Savannah (Host) (2:29)

Wow.

Dr. Natalie Crawford (2:30)

That's a huge change in a short amount of time. And then if we want to go one layer deeper, we know that sperm counts have dropped 50% in 50 years. And then we also know that more women are being diagnosed with low ovarian reserve, having a low egg count.

Savannah (Host) (2:46)

And is that amh?

Dr. Natalie Crawford (2:48)

That's amh. AMH is the test that we use to check how many eggs that you have. So we have more women with a low AMH before.

Savannah (Host) (2:54)

Okay.

Dr. Natalie Crawford (2:55)

And then we also are seeing higher rates of miscarriage. Put all of that together with the fact that women are waiting longer to get pregnant. You know, they're chasing dreams, they're going to school, they're not finding their partner as early. So we see infertility rates are dropping, making it harder to get pregnant. We see people waiting longer. And one of the big things that I'm passionate about, that I know you are too, is why do we live in this culture from medicine that makes you fail first?

Savannah (Host) (3:18)

Exactly right.

Dr. Natalie Crawford (3:19)

Because if you walk into your doctor right now, you go into your OB and you say, we want to get pregnant soon. What should we do? 90% of the time you're going to hear, just go try for 12 months and then come back if it doesn't work. And that really takes a lot of the agency away from you to say, well, how do I optimize my hormones? What things should I be doing to have a higher chance of success? What about, does my partner have sperm? How is my AMH or my egg count? Yeah, that data is really important as it speaks to what's happening in your body. And then not even to think about the fact that endometriosis, pcos, a lot of these diseases are quite prevalent, and. And women aren't given the opportunity to even get to a diagnosis or know

Savannah (Host) (3:59)

they have it, without a doubt. What would you say when it comes to infertility today? What would you say are some of the leading factors to it?

Dr. Natalie Crawford (4:09)

A couple important factors. One I want to state really clearly, infertility, it's 50% female, 50% male. And that's important because so often women take the whole burden.

Savannah (Host) (4:18)

Yeah, right.

Dr. Natalie Crawford (4:19)

We say, it's just me. I've had so many women sit across from me saying, you don't even need to test him. And that's not true. To be specific, a third of the time it'll be just the woman, a female factor, a third of the time, a male factor, and one third of the time there'll be a combination. So it might be, oh, she has endometriosis, and he also has a low sperm count.

Savannah (Host) (4:39)

Okay.

Dr. Natalie Crawford (4:39)

But to think greater than that, what's underlying this rise in infertility? It's the rise in Chronic inflammation. So inflammation is our body's response to something that is damaging. And we can have normal inflammation we call acute inflammation. So you get a cut, your inflammatory system activates to heal that. But chronic inflammation is when your body has a constantly activated immune system because of external or internal factors. But a lot of these can be either underlying disease. So endo is one of those, but other the world around us. So the foods we eat, the endocrine disruptors in our world, and then how we live our lives, the foundation of our day, how much we sleep or we don't sleep, how stressed we are, if we exercise, what type of exercise we do. All of these decisions actually play a role in how much inflammation we experience day to day. Isn't that interesting?

Savannah (Host) (5:34)

I have said, I believe it's in our food that we eat. It's our environment, it's the air that we breathe. There is no other explanation to me,

Dr. Natalie Crawford (5:44)

and there is data to support that statement. Like, we know that higher levels of endocrine disrupting chemicals, meaning exposures to plastics, to fragrances, poor air quality, heavy metals in your water, and all of the populations where we show higher levels of these people also have higher levels of infertility. So it's not just a theoretical. It's really one of the things that's proven. And we know this is impacting our hormones and our ability to get pregnant.

Savannah (Host) (6:10)

Yeah. And so you have been very open to just about your journey and the losses that you've experienced. And can you go a little more into that? Like, is that why you really chose to focus on your book, the fertility formula? You know, what exactly was it?

Dr. Natalie Crawford (6:28)

Savannah going through infertility is a terrible experience. You know, I don't wish it on anybody, because anything that challenges who you see yourself as or your future really is isolating and comes with such a personal cost. I was going through my training when I had my losses. So I was at the end of my OB GYN residency and the beginning of my fertility fellowship, and I had four pregnancy losses before I had my two kids. And I'll tell you, even as a physician who sat across from women who'd walked through it, until I went through it myself, I had no idea what it was like. I lost my second pregnancy when I was working. I was running labor and delivery. I remember going to the bathroom and bleeding and then having to, you know, put myself together and get back to work and go deliver other people's babies. But I remember pulling over the car on the way home and throwing up. It was Just, it was terrible. The pain was terrible. Emotionally, it was terrible. And I went and sat across from my doctor at that time and said, I think something's wrong. Had this list of problems. And I was told, well, we don't do any evaluation until you've lost three pregnancies. So must three. Three. So it must be bad luck. Go, keep trying again, and then come back if it doesn't work. Very dismissive. Especially as a woman who felt like I was pretty in tune with my body and felt like something wasn't right. I lost the third. It got the testing, it was all normal. I was told IVF or there was nothing they could do to help me. Lost the 4th because I couldn't do IVF yet because of where I was, my medical training. Like, here's the ironic thing. I was the fellow who was performing ivf, so I was doing the egg retrieval. I was doing the ultrasounds, the. So I couldn't go through it as a patient yet because this was my time to learn how to do it as a physician.

Savannah (Host) (8:15)

Oh, my gosh.

Dr. Natalie Crawford (8:17)

And then there was insult to injury.

Savannah (Host) (8:18)

That feeling. I couldn't imagine the feeling, because, of course, you're a doctor. You're wanting to work, so help, and you're wanting to help these women, and you're so happy for these women, but you're also human, so you're dreaming for what they're going through and you can't yet do it.

Dr. Natalie Crawford (8:36)

And to make it worse, I started to really have this narrative that was so harmful, like, how am I going to be a good fertility doctor if I can't even get myself pregnant Right. Oh. Which I was so unprepared for. During this time, I really felt a strong sense to control what I could. You go through infertility, you go through anything with your health, and you start to realize how much is out of your hands and you don't control. And I started really feeling like whatever the variables are that I can control, I want to do those. I want to take them off the table. The foods I eat, the chemicals we're exposed to. And I started doing a lot of research in this time because we do a lot of research and fellowship. You do a year and a half of it. And I studied why some groups of people got pregnant and others didn't. And I looked at endocrine disrupting chemicals and vitamin levels and AMH levels and seeing what was going on. And I still remember going home one day and cleaning out our entire kitchen, getting rid of the plastic, getting rid of Everything that we were using to store food and cook on it. And I was aghast that not just it was suggestive in literature, but there was compelling evidence that endocrine disrupting chemicals impair our hormones and our fertility. This is a decade ago. And I was like, why has anybody said this when I've sat here?

Savannah (Host) (9:52)

You would also think with what you're saying right now, how there is documentation to back it up. There is evidence to back it up. Why are we continuing to manufacture products?

Dr. Natalie Crawford (10:01)

Well, that's an. That's an entirely separate point that's so important, because like it or not, America is a capitalist society, and corporations want to make money, and they will put financial gains over your health time and time again.

Savannah (Host) (10:19)

Without a doubt.

Dr. Natalie Crawford (10:20)

Without a doubt. And we.

Savannah (Host) (10:21)

I mean, you've seen it. You've. You're seeing it much more frequent. You're also seeing it out in the open. And it hasn't been until recently where corporations have been forced to remove food dyes and things of that nature. Like, we're gonna have to reach that point.

Dr. Natalie Crawford (10:38)

So there's an idea from a lot of people thinking, well, surely it wouldn't be in my products if it was bad for me. You know that. And that's not true.

Savannah (Host) (10:46)

No.

Dr. Natalie Crawford (10:46)

In fact, they can also do misleading marketing. A good example here is the difference in unscented and fragrance free. So let's say you go to the grocery store and you want to buy a laundry detergent that doesn't have any endocrine disruptors in it. So we know fragrance is one of the big areas where those phthalates can enter into your system. And because you're washing your sheets, your clothes, this is a very big area where things can get in your skin.

Savannah (Host) (11:09)

So hard for me, I love things that smell.

Dr. Natalie Crawford (11:11)

I know, but let's say you see something that says unscented, and you say, okay, that's good for me, that doesn't have any fragrance. That's actually false. What you should be looking for is fragrance free has zero fragrance. Unscented means you do not smell this. It can be manufactured with a toxic chemical in it, and they can mask that with another chemical, which often is easier because they don't have to change their entire formulation.

Savannah (Host) (11:37)

Yeah.

Dr. Natalie Crawford (11:37)

So unscented is what we call a greenwashed marketing term where they can throw it on a label, they can upcharge you. You think you're making the right decision, missing your fragrance, but saying, okay, this is better for my hormone health, when in reality it's just as bad as something that has fragrance, you need to pick something that says fragrance free.

Savannah (Host) (11:56)

Wow, that is insane.

Dr. Natalie Crawford (11:59)

Isn't that insane? So it really speaks to the truth is that when it comes to our health, like, we have to be the one in charge. Like, nobody's gonna care for our health. Like we are. The idea that this information's too hard to understand, I push back on. Like, people are really brilliant. They can understand things. They just have the opportunity to do so. Because you can't make decisions if you don't even know.

Savannah (Host) (12:22)

Exactly. I have gone by saying my entire life, like, when you know better, you do better.

Dr. Natalie Crawford (12:26)

Yes.

Savannah (Host) (12:27)

So you have to look into these things. You have to do your research because your life truly does depend on.

Dr. Natalie Crawford (12:33)

Absolutely.

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Savannah (Host) (15:47)

and so in your book, you talk about something that I find extremely just I was just very intrigued by it. And it is trimester zero.

Dr. Natalie Crawford (15:57)

Yes.

Savannah (Host) (15:58)

Can you explain that?

Dr. Natalie Crawford (15:59)

I love this idea of trimester 0 and I think it's a very compelling term. The idea here is that the months before you conceive set up the stage for both egg quality and sperm quality, which will impact not only your ability to get pregnant, but also the health of the baby, the health of the pregnancy. So when you're sitting across from your doctor saying, what can I do to prepare myself? It's not just early testing. That's one piece of the puzzle. The other is let's make all the lifestyle changes we can to decrease our inflammatory burden because we know when our body has more inflammation. That inflamma directly damages the DNA inside the eggs and inside the sperm and it impacts their ability to function. And so the five areas that I recommend people focus on are going to be sleep, stress, exercise, diet and toxins. And it's not about being perfect. Right. It's not a list of if do this or else.

Savannah (Host) (16:55)

It's not like, okay, stop living your life.

Dr. Natalie Crawford (16:57)

No, but every single day looks different and you'll be exposed to different things and acknowledging the truth about where you are. So a good example, right if you didn't get much sleep last night because you're traveling, you're doing all these, that means you want to look at what you're doing the next day to say, well, what else can I prioritize? Because I'm starting with a little bit more inflammation because I didn't get enough sleep. So I don't want to double down on that by, you know, being really stressed, eating those ultra processed foods, drinking out of plastic all day, but in the same breath. Sometimes when we travel, we don't eat as good or we're exposed to fragrance, so we meet ourselves where we are, but we have the knowledge to make as many smart choices as we can throughout the day. And the reason why trimester 0 is so insightful is that your. Your eggs are in your body your whole life, but they're most sensitive to the world around you in the 60 days before they ovulate. So that's a nice window of opportunity.

Savannah (Host) (17:49)

See, what's also great is I would have loved to have been told that information before now.

Dr. Natalie Crawford (17:55)

Right.

Savannah (Host) (17:56)

You know, I mean, I'm going through.

Dr. Natalie Crawford (17:57)

Especially if you're gonna go through egg freezing, right?

Savannah (Host) (18:00)

Knowing.

Dr. Natalie Crawford (18:00)

Because sometimes I'll have patients say, well, I can't undo the past, so let's just like, roll with the cycle as fast as possible. Instead of thinking about, hey, how do I decrease inflammation for a couple months before I go through this, and then set myself up for the best quality eggs that I can get.

Savannah (Host) (18:17)

Do you feel like in your clinic, do you see or do you have a lot of women come to you who feel like, you know, they've done egg retrieval before and maybe it didn't work or they didn't get what they wanted. And then they come to you and they're like, I just kind of feel like I was left at the doctor's office, you know, like, that they didn't. You were kind of seen as just a number, and it's. It's like a factory. I mean, I'm not gonna lie. When I went into my doctor's office, I was shocked at how many women were sitting out there.

Dr. Natalie Crawford (18:48)

You know, I have my own bias here, right? I started my own fertility practice with a partner more than six years ago. So we're physician owned, because the standard model for fertility in this country is usually bought by private equity, and they're putting profits at the top of the pyramid. Right. That's what businesses do. And so they make decision from a financial standpoint, whereas we always talk about putting patient care at the top of the pyramid. There are many times we make decisions that are not financially advantageous for us, but they are best for our patients. However, if you just go to the fertility clinic that's closest to you, the standard approach would be you see your doctor for a consult and then you may not see them at all again throughout the entire cycle. I don't like that this is such a personal thing that you're going through. And I think it's really important that you know what you're doing, why you're doing it, you have your questions answered, and you get real time updates about what's happening. I don't want to act like there can't be good versions of that system. Everybody's practice is a little bit different. So maybe some practices have a really great coordinator or nurse that you can lean on a lot, and they function like that. But your statement is probably one of the top ones I see from patients who come in for a second opinion. They've done a prior cycle. They felt like their doctor didn't know much about them at all. Nothing was personalized. It was just like, this is the protocol we do.

Savannah (Host) (20:08)

Yeah.

Dr. Natalie Crawford (20:08)

And their outcomes reflected that.

Rula and Quince Advertiser (20:10)

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Dr. Natalie Crawford (20:10)

Instead of making personalized decisions based on the circumstance, they were told when they asked, are there lifestyle things I should do? Should I eat certain way? They were told, oh, none of it matters. You know, as long as you're freezing your eggs or doing ivf, that'll take care of it. Very dismissive mentality. And that's a process problem we have with IVF right now is a lot of times the people making the decisions are not the physician who would love to see you more. Yes, but they're a cog in a bigger system.

Savannah (Host) (20:38)

And in your book, you talk about the anti inflammatory diet.

Dr. Natalie Crawford (20:42)

Yes.

Savannah (Host) (20:43)

And how important it is. Can you explain kind of what this diet is? Because I feel like a lot of people hear anti inflammatory and they think, oh, God, so you can't have anything. Right.

Dr. Natalie Crawford (20:55)

An anti inflammatory diet. And I approach, I live in Texas, Right. So I have patients who eat all kinds of things. And food is so cultural and it's so ingrained in how we were raised and our celebration. So I just want to start by saying nothing is off limits forever. Like, by no means. But again, we're trying to pull that inflammatory burden down so that you can enjoy things when they come up because you have the resilience, meaning your body can eat cake and heal from it. But most of the time you should be making decisions from food that will decrease inflammation. Food is never net neutral. It's either worsening inflammation or improving it. The staple of your diet needs to be fruits and vegetables. They have a lot of fiber, they have a lot of antioxidants. Fiber is this under talked about nutrient. It is the food for our gut microbiome. So inside your gut are millions of bacteria and they do many different things. One of them is they metabolize estrogen. So if you want to have the best ovulation, the best fertility, we need to metabolize estrogen how we are supposed to. And when your gut microbiome is off the top, reason for this is high consumption of ultra processed foods or environmental chemicals in our food and in our kitchen, then you can't metabolize estrogen the same way and it's going to throw everything back off. The brain is going to interpret this estrogen differently. You're going to experience bloating, your ovaries won't respond the same. So thinking about, quote, healing your gut really starts from fiber because that's the food for the gut microbiome can shift them back normal. The other thing that a low fiber diet, when your gut microbiome starts shifting is you get something called fancy words, intestinal permeability. So if we want to think about it, inside your gut, your intestines are lined with a single row of cells, just a single layer and there's not supposed to be any gaps between them. But when there's inflammation inside your intestines, you get these little gaps and then the toxins, the fake stuff and ultra processed foods can go right through that, right into your bloodstream. So if you ever eat, you know, really crappy like french fries or other food and you feel bloated immediately, it's not like delayed, it's almost immediate. It's passing right through your gut, getting and going into your bloodstream, causing direct inflammation.

Savannah (Host) (23:08)

Wow.

Dr. Natalie Crawford (23:08)

So fiber and fiber can come mostly from those. Plant based products are some of the best way. Importantly, animal meat doesn't have fiber. It doesn't mean animal meat is bad, but it does mean almost all Americans need to explore incorporating some plant based protein into our diet. Plant based protein? Think beans, lentils, tofu, It's a superfood because it's giving you fiber and giving you protein. Okay, so in Texas I'm like, hey, red meat every day is probably not going to help you get to. It's going to be really hard to get your fiber goal. So at least one of those meals per day I want to see you put in a plant Based protein source because that's going to help you get to that fiber goal in addition to having, you know, fruits and vegetables at every meal.

Savannah (Host) (23:53)

Okay, okay.

Dr. Natalie Crawford (23:54)

And that's not how most of us are raised to eat.

Savannah (Host) (23:56)

No, not at all. I'm like, give me all the red meat, please.

Dr. Natalie Crawford (23:59)

So it's not that red meat is inherently bad, but a lot of it is about the ratio because if you're filling up on that, red meat is very nutrient dense, but you probably get full very fast on it. You're less likely to eat your allotment of fruits and vegetables. You're not getting fiber from it. Yeah, right. So we have to be very mindful that fruits, vegetables, fiber, plant based protein sources need to be at the top of our hormone friendly, fertility friendly pyramid.

Savannah (Host) (24:23)

Okay.

Dr. Natalie Crawford (24:23)

Okay. Healthy fats are also underutilized. And healthy fat can be in some animal products also. Think eggs. But then I. We love the healthy fats in olive oils, nuts, seeds, avocados. Fat is the backbone for every hormone you make.

Savannah (Host) (24:38)

Okay.

Dr. Natalie Crawford (24:39)

Wow.

Savannah (Host) (24:39)

I had no idea.

Dr. Natalie Crawford (24:40)

And this was really harmful because, you know, many women grew up in the era of low fat, no fat. They still feel like skim milk is preferred to whole milk.

Savannah (Host) (24:50)

And actually give me all the whole milk.

Dr. Natalie Crawford (24:52)

But that's great because the fat in the whole milk is actually one of the really nutrient dense. Good properties of it is it's helping you get enough healthy fats in your diet that then we can leverage to make hormones. Okay. And then when it comes to some of the other groups, I think what we just wanna think about is individualization. Right?

Savannah (Host) (25:11)

Yeah.

Dr. Natalie Crawford (25:11)

When it comes to animal meat, as we said, we want to think about some plant based protein sources. Eggs are wonderful. They're also a good source of choline. If you're trying to get pregnant, choline's wonderful for brain development. And then also fish, which are a great source of omega 3 fatty acids that we should be incorporating into our diet at some point. If we eat meat, they would be another great substitute for not having red meat every day. Think about leveraging some to fish.

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Savannah (Host) (28:31)

And do you have like an anti inflammatory diet that you have written?

Dr. Natalie Crawford (28:35)

It's in the book. I have an entire 12 week plan and the the diet really came from the place of especially if you have a known inflammatory disease. Let's say you have endometriosis or you have unexplained infertility, recurrent pregnancy loss or you did IVF and you didn't get the outcome you wanted. To me this is inflammation impacting your fertility unless proven otherwise. So I tell my patients we're gonna go on this 12 week a little more hardcore because we're gonna take some food groups out, introduce them back, and see if you're sensitive to them or not. But we really wanna be seeing what foods for you are the most anti inflammatory. Because our bodies are different.

Savannah (Host) (29:13)

Everyone's different.

Dr. Natalie Crawford (29:14)

We are. Right. So I have celiac disease, which ended up being the cause of my miscarriages I had way back when, but I didn't get diagnosed until 10 years after. Isn't that crazy? So at the time when I was told all the testing was done, everything was normal, it was just bad luck. That wasn't true at all. It actually was gluten sensitivity. Right. That's what celiac disease is, an allergy to gluten, which was causing me to be so inflamed that my body wasn't able to carry a pregnancy.

Savannah (Host) (29:42)

But what's crazy is it it took 10 years to diagnose that. And while you're sitting there feeling like my body's failing and we give ourselves

Dr. Natalie Crawford (29:51)

these different narratives, I just, I'm more sensitive to things. I just get tired. It's because of my work. All those subtle signs of inflammation we kind of push away. But my celiac got diagnosed finally because I started getting numbness of my fingers and toes. And then I got an mri, which then led to a bone scan, and I had what's called osteopenia. So I was like almost had osteoporosis, my bones were getting so thin. Right. At age 41, which was crazy. And my doctor worked it up and that's how we found out the celiac. But just think about the fact that for a decade plus of my life, when I had real symptoms, which was the pregnancy loss.

Savannah (Host) (30:31)

Yeah.

Dr. Natalie Crawford (30:32)

Imagine if I could have gotten diagnosed with celiac then like a decade of improving my bone health, healing my gut, decreasing inflammation.

Savannah (Host) (30:39)

Yeah.

Dr. Natalie Crawford (30:39)

And this is why we have data showing that if you have infertility, you have a higher risk of chronic disease later. And it's not that infertility is causing it, but it's that a lot of the buckets of infertility are caused by chronic inflammation being so harmful. And unless we address the chronic inflammation, you are now on a different health path where later in life you have a higher risk of heart attack, stroke, stroke, cancer, earlier death. So it's really important to zoom out and say fertility is more than just getting pregnant. It's really a state of cellular health within your entire body.

Savannah (Host) (31:16)

Yeah. And so when it comes to fertility, I want to kind of get your hot take on some of the fertility myths that we all hear. What is the biggest lie you've been told about fertility that you're just tired of hearing?

Dr. Natalie Crawford (31:31)

Oh, we addressed this one a little bit earlier, but that it's all women's fault. Right? Men is 50, 50 and you know the sperm life cycle, it takes 90 days to make a sperm. So back to that trimester 0, 60 days where an egg is the most sensitive. 90 days to create a sperm.

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Dr. Natalie Crawford (31:47)

Men make so many sperm, they make 1500 sperm a second.

Savannah (Host) (31:51)

See, like, how is that fair?

Dr. Natalie Crawford (31:52)

It's totally not fair. But it does mean that their lifestyle matters just as much, if not more, because a singular change that a man makes makes can result in completely different sperm in three months from now. So it's really important that men are a part of the puzzle, that they're, you know, at consultations when they can, they're making the same lifestyle changes. They are in it together with their partner.

Savannah (Host) (32:13)

Well, that was the thing. My partner literally went to every single appointment I went to. Like, even if it was just blood draw, it's perfect. Like every single appointment that I went to, I was like, you're an angel. But the whole time too, he was like, like, just don't, just don't be mean, just don't be mean. You know, like all the like. And he doesn't know what to expect either, you know, and it was so funny cuz whenever we got through it, he was like, you weren't bad at all. I was like, yeah. I mean, I tried not to be. I was.

Dr. Natalie Crawford (32:41)

But you know, no, you, you handled it with so much grace. We all watched you online. It was actually quite impressive.

Savannah (Host) (32:47)

Thank you. And so also, one thing we haven't touched on is birth control. Yes, birth control and fertility. I know, I was on birth control for years. And we have seen online recently too to where people are saying it messes with your fertility long term. So is that true in your opinion or not?

Dr. Natalie Crawford (33:09)

There's a lot of nuance with birth control. So let's get to the truth of it really quickly. Most of the time when people talk about birth control, they're talking about the pill, which is a type of estrogen and a type of progesterone that is feeding into the receptors in the brain. So the brain doesn't send out any of the hormones to make you ovulate. So it's kind of putting a little block in the brain. You don't ovulate, you don't get pregnant. That's One of the ways where the birth control is highly, highly effective.

Savannah (Host) (33:32)

Yes.

Dr. Natalie Crawford (33:33)

We have had very large, very good studies showing that the pill has no higher rate of infertility. Now remember what infertility is. It means by 12 months of trying, the same number of people are pregnant who previously used the pill versus is people who use no contraception. So no higher rates by 12 months. There's still a lot of myths about the pill that we have to address. One is that there could some people say they have what's called post birth control pill syndrome. That's actually not a real thing.

Savannah (Host) (34:03)

Okay.

Dr. Natalie Crawford (34:03)

Okay. So it's really important to kind of.

Savannah (Host) (34:05)

That's something someone has just self diagnosed with.

Dr. Natalie Crawford (34:07)

Yeah. They said, oh, I stopped the pill and now my periods are irregular or I have acne, or I gained weight.

Savannah (Host) (34:13)

Yeah.

Dr. Natalie Crawford (34:14)

What this is representing is really a cultural problem where young women were given the pill, maybe for a real medical problem, but not explained what was going on. And I don't know if this was your experience or not, but let's say if you have really painful periods, your doctor may say, here's the pill, it will help.

Savannah (Host) (34:30)

Yes.

Dr. Natalie Crawford (34:30)

Okay.

Savannah (Host) (34:31)

That was basically.

Dr. Natalie Crawford (34:32)

That's not false. Like it probably did help to some degree. Your pain probably did get better. But a better statement if they didn't say this would have been, I'm really concerned that your pain could be endometriosis. The pill may help with some of the pain. It's not a permanent solution. It's not gonna make it go away. When we stop the pill, the pain's going to come back. So we need to have a game plan for when do we do surgery, what we're going to do about your fertility, when we're gonna check your egg count, because we know endometriosis is associated with not just painful periods, but infertility and a low egg count because of the inflammation. So wrapping it up, which doesn't take that much time, I said it in 60 seconds. That the pill may be right in the moment because maybe for a teenage girl it is the right thing to do. But a lot of time we're not empowering people for how they come off the pill and what to expect about their body.

Savannah (Host) (35:22)

Yes.

Dr. Natalie Crawford (35:23)

Okay. And the pill itself only has, we call a half life of 28 hours, which means that it's out of your half. The pill is out of your body in a day, essentially by two days, three, four is out of your body. So this idea that the pill is going to last in your body for months is also a myth. That's perpetuated and problematic. And even physicians are guilty of this. Because if you have stopped the pill, your period should resume immediately. You should have your next cycle within six weeks, and then you should have regular periods. But if you go to your doctor after three months, after stopping the pill, and you say, I don't have my cycle back, or it's your regular, some women are told, oh, it's the pill, just keep waiting. That's totally false. Right. Once the pill is gone, it's quickly out of your body. It's important for us to track our cycle so we can know are we ovulating and what's happening.

Savannah (Host) (36:12)

Yes.

Dr. Natalie Crawford (36:12)

But on the birth control and the reason why all this gets lumped together, there's two others I do want to mention. The progesterone iud. The progesterone IUD is a T shaped device we put in the uterus that delivers progesterone. It can last often many years, depending on the size of the device, from anywhere from, from three to seven years usually does stop you ovulating in the early years. And then that usually kind of switches. But its primary method of action is that progesterone thins out the lining in your uterus. So if you've ever used an IUD or had a friend, they.

Savannah (Host) (36:43)

I did. I actually got an IUD put in and I was told, you're going to feel pain. Like this is a foreign object in your body. Your body's going to like, want to push it out. So just give it a few months. Months. Like, you need to get used to it. And then finally at like six months, that's how long they told me to wait. At six months, just be in pain for six months? Yeah.

Dr. Natalie Crawford (37:03)

No big deal.

Savannah (Host) (37:03)

Yeah. And at six months, I went into a new doctor and I was like, I gotta figure something out. Like, this pain hasn't gotten any better. And the doctor couldn't find the IUD and it had broken apart, perforated my uterus, and I had to have emergency surgery. I literally called my mom and was like crying in the doctor's office by my side myself. They're like, you got to go across the street to the hospital now. Yeah.

Dr. Natalie Crawford (37:27)

And you probably were not even aware that that was a potential complication that could even happen.

Rula and Quince Advertiser (37:33)

No.

Dr. Natalie Crawford (37:34)

So I, I have a love hate relationship with IUDs. A lot of OB GYNs love them because they are a very effective birth control one. They're terribly painful. They can cause scarring inside the uterus. So I do not love them. In young patients who haven't had a family yet because they can perforate, even though it's not a common thing. The more painful the insertion, the higher the risk that it could be perforated. But also it changes directly the lining of the uterus. And we know that for at least six months after you take that IUD out, you're gonna have a change in the receptivity, meaning harder for an embryo to implant. So if we go back to that infertility timeline being 12 months. Yeah, if you used an IUD by 12 months, maybe you catch up. But you see lower fertility rates for those first six months. Months. But so many young women are told, just pull the IUD and start trying the next month. Instead of being told, well, if you have an iud, I want you to take it out at least six months before you want to get pregnant. Give your body time to build your lining back up and get the receptivity back to normal, which is really important. And your experience highlights how under counseled so many women are when they go get an iud. I don't love invasive procedures. I think I've had a progesterone IUD myself too, and I hated it. But I think we have to give allotment for. At the end of the day, it's your decision. Maybe, maybe an IUD is perfect for the season of life you're in. Maybe the birth control pill is. Maybe no contraception is. But you should be the one making an informed decision. Informed, informed decision, which means risks, benefits, side effects, what to expect when you come off of it and you're allowed to change your mind. It can be right for you now and not for you in a year or so. But this idea of just do this, this will be great without any further context, I despise. Luckily, I think we are seeing a new generation of physicians, at least those who are online, who are starting to hear patients stories. And we've seen a huge change in even pain control for IUD insertion has changed in one year, how we approach putting an IUD in instead of just cough, you're going to feel a pinch. Here you go. Women are now getting, you know, night nitrous gas. They're getting localized numbing, which of course they should have gotten.

Savannah (Host) (39:49)

Yes. And I also think too, it's very interesting what a lot of people don't realize is insurance carriers as well and what they mandate that doctors do in the process of either diagnosing someone or how they treat someone. I saw a doctor in Beverly Hills. And she didn't accept insurance.

Dr. Natalie Crawford (40:09)

And.

Rula and Quince Advertiser (40:09)

But.

Savannah (Host) (40:09)

But she's phenomenal. And I was like, all right, it's fine. I'm going to do it. And the reason she didn't accept insurance was because she refused to prescribe, like, narcotics, pain meds for endometriosis, because that's what the insurance carrier said. Like, first step, do this. And if it doesn't work, then do this.

Dr. Natalie Crawford (40:27)

That's such a good point that people don't understand because they often put their doctor as the enemy. So why does your doctor not order this test or do this test thing? Sometimes it's not the doctor's fault. It's insurance mandate. Sometimes the doctor, though, is making an assumption. They're going to say, oh, Savannah doesn't want to pay out of pocket for this lab test. And that's why we have to learn to advocate for ourself in a health system that isn't really designed for us. Yes, it's not. But you can have some of the language. It's one thing in the book giving you questions to ask and setting the bar for what's normal. Because here's the thing. If you think what you're experiencing is normal, it's just bad, or you tolerate it poorly, or you have different standards, you don't know any different, versus saying, hey, this is actually not normal. I deserve better than this. Once you know what else exists, then you can do better because you know better. So raising that fund of knowledge so we can become our own health advocate is really important.

Savannah (Host) (41:24)

And we have spoken about endometriosis, but I feel like I see all over social media and everyone that I come in contact with endometriosis, pcos, and it feels like everyone has one of them. And can you kind of explain why do you think we're seeing so many people talking about it now or so many people being diagnosed with it?

Dr. Natalie Crawford (41:49)

So the rate of each of these is about 10%. So about 10% of women who have endometriosis that we know of, and 10% will get diagnosed with PCOS. So that's about 20% of all women. Most of us think these numbers are much higher. Right. For patients who have unexplained infertility, we think endometriosis plays a role in at least 50% of it. Extremely high numbers.

Savannah (Host) (42:09)

Yeah.

Dr. Natalie Crawford (42:10)

Endo particularly is really hard to diagnose. It's been a surgical diagnosis for a really long time, which means to get the real diagnosis, I have to put a camera in our abdomen. We can have a Lot of suggestion of it based on pain with period, pain with intercourse, GI changes, certain ultrasound findings. But you have to know to ask the right question or you have to know to tell the right symptom. Because part of the art of being a doctor is asking you the right questions to get the re. The real answer. That then leads me down a diagnostic pathway. Honestly, I think why we're seeing more of it is social media in a good way. Because too often the average time to diagnosis for endometriosis is seven to 10 years. Seven to 10 years from the first time you went to a doctor with whatever your symptom was until you get diagnosed. And that's because women get dismissed, they are not believed and they get gaslit. And the moment a doctor tells you it's all in your head or it's

Savannah (Host) (43:07)

not that bad, or it's just normal.

Dr. Natalie Crawford (43:09)

This is normal. Everybody else deals with this. This is just one what a period is, that becomes the narrative you now believe. Like, I don't tolerate this. Like, look at all my friends functioning normally. I need to figure out how to function. Instead of believing our body, like, don't we deserve the ability to listen and believe your body's giving us little red flag warning signs for if it's functioning normally or not?

Savannah (Host) (43:35)

Yes.

Dr. Natalie Crawford (43:35)

And isn't it one of the saddest tragedies that that society has taken that away from women specifically? Right. You, you then have to get so sick, so much pain for people to

Savannah (Host) (43:46)

even give you a chance, for people

Dr. Natalie Crawford (43:47)

to give you a chance to feel confident enough, saying no. This demands attention. And I do think that's why we are seeing so much people sharing their stories online, being very vulnerable, sharing about it in real time. I mean, when you talk about everything you go through, it makes another woman not feel alone. It helps a person get a diagnosis faster, gives them language to advocate for their care. And it's so important. Both of these, both endo and pcos have both a genetic component, something you don't control at all, and likely some environmental component. Exposures that happen in your childhood or when you're in utero or they are predisposing you to have the disease expressed at a certain time. So.

Savannah (Host) (44:32)

Well, it's like you just even said like with it's. It all goes back to your childhood.

Dr. Natalie Crawford (44:37)

It does.

Savannah (Host) (44:38)

Like, I went through a therapy program and I was there for a week and they had us do this test thing of like, did you experience this, this, this, all these things as a child? If you did, you had X amount you're more likely to have like body like inflammation, more likely to get cancer, more likely trauma in childhood.

Dr. Natalie Crawford (44:59)

Stress and trauma in childhood is associated with infertility, but also chronic disease. Right. Earlier death, cancer even. Isn't that crazy? That speaks to which we haven't even really talked about that chronic stress actually causes inflammation in your body because it's a response. You have a physical response.

Savannah (Host) (45:17)

Yeah.

Dr. Natalie Crawford (45:17)

And you know that, right? If you're in a stressful experience, you feel, oh yes, feel your heart racing, you feel things getting tighter, sleep, can't do anything. Things are actually changing on a cellular level to try to get you to run away from the stress. But when we don't, and we compound it because we stress, eat and we stress drink and we doom stress, do everything, we just like put it into a bucket and do these other things and we don't deal with the stressor that inflammation builds up. So it's not just theoretically bad for you. Chronic stress does play a role in your hormone health now and in the future. But childhood stress and trauma specifically, that's when your body gets programmed for how it's going to respond to the world around you.

Savannah (Host) (45:56)

That's the thing I love doing all the childhood work with therapy and actually, because I'm not gonna lie, I'm one of those people that was like, oh, that's such, like you're not gonna remember what happened to you as a child. But it's so true. It's like the book the body keeps the score. It is 110 factual. Like your body holds it as a child. That's why they say no screen time for the first, what, what two years of a child's life like, I wholeheartedly believe in that.

Dr. Natalie Crawford (46:26)

It is really interesting. And just because something's difficult, right, like it goes against common culture, right. Kids are on screens, food is ultra processed, there's endocrine disruptors in our environment. Hustle culture makes you stressed.

Savannah (Host) (46:38)

Oh yes.

Dr. Natalie Crawford (46:39)

However, taking the time to carve out a healthier way of living is one of the single most impactful things you can do for your fertility. But also so your health, your well being, your children's health and your vitality long term.

Savannah (Host) (46:54)

And when we speak about IVF too, can you explain to people who may not know that process, like they may have someone that's going through it in their life, but I don't think the majority of people listening really know what that process is like.

Dr. Natalie Crawford (47:14)

First, let's say it's a lot harder than you think. Even if it doesn't last as long. It is both emotionally and physically hard. It takes time and it takes money. So it is challenging all of the resources that a human has at the exact same moment. To put it really simply, women are born with all the eggs they ever have. And I like to think about them as in a vault in your ovary. And every month, you have a group of eggs coming out of that vault. Now, when you ovulate a normal month, one of these eggs will grow an ovulate, the rest of the eggs will die, and the next month, you have another group. This idea is really important because when we do IVF or egg freezing, I can only get the eggs outside the vault to grow. I cannot tap into the vault. One of the biggest myths I hear about IVF is people say, well, I don't want to run out of eggs faster because they're under the impression that we're tapping into that.

Savannah (Host) (48:02)

You're tapping into that.

Dr. Natalie Crawford (48:03)

Exactly. And I can't do that. I can only. Only get the eggs outside the vault to grow. We all have our own unique potential of how many eggs we have. And one interesting fact is that when the vault is more full, more eggs come out every month. And as the vault starts to get emptier, fewer eggs come out. So evaluating the eggs outside the vault gives us an idea of how many we might see in one IVF cycle. And these eggs make amh. So then we talked about AMH being a test for how many eggs you have. It's not a perfect test, but it's a reflection of how many eggs are outside the vault, giving us an idea of how many are on the inside.

Savannah (Host) (48:41)

Wow. And when you go through ivf, can you talk to me about the two week wait after IVF or trying to conceive naturally?

Dr. Natalie Crawford (48:52)

Good point. So when we think about IVF as it currently is, in vitro fertilization means fertilizing eggs in the last lab. So we're gonna get those, that group of eggs to grow. That takes about two weeks of hormone shots. Another myth is that these are crazy hormones that you're putting your body. They're the exact same hormones that the brain makes FSH and lh and you're giving themselves in shot form because they're peptides that if you took a pill by mouth, they'd be dissolved. So you're taking shots for two weeks. You're getting ultrasound appointments during that.

Savannah (Host) (49:22)

Watch the shots. I mean, I was started off, first few days, four shots a day, and then five shots a day shots by like a Few days in.

Dr. Natalie Crawford (49:31)

Yep. So it's multiple shots. Right. And a lot of times this involves mixing the medication, a lot of obsessing over it, and.

Savannah (Host) (49:38)

And it's extremely confusing. Like, if it was not for my best friend who's a nurse, she came over every single night.

Dr. Natalie Crawford (49:46)

So good.

Savannah (Host) (49:46)

Mixed my meds, gave me my shots, like what I would have done.

Dr. Natalie Crawford (49:51)

It is confusing, and it's overwhelming. And you have to be really organized. You have to learn a whole new language, a whole new skill set that. So two weeks of these shots, they are subcutaneous, which means they just go in the fat area of the stomach, much like a GLP one would. And then you get ultrasound. So these are vaginal ultrasounds, so we can watch and measure the follicles. And then when the eggs are mature, which is determined by size and estrogen, we go and we do the egg retrieval procedure under anesthesia, where we take a needle, insert it vaginally into each follicle. An egg grows inside a follicle. We drain those follicles, get test tubes full of your eggs, and then if you're freezing your eggs, they're frozen. If you're doing ivf, we then take sperm sample from that day, pick up a sperm, inject it into each egg, which is the in vitro part of the fertilization. And then we find out how many fertilized. Usually it's about 75% of the eggs will fertilize. From there, they have to grow to what we call an implantation stage embryo called the blastocyst.

Savannah (Host) (50:48)

Okay.

Dr. Natalie Crawford (50:49)

Natural conception egg and sperm would meet in the fallopian tube, grows and develops till it lives in the uterus. It arrives five to six days later. So that happens in the lab. One of the advantages is the lab doesn't have any inflammation like your body would.

Savannah (Host) (51:02)

Yes.

Dr. Natalie Crawford (51:02)

So especially for somebody with endometriosis, that can be a huge advantage to freezing your eggs or doing IVF. Now we expect about 50% of those fertilized to make it to blastocyst. That's when you can do genetic testing. You can freeze the embryos, et cetera. Yes, you can do. Although it's less common because success rates are lower, you can do what's called a fresh embryo transfer. It would be on that day five, when the embryo gets there, just put it back in your body.

Savannah (Host) (51:28)

Wow.

Dr. Natalie Crawford (51:29)

But we know that has lower chance of success rates because there's a mismatch between the lining of the uterus and where the embryo is. Many women will start bleeding already or the lining has been exposed to these very high hormone levels. So the vast majority of the time, you're going to freeze the embryos, have a period, and then we're going to do another cycle to do the transfer.

Savannah (Host) (51:47)

Yes.

Dr. Natalie Crawford (51:48)

And this will be when we get the lining to grow. We then start progesterone and we do the transfer on the six day of progesterone and we put the embryo back in, kind of mimicking when it would go in your body after ovulation.

Savannah (Host) (51:59)

Wow.

Dr. Natalie Crawford (51:59)

But then you still get the two week wait, right? The two week wait is the time period from when you ovulate or when you put an embryo in until when you find out you have a pregnancy test. And that is probably mentally and emotionally one of the hardest times. It's unknown. You're looking at every symptom. We typically pump you full of high doses of progesterone. Not to be mean, but because progesterone is so important in early pregnancy, and we want to do everything we can to try to give you the highest chance of success.

Savannah (Host) (52:27)

And you said, you mentioned, obviously, like GLP1s. We did not speak about that. Are you an advocate for micro dosing GLP1s for fertility?

Dr. Natalie Crawford (52:41)

I love this question. The medical recommendation, which we have to clear as our disclaimer is right now, you should stop GLP1s 2 months before you conceive. And that is because of fear of potential fetal outcome, because we don't have enough data. There have been times in medical history where medications were introduced too close or during early pregnancy and there were fetal side effects. So we want to be very careful of that. So if you come to me and you say, I want to do a GLP1 and I want to do this fertility treatment, those things usually don't go hand in hand. Why we do one or the other. With that being said, GLP1s are probably one of the most powerful tools we're seeing that can change your environment, decrease inflammation, and improve insulin resistance, which is one of the top causes of chronic inflammation in America. Microdosing GLP1s has very powerful to decrease inflammation and change what's going on. They're life changing. For many women with endometriosis or autoimmune

Savannah (Host) (53:36)

disease, light, life changing, lifechanging. It's also lifechanging because people don't realize with endo, you shouldn't do alcohol, you shouldn't do sugar. You should.

Dr. Natalie Crawford (53:45)

Your inflammatory burden's already up here because of the endo. So whereas your friend can drink a drink and go back to normal. That drink sets you over the edge. That piece of cake sets you over the edge. Not getting enough sleep. Like, you're. You're just living at a higher level. And so there's very few things that can take our baseline down. Right. All of the lifestyle things, you're trying not to add to it. But GLP1s can take the baseline down. And so for people, especially if they have chronic inflammation, and maybe we know why, maybe we don't. I think they're a powerful tool right now clinically. In practice, we're often doing it if we don't get the outcome we want or we're talking about it. And it might be a purposeful pause in fertility treatments saying, we're going to do this, decrease our inflammation, and then go put the embryo inside. Right. We're going to kind of get what we need to change the environment, get it all ready, and then get you pregnant.

Savannah (Host) (54:31)

Okay.

Dr. Natalie Crawford (54:32)

I think we're gonna see really exciting research come in the next five years when it comes to GLPs and endo unexplained and autoimmune disease specifically.

Savannah (Host) (54:40)

Okay. I love that. I do. Okay. So before we wrap up, I just want to do one quick thing, which is myth or medicine. So I am going to read these to you and then you tell me, myth or medicine?

Dr. Natalie Crawford (54:53)

Okay.

Savannah (Host) (54:54)

You have to try for a full

Dr. Natalie Crawford (54:56)

year before starting after myth, myth, myth, myth. As loud as I can state myth.

Savannah (Host) (55:01)

Yeah, you.

Dr. Natalie Crawford (55:01)

You can get tested right away. You can call a fertility doctor today, say you want to get tested. You don't have to fail first birth.

Savannah (Host) (55:07)

Birth control causes long term infertility myth Stress is the main reason most women can't get pregnant.

Dr. Natalie Crawford (55:14)

It is a reason, but I wouldn't say it's the main one. But it definitely does matter.

Savannah (Host) (55:18)

Okay. Eating pineapple core after IVF transfer helps implantation.

Dr. Natalie Crawford (55:24)

Pineapple core does have a lot of vitamin C, but it also has bromelain in it. So bromelain's an enzyme that is actually important in implantation. So the thought here is that it's a little bit of an anticoagulant. Does it help the placenta invade the uterine wall? Like, it's not going to hurt. Pineapple core is overall healthy but not been proven to get you pregnant.

Savannah (Host) (55:43)

How does one even eat pineapple core?

Dr. Natalie Crawford (55:45)

Yeah, doesn't it sound as fun as, like, the actual pineapple itself?

Savannah (Host) (55:49)

Yeah. You should stop drinking coffee completely if you're trying to conceive.

Dr. Natalie Crawford (55:53)

We recommend maxing out at one cup, which is usually around 200 milligrams. And then we'll give the caveat that usually a shot of espresso is about 75 milligrams. So an average grande drink which has two shots has 150 milligrams, and that would be fine and safe.

Savannah (Host) (56:08)

If you've had a baby before, you can't have fertility problems the second time.

Dr. Natalie Crawford (56:12)

That's false, right? That's a myth. Secondary infertility happens at least 30% of the time. As women get older, they tend to get less metabolically unhealthy. And then also so your whole body changes after you've had a pregnancy.

Savannah (Host) (56:23)

Fertility is only a women's issue. Men don't need to worry about it.

Dr. Natalie Crawford (56:27)

50, 50 men definitely need to worry about it.

Savannah (Host) (56:29)

Irregular periods just mean you have an irregular cycle. It's not a big deal.

Dr. Natalie Crawford (56:33)

Your period is a vital sign. And we didn't go into this tons. Although there's two whole chapters in the book walking you through what's normal, what to do when it's abnormal, and even how to track your cycle. Knowing when you ovulate is one of those top things you can do to check your hormonal health, because it should be regular.

Savannah (Host) (56:49)

You can't get pregnant while pregnant. Breastfeeding.

Dr. Natalie Crawford (56:51)

That is false. You can get pregnant when breastfeeding.

Savannah (Host) (56:54)

Okay. Age only matters for women. Men can father children at any age with no issues.

Dr. Natalie Crawford (57:00)

That's false. Actually, advanced paternal age is when men are 50 and older. We see a change to sperm counts, but we also see an increase in very specific disease types. New onset of autosomal dominant diseases. Think like dwarfism, something called imprinting disorders. And then a higher tendency for children to have mental health problems, like schizophrenia. Autism are two top examples.

Savannah (Host) (57:23)

No way.

Dr. Natalie Crawford (57:24)

That just goes to show.

Savannah (Host) (57:25)

How do you test for that?

Dr. Natalie Crawford (57:26)

Many of these things you can't test until the baby is born. You can't test the sperm specifically, but if you are a man or you have a male partner and you're waiting for this right time, you know, it's very easy for a man to freeze sperm in his younger years, and that could be something to leverage if he potentially is on the path to father children at a later age.

Savannah (Host) (57:43)

Wow. That is insane. I had no idea.

Dr. Natalie Crawford (57:47)

Crazy.

Savannah (Host) (57:48)

You are absolutely amazing. Well, thank you so much for coming on. Can you please tell people where they can get the gift of the fertility formula?

Dr. Natalie Crawford (57:56)

Absolutely. Thank you, Savannah. The fertility formula is available anywhere you buy books. I like to think about it as broken down into three parts, like understanding everything you should know about your body now no matter if you want to get pregnant or not to learning to advocate for yourself when it comes to your cycle. What's abnormal. And then when you're trying to get pregnant, pregnant. And then part three is optimizing your health which really means decreasing inflammation in a way that's really tangible and accessible.

Savannah (Host) (58:21)

Amazing. And you can get it on Amazon everywhere.

Dr. Natalie Crawford (58:24)

Amazon everywhere. You can learn more about it at my website@natalie crawfordmd.com Amazing.

Savannah (Host) (58:29)

Thank you so much.

Dr. Natalie Crawford (58:30)

Great to be here. Pluto TV has thousands of free movies and TV shows. We're coming at you with everything we got. This is the mindset. Free. This is this is the mantra.

Savannah (Host) (58:41)

Free.

Dr. Natalie Crawford (58:42)

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