unPAUSED with Dr. Mary Claire Haver - Toxins, Stress, and What They're Doing to Your Hormones with a Top Reproductive Endocrinologist

Episode Date: June 12, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Natalie Crawford, double board certified obstetrician, gynecologist, and reproductive endocrinologist, and author of The Fertility Formula. In part two of this conversation, Dr. Crawford gets specific about the forces working against our hormones every day, chronic stress, disrupted sleep, inflammatory food, and the endocrine disrupting chemicals most women have never been warned about. She explains how cortisol triggers insulin resistance, how insulin resistance drives inflammation and ovarian dysfunction, and why resistance training and building skeletal muscle is one of the most direct interventions a woman can make at any age, including perimenopause. On sleep, she makes the case that it is the single most under addressed factor she sees clinically, explaining how FSH and LH are released in the early morning hours and why disrupted sleep directly interferes with ovulation, estrogen, and progesterone production. The conversation also covers anti-inflammatory nutrition and gut health, the difference between unscented and fragrance-free, why forever chemicals and phthalates are disrupting the hormone system from inside most women's homes, birth control timing and uterine lining recovery, and what egg freezing actually is and is not, and who it is most likely to benefit. Guest links Natalie Crawford, MD Natalie Crawford, MD (Instagram) Natalie Crawford, MD (TikTok) Natalie Crawford, MD (Facebook) Natalie Crawford, MD (YouTube) Natalie Crawford, MD (LinkedIn) Books “The New Perimenopause,” by Dr. Mary Claire Haver “The New Menopause,” by Dr. Mary Claire Haver “The Fertility Formula,” by Dr. Natalie Crawford To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

I think it is important for women start to learn that hormone dysfunction is an abnormal sign from your body. It can start to be normal, right? Perimenopause is a normal phase we will all go through. But when it happens early, it's not, right? And so just, again, the same added. Like, we shouldn't ignore these signs. We have to know to look for them. We have to understand what's supposed to happen.

And how do we take at least the static off the radio? So the brain and over, you can have the clearest communication that it can. We want to be able to be in that place at all. stages of our reproductive life, regardless if we're trying to get pregnant at this moment. The views and opinions expressed on unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. In part one of my conversation with Dr. Natalie Crawford,

a double board certified OBGYN and reproductive endocrinologist, she helped us rethink fertility entirely as a window into a woman's overall health. We talked about ovarian aging, egg quality, PMOS, miscarriage, and why the fertility story and the menopause story are often the very same story viewed through different stages of life. In this episode, we move from understanding fertility to protecting it. Dr. Crawford, author of the fertility formula, explains what chronic stress actually does inside the body, how inflammation, insulin resistance, and hormone function are connected, and why sleep, strength training, nutrition, and even environmental toxins may play a larger role in reproductive health than many women realize. We discuss why muscle may be one of the most

powerful tools we have for metabolic and reproductive health, and the life's life. And the life's style habits that support healthier hormones signaling throughout a woman's life. We also get specific about why women deserve information about their bodies before they experience a crisis and how they can advocate for themselves from the start. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to Unpaused. The podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. What does the research actually show about chronic stress and fertility?

This is a big one, right? Because many physicians will say, don't stress about being stressed. Chronic stress physiologically increases your inflammation. Purposefully. So let's think about what happens. When you have stress, your body is going to have cortisol release from your adrenal glands, your stress hormone. cortisol itself is inflammatory. One of the reasons why is that, let's use the favorite analogy of a bear.

You see a bear, you want to run from the bear. Your body, your cells need glucose to survive, right? Your survival from the bear shouldn't be based on when you ate your last meal. If glucose is the fuel for every single cell, for your muscles, for your heart and your lungs, your survival shouldn't depend on when you ate. So when you get stressed, cortisol arises, you are going to break down stored glucose from your liver and put it into your bloodstream so that you can run. And in the olden days, you would run from a bear.

You would use up all that glucose by yourselves and you would go back to normal. But in the modern world, you are stressed over and over again. Right. And our body can't tell the difference between a bear or a bad evaluation or work. Right. A bad email, a bad meeting, a doctor's appointment. A breakup. The internet. There's so many things.

And so your body is doing what it's trying to to keep you alive. And yet we are not in a position to even. understand it. So one thing that I think has to go into this discussion is what really happens to your body when this is, because this is a big key. I don't think what may get. Glucose goes into your cell via insulin. We've talked about insulin resistance a couple of times. So insulin's a hormone that comes from your pancreas. You eat food, food gets broken on to glucose. Pancreas secretes insulin. I like to think about insulin as a salesman, knocking on the door of the cell, allowing it to open and glucose comes in. So in a normal world, glucose levels up, insulin up,

knocking on the door, door opens, both of them go down back to normal. What happens is when glucose is higher, longer, and that can be because you're eating foods that have what's called a high glycemic index, a lot of our ultra-processed foods, cause a bigger glucose spike, or we're eating more frequently, we're not getting as much sleep, stress like we just described, now we have more glucose in our bloodstream. Well, the pancreas is going to release more insulin. And what would you do if you had a salesman come to your door every single day? Move.

You move. Lock the door. Lock the door. Stop answering. Essentially, you stop answering. You're going to say, I'm so sick of seeing that salesman. And that's what your cell starts to do to insulin. So they ignore it. But the cell is starving because it wants glucose. So you break down even more glucose and put more into your bloodstream because the cell really wants it. More insulin's released. So now that salesman is banging on the door and you finally go answer and let glucose in. So it takes the salesman banging on the door to get the cell to answer. It takes a higher level of insulin to get. get you to answer. Insulin is not benign. Insulin's a growth hormone. So when insulin levels are high, that's one of the top drivers of inflammation. You're going to just deposit that visceral fat, that really problematic fat for your long-term health. Insulin actually directly changes how your ovary responds to the brain and how it makes hormones. You make less estrogen in the setting of insulin. Okay. So you're supposed to have some insulin. You need it for life, but this chronically elevated insulin is very detrimental to your health. The piece of that, puzzle that's so important is to say, okay, we can understand maybe how diet can come into it,

but let's say sleep. When you get sleep is one of the times where your body can go and clear up some of this inflammation, but also your cells can become more insulin sensitive. So if you're not sleeping as much, you're already starting out in a deficit. From the stress standpoint, okay, well, we can't prevent the stress. This is the crazy world we live in. But what we do when we encounter, it can be really impactful. One clue or fun fact, right, is that muscle, has a transporter on it called glute four that allows glucose to be utilized without needing insulin. So if you build and use skeletal muscle, which is the exercise of choice for hormonal health, for long-term health, you ask. She means resistance training. Residence training, strength training.

Picking up weights, you're using your body. If you can't pick up weights yet, but building your muscles, when you are then stressed, if you use those muscles, you can get glucose out of your bloodstream into your muscles, lower it, and not see the insulin resistance that develops from stress. Chronic stress causes insulin resistance. In that wild, not regardless of the foods that you eat because of the mechanisms we just described. So if you have the bad email or the bad meeting, you could do 10 squats in place, or you could go walk, you could do something to activate your muscle and that can help get that glucose in. And then the more muscle you have, the easier that will be. But then also when we're stressed, what do we do? We stress eat, stress drink. So many of us add to stress

with a negative behavior that worsens inflammation and insulin resistance instead of thinking, okay, that meeting was terrible. I feel the heart palpitations. I know my body's gearing up for the bear. I'm going to go do 10 squats really quickly. That will bring you back down to baseline and stop this cycle from happening. And so these three components of building the muscle, getting enough sleep and learning to manage stress, you can't prevent all stress, but learning to manage it, that's the foundation for every single day that you're going to make a decision on that impacts inflammation levels in your body. Talk to me about the life study in reference to inflammation and the ability to get pregnant and how it affects fertility. So one thing to understand

that we have to break down is that it's really hard to study fertility. There's many different outcomes. Are you looking at a positive pregnancy test? Are you looking at a live birth? Are you looking at people trying to get pregnant with IVF, what is the outcome? So some of the best data we have are cohort studies, which means we're following a group of people. And the life study is one of those and they followed their natural behavior. So people who didn't have any known fertility problems who first started trying to get pregnant and did a bunch of evaluation of lifestyle factors. And in the life study, one thing they checked was looking at markers of stress, specifically salivary amylase, which hasn't something we routinely check in clinic.

But seeing if patients were subjectively, did they report feeling stress, did they have higher salivary amylase levels? And those things were correlated. But that people who had higher levels of salivary amylase, it took them longer to get pregnant. So we call them a month-to-month chance of getting pregnant, your fecundability, the probability of pregnancy that month. And they had increased the rate of infertility. To the point where we can sit here and say really clearly, stress is not benign. This whole don't stress about being stressed is a harmful additive. And again, there will be stress.

stressors that you cannot control. But thinking about how do I build in time, how do you have real self-care? How do you manage stress? And how do you take care of yourself on the other tenants? If stress is going to be one that's increasing that inflammatory burden, how do we lower it down? Because when you are stressed, many people don't know that it actually changes the adrenal glands. And the adrenal glands are really important in progesterone production and actually can have you make progesterone at times of your cycle when you're not supposed to. And so chronic stress can be associated with elevated progesterone, and that's part of why it can be harder to get pregnant, because earlier I said progesterone opens and closes the implantation window. It also binds back,

you know, to suppress ovulation. Right. So in many clinicians and patients really think that ovulation, again, is this all or nothing idea. So yes, there are circumstances where the walkie-talkies can be turned off and you won't ovulate at all. Things like hypothalamic aminorrhea. If you're severely exercising a ton, your calorie intake is very low. If you do have a huge chronic illness or a serious life traumatic stress, your brain may see these feedback and say, this is not a good time to be pregnant. I'm going to shut down the system. But the light switch is not just on or off. It's a dimmer switch. So there are these stages where things are not functioning normally, but you'll still get a period, but it's often some way. I mean, this is perimenopause.

Exactly. But it is presenting even younger and this hormone dysfunction. So I think it is important for women start to learn that hormone dysfunction is an abnormal sign from your body. It can start to be normal, right? Perimenopause is a normal phase we will all go through. But when it happens early, it's not, right? And so just, again, the same added. Like, we shouldn't ignore these signs. We have to know to look for them.

We have to understand what's supposed to happen. And how do we take at least the static off the radio? So the brain and over, you can have the clearest communication that it can. We want to be able to be in there. that place at all stages of our reproductive life, regardless if we're trying to get pregnant at this moment. Okay, so you have a woman who's trying to reduce her inflammatory burden. What is your advice? I mean, that's a huge part of the book. It is a huge part of the book. It's not just like, oh, this is all the scary stuff. You actually give, this is what we should be doing. So let's start

with stress. How do I lower my stress? I have a threefold approach to stress. So number one is going to be, yes, to the degree you can, you should cut out things that you know cause you stress. We'll use infertility, if you have that friend who's pregnant and her posts are really triggering for you or cause you stress or maybe it's going to the baby shower. There are opportunities where you know you're putting yourself in a stressful situation that you should try to limit avoid or build resilience around, right? So maybe you're going to call your friend and plan a lunch date instead or maybe you're going to, you know, mute her on Instagram so you don't have to see what's going on because that's causing you stress. So limit what you can. You can't limit everything.

My second is going to be carve out 20 minutes of your day to have that cortisol release, which actually can be very impactful for getting your body to be more sensitive to these hormonal shifts. It kind of have a moment of the static going away allows the brain to remember how it's supposed to act. What does that look like? What do you do in that 20 minutes? That can look different for all of us and it can look different every day. That's important because many women, I'll put myself in the bow. Like we're perfectionist.

We like to do things a certain way and we're very all or nothing. So understanding that 20 minutes can look different. And maybe it's sitting outside, feeding the grass, a walk, meditation, mindfulness, yoga, acupuncture, a bath. It can look different every day. But it shouldn't involve your phone. Shouldn't involve any notification. So really carving out.

Journaling is one of my favorite ones. It allows me to kind of get the brain dump out. I don't have my phone around me. I feel calmer afterward. But leveraging something to give yourself the cortisol release should happen every day. And then the third one, as we said earlier, is to say, when I do get stress, I'm going to act differently. I know my body's going to put more glucose into my blood.

So instead of stress eating, stress drinking, stress scrolling, I'm going to move my body to leverage the skeletal muscle. So go on the walk, do the 10 squats, do some pushups. It can be something in place, but you're going to try to get that glucose out of your bloodstream and into your cells so you can break that pattern of insulin resistance. And what about sleep? Sleep is the number one thing that when I clinically see patients, they are not doing enough. And it's weird because we have this badge of honor.

I don't need sleep. I have so many patients and I have friends. Sleep when I'm dead. Yeah, I don't need to sleep. That's just wasting time. I can do other things. For every hour less a woman gets of sleep, she'll get fewer eggs in an egg retrieval cycle. For every hour less a man gets, he'll have lower testosterone and lower sperm counts.

Poor sleep from either partner takes you longer to get pregnant. This is not just suggestive. data, it's quite clear. Your body needs at least seven and a half hours of sleep, probably more in the ludial phase. It's a big caloric need to make progesterone. But that sleep has to be real sleep in the bed. So do the stages of sleep matter here in fertility or has anybody looked at that yet? We don't know that yet. I would assume it probably does. So that would be really interesting data to have. But at the end of the day, what we need to be doing is really thinking about what time do I need to get up, when do I need to get in bed, where can I put my phone? How do I make the room cool, dark? I love a sound

machine, a sleep mask. And really importantly, if you sleep in the bed with another human, they have to be on the same sleep pattern as you. They have to be. If you're trying to get pregnant, they should be, right? Because we just talked about how important it is for men's health too. But very often I see discordant sleep couples where the man is coming in hours later. You're trying to go to bed, but then your sleep is disrupted, harder to get back to sleep. And we really should have this team-based approach to how we get sleep. I can add on to this one really quickly. If physiologically, sleep clears inflammation and improves insulin resistance, we said those two things, but your gonadotropins, FSA and LH are released from the brain in the early morning hour. So if you are not getting enough

sleep, your brain is not going to be able to release the amount of FSH and LH it needs to ovulate or to make estrogen and progesterone. What about exercise? What type of exercise should you do? building muscle is the key. So strength resistance training at least three times a week is what most women need to do that they're not doing. Every single expert I have had on, cardiovascular, endocrinology, Stacey Sims, Vondervite, all say strength over cardio. Strength over cardio. They're both important, but. Yes. And for fertility specifically, you know, over-exercising, so too much vigorous activity can also be harmful because it can be stressful to the body. Exercise is this interesting inflammation balance. Again, all inflammation's

not bad, but we have to leverage it. It's the chronic inflammation that is harmful. When you're building muscle, you're going to have an inflammatory response. It's how we build muscle. But if you're over-exercising, we're talking long runs, vigorous activity, it is going to interfere with the brain. To the point that runners, 58% of runners will have a ludial phase defect. Going back to having a short luteal phase, they are exercising to the degree that their brain is not able to send out the signal to have enough progesterone made. I live in Austin, so I have a lot of runners. So if I sat across from people, if I dared to sit at this table and say, do not run, people, they would hate me. And it's not do not run. But what I will tell my runners is to say, track lovelation, your luteal

phase is what we're titrating to. So if your luteal phase is short, you're running too much. take out a run day, you need to add weights. Every runner probably needs to add more strength and resistance training. Yeah, because bone density is it. They're getting ahead. But then we're looking at how long are you running how many days? And if you're starting to notice that short ludial phase, your ratio is off. So look at that.

That's a body clue that you can take from your cycle that you would make a direct behavioral change to improve your health. Do you believe in workout more, eat less? No, no, no. Food is the nutrients of the building blocks for your entire body. And for hormones specifically, like you need nutrients, you need healthy fats. You know, you and I grew up in this nice, you know, era of everything, cardio, avoid all fats, really a very hormonally poor environment for our health.

But that's not what your body needs to make hormones or to ovulate. This episode of Unpaused is brought to you by Alloy Health. We talk a lot about hormones affecting mood and energy, but they also play a major role in your skin. collagen, hydration, elasticity. And in midlife, when hormone levels start to shift, your skin changes too. I first heard about alloy through a close friend who is a dermatologist. She shared how few products truly address hormonal skin changes. Once I understood that alloy's approach is rooted in hormone science and physiology,

I decided to try it myself. It changed the way I think about how skin care is at this stage of life. Alloys M4 line includes the M4 face cream, M4 face serum, and M4 eye cream. These are prescription strength formulas made with estriol, the gold standard hormone your body stops producing naturally, and they are backed by clinical research. Women are seeking smoother-looking skin, improved firmness, and a brighter, more even tone. If your skin is changing, your skin care should change too. With Alloy, you consult with a doctor and receive expert guidance and have your treatment delivered right to your door.

Head to M-A-L-L-O-Y.com and use code MCH-20. That's MCH-20 to get $20 off your first order. History That Doesn't Suck is a legit, hard-hitting American History podcast told through entertaining stories. As we approach America's 250th anniversary, now it might be the time to go back and learn how we got here. With more than 200 episodes, you can binge your way, decade by decade, defining event to defining event from the founding into the 20th century. Join me, Professor Greg Jackson, for History That Doesn't Suck, an Odyssey podcast, available on Apple Podcasts, Spotify, or wherever you get your podcasts.

This podcast is sponsored by MIDI Health. You've heard me talk about my menopause toolkit. It consists of nutrition, exercise, hormone therapy, and other medications. stress reduction, sleep quality, and community connection. When you put those pieces together, they don't just ease symptoms. They support your long-term health. That's why I recommend Midi Health. They put your toolkit to work for you.

Midi is a virtual clinic built by leaders in women's health with clinicians who understand the science of female aging and who take the time to understand you. Through one-on-one visits, they listen to your symptoms, your goals, and your concerns, then create a personalized care plan tailored specifically to you. And best of all, MIDI is covered by most major insurance plans, making expert, high-quality care accessible and affordable for every woman, all of which is why MIDI should be part of every woman's menopause toolkit. Book your virtual visit today at join midi.com. That's join

midI.com. You talk a lot about food in the book. What is the fertility formula plan? What are the core principles for nutrition? We're really looking at anti-inflammatory eating and really making sure we're taking care of your gut microbiome and healing your gut. A lot of people, when you consume these ultra-processed foods, causes a lot of localized inflammation in your gut, multiple levels. We've talked about how it's bad for insulin resistance, changes the microbiome of your gut. Your gut have an entire bacteria system that do many things. They control the level of, inflammation in your body, but they're hugely important in estrogen metabolism. So if we want to look through the lens of hormonal health, if you have an abnormal gut microbiome, higher rate of infertility, but also harder time ovulating because the feedback to the brain is being interfered. Your gut microbiome needs fiber. Fruits, vegetables, fiber, right? So this is what the premise,

the core of your diet needs to be really high in fiber, fruits, vegetables, lots of antioxidants. I love protein, but we are living in the place where we see this huge protein. emphasis at the expense of fiber. It's not one or the other. And if we think about most Americans actually need to really look at increasing that fiber. Yeah, if they're one nutritional intervention. That would be the one. Every single expert, including you, has said, do not sacrifice fiber to get your protein. Exactly. So that's important for the discussion, though, because, you know, plant-based protein has fiber and protein in it. Animal-based protein does not have fiber. So if you're eating chicken breasts, that's got great protein, but it doesn't have any fiber in it.

If you're going to consume plant-based protein options that don't have as much protein, they also do have fiber. So most people do need to incorporate some plant-based protein into their diet to meet their fiber and protein goals. Extra scary when we start looking at people thinking about carnivore diet who are taking no fiber in at all, or standard American diet, which is very low fiber and high and ultra-processed foods. So high fiber, fruits, vegetables, unlimited amount. Every fertility study says the same. Six servings of fruits and vegetables, you're going to have the highest rate of getting pregnant. When you start having less of that, lower probability per month. When it comes to fat, healthy fat is your friend. We want to see those healthy fats from whole food

specifically. So the olive oils, nuts, the avocados, the seeds, those are going to be, and they should be rich in your diet. We want to see you leverage more complex carbohydrates over the refined carbohydrates. And we really want to be limiting the ultra-processed foods, the added sugar, things that are inflammatory without a nutritional benefit. And then when it comes to dairy and gluten, for dairy, whole fat dairy over low-fat. Low-fat dairy does not have any benefit, and you're losing part of the benefit of dairy is the fat inside of it. Dairy and gluten have the two biggest sensitivities that we see on a population-based level.

That doesn't mean everybody needs to avoid them. But I do say if you have inflammation, you're reading the book, I have a whole page of inflammation symptoms or you have unexplained infertility or pregnancy loss. It is worth doing a trial of removing them from your diet, adding them back in. Because if you say, oh, well, I added gluten back in and now I feel fatigued again, you should avoid it. It is causing some cellular reaction, even if you don't have that diagnosis yet. Because sometimes your body is giving you clues, even if it's hard to get to a diagnosis, but we can make decisions based off of those. Is there something that a lot of people think is neutral but is actually causing inflammation?

You know, at the expense of being disliked, fertility studies show that red meat is probably one of the most detrimental things to the fertility outcomes. Again, certain study types are really hard. Dietary studies are very limited based on we don't control all dietary factors. And all red meat is grouped together. And all red meat is not created equal when it comes to quality of the meat. But when we look at quartile, so women who ate the least versus women who ate the most, The more red meat you consumed, and it was linear in direction, you had poor embryo quality, lower pregnancy rates, worse stage of endometriosis.

All the fertility metrics that we look at are worse in the context of people who are eating more red meat. It doesn't mean it's inherently bad. I tell my patients don't eat it every day. And we live in Texas. We live in Texas, so we have to say that. I do have patients who eat it every day. And so we want to really leverage other protein-based sources. we already talked about plant-based protein,

but fish is underutilized, even in Texas, right? Has a lot of a great omega-3 fatty acids in it. It doesn't have some of the trans fats that we see and the saturated fat and some of the other animal products. So swapping out some of that red meat for fish, if we like to consume animal-based meats, can be one way that we can get to those protein goals in a more nutritious way.

Let's talk about toxins. Let's talk about toxins. You have a chapter on endocrine disrupting chemicals. that I think is genuinely alarming. And so what are the top offenders that most women have no idea are in their daily lives? Mary Claire, when I was in my fellowship, still going through my infertility, I started meeting with my program director about my fellowship project. And we have to have a thesis.

So you have to be published in a journal and you have to defend it at your REI oral boards. So just like you have to go through your surgical cases and your others, you get an entire hour and a half to talk about your research project. And most people do an IVF project, and I wanted to do something that related to natural fertility, why some people get pregnant and why others don't. And I started studying endocrine disrupting chemicals with the EPA and looking at ovarian reserve, time to get pregnancy and thyroid levels, and diving into the data, looking at endocrine disruptors, chemicals that either mimic or block or change. Essentially, they're interfering with the walkie-talkies one way or another,

and many of them impact your gut health and cause inflammation directly, what they do to your fertility. This was well over 10 years ago, and I was alarmed by what I was reading, not just suggestive data, but things like PFCs, perfluorinated chemicals, forever chemicals that come out of plants, leach into our soil and our water. They're in non-stick pans, how we see BPA and what's in our plastics and how plastics also cause fibrosis in the ovary, get passed through the placenta. looking at fallates and fragrances. And in that time, I remember coming home one day and completely cleaning out our kitchen. And my husband walking in, Jason's saying, what are you doing? I'm a fellow. We don't have tons of money to go buy an entirely new kitchen. I said, I can't believe we're living in the world where there's data talking about how bad these teflon pans are, these non-sick pans. And yet we cook off them every day. Like, why don't I know? And the plastic Tupperware, I would take my food in to work

every day. And heat it up. And heat it up. I said this isn't just maybe bad. Like this is known bad, yet nobody's talking about it. Other countries are regulating it and we are not. Toxins are scary and I get the most pushback on it because the world is toxic. In America, this is highly unregulated and people deserve to understand that so that you cannot obsess over it, but that you can control the exposures at hand, especially what you're exposed to most often, which is going to be usually in your home, thinking about what

you prepare your food on, how you cook your food, how you store it, your air, your water, your bathroom products, the things that you're exposed to most of the time. And what about cosmetics? Yeah, cosmetics are a big player. One of the things that I talked about recently that got a lot of attention is just showing not only is our system not protecting us by limiting chemicals. We're allowing marketing practices that are really deceitful. For example. For example, there's a big difference in unscented and fragrance-free. Unscented is actually a scent, masking another scent. So the net of that is I can smell this and I don't smell anything,

but I can have toxic ballets and chemicals inside of it. I've just neutralized them with some other chemicals so you don't smell them versus fragrance-free, which has no fragrance in it. So you might be going to the store, looking at your laundry detergent, for example, something that's going to go on your clothes. And you're choosing unscented, thinking that you're making a good choice. But in fact, there is still toxic chemicals in there because it's not fragrance-free. That scent has just been neutralized.

That's wild to me that consumers don't know it and that corporations are allowed to get away with that. So when you're choosing products, for the most part, fragrance is one of the biggest offenders of phallates that we have. And so phallates are known endocrine disruptor. And this is even more important for women when you're trying to get pregnant. Yes, you're pregnant. But also think about pari menopause menopause. Why do we want to interfere with our hormone system? Make this even harder for us. So it's really important to start thinking about what is in our bathroom and what are these products. Yeah, what are some simple swaps. Like what, if I'm going to go in like low talks my life, I start in the kitchen. Start in the kitchen. So the kitchen's going to be the first place to start. So the biggest offenders are going to be, you know, plastic cutting board's got to go. We really want to have, you know, a wooden cutting board looking at what you're cooking in. So getting rid of Teflon, non-stick, stainless steel is going to be a better option for the pants that you're cooking in. We should get rid of all plastic in the kitchen. I want to say this extra for people who are parents, right? Because a lot of plastic comes in when we have children. Maybe we're grandparents. We have kids coming over stainless steel plates and little cups

are a much better option, even for children, glass bottles over plastic bottles. I mean, think about the plastic bottles. You put in the warm. leaves I put in all the baby's bottles. It's really important to be aware and to make the changes you can. And I'll use an example for my own life. My daughter, I was into this toxin world when she was born and we had glass baby bottles. And I remember crying when I took her to daycare because she had to go to daycare because I was a medical trainee. And they didn't allow any glass.

So they had to be plastic. And being just like really distraught thinking about how bad plastics are and they're going to heat up the plastic. You control what you can because you can't control everything. everything. And that's really the overarching premise here when it comes to toxins. I'm going to control what she's exposed to in my home because I can't expose what she's controlled, exposed to in the whole world, right? And that's parenthood in a nutshell. But so some of the other biggest offenders in the kitchen to go food. So a lot of us are ordering to go food. We're door dashing food. We don't want to cook. And to save time doing dishes, we're just eating it out of

that black plastic container. The food is warm when heat activates chemicals coming out of plastic, getting into our food. So that's an opportunity for us to say, if you're doordashing the food, you don't control what the restaurant puts it in, but put it onto a plate when it gets to your house. Play it. Yeah. Or put it into a glass dish to put in the oven if you're not eating it yet. So make the mindful choice when you can. And then processed foods, even those that appear healthy, think about protein bars is a big example here. These are often wrapped in ways that can have toxins in them. Don't eat protein bars when you're at your home. Save those for if you need them when you're traveling when you're at work when you don't have the opportunity to have other food. So

make smarter food choices when you're there leveraging whole foods when you can instead of those that come in a package. What if the problem isn't your skin? It's the makeup. Because at a certain point, the products that used to work just don't anymore. Foundation starts to look flat. Blush sits differently. And by 3 p.m., everything feels dry, heavy, or overdone. The reality is, a lot of traditional makeup was never designed with changing skin in mind. That's where OG comes in, a certified organic beauty brand that delivers luxury-level performance. Instead of loading products with fillers and heavy pigments, OG's crystal contour collection is made with nearly 90% skincare ingredients.

Green coffee oil, hajoba, elderberry extract, ingredients that nourish the skin, while you're wearing the makeup. And the best part, OG is NSF certified organic, one of the most rigorous standards in the beauty industry. So every product is made without synthetic fragrance, artificial fillers, or unnecessary additives. The routine itself could not be easier. Copper adds warmth and definition.

Rose quartz gives that fresh pop of color, and opal creates the prettiest glow. Everything blends effortlessly and melancholy. right into the skin. So your makeup looks natural, radiant, and like it's working with your skin instead of against it. If you're ready to raise your beauty standards, OG's got you covered. Go to OG.com forward slash unpaused and use the code unpaused for 20% off. That's OGEE.com slash unpaused and enter the code unposed to get 20% off. So if I have a woman who's 35 or doesn't matter how old she is, who's been trying to get pregnant

for six months and is scared to seem impatient when she asked for an evaluation. I mean, what should she be asking for? What can she do on her own? First and foremost, you can come see us anytime. You can come see me, a fertility doctor, without a referral from your physician, you don't need to wait for your OBGYN to say, and you could say, I'd like fertility testing. And that is allowed and permitted regardless if you haven't started trying or if you have infertility. So this idea that you can get your ovarian reserve checked, we can check your anatomy, we can check a semen analysis, I love seeing patients like this. Everything might be normal. You might then go on your way and we'll decide how long you should try, talk about what you should be doing, and based on your

family goals, talk about when you need to come back or we need to advance care. But I'll tell you this, about one third of the time when these people come to me, we will find something that changes what they're doing, whether it's a low sperm count or we go to a urologist or whether it's, oh, thyroid disease that now we go and we get treated or a uterine septum that thank goodness we repaired before she went on to have three miscarriages before it got diagnosed. A uterine septum is a birth effect of the uterus has about an 80% association with a miscarriage, but that can be simply corrected by a pretty easy surgical procedure. So why should we have to go through the failure again, right? You don't have to, and that's important for people to know. Your doctors have been notified that if you haven't

gone pregnant by one year or if you're 35 by six months, then we definitely should do an evaluation. But I'm really trying to pivot this to say you can ask for it early and you're not going to seem impatient and that's within your right. And I think that data is really helpful, especially as you are getting older and getting started. So what can you know about yourself? Start to track your ovulation before you want to get pregnant, not just relying on the when your period's coming, but are you ovulating and how long is your ludial phase specifically? Because that's an opportunity where we can usually make a big difference in helping you get pregnant. And coming off contraceptive, if you want to get pregnant when you stop birth control is going to be really important as far as having the highest rates of success.

Huge study. There's no higher rate of infertility from any type of birth control. And that's really important. Wait, what do you mean by that? So that means that at 12 months of trying to get pregnant, after stopping any method of contraception. So IUD, birth control, pill, whatever. Same amount of people are pregnant at 12 months as used no contraception.

Okay, so good. But what's missing from that discussion is that doesn't mean that your fertility is the exact same once you stop that birth control. IUD is one of the most important ones to discuss here. Progesterone IUD works by having progesterone in the uterus. It gets absorbed systemically. Usually at its start, it prevents ovulation. But these can last for many years, up to five or seven years.

And so at that point, ovulation is usually resumed because progesterone levels are lower, but you've had this progesterone exposure to the uterus every single day for years. Again, the uterus is usually only exposed to progesterone for half the cycle, not the whole time. And we know that progesterone iodis can change the receptivity of the uterus, the genetic expression of estrogen progesterone receptors for up to six months after removal, and we see lower pregnancy rates in those first six months. They catch up, so by one year it's no different. but if you're sitting across from me saying,

I want to do everything I can to have the highest chance of pregnancy, let's remove that IUD six months before you want to start trying so that you have those months to learn to track your cycle, let it come back, but also let the uterine lining get back to a normal. I used to tell patients, well, as soon as you have what you would consider a normal period, you can start trying again once we removed a progesting containing IUD. You know, because I knew that their lining was thin

and they were higher chance of miscarriage if they'd, conceive because there's not enough cushion, right, to support the baby in a very simplistic way. So I'm like, once you have like a normal period, you're good to go. Is that completely wrong? It's not completely wrong. I would say the bigger problem in today's day and age is that these women have never had a normal period. Many women are getting progestin IUDs at a really young age or they're hopping from, you know, birth control or, you know, the implant to the IUD and their period's not a vital sign to them. So they don't know what's supposed to be normal and how much blood is normal. When do you know if that has repaired? Another thing I see after IUDs, you know, I see scar tissue inside the uterus.

And I see a very select group of patients, but this is going to be higher in women who have a really traumatic insertion. We can talk about pain in our fields and how it's been, you know, under-addressed for such a long time. But if you had a very painful experience getting your IUD in or out, And then specifically, if you're not having periods after it's removed or they seem extremely light, it's normal for their life for a few months because the lining does have to grow back. But I just say after three months, you should start to see it grow back more and have a more normal bleed. If you don't, I'm worried there could be some scar tissue inside the lining. And I have a handful of patients that that was what was causing their infertility.

And we went in and took out the scar tissue and then they got pregnant. But again, should they be forced to wait for a year before we even find it? out that that's going on. No. Talk to me about egg freezing. What is it? I love egg freezing as an opportunity for women to invest in themselves in their future. It is not an insurance plan for their fertility. And that's an important distinction. What does that mean? So an insurance plan is always going to pay off, right? You wreck your car. Car insurance is going to kick in and cover you. If you invest in the stock market, you think it's a good idea. But the ROI on that investment depends on when you pull your money out and things that you don't know yet. And that's what

egg freezing is. A smart thing to do, but we have to understand that there's risk involved, and we don't know the return on that investment till later. In its simplest form, egg freezing is trying to get one month's group of eggs, all to grow, take them out of the body. What egg freezing is not is tapping into the vault. When the field advances and we can tap into the vault, it will change fertility science forever. It'll be coming. When we can mature eggs in the lab completely, we will have a dramatically different outcome for older women who are trying to get pregnant because one of the things that's hard for us is that as you get older, if you only have five eggs coming out of the vault, I can only get five eggs in that month in that cycle.

And then the next month I can do another cycle, hopefully get another group of five. But that's why someone has to do many, many cycles. If you were an average 30-year-old, I could do one cycle and get 20 eggs. It's hugely different. That's why egg freezing is easier when you are younger and you have more eggs and in general their egg quality is going to be better. But it really does depend on how many eggs that you have and your future family goal to know should you do it, is it worth it for you? If we look at population-based data and cost, which I don't think is always the best way to make a decision, but in cost-effectiveness studies, looking at is this money good for you to spend because the odds that you will need them is going to increase? For a woman who's 32 to 34 and not

ready to start her family yet and once more than one child, it is cost effective to freeze her eggs. So, you know, young 30s is a good time because you'll tend to get a good grouping of eggs and you know you're not ready to be in a position to try them. But your 20s are even better. If you know you want to have kids and specifically if you don't have a partner or you're on a crazy career path like we are, putting eggs in the freezer when you have more of them and they are of better quality is going to give you not just a peace of mind, but an opportunity for later. It's not a guarantee those eggs will turn into a baby, but it is going to dramatically change what your family planning will look like,

specifically if you want to have more than one child. If I tell you, the odds of getting pregnant naturally at age 30, 20% per month, at age 35, it's 11 to 12% per month. At 38, it's 5% per month. And a 40, it's less than 3% per month. Again, that's not zero, and that's not everybody, and people will have success. But you can see why it's markedly hard. at that age. What I see so often is a woman coming to me at 36 with her new husband. They're really excited and they want three kids or four kids. They want a big family. Even if we get pregnant today, right, we have to be pregnant, recover, get pregnant again. We know we're going to be having one or two of those kids or hoping to have them at a time where it is going to be harder

to conceive them. So if we have eggs in the freezer when you're younger, we're saving them. The kindergartners are still in alphabetical order because they're your younger. are eggs, and it's going to give us an opportunity to make this easier for you as time goes on. How old is too old? I mean, is there an age at which, you know, for egg freezing? Because I hear it's heavily marketed. I heard this yesterday from someone. I was asking them about their opinion on egg freezing. We're asking me. Well, I'm asking you now. And so here's what their take was that is being marketed to women who it's not going to be successful for. And it generates a lot of money for a practice. And first of all, I don't even know what it costs.

that would be important to talk about, but that it's really should be done in younger patients. And women are coming in too late, but they're doing it anyway, knowing that they're not going to have good outcome. I think one of the biggest issues in my field is not explaining things to women and giving them the autonomy to make the choice.

I can give you really bad odds. I mean, this is just women's health altogether. I can give you really bad odds, but if it's 0% versus 2% and you decide it's worth your time, money, physical, emotional energy because you want to say, I did everything I could to have the outcome I wanted.

I believe that should be your choice. I can break down the odds of what it's going to be for somebody's age. The oldest patient I've had freezer eggs has a baby in her hand right now, frozen at 43. Okay? So she was going through a divorce. You know, I mean, there were a lot of life circumstance that led her to that place to be freezing eggs at age 43, but she now has a child from it.

Is that going to be the story for every 43-year-old? No, right? But she, did she have to do more than one cycle? also yes, but she made that decision and said, I need to do this for me. And if it doesn't work out, I understand where the math falls. And I think women can handle really bad news. And I think we can make decisions in line with our priorities if we give them the data to do so. And so I think this generalized statement that it should only be done in young women is presuming that we're going to say it's not worth the money, cost, time, emotional, physical energy. You take away the

your agency, exactly. So you should be the one making the decision. decisions that impact your reproductive future, somebody else, another physician, an organization, or time shouldn't be making it for you. So we're going to wrap up, but I want to talk about the book. You dedicated it to two people. Not trying to make you crying. We're going to start an end of this episode. Campbell and Red. Who are they? They're my rainbow babies. So, you know, Campbell's 11 and Red is 10, they're really close in age, and I love being a mom more than anything. You know, it fuels me every day when I see patients sitting in a hard spot to know that I have such a hard job, you know, at a single genetically normal embryo will have a 65% chance of success. It's incredible

compared to the numbers I said earlier for natural fertility rates, but one of my best friends is an orthopedic surgeon, and she said, if I had a 65% chance of success with my ACL repairs, like I would never be able to do this. And to know that not everybody will always leave with a child. The good news is that the field is really successful if we keep going, which can be limited by a variety of factors. But my kids have changed how I do everything. You know, they also give you an extra fuel for taking care of yourself.

And it's been my biggest dream that the information I wish I had had earlier, that I can give to people earlier and that maybe it will change the trajectory of their health journey. But it's been really sweet to write the book with them to see them be supportive of it, too. Go from, you'd say the book was like a four-letter word for a while. Mom hasn't write the book. You know, he spent all the time writing and pouring into it. And then when the first box came to our house and they opened it, you know, my son who's telling me, took his first copy and, like, propped it up in his room.

He's got, you know, my pink and blue book, like up on his shelf. And he's so, he's so proud of it. It's really, it's something special to have your kids. I think a lot of times working women specifically worry about that. that mom guilt or the balance. But to be able to chase your dreams and bring your kids along and have them be so proud of you, you know, I'd like to give that message if somebody younger is where I was saying, when will I have kids? When's the perfect time in my career? Like, don't worry about the perfect time in your career because there is none. Like when you feel

ready to have children, start trying to have children because it's not a guarantee for any of us and the more time we have to work with, like, the more opportunity we'll have. It's also dedicated to the worst club with the best members. Every woman who has doubted her future, questioned her health, and long for answers. Why'd you say that? This is affectionately what the infertility community calls ourselves, like the worst club with the best members. That's an extremely supportive community, both from, you know, patients online,

sharing their stories, helping share education, helping women, advocate for themselves. For too long, women went in. IVF is hard to understand. And doctors would say, just do IVF and not explain it at all. And yet it's so high stakes, right? Physical energy, emotional energy, financial, right? And then time. It takes some of your potentially last reproductive years into a process. And so that community has rallied behind me. I'll say the patient advocates and the women sharing their stories. I started my Instagram account 10 years ago. my field, the colleagues, like, weren't thrilled, right? They thought patients didn't need this information.

Some of the older guard thought it would make their jobs harder to have patients questioning them more. In fact, I won an award in 2019 by resolve, who was the National Infertility Association nonprofit for patient education. And I sat next to a past president of ASRM who said, can you believe the winner of this award got it because of social media? Isn't that ridiculous? us. And I said, I'm going to go accept it right now. You can listen to my speech. You know, connecting with patients where they are and women sharing their stories has been so insightful. I mean, I was in that club and it changed how I thought about my own health. I realized the questions I had, I didn't learn the answers to them in my own training as a fertility doctor.

And I dedicated part of the book to them because they've shown up for me from day one online, rallying behind me. And I will cry now thinking about, you know, this book just came out. and how these women and men have shown up to events and bought the book and shared it with each other. And people who are past needing it, but recognize the fact that their own journey could have been different had they had it and are so excited to share it with other people. It's really quite powerful and emotional. And what do you want women to take from this book? Women and men, really. You do not have to fail first.

Your health, whatever lens we're looking from, but especially, specifically your fertility. It is worth having the data about your own body and it's worth making decisions from a place of knowledge and you deserve that knowledge about your body. Dr. Natalie Crawford? Awesome. And thanks for coming on on Pazzo.

Thank you for having me. Dr. Crawford's new book, The Fertility Formula, is available now wherever you buy books. You can find her on Instagram, YouTube and Threads at Natalie CrawfordMD, also on her website, Natalie CrawfordMD.com. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information

on health, fitness, and navigating midlife at thepawslife.com. My new book, The New Perimenopause, is available now everywhere and anywhere you buy books and through our website. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you you love. We would be so grateful. You can find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with pod people. I'm your host, Dr. Mary Claire Haver.