Fertility Expert: 1 in 5 Couples Now Have Infertility — What Every Woman Should Know Before Trying to Conceive | Dr. Natalie Crawford, MD - Post Run High

Episode Transcript
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Speaker 1 (00:00):
Fifty percent of infertility is male, fifty percent is female.
The narrative that your fertility is all luck, that there's
nothing you can do about it really has simplified it
to the point of we don't learn about it, we're
not educated, and we're not making choices in line with
giving ourselves the best.

Speaker 2 (00:14):
Odds of success.

Speaker 3 (00:16):
Doctor Natalie Crawford, a board certified opgyn and fertility specialist,
breaks down how fertility actually works and what men and
women are commonly getting wrong. Have infertility rates been going up?

Speaker 1 (00:28):
When I first started practicing, one out of every eight
couples would have infertility.

Speaker 2 (00:33):
Now that stat is one out of every six.

Speaker 1 (00:35):
It's really important to understand that your fertilities what we
call a health marker. If you have infertility, you have
higher rates of chronic disease, cancer, and earlier death. If
you're in your twenties, won't be pregnant one day, but
not now. Knowing your is so essential.

Speaker 3 (00:48):
What are people doing three to six months before trying
to conceive?

Speaker 1 (00:51):
Fifty eight percent of runners will have aluteal phase defect.
I mean their luteal phase would be less than eleven days.
That makes it harder to get pregnant.

Speaker 3 (01:03):
Hi, guys, Kate here. Thank you so much for tuning
into our conversation today with doctor Natalie Crawford. If you
are enjoying post run high, please be sure to follow
the show wherever you are listening, and we will be
right back after this shortbreak, Doctor Natalie Crawford. So many

(01:25):
women are told fertility is simple. You come off birth control,
you track your cycle, and when you're ready, it just happens.
But for a lot of people, it's not that straightforward,
and you work with men and women navigating this every
single day. So what are we most commonly getting wrong
as it relates to fertility.

Speaker 1 (01:43):
The narrative that your fertility is all luck, that there's
nothing you can do about it really has simplified it
to the point of we don't learn about it, we're
not educated, and we're not making choices in line with
giving ourselves the best odds of success. And so really
wanting to reframe this is there's actually a lot of
different things we can do that can help us. And
this includes the information we learn, how we advocate for ourself,

(02:05):
and how we optimize the world around us. And that's
really what I'm here to talk about. And why I'm
so excited to sit with you today.

Speaker 3 (02:11):
Have infertility rates been going up?

Speaker 2 (02:13):
They have.

Speaker 1 (02:14):
So I've been a fertility doctor out of practice for
more than a decade, and when I first started practicing,
one out of every eight couples would have infertility. Now
that stat is one out of every six, and here
in the United States, for couples trying to get pregnant
for the first time, it's one out of five. So
we've had a huge increase in the rate of infertility.
And we couple that with the fact that the world

(02:35):
around us is also getting sicker. We see more autoimmune disease,
more chronic inflammatory disorders.

Speaker 2 (02:41):
There's a direct.

Speaker 1 (02:42):
Correlation with the increase in infertility and the change in
our overall health and our environment.

Speaker 3 (02:47):
So when I hear the stat one in six people,
it scares me immediately, right because that's I mean, one
in six people. It's just yeah, you know somebody, and
the chances of it happening to you are high. So
how do you guys to find infertility?

Speaker 1 (03:01):
Okay, I love this question because I really want to
push back against it. But right now, the definition of
infertility is trying to get pregnant for twelve months and
not having success. The problem with this, especially when we
look at the world where infertility rates are arising and
women are waiting longer to get pregnant, is the fact
that it doesn't really serve you to be forced to
wait before you're even available or allowed to get testing.

Speaker 2 (03:25):
So basic fertility.

Speaker 1 (03:26):
Testing to see if you have a normal sperm count
or what your ed count is, that is not recommended
to be done until you have proven infertility. And this
is so confusing for many people because you go to
the doctor and you'll say, hey, we want to get pregnant.
What should we do? And nine out of ten times
patients are told, well, just take a prenatal and try
come back if you're not pregnant within a year. But

(03:46):
that's a very disempowering narrative instead of really talking about
what we can do to optimize our environment and what
data is available to us, because we do live in
a world where there is more data that we can
leverage and we might make different decisions.

Speaker 3 (03:59):
So for a patient that comes to you and I've
recently went through this where you know, I'm currently seven
and a half months pregnant, But when we were trying
to conceive. I did do kind of all the pre
screening appointments with my husband, and they sort of said
the same thing to us, and I was like, well,
I have PCOS. So I'm a little nervous, you know,
I'm like, what if it is What if it's something
that's going to take me six months when I want
it to take three? You know, So what are you

(04:22):
saying to those patients now?

Speaker 1 (04:24):
Number One, you can always get fertility testing at any time.
You don't have to wait for your doctor to bring
it up. You don't have to get a referral to
a fertility doctor. You're obgi in maybe able to order
it or I order this on patients every single day.
Fertility testing includes evaluating your anatomy, your at count, your
partner's Seman analysis. Having normal testing doesn't mean you won't

(04:44):
have infertility, but certainly if something is abnormal, right, then
we want to intervene immediately. We don't want you to
have to go wait six months or a year and
struggle and then and only then help you. If I
want to double on that, if you know you have
a problem, that could make it harder for you to
get pregnant. So if you're sitting across from you, and
you have pcos irregular cycles, if you have known endometriosis,

(05:09):
if your partner has a rectail dysfunction, or it's difficult
to have intercourse because of pain or some other reason.
These are all reasons to not pass go. You should
get an evaluation right away, because we already know your
body's giving us the red flag warning signs that something's
going on. But I really want to pivot on this
narrative like reactive medicine, which is what infertility is right now.

(05:30):
So you were told just go try and then if
it doesn't work for you, then we'll test everything. In
today's world, I really want people to say, hey, let's
be more proactive. Let's start to optimize our body ahead
of time. I love patients like you who come and
say I want to get pregnant. What should I do?
Because there are lifestyle things we can change to put
us in a better position, and we can do early testing.

(05:53):
And I'll say about one third of the time when
couples come to me without infertility and we do testing,
we actually find something that they didn't do, something very different,
whether it is they have to go see a urologist
or their sperm count is very low, or we find
something anatomical or some underlying autoimmune disease like DIYORID disease.
So about a third of the time patients who do

(06:15):
not have infertility yet have something that's going to make
it harder for them to get pregnant, and we shouldn't
make them fail and try for a year first before
we find that.

Speaker 3 (06:23):
For our women and men listening today, why is what
we are about to talk about so important?

Speaker 1 (06:28):
It's really important to understand that your fertility is what
we call a health marker, So of course we want
to think through the lens of getting pregnant, but also
if you have infertility, you have higher rates of chronic disease, cancer,
and earlier death. And it's not that infertility causes any
of those, but it can be a sign of ultimately
cellular dysfunction or poor health that you might not have

(06:49):
really even noticed is going on. And that's an opportunity
for us to intervene to help you get pregnant, but
also long term for your health to live a long,
healthy life. So we know that the around us and
packs our fertility, We know our bodies giving us warning signs,
so this conversation is going to really bring up that
foundational knowledge so we can help more men and women
get help earlier.

Speaker 3 (07:10):
Okay, so what is a normal cycle.

Speaker 2 (07:12):
It's a lovely question. What is the menstrual cycle?

Speaker 1 (07:15):
Really quickly, if I want to give my one minute
explanation of it. Women are born with all the eggs
they're ever going to have. Let's imagine them stored in
your ovary. Every month, you have a group of eggs
come out of what I consider the vault in the ovary.
From this group, each egg grows in a small fluid
filled stack called a follicle. So your brain's going to
send out a hormone called f SH. Follicle stimulating hormone,

(07:36):
well named hormone. FSH gets a follicle to grow. As
the follicle grows, the egg inside is maturing, making estrogen.
This is called the follicular phase. Follicular phase is an
estrogen dominant phase. This is the time period from when
you have started bleeding until you get to ovulation. What
is really important for people to know is that your
brain has no idea what's.

Speaker 2 (07:57):
Happening in your body.

Speaker 1 (07:58):
It can't see your overt It is waiting for your
ovaries to come back and give a hormonal clue, and
that clue is estrogen. So when the egg is maturing,
it makes estrogen at high levels and it's very specific.
Two hundred peograms for fifty hours is the level of
estrogen that signals to the brain you have a mature egg.
Then the brain will send out a surge of a

(08:18):
hormone called LH and this will allow that follicle to
rupture and the egg to be released, and this is ovulation.
That egg has to be fertilized within twenty four hours
or it's gone, so it's very time sensitive process. But
then that follicle reforms into assists called the corpus lutium.
The corpus ludium is now going to make progesterone, and
this is called the luteal phase, and a hormone from

(08:40):
the brain called lutinizing hormone or LH send out. Now
impulses stimulates progesterone to be made in pulses. That cysts
can only live for two weeks maximum, it will die,
progesterone levels will drop, you'll get a period. Progesterone opens
and closes the implantation window. The reason why that's so
important is because you'll offer and have people sit across

(09:00):
from you and say, a normal period is a regular period. Okay,
you can actually have dysfunction within your period and still
be very regular based on how long the follicular and
the luteal phases are. And so the first stages of
not having a normal cycle all require you to know
when you ovulate. And that's why this is so tricky
because most women are tracking their cycles on apps which

(09:22):
are putting in their cycle day one, and unless they're
using a wearable or they're tracking urinary hormones, they actually
are just using an old fashioned method called the calendar
method to tell them when they're ovulating. The calendar method
just assumes the luteal phases fourteen days in length, and
it's getting ovulation wrong eighty percent of the time. I mean,
it's only right twenty percent. So if you're using that

(09:44):
app and you're saying, let's have sex around this time
because we're ovulating, it's wrong most of the time. So
a regular cycle, yes, is regular and predictable, but more specifically,
we want the luteal phase to be at least eleven
days in length or longer and we don't want the
follicular phase to generate be twenty days or longer.

Speaker 2 (10:01):
That's usually too long. So even though we can see.

Speaker 1 (10:04):
Extremes in this when it takes that long to get
an egg to grow, or when the corpus ludium can't
last as long as it should, these are signs that
there's some mismatch in the brain over communication. It could
be pcos, could be thyroid disease, could be elevated prolactant,
another hormone from the brain. It could be something called
gluteal phase deficiency, which can come from the brain's interpretation

(10:28):
of energy and other signals. So this can happen in runners.
This can happen if we're not eating enough, if we're
over exercising. It's kind of this hypothalamic dysfunction. So we
have all these different subtle signs before our periods just
totally irregular are absent. So it's a little bit of
a simplification to say it just should be regular and predictable.

(10:49):
It should, but there's a little more nuance to how
we really need to learn to track it.

Speaker 3 (10:54):
And it is so interesting because I feel like growing up,
what we do use are just the basic apps to track. Okay,
when is our period come each month, so that we
kind of know what to expect. We have our tampons
and pads ready to go. But when you're trying to
get pregnant is it is a lot more complex than that.
So I'm curious for somebody that is looking to get
pregnant at some point, and maybe it's just in their

(11:14):
twenties right now, not trying to conceive in the near future,
but wants to know what their body's doing and what's
going on. What are the signs that we're ovulating versus
not ovulating.

Speaker 1 (11:23):
I love it. This, I think is one of the
missed opportunities. So we talk about what can you do.
Learning to track your cycle before you want to get
pregnant is on the list. So if you're in your twenties,
you want to be pregnant one day, but not now.
Knowing your baseline is so essential because one of the
first questions that I'll ask a patient when we're talking is, well,
how how did it used to be? Has your period
always been like this? So the earlier we learned to

(11:46):
track our cycle, it's so important. Number One, let's review
what we call fertility awareness methods, and these are all
based on physical signs includes from your body. One is
going to be very free and easily accessible. This is
cervical mucus. Your cervical mucus blocks anything from getting into
the uterus. It's in the cervix and it changes when
estrogen's at its peak, so that sperm can swim through

(12:08):
it and get to an egg. So it becomes very sticky,
stretchy like an egg white. That's called type four cervical mucus.
There's a lot of misconceptions about cervical mucus, but you
can actually just check it before you go to the bathroom.
Just wipe with toilet paper. It comes out your vagina
and if you look at the toilet paper, it'll be
very sticky stretchy. The reason why you have to wipe
is it can actually just fall in the toilet and

(12:28):
then you may miss it. The last day of type
for cervical mucus is considered ovulation, So free, easy boom.
You can know right away. Second is going to be
a rise in your core body temperature. When you make progesterone,
your body temperature rises by point four degrees fahrenheit. So
if you can detect when this is rising. You can
know when ovulation happened. Okay, this used to be so difficult.

(12:50):
I told nobody to do this because it would take
graph paper and special thermometers. But this is really where
wearables have made a big difference for us. So you
have or ring Apple watch natural cycles. You have more
sensitive time periods where we're getting your temperature and we
can know when, in fact your temperature dips and then
rises and detect ovulation. And another one is you can

(13:11):
actually check your urinary hormone, so you can see LH surging,
you can see progesterone rising, So there's now urinary based tests.
One is called an ovulation predictor kit or an OPK,
where you pee on it like you had a pregnancy test,
and you can.

Speaker 2 (13:24):
Know when you have a positive LAH.

Speaker 1 (13:26):
So you see that surge, you'll ovulate the next day.
In addition to those, sometimes you get little physical signs.
So there's something called middle schmirtz, which is actually ovulatory pain.
It's German for middle of a cycle.

Speaker 2 (13:38):
If we think.

Speaker 1 (13:38):
About we've got that follicle, the egg is microscopic inside,
and that follicle is going to rupture kind to open
up to allow the egg to come out. You can
actually feel that in some women. So if you have
one sided pain always around the middle of your cycle,
you might have middle Schmertz and that's one of the
most sensitive signs for ovulation. So if you are trying
to get pregnant have sex, then if you're not trying,

(14:00):
you can mark that as ovulation day, and then you
can know how long your follicular and luteal phases are
based on that alone.

Speaker 3 (14:07):
I like that you also reference the device or ring
because I feel like now, I mean, you know when
we were in high school, was I feel like a
little different. There weren't as many advancements in kind of
tracking devices and wearables for us to have this readily
accessible information that makes it easy for us to digest,
like your basal body temperature. The ORR ring does tell you.

Speaker 1 (14:24):
Which it does, It tells you and you compare it.
Natural Cycles has a wearable, but they have an app
to with their algorithm that they can tell you which
days to have sex or avoid sex, whether you want
to prevent or try to get pregnant, and that can
be a really powerful tool as well if you want
to be able to leverage this data about your body
for whatever your goals are at the moment, It's so
much easier. I'm a huge fan of or ring and

(14:45):
wearables because it really is your body's given you data
every single day. It's just learning to interpret it and
leverage that so that you can make decisions based off.

Speaker 3 (14:54):
Of it and for the easiest way for women to
interpret it and be able to bring it to you
as a doctor. Are you encouraging people now to go
out and start wearing these wearable devices?

Speaker 2 (15:05):
I love it.

Speaker 1 (15:05):
I know not every physician loves it, but to me,
the more data you have, bring it in. If you've
gotten labs done, if you did functional health, you have orring,
you have natural cycles, you can bring data. Because our
recall of data is actually very poor. Meaning if I
ask Kater your periods regular like nine nuts and women,
I'll say yes. And then if I say okay, show

(15:26):
me or tell me about your past three cycles. How
long was it and what day did you ovulate? We'll
actually see that it can vary by more than a week,
which is not as regular as we want it to be.
The true regularity we're looking for is within one to
two days of difference. If I put a calendar in
front of you. You should be able to take your
finger and point when you think your next period will come,
and you should be within one to two days off.

(15:48):
And if it's more than that, it could be what
we call irregularly regular not missing all completely, but there's
some disconnect and how tightly it should be synced up.

Speaker 3 (15:58):
So I also have a question about the LH because
when I was trying to get pregnant, I bought an
ovulation kit and I was religious about testing my LH
levels each month, and my LH never spiked. And I
actually talked to a couple of my friends, one who's
LH level spiked and that was kind of how she
was able to figure out when her fertile window was,
and then other friends who's LH also never spiked. So

(16:18):
I'm curious, does that happen and what's going on if
it's not showing up as a true LH surch.

Speaker 1 (16:25):
Most of the time you are actually surging, we're just
not detecting it. So let's think about it really quickly.
LH is released from the brain in the early morning hours,
we'll say four to five AM, and so it has
to have enough time to get through your kidneys and
into your urine. Right it's released from the brain into
the blood, it has got to filter through your kidney
so you can peel out. One of the biggest things
that I see as a mismatch is early morning risers.

(16:47):
They're taking their urinate on first thing in the morning,
which is what the test says to do, and it
hasn't processed through the kidneys yet, so by the time
the next day comes, they've already metabolized that LH out
of their body, so they miss it because of the
timing interval. So I actually recommend that women take an
OPK between ten am and two pm. That's enough time

(17:08):
for it to get into your urine. We also have
to be mindful of how much water we're consuming because
we can dilute our urine. This it's a test based
on concentration, So if your urine is really dilute, if
you always pee clear, which we love overall for kidney health,
there just may not be enough hormone in it for
the test to detect in the sample.

Speaker 2 (17:27):
So may that might be a moment.

Speaker 1 (17:28):
Where I say, like, if you're trying to test, don't
drink tons of water.

Speaker 2 (17:32):
Just right in that interval.

Speaker 1 (17:33):
Try to have a little bit more concentrated urine so
we can get a real sample, which is not reality,
We'll say for many of my runners, who get up early,
who drink a lot of water.

Speaker 2 (17:43):
Who go on their day.

Speaker 1 (17:44):
There's also a few other categories though, so people who
do potentially have PCOS, they often have a really hard
time detecting a positive because they are an elevated baseline LH.
So it can be really difference to see a surge
or to see a difference in that world they offer
to have. If you're using the lines, there's two different types.
One is a digital test that's based on a numeric

(18:05):
value and they're waiting for it to change to go
from lower to higher. The other one is a line test,
and the line will tell you it needs to be
at least as dark or darker than the control line.
So the problem for a lot of women with pcos
is it kind of lives really close, but it never
gets darker. Same thing happens if we get into having
low ovarian reserve. We have more LH coming from our

(18:26):
brain naturally as we tend to get older, so it
can be harder to get that real surge because that
baseline is kind of elevated, so you don't really detect
the difference.

Speaker 2 (18:35):
But sometimes it's not a reliable test for everybody.

Speaker 1 (18:38):
It can be really frustrating too, right so, whether you're
getting false negatives or false positives. Most people though it
is a good test. We just have to switch how
we're using the test, So simply switching the time of
day we're using it and making sure we're not too dilute,
that can be helpful.

Speaker 3 (18:51):
And regardless, don't stress no doctor.

Speaker 1 (18:55):
If you are having regular periods, you are most likely ovulating.
Now are you ovulating to the best you can can?
There be warning signs. Those are the nuance within it.
But many people maybe they won't get an LAH at
all and then they say I'm not ovulating at all.
That just not may not be the fertility awareness method
for you. You might be somebody who needs basil body

(19:16):
temperature or needs cervical mucus to really be able to
detect what's happening.

Speaker 3 (19:19):
I like that we talked about this and kind of
went over the cycle and everything that happens in between,
because I think, you know, it's so important for people
to know their baseline and I wish, having gone into
trying to conceive when I was twenty eight, that I
had known what my baseline was at twenty two, twenty three,
twenty four, start just to start, So I think it
is really important. So if you're listening out there and
you're not trying to conceive right now, but you want

(19:40):
to have babies at some point, I think it's a
good time to start really tracking and getting on top
of getting on top of your cycle.

Speaker 1 (19:46):
I mean, this is not too early to track and
just know what it is. And similarly, I love this
focus and we'll talk more about it on trimester zero,
Like what should you do in the Hey, we want
to be pregnant soon, Like, this is a wonderful time
to take three months or so and really learn to
track not just when your period's coming, but track your ovulation.
Because if you notice some of these subtle abnormalities again,

(20:08):
don't pass go go get them evaluated right now. You'll
save yourself time.

Speaker 3 (20:11):
So, coming off of birth control, what do we actually
need to know that happens to the body when we
come off of birth control?

Speaker 1 (20:18):
You love this question because there's a lot of misinformation
about birth control right now online, especially most of the
time we're talking about birth control. We're talking about the
birth control pill, so we'll focus there first. The birth
control pill is a synthetic form of an estrogen and
a progestine. What this does at the brain level is
the brain sees that estrogen, so it thinks that you
already have a mature egg. So it does not send

(20:39):
out any fsh r LH. We're just severing the communication.
If we can imagine the brain and the ovaries are
on walkie talkies, they're turned off, okay, which is fine,
you're not ovulating. Highly effective for preventing pregnancy, wonderful. The
birth control pill only has a half life though, of
twenty eight hours, so if you stop the pill, it's
out of your body really quickly. Communication the walkie talkie

(21:01):
is going to get turned on. Whether the brain and
overy can communicate, well, that's left at what's happening with
your body right the state of your overall health, how
much inflammation you have, the calories you're eating, how things
were before you started the pill, if you have PCOS
or not. So there's other underlying factors which we'll control.
If the brain and overy can communicate the birth control

(21:21):
pill doesn't keep the switch off longer. It doesn't make
it so that it's going to be harder to communicate later.
And this is some misinformation even from physicians sometimes where
patients will be told they'll go in three months after
stopping the pill, they won't have a period, and they'll say,
my period's not back yet.

Speaker 2 (21:37):
And sometimes they're.

Speaker 1 (21:38):
Told, oh, that's just because of the birth control, just
keep waiting longer.

Speaker 2 (21:42):
That's false. It's well out of your system.

Speaker 1 (21:44):
If your brain and ovary could communicate effectively, it would
already be happening now. Because it just you miss the
window of opportunity to learn to track your cycle. Therefore
you miss some of these big warning signs that things
are wrong. So it's very important, but I think that
if you're on the birth control pill, it does not
cause higher rates of infertility. Important, you do not run

(22:06):
out of eggs faster or slower. Eggs come out of
that vault every single month, regardless if you're on birth control, ovulating, pregnant, postpartum,
we do not change that. But you have lost your
body's biggest clue to know if your hormones are in check,
and so giving yourself at least three months, if not six.
To learn to track your cycle, make sure things are

(22:28):
normal is really important. Two different things I want to
differentiate there on the birth control conversation. One is going
to be progesterone iods. Progesterone iod works a little bit differently.
It is localized to the uterus and it releases progesterone
for a very long time, five to seven years. Many
women lose their period during this time because the progesterone

(22:49):
thins out the lining of the uterus. Remember that in
a normal cycle, you only have progesterone after ovulation. When
this happens, it can be great, highly effective birth control.
Many women are resolve their anemia, they're not bleeding anymore. Great,
But when you stop the IUD, you pull it out.
We do see a change to the receptivity of the
uterus for about six months after the IUD has been

(23:11):
removed because of that high progesterone and that thin lining.
By one year everything's back to normal, and even by
one year there's no difference and the number of people
who've gotten pregnant and not. So we can say the
progesterone IUD does not cause infertility, because it doesn't, but
it can make it harder to get pregnant those first
six months after you stop it. So if you want
to get pregnant and you have a progesterone iud I

(23:33):
would like you to get that removed six months before
you want to get pregnant, so your endometrial lining has
time to recover and get back to its normal receptivity.
Then the third special birth control we should mention is
the Depo Prava shot. This is the shot of high
dose progesterone, and in this one, the progesterone is so
high that it prevents you from ovulating and it will
prevent ovulation for three months, so you have to get

(23:55):
the shot every three months for it to be an
effective contraceptive. However, a single shot can prevent pregnancy for
up to eighteen months, So if you want to be
pregnant anytime in the next two years, we don't want
to be getting a Depo Preva shot because that can
last a really long time.

Speaker 3 (24:10):
So it seems like depending on what type of birth
control you're on, there is a different type of kind
of detox that you have to go.

Speaker 1 (24:18):
Through exactly that you should come off of it, and
a lot of it is just to give your body
time for you to be able to tell learn about ovulation,
track your cycle, but also because some of the impact
it can have on the uterus or ovulation, even if
it doesn't cause infertility at the population level. If I
told you what might be harder for you for the
first six months, but you'll catch up on the back end.

(24:39):
We should have those six months when we're not trying
to get pregnant yet.

Speaker 3 (24:42):
Also, I feel like for somebody that is getting the shot,
I mean, eighteen months is a long time, So you
really have to know your stuff. When you're getting on
a certain type of contraceptive, you know, you got to
go into it and really think, like, could I see
myself wanting to get pregnant in the next time.

Speaker 1 (25:00):
Is pregnancy in the cards in the next two years? Maybe, Well,
then this isn't a great option for me.

Speaker 3 (25:04):
Oh my gosh, because that's like devastating. If you're I mean,
I'm twenty eight. If I had to then wait till
thirty to get pregnant, I would be like, oh, I
want to get pregnant.

Speaker 1 (25:12):
I'd be so upset that you didn't know that when
you chose that contraceptive choice, simply because nobody told you.

Speaker 3 (25:26):
How does age actually impact fertility.

Speaker 1 (25:29):
Age is a huge part of fertility. We can't sit
here and act like it's not. But to simplify the
biologic clock to purely being age really does a disservice
because you can't control your age, and if we don't
give women the understanding of what's really happening behind the scenes,
there's nothing you can do about it. So let's break
down age and the biological clock. There's two main things
that happen over time. We see a change in our

(25:51):
egg count, the number of eggs that we have, and
we see a change to our egg quality, meaning the
genetic normalcy and the ability of the egg to function
to make hormones. The mitochondrial health really important for women
to know. The mitochondria of the eggs get exclusively passed
on to the embryo, so your future baby, it's mitochondria
came from you one hundred percent. So your mitochondrial health,

(26:14):
what you see people talking about in wellness and longevity spaces,
absolutely correlates with your fertility as well. Let's talk about
agg count though, because this is what most people think of.
I see so many women at age thirty five and
they come in thinking I'm almost out of eggs because
I'm thirty five, my fertility is going to plummet off
a cliff and help me. Thirty five does become important,

(26:35):
but it's because of the quality, not the count. Very
few women are out of eggs at age thirty five.
We go back to my vault analogy. All the eggs
are inside the vault. Every month, you have a group
of eggs coming out. From the group, one will ovulate,
the rest will die next month another group. We actually
lose most of our eggs before we've ever ovulated. You
have six to seven million eggs when you're a five
month old baby inside your mom, one to two million

(26:57):
by the time you're born, and a half million and
by the time you have your first period. Why do
you lose so many before you ever ovulate. It's because
when you have more in the vault, more come out
every month. It's just one of these ways the vault
tries to control and be at this perfect level. When
there's fewer in the vault, you start getting older, Fewer
come out every month. So we can evaluate the number

(27:18):
of eggs outside the vault, and we can use that
for a surrogate marker for how many are inside, So
more inside, more come out. I'll see more on ultrasound
that's called an AFC a nantrofollicle count, and I'll have
higher levels of AMH anti mularian hormone in my blood.
AMH is made from all the cells of surround each eg.
But to put it simply, as we get older, we

(27:38):
have fewer eggs. Okay, but for the most part, women
still have eggs well into their forties. An average forty
year old would still have about eight eggs coming out
of the vault every single month. We don't tend to
have the vault completely empty until our upper forties or
even fifty. Okay, so we're not out of eggs. Why then,
for so many people, is fertility capped when we start
to get into our forties. That's because of the quality component,

(28:02):
And unfortunately there's no real test for this. Quality is twofold.
So I said, genetic normalcy and then function. Let's imagine
genetics really quickly. Your chromosomes are forty six xx, and
so in each of your eggs they're actually paired up
twenty three x twenty three x with their perfect little
mate and they're held apart by these miotic spindles, which

(28:23):
are proteins, and they divide when you ovulate. So that's
the important concept. They've been held in perfect position until
you ovulate. So when you ovulate at twenty five, they've
been sitting there for twenty five years. When you ovulate
at forty four, they've been sitting here for forty four years.
Wear and tear of time. These are little proteins. They
break down over time. And I like to say, imagine

(28:43):
their kindergartener's in alphabetic order. The longer I've asked them
to sit in alphabetic order, the higher likelihood somebody's going
to get out of line, right, and this happens. So
there's a tincture of time no matter what. But the
missing piece to the puzzle, too, is the double hit
we have from inflammation. Inflammation changes our mitochondrial function. It
actually comes in and degrades these proteins faster. And inflammation

(29:07):
can come from so many things, but we know cigarette smoking.
For example, women who smoke cigarettes have more genetically abnormal eggs.
They go into menopause earlier, they run out of eggs faster,
and it impacts their egg quality. So some things that
cause chronic inflammation give us a double hip zoom out.
As we get older, we tend to get more metabolically
and healthy people get more chronic disease, more cellular dysfunction.

(29:29):
And we know this really tangibly from fertility studies that
women who are thirty eight and older have more abnormally
shaped mitochondria, they have more inflammation inside their eggs. When
we test the fluid that's inside their eggs, it's wild,
but that itself is a modifiable factor. So if I say,
over the population, if you tend to get less healthy
as you get older, well then that makes it that

(29:52):
if you're older and you do want to get pregnant
or think about your ovarian health, that's something you can
start to control. We can start to look at increasing
the inflammation in your world, and that puts some more
power into your own hands and some agency over something
that's been simplified to say your equality is just your
age and you can't do anything about it. Like there

(30:12):
is tincture of time, you run out of eggs and
they get more genetically abnormal as time goes on. So
it does become harder to get pregnant as you get older,
and you have a higher miscarriage rate as you get older,
but you absolutely can still conceive. It's just even more
important that we start to control the variables that we can,
that we have data about our bodies, and we get
testing even earlier. And that's an important piece of the puzzle.

Speaker 3 (30:35):
At what age should women start thinking about fertility proactively,
like in an ideal world? When are you thinking about fertility,
egg freezing, all of these things?

Speaker 2 (30:44):
I love this question number one.

Speaker 1 (30:47):
I think most people should know there is a test
we can do, not for quality, but for count. So
I mentioned the AMH blood tests earlier. It's not a
perfect test. Your body's going to send out a different
number of eggs every month, but it's going to be
around the same. So I like to think about it
as a category. The reason why this is important is
if you come in, let's pretend you're not pregnant, and
you say, hey, I'm really curious if I can get
my fertility tested. I want kids one day, but not now.

(31:08):
And if I draw your AMH and if we view
it as normal, above average, below average, or low, if
it is below average or critically low, you might make
a different choice than where you sit right now. Right,
we might say, gosh, we are running out of eggs
number one, why do you have some underlying disease we
need to evaluate. That's a huge piece of the puzzle

(31:30):
because a lot of those factors can impact your fertility.
But also if we think about, okay, well should you
freeze your eggs? Should you freeze embryos? If you're with
a partner, maybe you were trying to wait till you're
thirty four, but now we need to change your timeline
because you don't have that time left. This is important
because right now, the American College of Objian does not
recommend testing AMH unless you have infertility. So we go

(31:52):
back to the narrative you have to fail first.

Speaker 2 (31:54):
That is the current.

Speaker 1 (31:55):
Recommendation, and we're failing too late, and we're failing too late.
And the reason why is they will say, well, it's
because AMH doesn't mean you'll be fertile, and it doesn't
mean you'll be infertile, and there's truth to that. It's
one piece of the puzzle. If I have two exactly
similar women, everything else is the same. One of them
has an AMH that's low, and let's say she only
has five eggs outside her vault and the other has

(32:16):
a normal AMH. And let's say she has twenty eggs
outside her vault. They're both ovulating one egg a month.
That would have the same odds at getting pregnant. Now,
the woman who has only five eggs, she could only
get five eggs that month from IVF and her best
friend could get twenty. So she's gonna have to go
through more cycles to get the same outcome. But the
bigger question, as I said earlier, is but why why
is it five? Does she have endometriosis or autoimmune disease,

(32:39):
or has she been exposed to something that we could
stop that could improve her long term outcome. We're losing
the agency to detect some of these things. If you
end up having hashimotoves, the sooner we know and we
treat it and we decrease inflammation, the better that's going
to be for you. I say that because you can
still ask for an AMH. And I often tell patients this.
You might if you want to understand your fertility. You

(33:01):
want kids one day and you're in your twenties, whatever
age you are hearing this, and you don't know your
ovarian reserve that's what we call this. You should ask
for an AMH. We also live in the world where
we have more access. You can add an AMH onto
Function Health. You can go to lab Core and order
it yourself.

Speaker 2 (33:18):
That's great.

Speaker 1 (33:18):
We're improving the ability for you to get data about
your body. I strongly believe I should not be the
gatekeeper of somebody getting data about their body. That's going
to put you in the driver's seat. If the greater
question is when should I consider freezing my eggs if
kids is a life goal and I'm not ready to
have them. Based on studies about thirty two thirty three
is when most women will have great success with the eggs,

(33:39):
so they'll have the highest ROI. So doing that means
that they likely will need them, and they will have
enough of them, and they'll be good enough quality where
that investment will be worthwhile. But I've had women at
both younger and older ages decide to freeze their eggs
still have success. So in general, the more eggs you have,
the younger you are, you will get a better per cycle.

Speaker 2 (34:00):
Turn on that investment.

Speaker 1 (34:01):
So if you know you want kids, like you life
would not be complete and you know thirty two thirty three, Like,
there's no way that that's not what my cards are
going to have because I'm chasing this dream or doing
this thing, or i want to have a partner and
there's no partner on the horizon. Then the sooner you
get in for an evaluation, you consider freezing your eggs.
It can pay off for you in the long run.

Speaker 3 (34:23):
Yeah, It's like, as a woman, you just really have
to take your health into your own hands when it
comes to fertility. And you know, I'm going to Lenox
Hill for my obgion and that's where I'll be delivering,
and I am by far like one of the youngest
people that is in the waiting rooms at these appointments,
to the point where even my doctors will say, like
we've asked, what's the average age of people coming into
the you know, hospital with pregnancies, and it really is

(34:45):
thirty five and up, which is so interesting because thirty
five is now considered a geriatric pregnancy. So I think
it's also important for women to know, like, you're not
behind if you're thirty and you can't foresee yourself getting
pregnant anytime soon.

Speaker 1 (34:57):
No, I mean, there's so many incredible women doing amazing things,
and pregnancy is not on the horizon. The reason why
age thirty five is considered advanced maternal age or geriatric pregnancy,
it has to do with the fact that at that age,
about half your eggs are going to be normal and
half your eggs are going to be abnormal. If we
put it in genetics. To put it simply back before

(35:18):
IVF an, egg freezing and anything, this just meant that
women who were thirty five and older who were pregnant,
we wanted to make sure we give them opportunity for
advanced genetic testing. Well, now we have more advanced genetic testing.
You're probably getting blood drawn at you know, ten to
twelve weeks and you're finding doing some initial genetic screening.
So technology has changed to make that available to everybody.

(35:38):
But previously, when these definitions came about, we were only
offering advanced genetic testing because it was more invasive to
certain subsets of women because they had, you know, a
fifty to fifty chance with their eggs. It didn't mean
a fifty to fifty chance of having something abnormal in
the pregnancy, but it just meant they statistically had a
slightly higher likelihood of having a genetically admirable pregnancy, and

(35:59):
we wanted to give them opportunities to diagnose that earlier
by offering them tests doesn't mean all your eggs are
bad or that your fertility declines off a cliff. Fertility,
for the reasons we said earlier, does start to get
harder as you get older, but we see that really
start to happen at age thirty eight. So if you're
thirty five thirty six listening like, you're okay, but how
many kids do you want? I don't know, right, And

(36:20):
so that is something that when I set across from
patients too, and I will famously somebody say like, well,
what is your goal? And I know you don't have
to have life figured out, but I want you to
try to pretend for a minute, if you have the
pen to the storybook of your life, what does it
look like? And how many kids do you have? Because
if you know you come from a really big family
and you want four or five kids, and you're sitting
across from me at thirty five or thirty six, we know,

(36:43):
based on math, right, how long it takes to be pregnant,
how long it takes your body to recover. Some of
these pregnancies for them to happen, We're asking for them
to happen at an age where statistically it's.

Speaker 2 (36:53):
Going to be harder.

Speaker 1 (36:54):
So sometimes couples intervene and want to freeze eggs or
embryos before they even start trying to get pregnant, because
the stage when they are finally ready the size family
they want may not be compatible with the odds of
getting pregnant at those ages.

Speaker 3 (37:10):
I might even do it in between, Like we've kind
of thought, well, I've been thinking a little bit about
the embryo freezing, because man, it takes a lot out
of you've been having one baby, especially when you're working,
as you know something you.

Speaker 2 (37:22):
Don't know until you're in it.

Speaker 1 (37:23):
That pregnancy is amazing, beautiful, glorious, but it's a huge
metabolic strain.

Speaker 2 (37:27):
Your body changes so much.

Speaker 1 (37:29):
You so much by the way, you're a different human
and you'll be a different human on the other side
of it. And that so many women feel pressured to
have that next baby because of time and not allow
themselves maybe the time or space they want to really recover.
It can be really beautiful that freezing embryos can give
you space to feel enjoy your new child, get your

(37:52):
body back to feeling like your own sense of self
or your new self before you put yourself through this again.
And so it really does open up doorways of opportunity
to be able to have that bigger family or space
your children out. That isn't really thought about enough, and
it's something that I think we have to bring into
the discussion later when we see women waiting longer. Yeah,

(38:12):
maybe it won't be hard for them to get pregnant
that first baby, but if they're inside dreaming of a
bigger family, we need to be having those discussions.

Speaker 3 (38:20):
Quick side quest. But what I'm so impressed with by
you is that you told me that you have a
ten and eleven year old. So you did two back
to back pregnancies.

Speaker 1 (38:26):
I did, and almost unmeaningly because I had really bad
infertility getting pregnant my daughter, so I had recurrent pregnancy loss.
So I was at person who I started trying for
my pregnancy at the end of residency. So to be
a fertility doctor you do medical school and then four
years of OBGIAN training, and then three years of reproductive
endocrinology or hormones and fertility. So at the end of OBGI,

(38:49):
in my husband and I were ready to start trying, and
even though as obgan very classic like let's just start trying,
no preparation, no tracking.

Speaker 2 (38:57):
Cycles. Had my first pregnancy loss.

Speaker 1 (39:02):
Very medical about it, like one and four pregnancies and
in a loss, it's okay. After my second, which was
much more traumatic, I was further along. I was working
on labor and delivery when it happened. I really hit
me very hard and went to the doctor and then
was told, well, you need to have another pregnancy loss.
You have to lose three before we'll do testing, which

(39:24):
was even as a doctor, even somebody who probably has
told people that, I sat there feeling that's the worst
thing you could say to me, like I have to
go get pregnant and lose a pregnancy again before I
can go on.

Speaker 2 (39:38):
Overall.

Speaker 1 (39:38):
Now that's not the case. So luckily we've shifted that number.
People don't have to lose three pregnancies. But what I
then lost my third, I lost my fourth. I had testing,
It was all normal, and so I had this very
long journey and I got to the point where I
was told to do IBF, And during that whole time,
I kept asking, like, am I running too much? What
should I be eating? What about my psyche? What about

(40:00):
my ludio phase?

Speaker 2 (40:02):
What about this?

Speaker 1 (40:03):
And it was very dismissed. So I felt like the
questions that I had even as a physician were really dismissed,
and I was told they didn't make any differends. And
so when I got into fellowship, I said, okay, well,
if we have to do IVF, which I'm not opposed to,
what can I do to have the highest chance of success?
And I was told it doesn't matter, just do IVF.
You just have had bad luck. We just need to
do IVF to figure out which embryos are normal. And

(40:26):
I couldn't do IVF yet because I was in medical
training and I was the fellow performing IVF, so I
couldn't take off time to go through it. So which
everybody's always like what when I say that, But you
know that's how medicine is.

Speaker 2 (40:39):
So that part didn't bother me.

Speaker 3 (40:40):
And explain to us what goes into IVF, Like what
does that taking off look like?

Speaker 1 (40:45):
You have to give yourself hormone shots, you come in for,
you have ultrasound appointments every two to three days. You
have to undergo a procedure under anesthesia often need to
do multiple cycles and still a lot of appointments and
a lot of space, and it was my time to
be the learner in that, and I was okay waiting
like that actually didn't bother me, but I was. I'm
a very goal oriented person, so it's like, okay, well fine,

(41:07):
if we're going to do IVF in six months, Like,
how do I have the best cycle? Surely some of
these things matter, and clinically, being on the side of
it from the lab, I saw some people just had
bad Egger sperm quality, and I kept feeling like there
has to be a reason why. Long story short, this
is why I got really interested in doing all my
research and natural fertility, because I went to my program

(41:27):
director and said, I want to know why some people
get pregnant and some people don't, Like I really want
to study vitamin levels and ovarian reserve and ludial phase
and environmental chemicals and figure out what's going on. And
so I was able to do all of my research
and fellowship on this and really found that inflammation was
a big piece of the puzzle. To make this very

(41:48):
long story shorter, I ended up trying to decide well
inflammation is bad, harmsig and sperm quality, So what causes
me to have inflammation? And my husband and let's change
our lives and sort of really trying to learn to
listen to my body, which sometimes being dismissed really takes
away from you.

Speaker 2 (42:03):
So it takes a lot.

Speaker 1 (42:04):
And one of the things I learned was that I
was really I felt inflamed after having gluten. I would
just say I felt like fatigued or had a headache,
or wouldn't ever say I had GI problems. But I
cut gluten out of my diet and I ended up
getting pregnant with my daughter and staying pregnant with her,
and then in postpartum, I kept eating that way and
I got pregnant with my son immediately for surprise, and

(42:27):
stayed pregnant with him. It was a completely different experience
because I wasn't going to go back on birth control.
It takes us years to get pregnant with my daughter,
and ten years later I got diagnosed.

Speaker 2 (42:38):
To celiac disease.

Speaker 1 (42:39):
So it wasn't just circumstance that this was one of
the things causing inflammation in my body. And it really
speaks to the fact that inflammation can do a lot
of damage, and we've normalized feeling tired, feeling fatigued, having headaches,
being bloated, having gi distress, all these little signs of
your body's giving you how we just think that's just
how we are. We don't tolerate it well, and we

(43:02):
stopped really learning to listen to those clues. So my
kids are really close in age. And it was tough.
I mean it was really really tough. We can talk
about that too, like postpartum recovery, like I never felt
like I got back to myself, but having not having
infertility with my son was such a blessing and healed

(43:22):
a part of my heart that I didn't even know
I needed. My whole pregnancy with my daughter, I was
waiting for the other shoe to drop right like I'd
lost four pregnancies before. Why was this going to be
the one? I was almost in denial of it. I
told my friends not to throw me a baby shower.
I didn't want to get maternity pictures. Really lost that
naive joy that pregnancy can bring. And that was one
of the things that I share with my patients that

(43:44):
if you've gone through infertility, your whole pregnancy will be
a little bit different because of it. And you know,
my son healed a part of my heart because I
didn't have to go through all of that to be
able to get pregnant with him. His pregnancy was like
very joyous, and you know, I previously would have told
you I wanted a big family, but having such a

(44:04):
joyous experience with Ham, I was like, you know, I'm
not really willing to put myself back into the infertility docket.
I didn't know it was as simple as if I
keep gluting out of my diet, I'll be okay. I
didn't know what the magic piece of the puzzle was,
and I just said, I'm he healed this part of
my heart. These are my two kids. Like, I'm so
happy and I'm done. But I also don't know it
was hard.

Speaker 2 (44:24):
It was hard. I was in training, I was taking
more boards, I was starting my new job. I started
my first job after training with a two year old.

Speaker 1 (44:31):
And like a six month old. You know, it was
wild time. So I think, had I not had infertility,
I would have spaced my kids different. But you kind
of get I was behind, so I wanted to catch
up and I wasn't going to go back on birth control,
and I honestly never thought it would happen that quickly.

Speaker 3 (44:47):
It's it's amazing. And it also puts things into such
perspective when you are pregnant, right, because there's so many
people that struggle with infertility and miscarriages, and there's all
these things that can go wrong during your Pregnancyana you
said you had a pregnancy where you had a later
stage miscarriage. Like, there's just so much that can go
wrong that I feel like I constantly kind of level
set with myself where I'm like, Okay, it's hard. Being

(45:07):
pregnant is hard, but people have it so much harder.
So just be grateful for the fact that this pregnancy
is going as smoothly as it possibly can.

Speaker 1 (45:14):
Yeah, It's it's a good lesson in motherhood to ground
yourself too, because it's really one of those first I mean,
infertilities like this too, but being pregnant you've lost control, right,
So controlling the things you can being grounded in the
gratefulness that you have like that is that is the
new version of life that kind of goes on. But

(45:34):
it is hard, and it's hard when you're pregnant too,
Like to know that friends are struggling to know how
do you show up for them when you're pregnant if
they have infertility. My big piece of advice, there's always
to be the one to bridge the gap, right, Like
don't put the burden on the person you know that's suffering.
Like I say, hey, I know you guys have had
some pregnancy losses, and if I know I'm pregnant right now,

(45:56):
but I'm still your person if you want to call
and complain, or you to talk about an appointment, like
I still want to be here for you, or to
say give them the first out, like I know we're
having this baby shower and I'd love to see you,
but if you'd love for us just to go to
lunch to celebrate alone sometime instead of publicly, like that's
totally fine. Like don't feel like you have to give
me a reason, right, Like be the person I'm gonna

(46:18):
get emotional about it being on that other side, because
if you're going through it, you feel so behind, you
feel so isolated, and then you feel like a burden
to your friends, Like oh K, it's in this joyous
stage right now. I don't have to call her and
like bring her down with like my sad news, and
so if we're really looking at our friends and our
family and how we bridge that gap, Like I love

(46:39):
that you're grateful for where you are, but like, that's
another thing to keep in mind too, is like actively
showing up by not letting there be an elephant in
the room and kind of help bring reality to the surface,
because that's what all relationships are.

Speaker 2 (46:52):
It's all communication.

Speaker 3 (47:03):
What is the right thing to say to somebody that's
going through a miscarriage the truth?

Speaker 1 (47:08):
If you don't know what to say, you can say,
I don't know what to say, but I love you,
I'm here for you, I'm wrapping my arms around you,
We're praying for you. Whatever the feeling is you have,
say it. You can say you don't have all the
words I would say. Tangible actions speak ten times as
loud as a let me know what I can do
for you. Let me know what I can do for you.

(47:30):
It's very kind, but it puts the burden on the
person who's already going through so much to come up
with something that they think you can do that's not
too big of an ask or but values your importance.
So instead come to them with something you can do
say hey, I'm so sorry for your loss. I just
gave you a door dash gift card, or I dropped

(47:50):
off a coffee on your doorstep, or there's flowers here,
or your next doctor's appointment if your husband can't go,
I'd love to go with you. You know, like something
very tangible that they can either easily say yes to
or they don't even have to accept it, like you
just gave it to them. Those mean the most because
there's no burden attached to that gift. It's just a

(48:12):
sign of your love and support without them having to
come up with a way for you to show your support.

Speaker 3 (48:18):
I know that when miscarriages happen, or when complications in
pregnancy arise, the first thing for people to think is
what did I do wrong? Right? Especially women, and women
are so hard on themselves in these situations. So what
would you say to somebody that's dealing with a pregnancy
complication or going through a miscarriage and is feeling maybe
shame around it.

Speaker 2 (48:39):
First of all, I'll say, I see you.

Speaker 1 (48:40):
I understand because I've had all those same feelings and emotions.
So what you're experiencing is a common feeling. But you
did not cause your miscarriage. There's nothing you did that
contributed to the outcome that is happening. I also want
to say, like give yourself time to grieve. It's a
weird space with pregnancy loss where sometimes you don't feel
like what you said earlier, like oh, this isn't as

(49:02):
bad as some other people have it, you know, and
so that it's not the same type of grief as
like losing a loved one, having a child died.

Speaker 2 (49:11):
This is a death.

Speaker 1 (49:12):
This is a real loss, like regardless of how far
along you are, I mean it is. You have a
right to grieve, but there are so many feelings associated
where you don't feel like you have that right or
you get dismissed and somebody almost like tells you you
don't right to say, oh, if you had to terminate
this pregnancy. But it's not like somebody died in a
car accident, like yes it did, Like this is our child,

(49:34):
our daughter, Like we have an entire life, we are
hoping for this child.

Speaker 2 (49:40):
So I think just have.

Speaker 1 (49:41):
Knowing that you didn't cause it, but also that you
try to give yourself space to grief. I mean I didn't,
I wasn't permitted to you. In my first pregnancy losses
was how it.

Speaker 2 (49:51):
Was working in my job.

Speaker 1 (49:53):
But I also want to say I didn't tell until
I had my fourth, and it's kind of at a
place where I needed help. So I told more people
because my husband was out of town when it was
all happening. But before then, I kept everything very secret.
And there are people in my life who absolutely would
have showed up for me. They would have helped me grieve,
they would have helped support me, but they didn't know

(50:14):
what was happening. And then I got into the bad
place where how do you tell somebody who lost your
third pregnancy when you didn't tell them about any of
the ones before. You really get so isolated. So I
really encourage my patients too, because it's helpful in the
grief process. Let's say this is real, You're going through
it no matter what happens. If you lose this pregnancy tomorrow,

(50:36):
in two weeks and two months and a year like,
it's going to be devastating. So tell the people in
your world who will show up for you, whether it's
your mom or a sister, or a best friend or
a colleague. If there's somebody who's that support person like
call and tell them, like, don't have to walk any
road alone. So alleviate some of that burden by sharing
it with the people who you know will show up.

Speaker 3 (50:58):
So there's a lot of talk about when we should
announce our pregnancies and tell people about our pregnancies. So
based on miscarriage stats and you know when people typically lose,
you know, lose the pregnancies, when do you recommend people
tell others that they're pregnant.

Speaker 1 (51:17):
So this depends on who the others are, right. I
always want to frame this discussion by saying, there's an
entire community of infertility patients who are sharing every single
moment of their journey online, from their positive pregnancy tests
to their pregnancy loss, to their hCG levels, and they
are changing the narrative for what patients experience by decreasing

(51:39):
stigma and showing what it really is. So there's a
huge vulnerability and strength in that that has to be committed.
I could never do that. I didn't do that, right,
I'd my my pregnancy loss is pre date Instagram, so
like that wasn't my reality. But you also don't have
to share with the internet at any time, right, And
who you share with. It should gradually be stages, meaning

(52:02):
the moment you get a pregnancy test, you should tell
your number one person, right the person that if you've
got a devastating diagnosis, you know, if you got cancer,
who are you going to pick up the phone and call? Like,
you should call them when you get pregnant because if
something goes wrong, you need them as we get further along,
And I think to the heart of your question, like, statistically,
when is it less likely? You know, once we have

(52:23):
normal development and a heartbeat, it's much less likely that you're.

Speaker 2 (52:26):
Going to lose the pregnancy.

Speaker 1 (52:27):
So for the average person who doesn't have infertility, isn't
going to a fertility clinic, They're not usually having that
first ultrasound and appointment until ten to twelve weeks. So
that's why we have this generous advice of once you're
out of that first trimester, then feeling more confident that
things are going to go on. But if you've been
at a fertility clinic and we've done an ultrasound at
six and a half and eight and a half weeks,
and we've seen good growth and a heartbeat, there's very

(52:50):
little that's going to happen over those next few weeks.
You're already in this lowest category of loss, where there's
less than generally like a five percent chance something's going
to go wrong from that stage, which is really great.
Some people want to wait till anatomy scan to avoid
the position you're in. You were in right some of
those hard decisions depending on what would happen in a

(53:10):
different circumstance. There's no right there's no right choice. So
often patients will sit across say, what are we supposed
to do? What's the right choice? It's like, no, all
the choices are bad, right, Like, I'm sure you felt
that way, Like, we don't like any of these options.
We just want everything to be good. And so if
you or somebody where that choice would feel harder in
the public eye, whoever your public is, then be mindful

(53:33):
about sharing with them until after you're at that stage,
because that's when you have the most information about that pregnancy.

Speaker 3 (53:39):
And just because I've had friends that recently have gone
through it, what are the early signs to look out
for that kind of show that you might be having
a miscarriage.

Speaker 1 (53:49):
You know, for the most part, it's going to be
having bleeding although bleeding and pregnancy can be common, you
can have something called a subquorana chematoma. This is a
little bit of bleeding underneath the place ena. The placenta
is so incredible and amazing. I want us to think
about what it does is it comes up against the
uterus and it eats away at the blood vessels of
the uterus and forms this attachment. So as it's eating away,

(54:10):
sometimes you can get a little bleeding blood vessel before
the full attachment has formed, and that's what causes this
sEH or subcornachematoma. I think about like a little blood spot,
a little bruise. It'll usually go away and you can
bleed from it. So not all bleeding is a pregnancy loss.
But if you are having bleeding and you are pregnant,
you should always be evaluated by your doctor. Okay, you
can be assigned that the pregnancy is not progressing. It

(54:32):
could be a pregnancy loss or an ectopic pregnancy. We
always want to have more information about it. Cramping can
actually be really common as the placenta is growing in.
I don't know if you ever felt cramping as your
percina was growing in. I know when I was pregnant
with my daughter, I was just certain I was going
to have a miscarriage. You can't have any bleeding, but
just really intense cramps. I mean, the placenta is eating

(54:53):
away a part of the uterus to form that attachment,
and it can be painful. So cramping with bleeding is
a little bit different than just having cramping. And then
if we are before that twelve week mark and we
have a loss in our pregnancy symptoms until the placenta
kicks in the placenta usually kicks in around ten weeks,
then it will start making progesterone. But before then, all

(55:15):
the progesterone comes from something that corpus lyudium, and the
corpus ludium, I said way early in the discussion, can
live for two weeks. The one exception is if you
get pregnant hCG, the hormone made from a pregnancy structurally
is the same as LH so it binds the same
receptors and causes the corpus ludium to make progesterone. We
call this rescuing the corpus lyudium. That's why you have

(55:38):
all those huge wave of pregnancy symptoms. Because once HGG
comes in, it's rising. With a normal pregnancy, they'refore stimulating
more and more progesterone, so suddenly your boobs get released,
so and you get nauseous, you get sensitive to smells
or taste, and you're so fatigued you can't keep your
head up, and you get kind of that brain fog.
All these that morning sickness, these classic first train mass

(56:00):
or symptoms are all from that high progesterone. So if
you're having those and then they go away and you're
before ten weeks, then we are potentially concerned that is
they're not enough progesterone being made.

Speaker 3 (56:11):
And I remember also early on in my pregnancy, I
never had morning sickness, and my doctor said to me,
he was like, you're one of the lucky ones. But
then I remember also reading stats that if you don't
have morning sickness, it can be concerning because people that
are having mourning sickness sickness. It's actually good to have
that symptom. It means things are going right in your body.
So I'm curious, what would you say, Is it true

(56:33):
or false that morning sickness correlates to a healthy pregnancy.

Speaker 1 (56:37):
No, any pregnancy symptom can make you just feel more
reassured that there's a pregnancy in there, regardless of if
it's just soret and big breasts or if it's morning sickness.
But having one single one doesn't mean the pregnancy is better,
or if you don't have another one doesn't mean that
it's worse. So, by no means is it like, oh,
if you don't have morning sickness, now we're worried about you.

Speaker 2 (56:58):
That's not the truth.

Speaker 3 (56:59):
And then between having a miscarriage and trying to conceive again,
what is the amount of time that you recommend.

Speaker 1 (57:05):
Lovely question. It depends on how far along you got.
So if you had what we call a chemical pregnancy,
so you just had you had a positive pregnancy test,
maybe it lasted for a while and then it went away, you.

Speaker 2 (57:16):
Can start trying immediately.

Speaker 1 (57:17):
Okay, Well, if the pregnancy test is negative, you can
now start trying right away. If, however, you were further
along in the pregnancy you needed a DNC procedure, you
had to take mesoprostol or other medication to induce the pregnancy.
We really want to make sure your hCG levels get
back to zero. That can take some time. That's that
pregnancy hormone, but all those little placenta bits, they can

(57:39):
make hCG also, so we want to make sure we
don't have anything retained inside. We call it a retained placenta,
tiny piece of that can cost scarring in the uterus
as well and can cause an infection, can make it
harder to get pregnant in the future, So we want
to make sure that you've given your body time to recover.
I tell patients, hopefully your doctor's checking an hCG level
so we know when that happens. If they're not, though,

(58:01):
you should be able to get a negative pregnancy test.
And so once you've had that negative pregnancy test, then
you can start trying again.

Speaker 3 (58:07):
And if you're somebody that's gone through a miscarriage, what's
a reassuring kind of mindset shift that you can view
the situation as.

Speaker 1 (58:15):
When I was going through mine, one of my doctors,
not the dismissive one, but later on I sat across
with somebody who said, I don't have a reason why
this won't happen for you, and I believe that you
will get pregnant and stay pregnant. That was like a
mantra to me that I played over in my head
anytime I started to have doubts, is it me? Is
it never going to happen? Is my body rejecting the pregnancies?

(58:38):
Like I say, like my doctor believes this will happen,
Like this will happen for me? And having a phrase
whatever it is to just kind of shift yourself that
there's nothing you have caused, there's nothing you can do,
but also taking control where you can. Right you can
similarly not have caused your miscarriage, but say I want
to advocate and get more testing, and I want to

(58:59):
know more and learn more about my body, and I
want to make sure I'm optimizing everything that I can control,
because I can't control everything. Those are also really helpful
mindset shifts instead of worrying about every little detail like
did I do this right or do that right? Kind
of cultivating that life where you're making decisions from a
place of knowledge and so you don't have to worry
about them.

Speaker 3 (59:29):
If you could design a three to six month protocol,
what are people doing three to six months before trying
to conceive?

Speaker 2 (59:34):
Okay, well it is a protocol and it is in
the book.

Speaker 3 (59:36):
But I shout out the fertility formula shout.

Speaker 1 (59:38):
Out the fertility formula because that is the answer to
the question. But really what we want to do is
we want to do a few different things. One we
want to advocate for earlier testing where we can getting
a Seaman analysis, getting the AMH blood tests, and learning
to track your cycles with the methods we talked about earlier.
Those three things right away. Number two is going to
be you want to try to decrease inflammation where you can.

(59:59):
Sperm made in the body, it's about a ninety day
life span for sperm. It takes about ninety days for
sperm to develop, so three month time. And then for women,
your eggs are in your body your whole life, and
they absorb the wear and tear like we talked about,
but in the sixty days prior to ovulating, they're the
most susceptible to the world around you.

Speaker 2 (01:00:15):
So really looking at.

Speaker 1 (01:00:16):
Decreasing inflammation where you can is so important. So I
like to consider this your inflammatory burden, the amount of
inflammation you're exposed to that you can control. And these
different decisions can make the higher more inflammation, therefore worse
egg and sperm quality, or they can lower it. So
here's the five what I call my five non negotiables.
Number one sleep Sleep is when your body clears inflammation.

(01:00:36):
For every hour less a woman gets sleep, it's harder
to get pregnant. For every hour less a man sleeps,
lower testosterone, lower sperm counts. We want to sleep at
least seven and a half hours a night, so we
really want to make sure that's a sleep time, not
in bed on phone time. Number two is going to
be we want to make sure that we're building and
using skeletal muscle. It's not that all exercises bad or good.

(01:00:56):
There's but we want to shift exercise from just one thing.
We want to build skeletal muscle because being able to
use that skeletal muscle can help decrease inflammation directly. And
we also want to make sure, especially for some of
our runners, that we're not overrunning. I will say this,
fifty eight percent of runners will have a luteal phase defect,
meaning their luteal phase will be less than eleven days.

(01:01:17):
Fifty eight percent of runners. Okay, that makes it harder
to get pregnant. So when I have runners, I'm in Austin,
so I have a ton of runners who come into
me and like the answer is not stop running like
I will lose all my patients. But what I tell
them is, we really want to track your ovulation and
we want to tie trait to your luteal phase. So
if your liteal phase is less than eleven days, your
ratio of running to lifting weights is too much. You've

(01:01:39):
got to pull back on how far you're going or
the number of running days you have. Add in some
weight training days because we need that luteal phase to
be longer.

Speaker 2 (01:01:48):
So that's one thing.

Speaker 1 (01:01:48):
We don't have to give up what we're doing, but
we're modifying our exercise to be in a way that's
benefiting us. So both under exercising but also too much
can be problematic. We want to mitigrate stress where we can.
Stress can actually cause inflammation in our body because of
the cortisol response, which is very inflammatory. So this is

(01:02:08):
carving out time for ourselves, setting boundaries, but also activating
some of that skeletal muscle can actually combat. So instead
of having stressful behaviors like stress eating and stress drinking,
we want to make sure that we're activating our muscle
when we're stressed, and that can help kind of break
this stress inflammation response and then we have the two
biggest lovers that are the hardest, and that's going to

(01:02:28):
be diet and toxins. So for diet, we really want
to focus on having an anti inflammatory diet. This is
going to be high in fiber, fruits and vegetables, going
to help with our gut microbiome. We want to make
sure we have healthy fats, whole foods, complex carbohydrates. We
really want to avoid the ultra processed foods, the refined
added artificial sugars. Those don't really have a place in

(01:02:50):
your day to day life of your diet. And for
environmental toxins, these things influence your hormones and your inflammation directly.
These are things like plastic fragrance, their pervase and our environment,
and that can be really overwhelming.

Speaker 2 (01:03:04):
But I do have a whole.

Speaker 1 (01:03:05):
Chapter in the book that goes over how do you
cultivate a healthier house? Which is where I want people
to start. The things you're exposed to the most in
your kitchen, in your home, in your bath, and beauty
products that go in and on your body. This is
where we should start because if we are making decisions
in a way that's lowering our inflammation, the majority of
time will be in a place where we're able to

(01:03:25):
handle inflammation when it comes at us.

Speaker 3 (01:03:27):
Are there any supplements you recommend people take when in
this three to six moths?

Speaker 1 (01:03:31):
So everybody should take a preneedal vitamin with at least
four hundred micrograms of folic acid. I recommend a vitamin
D supplement which leads one thousand international units a day.
And then specifically for fertility, we see benefits with coenzyme
Q ten and the fertility dose is six hundred milligrams
a day. And it says you brought up supplements. Men
should take a multivitamin, also get lots of good antioxidants,

(01:03:51):
and we do have.

Speaker 2 (01:03:52):
To be careful of bio ten. Bio ten is a
B vitamin.

Speaker 1 (01:03:56):
It's in a lot of hair, skin, and nails, but
at doses that are really hotgh it actually can bind
hormone levels and can interfere with some of your blood testing.
So things like neutrifhol or vitamins of say hair skin
and nails, we actually shouldn't be taking those because it
can interfere with our testing later.

Speaker 3 (01:04:11):
So I like that you brought up men, because how
much of fertility is a male factor.

Speaker 1 (01:04:14):
Fifty percent of infertility is male and fifty percent is female.
So I love seeing this new attention towards men. In
the same breath, we have a fifty percent drop of
sperm counts in fifty years. The sperm lifespan, as we said,
is ninety days, so there's huge opportunity for improvement. A
man can make one single change and have completely different
sperm perimeters than three months from now.

Speaker 3 (01:04:34):
What are the biggest things hurting male sperm today?

Speaker 1 (01:04:37):
Number one that I'm seeing in clinical practice is going
to be cannabis use. Cannabis use across the board for
men decreases testosterone levels, sperm production, and it influences the
DNA inside the head of the sperm. In fact, it's
associated with higher miscarriage rates in their partners, even if
their partners are never around the cannabis or never use
it themselves, So direct correlation with miscarriage from male partners

(01:04:58):
who are using cannabis. Anything also that is increasing inflammation
we see can be detrimental, so high levels of alcohol,
we see nicotine, vaping, smoking, We also see ultra processed
foods being overweight. The other big one is going to
be heat to the testes. So the thing right now
that we're seeing a lot of is men in the sauna.
The testes are outside the body because sperm want to

(01:05:19):
be made at a lower core body temperature. So if
you are constantly raising the body temperature of the testicles,
you are increasing the environment for sperm production, and that
actually is really harmful to sperm.

Speaker 3 (01:05:30):
So basically, all of the preparation that women are doing
men should also be considering as well.

Speaker 2 (01:05:34):
Exactly, this is a team sport.

Speaker 3 (01:05:35):
Okay, So timing sex correctly. You have a patient now
that understands their cycle, they know when they're ovulating, and
they're also doing all the things right. They've been preparing
for three to six months and now it's their time
they want to get pregnant. They've been doing everything right.
What is our fertile window and how many days per
cycle can we actually get pregnant? How are we timing
our sex?

Speaker 2 (01:05:54):
Love it?

Speaker 1 (01:05:55):
The I can live for twenty four hours, so remember
we said that earlier. However, sperm can live for up
to five day and the female reproductive track, so this
means the five days before and the day of ovulation
are the best days to try to have sex. If
you want to get pregnant. That's what the fertile window is. Now,
everybody asks is there too much sex or should you abstain?
Abstaining too long can actually decrease pregnancy rates because you

(01:06:16):
get a lot of blockage, a lot of dead sperm
in the tract. Sperm are meant to be frequently ejaculated,
and in fact we see more frequent ejaculation every one
to two days associated with better sperm function. So if
you're already having intercourse every day or every other day,
you do not at any time need to have less
sex or save it up so that you'll have more
sperm there. You'll have enough sperm the next time you

(01:06:37):
have sex, as long as you're having it in that
fertile window.

Speaker 2 (01:06:40):
But we will say the two best days are going.

Speaker 1 (01:06:42):
To be the day before and the day of ovulation
are the two highest yield days.

Speaker 3 (01:06:47):
So there's some myths maybe around also sex positions and
laying in bed post having sex. So do sex positions
matter for getting pregnant?

Speaker 2 (01:06:55):
They don't.

Speaker 3 (01:06:56):
Does laying in bed afterwards or elevating your hips.

Speaker 2 (01:06:59):
Actually help, doesn't make any difference.

Speaker 3 (01:07:00):
Okay, I definitely did that, and I thought it did.
It's fine if.

Speaker 1 (01:07:03):
It's not wrong to do so, but it's not helping
you get pregnant. Similarly, if you need to go to
the bathroom, like get up, go to the bathroom, that
can decrease your chance of a urinary tract infection, so
you don't need to put anything in try to save
the sperm. The sperm quickly move out of the ejaculate
and into the cervix of vagina within seconds.

Speaker 3 (01:07:19):
So common conditions that I see affecting fertility with friends
is PCOS and endometriosis. So a, if we have PCOS
or endometriosis, why are they impacting fertility? And how do
we know that we have it? And what do we
practically do?

Speaker 1 (01:07:34):
Okay, PCOS is polycystical variant syndrome. To put it simply,
let's imagine it's having more eggs in the vault, so
more come out every month. Your brain doesn't know this
is happening, and it's sending out the same f SAH
signal as if you had a normal amount of eggs.
This means the FSH is getting too diluted. So I
told you think no follicle is getting a strong enough signal,
So you often see a very long follicular phase. If

(01:07:55):
I don't have as strong of a signal, it takes
longer to get an egg to start growing in to ovulate.
But all of those days the ovary is not functioning
like it should. The ovary wants to make hormones. Estrogen
is its hormone to choice. It only makes estrogen when
you're growing an egg to ovulate, so when it can't,
it shifts and it starts making testosterone. So we start
to see a lot of the testosterone like symptoms of PCOS,

(01:08:15):
which can be acne, hair growth, even hair loss. And then,
to make it worse, this shift makes us insulin resistant
and we get this huge metabolic syndrome with PCOS, which
can be really hard to combat but can cause women
to distribute visceral fat. So even if they're skinny, they
tend to get fat in that lower abdomen area, and
they tend to have a very sensitive nature to certain

(01:08:36):
triggers because their baseline inflammation is just higher. So PCOS
is diagnosed by two out of three. One is having
irregular or absent cycles, two is having a high account,
and three is going to be any clinical or lab
signs of high androgens like testosterone, So pcos can impact
you from multiple different ways. We want to target it

(01:08:56):
by improving metabolic health, so fighting insulin resistance life cele
measures can play a big role, like we talk about
in the book. But most women or many women with
pcos will not ovulate as well as they could, and
medication to help them ovulate called ovulation induction, can play
a big role in helping them get pregnant faster. Indemetriosis
is really different. The endometrium is the lining of the

(01:09:18):
uterus that you're bleeding off, and in endometriosis you have
implants of tissue that's really similar to that, but.

Speaker 2 (01:09:24):
It's outside the uterus.

Speaker 1 (01:09:26):
Your body responds to this tissue as it's a foreign invader.
So instead of saying like, oh, that's just a little
endometrial cell that's here, your body says abnormal, abnormal immunes
as them activated. Think of it as an autoimmune disease,
and you get patches of inflammation around this indometrial tissue.
Over time that goes from being extremely painful pain with

(01:09:47):
sex GI changes pain with your period to scarring, destroying anatomy,
a decrease in your egg count, a huge inflammatory burden,
so endometriosis can be impactful for your fertility across many,
many lives. Both of these are diseases that are often
given a prescription for birth control pills because the pill
can help. It suppresses ovulation and endometriosis. Estrogen fuels these

(01:10:10):
indumetrial implants, so a lot of the symptoms get better.
The birth control pill lowers testosterol levels, so women with
PCOS a lot of their symptoms get better. The disservice
here is not telling these women before they started the pill, oh,
I think you may have PCOS, or oh you might
have endometriosis, and these are things you.

Speaker 2 (01:10:27):
Should do lifestyle wise.

Speaker 1 (01:10:28):
This is what to expect when you stop the pill
and really just lost opportunity to learn more about their
disease and how it can impact them later.

Speaker 3 (01:10:35):
How long do you typically see with PCOS and endometriosis
it taking for those patients to get pregnant.

Speaker 1 (01:10:40):
I mean for endometriosis, it takes seven to ten years
for the average patient to get a diagnosis. Doesn't mean
everybody's going to have infertility, And I would say that's
a hard question to answer across the board because there's
so many different presentations of it. But if you know
you have PCOS or INDO, you should not have to
wait to get an evaluation like you did. You went
to your doctor, but I have p can't I get

(01:11:01):
testing now? The answer should always be yes, because you
have a risk factor for infertility.

Speaker 3 (01:11:06):
We're trying to get pregnant. We're hitting our fertile window,
me and my partner. Right. My next question is the
two week weight. After you've had sex, you're hitting your
fertile window for a month. Explain to us what the
two week weight is, why it feels so intense, and
what symptoms you should be looking out for if you're
trying to get that positive pregnancy test.

Speaker 1 (01:11:22):
The two week weight is the time period from ovulation
until when you could get a positive pregnancy test or
miss your next pregnancy. Now, understanding that it starts with ovulation,
fertilization happens the next day, and then that embryo is
going to grow and develop and it won't be ready
for implantation or even inside the uterus until days five
or six. So the whole first five or six days
of the two week weight, if even if a fertilization's happened,

(01:11:44):
that mbrea's in the Filippian tube, not even in the
uterus yet, don't take a pregnancy test, it's too early.
Once the embryo starts to come into the uterus, it
can start to implant and so typically the soonest you
could see a positive pregnancy test is usually day eight
to ten after ovulation. Once that embryo is in an
implanting now usually takes a little bit longer for HGG
to get into the bloodstream and be high enough to

(01:12:05):
detect on a classic pregnancy test. But the reason why
you have intense symptoms is because hopefully, if you are
getting pregnant, you're going to have that Russia progesterone that
we're looking for. So those symptoms we talked about earlier
that you could have in pregnancy or in that corpus
lutium time period, nausea, morning sickness, sore, breast fatigue, brain fog.
You can even have some spotting in the implantation time,

(01:12:27):
but that shouldn't be like a full period. But again
it's from that placina starting to grow in.

Speaker 3 (01:12:31):
So there's little things that you can look out for.

Speaker 1 (01:12:33):
There are things you can look up for and you
can do earlier testing. My only thing is that don't
stop Let's pretend if you are on progesterone or medication
from your doctor, don't stop any of that based on
our early testing because it just may not be as accurate.
We want to make sure you're testing at that date
when you would expect a missed period.

Speaker 3 (01:12:50):
So we talked about so much today. We covered so
many different things as they relate to fertility and the
female cycle. You have a new book that just came
out with the fertility Formula. What did you put in
this book that you want everybody to know is out there?

Speaker 2 (01:13:02):
Thank you?

Speaker 1 (01:13:02):
It really is walking you through what we talked about today,
but in greater detail. So the first part of the
book is everything I wish you knew about your body, hormones, periods,
biological clock, and how inflammation impacts all of it. The
second part is how to advocate for yourself if your
periods are abnormal, how do you track your cycle? What
do you do if you're wanting to get pregnant or
if you have infertility? And in the last half of

(01:13:22):
the book is all about the lifestyle factors. So going
through those five non negotiables, giving you the plan and
the guidebook for what you can do to lower your
inflammation and ultimately help yourself be in the best position,
whether you're trying to get pregnant naturally or you're undergoing
fertility treatment or IVF, because we know that eggensperm quality
are so sensitive to the world around us.

Speaker 3 (01:13:42):
One of my favorite things too, that I know you
have in the book are checklists where if you are
going in for IVF treatment, or if you have PCOS,
or just going to with the doctor for the first
time to talk about fertility, you literally have checklists on
what to ask your doctor.

Speaker 1 (01:13:54):
I have question lists in the back of the book
for you to ask, just to try to lower that
because it's hard when it's so new and foreign to
you to even know what to ask if you don't
understand what's in front of you. So by just helping
educate and giving you the questions to ask for, advocate
for yourself, trying to make that road a little bit
easier to walk.

Speaker 3 (01:14:12):
I'm scared about giving birth. What do you have to
tell me going into it?

Speaker 1 (01:14:17):
You know, you know women have given birth for many, many,
many years, and the unknown is the scary part. So
I would say, try to put yourself in a position,
not from the internet, not from friends, but to learn
lean on resources from people who can educate you about
the process. So you know what questions to ask and
how to advocate for yourself. But you're going to get

(01:14:38):
through it beautifully. You've done the thing you can to
prepare yourself the best, which is exercise, daring and throughout
your pregnancy. So go into your pregnancy in a good
state of health and continue to exercise throughout. It is
the number one thing you can do to have a
good birth experience and help your recovery on the back end.

Speaker 2 (01:14:53):
And you've done that, and you're doing that.

Speaker 3 (01:14:55):
There's a lot of different opinions around working out when pregnant.
I have been consistently working out throughout my my pregnancy.
It's helped me feel amazing. I mean, running has been
great for me. Strength training it just a it's so
good for the mental, but I feel like physically it's
also been a really good thing for me to do.
So I'm curious what is your perspective on working out
when pregnant.

Speaker 1 (01:15:12):
You absolutely can work out when you're pregnant. We'll say,
if your doctor tells you you cannot, you have a
medical reason. There's a few of those based on if
you have a placenta covering your cervix, or you have
some medical condition, that's going to be different. But for
the average person, as we said, are working out is
so great for stress relief, for you know, inflammation levels,
for your own health.

Speaker 2 (01:15:33):
But also for your body's ability.

Speaker 1 (01:15:34):
Your body is changing throughout a pregnancy to get through
birth and to recover. Okay, building using skeletal muscle. Listening
to your body is key here. Knowing that you may
not be able to do what you did before, especially
if you're a runner, It's going to feel different, be different,
you know, we talked about even earlier, like even running
outside may not feel as comfortable. You can't see your
feet as well, your sense of gravity is different. So
listen to your body and trust it, but keep moving

(01:15:57):
it and keep your strength up.

Speaker 2 (01:15:58):
That's one of the best things you can do.

Speaker 3 (01:16:00):
And also compartmentalize that your body is going to change.

Speaker 2 (01:16:03):
It is you're going to bounce back, it's okay.

Speaker 3 (01:16:05):
Yeah, What do you have to say to somebody who
is anxious about literally being in the delivery room and
feeling very vulnerable in the state of doing a vaginal birth.

Speaker 1 (01:16:14):
I would say it will not matter to you. It
feels so overwhelming right now, but in that moment, when
you're about to meet your child, your emotions and your
instinct will take over and you will not care about
being vulnerable anymore. It's too hard to understand that when
you haven't gone through it. But I would say, let
yourself be anxious about it if you want, because you

(01:16:35):
know anxiety is because you care about it. But I
wouldn't let that over consume you because your maternal instinctle
kick down and you won't care. You'll be so excited
to meet your child.

Speaker 3 (01:16:44):
What is one thing you wish you could broadcast to
every person trying to conceive right now?

Speaker 1 (01:16:49):
You shouldn't have to fail first before you get data
about your body. You can't make decisions on data you
don't know, and nobody is going to advocate for your
health like you are, so you deserve. If you get dismissed,
go see somebody else. Take your health seriously, but none
of it is your fault. This is not a fear
mongering or a blame game. We're just trying to give
you the tools so that you can have the best
chances at the future.

Speaker 2 (01:17:09):
You want well.

Speaker 3 (01:17:10):
Thank you so much for being with data day by
having me Hi, guys, Kate here. If you made it
this far, thank you so much for being here. This
is one of those conversations I will definitely be listening
back to the next time I'm trying to conceive. Fertility
is something so many people assume they understand until they're

(01:17:30):
in it, and my hope is that this gave you
a clear, more honest picture of what conception actually looks
like and the proactive measures we can take going into
our fertility journeys. If you have more questions after listening,
please DM me. I know I have more questions coming
out of today's conversation, so we will definitely be having
Natalie back on at some point. And if you're enjoying

(01:17:53):
post run high, please be sure to follow the show
wherever you're listening, leave us a review, and share this
episode with a friend. Your support truly helps us continue
bringing you inspiring conversations. We're posting weekly episodes, so I
will see you guys next week.

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Fertility Expert: 1 in 5 Couples Now Have Infertility — What Every Woman Should Know Before Trying to Conceive | Dr. Natalie Crawford, MD

Episode Transcript

Host

Kate Mackz

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Fertility Expert: 1 in 5 Couples Now Have Infertility — What Every Woman Should Know Before Trying to Conceive | Dr. Natalie Crawford, MD