and sperm.   In general, we focus on the number (concentration), motility (mobility) and the morphology (shape) of the sperm.
Using the information from our discussions with you as well we the results from your testing, we can formulate an individualized cost-effective and time-efficient fertility treatment plan to quickly and safely help you expand or grow your family.
Contact: Contact Conceptions Fertility Clinic at 303-794-0045 or view our contact us page
FAQ #7 - What Happens If My IVF Cycle Fails?

No one likes to consider the possibility of an IVF cycle not resulting in pregnancy. The reality is, however, that at least 30-40% of the time, it will not. After the emotional dust settles, it is very important that we sit down and critically review the treatment cycle to try to learn more from the experience. We call this a “failed cycle meeting”. A failed cycle meeting is just as important as the actual treatment cycle. In the meeting, all aspects of the treatment cycle will be reviewed.

The review should evaluate both embryonic reasons for IVF failure and environmental reasons:

Embryonic reasons will evaluate any potential problems with the eggs, sperm and/or embryos that might have resulted in the lack of pregnancy or miscarriage. Things such as the protocol (medications and dosages used), number of follicles, estrogen levels, size of follicles at the time that hCG was given, number of eggs obtained, egg maturity, fertilization rate, percentage of embryos that progress to blastocyst (implantation stage, typically day 5 or 6 of embryonic life) and quality of the blastocysts (this can include genetic testing of embryos- called complete chromosomal screening (CCS)). Problems in this area might be due to egg quality or the type of stimulation utilized.. Sometimes, adjustments can be made to the stimulation protocol that might ultimately improve embryo quality and pregnancy outcome.

Environmental factors are also an important aspect of the failed IVF cycle meeting. This area will include things such as the preparedness of the uterus (endometrial thickness and structure), immune factors (including both autoimmune and alloimmune problems) as well as the embryo transfer. Immunologic factors can be tested using parental blood and might include tests such as antiphospholipid antibodies.

These areas will be discussed openly and honestly so that any future IVF attempts can be revised to improve the chances of a positive outcome. The point here is to have an opportunity to put our heads together, and allow you to ask questions in order to improve the chances for pregnancy on your next IVF attempt.

Contact: Contact Conceptions Fertility Clinic at 303-794-0045 or view our contact us page
National Infertility Awareness Week (NIAW) - April 21-27, 2013

Infertility is a disease affecting one out of every six couples in the United States, 7.3 million nationally. Are you suffering or know someone who is suffering with infertility? Infertility isn't whispered about between girlfriends anymore, infertility is A REAL disease and needs to be talked about. Women are not the only ones affected by infertility 30-40% of males are affected by the disease as well.

  • If you are 35 or older, have you been trying to conceive for more than 6 months without success?
  • If you are under 35, have you been trying to conceive for a year or more without success?
  • Have you had two or more miscarriages or pregnancy loss?
  • Has your spouse or partner been tested for fertility problems?
  • Do you suffer from painful periods or irregular periods?

If you answered Yes to 1 of the above questions talk with your Women’s Health Care provider to discuss your treatment options.

Help is available; speak with someone who cares.


For additional infertility information visit American Fertility Association.

For information on NIAW visit RESOLVE.

Contact: Contact Conceptions Fertility Clinic at 303-794-0045 or view our contact us page
Introducing the NEW Heart to Heart patient video essay contest!
This contest is open to infertility patients who achieved their dream of parenthood with a little help from
BRAVELLE® (urofollitropin for injection, purified), MENOPUR® (menotropins for injection, USP), and/or other
qualifying Ferring fertility products, in an assisted reproductive technology (ART) cycle.
To enter, the patient must submit a video entry that creatively tells the patient’s story of success with
qualifying Ferring fertility products.
• Grand prize: $15,000 educational fund (as a 529 or similar savings plan)
• Four runners-up: $2000 educational fund (as a 529 or similar savings plan)
Contact: Enter the Contest at

It is estimated that 140,000 people under the age of 50 are diagnosed with a malignancy each year in the United States.  The good news is that cancer survival rates are higher than they have ever been, likely as a result of early detection programs and advancements in treatment protocols.  Patients with cancer are now able to live substantially longer and lead more productive lives.  Therefore, quality of life issues, such as maintaining fertility potential, have become important areas of research.  It is well known that surgery, chemotherapy, and/or radiotherapy administered during the adolescent or reproductive years can leave cancer survivors unable to fulfill their desire for having a family. 

The American Society of Clinical Oncology released specific recommendations on fertility preservation in cancer patients to improve the information flow to the reproductive community.  It states, “As part of informed consent prior to therapy, oncologists should address the possibility of infertility with patients as early in treatment planning as possible.   As part of education and informed consent before cancer therapy, oncologists should address the possibility of infertility with patients treated during their reproductive years and be prepared to discuss possible fertility preservation options or refer appropriate and interested patients to reproductive specialists”.  The problem lies in that a majority of oncologists do not discuss this issue at diagnosis routinely or patients feel the information they received was inadequate.   Therefore, many patients do not realize until it’s too late that their fertility potential is diminished or completely absent.

The challenge, as reproductive specialists, is meeting the unique needs of cancer patients and survivors.

Role of the Reproductive Specialist
As a fertility specialist, I will primarily see two types of cancer patients:  newly diagnosed patients and long-term survivors.  Newly diagnosed patients will be seeking assistance with fertility preservation methods before the initiation of cancer treatment.  Cancer survivors may require assistance in order to have a child after treatment or remission of their cancer.  The needs of these patients are distinct from those of your standard infertility patients;  therefore, require modifications to my standard practices.

Newly diagnosed cancer patients are dealing with a shock and emotional distress inherent to their cancer diagnosis.  Then, as reproductive specialists, we give a second traumatic shock for these patients to consider:  their possible infertility.  These patients will likely need increased emotional support and sensitivity from those around them.

These patients will also have a short period of time in which he or she will be able to undergo fertility preservation techniques:  time is of the essence.  Discussion at the earliest possible opportunity is encouraged to allow patients fullest range of options.  For example, several patients will have approximately two to six weeks between surgery and adjuvant therapy, which may be an opportune time for fertility preservation.  Others may have less time;  therefore, not meeting eligibility requirements for standard fertility procedures.  Patients, especially female patients, must be counseled in an expedited fashion in order to afford them their full range of fertility preservation options.

It is important for patients to understand treatment effects and the possible impact on future fertility options.  Communication is a key component in the care of these individuals. 

Visit our Fertility Preservation for Cancer page for resources and information on making an appointment to discuss your individual fertility needs.

Contact: Contact Conceptions Fertility Clinic at 303-794-0045 or view our contact us page
FAQ #5 - Egg Health Testing and Diminished Ovarian Reserve (DOR)
At birth, women have 1-2 million eggs.  This number slowly decreases throughout life.  At puberty, a woman has approximately 250,000 eggs, in her 20's this number decreases to 100,000, in her 30's it's down to 10,000, in her 40s as low as 1,000, and by the time she reaches menopause she will have no functional eggs left.  As these numbers decline, so does the quality of those eggs.  As a result, the ability to become pregnant decreases and the rate of miscarriage increases as a female ages. For example, a classic French study done with women using donor sperm showed a 74% pregnancy rate with up to 12 inseminations for women younger than 31 years old versus 54% for women over 35.  Similar trends are seen with embryo transfers resulting in live births, 44.9% for women under 35 and 26.6% for women 38-40 years old. The rate of miscarriage also increases as women age from 11.4% in women 33-34 years old compared to <45% for women 41-42 years old. For this reason, it is very important to evaluate egg health in trying to become pregnant, especially if you are over 33 years old, have unexplained infertility, have menopausal symptoms (such as shortened menstrual cycles or hot flashes), or have had previous ovarian surgery.
In the early follicular phase of a woman's menstrual cycle, specific hormones can be measured in the blood to provide an approximation of how many eggs the ovaries have and if they are still healthy.  Follicle Stimulating Hormone (FSH) and Estradiol levels are measured by a simple blood draw.  Elevated levels of FSH and Estradiol, during this time, can indicate a decreased ability to achieve live birth compared to someone with normal levels at the same age.
There is one other blood test that can be drawn at any time during a women's cycle that corresponds to egg health.  This blood test is an anti-mullerian hormone (AMH) level.  AMH is released by the granulosa cells of the follicles, so it corresponds to the antral follicle count.  In general an AMH level >2 is normal with healthy ovarian reserve and <1 suggests poor egg health or diminished ovarian reserve. 
A transvaginal ultrasound can also be done in the early follicular phase to count the number of small follicles (2-10mm in size) on each ovary.  The number of these follicles reflect underlying egg supply and the ability of those eggs to be recruited for ovulation.  Lower resting or antral follicle counts correspond with decreased egg health and diminished ovarian reserve.
The evaluation of egg health and identification of diminished ovarian reserve can provide good insight as to a woman's chances of becoming pregnant and the likelihood of having a miscarriage, assuming other factors that effect fertility have been evaluated and are within normal limits.  It can also guide providers to select appropriate fertility treatments and plan what is best for that patient.  For patients with DOR, unfortunately it is not reversible.  However, there are some treatment options.
 1) DHEA, a medication that helps make eggs more responsive to recruitment
 2) In vitro fertilization with genetic testing of embryos prior to transfer
 3) Donor egg in vitro fertilization (IVF)
For this reason, egg health testing is a crucial part of the infertility work up and plan.   
- ASRM  and ACOG.  Age-Related Fertility Decline.  Fertil and Steril 2008
- ASRM, Egg Health Testing
- ASRM Practice Comittee.  Aging and Infertility in Women.  Fertil and Steril 2006
- ASRM, Prediction of Fertility Potential (Ovarian Reserve) in Women
- Strauss III and Barbieri, Yen and Jaffe's Reproductive Endocrinology, 5th ed. 2004
Contact: Contact Conceptions Fertility Clinic at 303-794-0045 or view our contact us page
FAQ#4 - Nutrition and Infertility

One's overall health and well being certainly plays an important role in infertility and trying to conceive.  Doing things to improve one's health, such as exercising, changing your diet and taking supplements can help to increase your ability to become pregnant.   




Decreasing inflammation in the gut and throughout the body, provides a more ideal place for conception to occur.   This can be done by eating a diet that is limited in processed foods and junk food, and by eating more olive oil, nuts, seeds, oily fish, pasture-fed meat, and live yogurt (or probiotic supplements).  All of which have been shown to decrease inflammation throughout the body.


Nutritional supplements, specifically one's that contain chasteberry, L-arginine, vitamins (including folate) and minerals, have been shown to improve pregnancy rates and could be used in conjunction with conventional infertility therapies. 


Avoiding caffeine, alcohol and tobacco not only improves fertility, but prepares women for pregnancy when those things should be stopped completely. 


Being overweight can also contribute to infertility.  Improving your diet and exercising to decrease your body weight by as little as 5% can improve infertility significantly.   




Studies have shown that a diet consisting of fish, chicken, fruits, vegetables, and whole grains improved motility up to 11% compared to those who eat red or processed meat, refined grains, snacks and sweets.  However, red meat is also rich in carnitine, vitamins, iron, protein, and natural animals fats, all of which are are important to overall health, so cutting it out of the diet completely may not be necessary.


There is also evidence that a diet high in trans fats, such as margarine, hydrogenated vegetable oils, and to a smaller extent in meat and dairy products, leads to an increased level of trans fatty acids in sperm, which is related to lower sperm concentration. 


Drinking alcohol and smoking marijuana or tobacco can also decrease sperm count and motility, so this should be eliminated while trying to conceive. 


Certain dietary supplements, such as L carnitine, Acetyl L carnitine, CoEnzyme Q10, Vitamin E and Selenium have also been shown to improve sperm count, morphology (shape) and motility.  More importantly, a 2004 study showed increased pregnancy rates with infertile men that used these vitamin supplements (21.8%) versus placebo (1.7%).  These are even available in a single supplement, called Proxeed.  



  • Agarwal A, Nallella KP, Allamaneni SS, Said TM. Role of antioxidants in treatment of male infertility: an overview of the literature. Reprod Biomed Online. 2004 Jun;8(6):616-627. Review. on web 7 April 2004. 
  • Balercia G, et al..  Placebo-controlled double-blind randomized trial on the use of L-carnitine, L-acetylcarnitine, or combined L-carnitine and L-acetylcarnitine in men with idiopathic asthenozoospermia. Fertil Steril. 2005 Sep;84(3):662-71
  • Beauchamp G, et al. Ibuprofen-like activity in extra-virgin olive oil. Nature 2005;437.
  • Cavallini G, Ferraretti AP, Gianaroli L et al. Cinnoxicam and L-carnitine/acetyl-L-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermia. J Androl. 2004 Sep-Oct;25(5):761-770. 
  • Chavarro, et al. Trans fatty acid levels in sperm are associated with sperm concentration among men from an infertility clinic. Fertil Steril. 2011 Apr;95(5):1794-7. Epub 2010 Nov 11
  • Collier-Hymans LS and Neish AS. Innate immune relationship between commensal flora and the mammalian intestinal epithelium. Cell Mol Life Sci 2005; 62-1339-48.
  • Crawford MA, et al. Comparative studies in fatty acid composition of wild and domestic meats. Int J Biochem 1970;1(3):295-300.
  • Gaskin, et al. Dietary patterns and semen quality in young men. Hum Reprod. 2012 Oct;27(10):2899-907. Epub 2012 Aug 11 
  • Menchini-Fabris GF et al. Free L-carnitine in human semen: its variability in different andrologic pathologies. Fertil Steril. 1984 Aug;42(2):263-7.
  • Sheil B, et al. Probiotic effects on inflammatory bowel disease. J Nutri 2007;137:819-24S
  • Wall R, et al. Fatty acids from fish, the anti-inflammatory potential of long-chain-fatty-acids. Nutri Rev 2010;68:280-9.
  • Westfall LM, et al. Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women. Clin Exp Obstet Gynecol. 2006;33(4):205-8.  
Contact: Contact Conceptions at 303-794-0045 or view our contact us page
FAQ #3 - What is Polycystic Ovarian Syndrome (PCOS)?

What is PCOS?

PCOS is a very common endocrine disorder where there is an imbalance in the female sex hormones.  These imbalances lead to problems with ovulation, excess androgens or masculinizing hormones and insulin resistance.  As a result, someone with PCOS might struggle with irregular periods, difficulty becoming pregnant, acne, abnormal hair growth, obesity, elevated cholesterol, and type 2 diabetes.  However, not every women with PCOS will exhibit all of these symptoms.  Irregular periods or difficulty getting pregnant could be the only signs.  PCOS also appears to be a genetic disease, as there is increased incidence in women with a mother or sister who have PCOS. 


How is PCOS diagnosed?

According to the Rotterdam criteria, the diagnosis of PCOS is made if you exhibit at least 2 of the following criteria.   

1) Irregular periods (>38 day cycle length) or lack of periods

2) Polycystic ovaries on ultrasound (enlarged ovaries with multiple small cysts, often times they are distributed along the edge of the ovary in a row giving a "string of Pearls" appearance)

3)  Hyperandrogenemia (elevated levels of free or total testosterone) OR signs of hyperandrogenism, such as acne and hirsutism (dark coarse hairs in male pattern areas, such as chin, chest or abdomen).


We also need to rule out other etiologies for these signs and symptoms, such as high prolactin levels, abnormal thyroid function, androgen secreting tumors, and congenital adrenal hyperplasia, another endocrine disorder.  


Additionally, once you have been diagnosed with PCOS, you are at increased risk for elevated cholesterol, diabetes, heart disease, sleep apnea, and endometrial cancer and need to be monitored more closely for these things. 


How does PCOS relate to infertility?

Ovulation, which requires precise elevations of LH and FSH from the hypothalamus at precise times, gets disrupted in PCOS because there is an imbalance of these female sex hormones.  Women with PCOS ovulate infrequently and sometimes not at all.  As you remember from our initial blog about conception and infertility, one of the requirements for conception to occur is that ovulation must be occurring (releasing of an egg each month).  Thus, women with PCOS may have a difficult time getting pregnant. 


What is the treatment for PCOS?

There isn't one treatment for PCOS; instead there are multiple treatments that help with the effects of PCOS.

1) Birth Control Pills:

If you aren't trying to become pregnant, birth control pills can be used to treat irregular periods, making them regular.  They also help improve acne and slow hair growth. 

2) Exercise and Weight loss:

A decrease in body weight by even as little as 5%, can help decrease the effects of PCOS, including anovulation, insulin resistance, and  hyperandrogenism.

3)  Metformin: This medication decreases both liver glucose production and intestinal glucose absorption.  It is also an insulin sensitizer that makes glucose more sensitive to breakdown by insulin.  Metformin may help slow the progression of pre-diabetes to overt diabetes.  It also decreases LH and free testosterone levels, and increases SHBG.  All of these things help restore the normal balance of female sex hormones, improving menstrual function, with more regular periods and ovulation.  Metformin is not typically used alone as a first-line fertility medication as it was not shown to improve live birth rates compared to the medication Clomid (Legro, 2007).

4)  Spironolactone:

This is an antiandrogen that can be helpful in preventing the excessive hair growth.  This medication can be harmful to a growing fetus, so it is imperative that a woman on this medication isn't pregnant.

5)  Clomid or other medications that induce ovulation:

This can be used alone or in conjunction with Metformin to help induce ovulation in women with PCOS who are trying to become pregnant.  (see our last blog for more information about Clomid).

6)  Other treatments, such as laser hair removal, acne medications, and medications to treat high cholesterol levels or diabetes may be indicated. 


Legro, et al. New England Journal of Medicine, 2007.

Contact: Contact Conceptions at 303-794-0045 or view our contact us page
FAQ #2 - What about Clomid?
Clomiphene Citrate (Clomid)
Many women undergoing fertility treatment inquire about clomiphene (commonly referred to by the trade name, Clomid).  Clomiphene has been around for many years and depending on a woman’s age and fertility testing, is often viewed as first-line treatment for infertility.  This drug is considered an “agonist-antagonist”, meaning it acts like estrogen in some parts of the body and acts like an estrogen blocker in other parts of the body.    It is able to stimulate ovulation (release of an egg) by actions through the brain (hypothalamus) so that the women’s own hormones secreted by the hypothalamus and pituitary are increased, thereby increasing the drive to the ovaries each month to produce an egg (or a few eggs).
In general, clomiphene is pretty well tolerated by most women.  The common side effects of clomiphene include hot flashes, mood swings, and occasional headaches.  Other side effects have been reported and there is an increased risk of multiple pregnancy (typically around 8-10%) and a small risk of blood clots and visual changes, although these are (thankfully) very uncommon.
There are several studies evaluating the efficacy and success rates of clomiphene.  There is good evidence to show clomiphene will increase the odds of ovulation and pregnancy in certain groups of women.  It is often prescribed for women who do not ovulate regularly (a recent report showed ovulation rates up to 73%, Homburg, et al).  It is important to remember ovulation rates are not always good surrogates for pregnancy rates.  Another classic paper by Guzick, et al, evaluated the success rates of clomiphene with intrauterine insemination in women with unexplained infertility, and found the pregnancy rates were around 8% per cycle.  Keep in mind it is important to consider all factors when reviewing the literature: patient age, diagnosis, study design, etc. 
The largest study to date was recently published by a large IVF clinic in Boston (Dovey, et al). They evaluated over 4100 cycles of clomiphene with intrauterine insemination (IUI) in over 1700 infertility patients from 2002-2007.   This included women with multiple infertility diagnoses.   The pregnancy rates per cycle initiated based on age were very interesting:


< 35 years

35-37 years

38-40 years

41-42 years

> 42 years

Number of cycles






Pregnancy rate per cycle






As you can see, although reasonable, the overall success rates with clomiphene are lower than one might expect and decrease significantly with advancing age.  Another interesting finding with this study showed that for women that conceived with clomiphene and IUI, the majority (80-90%) did so within the first 3 cycles.  Therefore, for most patients, there is little benefit of extending this type of treatment beyond three cycles. 
I will sign off by reviewing a concept we covered in our last blog and is displayed in the findings of these studies:  maternal age is the most predictive factor in obtaining pregnancy.  As clomiphene is not terribly effective for older women, they may be better served by going directly to more aggressive treatment including assisted reproductive technologies.
Homburg, et al. Hum Reprod 2005;20:2043-51
Guzick, et al. Fertil Steril 1998;70:207-13
Dovey, et al.  Fertil Steril 2008; 90:2281-2286
Contact: Contact Conceptions at 303-794-0045 or view our contact us page
FAQ #1 - How to make a baby

Welcome to the first frequently asked questions (FAQ) blog installment for Conceptions Reproductive Associates!  We are happy you have chosen to follow along and we hope you find the various topics and entries informative and helpful.  We plan to touch on several topics that seem to come up frequently during consults and Q&A sessions.  We welcome your ideas as well, so please send in suggestions if you have a particular area you are interested in. 

For the initial blog, I thought it would be prudent to write about the basics: how to make a baby.  Clearly most people have the fundamental idea of how this works, but what happens when conception doesn’t happen spontaneously?  How long is too long?  When should you be evaluated?  What is involved in the evaluation?  I could go on and on but let’s cover these topics for now and this will likely serve as an excellent springboard for topics and questions in the future.

“Infertility” is defined as the inability to conceive after one year of unprotected intercourse (not using contraception) for women less than 35 years old.  For women 35 or older, it is diagnosed after 6 months of unprotected intercourse.  Technically speaking, most people are not “infertile”.  Most people who are diagnosed as such are truly “subfertile”, meaning it is taking them longer to conceive than average couples their age.  On average, 57% of couples will conceive within 3 months, 72% in 6 months, 85% in 1 year, and 93% in 2 years.  Age does matter when looking at statistics, and interestingly, maternal age tends to be the primary factor when it comes to predicting fertility.  Infertility is considered a public health problem in that it affects over 6 million women in the United States.  There has been a recent interest in research to prevent infertility (although not all causes can be prevented).

There are essentially four areas that need to be in working order for conception to happen: 

1)      Ovulation must be occurring (releasing of an egg each month)

2)      The fallopian tubes must be open (this is where fertilization occurs)

3)      Sperm must be present and functional

4)      The uterine environment must be receptive to pregnancy/implantation

There are far more details about all of these components (I.e. ovarian aging plays a big role), but knowing a few basic concepts will help you get on the right track.  It is important to track your menstrual cycles each month.  Most women who ovulate regularly will have fairly regular menstrual cycles (often 26-35 days but usually they only vary within a few days of your own “set point”). Basal body temperature charting can be done to track ovulation, and over the counter ovulation predictor kits work very well for most women.  In the world of fertility, we often speak of “cycle days”.  Cycle day 1 typically refers to the first day of your period (full flow), and often ovulation will occur around cycle day 14-16 for women who have 28-30 day cycles.  If you are not having regular cycles as described above, you should seek evaluation sooner to look for potential causes that may be easy to correct. We will often evaluate specific fertility hormones (ovarian reserve testing- a great topic for the next blog), and other hormones that can affect ovulation.  Things like polycystic ovarian syndrome (PCOS) are common causes for irregular ovulation.

The fallopian tubes are usually evaluated with some imaging study.  The hysterosalpingogram (HSG) is commonly used and this is performed in a radiology department.  It involves placing a small catheter into the cervix and injecting dye into the uterus and fallopian tubes to confirm they are patent (open).  This exam also evaluates the internal portion of the uterus (uterine cavity) which is not well seen on routine ultrasounds (sonograms). The exam does cause mild discomfort so I would typically recommend taking ibuprofen or acetaminophen prior to the procedure.

A semen analysis is a standard part of the basic fertility evaluation. Even if a man has no risk factors (i.e. tobacco, alcohol, drugs, family history, certain medications, prior surgeries, etc.), we often still see mild abnormalities in the semen analysis.  Sometimes we can help improve this with basic lifestyle changes and vitamins.  Sometimes we need to involve a specialist in male reproduction depending on the results and clinical history. 

Speaking of sperm, the timing of intercourse and “sperm exposure” is quite important.  Sperm can actually stay alive in the female cervix for several days; however the period that an egg can be fertilized is quite short (12-24 hours).  In general, it is best to time intercourse 2 days before, the day before, and the day of ovulation.  The use of ovulation kits can be very helpful in coordinating this.

Finally, the uterus and ovaries can be visualized quite well with a transvaginal ultrasound.  This is often done in the early part of the menstrual cycle.  This study gives us good information about the structure of the uterus, presence of fibroids (common tumors of the muscle wall), and ovarian structure.

A few last thoughts…remember the primary predictive factor in making a baby is maternal age.  Fertility in women actually peaks around age 22-25, and slowly declines after that.  Once a woman approaches her mid-30’s, it can become far more difficult to conceive.  The number of eggs declines quickly and the quality also diminishes.  These changes are often referred to “diminished ovarian reserve”.  When you look at graphs of fertility decline in relationship to age, most of those studies were evaluating population data.  Each individual may vary, and chronological age may not correspond to ovarian age.  What does this mean?  Sometimes the ovaries age more quickly than our chronological age.  Unfortunately, the opposite doesn’t seem to exist (our ovaries never act “younger” than our chronologic age).

When should someone be evaluated earlier than usual?  I would recommend this for older women, those with risk factors such as irregular periods, prior difficulty conceiving, a family history of early menopause, previous gynecologic surgery, or men who have risk factors that may affect sperm function.  Remember, when it comes to making a baby, it is always better to be evaluated too soon rather than too late.

Contact: Contact Conceptions at 303-794-0045 or view our contact us page
Connect with Facebook & Twitter
Conceptions utilizes social media to connect with patients and provide information on Conceptions, Fertility, and IVF.  Visit one of our social media pages:
Contact: Contact Conceptions at 303-794-0045 or view our contact us page
Accreditation by the College of American Pathologists (CAP)
Conceptions Embryology Laboratory has been awarded accreditation by the College of American Pathologists (CAP) based on the results of an onsite inspection.


Contact: Contact Conceptions at 303-794-0045 or view our contact us page
Ferring Fertility - My Little Miracle Essay Contest
Win a $10,000, $7,500 or $5,000 Education Fund For Your Miracle Child! Share your story by entering Ferring's eighth annual "My Little Miracle" essay contest.
Contact: Contact Conceptions at 303-794-0045 or view our contact us page
The American Fertility Association’s - Illuminations Denver
About Illuminations: Illuminations is the name of the event series that takes place across the country in cities such as Los Angeles, San Francisco, Atlanta, New York and now coming to Denver, celebrating the work of individuals and organizations in local communities who have made a positive difference in the fields of fertility, reproductive health and family building.
About the Attendees: In attendance at Illuminations are physicians and other healthcare professionals including nurses, therapists, complementary medical practitioners, patients, and former patients.
About the Celebrities: Billy Baldwin, Felicity Huffman, Angela Basset, Jennifer Beals, Marcia Cross, David Marshall Grant, Luke MacFarlane, Olympian Mitch Gaylord, and our own Brenda Strong are just a few of the celebrities that have attended our events.
About Your Donations: Illuminations events benefit the work of The American Fertility Association (The AFA), and have raised nearly $1 million to date. Each event highlights one strategic goal of The AFA, and the money raised at the event goes towards supporting the work required to accomplish that strategic goal. Past events have supported infertility prevention, outreach to the lesbian and gay communities and our work with couples having difficulty conceiving.
Illuminations Denver will focus on The AFA’s work empowering women to take control of their fertility.
Contact: Conceptions at 303-794-0045 or view our contact us page
Dr. Mark Bush at Midwest Reproductive Symposium
Dr. Bush was asked to give two workshops and a lecture at the prestigious Midwest Reproductive Symposium in Chicago in June of 2010.  His invited topic was IVF Protocol Management and Implantation.  This conference was attended by reproductive physicians, nurses and embryologists from around the world.  Dr. Bush's workshops were standing room only.  He discussed topics that included management of PCOS, hypothalamic dysfunction, IVF in women who have poor egg health testing who want to use their own eggs, laparoscopic myomectomy and other surgical techniques, as well as innovative testing and management of recurrent pregnancy loss and implantation failure. A copy of his lecture can be found in the lecture library (link).
Contact: Contact Conceptions at 303-794-0045 or view our contact us page
National Infertility Awareness Week April 24 - May 1 2010



Infertility is a disease affecting one out of every six couples in the United States 7.3 million nationally.


Are you suffering or know someone who is suffering with

infertility? Infertility isn’t whispered about between girlfriends anymore, infertility is A REAL disease and needs to be talked about.


Women are not the only ones affected by infertility 30-40% of males are affected by the disease as well.


• Are you 35 or older?

• Have you been trying to conceive for more than 6 months?

If you are under age 35, have you been trying to conceive for a year or more without success?

• Have you had two or more miscarriages or pregnancy loss?

• Has your spouse or partner been tested for fertility problems?

• Do you suffer from painful periods or irregular periods?

If you answered Yes to 1 of the above questions talk with your Women’s Health Care provider to discuss your treatment options.


Help is available; speak with someone who cares.

Contact: Contact Conceptions at 303-794-0045 or view our contact us page
(More Items...)
“Committed to providing only the best possible care while treating every fertility patient like family.”
Dr. Ryan Riggs
“At Conceptions, the quality of care that our Fertility Patients receive is our #1 priority!”
Dr. Dana Ambler
©2015 Conceptions Reproductive Associates of Colorado | Denver | Littleton | Lafayette | Lone Tree | Sky Ridge | Colorado Fertility Clinic & IVF Doctors
Site Map