Well with Arielle Lorre - 220: All About Fertility with Dr. Natalie Crawford

Episode Date: December 28, 2022

Dr. Natalie Crawford is a fertility doctor board-certified in Obstetrics and Gynecology and Reproductive Endocrinology and Fertility. Today she joins the show to discuss common misconceptions about fertility, why more women seem to struggle with infertility today, and what we can do for optimal hormone and reproductive health. We talk about cycle syncing, how to improve egg quality, how our lifestyle impacts fertility, the truth about aging and fertility, the one question every woman should ask her doctor if she wants kids, and so much more.   Visit CULINAHEALTH.com to register to book your first initial session and mention the Blonde Files or BLONDE and we’ll connect you with Vanessa’s team of dietitians for your initial session.   Shop K18's leave-in molecular repair hair mask at Sephora and sephora.com.   Visit athleticgreens.com/blondefiles for a FREE 1 year supply of immune-supporting Vitamin D and 5 FREE travel packs with your first purchase.     Produced by Dear Media.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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so will auto-hure without your rice-adviseur or sunnycars. combe. The following podcast is a dear media production. Hey, welcome to the Blond Files podcast.

I'm your host, Ariel Lorry, and I'm here to talk all things wellness. From how to achieve optimal health and well-being to the best beauty tips and everything in between, no topic is off limits, and I'm bringing it to you real and unfiltered. I know there is so much information out there, so I'm here to help you navigate it all. Thanks for listening. Let's get into it. Hi, everybody. Welcome to the show.

Welcome to the last episode of 2022, I think. I'm not looking at my release calendar right now, but I believe this is our last episode. And it is a good one. So this episode is all about fertility. I realized that I've done a number of episodes on women's health, women's reproductive health, but never an episode solely on fertility. And this episode is just so relevant and so helpful, whether you have kids, whether you're planning to have kids, trying to have kids, whether you may have kids in 10 or 15 years down the line, whether your partner may be having kids, whatever your situation is, this episode is really packed with so much value. I definitely learned a lot. So I am talking to Dr. Natalie Crawford. She is a fertility doctor board certified in

obstetrics and gynecology and reproductive endocrinology and infertility. She is director of patient experience and education and co-founder of fora fertility, a boutique fertility practice in Austin, Texas. Natalie is passionate about amplifying women and promoting and educating fertility awareness. Her podcast as a woman aims to empower women through education and give people easy access to health and fertility knowledge. And today she joins the the show to discuss common misconceptions about fertility, why more women seem to struggle with infertility today, and what we can do for optimal hormone and reproductive health. We also talk about cycle-sinking, how to improve egg quality, how our lifestyle impacts

fertility, the truth about aging and fertility, and the one question every woman should ask her doctor if she wants kids ever. So definitely listen just to hear that. And we go over so much more. So I think you guys are going to really enjoy this episode. So with that, please enjoy Dr. Natalie Crawford. Welcome, Dr. Crawford. Thank you so, so much for having me. I'm so excited to be here. I'm really excited to have you here. I was thinking back over the episodes that I've done. I'm maybe 250 episodes into the podcast. And I've had. had people come on to talk about hormones, but not about fertility specifically. And this is an area where I think there are so many misconceptions, a lot of confusing information, and judging from the

questions that people sent in on social media, it seems like people just don't know really where to start and what to do when it comes to fertility. So really excited to get into everything with you. maybe to start, we can talk about some of the misconceptions around fertility. Yeah. So I'm a fertility doctor. And one of the things that struck me the very most when I started my training in fertility. So when we do our training, you do four years of OBGYN and then three years specifically about infertility. And over and over again, I sat across the table from really successful, accomplished, smart,

intelligent people who were shocked at how fertility declines with age and that just by being healthy, they can't counteract the impact that age has on our fertility and how nobody has really told things to them in a very transparent way, meaning if you want four kids and you're not ready to start your family until you're 36, it's really unlikely you're going to have four kids. That's unlikely to happen unless you're just an exception. case or you utilize reproductive technology to help grow your family. And I saw people who just were floored by that, who maybe had been partnered and they could have started their family earlier or they could have frozen their eggs or frozen embryos. But nobody really had given them the

opportunity to talk about what happens as we get older, what happens to our egg quality, what happens with natural fertility, and all the things that impact our ability to get pregnant. are not very effective at reproducing, even in our best years, the chance of getting pregnant per month is about 25%. So we think about percentages, you know, if you got a 25% on a test, you think that's terrible. So that is the best when we're our youngest, our most fertile, is going to be 25% per month. And it drops from there. When you're 35 to 37, it's going to be about 10 to 12% per month. And when you're 40, it's going to be 5% per month. And when you're 42, it's going to be less than 3% per month. And those numbers make most people's eyes like pop out of their heads because

nobody said it so clearly. And then the second thing is that your period's a vital sign, right? Like just how important understanding your own body is and that nobody talks to us about this when you're growing up or your early adult years or whatever we're learning about in sex ed, none of it is the stuff that we really need to know about how our body works, how our hormones work, and how all of that plays into eventually the ability to get pregnant. I think that maybe because of the prevalence of reproductive technology and how advanced it's gotten, there is this sense of, well, maybe the sense of urgency has disappeared a little bit, but people don't really, like you said, have anybody who tells

them. Even with that, the viability of having kids after your early 40s, and that's maybe if you're lucky is so slim. Yeah, I just, I think you're right on. And the thing I do hear all the time in people who are purposefully waiting to start their families, but not intervening sooner is, well, I just figured I could do IVF. But IVF similarly, the success rate of IVF is correlated with age. The ability to have IVF be successful is strongly associated with how young you are. So this mindset that IVF is this awesome technology and you can just utilize.

it and it'll guarantee that you can get a pregnant. So it's okay if you wait longer is really false. And I think if we look at, I do love the narrative that people are starting to talk about this more. So we'll just use a pop culture reference of Jennifer Aniston. So recently coming out and saying, you know, everybody speculated about me and Brad Pitt for years, but we tried and we tried IVF and we were never able to have success. So to me, that is so eye telling that you can have all the fame, all the best connections, all the money in the world. But if you, you're not guaranteed success with IVF, it is still a new technology when it comes to medicine. It's amazing that it's helped millions of babies be born that wouldn't have been born otherwise. But it can't overcome age.

And everybody at some point will get to the point where IVF won't help them get pregnant. And a lot of people are really surprised by that because they think that's like their backup plan. I'll just do IVF. Yeah, I'm in my later mid-30s, put it that way. And I don't want kids. There's no part of me that wants kids. However, I have sat across from OBGYNs who have said to me, just freeze your eggs because I've had so many women sitting across from me saying exactly what you're saying, and then they hit a certain age, and all of a sudden, all they want is kids, and then they don't have the option. And I remember, I remember deliberating over it and thinking, yeah, I guess I can just freeze my eggs and maybe when I'm in my 40s and I decide that I want kids.

Like there's this assumption that if you do that, then you can get pregnant no matter what if you decide to. And I see it happening a lot with my friends as well who are in their late 30s who are freezing their eggs so that it takes the pressure off of the decision to have kids or, you know, start now. And again, this assumption that, okay, I froze my eggs and if and when I decide to get pregnant in the next few years, I'll do it. And it will happen. If you are struggling with your relationship with food or your relationship with your body or if you are trying to lose weight and improve your health or if you're tired of bad diets that don't work and don't know where to start when it comes to nutrition, it's time to talk to a dietitian from Kalina Health. I just had Vanessa Rosetto, who is, the CEO and a registered dietitian herself on the podcast two days ago. So if you missed that episode, it is so amazing. She's been on the show three times now because she is just that knowledgeable and you guys have always loved her. That episode is from December 26th. But she made a really excellent point. And that was that if we're struggling with mental health and anything in that realm, we're very quick to seek out a therapist to help us navigate that. But when it comes to our

health or our relationship with food or anything having to do with nutrition, we don't think to go to a registered dietitian necessarily, and it can oftentimes be inaccessible due to cost. But one of the amazing things about Kalina Health is that they accept most major insurance plans. And with extensive training in medical nutrition therapy, Kalina Health's dietitians have the knowledge and expertise to help you make sustainable, healthy changes. to your diet. A registered dietitian can help you create a personalized plan that will help you reach your health goals, whether you want to lose weight, manage a chronic condition, or just feel your best. Kalina Health has worked with more than 10,000 patients, and they have

patients who lost 100 plus pounds without any drastic changes to their eating habits. So with the new year upon us, if you have specific goals that you want to reach, or if you are just wanting to feel your best, definitely visit colinahealth.com to register to book your first initial session and mention the blonde files or blonde and they will connect you with Vanessa's team of dietitians for your initial session. So again, that's colinahealth.com, C-U-L-I-N-A-Halth.com and mention the podcast or blonde to be connected to Vanessa's team. Hi, I'm Caroline Stamberry and I am divorced, not Dead. Fresh off the back of my divorce, I'm bringing real stories, real life, real talk on all things that aren't said. Why do we put so much pressure on ourselves for the happily ever after? Does our love

story really have to be one great lengthy novel? Or can we be happy with a book of short but exciting love stories? I guess we'll find out on divorce not dead. And lucky me, you'll be joining me for the journey, so buckle up. The hard thing about egg freezing, and I think this is hard for the public, you know, to kind of grasp when you only see one piece of the puzzle is that it is so much more successful in your early 30s than your later 30s. The problem is a lot of people aren't ready to spend that type of money, to go through that process, to really address freezing their eggs at that standpoint. There was a really great study that came out showing people who froze their eggs in their early to mid-30s versus people who waited and used IVF to get pregnant later in their late 30s or

early 40s. And not surprisingly, the chance of actually having a baby and spending less money, much favored freezing your eggs at a younger age. That being said, to your point, I have seen people and I tell patients this all the time. It's really easy to be you and Errol, I don't know, your entire circumstance, but it's really easy to say, I feel this way, this is what I want. There's moments in our life where suddenly we might meet somebody that changes all of our views. And I think we have to understand that life ebbs and flows like that. And for women specifically, our ability to get pregnant sharply sharply declines after age 37. I mean, 35 and 36 a little bit lower, but 37, there's a huge drop.

And every year it gets exponentially worse. And you can't go backwards, right? So if there's a meniskeal chance, freezing your eggs relatively does provide comfort. And what that means in most of my patients will say, even if they never use the eggs, The ability to embrace a relationship without fear, oh gosh, he really wants kids. I maybe do, maybe don't and not sure. And just the pressure it puts on time is really invaluable to a lot of people. And also the ability to chase your career or whatever other goals you want or just to have a family at a later age,

maybe when you're more financially stable or you're just ready. When we look at egg freezing, I've had a lot of people say, ooh, that's like an insurance policy on your fertility, which is like one of my least favorite things because an insurance policy pays out, right? Like your house burns down and you have homeowners insurance, you get a new house, right? Like, that's how it works. This is playing the stock market. This is an investment in your future fertility. And on the all, is investing your money a good thing? And does it usually pay off in a good way? Yes. However, does the return on that investment depend on factors associated with when you pull the money out, right? You pull your money out of the stock

market right now really different than if you pulled it out a year ago. And that's because maybe we don't understand the sperm source or how your uterus is or other factors that impact actually having a live born child. So I always say, like crazy thing is an investment in you. It's an investment in your future fertility because it gives you the opportunity to explore having a child with a future partner. It is not a guarantee. It is not a insurance policy. But at any time point, any eggs frozen at a younger age are going to have a higher chance of making it to a baby

than naturally waiting and doing IVF at that earlier age. So specifically for people who have fertility benefits, like we're seeing so many tech companies really try to attract smart, you know, young workers with these amazing fertility benefits

and you can freeze your eggs and at really no expense to you. To me, I tell everybody, like, you really need a very comprehensive compelling reason not to do it. Not that the process is super easy, but the potential that those eggs could give you could change your entire life. And so the usual rate limiting step is money because this stuff is expensive. So if that barrier is taken away, whenever I talk to people, I say, well, why are you not? Like, are you that convicted? Because I don't know about you,

but my life, there's so many moments where I would have said, oh, I'll never be on social media. I don't like sharing my personal life. And now I have a huge Instagram and YouTube and all this other stuff. Right. Like sometimes things just change as we evolve as people. So unfortunately, our fertility just really has this very early, you know, hard stop on it for the vast majority of people. Mm-hmm. Yeah.

I get that. And I have thought about that in my own situation only because my whole audience knows this. I got sober in my late 20s. Congratulations. Thank you. And prior to that, my life was a shit show. And I was aimless and untethered. And I had nothing going on in my life. So I feel like I kind of lived out my 20s a little bit in my 30s. And so part of me wonders, well, then am I going to in your 40s? In my 40s, feeling like people you normally feel in their 30s, starting a family, that kind of thing. So that is the one thing that gives me pause. Otherwise, I do feel confident in my conviction right now. But like you're saying, that can totally change. Yeah.

And I have people, I will tell you this, because I think sometimes we don't see other people who are like us. We just see other people who want to be a mom so desperately. Like, that's their whole goal. And all you can say is, I don't really feel that, right? So you know you're different. I freeze sex for tons of people who tell me, I don't think I ever want children. But in case I changed my mind, I don't want to say I never got the chance to try.

Yeah. So I think there's, you know, a fine line there. Sometimes just to see, oh, people. do go through this who are like me and say they don't see themselves having kids. And obviously we're talking about genetic kids because there's so many different ways to have a family. So just having genetic children is obviously not the only way. I mean, you could always decide in your late 40s and use an egg donor and still carry a pregnancy. You could adopt. You could do an embryo donation. So there's lots of different alternative paths to becoming a parent. But if we're talking about

having a genetic child, there is a time clock on that. And And so I think you're at least asking the questions and answering it, which is what I tell everybody. The worst thing for me is when people just put this out of their mind, right, out of sight out of mind. And they just feel like I'll deal with that fertility situation or if I'll have kids later. And then suddenly they're 41 just thinking about it and realizing how hard this is going to be for them versus somebody who said, well, I thought about this a lot in my 30s and I felt very strongly that I didn't want kids. So if I can't have them now that I'm 41, like, I understand

that. And that's really part of it as being in the driver's seat of making the choice versus letting just our biology and our physiology like happen as they're supposed to. And then being surprised when the most probable thing actually occurred, right? That's what too many people find themselves in the shoes of. I was, every single, I mean, every single week I have somebody. I was waiting until I got married to have kids or to deal with my, fertility are now 41 and we want a family of three. I have to sit across table and say that is, I don't know that that's possible. You know, like we're, we're going to be really happy to have one, or we're going to have to spend hundreds of thousands of dollars to get enough embryos to make this

happen. And that very same person had she frozen her eggs at age 32, could probably have the family of her dreams. So it's just the failure to even like rationalize or think about it. And that's the whole reason why I have a podcast or I'm on social is just to have people think about these goals and how they vision their life and making sure just like every other goal we set for ourselves, we don't just let this goal about our body and our fertility just totally take the back burner. You mentioned something in the beginning about our periods being our vital sign. So let's go over that quickly before we then get into things that impact our fertility and go down that road. So what is a healthy period? A healthy period is a regular, predictable period,

meaning you could look at a calendar and put your finger on the day you think your period is going to come and only be within one to two days of off. Your period also should not be so debilitatingly painful that you cancel plans, like you're canceling dinner with your friends or calling in sick to school or to work. Your period should not be so heavy. that you bleed through your clothes, that's not normal. Your period should not have tons of spotting before it starts. Like a day of spotting can be normal. But if you spot for an entire week and then you get your full flow, that is also not normal.

If the average period is going to come somewhere between every 25 to every 35 days, everybody's set a little bit different, but it should be about the same for you. So if one month, it's 25 days apart, then X, it's 35, then it's 28, then it's 12, then it's 42, that's not regular and you probably have something up with your hormones, whether it's your brain hormones, thyroid disease, PCOS, something else, something is not regulating your cycle correctly. The other thing to know is that in addition to just having our eggs kind of deteriorate in quality as we get older, we do also run out of them. And there's almost no signs for this happening except a shortening of your cycle. So a huge red flag in my brain,

is somebody who tells me, my period's my whole life, we're 30 days apart. But then for the past year, now they're 24 days apart. Like, that's a huge shift. And I'm now suddenly really worried that that period is reflecting that they might go into early menopause or about to run out of eggs. So what I find is people have terribly painful periods and they have endometriosis and they have no idea, where they bleed through their clothes and they have uterine fibroids. And they, you know, are miserable because they have such heavy bleeding or they have undiagnosed PCOS or thyroid disease that they need medical treatment for. So that to me is something when it's really frustrating to hear somebody say, oh, my doctor told me to try to get pregnant for a year and you talk to them and they only have

three periods in a year. You're like, oh, you know, hold that show. Like you're not going to get pregnant if you only have three periods a year. That's so unlikely. You needed to come see a doctor or a fertility doctor much earlier to try to figure out what hormonally is going on because that's not normal. It is important to note that if you're using hormonal contraception, birth control pills, an IUD, an implant, a shot, a patch, a ring, that will alter your period, which is totally fine. They're effective forms of contraception, but then you can't be on the mindset of using your period as a vital sign because it's being masked by the contraception. So what we're talking about talking about when I say your period is reflecting the rest of your hormones and how your

anatomy is and what medical diseases you may have is when you're not on hormonal contraception, what is your body doing? What are some of the things that we can do prior to trying to get pregnant if things do feel like they're a little bit off, understanding that everybody's case is different? So obviously, listeners, if they're experiencing this, should go see someone like you, a reproductive endocrinologist, but are there things that we can do lifestyle-wise that can impact our fertility and help to regulate things and prepare our bodies for that? Yeah, great question. So let's just reiterate, you should always go see an OBGYN or reproductive endocrinologist to find out why, because that root cause is really important. If you see a doctor who doesn't seem to care about

your root cause, then go see another one, right? All doctors are not created equal and you deserve of somebody who's going to listen to you and try to figure out what's going on. When you figure out what's going on, there's a few general just fertility lifestyle principles and all, but there's also some that are different if we have, let's say, endometriosis versus PCOS. When we think about the body and fertility, one of the biggest things is that our eggs are held in a phase of cell division where the chromosomes are held in this little perfect spot. And what happens as we get older is those proteins holding the chromosomes and the right spots start to break down because of wear and tear.

So one of the top things that can cause this or accelerate it, therefore negatively impacting your fertility is going to be smoking cigarettes. Every single fertility doctor you ever meet is going to say, like, top number one thing to never ever do is smoke cigarettes because it's going to impact IVF success, your egg quality, your egg number, your miscarriage risk, everything. Number two, it appears that marijuana is probably just as damaging. We just don't have as much data on it. Number three is going to be to drop inflammation.

Now, that sounds like really broad and like, oh, that's so trendy to drop inflammation. But probably inflammation in the body, which comes from a lot of different factors, I tell patients to say, this is toxic, right? That is your body in an unhappy state that does not want to be pregnant. And this toxic state builds upon itself. And we call that chronic inflammation. and it's the root cause of a lot of diseases, and it's probably a huge piece that's correlated with PCOS.

And that's why some of the remedies just for anybody who has unexplained infertility or wants to have the best fertility possible to drop inflammation, I always talk about this with PCOS patients as well. So what does that mean? Getting sleep is going to be crucial. So at least seven and a half hours a night of regular sleep at the same intervals, meaning around the same hours, you don't like sleep in late on the weekend and wake up early the other days. And that's because sleep is when your cells repair. So if you're going to try to

fight inflammation, you've got to let your body repair itself. So sleep's going to be the top one. I put almost all patients on melatonin, regardless of what they tell me about their sleep, because it does have some good impact on the brain hormones, but is associated with better sleep and more solid sleep. We're also going to want to see our food choices, right? Like what you put in your body, it really impacts the rest of your life. So lots of good fruits and vegetables, whole grains, limiting. Processed foods, sugars, limiting meat if you're PCOS patients, there's a huge study done that more servings of meat people ate, the less they were likely to ovulate. And there's probably

a lot of reasons because if you eat more vegetables and eat less meat, right, usually you're replaced meat with vegetables. And some people just eat meat and potatoes. So there's a lot of kind of cross-bias there. Was that red meat or any animal protein? So that was any animal protein in that study. Further studies look like red meat is the worst. And so what I usually tell patients is, why don't you do red meat one time per week? You know, your other meats, you know, limit your meals to like one time per day of having meat in them. That way you're automatically shoving more like whole grains and veggies and fruits into those other meals and making yourself kind of expand your palate a little bit more than just kind of the traditional like meat and carbs

that a lot of people fall back on. Exercise is important, you know, but a lot of, we don't really know, is it important to drop stress because lowering stress lowers cortisol, lowers inflammation? Or is it building up muscle mass, which also helps fight insulin resistance, which is inflammatory as well? And it's probably both. So I would rather somebody not like run a marathon. I'd rather you do, you know, yoga and walk and do resistance training with weights

and really try to get some lean muscle mass on your body. And I think sometimes we just don't think about these things. I mean, or we know them. I'm always like, this is not like shocking news. A lot of the stuff is things we think about. But they really, too, might make a difference when we're trying to fight inflammation overall. And then the other toxins are going to be alcohol.

Most studies look at four drinks per week or less if people do drink. I mean, of course, alcohol is a toxin. I'm like going to preach to the choir tea area, but alcohol is a toxin to our body, and it causes a huge inflammatory response. I prefer most patients not to drink at all. And then just if you like to drink and have it on occasion, fine because your body can process that toxin. But if you drink every single day, your body cannot do anything else. And it is very overwhelmed trying to heal from that inflammation just that the alcohol is ensuing.

And then thinking about all the toxins in our world, like are you eating off plastic? Are you putting things, you know, microwaving plastics or heating them up? Are you cooking on Teflon? Are what's in your products like your makeup or your hair products? and really just trying to be mindful that, you know, all of those things together can add up to an environment that really can negatively impact your fertility. I have put my hair through a lot over the years with different phases when it comes to color. You guys may remember my brief stint as a brunette.

I think that lasted about two weeks maybe. And then I went back to blonde and back to blonde. So my hair was under a lot of stress, but my colorist thankfully knew about K-18, and we used that to keep my hair from getting damaged and to repair any damage that was done. And my hair remained so healthy throughout that whole process. So K-18 is bringing you the future of hair care with their leave-in molecular repair hair mask that reverses damage in just four minutes. Unlike most products that cover up damage, this clinically proven break. through repairs damage from bleach and color, chemical services, and heat on all hair types. So the secret here is their patented K-18 peptide, born after 10 years of complex

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purchase. All you have to do is visit athletic greens.com slash blonde files. Again, that's athletic greens.com slash blonde files to take ownership over your health and pick up the ultimate daily nutritional insurance. I want to talk quickly about cycle sinking because this is something that is really popular on social media. I've had other hormone experts come on the show and debunk it a little bit. Is there any validity to it, do you think? Or is it just kind of like a sexy wellness trend? Okay. I love cycle syncing, but I think a lot of people sell it as one thing that it's not.

Cycle sinking to me is looking at your world and your life and tailoring your energy and what you eat and what you do to where you are in your period. And there is science that your hormones are different. these two phases and you're going to have different levels of energy and your body needs different things. What it is not is if you do these lifestyle things, your periods are going to sink and be more regulated. That's not what it is. And I do see people kind of sell, especially to the PCOS community, if you do these things, it'll help you be in this phase or that phase. The reality of cycle sinking is saying, okay, in the first half of your cycle, your body is starting to grow an egg.

When it grows an egg, you're making estrogen. You don't have any progesterone because you're body only makes progesterone after you ovulate. So this is an estrogen only phase. This is a time period where you have a lot of energy. You're actually very focused. This is the time to make big like goals on your to do list, to like do the heavier workouts, to do whatever it is you want to focus on. You're going to have more focus in the follicular phase. So that's the time from when your period starts to when you ovulate. And you're going to be able to accomplish more physically. You're going to have more energy. So that's a great time to sync up. those type of lifestyle activities with where you are. As far as what your body needs, it does like a lot of things. The egg is very sensitive in this time. So this is a great time for like leafy greens and whole grains and omega-3s. This is when the egg is susceptible. When you're ovulating, your estrogen is peak ovulation. That's what's going to give you that like wet cervical mucous discharge. Your sex drive is going to be the highest. Your libido, that's nature at ovulation for a reason. And this is a time where typically

your body is still like at the very peak of the energy and very focused. And then after this, you start to make progesterone. And most people, progesterone is a progestating hormone. Suddenly your body's like, oh, let's get ready for a baby. Whether you're pregnant or not, you now have progesterone. And this is going to make you feel more sluggish, have less energy, want more sleep, feel more bloated, and crave more like salty things and the chocolates and those type of things. And this is your body now wanting to put on calories, get a little extra, get ready for that pregnancy to implant. So if we're leaning into that, we're going to say, okay, I need more sleep in this time. I'm going to do kinder exercise to my body. I'm going to do yoga and walking and stretching

and take it easier. I'm going to kind of give myself that moment. And it's the time where you do want to be mindful of some of the like inflammatory things that you could be consuming because you're going to feel the impact of them much more because your body is very sensitive. So I think cycle thinking is really fascinating overall. And if we think about understanding our hormones and what we do, I'll also say, though, like, again, what you do in these phases, like, oh, you should eat these seeds and this phase and these seeds and those or take these vitamins in this face and these vitamins and those. Nothing has shown you need to do or buy or any of that. What I think of it, I think of it, is just like listening to what your body might need at a different moment and adjusting and planning

for that. Oh, okay. Oh, I have to do this big project. Let me kind of give myself space for that when I'm in this follicular phase with lots of estrogen and good mental focus. But people do try to manipulate women's health a lot and sell you things. And that is often very bogus. So it sounds like you can just use it to maximize whatever it is that you want to maximize, whether it's productivity or just using each phase to your advantage. I personally love when I feel the progesterone come on. A lot of people PCOS do. Like I think people who cycle regularly feel a little bit different about it, but PCOS patients tend to like love progesterone and it's very calming for them. And I think because if I look at your lifespan of cycles, you get less of it because you don't ovulate as much.

So suddenly it has this very like grounding sense. Well, for a lot of people, I don't know how you feel about it. That's exactly how I would describe it. That's so interesting. very grounding. It's like this sense of calm and peace descends upon me. Isn't it fascinating? And that's your calm moment, right? You don't want to fight with anybody. You don't really want to go like give a big presentation. You're just kind of like in your own self at that moment. So interesting. So you mentioned birth control a little bit before. A lot of people that sent in questions on Instagram asked about coming off of birth control in preparation of getting pregnant or just because they're, not to be on birth control anymore. What are some ways that people can support their bodies coming off of birth control? What you're not asking that I'd like to answer is that there's no such

thing as post-birth control pill syndrome, meaning the birth control pill does not cause your hormones to be out of whack or cause you to develop any abnormalities. That being said, as we talked about earlier, birth control pill is giving you artificially programmed cycles, so you do not have insight to what your body is doing. Let's use a PCOS patient, for example. In PCOS, you don't ovulate regularly, and one of the hallmarks is because of this, the ovary gets really bored and starts making testosterone. So when you take the birth control pill, you're going to have your testosterone lowered because of one of the things the birth control pill does is it increases something in the liver called sex hormone binding globulent. So suddenly you have less testosterone.

testosterone, that's cool. Like you might have less acne, you know, have less like hair growth, kind of some people who have PCS love birth control for that reason. But also it gives you set estrogen and progesterone every single day. And then when you don't take the pills, you get a period. So everything there is kind of artificial, but that's fine. But when you stop it now, your body's going to revert back. And the very classic PCOS person is going to have regular periods the first month or two. they stop birth control pills and then they start getting further and further apart until they get back to kind of whatever their underlying pattern is. And that's because our testosterone levels start to kind of slowly rise back to baseline as you get off the pill. Your body kind of gets further away

from having your hormones able to kind of be normal and that testosterone is acting as a block. So I always say your birth control pill, you have no idea what your cycle is doing. And if you want to be pregnant or you want to just not be on the pill, and let's say you want to understand your body and you say, gosh, do I have PCOS or do I have thyroid issues and I want to kind of see what my period is doing, you're going to take it about three months to settle into whatever's there. Okay. That's not because the birth control pill last long. The birth control pill is actually very, very short acting. Remember, if you don't take it at the same day around this same time, you might ovulate and get pregnant. We've all heard of people who got

pregnant on the pill. Yeah, I was going to ask how far in advance if somebody does want to get pregnant, should they discontinue? I usually say three months because that's a long enough time because it's not just let the pill get out of your system, but it's let your brain wake up because that's what's really happening. When you take birth control pills, you're taking estrogen and progesterone. Estrogen and progesterone are normally made by the ovaries from signals from the brain. And the reason why the brain sends out nothing is because they don't need to. You already has estrogen and progesterone.

So suddenly when that's gone, the brain has to wake back up. and be like, okay, hey, wait, what do we do? And if you haven't gotten a period by three months off of birth control pills, something is up. Go see a doctor. If you've been off the pill for three months and your periods are irregular, go see a doctor. If you want to be pregnant, I usually say I recommend stopping the pill about three months before you want to start trying to get pregnant and use condoms if you're not quite ready, but allow yourself to track your cycles and just mark when does that first day happen? And note, is it regular or is it irregular? So that you can be a head of the game and go seek help if something is abnormal. I will interrupt and just say the depo-prevara shot is a totally different beast. It is a very long-assing progesterone only, and it is scientifically proven to delay ovulation for three months. That's why if somebody gets the shot, they get it every three months. However, it can prevent ovulation for up to 18 months, a year and a half.

So do not get the Debo-Provera shot as your birth control. if you foresee yourself wanting to start trying to get pregnant in the next one to two years, that would be a time you'd want to transition to another form of contraception. And the third would be if you have a progesterone IUD, like a Morena or a Kyelina, one of the amazing things about those is you might have no periods. And that's because the local progesterone effect on the uterus bends out the lining and allows you to have no bleeding. Wonderful. Nobody needs to bleed if they don't want to. But when that lining's been very thin over a very long time, you might start ovulating,

but not have enough of a lining to bleed off. And it can be very kind of confusing. So I usually do recommend if you're wanting to get pregnant off of an IUD, getting it removed about six months before you want to get pregnant to get your body some time to start getting that lining built back up if you have no periods. If you have periods on your IUD, which some people do still have monthly periods, then you're fine, don't worry about it. But if you have amenorrhea or no periods with an IUD,

take it out about six months ahead of time, use condoms or something else, but give yourself a chance to see if your cycles are going to come back. Are there any other kind of biomarkers that people should look for or test for no matter what once they start to think about getting pregnant or should it be on a case-by-case basis and if people are finding that they're struggling

to get pregnant, then they go in and they get some sort of testing done. So definitely, if you're struggling to get pregnant, so we define infertility as trying for a year if you're underage 35 or trying for six months if you're 35 and above, and you're not pregnant by those timelines, you should get a semen analysis of the partner, you should get your uterus and fallopian tubes checked, and you should get an evaluation to see if you ovulate, which there's a variety of ways to do. The thing that is very debatable, and I will kind of come off of what my professional society would tell you, is that I believe more people should be offered tests of their ovarian reserve,

which is a measure of how many eggs you have. These tests are not perfect. But what they do is they give you insight is if you might be running out of eggs early. The thing that is kind of a double-edged sword here is that your body doesn't really care if you're running out of eggs early if you haven't run out of them yet. meaning I could have a lot of eggs, you could have a little eggs, but we both are going to ovulate one egg per month. So if we're the same age, we're going to have the same chance of getting pregnant. But if you are looking to have more than one child, if you're looking in the future,

if you're purposely waiting, then knowing that you might have a lower egg count than your peers might cause you to do something different to freeze your eggs or to start trying to get pregnant sooner. And I have had patients get their ovarian reserve tested and make a total different life plan once they find out that information. This is the test that we usually use is called AMH. That stands for anti-malarian hormone and it's a blood draw. AMH is made from the cells that kind of each little egg grow inside. So in general, when you have more eggs, you have more AMH. When you have fewer eggs, there's less AMH. It can fluctuate every month because it's actually about how many eggs are active in a given month, but in everybody, it drops

over time and eventually it gets to zero when you're out of eggs. So to me, if I was purposely delaying childbearing or I was in a situation where I was considering egg freezing, I would want to get an AMH checked because it might tell me, hey, everything's normal. Okay, that just, that makes me feel good. That doesn't mean I can get pregnant. It's not a test of my fertility. But if it's low, it would give me the chance to say, well, shoot, like, maybe.

we should try now. You know, I'll use myself an example. My husband and I actually got married and we were 24. And we didn't have our first kid until we were 32, which is fine. But if I had at age 28, found out my egg count was really low, I could have definitely started to have a kid then. We always wanted to have a child. But I was in medical training and I was purposefully waiting. So if you would do something different with that data, maybe you try sooner, maybe you freeze eggs, then you should ask. And I think every OBGYN should be asking this in the same breath. And as are you trying to get pregnant? Do you want birth control? I think they should all say, well, do you think you want to have kids someday? Should we check your ovarian reserve? That is not what a lot of professional societies say. They'll say, oh, that will cost, it's not a very expensive test, but they'll say you're going to cost people money and you're going to cause more worry because they can still get pregnant naturally, which is a fact. But then they're going to spend so much more money down the line. Yes, exactly. Yeah. And then our goals are not just, that's so focused on now, like that recommendation, like that people only care about right now. And I see a lot of people who struggle with secondary infertility. They have one kid and they really want to have a second and now

they can't. And that's a really hard place for them because often the desire for a second child is very little to do internal, but a lot to do with I'd like to give my existing child a sibling. Like I want them to have the experience of growing up with a buddy, you know, a sibling, somebody who's a shared life experience. And if you, knew, based on this, that you were very unlikely to have a second child unless you froze some eds now, like that you could have the choice to make that decision or not. And that's why I think that test is very empowering. You can then choose what you want to do with it. And if you don't end up having the second sibling, like, that's okay because you'll say, you know what, I could have

frozen my eggs, but we didn't. Like, so I feel good with this past versus saying, oh my gosh, had I known, then I would have done something different. Like, that's. That's. You know, that. And regret in the back mirror from something you had no idea was going on in your body. To me, that is something that as a medical community, as a provider for fertility, like, we can do something about that. So that to me just, I hate that. So I try to encourage, and I know like my OBGYNs here in Austin are fantastic about it, them to kind of ask both, are you trying to get pregnant now? Oh, no, great. Let's talk about birth control. Do you want to be pregnant someday? Maybe. Oh, should we test your ovarian reserve? Should you consider freezing your eggs, right? And kind of having this

conversation from both sides so that somebody doesn't find out a data point later that could have dramatically changed their entire life. Yeah, that is really valuable information. And I'm sure that is going to be so helpful for so many people listening. If people do have, say, a low egg count, are there things that they can do to increase that? I mean, I don't really know anything about this stuff. So can you increase your egg count? And can you increase your egg quality? So we'll say overall no, but kind of yes. The analogy that I'm going to use to make it make a little more sense is if we just picture for a moment that inside our ovary is a little vault where all our eggs are kept, right? So you're born, your vault is full. Every month eggs come out of your vault.

Vault is empty. That's menopause. What actually happens is every month a group of eggs comes out of that vault. One of these eggs ovulates, the rest of them die. The next month another group comes out. And when you have more eggs, more come out every month. And as you have fewer eggs, fewer come out every month. So the average 30-year-old has 20 eggs coming out of her vault. One will ovulate 19-dye. The average 40-year-old has like eight eggs coming out her vault. So that's kind of a reflection of how many eggs we have remaining. Now, that's why that AMH test, it's made from the cells that are outside the vault. So that's why it can vary every month by a little bit because the body may not send out 20 eggs every single month. When you start getting into a lower egg count,

so you get a low AMH back, oh my gosh, that's very shocking. What does that mean? It means that the month we checked it, you had fewer eggs outside the vault. That could be random, right? Like, everybody has a random bad month. That could be influenced. Like, long-term birth control use actually can send a few. They actually make the cells less active, but you can have an artificially low AMH and you stop the birth control pill and repeat it in a few months and it's kind of back normal.

Or it could be reflective that you're running out of eggs sooner. You can't make the vault have more eggs in it. But it does look like you can improve the quality of the month. somewhat by some of those healthy lifestyle choices like decreasing inflammation, probably taking antioxidants and vitamins, things like COQ10, dropping your stress level, looking at the foods you eat and the world around you. And you might be able to utilize some of those things to influence the number of eggs that might come out of the vault in a short term period or the number of eggs that are responsive. And that becomes really important for egg freezing or IDF because we think

about those two technologies. We can only get the eggs outside the vault to grow. So the worst news for somebody who has a low AMH, maybe you say, well, that's fine, I'll do IVF. And that's great. But I'm going to get less eggs from you because of your low AMH than I will, your best friend, who's your same age who has a normal AMH. That means that you're going to have fewer embryos, less opportunities for pregnancy, and potentially need to do more rounds or cycles. So if we think about somebody who has half as many eggs and only has 10 available one month,

they're going to get half as many as their friend. But I could get the 10 eggs from the next month too. That's when people do multiple rounds. They kind of get the group for one month and the group from the next month. So we can influence their quality by the things around us. And we know that. I think we're just starting to see more attention on this, that healthy diets, healthy lifestyle patterns,

and avoidance of toxins are the magic combination there. You can't really undo what's already been done. Right? So I say, the damage has been done. You can't undo it. And for some people, we don't know that you caused it. Right. Like, you might have just been born with a low-ed-count number. Who knows? Or maybe you had an autoimmune disease and you ran out of them faster. That's not your fault. But what we're trying to do is when we find that, how do we maximize the quality of them? How do we look at the controllable variables about what you can't control? And then some of the things are things we do. Like if we're doing cycles, we'll use different medications. People have a lower egg count to try to really maximize. the quality or get every egg to respond that we can. So it's really shocking news if people get a low AMH and I guess my overall message would be, it is okay. It does not mean that you won't have a family. It just means that, you know, maybe your best friend's running a 5K and you're running a marathon, but you can definitely do it. You just need a plan and you need a team and people run marathons all the time. So there's no reason why you can't. But it's about knowing that data and then being

able to kind of prepare for that versus just having no idea. And that's keep coming back to that idea because I think for too long, people haven't talked about fertility or equality or periods. And that just leaves everybody in this place of not knowing what's true and what's, you know, false. It seems like more and more people struggle with infertility now. Is that just perception? Because with social media and all these platforms, we hear about it more and because people are being more vocal about it, or do you think it's also partially environmental and being exposed to a lot of toxins and this urgency culture and stress and all of that? Or maybe is it a combination? I honestly think it's a combination of both. I mean, definitely we see more people talking about infertility, which I think is good,

breaking the stigma of it. That is making more people aware, oh, I don't have a period every month. That's not normal. Let me go get checked out. Those are good things, right? More awareness and more diagnosis ultimately helps more people. On the flip-in, we have data showing that we have higher levels of male factor in fertility than we've ever had, lower sperm counts that is directly, you know, associated with increase in toxins in our environment and why we think we're seeing that. And I think I have more patients than ever with lower egg counts. We know our eggs are really susceptible when our moms are pregnant with us, right? So if we think about like what moms did in the 80s and early 90s and how much like plastics and fast food and just the world sugar and the world we lived in

what we were exposed to when our moms were pregnant with us, it was not the healthiest environment. And I honestly think we are seeing the result of that, right? The world that our parents had when their moms were pregnant with them, right, like in the 50s and 60s, you couldn't just get, have access to all this sugar and processed food and junk and all these toxins that, you know, we have seen. So ultimately, I think there's truly. higher rates of infertility, and I think that's due to toxins in the world around us. And we see higher rates of autoimmune disease than ever and higher rates of cancer than ever. But I also think that there is an awareness about it. Anytime you do have more awareness,

I think it's good, but you have to understand the other edge of the coin, like you said, is that means more people might see the doctor. They actually know IVF exists, right? That didn't exist 45 years ago. So if you couldn't get pregnant, you might say, what do they have to offer me? So were people getting diagnosed or seeking care? Whereas now you might say, we're not getting pregnant. What can I do? Is there surgery I can do? Can I do IVF?

And you're actually going to seek help because you've seen online or you've heard people talk about that this is something that we can evaluate and we can treat. I know we're running out of time, but I do like to ask my guests, one thing we should stop doing and one thing we should start doing. So that can pertain to fertility, hormones, or anything. I love that question. If I could, you know, tell everybody, you know, something to stop or something to start doing, I would say the things that I would recommend you stop doing, kind of already covered this, but we'll just say, avoid the toxins that don't really add anything to your life, cigarettes, marijuana, alcohol. You don't need them. You can find happiness in other places. And they're all usually a substitute for something else. And they are harming your body. And I would say the thing I want you to start doing is getting more sleep. Because I think that the vast majority of people, we live in this busy, busy world. We have a thousand things on our to-do list.

We scroll our phones at night. And most people have really poor sleep hygiene. And so putting your phone, you know, across from your bed, taking some melatonin, turning out the lights, you know, reading a book before bed instead of watching TV or being on your screen, getting up at the set time every day, you know, doing light workout in the first thing of the morning, that type of sleep and morning routine can totally change your life and can have a huge impact on your hormones. Speaking my language, I love it. Well, tell everybody where they can find you and follow you, listen to your podcast, all of that. Thank you. So I am on Instagram at

Natalie Crawford, MD, and I have a YouTube channel called Natalie Crawford, MD that has all fertility-related content. And I host the As-A-Women podcast, which is also by Podcast Nation, and you can find it on all podcast players. And if you're interested in becoming a patient, I practice in Austin, Texas, and our practice is called Bora Fertility. Amazing. Thank you so much for coming on. Oh, thank you so, so much. Wonderful. I hope you enjoyed that episode. If you liked it, and if you like the show in general, please take a second to rate, review, and subscribe. It goes a long way, and it's actually the best way to support the show. Also, if you want to to see more about each episode, you can head over to The Blonde Files podcast on Instagram. I'm

always posting about each episode there or over on my personal page at Ariel Laurie. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.