Realfoodology Podcast Summary

Episode Title: Getting Pregnant After 25, What You Need To Know
Host: Courtney Swan
Guest: Dr. Natalie Crawford, Double Board Certified OBGYN & Fertility Specialist
Release Date: February 3, 2026

Episode Overview

This episode centers on empowering women with science-based knowledge about their reproductive and metabolic health—especially for those looking to conceive after age 25 or later in life. Courtney and her guest, Dr. Natalie Crawford (OBGYN and reproductive endocrinologist), debunk the "doom and gloom" around age and fertility, emphasizing what women (and men) can do to optimize their chances of conception, regardless of their age. The discussion blends nuanced science, relatable stories, practical tools, and advocacy for a more personalized and proactive approach to fertility.

Key Topics & Insights

1. The Backwards Approach to Women's Fertility in Medicine

[06:11–08:38]

• Dr. Crawford describes how medical training—and routine gynecological visits—focus on preventing pregnancy without addressing future family-building goals.

• Quote:

  "In our 20s, healthcare focuses on ‘How do you prevent kids? Don’t have kids. What birth control do you want?’ There’s never a conversation of ‘Would you like kids someday?’ or how to achieve that goal." —Dr. Natalie Crawford [06:32]

• She advocates teaching cycle awareness and fertility basics proactively, not just when women struggle to conceive.

2. Early Education and Empowerment for Women

[08:38–12:41]

• The hosts lament the lack of fertility education for women in their teens and twenties.

• Dr. Crawford highlights the importance of learning to track menstrual cycles as an essential “vital sign,” not just for conception but for overall health.

• Quote:

  "Your period actually shifts when you ovulate... and gives you a lot of data we’re not learning to leverage. If we learn our normal when we’re younger, any shift from normal always warrants an evaluation." —Dr. Natalie Crawford [08:58]

3. Birth Control: Benefits, Gaps, and Lessons

[11:35–12:41]

• Both speakers discuss experiences with long-term hormonal birth control, and how it can mask underlying issues (e.g., PCOS, endometriosis), sometimes leading to unwelcome surprises when women try to conceive.

• Dr. Crawford stresses the importance of providing not just solutions (like birth control) but explanations and future planning.

4. The Power of Metabolic and Inflammatory Health Over Age

[22:35–28:59]

• Popular narratives over-emphasize age as the sole determinant of fertility; Dr. Crawford provides a nuanced view:

  • Genetics (age, egg count) matter, but so does the overall health and environment of the eggs and body.
  • Metabolic markers (inflammation, insulin resistance) and lifestyle are equally crucial.

• Quote:

  "The empowering part of the narrative is that... but half the discussion is my health—decreasing inflammation, understanding my body and tracking my cycle, maybe earlier fertility testing." —Dr. Natalie Crawford [24:24]

  "I think the older you are, that just gives you more ownership: I can’t rewind the clock... So instead of perseverating over doom and gloom statistics, say: What factors can I control?" —Dr. Natalie Crawford [25:00]

  • Dr. Crawford shares examples from IVF where improving lifestyle led to markedly better outcomes with subsequent cycles.

5. How to Be Proactive: Testing & Tracking

[12:41–15:58], [47:44–54:07]

• Ovarian Reserve (AMH) Testing: While most guidelines do not routinely recommend Anti-Müllerian Hormone (AMH) testing in young women, Dr. Crawford argues it can be helpful for earlier awareness and choices.
• Cycle Tracking: Use actual ovulation indicators (body temperature, cervical mucus, urinary hormones) rather than just period apps.
• Genetic Carrier Screening: Before trying to conceive, both partners should consider screening for silent genetic diseases.
• Other Markers: Thyroid hormone, Vitamin D, and other vitamin levels can affect fertility and are worth checking preconception.

6. Lifestyle Interventions Make a Difference

[32:02–43:36]

• Dr. Crawford and Courtney share their own histories of poor health in their twenties, contrasting it with their current focus on clean, anti-inflammatory diets, gut health, and blood sugar stability.

• Inflammation and Gut Health: Chronic inflammation is a “hijacker” of fertility.

  • Diet and gut health are the biggest modifiable factors; processed foods, endocrine disruptors, and persistent stress all diminish fertility.

  • Quote:

    "Inflammation interferes with hormone secretion... If you have high inflammatory levels, you have a higher likelihood of having ovulatory dysfunction." —Dr. Natalie Crawford [34:46]

• Sleep, Stress, and Muscle:

  • Sleep is critical for managing inflammation and insulin sensitivity.
  • Chronic stress and sedentary life worsen outcomes; muscle-building helps improve insulin sensitivity independent of insulin signaling.
  • Dr. Crawford also gives practical analogies for insulin resistance and lifestyle impacts.

7. Fertility is a Team Sport: Men Matter

[48:04–48:59]

• 50% of infertility is due to male factors; men should be as engaged in lifestyle improvements, supplementation, and preconception testing as women, especially since sperm regenerate every three months.
• Partners should be equal participants in the fertility journey.

8. Preconception Preparation Checklist

[46:00–54:07]

• Supplements: Prenatal vitamins for women and men (or at least a men's multivitamin).
• Lab Work: Check for vitamin deficiencies, metabolic markers, and genetic screening.
• Joint Lifestyle Review: Diet, drinking, physical habits—both partners should address modifiable risk factors before trying to conceive.
• Cycle Health: Investigate abnormal periods or suspect symptoms (heavy flow, irregular cycles, pain) before starting to try for pregnancy.

9. Diets and Health Trends

[54:17–62:10]

• Whole, real food diet is best for hormone and reproductive health.
• Dr. Crawford critiques restrictive ("carnivore") and low-fat diets, advocating:

  • High-fiber, diverse real food

  • Inclusion of healthy fats (especially for hormone production)

  • Full-fat dairy can be beneficial for some (vs. low-fat/skim).

  • Quote:

    "Cholesterol is literally the backbone of your steroid hormones. If you're not eating fat, you're not giving your body what it needs to make progesterone and other hormones." —Dr. Natalie Crawford [58:50]

10. Advocacy and Navigating the Healthcare System

[63:37–67:33]

• Women should advocate for themselves: Schedule specific medical visits, prepare information for providers, and be willing to seek a new doctor if not heard.

• No one is “married” to a particular provider; patient-doctor relationships should be symbiotic and empowering.

  • Quote:

    "If you're getting dismissed, gaslit, not getting what you want... Go see somebody new. If you're trying to get pregnant or have infertility, you need to trust that the person helping you is aligned with your goals." —Dr. Natalie Crawford [63:32]

Notable Quotes and Moments

• “For every single woman, time will make a decision for you eventually. That doesn’t mean age is the end-all, be-all, but it does mean that we deserve knowledge and data about our bodies earlier so we can be the one in control of our reproductive future.”
  — Dr. Natalie Crawford [14:12]

• “I’m healthier now being pregnant at 41 than I would have been at 24, because I was binge drinking and living off SlimFast bars.”
  — Courtney Swan [32:03]

• “Fertility is a health marker. Women with infertility have a higher rate of cancer, cardiac issues, stroke, metabolic syndrome... There’s an underlying common cause that is contributing to both the infertility and this latter risk of disease.”
  — Dr. Natalie Crawford [21:07]

• “You deserve to have a healthcare relationship you feel really good in, where you feel seen and heard, even if they can’t get you all the answers.”
  — Dr. Natalie Crawford [67:10]

Timeline of Important Segments

• [06:11] — Dr. Crawford outlines her mission to educate and empower women proactively about fertility.
• [08:58] — First step for women: learn to track their cycles for hormonal insight.
• [12:41] — AMH and ovarian reserve explained; why earlier testing can be empowering, not stressful.
• [20:02] — What influences AMH and what’s in your control? Genetics, inflammation, toxins.
• [22:35] — Why narratives around age and fertility are misleading; metabolic health matters too.
• [32:03] — Courtney’s personal story: Why she’s healthier at 41 than in her 20s.
• [34:46] — Inflammation’s role in fertility and why it must be addressed preventively.
• [39:22] — How stress and muscle mass impact insulin resistance and overall fertility.
• [48:04] — The importance of including men in fertility health; sperm health basics.
• [54:31] — Diet matters: processed food versus real food and fertility outcomes.
• [58:50] — Full-fat dairy and healthy fats: essential for hormone production.
• [63:32] — Final advocacy: How to get what you need from the healthcare system.

Episode Takeaways

• Women should be given data, cycle education, and actionable options on fertility starting in their twenties, not only after issues arise.
• Your fertility is influenced by much more than just age—diet, inflammation, sleep, stress, muscle mass, and lifestyle all matter deeply.
• Advocacy is crucial—know your body, request the right tests, and never hesitate to seek new care if your needs aren’t being met.
• Fertility is not just a woman’s job; men’s health, habits, and involvement are equal contributors.
• Simple dietary and lifestyle changes can have a profound impact on hormone and reproductive health.

Relevant Links & Further Resources

• Guest: Dr. Natalie Crawford, MD — @nataliecrawfordmd | "As a Woman" podcast
• Book: The Fertility Formula — Preorder details available via Dr. Crawford’s platforms
• Host: Courtney Swan — @realfoodology
• Practice: Fora Fertility (Austin, TX)

This summary isolates the central educational content and key empowering messages, providing a roadmap for anyone interested in optimizing their fertility and overall health—even decades before trying to conceive.