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The Neuro Experience
Why ‘Doing Everything Right’ Still Won’t Get You Pregnant | Dr. Natalie Crawford
01:03:15
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- [00:00]
Louise Nicola
Fertility can feel like a cruel lottery. You see women doing everything right, tracking every cycle, optimizing every variable, who still can't conceive. It's confusing. It's emotionally devastating for some, and honestly, it makes me question whether anything you do even matters.
- [00:17]
Dr. Natalie Crawford
Fertility is a representation of your overall health. Women who have infertility. I'm in this bucket. Have a higher rate of chronic medical disease, stroke, heart attack, diabetes, cancer, and earlier death.
- [00:27]
Louise Nicola
I can't tell you how many times, almost everything that now I'm believing is coming back to inflammation.
- [00:34]
Dr. Natalie Crawford
This is truly how chronic inflammation in today's world is hijacking our fertility.
- [00:39]
Louise Nicola
Wow. I don't know a woman who hasn't felt the pressure of her own biology, the clock, the fear, the confusion. And IVF is the one topic everyone whispers about, but no one truly understands.
- [00:51]
Dr. Natalie Crawford
Even though the odds of success with egg freezing are better if you're younger. I've had women over age 40 freeze eggs who are holding a baby in their arms right now. I've had women go through IVF at advanced ages. For most of them, it's not going to be achieved in a single cycle. But people run marathons all the time, and it's up to us to make the decisions that are right for us.
- [01:08]
Louise Nicola
Dr. Natalie Crawford is the fertility doctor, rewriting what women know about their bodies.
- [01:13]
Dr. Natalie Crawford
So many people have a life goal of having a child, yet the approach is, I'm not ready, so I'll think about my fertility later. And the thing that I'm sick of hearing every single day from patients is, if I'd only known this information sooner, I would have made different decisions.
- [01:27]
Louise Nicola
I'm Louise Nicola and this is the neuro experience. Natalie.
- [01:32]
Dr. Natalie Crawford
Hello.
- [01:32]
Louise Nicola
Fertility can feel like a cruel lottery. That's what I truly believe. When I look at every area in medicine, every specialty, I look at fertility, and I think it's all about luck. You see women doing everything right, tracking every cycle, optimizing every variable, who still can't conceive. Then you hear about women who seemingly ignore all of the rules, fall pregnant easily. So I've watched clients with robust AMH levels struggle. Then I've got close friends who were told in their 30s, this is going to be a very difficult path for you with extremely low AMH levels. They tried everything. They gave up at 42, fell pregnant naturally. It's confusing. It's emotionally devastating for some, and honestly, it makes me question whether anything you do even matters. So you have five fertility non negotiables, foundational factors that people need to know about along their fertility journey. So why don't we start with there?
- [02:34]
Dr. Natalie Crawford
I'm glad that you bring this up because it does seem unfair sometimes. If you're going through infertility, why is this happening to you? I've had pregnancy loss and infertility myself. And being on that side of the table, even as a physician, it feels hopeless. You can feel dismissed sometimes by your physician, and it feels really isolating to get left behind as peers, friends, family are moving on to a life stage that you desperately want to. But I want to push back on this luck narrative quickly because luck is something you have zero control over. And when we think about our knowledge, the choices we make, we think about the doctors we choose to go to or get opinions from. That is the definition of not luck. That's planning and preparing and making active decisions. And when it comes to our fertility, for all of us, it is finite. Age is one piece of the puzzle, but not the whole puzzle. And we don't want to let just time make a decision for us. We want to plan for a life goal, if having kids is a life goal. But even more than that, fertility is a representation of your overall health. Women who have infertility. I'm in this bucket. Have a higher rate of chronic medical disease, stroke, heart attack, diabetes, cancer, and earlier death. And it's not that infertility is causing these things, but it's a common causal factor that's putting you at higher risk for inf. Is also putting you at higher risk for these health conditions later. And this is because we have to start thinking about infertility for many people as a red flag that your cellular health is not functioning appropriately. And this is truly how chronic inflammation, in today's world we're exposed to so much is hijacking our fertility.
- [04:12]
Louise Nicola
Wow.
- [04:12]
Dr. Natalie Crawford
So when it comes to fertility non negotiables, this is really looking at changing the narrative of I'm going to do what I want to, but instead we're going to say, I live in an inflammatory world. Every single day I make choices or I'm exposed to things that I have no control over that are causing chronic inflammation inside my body. This is contributing to insulin resistance, hormone dysfunction, abnormal gut health, slew of problems, but it's also contributing to infertility. So if we want to walk that narrative back, we want to have an active plan to combat this inflammation that we're exposed to. And this is going to be by focusing on sleep, stress, exercise, diet, and avoidance of toxins.
- [04:53]
Louise Nicola
I want to stop right there. This word inflammation?
- [04:57]
Dr. Natalie Crawford
Yes.
- [04:57]
Louise Nicola
I can't tell you how many times. Almost everything that now I'm believing is coming back to inflammation. I don't care whether it's, you know, there's so many paths to diseases, but.
- [05:08]
Dr. Natalie Crawford
I feel like it's all coming to the same.
- [05:09]
Louise Nicola
It's all coming to inflammation.
- [05:11]
Dr. Natalie Crawford
You know, Louisa, my pathway to start thinking about this. Cause this isn't really how we're trained in medicine. We learn about inflammation on the disease pathway. Right. Acute inflammation is your body healing from a cut or something quickly. And chronic inflammation is when your immune system is constantly activated. And certainly that results in a toxic process. But when I started researching natural fertility, which is what I did all of my fellowship thesis on, most people do an IVF project or something in the lab. Cause it's easier to control more of the variables. Of course, epidemiologic research is more complex. But when I was looking at ovarian reserve and vitamin levels and environmental toxins and abnormal menstrual cycles and luteal phase issues, I saw the word inflammation everywhere and started really realizing exactly what you said. Our cells, we have one body. Everything's connected. We've gotta start really looking at how this process of inflammation is the precursor to so many disease states across organ systems.
- [06:09]
Louise Nicola
But where I am having trouble understanding. Okay, you've got, yes, we've got natural conception. And then, you know, let's just call it. If you're with a male and you want to do the natural way of trying to conceive. Okay. And maybe you don't, and maybe there's an inflammatory process. Maybe you're not ovulating. I'm not sure why that might be happening. So that could lead you to infertility. Okay, but what about for the woman who wants to do this via ivf? Let's just say she's reached a point in her life. Maybe she wants to do this alone and she's opting for sperm donation and she has a low amh, and the stimulation from the like to stimulate the ovaries is not working. She's not classified as infertile then, is she?
- [07:03]
Dr. Natalie Crawford
That's an interesting definition because officially the old definition of infertility would say no. So infertility was officially defined as failure to get pregnant after 12 months of trying to conceive. Okay, that has some issues, especially for the patient. Example that you're explaining. What if we need donor sperm to conceive? What if we need, you know, gametes that we don't have? What if we're born without a uterus, and we need a carrier hysterectomy. So there's a few different scenarios that don't allow you to necessarily try naturally for that amount of time. And the definition of infertility has officially been expanded to include those things. When we think about it, even with ivf, one of these false myths that I see all the time is people say, I can just do ivf, IVF will work, I can wait. And even we're doing ivf, we can only work with the eggs and sperm that we're given. And AMH is just one piece of the puzzle. So maybe let's explain what AMH is to a degree and the difference in egg quantity and quality, but also how they're related, because I think that's the heart of what you're asking. I like to think about all the eggs that you're born with as a woman are kept inside your ovary. And I like to imagine them as in a vault inside your ovary. So when you're born, that vault is full. You, you have about 1 to 2 million eggs at birth. Every single month, a group of eggs is sent out of the vault, and each egg grows inside a follicle. The brain is going to send out a hormone called fsh, or follicle stimulating hormone, well named. It stimulates one follicle to grow, and that follicle is going to grow and make estrogen and ovulate. The rest of the ones that are outside the vault will die. And the next month you have another group sent out of the vault. So there's this delicate balance between the brain and the ovary. What we know is that when the vault is more full, so when you are younger, more eggs come out of the vault every month. And as the vault gets less full, typically as we get older, fewer eggs come out of the vault every month. Now, when it comes to IVF or egg freezing, I can only get the eggs that are outside the vault to grow. I'm limited by your own potential. But what's interesting is I can estimate those eggs out of the vault by either counting them on ultrasound. That's called an AFC or an antral follicle count, or. Or by checking a blood test called amh, anti mullerian hormone. AMH is made from the granulosa cells that surround all the follicles. So more eggs remaining, more come out higher amh, fewer eggs remaining, fewer come out lower amh. But that's pure numbers. There's also the quality of these eggs, which really plays a Huge role. And this is how inflammation can really come in and give us a double hit. We know that inflammatory diseases, autoimmune disease, smoking cigarettes, endometriosis, they can actually get into the vault, decrease the number of eggs that you have, so directly damaging your ovarian reserve. That's really scary data if you think about it, especially if you don't know this information. But the other thing is it changes the quality of the eggs. So quality is both genetics and metabolic competencies. How I explain it. Genetics are the chromosomes inside your eggs which are going to pass on, are held in a perfect stage of cell division, metaphase of meiosis. So remember, when your chromosomes meet in the middle of. So you have meiotic spindles holding them apart. These are proteins. And as we get older, our proteins break down. We're not surprised by that. So they get out of order. The chromosomes get out of line at a higher rate as you get older. From tincture of time, that process is accelerated. If you're exposed to more inflammation, inflammation breaks down proteins. So those chromosomes are going to have a higher odds of being out of order. And then more genetically abnormal eggs. But also the eggs have the mitochondria, and the mitochondria gets passed to the embryo, and the egg health controls fertilization and early embryo growth. So if you are exposed to more chronic inflammation or insulin resistance, you're going to have more mitochondria that are not going to function as well. Now, in a population, we see this happen more as people get older. We get more metabolically unhealthy the older we are. And so we see that mitochondria in women who are 38 and older, 10, tend to be more abnormally shaped, not functioning as well.
- [11:01]
Louise Nicola
It's a normative database you're talking about.
- [11:03]
Dr. Natalie Crawford
Yeah. And we tend to see more inflammation in the follicular fluid, but that can vary. And when you look at it and stratify for people of infertility and those who don't, we see that higher rates of inflammation and abnormally functioning eggs in people of infertility. So this, to me is good news in a way, because you can't change your age. We absolutely cannot roll back the clock. We can't change when you found your partner, when you were ready to get pregnant, your age is something at some degree we have. But if we can influence the metabolic health of our eggs by the decisions that we're making and the choices and how we're actively preparing our life, then we have a lot more control over our potential outcome. And that discussion needs to be had much earlier.
- [11:44]
Louise Nicola
I'm so happy you said this because this once again proves that we have agency in some aspect, right? I'm not saying. At age 50 and beyond, one of the most overlooked pillars of longevity and health is is hydration. Your brain is 75% water. Even a 2% drop affects cognition, reaction time and mood. And it's actually more pronounced in women. And I realized a while ago that I was drinking enough water, but I wasn't actually hydrating. And that's where cure hydration has become a staple for me. It's a plant based electrolyte, so there's no sugar. It's using the same science behind oral rehydration solutions, like the stuff that's used in medical settings. Because this is what actually works. And it doesn't taste like you're having a brick of salt. I use this almost every day. And you guys know how I travel so much. You get so dehydrated. So I use the cure sachets. I take them on the plane, I sip them all day. I love the raspberry flavors. I mean I love the watermelon flavor. But honestly, it's probably the best, easiest, most effective way to stay hydrated. You should be having at least one sachet a day. And this is of electrolytes. So your brain can function optimally if you are having electrolytes and if you don't know which one to have and if you're still having Gatorade or even hydrolyte, you need to be getting this one cure hydration. You'll get 20% off your first order at cure hydration.com neuro or just go to their website, look at all the flavors, type in code neuro and you will get a 20% off discount. Let's talk about morning fuel. If you are one of those people who doesn't like to eat first thing in the morning, but you know you have to because you know you are a woman and you need energy and stamina before you go to the gym. Then I have the absolute best thing for you. Hu hu is amazing. They have this thing called a complete meal. It's got 35 grams of protein. Yes. 35 fiber, 27 vitamins and minerals and it tastes good. I have their chocolate one and then they also have a coffee flavored one. It's so easy. I can only have liquids in the morning. I don't know about you guys. I can only have liquids. I have this first thing in the morning, go to the gym and then during the day I like sipping on. They have this, their daily greens, which is like one of the things I sip on daily, but it's in a can and it kind of tastes like I'm having a mocktail. But it's got 42 micronutrients in a clean, refreshing can. It's my micronutrient insurance. When life gets chaotic. And it also tastes amazing, they have different flavors as well. So if you want a simple, reliable nutrition that actually supports long term health and it's efficient, try heal. You'll get 15% off your first purchase as a new customer. If you go to huel.com neuro just go to their website, look at all the things that you can buy. Type in neuro at checkout for your 15% off.
- [14:54]
But it's interesting, this whole mitochondrial effect, because isn't the most amount of mitochondria in a woman held in her ovaries, is that correct?
- [15:03]
Dr. Natalie Crawford
Because you have so many eggs and there's mitochondria in each one because you.
- [15:06]
Louise Nicola
Need one egg each month to be fertilized. Right. And a woman who is OB ovulating each month maybe have the same, but it does not matter. And I'm asking this because of the amount of questions we get. And I do believe that a lot of women, myself included, I didn't even know about AMH until I was around 25, 26. And I mean, that's still young. And my doctor first told me, okay, this is your AMH level. I was like, what are you talking about?
- [15:30]
Dr. Natalie Crawford
What is that?
- [15:30]
Louise Nicola
Yeah. And I remember distinctly she said, this is the number that will determine if you can fall pregnant or if you can have a baby or not. I remember, I was like, that's not true. Yeah, well, that was 10 years ago, right? I was like, oh my God. Wait, what?
- [15:43]
Dr. Natalie Crawford
It's terrifying.
- [15:44]
Louise Nicola
It's very terrifying. So I can imagine how many women are really led to believe that AMH is the sole number one thing. If it's high, great. If it's low, great.
- [15:53]
Dr. Natalie Crawford
You know, AMH is one piece of the puzzle. It is helpful information to know where you might be falling on the curve of am I running out of eggs? To be clear right here, you know, the American College of Ob GYN recommends that you do not check AMH levels in women who are not actively having infertility. And I adamantly disagree with this. But their point is that it can cause undue stress and anxiety. And young women to find out their AMH is low and potentially be in a position not to do anything about it. There is a big study showing that if you have a low AMH or you have a high amh, as long as you're still ovulating regularly, you don't have a higher rate of infertility. And this was one study, although there's some others showing that low AMH is associated with poor egg quality, potentially, or worse, pregnancy out or having a harder time getting pregnant. And I think that really speaks to why is your AMH low? Because there's some causes that are due directly to inflammation and there's some causes that are not at all. You were just born with a lower number of eggs, and maybe it's genetic. And so the outcome of these two different groups when you go try to get pregnant is going to be different. A notable cause is endometriosis, chronic inflammatory disease. This can cause a low AMH and.
- [17:06]
Louise Nicola
Also infertility and also autoimmune diseases.
- [17:09]
Dr. Natalie Crawford
Absolutely. Autoimmune disease falls into the same camp. Anything that's going to cause chronic inflammation can contribute to both. But there's other causes of amh. Everybody's born with a different number. We don't know where you start, the rate of decline. Women who maybe lose an ovary because of a cyst, something totally unrelated to inflammation. So there's some factors that do contribute to a lower AMH that may not impact your ability to get pregnant naturally. But if we think about the brain and the ovary again, one of my favorite things to explain is that they are like best friends living in different states. They don't see each other every day, they don't know what's happening. They're listening for the hormone text messages. So you're ovary sending an estrogen signal to tell the brain what's going on, and then it's going to respond back with FSH or lh. And what happens is when you have both a high or a low egg count, high or low amh, there is miscommunication between the brain and ovary. And we see harder to get pregnant at both these very high AMHs and at very low ones because the brain is sending out its regular amount of fsh. And this tends to get either diluted if you have too many follicles or too strong of a signal to each one. And you might be ovulating late or early or irregular. And this can cause some ovulatory dysfunction. So it's another way where your AMH value, yes, is important, but it can influence multiple different aspects of trying to get pregnant. And that's also why understanding your hormones and tracking your cycle can be really important as learning to clue in and listen to your body.
- [18:41]
Louise Nicola
And I think at the end of the day, I mean, I even see myself, like, when I travel back to Australia, cycle, maybe off, like one or two days. It's really interesting. Sometimes a couple more days, and then, you know, when I'm not stressed and you just see.
- [18:55]
Dr. Natalie Crawford
And it's a.
- [18:56]
Louise Nicola
It's really interesting as a woman to track something like this.
- [19:00]
Dr. Natalie Crawford
I mean, Louisa, when did you learn to track your cycle?
- [19:02]
Louise Nicola
Two years ago, right? Yeah. No one told me that this is.
- [19:05]
Dr. Natalie Crawford
Stuff that we should be taught when we are younger. We should learn what ovulation means, how to identify if our period is normal. Yet this is not what current education is. And instead, most of us are learning this at an advanced age. Maybe we're going through perimenopause and things get funky. Or when we're trying to get pregnant and we're saying, what is happening to my body? But we deserve to understand what's really happening with our hormones and our cycle at a much younger age.
- [19:31]
Louise Nicola
Oh, yeah, it's interesting. So I was an elite triathlete, so I raced for Australia.
- [19:35]
Dr. Natalie Crawford
Impressive.
- [19:37]
Louise Nicola
Three sports. That's crazy. And I remember leading up to Beijing, I was training. We were training 40 hours a week. I was in my 20s, and there was a time where my period didn't come for 50 days. I remember it. I remember it because I remember, like, I went to the doctor, I was like, what the hell? 50 days. Then it came, and then maybe it didn't come for two months. And I lost a lot of weight at the time. Do you see women in this, you know, phases where maybe, you know, with the rise of GLP1s, is there any, anyone in your practice that may have gone through something like this where they're training so hard and they're not ovulating?
- [20:14]
Dr. Natalie Crawford
Absolutely. So hypothalamic amenorrhea is when your brain, the hypothalamus, is that command center listening to those signals from all over. And then it's telling the pituitary gland to send out those other signals and it can get shut off from extreme stress, undernutrition, over exercising, chronic illness. Essentially, when your brain says, I'm not sure that Louisa can carry a pregnancy right now, we're gonna start to shut off what is coming out. We don't want her to ovulate. And of course, there's stages. It's never an on, off switch. There's stages of hypothalamic dysfunction as well, that we start to see period changes in if we're paying attention to them. But I'm in Austin. I see a ton of athletes. I see many people who play at an elite level. And what's really hard is very often they say, I'm fine, that my period's not here. It's like, oh, that's kind of a bother. I'm okay with it. But then the longer they go without that estrogen, because estrogen's made in its highest amounts when we're ovulating, they start to notice that their performance is going down, that they don't have the same recovery, their heart rate variability is not as high, they can't achieve their same goals. And it becomes quite problematic. And I think, think this narrative of understanding that unless you're on hormonal contraception, you need to be having a regular monthly cycle. And if you're not, your body is telling you something is wrong that warrants an evaluation. And sometimes it's factors choices you're making. Exercising, eating, Sometimes it's a disease. Thyroid hyperlactin. And we really have to do a big investigation to see what's happening. Your question about GLP1s is interesting because GLP1s are twofold right now. They can be game changing for certain patients with metabolic disease. I see a ton of women with pcos, a lot of women who are also overweight. And of course, fat cells make a form of estrogen that can further confuse the brain. And we know fat cells are so inflammatory, so you get a double hit again from being overweight. Losing weight with GLP1s can be great. It also can reverse insulin resistance in so many patients. And I have pcos patients who were not able to ovulate who suddenly could after being on a GLP1. Or even more impressively, they'd gone through IVF and not had good embryo outcomes, took a break, went on a GLP1 and then had another cycle and had completely different outcomes. So we have to acknowledge that for the right patient, those who have a lot of inflammation, insulin resistance, or weight to lose, those can be barriers to fertility. And this can be a useful tool that should be in our toolbox. In the same breath. We also see more patients getting skinnier than ever, really being underweight because they're.
- [22:48]
Louise Nicola
Not eating, they're not meeting the protein requirements. Yeah.
- [22:50]
Dr. Natalie Crawford
Unfortunately, we're switching back, I think, from this body positivity image to the era of being extremely thin. We see celebrities being very thin and that's trickling down to where the regular person wants to be extremely thin again. And your body may not be functioning at its best. We want to have some fat reserves, not too much, not too little, but right in the middle in order to carry a pregnancy. Being pregnant is a very big deal. And even if you don't want to be pregnant at this moment, the point of having a menstrual cycle physiologically is to allow you to get pregnant. And so if your fat is so low that your body's not sure that it can support a pregnancy, it's going to start to change how you ovulate, and it's going to change that threshold for which it wants you to be able to. And the worst thing about this is that it can take years to get full recovery from the hypothalamus. So if you do go into hypothalamic amenorrhea, it's not always as easy as, oh, I'll eat more and put on weight, and this will fix it. Sometimes can take a really long time to convince the brain that things are stable enough to start ovulating again.
- [23:54]
Louise Nicola
Wow.
- [23:55]
Dr. Natalie Crawford
I know.
- [23:55]
Louise Nicola
All right, I want to switch. Not really switch, but I really want to talk about IVF. IVF has helped 13 million people.
- [24:02]
Dr. Natalie Crawford
Actually, it's up to 17 million babies have been born from IVF.
- [24:06]
Louise Nicola
Wow, that's amazing. Women hear the term ovarian reserve, which we've covered. And this obviously relates to IVF in a sense. But I want you to walk us through exactly how these medications that you take, you know, during the stimulation process, but how the whole IVF process works.
- [24:27]
Dr. Natalie Crawford
Let's talk through IVF in one sentence. IVF is trying to get all the eggs that are outside the vault to grow. So instead of your body letting almost everything die, we're gonna say for this moment in time, we want them all to grow. Well, how we do this is by giving your body shots of hormones. And it's actually synthetic versions of LH and fsh.
- [24:43]
Louise Nicola
I thought they were stimulate. Do they. They're not actual hormones, are they?
- [24:47]
Dr. Natalie Crawford
They are FSH and lh. So they are. What's the hormones that are sent out from the pituitary gland? Sometimes we use growth hormone as an adjunct, but FSH is the primary driver. Just like it is in a natural cycle. FSH gets a follicle to grow. What we're doing with the stimulation meds is giving synthetic form of fsh. And so we are giving it, though, in higher than normal doses than your brain would normally make.
- [25:09]
Louise Nicola
Is that safe?
- [25:10]
Dr. Natalie Crawford
It is safe. It's vastly cleared from your body. It is going to fill those receptors in the ovaries and the eggs that are outside the vault. Our goal is to get them all to grow in this one moment in time that takes about two weeks, just like it would in a natural cycle. It takes about two weeks to get an egg to grow to maturity. That is happening in ivf. These are daily hormone shots, subcutaneous shots, so much like people give themselves the GLP one, just right into the fat area of the abdomen. And you usually come in for monitoring, which is an ultrasound measurement of the follicles. To put it simply, they get bigger as the eggs get more mature. And we're also checking estrogen levels, because the more mature an egg gets, it makes more estrogen. And we can titrate the medications as we go along. And we're trying to find out when we're at peak maturity so we can take these eggs out of the body. This is going to be the procedure called an egg retrieval, which is typically done under some anesthesia, twilight anesthesia, like it would be for a colonoscopy. And this is great because you're not going to feel it. We put a attached to a vaginal ultrasound, and we can enter the ovaries vaginally. So we put this needle into each follicle, drain the follicular fluid. We're then able to pass off test tubes of follicular fluid, which will then contain the egg. And an embryologist inside the lab will identify the egg from that fluid. This procedure is really quick, takes 15 to 20 minutes. The follicles will then drain. It's not that different than naturally. The follicle would rupture inside your body and the egg would be released. So we're just draining them directly so we can capture those eggs. And then from there, the eggs will be fertilized in the lab. They will then grow out to an implantation stage embryo, which is called a blastocyst. A day, five or six embryo, and then genetic testing can be done, or the embryos can be frozen, and then we can do an embryo transfer and most transfers now, what we call frozen embryo transfers, where the embryos get frozen, you would have a period bleed off that endometrial lining that was exposed to those higher estrogen levels, and then we regrow a lining. There's a few different protocols to do that, but essentially we're trying to put the embryo in, in that perfect implantation stage.
- [27:15]
Louise Nicola
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- [29:33]
Dr. Natalie Crawford
Not every egg is going to be mature, fertilize, make it to a blastocyst, be genetically normal or implant. So with a single genetically normal embryo, we see live birth rates of about 65%. Which is actually incredible when it comes to what the technology can do. Because if I have a 30 year old sitting in front of me, she naturally would have about a 20% chance of getting pregnant per month. So 65% for a single genetically normal embryo is really great. If I look at cumulative pregnancy rates with multiple embryos, if I have two. Not at the same time, but if.
- [30:04]
Louise Nicola
Why not at the same time?
- [30:05]
Dr. Natalie Crawford
Because at the same time, we are only going to be increasing risks. Right. Multiple pregnancies have a lower live birth rate per embryo and higher risk to the mom. And we're also not gonna be in a place to really optimize the environment for each embryo. So the way I like to think about it is you went through so much to get these embryos. We want to give each single embryo the absolute best chance of success that it can have. And I don't want it to compete for resources inside your uterus with another embryo trying to implant as well. We want it to have the full surface area of the uterus to implant where it can and do the best. And this has changed dramatically in IVF as embryo freezing technology is so advanced.
- [30:43]
Louise Nicola
Really?
- [30:43]
Dr. Natalie Crawford
Yeah. Most embryos, 99% will survive the freeze thaw now. And we can do.
- [30:48]
Louise Nicola
Really?
- [30:48]
Dr. Natalie Crawford
Yes. So vastly different than it was 10 years ago. So when. When you went through all this.
- [30:53]
Louise Nicola
The thawing process.
- [30:54]
Dr. Natalie Crawford
The thawing. So we thaw them and then we go freeze, or we freeze them and then we thaw them.
- [30:57]
Louise Nicola
So I thought you lose eggs during the thawing process.
- [31:00]
Dr. Natalie Crawford
So for eggs, so the egg is a single cell, and the embryo at that stage is about 300 cells. Eggs survive the freeze thaw process 90 to 95% of the time now, which is significantly better than 10 years ago, is 40 to 50%. So we're able to change how we counsel patients as technology has improved, because 15 years ago, if you went through IVF and all your embryos were gonna not survive in the freezer. Yeah. We wanted to put them in your body and give them a chance. But now we can say single healthy baby is the goal. Yet we see that cumulative rates increase with the more genetically normal embryos you have. So after two embryos, two consecutive transfers, you have an 83% chance of live birth. And after three, it's 93%. So most women will have success with IVF * if they have enough genetically normal embryos. And that's where ovarian reserve egg quality really start to come into.
- [31:57]
Louise Nicola
Play. So is it better then to do a fresh transfer over a.
- [32:01]
Dr. Natalie Crawford
Frozen. No, not.
- [32:02]
Louise Nicola
Anymore. Not.
- [32:02]
Dr. Natalie Crawford
Anymore. First of all, we see lower live birth rates because the abnormal environment inside the uterus, an embryo is not normally going to implant. After 20 eggs are growing and you have this very high estrogen level. We see when you do fresh transfers, more preterm birth, smaller gestational age, more placental dysfunction because that placenta is growing in to that abnormal uterine environment. And with a frozen embryo transfer, we're seeing longer gestations, larger for gestational age babies, and improved birth outcomes. I also like to say it allows me the opportunity to really synchronize that endometrial environment with the embryo at its best chance. So if we're looking to have the optimal outcome per embryo, a frozen transfer is almost always the way to go. Few exceptions. If you are young, very good egg quality with very low ovarian reserve. Sometimes we lean towards a fresh transfer, so there's never a one size fits all approach. But if we're looking at foremost people, a frozen embryo transfer is going to be better. It also decreases the risk of something called ovarian hyperstimulation.
- [33:05]
Louise Nicola
Syndrome. Yes, my friend had.
- [33:06]
Dr. Natalie Crawford
That. It's.
- [33:07]
Louise Nicola
Terrible. She went through hell after she did the retrieval and it happened. It hit her maybe a few weeks.
- [33:13]
Dr. Natalie Crawford
Afterwards. So OHSS is because these very high estrogen levels, if we want to simplify it, if we say a single mature egg is going to have an estradiol level of around 200 picograms per milliliter. But that means if you have 20 mature eggs, your estrogen's going to be 20 times that. Your body's not meant to have an estrogen that high. And estrogen does a few different things to your blood vessels when it' that extremely high. The simple way to put it is that the water component of your blood starts to leak out. There's more permeability of your blood vessels and you third space fluid. So when we get ascites fluid in their abdomen, pleural effusions, fluid in their lungs, but then the blood component is actually quite thick, and you're at higher risk for kidney damage or deep vein thrombosis. In addition to just feeling terrible shortness of breath, nausea, vomiting, you're dehydrated but very puffy. It's not fun. Hcg, which is the pregnancy hormone, tends to make OHSS extremely worse because it encourages those ovaries to continue to make estrogen. And if I got you pregnant with a fresh transfer, if you get pregnant, this embryo is going to come, implant and start to make HCG at really high levels, and you're not going to get A reprieve because you have these high estrogen being chugged out. So we used to see very serious cases of OHSS back when I was in fellowship because we did so many fresh transfers. Women get very sick, they get hospitalized, they could be there for weeks getting IV fluid or having fluid drained off their abdomen. But this is something that's much more rare now because we can use OHSS specific protocols where we avoid HCG as a trigger. And then by choosing to do a frozen embryo transfer, we're letting the hormone environment normalize before we put that embryo in and letting people like your friend feel markedly better when you are.
- [34:54]
Louise Nicola
Fertilizing the egg and for it to reach the five day fibroblast.
- [35:00]
Sorry, these words. How much of this is reliant on the health of the.
- [35:05]
Dr. Natalie Crawford
Sperm? A huge portion is relying on health of sperm. So eggs and sperm are both crucially important here. And we know if we step back infertility in general, 50% is female factors and 50% is male factors. When it comes to in the lab we always say IVF can be therapeutic, but it also can be diagnostic. We often can see where the problem is happening. So if I am putting a sperm inside an egg, so this is called ICSI Intracytoplasmic Sperm injection, where someone in the lab is picking a good looking sperm and injecting.
- [35:35]
Louise Nicola
It. Oh, a good looking.
- [35:36]
Dr. Natalie Crawford
Sperm. Good looking.
- [35:37]
Louise Nicola
Sperm. It sounds like my friends and I got together one time, we're like, where's the good looking.
- [35:42]
Dr. Natalie Crawford
Sperm? Who's the good one? We actually challenge them. There's a little sperm obstacle course, how I like to describe it, it's called Zymot, where the sperm have to swim through.
- [35:49]
Louise Nicola
It. The sperm.
- [35:50]
Dr. Natalie Crawford
Olympics. Exactly. So you have the good looking Olympians are who we are choosing to win. But truly we're trying to find the best functional sperm to put inside the egg. People always ask if we can choose a male or a female sperm and we cannot. We're simply going on function and morphology or shape. But when we put that sperm in the egg. So if the embryologist is directly inserting the sperm, it's the egg quality that determines if it's going to allow that fertilization to occur. Egg quality, the egg's metabolic health determines those first three days because the male genome doesn't kick in until day three and beyond. So those first few days are all about the egg determining the health of the egg. Well, on day three, that male genome starts to kick on. And then of course both are important. But when I see Somebody who their embryos developed and they just stop at that day three of development. We now know there's a male factor at play and that the DNA inside that sperm is not as stable as it could.
- [36:47]
Louise Nicola
Be. But if this was somebody who was choosing to do it with a partner, their husband, whatever, it might be great. But what if they were choosing to do it through a sperm bank where they've already looked at the quality of. I don't know. Is that what sperm banks do? They look at the.
- [37:01]
Dr. Natalie Crawford
Quality? Not really. We all look at a semen analysis. Before you do ivf. It's very standard that some guy is going to provide a sample, you're going to make sure there's sufficient sperm that they move and the shape looks okay. But none of that is actually evaluating the DNA inside the sperm's head. And I've had some patients who have really poor outcomes even with donor sperm. Think about men who donate. They're not all created equal and sometimes they're younger, living a crazy life, more inflammatory life, for lack of a better word. And so we can sometimes see really poor outcomes due to male factors even with donor sperm, which can be extremely frustrating. The thing I like to say about is you can control what you can if you are partnered. Infertility is a team sport. So having your partner pay attention to some of these lifestyle factors because sperm are unlike eggs, eggs are inside your body. Your whole life already talked about this, absorbing the wear and tear. This means that the sooner we can start paying attention to a lot of these lifestyle factors, the better. Sperm, however brand new, about 1,500 sperm are made every single second. They develop across the course of the testes over 72 days and then it takes about 18 days to get them out the ejaculatory system. So in three months time a man's going to have totally new sperm. So he could change a behavior today and see a different semen parameters three months from now. That's extremely powerful. Yet one of the most underleveraged tools that we have because I have women who are doing everything right. They're following every anti inflammatory lifestyle practice they can, they're listening to the advice and yet their partner is using cannabis at night, not sleeping, hustling, getting in the sauna, the hot tub, and providing sperm that is not optimized and really inflammatory. And the DNA in their sperm is showing that. And we make these changes after a bad cycle and we see a very different outcome in the next one. And that's great that it can be influenced, but why are we not making these changes before the first.
- [38:54]
Louise Nicola
One? Yeah. Three months prior to.
- [38:56]
Dr. Natalie Crawford
100%.
- [38:57]
Louise Nicola
Right. You just used the word sauna. I want you to clear this up for everybody. If you heat the testicles correct. Okay. I'm not saying put them on.
- [39:06]
Dr. Natalie Crawford
Stove, a stove, but please don't do.
- [39:08]
Louise Nicola
That. If you heat them via going into a really hot tub or a sauna, is this killing the.
- [39:14]
Dr. Natalie Crawford
Sperm? The scrotum keeps the testicles outside the body for a reason. This is because for ideal sperm development, they need to be at a lower body temperature than the rest of your body. And in fact, we know that men who had an undescended testicle as a child, when the testes was inside their abdominal cavity and had to be surgically pulled down, they have a much higher rate of that testicle never functioning and making sperm or hormones, and that's just from the heat of the normal environment of your body. So, yes, putting your testicles into an abnormally hot environment is damaging for sperm production. So we do not want men who are trying to get pregnant to be in the sauna to be in the hot tub, to be doing things that are purposefully increasing the temperature of their.
- [39:55]
Louise Nicola
Testes. Thank you for clearing that.
- [39:57]
Dr. Natalie Crawford
Up. But for women, it's not the same. Our eggs are inside our body. So if a woman is trying to get pregnant, we do not want you to be exposed to that abnormally warm environment when there's a pregnancy inside. Because heat's important when you're pregnant, but when you're trying to conceive, sauna and hot tub use, those are not detrimental to female.
- [40:14]
Louise Nicola
Fertility. I actually want to get into some of the optimization. We will get to your non negotiables, but I just have so many questions I've listed here. One of them is, have you seen you've done this? How long have you been a physician doing.
- [40:24]
Dr. Natalie Crawford
This? Oh, my goodness. I started in fertility back in 2013 and before that in OB.
- [40:32]
Louise Nicola
GYN. You've done a lot of IVF.
- [40:34]
Dr. Natalie Crawford
Cycles?
- [40:35]
Louise Nicola
Thousands. You've seen really great. I'm sure you've got some miracle stories, success stories. I'm sure maybe you've listed them in your brand new book that comes out next year, the fertility formula. Have you ever done a one for one or a two for two? Meaning, like maybe 42 year old female IVF found the one, you've retrieved two eggs, they.
- [40:57]
Dr. Natalie Crawford
Survived. Yes. It only takes one. Odds are a very interesting thing when it comes to fertility because we're trying to set appropriate expectations and so we give you percentages and we talk about odds of success so that you can make the best game plan with the road ahead of you. But when it comes to getting pregnant or holding a baby in your arms, it's truly 0% or 100%. It doesn't matter what middle ground number I gave you or how detrimental it sounded. Even though the odds of success with egg freezing are better if you're younger. I've had women over age 40 freeze eggs who are holding a baby in their arms right now. I've had women go through IVF at advanced ages. It's a bigger journey for most of them. It's not going to be achieved in a single cycle. It often is taking more than one cycle to put those odds in the right place. But people run marathons all the time, and it's up to us to make the decisions that are right for us. And if we know what we're up against and we say, I'm gonna bring my best eggs and sperm to the table, it might take more than one cycle. Because the good thing about our ovaries is because a new group of eggs comes out of that vault every month. Even if I have a low count next month I'm gonna have another group. So we can do back to back IVF cycles where I get the eggs from this month and then I get them from next month. And I'm improving the total odds of success by putting more eggs into that, what we call the IVF funnel, that attrition ratio. But there have been people who've gotten very low egg counts. Single egg, two eggs, and they have children now. Is that the most common.
- [42:25]
Louise Nicola
Story?
- [42:26]
Dr. Natalie Crawford
No. It usually is going to take more than that. But having perspective is really important. And then always understanding what is your other option. So if you're older and you're single and you're going through this with donor sperm, you may not have another option. Your odds of getting pregnant naturally are zero percent, evidently. Right? So we say, hey, even if it's low with one or two eggs, we are raising you from baseline, and you're the one who should be able to make that decision. At least that's how we approach it at our clinic. Same thing if you have bad endometriosis or you don't have fallopian tubes anymore. For me to say that your age or an ovarian reserve level is going to disqualify you for treatment, I don't think that's fair. As long as you're still at a place where your ovaries can respond. So it's important to note that as the egg count gets lower, the ovary gets more stubborn. I always like to say the vault doesn't want to be a zero. So it really gets harder to grow an egg. And when this starts happening, the brain gets upset. It wants estrogen to be made, and it starts sending out more and more fsh trying to get that egg to grow. And this is essentially what starts happening in perimenopause, or what we call in the fertility world, diminished ovarian reserve. But at some point, the brain will be sending out all the fsh it has, and the ovary will be an ovarian failure and stop responding. This is menopause. Everybody will reach this point when this has happened. There's no amount of fsh I can give you that will get your ovary to respond, because your body's already trying to do that. So understanding that, we do all reach a critical threshold where I can't work magic. I'm trying to manipulate the physiology of your body. But when your ovaries decided it's done, it's.
- [44:02]
Louise Nicola
Done. I've come to see my skin the way that I see my brain. It's a barrier system. When your skin barrier is strong, inflammation is lower, and recovery, even cognitive recovery, is even better. So I have switched all of my skin care products to Jones Road Beauty. Their products are clean, they're organic, they're gentle. They're designed to work with your skin, not strip it. I use them moisturizer every single day. It feels like fuel for my skin. Not makeup, not fragrance, just support. And the face wash has become my reset. After training, I do it in the mornings, I do it at night. And quite honestly, like, I'm at the point of almost putting ghee on my face because I just didn't want all the harmful chemicals from the crappy products that are being sold. And Jones Road Beauty enables me to not put ghee on my face. So if you guys want to check it out, you can. You can go to Jonesroadbeauty.com, use code NEURO. You'll get a few free gifts with your purchase, but quite honestly, you will not be putting bad chemicals on your body and on your face. Jonesroadbeauty.com code.
- [45:15]
Dr. Natalie Crawford
Neuro. But technologies has made this entire field. Yet right now, we live in this great world where technology is really cool and companies are really investing in it. And there's a lot of being offered in the world of femtech, or fertility technology. But sometimes there's limited studies on what's actually going to help and occasionally can be harmful. A good example of this is something called the endometrial receptivity analysis test, or an ERA test. And this was a test that rolled out.
- [45:45]
Eight years ago, probably to solve this problem. Why didn't all you plate embryos not implant thinking, is it the uterus, is it the uterine environment or the receptivity? If we remember that progesterone, which is made after ovulation, opens and closes that implantation window, the thought here with this test was, do you need more or less progesterone? We did mock cycles, biopsied people's uteruses, got these results from a gene expression of estrogen and progesterone receptors. And then we modified how much progesterone they got in their embryo transfer based on this. And to us it seemed like, oh, this is going to solve all of it. Well, what happened is, in the majority of people, it actually decreased pregnancy rates. Okay. Because it was trying to solve a problem that was in a very small percentage of the population, recurrent implantation failure. Only about 5% of people will have that. Some of the data I said earlier, if we have enough euploid embryos, most people get pregnant. Yet we applied that to the population at large because embryos are so valuable. And we saw that shifting this progesterone window actually was detrimental to the vast majority of people. Technology gets rolled out, and I understand it because I had infertility too. You're desperate. You want anything that can help you. And there's this thought that says, throw me the kitchen sink. Anything that can help me get pregnant, I want.
- [47:00]
Louise Nicola
It. How many kids do you.
- [47:01]
Dr. Natalie Crawford
Have? I have.
- [47:02]
Louise Nicola
Two.
- [47:02]
Dr. Natalie Crawford
Two. But not everything is neutral. We tend to view these add ons as, oh, it's neutral or good. But we have to know that sometimes things can be harmful. So I live in a space where if there's something that is neutral or beneficial, let's discuss it and see if it makes sense for you. But things that there's not enough evidence behind to know that they're not potentially harmful, I'm very wary of for the average patient because we don't want to be in a place that can be harmful. Evaluating the uterine cavity and checking the fallopian tubes should be done in everybody before they get an embryo transfer. It's actually not. A lot of places won't do this, but you can have a dilated fallopian tube called a hydrosalpinx. So this is A blocked, dilated tube. I like to explain it as fluid actually accumulates in that tube and can leak back into your uterine cavity. Imagine if you. It's toxic pond water leaking back in.
- [47:48]
Louise Nicola
Yes.
- [47:49]
Dr. Natalie Crawford
Yeah. This decreases your implantation rates. Even if I go put a genetically normal embryo in by.
- [47:53]
Louise Nicola
50%. Oh, 50%.
- [47:55]
Dr. Natalie Crawford
50%. So.
- [47:57]
Louise Nicola
Huge. So why isn't.
- [47:58]
Dr. Natalie Crawford
This. Why is it not done by everybody? It's a fabulous question, but you do it, of course, right? You go through everything to get embryos. If there's anything we can change or modify, we want to do it. It's still a relatively new field, and we're learning a lot. But that is something that if you're going through ivf, you need to be making sure that that's in your game plan. Am I having my uterus and fallopian tubes evaluated? Because you also can have endometrial polyps inside the uterus. They may be asymptomatic, but they can increase inflammation and decrease implantation rates as well. So we really have to think IVF is an amazing technology, but there's a lot more that we need to be doing in preparation for that embryo.
- [48:35]
Louise Nicola
Transfer. And you're doing everything in your.
- [48:37]
Dr. Natalie Crawford
Clinic? We do everything in our clinic.
- [48:38]
Louise Nicola
Yeah. Like, to best prepare, like, all of the microbiome.
- [48:42]
Dr. Natalie Crawford
Testing. Microbiome testing, we talk about, you know, it looks like this is an interesting world looking at vaginal microbiome, uterine microbiome, gut microbiome. What we know for sure is that the gut microbiome is probably the very most important. People want to change. That least takes more work, right. To really change the foods you're eating and the composition of your own gut health. Looks like gut microbiome can be related to the others, but when they looked at uterine, they didn't look at uterine. When they looked at vaginal microbiome versus gut microbiome and infertile and fertile women, infertile women had a higher incidence of having abnormal gut microbiome versus vaginal. So that doesn't answer the question about the uterine microbiome, which we're very curious about right now. But I think it's speaking to the fact that we've got to walk back and start a more preventive approach to fertility versus always being looking for the magic pill. Doesn't mean that the uterine microbiome is not important, but probably if we're improving our gut microbiome, that's the first place to.
- [49:39]
Louise Nicola
Start. Let's end with, we're finally There. Let's get with the first question. First question, teach us what can every woman do whether she's 28 or.
- [49:49]
Dr. Natalie Crawford
38? I love how you frame that. I just want to say, because so many people have a life goal of having a child, yet the approach is, I'm not ready, so I'll think about my fertility later. But if we step back and think of everything we've talked about, if inflammation is contributing to chronic health disease later and making fertility worse, the sooner you understand your body, the better. So I'm gonna go into my lifestyle tenants. But before that, I think that everybody should get their AMH checked if they do wanna have a kid one day. Because finding out your AMH is low gives you the opportunity to find out why, but also to think about, should I freeze my eggs? Am I with a partner? Should I consider having a child earlier or. I've had women do nothing, but they were the one to make that decision versus having time make it for them, which is very powerful. You should learn to track your cycle. Not just when is my period coming, but when am I ovulating? Because the first stage of an abnormal ovulation is a shortened luteal phase, that second half of the cycle. But you only know how long that is if you know when you're ovulating. Yet most women use apps. They just put in cycle day one into their.
- [50:53]
Louise Nicola
App.
- [50:54]
Dr. Natalie Crawford
Yes. And it's predicting an ovulatory day based on a calendar method, which is highly inaccurate and only actually predicts ovulation correctly in 21% of.
- [51:03]
Louise Nicola
Women. I ovulated on day 14 last month. I know. It's TMI for.
- [51:06]
Dr. Natalie Crawford
Everyone. I think everybody loves TMI on.
- [51:08]
Louise Nicola
This. Okay, is that bad? 14, day.
- [51:10]
Dr. Natalie Crawford
14. No. How long is your total.
- [51:12]
Louise Nicola
Cycle? 28.
- [51:13]
Dr. Natalie Crawford
Days. Okay, so day 14 is great. We really want that luteal phase to be at a minimum 12 days in length. So if you ovulate on day 14, that means your luteal phase was 13 to 14 days. So that's perfectly appropriate. When we see that luteal phase getting shorter or having a lot of spotting in it, it's a sign that the brain ovary, we're not making enough progesterone, which is largely due to probably there's a few different reasons, but it can be an inflammatory process of the brain, some static interference. It can be from thyroid prolactin, but it's that first sign. So actually short luteal phase can be the first sign. You might have still a regular cycle. So if somebody just says, is your period regular? You're going to answer, yes, but is it normal? It actually is not. You just don't know.
- [51:54]
Louise Nicola
That. Okay, so.
- [51:55]
Dr. Natalie Crawford
Tracking. So tracking. And I go over this in the book, and we're running out of time, but to think about really learning your physical clues. This can be your body temperature, your cervical mucus or hormone tracking to look for an LH surge. These are ways that you can know when you ovulate, which much more accuracy. This can also help you get pregnant faster. So this is just knowledge about our body. And then if things are wrong, if your period is irregular, if you have severe pain, if you're bleeding through your clothes, those problems should be evaluated well before you want to conceive. You always deserve an evaluation of those issues. But then when it comes to the fact of what can I do? And this is so personal to me, because when I had recurrent pregnancy loss, and I asked my doctor, what can I do about this? And all my testing was normal, and I was told nothing. That's really not a true answer. Because there are things we do that make inflammation worse, cause insulin resistance, and contribute to infertility. First thing I think that everybody needs to do. You're gonna love this one. Is they need to sleep more. We know that a third of us adults sleep less than six hours per night. But sleep is so important to hormonal health and to inflammation and insulin resistance. So when you sleep, that's when your body can clear up some of that inflammation. It's when your cells become more insulin sensitive, ready to respond. But also it's very important in gonadotropin secretion. So the gonadotropins are FSH and lh. These are typically released in the early morning hours, but only if you're kind of having a normal nightly pattern. We know that increased sleep variability, so even just not having consistent sleep, can result in longer time to pregnancy. And for every hour of less sleep that you get, you're gonna have lower egg count retrieved, even in ivf. Right. So sleep is so crucial to your inflammatory state, to your body's health, to ovulation, but also to outcomes like getting pregnant in ivf. Easier said than done. I understand. But it's also for male and female partners, because sleep can be very detrimental to sperm. Longer time to get pregnant if the male partner is not sleeping enough. So again, it's a team sport.
- [53:55]
Louise Nicola
Here. So those Wall street guys are walking around with, yeah, unfit.
- [53:59]
Dr. Natalie Crawford
Sperm. Unfit. So sleep is the first thing. Second is going to be thinking about stress. And we've mentioned the words insulin resistance a lot. And I know that you've covered this before, but the way I like to think about it is when you eat any food, your food's gonna be broken down into glucose, and that's the fuel for the cell. This is normal. And then when glucose is released into your bloodstream, your pancreas is gonna release a hormone called insulin. And this is a perfect dance where glucose comes out. Insulin's like a salesman at the door, knocking on the door to let glucose in. Glucose goes in levels lower in the blood. Insulin goes away. Process repeats next time you eat. However, when you have higher glucose level, either because you're eating more, the foods that you're eating, the permeability of your gut, or even chronic stress, because stress does something to free up glucose, what starts to happen is that your cells become insulin resistant. And it's like if a salesman came to your door every single day, what are you gonna do? You're gonna stop answering. You don't wanna talk to him. That's what your cells do when they see insulin so frequently. And then it takes a really high signal of insulin to get the door open. That salesman has to bang on the door. When this happens, insulin starts to level up in your blood. This causes you to deposit more visceral fat, which is highly inflammatory, and then interferes directly with the hypothalamus and hormone secretion in addition to ovarian hormone production. So hugely detrimental. The worst thing about this is that your cell doesn't have glucose in it, so you're actually cellularly starved. But there's so much glucose in your bloodstream that your liver says, we need more glucose, and starts to break down the glucose it has stored from a process called gluconeogenesis and puts more glucose in your blood. So now you have even more. And you can see how this is a cycle that's causing so much inflammation. Well, when you are stressed, let's think about what stress does, because our bodies were meant to deal with acute stress. If you saw a bear, what do you want to do? You want to run. So in order to run from the bear, your body would free up some more glucose to get into your bloodstream, so it could fuel your heart, your lungs, your muscles to get away from the bear. So you'd have glucose released. You would run and use up that glucose, and then you'd go back to normal. But bears aren't what causes us to be stressed in today's world. It's an email, a bad Meeting, a bad doctor's appointment, notifications, all the things on our to do list, social media, it's a hundred things. So we're constantly undergoing this process and then we double down. We eat, we stress eat, we stress drink, we add to the glucose burden that is inside our body. Our cortisol is constantly activated. It's gonna make it harder to sleep at night. It's gonna really wreak havoc. And this is why cortisol is inflammatory. So long story short here is that the world is stressful. For me to sit here and say, louisa, you should be less stressed is very breath work. But I do think that means we should carve into our day. I think have two different approaches. One is gonna say carve in 20 minutes that you do. Allow your body time to let cortisol go down and not just in response to something stressful, but more preventatively. And you and I are wired differently. So it might be yoga, meditation, acupuncture, walking outside, feet in the grass, talking to friends, seeing a therapist, journaling. It doesn't really matter. It's just we all know when we get that.
- [57:14]
Feeling and that's what we are searching and striving for. The other is going to be. I recommend when you have a stressful life event, run from the bear, meaning you get out of a meeting, it's really, really terrible. Go walk the stairs, do a couple squats, do something to use up that glucose. And the reason why is that in our muscle we have a transporter called GLUT4 that essentially is like giving glucose the key to the cell. I don't need insulin anymore, I don't need the salesman. So I can allow glucose into those muscle cells by building and using skeletal muscle. So when I'm stressed, go use some muscle. But also that means the best exercise for hormone health and for fertility is to build more muscle and then use that muscle strength. And resistance training at least three times a week is the key to really help combat insulin resistance. And it's something that so many women, at least we see more people talking about it now, But I still see a large portion of younger women who are not, not doing any strength or resistance training. They're still very cardio focused and still chasing a certain body type, size or aesthetic. Yet these things, sleep, stress and exercise are really foundational principles for your day, how you're going to structure your day and what you're going to do. You can make decisions and we can't control anything or we can't control everything, but we want to Set ourselves up so that we can control what we are exposed to during that day. The other two tenants here are food and toxins and we could have a whole show on just these two. The best thing to think about when it comes to this is that food is probably one of the top sources where inflammation is getting into our body. Ultra processed foods have very limited nutritional value. They're highly inflammatory, they harm our gut microbiome, they cause a leaky gut, they wreak havoc on our hormones, they really need to be eliminated from our diet. Fiber is the food for the gut microbiome. Fiber is found in its best quantities in fruits and vegetables. We need to be increasing the amount of whole foods that we are eating as the main tenant of our diet. And then when it comes to the quality of the foods, right, if we eat animal products, we want to have really high quality meats, make sure that they are not full of toxins or chemicals. We don't want processed meat at all. But we really also want to encourage some of those plant based protein sources like beans, lentils, tofu, that have other nutritional values and are really high in fiber as well. So looking at an anti inflammatory diet approach is largely less added sugar, no ultra processed foods. Thinking about whole foods and real ingredients, the things that you can find and actually the greatest source of toxin exposure. When it comes to environmental toxins, there's so many toxins, there's toxic behaviors. Alcohol, cigarettes, cannabis, there are endocrine disrupting chemicals, BPA, phthalates, PFCs, parflurenne, chemicals forever chemicals that can be in different products, there's heavy metals, things that can be in our water and our air. So there's a lot to be fearful of. And my messaging is never to be afraid, but to really be mindful because these are things we choose. Get a water filter that can help filter out tap water tends to be the best. But make sure that you're getting a filter appropriate for your environment. Think about an air filter in your home. You can go to the environmental working group and you can actually look up your water and find what is in your tap tap water and what water filter you need. And you can go to the EPA and you can actually look at the air quality in your environment as well. Looking at the food products because most of these chemicals are coming through the kitchen or from food packaging. So cooking more, eating out less, but eliminating plastics, Teflons, really making sure we're not microwaving or putting hot things into these substances because heat can really cause it to leech and then of course, beauty products which have a lot of phthalates and other fragrance things that we're really loving in some way. The ones that you use every single day can be the most detrimental to your body. That's how we're exposed. So shampoos, lotions, moisturizers, face washes, we should start to look at our daily products and we can go to the Environmental working group and look at Skin Deep and you can search your products and find which ones are better. And the goal here is to say on a day to day basis, I'm setting myself up to have a lower inflammatory burden. If I have a lower inflammatory burden, I can then adjust when I do have something really stressful happen, or if I do want to go celebrate and have that piece of cake, or if I don't get as much sleep for one singular night, that's not going to have such a detrimental impact as it does now for the majority of people who are living with such a level of exposure that it's really damaging our cellular and metabolic health. And having infertility can be one of those first actual signs of it. It's a red flag for your body. And so to me, these are all factors that even people who are very healthy, there's usually something that they can do better. And by taking charge of those factors, you're now putting yourself in a position to say, I have the best eggs and sperm that we can. I understand my body. I'm making active decisions in line with my goals. And even though I can't control everything, I'm more of in a position of power because the unknown is scary. And the thing that I'm sick of hearing every single day from patients is if I'd only known this information sooner, I would have made different.
- [62:19]
Louise Nicola
Decisions. When does your book come.
- [62:21]
Dr. Natalie Crawford
Out? The book comes out April 14th and it's available for pre order right now. It'll be in all major bookstores. You can find more about it. Natalie crawfordmd.com book we're gonna link it.
- [62:31]
Louise Nicola
Below. Dr. Natalie Crawford, thank you so much for being part of the youe Experience.
- [62:35]
Dr. Natalie Crawford
Podcast. Thank you for having.
- [62:48]
And Doug, here we have the.
- [62:49]
Louise Nicola
Limu Emu in its natural habitat helping people customize their car insurance and save hundreds with Liberty Mutual. Fascinating. It's accompanied by his natural ally, Doug.
- [63:03]
Dr. Natalie Crawford
Limu. Is that guy with the binoculars watching.
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Louise Nicola
Us? Cut the camera. They see us.
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Dr. Natalie Crawford
Yes. Only pay for what you need at libertymutual.
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Louise Nicola
Com.
- [63:12]
Savings Ferry Unwritten by Liberty Mutual Insurance Company Affiliates excludes Massachusetts.