July 28, 2025 • 41 mins
Fertility can be a confusing and emotional road—and no one should have to navigate it alone. In this episode, we go beyond the usual fertility talk to explore the real-life struggles behind infertility, from missed diagnoses to lifestyle shifts that made all the difference. So many of us are left searching for answers without knowing where to turn. Reproductive endocrinologist Dr. Natalie Crawford is here to help! She shares her insights on common fertility myths, the importance of male factors, and why a whole-body, proactive approach matters. Whether you're trying now or planning for the future, this is a conversation full of honesty, hope, and empowerment.
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Speaker 1 (00:00):
Hey y'all, big announcement here. I am so excited to share.
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Sunshine's incredible weekend of connection, joy and community. And if
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(00:22):
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this is your chance to be part of a truly
special and memorable weekend. Tickets are selling fast, so head
to hellasunshine dot com slash shine Away to grab yours.
(00:42):
Fertility is complicated, It's loaded with emotion, and it can
be scary to talk about. But what if it doesn't
have to.
Speaker 2 (00:49):
Be that way.
Speaker 1 (00:50):
Our guest today is here to cut through the noise
and panic and show us how to take charge of
our fertility on our own terms. Doctor Natalie Crawford is
a former OBGYN, reproductive endocrinologist, and fierce advocate for women
owning their reproductive health.
Speaker 3 (01:06):
You actually can make such a bigger difference faster when
it comes to male fertility than female fertility based on
lifestyle choices, and that because the life span of a
sperm is about three months, meaning they could make a
change today and have completely new sperm created three months
from now that have not been exposed to whatever they
(01:28):
did previously.
Speaker 1 (01:32):
Get ready to have your mind blowan. I'm simone voice,
and this is the bright side from Hello Sunshine, y'all.
There is no shortage of fertility content out there. You
can spend hours online trying to piece together what to eat,
when to freeze your eggs, how to track your cycle,
or whether that one influencers supplement stack is actually doing
(01:55):
anything to help them. Even with all the conversation that's
happening around fertility right now, it can still leave you
feeling really confused, broken in some way, or behind. Today's
guest is someone I have been following for a while,
and I'm so excited to bring her here on the
bright side, because when it comes to understanding our bodies,
our hormones, and fertility, doctor Natalie Crawford is one of
(02:17):
the most trusted and truly empowering voices out there. As
a board certified reproductive endocrinologist in Obgin. She has helped
thousands of women on their journeys to motherhood. And what
I love most about Doctor Natalie's approach is that she
offers science back tips that can empower women to make
the best choices for themselves, to advocate for themselves at
(02:41):
the doctor's office. She's not here to sell us a product.
She's simply here to provide the tools and the simple
micro habits, little changes that we can make to our
lifestyles on a daily basis to improve our odds of
a successful fertility journey. You already know I've been on
my own journey of trying to better understand my cycle,
my hormones, and my long term fertility health. And it
(03:05):
can be overwhelming. It truly can, and it can often
feel like, oh gosh, I don't even know where to start.
We'll start here, start with us today, because we're going
to talk about some of the most misunderstood but important
topics around reproductive health, like what actually impacts egg quality,
how to understand your ideal egg freezing window, and why
(03:26):
focusing on your partner's fertility for those of you in
a heterosexual partnership may provide faster results than you might think.
Whether you're trying to conceive, hoping to in the future,
or just want to understand your body better, there is
so much here for you. Please save this episode, bookmark
this episode, and if you know someone who is trying
(03:47):
to conceive right now, this is the kind of conversation
that you're going to want to send to them. All right,
here's my chat with doctor Natalie Crawford. Doctor Natalie, Welcome
to the bright Side.
Speaker 2 (04:03):
Thank you Simone so much for having me here.
Speaker 1 (04:05):
I feel so lucky that I get to host this show,
and I know you have a podcast as well, but
I have learned so much about my own body and
just about women's health through the conversations that we have
on this show, and I know that our chat today
is going to be incredibly informative as well, specifically on
the topic of fertility. Your videos are wildly popular online.
(04:28):
You have several viral videos on Instagram and TikTok, and
it's so clear to people how passionate you are about
this topic of fertility. I'd love to hear about the
moment that you would say your heart really got lit
on fire about fertility, about women's health, and that moment
that just set you down this path that you're currently on.
Speaker 3 (04:48):
I took a little bit of an indirect road to
the fertility stands. I always wanted to be a doctor.
I went to medical school. I actually did a year
of emergency medicine first. I just loved the diagnostic challenge.
Very quickly realized I wanted to be more involved in
my patient's story long term. I wanted to see them
through the problem, and that really led me towards women's health.
(05:10):
And because I still loved the diagnostic challenge. There's nothing
as diagnostically challenging as the hormone, so I'm very nerdy.
I loved that diagnostic puzzle of trying to figure out
what was really going in the inner workings of our body.
And of course, walking with somebody through a fertility journey
is truly being involved in their life and their story.
(05:31):
I switched from emergency medicine to Obigian and then loved
fertility so much that I did three years of fellowship
after Obgian training so that I could really be a
hormone and fertility expert. And during that time, I will
say I had my own experience with infertility that I
was very unprepared for even as a professional. I had
four pregnancy losses during training. I realized I was looking
(05:56):
for the answers to the questions I had that I
weren't taught in training. Medicine is so reactionary, especially women's health,
where we don't always talk about prevention. We don't talk
about prevention at all when it comes to fertility or
understanding your body. By definition of the field, infertility is
not having success trying to get pregnant, and then that's
when you get all this testing done. So I really
(06:18):
started researching and looking for answers myself and experience to
what it was like being a patient. And that led
me very strongly in my fellowship to want to understand
natural fertility, more understand the factors we can control, and
help educate women so that they could have more ownership
over their bodies, understand the journey they're walking, try to
(06:41):
have more control over an uncontrollable situation. And that's kind
of what spurred me from not just you know, being
a fertility doctor what I do every day, but really
trying to talk about this online and on social platforms
to try to reach more people and help women really
understand what's going on with them.
Speaker 1 (06:57):
I do feel like fertility is something that we have
been talking about more on social media. I think those
conversations have been helpful in creating a space where parents
feel less alone. And then there's the other side of it,
which is this like infiltration of uninformed voices and all
of the misinformation that can come along with having conversations online.
(07:20):
I'm thinking in particular about this one clip that's been
circulating from a podcast host and she.
Speaker 2 (07:28):
I know the clip.
Speaker 1 (07:29):
You know the clip, Okay, so you know the clip.
She basically suggests that she manifested being pregnant, and I
can only imagine how hurtful that is and how callous
that feels for someone like you who's had several pregnancy
losses and did have so many challenges in getting pregnant.
Speaker 3 (07:48):
It was an extremely hurtful clip towards the unfertility community
as a whole, you know, and very short sighted. And
I always want to say, we are all entitled to
our own experience, and anytime somebody is talking about their
own own personal medical history, whether it is a positive
or negative experience, you know, that's something that they don't
have to share with us. And so you know, there
(08:09):
is something about opening up the space for the discussion
whether it is an easy or a hard road, that
is important. But I do agree we have to be
very mindful that there's sometimes no amount of manifestation that
will overcome certain medical conditions. And even though she had
a great experience, and I'm so happy that that was
(08:29):
got to be the road that she got to walk,
and there is something to be said for, you know,
trying to put yourself in the best position to get
pregnant and controlling what you can control. I think all
of that is great, but we have to acknowledge that,
you know, there's so many medical conditions that cause infertility
that no amount of manifestation or good lifestyle choices will
(08:51):
ever overcome, and that it is something that is so
sensitive to so many people, because you know, society kind
of teaches you that. Forertility is a rite. It is
like something we almost take for granted. I'm going to
prevent having kids so much to my reproductive life. We
talk about contraception and not getting pregnant, and then suddenly
(09:12):
when somebody decides they want to be pregnant, it's a
complete one eighty and we're not always prepared for what
that journey would look like, whether it's positive or negative.
So I always think you never want to say boo
for somebody for sharing their personal experience. But it is
very insensitive when we talk about fertility and our positive experience,
(09:33):
and with such generalized terminology. It really is a privileged view,
not accounting for what so many people who walk the
fertility road experience. Not everybody even has success even with
infertility treatments. It's a really tough journey for a lot
of people.
Speaker 1 (09:49):
You mentioned that you experienced several pregnancy losses while you
were training to become a doctor. Can you tell me
more about that and how you over came that. I mean,
that sounds so traumatic to be in school in academia
trying to learn, and then you're also dealing with your
own personal health issues.
Speaker 3 (10:09):
Simono was terrible. I was an Obiguyan resident, so I
was in my last year of residency. So I was
the chief resident, which means you're running the labor and
delivery floor, you're making the decisions. I mean, the most
traumatic experiences I had. A miscarriage was our second pregnancy,
so it would be our second pregnancy loss. I was
the chief resident in charge of Obiguyan. Right, I was
(10:30):
delivering other people's babies that night while actively miscarrying. And
this is something that all physicians have to do in
some way, is put your own personal needs to decide
to take care of patients and what they need in
the moment. I think every physician will always say that
that is something you learned to do is I'll deal
with this later because I got to focus on the
patient in front of me.
Speaker 2 (10:51):
But it was, you know, devastating.
Speaker 3 (10:54):
I remember, you know, crying in the bathroom, having to
try to just like put on my focused face while
I'm actively bleeding doing surgery, and you know, crying on
the way home and just feeling like how can I
know so much and this is my job yet find
myself in this position, And when I went to see
my own doctors, was told, oh, it's just bad luck,
(11:16):
Oh you're distressed, Oh it'll happen, and really was dismissed,
which I think is a common experience now that so
many women feel like they go seeking for answers or
saying they feel like something's wrong and just told no,
don't worry about it, without any test being run or
more stuff being evaluated, and you know that carried on
(11:38):
for me.
Speaker 2 (11:39):
It was really a traumatic experience.
Speaker 1 (11:45):
More from doctor Natalie Crawford. After this shortbreak, Now, your
turning point with fertility actually came with the diagnosis of
Celiac disease. I was not aware of this connection. Tell us,
how did Celiac disease disrupt your fertility?
Speaker 3 (12:04):
Well, this is a great question because I had unexplained
in fertility. I had unexplained pregnancy loss. That was the
diagnosis I ended up getting. I was in Fellowship, and
when everything's turning back normal, they do all the testing,
you get this unexplained diagnosis. And I always say unexplained
truly means undiagnosed, because nothing's easy to diagnose. It's one
(12:28):
of those diagnoses that's really unsatisfying as a patient. I mean,
unexplained that sounds terrible. And I was told there was
nothing I could do that could make any difference, and
IVF was the only option. And I wasn't opposed to IVF.
I mean, I do IVF every day for patients, but
just because of my schedule, it wasn't a time in
my life where I could do it. So I said, okay, Well,
I can't do that because I'm of my job. I'll
(12:50):
have to do that in a little bit of time.
So what can I do in the interim to try
to make a difference here? And at the same time,
I was starting to research natural fortils and our cycles,
and I was doing a research project that I was
very passionate about about indocrine disrupting chemicals and our fertility
and really starting diving in this research about inflammation and
(13:11):
how that can cause miscarriage. And I started to say,
you know, if we're going to have to walk this road,
I'm going to control everything that I can and changed
my diet went very anti inflammatory, changed how I was
working out, took all the teflon and plastic out of
our kitchen. My husband thought I was crazy, but I
was just like, you know, we're going to walk this road,
knowing like it wasn't this, it wasn't this, and we
(13:33):
just ruled it out and in that learning to listen
to my body and how I ate. When I ate
anti inflammatory, I wasn't eating any gluten, and it wasn't
that gluten itself is bad in the majority of people,
but I noticed I felt more bloated more what we
would call of those inflammation symptoms after having gluten, and
since I wanted to be as low inflammatory as possible,
(13:55):
I cut it out. Happened to get pregnant, you know,
with clomid before we I didn't have to do IVF.
Ended up getting pregnant and had my kids that way,
which was kind of shocking after walking this road. And
I didn't get diagnosed with celiac disease until a decade later.
And what happened is I was never tested for it
back when all this other stuff was going on. I
(14:17):
wasn't tested for anything autoimmune. I wasn't tested for inflammatory markers,
and I really self treated myself with this idea of
something's going on, and I refuse to accept that it's nothing.
But Ciliac disease is obviously where you have a reaction
to gluten, and so the treatment is a gluten free diet,
but it causes such severe inflammation in your body, and
(14:39):
it is associated with a higher risk of infertility and
pregnancy loss. Has are a lot of autoimmune diseases. So
I think there's a lot about our lifestyle in the
world around us that we actually do have a lot
more power over and we have to especially in the
fertility and the women's health zone, where so little money
has been put towards research and understanding women's bodies. Have
(15:01):
to acknowledge that just because the study hasn't been done
doesn't mean that something's not impactful. And really, I love
the turn of seeing where people talk about fertility or
talk about listening to women and paying attention to their symptoms.
And that's one thing I always tell my patient is
you know yourself the best. If you tell me you
don't feel good, you feel off, things are not normal,
I believe you.
Speaker 2 (15:22):
I may not.
Speaker 3 (15:23):
Always be able to get to the answer, but we
should at least try. And we need to make our
life choices, the daily decisions in line with what we
think is going to be making a difference and not
adding or compounding on that problem.
Speaker 1 (15:37):
So just to make sure that I understand correctly, it
sounds like it wasn't necessarily Celiac disease itself. That might
have been the cause of the infertility, but the inflammation
that gluten was causing in the body impacted your ability
to conceive.
Speaker 3 (15:53):
Correct it's tied to the Celiac disease, but there's so
many different inflammatory conditions that people have, and we know
that inflammation really is so toxic to our body. When
we start thinking about the inflammatory response is meant to
be this acute self limited. Right, you cut your hand
and your inflammation system gets turned on. Your immune system
(16:14):
goes to heal that cut. But we live in an
inflammatory world. In addition, to see this huge rise of
autoimmune disease, which are all connected by inflammation. So so
many people have chronic inflammation. Think about pcos and endometriosis.
We see you know, autoimmune disease like celiac disease and
hashimotos at, you know, alarmingly high rates. A lot of
(16:36):
this is the world around us and the lifestyle we're living,
genetic factors and a combination of this. And as somebody
who does IVF every day for patients, ignoring the lifestyle
aspects and ignoring inflammation also puts us at a disservice
because we're working with eggs and sperm that come from
the body, and we're trying to put an embryo back
in the body, and we have to pay attention to
(16:58):
the holistic whole person in view if we want to
have the highest odds of success.
Speaker 1 (17:02):
And you're taking this holistic approach with your upcoming debut book,
The Fertility Formula. Congratulations, oh similar, thank you.
Speaker 3 (17:11):
What did you.
Speaker 1 (17:12):
Feel like you could do better or differently with this
book compared to the other resources that are in this space.
Speaker 3 (17:19):
One thing that I think is really important that the
book has is it's really walking you progressively through understanding
your body. Because so many facts build on themselves. Right before,
we talk about hormone dysfunction, what's supposed to happen when
everything's normal, what is supposed to happen as we get older,
what's happening with infertility. So it's walking you through all
of that in a way that I find really build
(17:41):
on itself and is easier to understand coming from an
expert instead of a lot of books that are written
are written from the patient experience, which are so valuable,
but that is a one sided view of somebody's journey
versus coming from the inside of somebody who takes care
of a vast multitude of patients different circumstances. But also,
(18:02):
I mean, half the book is really talking about lifestyle
and what you can do, So it's really the culmination
of what I feel like is my life's work and
coming at it from a place I'm so passionate about,
which is at every stage of the journey, you deserve
to understand your body, how your hormones work, and be
the one making the decisions for yourself. Right, it shouldn't
be lack of knowledge that makes decisions for you, because
(18:25):
for every woman that will happen at some point time
will make the decision for you if you do not.
Speaker 2 (18:32):
And I want to.
Speaker 3 (18:33):
See more people taking a proactive approach to their fertility
and their reproductive health. Well.
Speaker 1 (18:38):
Proactivity seems like this through line throughout your work and
just throughout who you are as a person, and I
know you're bringing that to this book as well. So
let's get into some fertility questions. What are some of
the most common misconceptions about infertility that you see in
your work and that you would like to say the
(19:00):
record straight on.
Speaker 3 (19:01):
I think the number one is going to be that
most infertility is due to a female factor. We certainly
see such a female focus on infertility, but half of
infertility is due to male factor. So if we really
look at it, it is not that everything is always
the woman. I see patients every week. He'll say, oh,
we don't need to test him, oh he had kids
in the past, or oh his test sawstone is fine,
(19:23):
or the problem is me. But half the time there
is a male issue involved, and we certainly can have
more than one thing going on. We always want to
test both partners. This also applies to taking good care
of yourself. What's good for your health is good for
your fertility, for both men and women, and not just
a I'm going to do all of this, but my
partner is going to do their own thing. That doesn't
(19:45):
really work when it comes to trying to get pregnant.
We really want to take a couple focused approach. I
think second that I think is really important to say
is that, well, well, IVF will always work or I
can just do IVF. IVF is an amazing technology. It
is one the only things we have that makes our
rate of getting pregnant higher than whatever our age related
(20:06):
rate is going to be because it gets harder to
get pregnant as we get older. But IVF is still
limited by age, a number of eggs that you have.
Speaker 2 (20:14):
And we see in.
Speaker 3 (20:15):
Pop culture, you know, celebrities having kids at a much
older age. They're not always transparent about the road they
walk to get there, you know, did they use donor eggs?
Did they freeze eggs earlier? Were they able to just
get pregnant in their fifties? But it's exceedingly rare that
women are able to conceive, especially after your age forty five.
It's not impossible, but it's much harder with your own
(20:37):
eggs at that stage to get pregnant. And so there's
this idea. I will see women wait, you know, a
long time. They'll say, well, I'll just do IVF. And
sometimes IVF doesn't always work. It's not always going to
be that thing that you can just do at any moment.
Speaker 1 (20:51):
I want to break each of these down one by one.
I'm so glad that you brought up male fertility because
I agree when I hear women talking about this topic,
it's always about and what we're doing wrong, and not
about what our partners can do to be better, more
fertile partners. So you actually talked about this on TikTok
and it went viral. What are a few things that
(21:12):
you would never let your partner do if you were
trying to conceive.
Speaker 3 (21:15):
I'm going to preface this by saying you actually can
make such a bigger difference faster when it comes to
male fertility than female fertility based on lifestyle choices. And
that because the life span of a sperm is about
three months, meaning women are born with all the eggs
we're ever going to have. They absorb the wear and
tear of our life. And that is why age becomes
(21:36):
so impactful to us, because they're just cumulative wear and
tear that builds up. For men, they are constantly regenerating sperm.
It is not fair. They are much more efficient at this,
but because of that, they could make a change today
and have completely new sperm created three months from now
that have not been exposed to whatever they did previously.
(21:59):
So it is such a room to make a difference,
which makes me even matter. So often that the male
site is ignored and we see, you know, women doing
all these things to try to make themselves better, and
like men are doing some of these things that I
say don't do. So Number one is going to be
smoked cigarettes or use marijuana. Truly, both of these factors
can impact our sperm counts, our motility, and the shape
(22:21):
of the sperm. Daily marijuana use can be so damaging
to sperm. It can both stop our brain from sending
out the signals to even make sperm, and it can
damage the DNA inside the head of sperm. Some of
the cases even of IVF that I've seen couples go
through and then they don't have good embryos. When I'm
diving back in what could be going on, a lot
(22:42):
of times the embryo stop developing when the male genome
kicks in. And when I go back and talk to
these partners, oh, well, they're using marijuana daily that they
didn't disclose and it was something that didn't they didn't
want to tell or didn't get detected. But it has
such an impact on both the production and the functionality
of sperm. In fact, miscarriage RAITs are even higher in
(23:03):
female partners who don't use marijuana, but whose partners do.
So if your partner's using marijuana, your risk of a
miscarriage is higher, and that goes back to damage of
the DNA inside the sperm head. Next is going to
be testosterone use. This one I see all the time
because we love people trying to take their own health
into their hands, but there are so many people healthcare
(23:27):
providers calling themselves hormone experts who don't truly understand how
hormones work. And sometimes men have a true problem where
they may go in and they might have fatigue, or
they might have low testosterone, they might have difficulty with
erections or ejaculations, and they are given testosterone. I had
a patient where this was the case. He was given
testosterone for his fatigue and he was on it for
(23:50):
twelve months while they were trying to get pregnant. And
testosterone tells the brain to stop making sperm. And the
reason why is that sperm and testosterone and are made
together in the testes. So if your brain sees a
lot of testosterone because you're taking tea shots, it says
we must have a lot of sperm. Also, we don't
need to send out any signals to make either. And
(24:11):
sometimes testosterone use the what we call azospermia or the
absence of sperm and the ejaculate. Sometimes that is irreversible,
and that can be really devastating to couples. And so
testosterone is essentially male birth control. Having low t can
be a medical problem, but there are other treatments for
(24:33):
it that are safer if you're trying to get pregnant
that are not testosterone itself. So would say no testosterone use.
And then we also want to avoid heat to the testes,
so you know, the scrotums outside the body for a
reason that is because you are supposed to make sperm
at a slightly lower temperature than the rest of the body.
We actually know that if a man has an undescended
(24:54):
testicle where it stays inside his abdominal cavity, the heat
of the abdominal cavity will actually droy the tubules that
make sperm inside the testes and render it not functional anymore.
And so that's why you know, little kids have surgery
if their testicles haven't descended so that they can have functionality.
But we think about other things that can really increase
(25:15):
the heat. Saunas, hot tubs, I mean, sauna use is
so popular right now, right we see so many guys
coal punch sauna alternating that. But what they're doing is
they're actually elevating some of the body temperature of the scroton,
which isn't supposed.
Speaker 2 (25:29):
To be warm like that.
Speaker 3 (25:31):
And also cycling, like long term cycling, because this crodon
can get compressed and the heat can really build up.
And I will see that if I've got patients and
the male partner really loves is a cyclist. We've got
to like cut down or break up, you know, time
in the saddle on the bike, because that can kind
of really ramp it up. I think it's important in
the same breath to say, like type of underwear choice
(25:53):
doesn't increase squirtle temperatures, so brief s boxers, that doesn't matter.
We do see a little bit of damage from laptop
in la. You know, if you've ever held your laptop
you're working, you know you can get hot underneath. Sometimes
we see a lot of guys sometimes who will like
PLoP that right on their lap while they're working, and
that can make an impact.
Speaker 2 (26:11):
And I once had this guy who had really bad
sperm count.
Speaker 3 (26:13):
You like to take a cell phone and put it
like under his scrotum while he was driving, and it
would increase the temperature and kind of impacted production of sperm.
So I think we've got to avoid heat, avoids, smoking
and marijuana use, and no testosterone for sure.
Speaker 1 (26:30):
We've got to take a quick break. But we'll be
right back with more from doctor Natalie Crawford. And we're
back with doctor Natalie. You kind of touched on this
with testosterone but when we think about female fertility, there's
a lot of talk on social media about supplements that
are being marketed that say that you can kind of
(26:50):
hack your fertility by taking a certain you know, concoction
of herbs and nutrients. What is one popular fertility trend
that you've seen online that's more noise than science and
what would you recommend instead?
Speaker 3 (27:03):
When it comes to supplements, I think we have to
be really mindful that not everything is neutral or good.
I do prescribe supplements, but for certain conditions, I want
to know what we're treating, what is going on, how
is this going to benefit. A couple examples, so a
lot of hair, skin and nails products that we see,
(27:24):
or greens powders that people are putting in smoothies, they
have extremely high levels of biotin. And you know, biotine
actually binds to the lab assay that test hormone values,
So it doesn't change how your body is making hormones,
but it changes what tests I'm getting. So if you're
coming to me and I'm trying to evaluate your thyroid,
(27:47):
your egg count, your testosterone, your estrogen, if you are
taking any of these supplements that have high biotin levels,
which is very very popular. It is actually interfering and
none of those test results are accurate. There's a little
bit of biotinine like a prenatal or a multi vitamin,
and that is fine, but additional hair, skin and nails
that can be like way too much. Also, when we
(28:09):
think about supplements, there's a lot of you know, vitamin
nutrient supplements that are trying to replace things like vitamin
E or vitamin C that maybe you're not getting enough
of in your diet. And then there's a lot of
herbal options that people like and they sound really good
in theory. So there's things that maybe will make your
progesterone higher, like vitex, or there's things like I've taken vitex,
(28:33):
get it. And there's things like Maco which maybe can
like make buis estrogen. And so a lot of these
things like Vitex is a good one. It's from the
Chase Berry Monks used to use it to cut their
sexual desire because it is changing how the brain would
send out prolactin and what we do not want to
do if you're trying to get pregnant or you're trying
to like have your best, most normal cycles have your
(28:54):
body and balance. For lack of a better word, is
be adding extra things to the mix that purposely by
to our brain and interfere with our brain's ability to
determine what's actually happening. And that's what a lot of
these herbs do. So I'm not a fan of herbs
when it comes to this because they're very unregulated. They
can really interfere with a lot of our different hormone
(29:16):
receptors and that's not the goal for if we're trying
to have our hormone healthy life or we're trying to
get pregnant, we really want that system to be communicating properly.
Speaker 1 (29:26):
So on the flip side of fertility and nutrition, are
there any foods or supplements that we can eat that
can potentially improve the quality of eggs?
Speaker 2 (29:35):
Is that?
Speaker 1 (29:35):
Is that real? Is that a thing?
Speaker 2 (29:37):
That is a thing? Right?
Speaker 3 (29:38):
So let's think about eggs in general. So we already
talked about you're born with all the eggs you're ever
going to have, you run out of them. Over time,
they sit inside your bodies. They do absorb the wear
and tear of your life, but they are most susceptible
or sensitive to the world around you the few months
before they are ovulating. Now, egg quality. Your chromosomes are
inside your egg from before you're born, and they are
(30:00):
held in a perfect position. And the analogy I like
to use for this is to imagine your chromosomes are
like a line of kindergarteners, and the longer I've asked
them to stand in alphabetical order, the higher the likelihood
that somebody is going to get out of line. And
that is what age related changes essentially start to do
to our eggs. The way've been standing there longer, they
start to get out of line. But the world around
(30:22):
us are the distractions, meaning inflammation, the foods we eat.
That's like puppies and kiddies and candy, right, the kindergarteners
are even going to get worse in context of those things.
When it comes to how we can eat to support
our hormonal health and our fertility, the best, it's not
super sexy, but number one, fruits and vegetables. Fruits and
(30:42):
vegetables have fiber. Fiber is going to be one of
the key components here because fiber is going to help
keep your gut permeability intact, meaning your guts like your
first line defense system, and a lot of people start
to develop something that trendy is called leaky gut. But
this is an increased permeability of your intestines, allowing more
(31:03):
than just the nutrients to get absorbed into your blood stream.
Speaker 2 (31:06):
That's a big.
Speaker 3 (31:07):
Contributing factor to having higher levels of inflammation and insulin resistance.
So when we start talking about the foods that you're eating,
the way to heal the gut lining is to have
high fiber and fibers and fruits and vegetables. Meat doesn't
have any fiber in it. Any diet that tells you
fruit is bad is false because fruits and vegetables have
(31:27):
so many important vitamins and nutrients.
Speaker 1 (31:29):
There's this whole cohort of people now who are saying
that vegetables are bad all of a sudden, and I
just mean, right, it's so absurd.
Speaker 3 (31:37):
How do we even believe that vegetables are bad for you?
You know, in the perfect world? And fertility data supports
that eating less meat, like more servings of vegetable protein
or thermal protein, is associated with higher rates of fertility
and better ovulation. Eating less red meat associated with higher
rates of getting pregnant. Lower rates of endometriosis, better embryo
(31:59):
results with IVF cycles. So we can't act like that
data doesn't exist. I mean, in addition to you know,
we also know the animal meat is a carcinogen. But
when we think about what's going to be the healthiest
for you, it's going to be limiting or avoiding, you know,
animal meats. I always say freeze and vegetables are the
mainstay if you eat animal meat. Let's say you're going
(32:21):
to have meatless Monday, so you're forced to eat more
fruits and vegetables that day. You're going to then on
the other days of the week have meat one time
a day at maximum, so you can kind of choose
when that's going to be, and red meat no more
than one time a week. So we're automatically by pulling
back on animal meat, we're going to have to replace
that with lagomes, with fruits and vegetables and other sources
of both healthy proteins, nutrients, vitamins, fiber that is going
(32:45):
to decrease our insulin resistance and heal our gut in
a better way.
Speaker 2 (32:49):
And then all of the.
Speaker 3 (32:51):
Ultra processed foods, the artificial added sugars, all of the
things that are not made in nature. We know those
are not good for us. And I know we grew
up on diets like this, right, we have to acknowledge
the fact that we grew up on artificial foods. And
it's not that I woulds say it's not never. But
you know, we know if you eat more than five
fruits and vegetables today, you're going to have a higher
(33:12):
chance of getting pregnant. This is not just like theoretical data.
We actually have data saying that that is going to
be a faster path towards pregnancy.
Speaker 1 (33:22):
Okay, I want to ask you about egg freezing. I'm
really curious about this because it feels like, I don't know,
maybe ten years ago, just anecdotally, I witnessed this boom
in marketing for egg freezing and it became this really
highly you know, talked about and sought after a solution
for women who wanted to delay a pregnancy. I have
(33:44):
heard now, though, that it's not exactly all that it's
cracked up to be, and perhaps that it's not as
reliable as we once thought it was. Is that true?
What is your take on egg freezing?
Speaker 3 (33:57):
Oh? I have a lot of thoughts on egg freezing.
First of all, I think it's really important. We had
this discussion to say that ten years ago, egg freezing
was just coming off an experimental status, Meaning when I
first entered the field, we're asking us to freeze a
single cell mostly filled with water and DNA, and we
want to thought and keep all the DNA intact. And
so a decade ago we would see that only about
(34:20):
forty percent of eggs would survive the freeze though process,
making it a lot harder to do on whole scale,
to have patients pay thousands and thousands of dollars for
and outcomes.
Speaker 2 (34:31):
Really not as great.
Speaker 3 (34:32):
Subsequently, from then, the technology has improved dramatically, whereas now
in our lab, ninety five percent of eggs will survive
the free thaw. So it's just a stark difference that alone,
and improvement in technology has led to more embryologists being trained,
more labs being able to do very high quality egg freezing,
and egg freezing up today is not egg freezing that
(34:53):
it was ten years ago. It also means though that
people who maybe froze their eggs ten years ago, who
are going to use them right now, or finding out
that they didn't get the outcome they wanted, and they
are being very loud, maybe online about how negative their
experience was. And same thing true that we said earlier
about the podcast. I never want to shame somebody for
(35:13):
sharing their in of one experience. Every experience is valid,
but we'd be so careful that our singular influence could
really alienate or how it can impact somebody. I do
think there are a slew of physicians or providers who
have not properly educated their patients. And one thing that
(35:34):
I hate is seeing people say I'm going to freeze
my eggs as an insurance policy against my fertility. Right, Oh,
it's an insurance policy and I'll have those eggs there.
Speaker 2 (35:43):
False.
Speaker 3 (35:43):
Right, you get a car accident, your car insurance is
going to pay money to help you out. Egg freezing
is an investment. It is like putting money in the
stock market. Where is this usually a good thing? Yes,
But it depends on the stocks you put it in,
how much you put it in, and the environment when
you go into take the money out. And we don't
always know what the ROI on that investment is going
(36:04):
to be. But it is generally considered a good thing,
right for most people. Most of the time it will
be a beneficial thing, but not for everybody, and so
you have to understand the uncertainty of the process. The
ideal age to freeze your eggs, I always say, is
the moment you're asking the question. If you say, should
I freeze my eggs? You should go get an evaluation
(36:24):
because you don't know what you don't know. But if
we look at studies, it's going to be by about
age thirty two thirty three. If you know you like
to have children as a life goal and you are
not ready to have them yet, at thirty two thirty three,
this is the age you should go get an evaluation
and at least learn more about the process. If you're
older than that and you're listening, now, you can go now.
I have had older women freeze their eggs and still
(36:46):
have success. There's a lot of assuming that happens with
egg freezing. So simone, if you were coming to me,
you so you want to freeze your eggs, We're going
to talk it through based on your age and how
many you have. If you have a partner who you
want to have children with, just you don't want to
have children with now, well then we're going to talk
about the difference in eggs versus embryos. Right, embryos are fertilized,
(37:07):
they cost twice as much. However, you have much more
data on how many do you need and kind of
how part of the process is going to fall Because
we know not every egg will fertilize, will become an embryo,
will be genetically normal, or will implant. Human reproduction is
extremely inefficient, but I think on the whole, egg freezing
(37:28):
is a game changer. So I always encourage women if
having kids is something they think they want to do,
especially if they're getting into their thirties and they're not
yet ready. You can see a fertility doctor. You can
have initial testing done to find out how many eggs
you have, learn about what the process would be like
for you, and then you can choose whether to do
it or not. But being the one to say I
(37:49):
know this exists, I'm not just educated on social media lies,
but I understand what's going on in my body, and
now I can say I want to do this or
I don't. That puts the power in your hands versus
back to what we said earlier, having time make a
decision for you.
Speaker 1 (38:04):
Doctor Natalie as we come to the end of our conversation.
I am thinking about those listeners, those folks in our
community who have been trying to conceive for a long time,
maybe let's say twelve months, and are still not having
any luck. What would you say are the questions they
should be asking themselves as they think about next steps infertility.
Speaker 3 (38:28):
No. Number one, big hug. You are not alone. It
can feel very isolating. You can feel left behind your friends.
I understand all of those feelings.
Speaker 2 (38:37):
Look online.
Speaker 3 (38:38):
There's a huge, robust community of people sharing their experience
with infertility that can help you feel us alone.
Speaker 2 (38:46):
Number two.
Speaker 3 (38:47):
Go get an evaluation and find a fertility doctor that
you trust. And evaluation is just data. Nobody's going to
force you to do any treatment. But you can't make
decisions on data you don't know, so go and find
out what is happening. The recommendation is if you've been
trying for twelve months and you're under age thirty five,
if you're older than age thirty five, you've been trying
(39:07):
for six months, and if you're forty year older, just go.
You don't have to try for any amount of time,
and you can have fertility testing done to at least
find out if there's anything that's obviously going to be
preventing you, or what your options are based on your tests.
If you don't have a fertility doctor who you like,
or if somebody dismisses you, you feel like they're gaslighting
(39:27):
you go find somebody else. This is too important of
a thing in your life to allow yourself to have
question marks about the person who is the captain of
the ship. Right you have to know that it's somebody
you trust, somebody who will take the time to explain
things for you, answer your questions and understand. I always
say with my patients, I'm not here to make you
(39:48):
do one thing or another. I'm here to explain the
options for you, tell you what can be best. At
the end of the day, it's your journey. You're the
one making decisions, So put yourself in the best position
for success. Control the factors that you can be an
active participant in understanding why your doctor may be recommending
(40:08):
one thing over another. You know you're not alone. Like
it can be hard. The number one reason why people
drop out of fertility treatment is not financial expense or
physical stress. It's the emotional damage that fertility does and
I think that just speaks to how hard it is.
We always say in the community that it's the worst
club with the best members.
Speaker 1 (40:28):
The worst club with the best members. I love that line,
and that community is so lucky to have you as
a voice. Thank you, Doctor Natalie.
Speaker 2 (40:36):
Thank you Simon so much for having me on.
Speaker 1 (40:41):
Doctor Natalie Crawford is a nationally recognized fertility physician who
is double Board certified in obstetrics and gynecology and reproductive
and chronology and infertility. She's the co founder of Fora
Fertility in Austin, Texas, and her debut book, The Fertility Formula,
goes on pre sale July seventeenth. The bright Side is
(41:02):
a production of Hello Sunshine and iHeart Podcasts and is
executive produced by Reese Witherspoon and me Simone Boyce. Production
is by a Cast Creative Studios. Our producers are Taylor Williamson,
Adrian Bain, Abby Delk, and Darby Masters. Our production assistant
is Joya putnoy Acasts executive producers are Jenny Kaplan and
(41:23):
Emily Rudder. Maureen Polo and Reese Witherspoon are the executive
producers for Hello Sunshine. Ali Perry and Lauren Hansen are
the executive producers for iHeart Podcasts. Tim Palazzola is our showrunner.
Our theme song is by Anna Stump and Hamilton Lighthouser
Hey y'all, big announcement here. I am so excited to share.
Shine Away is back this October eleventh and twelfth in
Los Angeles. If you've been before, you know it's Hello
Sunshine's incredible weekend of connection, joy and community. And if
you haven't, well, this is the year to come. Throughout
the day, you'll experience thoughtful panels, fireside chats, workshops, and
(00:22):
immersive activations surrounded by voices that are shaping culture and
shifting conversations. Whether you're a longtime listener or just joining us,
this is your chance to be part of a truly
special and memorable weekend. Tickets are selling fast, so head
to hellasunshine dot com slash shine Away to grab yours.
(00:42):
Fertility is complicated, It's loaded with emotion, and it can
be scary to talk about. But what if it doesn't
have to.
Speaker 2 (00:49):
Be that way.
Speaker 1 (00:50):
Our guest today is here to cut through the noise
and panic and show us how to take charge of
our fertility on our own terms. Doctor Natalie Crawford is
a former OBGYN, reproductive endocrinologist, and fierce advocate for women
owning their reproductive health.
Speaker 3 (01:06):
You actually can make such a bigger difference faster when
it comes to male fertility than female fertility based on
lifestyle choices, and that because the life span of a
sperm is about three months, meaning they could make a
change today and have completely new sperm created three months
from now that have not been exposed to whatever they
(01:28):
did previously.
Speaker 1 (01:32):
Get ready to have your mind blowan. I'm simone voice,
and this is the bright side from Hello Sunshine, y'all.
There is no shortage of fertility content out there. You
can spend hours online trying to piece together what to eat,
when to freeze your eggs, how to track your cycle,
or whether that one influencers supplement stack is actually doing
(01:55):
anything to help them. Even with all the conversation that's
happening around fertility right now, it can still leave you
feeling really confused, broken in some way, or behind. Today's
guest is someone I have been following for a while,
and I'm so excited to bring her here on the
bright side, because when it comes to understanding our bodies,
our hormones, and fertility, doctor Natalie Crawford is one of
(02:17):
the most trusted and truly empowering voices out there. As
a board certified reproductive endocrinologist in Obgin. She has helped
thousands of women on their journeys to motherhood. And what
I love most about Doctor Natalie's approach is that she
offers science back tips that can empower women to make
the best choices for themselves, to advocate for themselves at
(02:41):
the doctor's office. She's not here to sell us a product.
She's simply here to provide the tools and the simple
micro habits, little changes that we can make to our
lifestyles on a daily basis to improve our odds of
a successful fertility journey. You already know I've been on
my own journey of trying to better understand my cycle,
my hormones, and my long term fertility health. And it
(03:05):
can be overwhelming. It truly can, and it can often
feel like, oh gosh, I don't even know where to start.
We'll start here, start with us today, because we're going
to talk about some of the most misunderstood but important
topics around reproductive health, like what actually impacts egg quality,
how to understand your ideal egg freezing window, and why
(03:26):
focusing on your partner's fertility for those of you in
a heterosexual partnership may provide faster results than you might think.
Whether you're trying to conceive, hoping to in the future,
or just want to understand your body better, there is
so much here for you. Please save this episode, bookmark
this episode, and if you know someone who is trying
(03:47):
to conceive right now, this is the kind of conversation
that you're going to want to send to them. All right,
here's my chat with doctor Natalie Crawford. Doctor Natalie, Welcome
to the bright Side.
Speaker 2 (04:03):
Thank you Simone so much for having me here.
Speaker 1 (04:05):
I feel so lucky that I get to host this show,
and I know you have a podcast as well, but
I have learned so much about my own body and
just about women's health through the conversations that we have
on this show, and I know that our chat today
is going to be incredibly informative as well, specifically on
the topic of fertility. Your videos are wildly popular online.
(04:28):
You have several viral videos on Instagram and TikTok, and
it's so clear to people how passionate you are about
this topic of fertility. I'd love to hear about the
moment that you would say your heart really got lit
on fire about fertility, about women's health, and that moment
that just set you down this path that you're currently on.
Speaker 3 (04:48):
I took a little bit of an indirect road to
the fertility stands. I always wanted to be a doctor.
I went to medical school. I actually did a year
of emergency medicine first. I just loved the diagnostic challenge.
Very quickly realized I wanted to be more involved in
my patient's story long term. I wanted to see them
through the problem, and that really led me towards women's health.
(05:10):
And because I still loved the diagnostic challenge. There's nothing
as diagnostically challenging as the hormone, so I'm very nerdy.
I loved that diagnostic puzzle of trying to figure out
what was really going in the inner workings of our body.
And of course, walking with somebody through a fertility journey
is truly being involved in their life and their story.
(05:31):
I switched from emergency medicine to Obigian and then loved
fertility so much that I did three years of fellowship
after Obgian training so that I could really be a
hormone and fertility expert. And during that time, I will
say I had my own experience with infertility that I
was very unprepared for even as a professional. I had
four pregnancy losses during training. I realized I was looking
(05:56):
for the answers to the questions I had that I
weren't taught in training. Medicine is so reactionary, especially women's health,
where we don't always talk about prevention. We don't talk
about prevention at all when it comes to fertility or
understanding your body. By definition of the field, infertility is
not having success trying to get pregnant, and then that's
when you get all this testing done. So I really
(06:18):
started researching and looking for answers myself and experience to
what it was like being a patient. And that led
me very strongly in my fellowship to want to understand
natural fertility, more understand the factors we can control, and
help educate women so that they could have more ownership
over their bodies, understand the journey they're walking, try to
(06:41):
have more control over an uncontrollable situation. And that's kind
of what spurred me from not just you know, being
a fertility doctor what I do every day, but really
trying to talk about this online and on social platforms
to try to reach more people and help women really
understand what's going on with them.
Speaker 1 (06:57):
I do feel like fertility is something that we have
been talking about more on social media. I think those
conversations have been helpful in creating a space where parents
feel less alone. And then there's the other side of it,
which is this like infiltration of uninformed voices and all
of the misinformation that can come along with having conversations online.
(07:20):
I'm thinking in particular about this one clip that's been
circulating from a podcast host and she.
Speaker 2 (07:28):
I know the clip.
Speaker 1 (07:29):
You know the clip, Okay, so you know the clip.
She basically suggests that she manifested being pregnant, and I
can only imagine how hurtful that is and how callous
that feels for someone like you who's had several pregnancy
losses and did have so many challenges in getting pregnant.
Speaker 3 (07:48):
It was an extremely hurtful clip towards the unfertility community
as a whole, you know, and very short sighted. And
I always want to say, we are all entitled to
our own experience, and anytime somebody is talking about their
own own personal medical history, whether it is a positive
or negative experience, you know, that's something that they don't
have to share with us. And so you know, there
(08:09):
is something about opening up the space for the discussion
whether it is an easy or a hard road, that
is important. But I do agree we have to be
very mindful that there's sometimes no amount of manifestation that
will overcome certain medical conditions. And even though she had
a great experience, and I'm so happy that that was
(08:29):
got to be the road that she got to walk,
and there is something to be said for, you know,
trying to put yourself in the best position to get
pregnant and controlling what you can control. I think all
of that is great, but we have to acknowledge that,
you know, there's so many medical conditions that cause infertility
that no amount of manifestation or good lifestyle choices will
(08:51):
ever overcome, and that it is something that is so
sensitive to so many people, because you know, society kind
of teaches you that. Forertility is a rite. It is
like something we almost take for granted. I'm going to
prevent having kids so much to my reproductive life. We
talk about contraception and not getting pregnant, and then suddenly
(09:12):
when somebody decides they want to be pregnant, it's a
complete one eighty and we're not always prepared for what
that journey would look like, whether it's positive or negative.
So I always think you never want to say boo
for somebody for sharing their personal experience. But it is
very insensitive when we talk about fertility and our positive experience,
(09:33):
and with such generalized terminology. It really is a privileged view,
not accounting for what so many people who walk the
fertility road experience. Not everybody even has success even with
infertility treatments. It's a really tough journey for a lot
of people.
Speaker 1 (09:49):
You mentioned that you experienced several pregnancy losses while you
were training to become a doctor. Can you tell me
more about that and how you over came that. I mean,
that sounds so traumatic to be in school in academia
trying to learn, and then you're also dealing with your
own personal health issues.
Speaker 3 (10:09):
Simono was terrible. I was an Obiguyan resident, so I
was in my last year of residency. So I was
the chief resident, which means you're running the labor and
delivery floor, you're making the decisions. I mean, the most
traumatic experiences I had. A miscarriage was our second pregnancy,
so it would be our second pregnancy loss. I was
the chief resident in charge of Obiguyan. Right, I was
(10:30):
delivering other people's babies that night while actively miscarrying. And
this is something that all physicians have to do in
some way, is put your own personal needs to decide
to take care of patients and what they need in
the moment. I think every physician will always say that
that is something you learned to do is I'll deal
with this later because I got to focus on the
patient in front of me.
Speaker 2 (10:51):
But it was, you know, devastating.
Speaker 3 (10:54):
I remember, you know, crying in the bathroom, having to
try to just like put on my focused face while
I'm actively bleeding doing surgery, and you know, crying on
the way home and just feeling like how can I
know so much and this is my job yet find
myself in this position, And when I went to see
my own doctors, was told, oh, it's just bad luck,
(11:16):
Oh you're distressed, Oh it'll happen, and really was dismissed,
which I think is a common experience now that so
many women feel like they go seeking for answers or
saying they feel like something's wrong and just told no,
don't worry about it, without any test being run or
more stuff being evaluated, and you know that carried on
(11:38):
for me.
Speaker 2 (11:39):
It was really a traumatic experience.
Speaker 1 (11:45):
More from doctor Natalie Crawford. After this shortbreak, Now, your
turning point with fertility actually came with the diagnosis of
Celiac disease. I was not aware of this connection. Tell us,
how did Celiac disease disrupt your fertility?
Speaker 3 (12:04):
Well, this is a great question because I had unexplained
in fertility. I had unexplained pregnancy loss. That was the
diagnosis I ended up getting. I was in Fellowship, and
when everything's turning back normal, they do all the testing,
you get this unexplained diagnosis. And I always say unexplained
truly means undiagnosed, because nothing's easy to diagnose. It's one
(12:28):
of those diagnoses that's really unsatisfying as a patient. I mean,
unexplained that sounds terrible. And I was told there was
nothing I could do that could make any difference, and
IVF was the only option. And I wasn't opposed to IVF.
I mean, I do IVF every day for patients, but
just because of my schedule, it wasn't a time in
my life where I could do it. So I said, okay, Well,
I can't do that because I'm of my job. I'll
(12:50):
have to do that in a little bit of time.
So what can I do in the interim to try
to make a difference here? And at the same time,
I was starting to research natural fortils and our cycles,
and I was doing a research project that I was
very passionate about about indocrine disrupting chemicals and our fertility
and really starting diving in this research about inflammation and
(13:11):
how that can cause miscarriage. And I started to say,
you know, if we're going to have to walk this road,
I'm going to control everything that I can and changed
my diet went very anti inflammatory, changed how I was
working out, took all the teflon and plastic out of
our kitchen. My husband thought I was crazy, but I
was just like, you know, we're going to walk this road,
knowing like it wasn't this, it wasn't this, and we
(13:33):
just ruled it out and in that learning to listen
to my body and how I ate. When I ate
anti inflammatory, I wasn't eating any gluten, and it wasn't
that gluten itself is bad in the majority of people,
but I noticed I felt more bloated more what we
would call of those inflammation symptoms after having gluten, and
since I wanted to be as low inflammatory as possible,
(13:55):
I cut it out. Happened to get pregnant, you know,
with clomid before we I didn't have to do IVF.
Ended up getting pregnant and had my kids that way,
which was kind of shocking after walking this road. And
I didn't get diagnosed with celiac disease until a decade later.
And what happened is I was never tested for it
back when all this other stuff was going on. I
(14:17):
wasn't tested for anything autoimmune. I wasn't tested for inflammatory markers,
and I really self treated myself with this idea of
something's going on, and I refuse to accept that it's nothing.
But Ciliac disease is obviously where you have a reaction
to gluten, and so the treatment is a gluten free diet,
but it causes such severe inflammation in your body, and
(14:39):
it is associated with a higher risk of infertility and
pregnancy loss. Has are a lot of autoimmune diseases. So
I think there's a lot about our lifestyle in the
world around us that we actually do have a lot
more power over and we have to especially in the
fertility and the women's health zone, where so little money
has been put towards research and understanding women's bodies. Have
(15:01):
to acknowledge that just because the study hasn't been done
doesn't mean that something's not impactful. And really, I love
the turn of seeing where people talk about fertility or
talk about listening to women and paying attention to their symptoms.
And that's one thing I always tell my patient is
you know yourself the best. If you tell me you
don't feel good, you feel off, things are not normal,
I believe you.
Speaker 2 (15:22):
I may not.
Speaker 3 (15:23):
Always be able to get to the answer, but we
should at least try. And we need to make our
life choices, the daily decisions in line with what we
think is going to be making a difference and not
adding or compounding on that problem.
Speaker 1 (15:37):
So just to make sure that I understand correctly, it
sounds like it wasn't necessarily Celiac disease itself. That might
have been the cause of the infertility, but the inflammation
that gluten was causing in the body impacted your ability
to conceive.
Speaker 3 (15:53):
Correct it's tied to the Celiac disease, but there's so
many different inflammatory conditions that people have, and we know
that inflammation really is so toxic to our body. When
we start thinking about the inflammatory response is meant to
be this acute self limited. Right, you cut your hand
and your inflammation system gets turned on. Your immune system
(16:14):
goes to heal that cut. But we live in an
inflammatory world. In addition, to see this huge rise of
autoimmune disease, which are all connected by inflammation. So so
many people have chronic inflammation. Think about pcos and endometriosis.
We see you know, autoimmune disease like celiac disease and
hashimotos at, you know, alarmingly high rates. A lot of
(16:36):
this is the world around us and the lifestyle we're living,
genetic factors and a combination of this. And as somebody
who does IVF every day for patients, ignoring the lifestyle
aspects and ignoring inflammation also puts us at a disservice
because we're working with eggs and sperm that come from
the body, and we're trying to put an embryo back
in the body, and we have to pay attention to
(16:58):
the holistic whole person in view if we want to
have the highest odds of success.
Speaker 1 (17:02):
And you're taking this holistic approach with your upcoming debut book,
The Fertility Formula. Congratulations, oh similar, thank you.
Speaker 3 (17:11):
What did you.
Speaker 1 (17:12):
Feel like you could do better or differently with this
book compared to the other resources that are in this space.
Speaker 3 (17:19):
One thing that I think is really important that the
book has is it's really walking you progressively through understanding
your body. Because so many facts build on themselves. Right before,
we talk about hormone dysfunction, what's supposed to happen when
everything's normal, what is supposed to happen as we get older,
what's happening with infertility. So it's walking you through all
of that in a way that I find really build
(17:41):
on itself and is easier to understand coming from an
expert instead of a lot of books that are written
are written from the patient experience, which are so valuable,
but that is a one sided view of somebody's journey
versus coming from the inside of somebody who takes care
of a vast multitude of patients different circumstances. But also,
(18:02):
I mean, half the book is really talking about lifestyle
and what you can do, So it's really the culmination
of what I feel like is my life's work and
coming at it from a place I'm so passionate about,
which is at every stage of the journey, you deserve
to understand your body, how your hormones work, and be
the one making the decisions for yourself. Right, it shouldn't
be lack of knowledge that makes decisions for you, because
(18:25):
for every woman that will happen at some point time
will make the decision for you if you do not.
Speaker 2 (18:32):
And I want to.
Speaker 3 (18:33):
See more people taking a proactive approach to their fertility
and their reproductive health. Well.
Speaker 1 (18:38):
Proactivity seems like this through line throughout your work and
just throughout who you are as a person, and I
know you're bringing that to this book as well. So
let's get into some fertility questions. What are some of
the most common misconceptions about infertility that you see in
your work and that you would like to say the
(19:00):
record straight on.
Speaker 3 (19:01):
I think the number one is going to be that
most infertility is due to a female factor. We certainly
see such a female focus on infertility, but half of
infertility is due to male factor. So if we really
look at it, it is not that everything is always
the woman. I see patients every week. He'll say, oh,
we don't need to test him, oh he had kids
in the past, or oh his test sawstone is fine,
(19:23):
or the problem is me. But half the time there
is a male issue involved, and we certainly can have
more than one thing going on. We always want to
test both partners. This also applies to taking good care
of yourself. What's good for your health is good for
your fertility, for both men and women, and not just
a I'm going to do all of this, but my
partner is going to do their own thing. That doesn't
(19:45):
really work when it comes to trying to get pregnant.
We really want to take a couple focused approach. I
think second that I think is really important to say
is that, well, well, IVF will always work or I
can just do IVF. IVF is an amazing technology. It
is one the only things we have that makes our
rate of getting pregnant higher than whatever our age related
(20:06):
rate is going to be because it gets harder to
get pregnant as we get older. But IVF is still
limited by age, a number of eggs that you have.
Speaker 2 (20:14):
And we see in.
Speaker 3 (20:15):
Pop culture, you know, celebrities having kids at a much
older age. They're not always transparent about the road they
walk to get there, you know, did they use donor eggs?
Did they freeze eggs earlier? Were they able to just
get pregnant in their fifties? But it's exceedingly rare that
women are able to conceive, especially after your age forty five.
It's not impossible, but it's much harder with your own
(20:37):
eggs at that stage to get pregnant. And so there's
this idea. I will see women wait, you know, a
long time. They'll say, well, I'll just do IVF. And
sometimes IVF doesn't always work. It's not always going to
be that thing that you can just do at any moment.
Speaker 1 (20:51):
I want to break each of these down one by one.
I'm so glad that you brought up male fertility because
I agree when I hear women talking about this topic,
it's always about and what we're doing wrong, and not
about what our partners can do to be better, more
fertile partners. So you actually talked about this on TikTok
and it went viral. What are a few things that
(21:12):
you would never let your partner do if you were
trying to conceive.
Speaker 3 (21:15):
I'm going to preface this by saying you actually can
make such a bigger difference faster when it comes to
male fertility than female fertility based on lifestyle choices. And
that because the life span of a sperm is about
three months, meaning women are born with all the eggs
we're ever going to have. They absorb the wear and
tear of our life. And that is why age becomes
(21:36):
so impactful to us, because they're just cumulative wear and
tear that builds up. For men, they are constantly regenerating sperm.
It is not fair. They are much more efficient at this,
but because of that, they could make a change today
and have completely new sperm created three months from now
that have not been exposed to whatever they did previously.
(21:59):
So it is such a room to make a difference,
which makes me even matter. So often that the male
site is ignored and we see, you know, women doing
all these things to try to make themselves better, and
like men are doing some of these things that I
say don't do. So Number one is going to be
smoked cigarettes or use marijuana. Truly, both of these factors
can impact our sperm counts, our motility, and the shape
(22:21):
of the sperm. Daily marijuana use can be so damaging
to sperm. It can both stop our brain from sending
out the signals to even make sperm, and it can
damage the DNA inside the head of sperm. Some of
the cases even of IVF that I've seen couples go
through and then they don't have good embryos. When I'm
diving back in what could be going on, a lot
(22:42):
of times the embryo stop developing when the male genome
kicks in. And when I go back and talk to
these partners, oh, well, they're using marijuana daily that they
didn't disclose and it was something that didn't they didn't
want to tell or didn't get detected. But it has
such an impact on both the production and the functionality
of sperm. In fact, miscarriage RAITs are even higher in
(23:03):
female partners who don't use marijuana, but whose partners do.
So if your partner's using marijuana, your risk of a
miscarriage is higher, and that goes back to damage of
the DNA inside the sperm head. Next is going to
be testosterone use. This one I see all the time
because we love people trying to take their own health
into their hands, but there are so many people healthcare
(23:27):
providers calling themselves hormone experts who don't truly understand how
hormones work. And sometimes men have a true problem where
they may go in and they might have fatigue, or
they might have low testosterone, they might have difficulty with
erections or ejaculations, and they are given testosterone. I had
a patient where this was the case. He was given
testosterone for his fatigue and he was on it for
(23:50):
twelve months while they were trying to get pregnant. And
testosterone tells the brain to stop making sperm. And the
reason why is that sperm and testosterone and are made
together in the testes. So if your brain sees a
lot of testosterone because you're taking tea shots, it says
we must have a lot of sperm. Also, we don't
need to send out any signals to make either. And
(24:11):
sometimes testosterone use the what we call azospermia or the
absence of sperm and the ejaculate. Sometimes that is irreversible,
and that can be really devastating to couples. And so
testosterone is essentially male birth control. Having low t can
be a medical problem, but there are other treatments for
(24:33):
it that are safer if you're trying to get pregnant
that are not testosterone itself. So would say no testosterone use.
And then we also want to avoid heat to the testes,
so you know, the scrotums outside the body for a
reason that is because you are supposed to make sperm
at a slightly lower temperature than the rest of the body.
We actually know that if a man has an undescended
(24:54):
testicle where it stays inside his abdominal cavity, the heat
of the abdominal cavity will actually droy the tubules that
make sperm inside the testes and render it not functional anymore.
And so that's why you know, little kids have surgery
if their testicles haven't descended so that they can have functionality.
But we think about other things that can really increase
(25:15):
the heat. Saunas, hot tubs, I mean, sauna use is
so popular right now, right we see so many guys
coal punch sauna alternating that. But what they're doing is
they're actually elevating some of the body temperature of the scroton,
which isn't supposed.
Speaker 2 (25:29):
To be warm like that.
Speaker 3 (25:31):
And also cycling, like long term cycling, because this crodon
can get compressed and the heat can really build up.
And I will see that if I've got patients and
the male partner really loves is a cyclist. We've got
to like cut down or break up, you know, time
in the saddle on the bike, because that can kind
of really ramp it up. I think it's important in
the same breath to say, like type of underwear choice
(25:53):
doesn't increase squirtle temperatures, so brief s boxers, that doesn't matter.
We do see a little bit of damage from laptop
in la. You know, if you've ever held your laptop
you're working, you know you can get hot underneath. Sometimes
we see a lot of guys sometimes who will like
PLoP that right on their lap while they're working, and
that can make an impact.
Speaker 2 (26:11):
And I once had this guy who had really bad
sperm count.
Speaker 3 (26:13):
You like to take a cell phone and put it
like under his scrotum while he was driving, and it
would increase the temperature and kind of impacted production of sperm.
So I think we've got to avoid heat, avoids, smoking
and marijuana use, and no testosterone for sure.
Speaker 1 (26:30):
We've got to take a quick break. But we'll be
right back with more from doctor Natalie Crawford. And we're
back with doctor Natalie. You kind of touched on this
with testosterone but when we think about female fertility, there's
a lot of talk on social media about supplements that
are being marketed that say that you can kind of
(26:50):
hack your fertility by taking a certain you know, concoction
of herbs and nutrients. What is one popular fertility trend
that you've seen online that's more noise than science and
what would you recommend instead?
Speaker 3 (27:03):
When it comes to supplements, I think we have to
be really mindful that not everything is neutral or good.
I do prescribe supplements, but for certain conditions, I want
to know what we're treating, what is going on, how
is this going to benefit. A couple examples, so a
lot of hair, skin and nails products that we see,
(27:24):
or greens powders that people are putting in smoothies, they
have extremely high levels of biotin. And you know, biotine
actually binds to the lab assay that test hormone values,
So it doesn't change how your body is making hormones,
but it changes what tests I'm getting. So if you're
coming to me and I'm trying to evaluate your thyroid,
(27:47):
your egg count, your testosterone, your estrogen, if you are
taking any of these supplements that have high biotin levels,
which is very very popular. It is actually interfering and
none of those test results are accurate. There's a little
bit of biotinine like a prenatal or a multi vitamin,
and that is fine, but additional hair, skin and nails
that can be like way too much. Also, when we
(28:09):
think about supplements, there's a lot of you know, vitamin
nutrient supplements that are trying to replace things like vitamin
E or vitamin C that maybe you're not getting enough
of in your diet. And then there's a lot of
herbal options that people like and they sound really good
in theory. So there's things that maybe will make your
progesterone higher, like vitex, or there's things like I've taken vitex,
(28:33):
get it. And there's things like Maco which maybe can
like make buis estrogen. And so a lot of these
things like Vitex is a good one. It's from the
Chase Berry Monks used to use it to cut their
sexual desire because it is changing how the brain would
send out prolactin and what we do not want to
do if you're trying to get pregnant or you're trying
to like have your best, most normal cycles have your
(28:54):
body and balance. For lack of a better word, is
be adding extra things to the mix that purposely by
to our brain and interfere with our brain's ability to
determine what's actually happening. And that's what a lot of
these herbs do. So I'm not a fan of herbs
when it comes to this because they're very unregulated. They
can really interfere with a lot of our different hormone
(29:16):
receptors and that's not the goal for if we're trying
to have our hormone healthy life or we're trying to
get pregnant, we really want that system to be communicating properly.
Speaker 1 (29:26):
So on the flip side of fertility and nutrition, are
there any foods or supplements that we can eat that
can potentially improve the quality of eggs?
Speaker 2 (29:35):
Is that?
Speaker 1 (29:35):
Is that real? Is that a thing?
Speaker 2 (29:37):
That is a thing? Right?
Speaker 3 (29:38):
So let's think about eggs in general. So we already
talked about you're born with all the eggs you're ever
going to have, you run out of them. Over time,
they sit inside your bodies. They do absorb the wear
and tear of your life, but they are most susceptible
or sensitive to the world around you the few months
before they are ovulating. Now, egg quality. Your chromosomes are
inside your egg from before you're born, and they are
(30:00):
held in a perfect position. And the analogy I like
to use for this is to imagine your chromosomes are
like a line of kindergarteners, and the longer I've asked
them to stand in alphabetical order, the higher the likelihood
that somebody is going to get out of line. And
that is what age related changes essentially start to do
to our eggs. The way've been standing there longer, they
start to get out of line. But the world around
(30:22):
us are the distractions, meaning inflammation, the foods we eat.
That's like puppies and kiddies and candy, right, the kindergarteners
are even going to get worse in context of those things.
When it comes to how we can eat to support
our hormonal health and our fertility, the best, it's not
super sexy, but number one, fruits and vegetables. Fruits and
(30:42):
vegetables have fiber. Fiber is going to be one of
the key components here because fiber is going to help
keep your gut permeability intact, meaning your guts like your
first line defense system, and a lot of people start
to develop something that trendy is called leaky gut. But
this is an increased permeability of your intestines, allowing more
(31:03):
than just the nutrients to get absorbed into your blood stream.
Speaker 2 (31:06):
That's a big.
Speaker 3 (31:07):
Contributing factor to having higher levels of inflammation and insulin resistance.
So when we start talking about the foods that you're eating,
the way to heal the gut lining is to have
high fiber and fibers and fruits and vegetables. Meat doesn't
have any fiber in it. Any diet that tells you
fruit is bad is false because fruits and vegetables have
(31:27):
so many important vitamins and nutrients.
Speaker 1 (31:29):
There's this whole cohort of people now who are saying
that vegetables are bad all of a sudden, and I
just mean, right, it's so absurd.
Speaker 3 (31:37):
How do we even believe that vegetables are bad for you?
You know, in the perfect world? And fertility data supports
that eating less meat, like more servings of vegetable protein
or thermal protein, is associated with higher rates of fertility
and better ovulation. Eating less red meat associated with higher
rates of getting pregnant. Lower rates of endometriosis, better embryo
(31:59):
results with IVF cycles. So we can't act like that
data doesn't exist. I mean, in addition to you know,
we also know the animal meat is a carcinogen. But
when we think about what's going to be the healthiest
for you, it's going to be limiting or avoiding, you know,
animal meats. I always say freeze and vegetables are the
mainstay if you eat animal meat. Let's say you're going
(32:21):
to have meatless Monday, so you're forced to eat more
fruits and vegetables that day. You're going to then on
the other days of the week have meat one time
a day at maximum, so you can kind of choose
when that's going to be, and red meat no more
than one time a week. So we're automatically by pulling
back on animal meat, we're going to have to replace
that with lagomes, with fruits and vegetables and other sources
of both healthy proteins, nutrients, vitamins, fiber that is going
(32:45):
to decrease our insulin resistance and heal our gut in
a better way.
Speaker 2 (32:49):
And then all of the.
Speaker 3 (32:51):
Ultra processed foods, the artificial added sugars, all of the
things that are not made in nature. We know those
are not good for us. And I know we grew
up on diets like this, right, we have to acknowledge
the fact that we grew up on artificial foods. And
it's not that I woulds say it's not never. But
you know, we know if you eat more than five
fruits and vegetables today, you're going to have a higher
(33:12):
chance of getting pregnant. This is not just like theoretical data.
We actually have data saying that that is going to
be a faster path towards pregnancy.
Speaker 1 (33:22):
Okay, I want to ask you about egg freezing. I'm
really curious about this because it feels like, I don't know,
maybe ten years ago, just anecdotally, I witnessed this boom
in marketing for egg freezing and it became this really
highly you know, talked about and sought after a solution
for women who wanted to delay a pregnancy. I have
(33:44):
heard now, though, that it's not exactly all that it's
cracked up to be, and perhaps that it's not as
reliable as we once thought it was. Is that true?
What is your take on egg freezing?
Speaker 3 (33:57):
Oh? I have a lot of thoughts on egg freezing.
First of all, I think it's really important. We had
this discussion to say that ten years ago, egg freezing
was just coming off an experimental status, Meaning when I
first entered the field, we're asking us to freeze a
single cell mostly filled with water and DNA, and we
want to thought and keep all the DNA intact. And
so a decade ago we would see that only about
(34:20):
forty percent of eggs would survive the freeze though process,
making it a lot harder to do on whole scale,
to have patients pay thousands and thousands of dollars for
and outcomes.
Speaker 2 (34:31):
Really not as great.
Speaker 3 (34:32):
Subsequently, from then, the technology has improved dramatically, whereas now
in our lab, ninety five percent of eggs will survive
the free thaw. So it's just a stark difference that alone,
and improvement in technology has led to more embryologists being trained,
more labs being able to do very high quality egg freezing,
and egg freezing up today is not egg freezing that
(34:53):
it was ten years ago. It also means though that
people who maybe froze their eggs ten years ago, who
are going to use them right now, or finding out
that they didn't get the outcome they wanted, and they
are being very loud, maybe online about how negative their
experience was. And same thing true that we said earlier
about the podcast. I never want to shame somebody for
(35:13):
sharing their in of one experience. Every experience is valid,
but we'd be so careful that our singular influence could
really alienate or how it can impact somebody. I do
think there are a slew of physicians or providers who
have not properly educated their patients. And one thing that
(35:34):
I hate is seeing people say I'm going to freeze
my eggs as an insurance policy against my fertility. Right, Oh,
it's an insurance policy and I'll have those eggs there.
Speaker 2 (35:43):
False.
Speaker 3 (35:43):
Right, you get a car accident, your car insurance is
going to pay money to help you out. Egg freezing
is an investment. It is like putting money in the
stock market. Where is this usually a good thing? Yes,
But it depends on the stocks you put it in,
how much you put it in, and the environment when
you go into take the money out. And we don't
always know what the ROI on that investment is going
(36:04):
to be. But it is generally considered a good thing,
right for most people. Most of the time it will
be a beneficial thing, but not for everybody, and so
you have to understand the uncertainty of the process. The
ideal age to freeze your eggs, I always say, is
the moment you're asking the question. If you say, should
I freeze my eggs? You should go get an evaluation
(36:24):
because you don't know what you don't know. But if
we look at studies, it's going to be by about
age thirty two thirty three. If you know you like
to have children as a life goal and you are
not ready to have them yet, at thirty two thirty three,
this is the age you should go get an evaluation
and at least learn more about the process. If you're
older than that and you're listening, now, you can go now.
I have had older women freeze their eggs and still
(36:46):
have success. There's a lot of assuming that happens with
egg freezing. So simone, if you were coming to me,
you so you want to freeze your eggs, We're going
to talk it through based on your age and how
many you have. If you have a partner who you
want to have children with, just you don't want to
have children with now, well then we're going to talk
about the difference in eggs versus embryos. Right, embryos are fertilized,
(37:07):
they cost twice as much. However, you have much more
data on how many do you need and kind of
how part of the process is going to fall Because
we know not every egg will fertilize, will become an embryo,
will be genetically normal, or will implant. Human reproduction is
extremely inefficient, but I think on the whole, egg freezing
(37:28):
is a game changer. So I always encourage women if
having kids is something they think they want to do,
especially if they're getting into their thirties and they're not
yet ready. You can see a fertility doctor. You can
have initial testing done to find out how many eggs
you have, learn about what the process would be like
for you, and then you can choose whether to do
it or not. But being the one to say I
(37:49):
know this exists, I'm not just educated on social media lies,
but I understand what's going on in my body, and
now I can say I want to do this or
I don't. That puts the power in your hands versus
back to what we said earlier, having time make a
decision for you.
Speaker 1 (38:04):
Doctor Natalie as we come to the end of our conversation.
I am thinking about those listeners, those folks in our
community who have been trying to conceive for a long time,
maybe let's say twelve months, and are still not having
any luck. What would you say are the questions they
should be asking themselves as they think about next steps infertility.
Speaker 3 (38:28):
No. Number one, big hug. You are not alone. It
can feel very isolating. You can feel left behind your friends.
I understand all of those feelings.
Speaker 2 (38:37):
Look online.
Speaker 3 (38:38):
There's a huge, robust community of people sharing their experience
with infertility that can help you feel us alone.
Speaker 2 (38:46):
Number two.
Speaker 3 (38:47):
Go get an evaluation and find a fertility doctor that
you trust. And evaluation is just data. Nobody's going to
force you to do any treatment. But you can't make
decisions on data you don't know, so go and find
out what is happening. The recommendation is if you've been
trying for twelve months and you're under age thirty five,
if you're older than age thirty five, you've been trying
(39:07):
for six months, and if you're forty year older, just go.
You don't have to try for any amount of time,
and you can have fertility testing done to at least
find out if there's anything that's obviously going to be
preventing you, or what your options are based on your tests.
If you don't have a fertility doctor who you like,
or if somebody dismisses you, you feel like they're gaslighting
(39:27):
you go find somebody else. This is too important of
a thing in your life to allow yourself to have
question marks about the person who is the captain of
the ship. Right you have to know that it's somebody
you trust, somebody who will take the time to explain
things for you, answer your questions and understand. I always
say with my patients, I'm not here to make you
(39:48):
do one thing or another. I'm here to explain the
options for you, tell you what can be best. At
the end of the day, it's your journey. You're the
one making decisions, So put yourself in the best position
for success. Control the factors that you can be an
active participant in understanding why your doctor may be recommending
(40:08):
one thing over another. You know you're not alone. Like
it can be hard. The number one reason why people
drop out of fertility treatment is not financial expense or
physical stress. It's the emotional damage that fertility does and
I think that just speaks to how hard it is.
We always say in the community that it's the worst
club with the best members.
Speaker 1 (40:28):
The worst club with the best members. I love that line,
and that community is so lucky to have you as
a voice. Thank you, Doctor Natalie.
Speaker 2 (40:36):
Thank you Simon so much for having me on.
Speaker 1 (40:41):
Doctor Natalie Crawford is a nationally recognized fertility physician who
is double Board certified in obstetrics and gynecology and reproductive
and chronology and infertility. She's the co founder of Fora
Fertility in Austin, Texas, and her debut book, The Fertility Formula,
goes on pre sale July seventeenth. The bright Side is
(41:02):
a production of Hello Sunshine and iHeart Podcasts and is
executive produced by Reese Witherspoon and me Simone Boyce. Production
is by a Cast Creative Studios. Our producers are Taylor Williamson,
Adrian Bain, Abby Delk, and Darby Masters. Our production assistant
is Joya putnoy Acasts executive producers are Jenny Kaplan and
(41:23):
Emily Rudder. Maureen Polo and Reese Witherspoon are the executive
producers for Hello Sunshine. Ali Perry and Lauren Hansen are
the executive producers for iHeart Podcasts. Tim Palazzola is our showrunner.
Our theme song is by Anna Stump and Hamilton Lighthouser
Host
Simone Boyce
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Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy, Jess Hilarious, And Charlamagne Tha God!
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.