people are waiting longer to get

pregnant but if we can imagine that

there is a vault of your eggs by the

time you're born you have 1 to 2 million

in your reproductive years 300,000 this

means if you and your partner wait till

35 your chances of getting pregnant are

going to be

approximately I feel like I better get a

move on but there are things that we can

do to improve your reproduction and this

is information that nobody talks about

so let's get into it let's do it Dr

Natalie Crawford is a double certified

practicing fertility doctor helping

people to optimize their lifestyle to

improve fertility rates of infertility

are increasing one out of every eight

women would have infertility and now

it's one out of every five and there's

multiple factors that are contributing

including irregular or lack of having a

period there's more autoimmune disease

obesity chronic stress people are

waiting but at 40 your chance of

miscarriage is 50% and suddenly you're

left behind and I know that because I

had four pregnancy losses and I'm going

to cry now

lots of people will be struggling with a

variety of the things that you've talked

about what would you tell them you can't

control everything but you should be

able to control the factors you can so

what would my daily habits look like I

love that question so what have I got

misconceptions around how to increase

our odds of getting pregnant yes there's

so many myths if for female orgasms does

that increase the chance of fertility

this is super interesting and then what

is the number one thing that people

don't do that impacts their reproductive

system it seems is so straightforward

it's not a pill that you take or a major

change of behavior it is

simply we've just hit 6 million

subscribers on the dire of a CO um so me

and my team would like to do something

we've never done before as little thank

you and we're calling it The dire of a

CEO subscriber raffle and here is how it

works every episode this month we're

going to pick three current subscribers

at random and we'll send one of you a

1,000 voucher one of you tickets to come

and watch the dver SE behind the scenes

live with our team and one of you will

have a 10-minute phone call with me to

discuss what ever you want to talk about

if you're a subscriber you're in the

raffle thank you from the bottom of my

heart for allowing me to do something

that me and my team love doing so much

it is the greatest honor of my lifetime

and I hope it I hope it continues uh off

into the Future Let's get to the

episode

Natalie who are you and what is the

mission that you're on hi Stephen I am a

fertility doctor which means that I help

people

grow their family or plan for their

family no matter what that looks like

but my mission started because early in

my career I realized I was seeing people

when they were already behind the game

they didn't have the basic knowledge

about how their body worked their

hormones their reproductive system and I

had to bring them up to speed and every

time somebody said I wish I'd known this

earlier I can't believe I wasn't taught

this why isn't this the stuff that we're

taught because I might have made

different decisions earlier in my life

and that was a pivotal moment for me

about 8 years ago when I started

wondering if I could reach people

earlier in their Journey before they had

infertility before they were in my

office if maybe that could change the

trajectory of their course if they could

be more empowered with that education to

make the decisions that are right for

them versus just letting time pass which

ultimately makes some decisions for

people and when we talk about getting

started earlier and thinking about this

earlier when we we we hear the topic of

fertility I think most of us think it's

something that people over the age of 35

need to start worrying about or you know

once we get up until close to our 40s

then we need to start thinking about our

fertility more consciously but what

you're saying is is that fertility or

infertility starts much earlier in the

decisions we

make 100% if we view fertility as the

ability to get pregnant and infertility

is a disease the World Health

Organization the CDC everybody defines

infertility as a disease the inability

to get pregnant so then we can view

fertility as more of the health the

wellness State and just like we're

trying to prevent disease and other

aspects when it comes to cancer

Alzheimer's many other diseases we need

to be approaching our fertility as a

preventative action taking steps to make

sure that if having kids is one of your

life goals you're not making choices

that is going to make that impossible or

extremely difficult when you get to that

stage and what is the sort of macro

social cultural backdrop to this because

the conversation around fertility and

infertility to me and this might just be

a sort of perspective bias seems to have

suddenly increased over the last couple

of years um and I don't know whether

that's because I'm in that age range now

where my friends are having the

conversations or that I think socially

we're starting to think more about it

because there is some pretty alarming

data that's emerged around people

struggling more than ever to conceive

children because there's like social

factors at play exactly what are what is

that social backdrop so it's very

interesting when you try to put the

whole picture together one because we

are more aware of fertility we have

social media people are sharing their

stories 20 years ago you didn't know

somebody might have infertility or be

struggling similarly there was less

access to reproductive technology things

like egg freezing didn't exist you

couldn't do IVF unless you travel to a

city that had a big enough program and

so when there were limited ways to treat

something there was less access to get

into care to even be evaluated so one we

do have people more aware about their

fertility getting diagnosed earlier and

easier finding out problems sooner and

some of that is well I think all of

that's wonderful socially yes rates of

infertility are increasing we used to

say one out of every eight women would

have infertility and now in the US it's

one out of every five who's just trying

to conceive for the first time will have

infertility so that's a huge increase it

stays even when you confound studies for

age so the number one thing everybody

says is well people are waiting longer

to get pregnant which is absolutely true

I think only 5% of people started their

family overage 30 back in the 70s and

now it's 25 to 30% so we see a huge

increase and the number of people who

are waiting to start their family I did

you are especially as women are being

power to chase other dreams go to

professional school they're delaying

entry into childbearing so part of this

is that people are waiting later

diseases develop later but then also as

a society people are less healthy we see

more obesity we see more diabetes we see

more environmental toxins than we ever

have so I really think this is something

where there are multiple factors that

are all contributing to this alarming

rise of infertility that we're seeing

and are we having less sex than we used

to I think people are having less sex

yes especially as they age in the

reproductive age range it depends people

when they get married tend to be having

less sex but interestingly there's been

a really good study looking at marijuana

so we'll use it for example people who

smoke marijuana tend to get pregnant

less even though they're having more sex

than people who don't so when you say

this group's not smoking marijuana and

they're getting pregnant even though

they're having less sex than this other

group it's showing us that it's not just

timing or not having intercourse there

really are other factors at play that

are very socially acceptable that are

influencing the ability to get pregnant

I was reading through some research

earlier about fertility and the sort of

global Trends and I read this one St

that said the global fertility rate has

decreased from

4.84 live births per woman in 1950 to

2.23 in 2021 and it is expect to drop to

1.59 births per Woman by

2100 which means that we're there's

clearly a traj I mean if this is true

then there's a

trajectory to having less kids yeah in

the US it's 1.3 is the average right now

for a single woman or one person will

have on average 1.3 children that's very

alarming when you start thinking about

is that number just people are waiting

or what about all the people who just

can't get pregnant and I see those

people in my office over and over and

over again that are not able to get

pregnant even if they're starting young

so I think that we really have two

factors going into that statistic you

saw when it comes to sperm you know

study came out last year looking at

sperm counts and they've decreased 50%

in 50 years what's most alarming about

the sperm count decrease in men is that

in the past 10 years it's decreased at

Double the rate that it did the 40 years

prior so when we start looking at more

recently the rate of decline is

accelerating and that's got to be the

world around

us and you in 2020 founded the fora

Fertility clinic which is based over in

Austin how many couples women people

have you seen since you've opened that

clinic and what is the typical sort of

case study of why someone will come to

you in that clinic what are they

searching for what are they struggling

with I love that question so yes it

started fora in 2020 with my partner

Amanda Skiller and she and I have been

practicing for quite a while at this

time and realized that there wasn't an

approach at least in Austin for

personalized care because of that

probably the number one type of patient

that we see is coming in who's already

had lack of success somewhere else

meaning went to a clinic has been trying

the average patient is going to be

overage 36 has been trying for one to

two years learned about their Cycles

tracking their Cycles relatively normal

evaluation trying to do IVF and now is

not getting the result they wanted what

I find the hardest thing for people is

the isolation you're suddenly being left

behind in your friend and your peer

group when you're trying to have a child

and those in your world have succeeded

and suddenly you're left behind and the

stress and the isolation that causes

really makes the entire process so much

harder than many other medical diagnosis

that somebody might get and you give me

some more color on how that feels

because you you know how that feels I do

know how that feels so I had four

pregnancy losses before I have my two

children and this was a long time ago

and I was in the middle of training so I

was a resident and a fellow definitely

was not taking care of myself very well

because that was the life style of a

doctor in training and I didn't tell

anybody I was pregnant minus my husband

for the first three pregnancies because

people weren't sharing about their

pregnancies I had this idea I need to

wait till I'm in the safe zone I'm out

of that first trimester and so when I

started losing those pregnancies nobody

knew I was pregnant so it was so hard to

come and tell somebody that I was losing

the pregnancy when I hadn't even opened

that door to trust them with the first

piece of information it was very hard to

come in with

that subsequent request for support or

help and I just felt like that wasn't

what people were sharing or talking

about my fourth pregnancy loss was an

ectopic pregnancy which is a tubal

pregnancy so this is a pregnancy that

implants in the fallopian tube instead

of in the uterus those pregnancies

cannot grow the fallopian tube doesn't

have the blood supply to support a

placenta and the fallopian tube can

rupture and it can become a surgical

emergency in and be very scary that was

diagnosed for me when my husband was off

in a bachelor trip in Las Vegas and I

had to receive a medication in order to

try to stop the pregnancy from growing

but there was still a risk of the tube

rupturing and I was forced to call

friends have somebody come with me be

with

me and sharing it there was so much

support given that I realized that was

such a mistake of mine not that you need

to post every pregnancy announcement on

the Internet or tell everybody your job

but there are people in your life who

want to support you and they can't show

up if you don't let them know what's

going on and that's one of the things

that I tell my patients is that give the

people in your world the opportunity to

show up for you tell the people who are

asking who you turn to in other times of

Crisis tell them that you're struggling

with this let them show up and support

you because most of the time people will

they care about you and that is going to

lessen the burden because that isolating

peace the doubt and the fear especially

if you're a goal oriented person I have

set so many goals and I'm going to do

this and here's my path to do it so to

feel like I was failing at becoming a

mother when I didn't fail at anything

and now my body was failing me felt so

shameful so so much guilt and I had

nobody to share that with or to help

alleviate that burden from me you use

the word guilt there there's um complex

set of emotions that I've had described

when someone finds out that

their their pregnancy or even their sort

of their sexual organs more broadly are

struggling with something and I've got

lots of friends that have been diagnosed

with a variety of different conditions

um in that in that sort of with their

sort of sexual health and you almost

observe a feeling that they can often

feel like they are broken in some way

like they're not they're not you know

working they're like a broken

person and I I I say that to try and

highlight the fact that those that's

there's so many people going through

that exact same thing and that all of

these conditions are very um a lot of

people are struggling in Silence with

that feeling of of inadequacy you're so

right there's so much stigma to

infertility there there's so much

misinformation and uncertainty when it

comes to reproductive Health together

that makes it difficult for people to

talk about or ask questions and when you

feel like one of the things that you

always thought was certain about your

future if you were a child and you

envisioned your life 30 years from there

something if you envisioned having

children and suddenly you're faced with

the potential reality that that might

not happen or it might not happen

without

intervention that really crashes down a

piece of your own identity and and who

you saw yourself to be who you wanted to

be and trying to struggle with that true

identity crisis at that moment really

brings out so many emotions it's what so

many of the people who sit across from

me every day say I just I don't feel

like myself I feel like I'm stuck while

everybody else is moving on because I'm

broken my body is failing me it's so

hard to watch somebody go through it and

even if I can't get everybody pregnant

or control the outcome the thing that I

always say is that at a minimum you need

to understand how your body works at a

minimum you can know that you're making

the choices that are right for you you

can feel good that you did everything

that you could and that there wasn't

education you needed or choices you

would have made looking back in the

rearview mirror and even when somebody's

deep in the midst of failed IVF Cycles

or sitting across from me

I say the same thing that's that's our

minimum you deserve to understand why

we're making the choices so that this

can be a process where you can advocate

for your care and we can collaboratively

do everything we can to try to achieve

this goal for you I had um got a good

friend who's just um because OB I'm at

the age now where my friendship cycle is

starting to go and get fertility tests

done and such and they're trying for

kids many of them are have been very

successful but I've got one particular

friend who has been trying for some time

they're struggling so they went and got

the the tests done and it turns out that

one of them in that relationship has

some has some issues which are

complicating their chances of getting

pregnant and when I heard that God I

can't imagine how that person feels in

that relationship because it I can

imagine in your head how you can start

to overthink and you can feel that word

again that word guilt towards your

partner and you can start thinking oh my

God this person's going to leave me

because I can't give them what they want

and all of that sort of complex those

complex slightly irrational but

completely understandable

thoughts the relationship aspect is so

hard even going through it myself

because my husband wanted to support me

and of course he did but I felt like I

was the one failing not him right I'm

the one who's not bringing my aame to

the table this is a me problem and even

though it's an us problem it felt like a

me problem to the point where

I really try to level the playing field

to all of my patients at least when I

see them and say it's the two of you

you're a team this is a team it doesn't

matter whose diagnosis comes back as

what we are trying to get us pregnant

and really reframe everything that way I

have a patient story from the Past who

had been going through infertility been

going through IVF because she found out

she was running out of eggs early and

she had taken a lot of blame for not

freezing her eggs earlier for waiting

longer and going through

IVF her

husband turns out his sperm wasn't

functioning the way that it should and

we didn't know that until you fertilize

the eggs with it and really see how

embryos grow in the

lab and she said to me at our follow-up

visit even though the outcome of that

cycle was devastating to have no embryos

developed because they found this sperm

issue it improved their marriage so much

because For the First

Time her partner and her they felt like

they were on even playing field that

they were both part of the reason they

were in this situation and whether it

was imposed by him or not she had

carried that guilt that shame that

broken feeling alone like it was just

her so let's get into it then let's do

it let's talk about fertility where do

we need to start I was going to assume

where I need to start here but I'm an

absolute muggle and idiot as it relates

to fertility and female and male

reproductive health so where do we start

if we want to understand fertility I

always like to start with the ovary and

understanding the difference in eggs and

sperm so we'll do sperm first and we'll

do eggs okay do you know how many sperm

you make in a day do I know uh how about

how many you make in a

second no I have no idea the average man

makes 200 to 300 million sperm in a day

and 1,500 sperm a second so men 1500 a

second you're just

like so men in their testes have germ

cells meaning they can just produce

brand new sperm at very high rates every

single day and in the ovary for women

it's so different because you are born

with all the eggs you're ever going to

have and you run out of them over time

and this means that one the number of

eggs you have raining is a part of the

picture and two your eggs sit inside

your body and they absorb the wear and

The Tear and the world around you your

whole life where your sperm lifespan is

90 days takes 72 days for a sperm to

grow across the testicle and then 18

days to get out the ejaculatory system

so you have three months so you could

change your life and change your sperm

counts in three months why does it take

18 days I thought if in my little idiot

head I thought that I make my sperm okay

today and then if I ejaculate that's the

sperm out no yeah those sperm those

sperm were made a couple months ago

really yeah they're like in storage

lockers so that you have some for every

day so they kind of get put in line so

that you can send them out at that right

time

period okay so but if you ejaculate

multiple times eventually you can't keep

producing more but so let's imagine that

you have lockers and we'll just pretend

that there's 200 million sperm in each

one if you ejaculate every single day

you're ejaculating 200 million sperm

each time now if you're saving up for a

couple days you're going to ejaculate

400 million and now if you've waited

three days 600 million the catch here is

sperm are so fragile they're so fragile

they like to die they get tadp oh those

little tadpoles so if you wait too long

you're just going to have a bunch of

dead guys and then they're going to

impair the ability of the better sperm

to even function and I use the analogy

of imagining that this is a Highway and

the dead sperm are stalled cars all over

the freeway even if your sperm counts

normal if you're having very long

abstinence periods in between your

intercourse times you're going to have a

sample that has so much debris and dead

sperm in it that it's going to make it

hard for the good guys to do their job

okay so there is so you do need to keep

ejaculating to remain to optimize your

fertility your chances of fertilizing an

egg yes oh I didn't know that and how

often G I always say it's going to

there's a fine balance here somewhere

between every day to every 3 to four

days is going to be the best whether

that is ejaculation in any form what

whatever suits your fancy we see that

longer than seven days for the most for

most people will severely increase the

amount of debris that you see and the

proportion of the ejaculate that is dead

sperm super interesting so let's go

we'll stay at the the foundations we're

talking about sperm and eggs so is that

sperm covered off is there okay and

sperm counts as you said earlier have

been reducing over the last 50 years by

50% which is horrifying um why is there

something in particular in our

environment that's causing that it's all

the things and some of them are

changeable and some of them are not so

we have to view the world as it is

certainly we see we've got more men who

are unhealthy who are overweight who

have other medical comorbidities that

are also impacting their ability to make

sperm like if you have high cholesterol

if you have diabetes some of those

things are going to impact your overall

health and the production of sperm so

this goes for sperm or egg the hormone

access from the brain to your gonad your

gonads are either your testes or your

ovaries your brain is constantly

interpreting signals from your whole

body and is trying to determine can

stepen have a kid right now and if you

become very stressed now back in the day

what was that there was a bear attacking

you there was a famine so you had no

food there was a plague going around

then it say this is not a good time to

have a child right now because because

you can't support your own body or the

world around you your adrenal glands are

making cortisol because it's so

stressful or your calorie intake went

down so your brain says this is too

difficult I'm going going to shut off

the system to make reproductive hormones

and that happens in both men and it can

happen in women so the brain is

constantly interpreting the world around

you and then sending out signals to make

eggs or sperm like to make eggs grow or

to be making sperm and the hormones that

are associated with them so estrogen and

progesterone for women and testosterone

for men and so one we have anything that

interferes with this pathway people are

more ill there's more autoimmune disease

more

inflammation there's more stress chronic

stress there's more obesity but then we

also see the environmental impact as

well so

certainly there's so many toxins in our

world from the foods we eat from the air

we breathe from the type of you know

kitchen wear that we use what we put in

and on our body all of it makes a little

bit of a difference and we know some

people if you live in an area with high

pollution you're going to have lower

sperm counts and a reduced fertility

rate but that might not be something you

can change because that's where you live

but it might be even more important for

that person to understand it and then

want to not also smoke marijuana or

drink out of plastics or do other things

that might be adding to that burden so

smoking marijuana and smoking cigarettes

are no NOS if I absolute no no know so I

think cigarettes most people are pretty

aware cigarettes are pretty bad for your

health if we talk about reproductive

Health in general cigarette smoking for

for women and your eggs are going to

decrease your egg count your egg quality

and the rate of miscarriage

significantly significantly for men what

we see is it decreases your sperm count

your sperm motility and the quality the

shape of the sperm also increasing

miscarriage marijuana does this as well

if you smoke marijuana even if your

partner does not and is never around you

when you're using it she has a higher

chance of a miscarriage just because

you're smoking marijuana how because of

DNA damage inside the sperm's head okay

I'm giving out bad sperm you're giving

out bad sperm what about vaping we don't

know as much about vaping but it appears

in all the preliminary studies to be

similarly very bad that what is in um

what you're breathing with vaping

might even be more harmful than

cigarettes

potentially what about phones and

laptops oh I love this one okay so

that's a great question and people ask

about it two ways to look at it there

was a study that was published last year

that actually looked at this and we'll

talk about just having your phone using

your phone and then location of the

phone in the study what they looked at

is phone usage from 2005 to 2018 so we

have to remember in 2005 phones were

different it wasn't quite the same but

they had a much higher uh radiation

emitted from them so modern phones

actually emit much less radiation so

even though we keep them on our person

they're ultimately safer than what we

saw as origin phones from 2005 to 2010

in this study that they looked at the

number of times that you used your phone

which is wild to us because we use our

phone constantly now but the number of

times you use your phone the more you

used it the less firm you

made okay

however that was most impactful for the

early generation phones from 2005 to

2010 so when they stratified and looked

at some of the phones we have now we're

not seeing that same impact and I think

that is because there's less radiation

and also everybody uses their phone more

than 20 times per day right you're using

it all the time location didn't matter

there was no difference of location

whether you kept your phone in your

pocket your back pocket the counter off

your body there was no difference so I

think that helps us understand some of

the radiation aspect of the phone and if

that is impacting sperm heat of the

testicle is of course something very

very different I do think you talked to

Reena about this so when it comes to the

testicles they live outside your body

for a reason we know that men who have

an undescended testicle even if it's

surgically removed sorry what's an

undescended testicle you can be born

with one of your testicles in your

abdomen instead of in your scrotum okay

and that's usually surgically corrected

before the age of one because if it

stays internally the heat of the body is

too hot and it destroys the cells the

inability to make sperm inability to

make testosterone so the testicle is

outside the body in the scrotum so that

it can be kept at a lower body

temperature we know that things that

increase the temperature of the scrotum

do impact sperm production and

testosterone production testosterone and

sperm are made together so one thing is

going to influence one it will influence

the other this is sauna use every day

hot tub use every day laptop in your lap

if you are putting your phone

exactly by your scrotum every single day

then it might be having an impact if

it's heating up and it's the heat that's

causing the problem not the radiation

that's being emitted from it so we

always are asking if I see somebody for

infertility I'm going through any

behaviors that are significantly

increasing the temperature of the

scrotum to see if that is a modifiable

factor what about hot baths if we're

having lots of hot baths if it's daily

and you sit in there for you know more

than 15 minutes then I would cut that

down to not be daily I see this a lot in

Austin from people who love to cycle so

they're on a bike they're outside they

want to go ride for two to three hours

at a time time numerous times a week

that's a lot of

heat contained right to the scrotum area

and we often see significantly lower

sperm counts in men who cycle at that

intense

level interesting right very

interesting um what about trt you talked

about the the correlation there and the

relationship between sperm and um

testosterone levels if Men start taking

trt which is hormone replacement

therapies testosterone repl therapy um

does that impact the quality of my sperm

and my chances of fertility stepen at

least one time per week I will see a

couple who comes into my office who has

been trying to get pregnant and the male

partner went to a Hormone Clinic a men's

health and he was put on trt for libido

or fatigue or something and essentially

that is male birth control because

taking testosterone yourself is telling

your brain that there is testosterone

present because naturally testosterone

is made as sperm is made if your brain

thinks there's a lot of testosterone it

says hey we don't need to make much more

we're doing really good so the hormones

from your brain stop being sent out and

no longer tell your testicle to make any

more testosterone or any more sperm so

trt use makes men aspermic meaning

having no sperm in the ejaculate you

still have an ejaculate it looks the

same to you but when we go look at it

under the microscope there's no sperm in

it sometimes that is irreversible the

longer you've taken trt for there is a

chance that I might not be able to get

sperm to return to your ejaculate it

might be permanent let's talk about eggs

let's talk about eggs you have this um

wonderful example where I guess it's a

bit of an analogy called The Vault yes

I've got um some marbles over here in a

jar which I thought would um help us to

visualize this idea of a vault so I've

put about I don't know there looks like

there's about how many marbles do you

reckon there're in there if you uh get

it right you win the whole lot uh 200

marbles 200 I'm going to say we'll count

after um well now you're counting that's

different than guessing no no no no I'm

not I'm not just go on have a guess how

many marbles are in there we'll count

after see who's right okay I said 200

okay anyone in the comment section below

Al so you can you guys can also guess

don't cheat don't skip to the end I

think there's about

he is counting that is not I can't count

them all can I cuz I can't see them all

seven times nobody else can see them all

and count them 140 okay this is the

analogy I'm going to pass them over to

you um I'd love you to use this as an a

visual aid to explain to me this idea of

the vault as a as a way to understand

how many eggs women have and how that

changes over the course of Our Lives

love it all right so I like to think

about the ovary as inside your ovary if

we can imagine that there is a vault of

your eggs so that is what this jar is

representing so again in contrast in men

testes are making brand new sperm every

single day in women when you are a five

Monon baby inside your mother's womb you

have the most eggs you're ever going to

have you have six to seven million eggs

by the time you're born you have 1 to

two million by the time you start

puberty you have half a million your

reproductive years you're going to start

with about

300,000 and by the time you go in to

menopause you'll have less than a

thousand left so you still have a few

eggs left women only ovulate about 400

to 500 eggs over the course of their

lifetime so if you're born with 1 to two

million and you only ovulate 400 to 500

that seems like confusing math so the

way that I think about it is that every

single month you are losing eggs from

this Vault and what is happening is that

the eggs are coming out in proportion to

how many are inside so when the vault is

more full more eggs come out that month

and when the vault is less full less

eggs come out so if we can imagine one

month you're going to have a group of

eggs all come out of the Vault and so if

this is our ovary what we would imagine

is that the Vault sent out all of these

small eggs and each egg grows inside a

follicle the brain is going to send out

follicle stimulating hormone once you

start puberty so before puberty all of

these eggs are just going to die after

that month is over but once you've

started puberty FSH so follicle

stimulating hormone from the brain will

come and stimulate one of these eggs why

only one because humans are not meant to

have litters you can only carry one

child at a time in our uterus so this is

the protective mechanism by which humans

don't have multiple children most of the

time so each egg grows inside what we

call a small follicle so the brain sends

out follicle stimulating hormone

this is one of the rare times where in

medicine hormones are named for what

they do in women not men because you

have FSH and lh2 FSH controls the

production of sperm for you and LH the

production of testosterone but for women

FSH controls the stimulation of one

follicle so this follicle will grow and

this one will ovulate and the rest of

them will die so that's one of the 400

that I'm going to lose these just go

away I want to make sure I understand

this so in the J

is the Vault that's inside the woman y

um at every month this is what's

available this month okay she produces

quite a few like when you're younger

yeah CU there's more in my jar

proportionately there's like okay

there's 20 or 30 and they're

proportionately to a jar that has 200

these numbers aren't obviously ratioed

but and then one of them is basically

selected to ovulate at random at random

so it's one of the great Mysteries if we

could control which one because it

doesn't have any more likelihood to be

genetically normal or good just because

it responds so what is interesting when

we think about this vault is as we said

when we have less eggs less are coming

out every month so you're going to start

to dump out less

eggs and the jar gets emptier what age

was I then and what age am I now so we

can say that you you know were 30 at one

point and now we're starting to get to

about age 34 at this point okay what

starts to happen just for numbers so at

age 30 you're going to have about 20

eggs come out of the Vault every month

one EG will ovulate 19 will die next

month another group okay when you get to

about 35 you're going to have about 14

to 15 so still pretty close when you get

to 40 it'll be about 8 to 10 per month

44 closer to three to four per month so

you start to see that after age 37

specifically a more rapid decline in how

many eggs are remaining therefore less

are coming out every month this idea is

really for two reasons one is that all

women run out of eggs when you run out

of eggs you're an ovarian failure also

known as menopause average age of

menopause is 51 to 52 I've seen somebody

have menopause at age 13 so I've seen

primary amenorrhea where somebody was

born with ovaries that never made

follicles I've had women who had their

periods and then they ran out of eggs in

their 20s so some people are on

different Pathways now maybe they were

born with less maybe something happened

to them along the way to make them run

out of them faster so certain things can

get in the vault and impact our ultimate

egg count so as we already said smoking

cigarettes marijuana use endometriosis

which we haven't touched on quite yet

but we will

chemotherapy environmental toxins so

certain things can get in here and make

us run out of eggs faster

what's also important to understand is

that the eggs that are out in one month

are all the eggs we have to work with so

when we start talking about egg freezing

or IVF I can only get the eggs that have

been sent out of the vault in that month

to grow I cannot tap into the Vault and

this is why if you've had friends go

through IVF or egg freezing and it

sounds random somebody got six eggs and

somebody had 24 somebody had to do

multiple Cycles or months sometimes in

order to help somebody get enough eggs

to have a normal embryo what we have to

do is multiple months so the 10 eggs

that are available this month I'm going

to get them all to grow not just the one

you are normally going to ovulate take

those eggs out of the body and then next

month when your body gives me another

group of 10 I'm going to get them all to

grow again and take those eggs out of

the body that is ovarian stimulation for

for either egg freezing or IVF trying to

say hey in this month I don't want to

let any of these eggs die because I need

more of them to get the job done or

we're running out of time and I'm trying

to expedite your opportunity for

conception so women have this decline in

the total number of eggs you're going to

have when you're 37 I think the number

is that you have close to 20,000 eggs

remaining so what a huge drop from when

you started puberty at half million so

it's just going down so fast every

single month what is also happening is

that because these this vaults inside

our

body when you smoke the cigarettes when

you eat processed foods when you get

sick if you have chronic inflammation

you're losing some but the ones that are

here at the bottom they've been here the

whole

time and so in addition to number of

eggs we have to talk about the quality

of the eggs because these

eggs down here at the bottom once you

get older they've been sitting here a

long time and that means that their

chromosomes inside of them are much more

likely to be abnormal than normal and

that's really the rate limiting step in

people getting pregnant when they're

older not that my vault is more empty

not that I'm sending out less per month

but that the ones that have been sitting

here have have been sitting here longer

and

they aren't as good I I use the analogy

for the chromosomes so if we

imagine your eggs hold your chromosomes

in perfect position so that they're

ready to then go be fertilized by sperm

it is like having kindergarteners stand

in a line for 40 years somebody's going

get out of line and when that happens

that increases the rate of genetic

abnormalities and most of those do not

fertilize do not implant or misc carry

at age 40 if you see a positive

pregnancy test your chance of

miscarriage is

50% because they've been sitting here

even if you're very healthy just time

and normal life impacts things but

there's choices you make that cause them

to degrade faster and there's things

that you do that might be protective and

that is something that we don't ever

talk about we when you're 35 your chance

of miscarriage is 25% so there's a huge

change that happens between AG 35 and

age 40 when you're 35 and you start

trying to get pregnant so if you and

your partner wait and you say

everything's good we're going to wait

till we're 35 your chances of getting

pregnant per month are going to be

approximately 10 to 15% per month that's

not not very high it's not great not

great at 40 it's about 5% per month so

we've dropped dramatically and just see

the positive test and then if you see it

50% are abnormal so the odds of the body

is going to choose from the eggs that

are sent out that one month when you're

40 the odds

that your body is going to choose one of

the two eggs that is genetically normal

because six of them are abnormal it's

not very probable so most months your

body's ovulating one that's not going to

have the potential to become a liveborn

baby I feel like I better get a move on

Jesus Christ it's not information to

scare people but it is information that

nobody talks about well as you were sat

here talking to me about this the

opposite of

confronting the truth is Regret yes and

I can't imagine how much regret you've

seen I wanted to ask you about about

that regret because you must have to

deliver so much bad news to people and

you must see

the retrospective Clarity that those

people suddenly get when they realize

that those decisions they could have

made

earlier especially

for people who are not used to not being

in control of things and who just didn't

have the data they needed to make the

decision there are people who have been

with their partner for very long time

and maybe kids weren't in the plan

earlier but they could have been had

they known that it would have been so

hard or potentially impossible later on

one thing that I think is important to

discuss here when it comes to regret is

testing female fertility because there

is a marker of how many eggs do you have

we call this your ovarian reserve how

many eggs are left in the vault and one

way you can test this is with a blood

test called amh or antim malarian

hormone and the other way is to do an

ultrasound and see how many eggs are

outside the vault at that month so both

of these are actually quite important

when you're thinking about how many eggs

somebody

has that number does not impact you

getting pregnant in one month and I

think that that's important because if

you

have we'll use a whole group you could

have a whole group of eggs or you could

have less how many eggs is your body

ovulating in each group so this

person crazy this person who has more is

ovulating one this person who has left

is ovulating

one so if I have two people who are the

same age and they have different ovarian

reserves meaning they have a different

number of eggs left in their vault

they're going to send out a different

number of eggs each month how many eggs

are they ovulating each

month one one yes look at me learning

look at you so they're each going to

ovulate one egg so what are their

chances of getting

pregnant the same the same so having a

lower egg count does not impact your

monthly chance of getting pregnant

that's determined by age by the

proportion of these eggs that are normal

or abnormal however if you have fewer

eggs there's fewer that I can get to

grow with IVF and you have overall less

of an opportunity to grow your family

this is important because a lot of

societies will tell people not to check

somebody's ovarian reserve and this

blows my mind I have a really hard time

with this because they say if it doesn't

impact your monthly chance of pregnancy

having a low ovarian reserve is only

going to cause undue stress so the

American College of OBGYN recommends not

checking an amh level in women who are

not trying to get pregnant and who are

not having

infertility I completely disagree with

this because you can't make decisions on

data you don't know

and if you know you're running out of

eggs faster you very well might make

different decisions you might freeze

your eggs you might try to get pregnant

sooner you might try to just be

healthier if you are doing behaviors

that you know are decreasing your egg

count you might stop smoking pot but if

you're never giving that opportunity

you're going to live in the regret

category where when you find that out

later I wish I'd known this earlier I

wish I'd been able to make a choice when

I had the opportunity and I had the eggs

remaining and so by not testing by not

knowing we are hurting more women and I

always tell my obgy and friends this

conversation should be hand inand with

Stephen are you'all trying to get

pregnant yes or no no what birth control

might you want let's talk about it oh

should we check your ovarian reserve to

make sure that your time is okay again

having a good account does doesn't mean

you're going to get pregnant your chance

is the same however it means you have

more opportunity of time to try to grow

that family and ultimately a greater

chance of success when it comes to IVF

or egg freezing because the factors that

determine success are how many eggs you

have and how many are normal a lot of

people do ask that question they ask um

you know they'll say things like well my

parents didn't have to worry about this

or my grandparents didn't have to worry

about getting checked and seeing how big

my ovarian reserve is so you know why do

we have to all start doing that

now we know a lot more now and I think

the honest answer here is that one way

to look at this is that when I was your

age egg freezing didn't exist so I could

not have Frozen my eggs and my early 30s

had I wanted to meaning would you check

it if you really can't offer somebody

things to intervene or way to make a

change however now we know factors that

impact how many eggs you have

and we have the ability to freeze eggs

with very high success rates now it's

accessible in almost all fertility

clinics with really great egg

survival so this poses the question of

should you know earlier we also have

Generations where people are curious and

they see things online they're not

afraid of scary health information

instead younger Generations want to

understand their bodies and I love that

but there's so much misinformation

online too that it's really saying that

this is personal we can talk about eggs

and ofal every single day but until

somebody comes in to my office or

somebody else's office to get their own

evaluation done they're not going to

have the true data they need to make

that decision but I think it's great

that we are approaching fertility as a

health marker trying to look for signs

earlier that things might be wrong

especially given the opportunity to try

to intervene if you find out your sperm

counts lower we might be able to try

interventions for 3 to six months and

see if we can get a new group of sperm

that potentially has fixed that

problem so say I'm starting out in life

with a full ovarian reserve or say you

know here's my ovarian reserve at say 20

years old if I start engaging in

unhealthy lifestyle choices if I start

eating process food if I become obese

Etc does that take marbles out of this

jar does that take eggs out of my

Reserve or does that just damage the

quality of the eggs in the jar both both

okay so it pulls them out and it makes

them less effective the way I think

about it is not that it's pulling them

out giving them an opportunity but

essentially let's imagine it's getting

you smoke cigarettes the cigarette smoke

is getting inside the Vault it is

damaging the DNA and some of your eggs

but it's also just killing some of them

inside the Vault themselves so that you

are running out inside the vault

ultimately people who smoke cigarettes

go into menopause years earlier than the

average age really because they have had

a destruction of the eggs inside their

vault if I wanted to make sure that my

ovarian reserve was 10 out of 10 you

know I did if I was to live a perfect

life in terms of what my aarian Reserve

needs to be healthy how would I live

what what what would my daily habits

look like that's a great question I love

it so what can you try to do because you

can't control everything but you should

be able control the factors you can so

number one we're going to say avoid

toxic behaviors so toxic behaviors

that's going to be your cigarettes your

marijana cocaine you're going to H not

have any alcohol definitely alcohol

especially in proportion is showing an

increased risk of damage so a drink here

or there like that's not studied as well

but we know moderate to high drinking

levels is associated with reduced egg

quality what's moderate to usually

considered four drinks a week four

drinks a week so if I have four glasses

of champagne a week yep so you have four

glasses tonight at dinner you've hit

moderate that is I mean most people

especially in Britain oh well here too

and I mean honestly with Co especially

we saw so many people increase their

drinking substantially so you would

limit the toxic behaviors number two is

you're going to limit the toxins in your

world that you can again if you live in

an area

that is a high pollution area that just

might be where you live but you should

not cook in plastic put plastic in the

microwave or the dishwasher you

shouldn't use teflon on your pans you

shouldn't touch thermal paper receipts

like at the airport if they print off a

ticket for you or a receipt from the

grocery store that has chemicals in it

itself takeout food so when you order

your takeout food and it comes to you

and it sits in the containers that it

comes in if you're not eating it right

away or even when you do eat it you

should take it out of that container and

put it in something else put it in glass

put it on a plate because especially

with heat we see leeching of those toxic

chemicals into the food and then you're

consuming the food even if it's high

quality good food it now has absorbed

chemicals from the packaging that it was

in so microwave meals in plastic you

know you take the plastic and you

microwave it shouldn't do

it how do we we know this have they have

they done research on this or is this

just so there is research done on it

it's always hard to study lifestyle

factors in humans and when it comes to

fertility because what is the outcome is

it the positive pregnancy test the

having the baby the absence of getting

pregnant that your regular Cycles

there's so many different variables you

can look at at an endpoint a lot of the

environmental chemical studies are done

on animal studies looking at some of

these chemicals but also we can see in

populationbased studies we do have now

where they've done cohort studies mean

they take a group of people and they

follow them for years taking blood and

urine samples to measure some of these

chemicals and then watching what's

happening with their normal behavior no

intervention are they getting pregnant

when they're trying to or are they not

and we see that greater exposure to

these known toxic chemicals are making

it harder for people to get

pregnant when it comes to other factors

to try to have your healthiest Vault

possible decreasing inflammation is

going to be very important so we think

about inflammation and there's two types

so you have acute inflammation you cut

your arm and it's going to react and

heal and that's a normal bodily process

but then you have chronic inflammation

where your body is constantly spending

its energy fighting that inflammatory

State and that inflammation markers the

prostaglandins the factors in your body

that get really high

that's actually pretty toxic to our

quality as well and that can be disease

States as well so things like

endometriosis or other inflammatory or

autoimmune diseases what um what ways do

we voluntarily increase our inflammation

is that dietary predominantly yes so

number one is going to be not sleeping

enough so sleep is when your body heals

sleep is when your cells repair their

damage so you need to get S and a half

to eight hours of sleep per night I

heard you say in a sleep is probably the

number one thing that people don't do

that does impact their reproductive

hormone

system yes it seems so straightforward

to say it's not a pill that you take it

is not a major change of behavior it's

not missing out on something in your

life it is simply giving your body the

time that it needs to heal from the

normal inflammation that you're going to

encounter during the day simply

prioritizing getting enough sleep is the

simplest things somebody can do to try

to improve their reproduction and how

their hormones are made and

interpreted we talked about stress

earlier stress impacts the brain in a

similar way there's different types of

stressors very similarly you have your

acute stressor the bear you have the

stress of everyday life and modern world

is a lot more stressful in a lot of

different ways

constantly we also see that that stress

is so individualized so it's not like I

can say you need to go to yoga or you

need to do acupuncture or you need to go

to therapy I tell my patients for stress

reduction understanding that having a

constantly stressed State constantly may

have having cortisol be made is not

going to allow your brain to in to

interpret the other signals that are

being sent it's clouding its judgment

and it's going to think that you're not

at a place to maybe support a pregnancy

and your reproductive hormones are going

to show for that what that comes down to

is that you've got to modify stress in

some way for you so everybody's

different and maybe it is acupuncture

maybe it is Yoga I I like to sit on the

back porch in the morning hours with a

cup of coffee and hear the birds people

like to go on walks therapy mindfulness

meditation journaling everybody's

different but you deserve taking 20

minutes every day and dedicating it to

something that doesn't have your iPad

your cell phone your computer the TV and

putting yourself in an environment where

you can

say like have that feeling of release

you get when your cortisol drops that's

important so that your body can then

properly respond when you do have a

stressful situation and can allow you to

heal not be under a constant attack

diet's going to be one of the hugest

things that people can make a change in

processed foods refined sugar processed

Meats those are not natural foods and

those are things that come with a lot of

chemicals inside of them a lot of

contaminants we know that processed

Meats for example type 1 carcinogens all

these sugars have a direct correlation

with somebody's ability to get pregnant

when it comes to the direct cause it's

usually going to be sperm quality or egg

quality depending on the study looked at

what about red meat oh I love that

question number one I think it's really

important that nutritional studies

people qualify meat differently so it

might be all meat it might be types of

meat so we have to take it with a in

perspective of the limitation of the

data we know that process Meats impact

fertility we know that red meats appear

to impact both sperm production and egg

and embryo quality there was an IVF

study done and the more servings of red

meat you had in a week the

less embryos you had developed

throughout the process than somebody who

had fewer servings

so that's telling us that

it's maybe not one red meat in general

is bad one serving but it's about the

amount right everything in moderation

nothing in excess we know that the

healthiest fertility diet high in fruits

and vegetables fruits and vegetables are

fiber sources they are antioxidants they

are helping our body function

appropriately they're helping our gut

function they are lowering inflammation

I say meat is okay I don't eat meat but

that doesn't mean that none of my

patients should eat meat I give them

this diet because I think you have to

make dietary change accessible if I told

everybody stop eating meat nobody's

going to listen to anything but we know

that it's the amount the quantity so I

say if you're going to eat an omnivore

diet which is going to be the majority

of people have a meatless Monday

meatless Monday you automatically can do

and you're going to have to substitute

in some of those other sources of

protein that are ultimately better for

you fish fish is great we should limit

fish to three times per week just due to

risk of mercury but fish is a wonderful

option it does have a lot of good

omega-3 fatty acids in it and ultimately

eating more fish and less red meat is

such a great substitute what about

skimmed milk and fertility I heard uh

I've heard you speak a little bit about

that past so what's interesting and I

think that we've grown up in this you

know fat obsessed culture that has

prioritized lowfat no fat foods and

number one

fat is important in the production of

steroid hormones estrogen progesterone

testosterone are steroid hormones so

they need cholesterol the source of that

cholesterol is important so we should

have those healthy fats the nuts the

avocados the oils fantastic healthy fats

are wonderful but when it comes to Dairy

we've seen that whole fat Dairy is

associated with better fertility better

ovulation than the skim dairy products

probably due to the processing if we

View skim milk as the processed version

if I'm going to take out the fat that

normally comes in the milk but still

want it to retain looking like milk it's

not just minus fat right it's minus fat

plus something else so in the production

process it's that or it's potentially

that the only benefit the dairy really

has is being a source of a healthy fat

option and that when you take out that

fat you lose that so I recommend that if

you consume Dairy

that you stick with the whole fat

versions you don't do skim or lowfat and

in moderation for for dairy consumption

I say that if you do meatless Monday the

rest of your meals for the week you

should have one serving a meat per day

that's going to make you just force you

to eat more fruits and vegetables and

then one of those meals you should have

red meat if you like red meat not

multiple times a week and then you

should limit processed foods

sugars processed Meats all those refined

carbohydrates all the packaged things

that are totally fake that should be

very rare those are your if occasion

type of foods not your everyday Foods um

the other thing we didn't talk about

regarding lifestyle choices is exercise

oh yes now there's kind of two schools

of thought here because I have some

friends who exercise a lot and they have

seen a

disregulated menstrual cycle yes all

their periods have completely stopped um

but I also read that exercise is good

for

fertility this is a great opportunity to

just think about how the ovaries work

like we've talked about having your eggs

but if we think about in a given month

you have that group of eggs that comes

out of the Vault each eggs in the

follicle we already said FS or follicle

stimulating hormone is the hormone from

the brain that goes and stimulates that

one egg to grow as that egg grows the

follicles growing and making estrogen

that process takes approximately two

weeks in the majority of women and when

you're estrogen level gets high enough

it tells the brain you have a mature egg

your brain doesn't know what's happening

in your ovary it can't see I always say

it's like having your best friend who

doesn't go on Instagram they have no

idea what's happening in your life

unless you tell them so the only way

that the ovary communicates with the

brain is actually through the production

of hormones so as that one follicle is

starting to grow it is making estrogen

and that estrogen is then telling our

brain we have a follicle growing that

follicle then is going to open up it

bursts it ruptures and what's a follicle

sorry oh a follicle is if we can imagine

this is a follicle the egg is

microscopic inside of it it is the fluid

filed structure that keeps your egg so

for people that are are just listening

and not can't see yes you're holding one

of the little eggs in your a marble I'm

holding a marble so if we can imagine a

follicle is a small fluid filed

structure in which the egg is kept okay

so the eggs inside the follicle exactly

and so the follicle gets bigger as the

egg gets more mature sure it makes more

estrogen that estrogen at a high enough

level and it's very specific 200 PS for

50 hours tells the brain you have a

mature egg the brain will then send out

LH or lutenizing hormone it allows that

follicle to open up then the egg is

going to be released and hopefully get

captured by the fallopian tube so it'll

be sucked up into the fallopian tube but

that fle reforms so the egg is gone the

follicle reforms and it becomes a cyst

in your ovary called the Corpus ludum

and it is now stimulated by LH from the

brain telling it to make progesterone

okay and what am I going to do with the

progesterone progesterone opens and

closes the implantation window without

progesterone a pregnancy cannot implant

into the uterus so this progesterone is

going to allow your body to have that

egg if it becomes fertilized and

develops into an embryo the egg gets

fertilized in your fallopian tube it has

to grow and develop into a stage of an

embryo so the SP comes along sperm swim

through the uterus into the tubes and

that's where fertilization happens okay

so the sperm comes through the fallopian

tube it meets the egg which is chilling

there chilling there and then what

happens then well hopefully

fertilization happen which is like the

sperm which is like the tadpole's head

hits the egg it's the egg it actually

has a little fusion reaction and pushes

its DNA in there pretty cool it then has

to grow and develop so you have a single

cell egg a single cell sperm they come

together you have two different DNA

components and then you start seeing

cell division just like you would expect

exponentially two cells four cells eight

cells 16 cells into the point where on

day five or six that embryo is now a

what we call a blasticus it's 300ish

cells and it is now at the stage where

it can implant into the uterus what is

so interesting is

that most your eggs are never going to

fertilize they're not going to grow

appropriately they're not going to get

into that uterus but what's so important

is that if an egg is coming in or the

embryo is coming in and there's not just

the right amount of progesterone it

cannot implant that's really important

because that's the mechanism behind a

lot of birth control but when you think

about progesterone starts being made

from this Corpus ludum perfectly timed

after you ovulate to open and close that

implantation window so that when the

embryo gets there it's ready and if the

embryo doesn't implant hangs out too

long it's going to close the Corpus

ludum only lasts for 2 weeks if it is

not supported by a pregnancy meaning if

we pretend this month you don't get

pregnant you're just having natural

periods then the Corpus ludum after two

weeks it

dies your progesterone levels are going

to drop and that's the signal to your

uterus to shed the lining in preparation

for the new group of eggs that's your

body saying we did not get pregnant this

month let's try again when a pregnancy

implants that embryo makes a hormone

called HCG which is what we check on a

pregnancy test and HCG can stimulate the

Corpus ludum to keep making progesterone

and that is what allows you to sustain

an early pregnancy until there's a

placenta the point of thinking about

that which there's a lot to go into

about optimizing intercourse and trying

to get pregnant is that things that

disrupt the brain's interpretation of

estrogen is going to impact your ability

to sense ovulation or to ovulate and

going to lead to menstrual

irregularities or absent periods like

you mentioned in some of your friends

who exercise maybe more frequently so on

one end of the spectrum if you are

intensely exercising you're training for

the Olympics you're an elite athlete

your body is going to stop sending out

FSH and LH altogether it is going to say

that the calories you're receiving to

the energy you're expending do not match

up and you cannot support being pregnant

with another human so it is going to

stop the production of FSH and LH and

you're not going to ovulate you're

probably fine because you're training

for the Olympics and you don't want to

be pregnant right now this also happens

though with eating disorders anorexia

for example we can see that I will say

when the brain is turned off when your

brain has decided that you can't be

pregnant right now it takes years of

being in recovery for it to turn back on

it has to be convinced for years that

the system system is going to be intact

again in the part of the brain that

controls if FSH and LH are released from

the pituitary called the hypothalamus so

we call this hypothalamic dysfunction I

like to think about the hypothalamus as

the you know airport control station

they're watching the planes come in and

sending out other signals it is

interpreting what your body is giving it

and then it's directing what is

happening estrogen is also made from fat

cells and this is one of the reasons why

being

overweight is so impactful when it comes

to your reproduction because if your

body is making extra

estrogen your

brain thinks an egg is on the process of

growing so it's because right the brain

thinks estrogen's only made from an egg

so if it sees some extra estrogen

because you're obese it's not going to

send out a strong enough signal to get

an egg to grow because the brain wants

to send out just enough to get the one

egg to grow it doesn't want 20 eggs to

grow so if it sees that estrogen it's

going to say ooh an egg's already

growing I'm going to send out less but

there is no egg because you're

overweight it's the fat cells making

estrogen and so exercise comes into this

play where exercising if you're

overweight can be extremely beneficial

for your fertility because if you lose

weight you drop that Baseline estrogen

level down and now your brain can more

clearly interpret this signal from the

ovary so suddenly your system is back in

check same thing for men estrogen when

men are overweight Coes to the brain and

the Brain estrogen and testosterone are

on the same conversion pathway so the

brain says oh Steven's gained some

weight I I see his estrogen he's making

enough sperm we're good and it's not

going to tell you to make as much

testosterone or as much sperm as you

need and then you get on this pathway

where you have less energy because your

testosterone is low but you're gaining

weight and you can't get that

testosterone higher you go to The Men's

Health clinic and they're going to draw

your blood and your testosterone will be

low and they're going to put you on that

trt and now your sperm Count's going to

go to zero so sometimes that entry point

to the whole problem was having extra

fat tissue so exercising to lose weight

can be very beneficial for your

fertility for men and women there's a

lot of talk on hit exercise or moderate

activity and for the regular person

whatever you will stick with is the best

if you're trying to get pregnant you

should not be trying to stress your body

to new goals training for the marathon

doing something if you think going going

to the gym every single day is that too

much no I usually say going to the gym

every single day if we think about 60

Minutes or Less is a normal amount of

inflammation from your muscles that is

good your body should encounter some

challenge along the day having more

muscle is also going to help combat

insulin resistance and other issues that

come in and interfere with our brain's

interpretation of our hormones as well

so we see that both overe exercising and

not exercising are the extremes that are

not going to be helpful for you but

moving your body in addition to helping

your hormones function better less

chance of becoming overweight better

interpretation by your brain of your

body's signals it's also a great way for

stress coping and lowering your cortisol

levels so exercise we should put there

right up there with the top thing

somebody can do get more sleep exercise

every day you mentioned menstrual cycles

there and how they can be disrupted for

long periods of time um my partner shed

quite openly um on her social media

channels her battle with this and she I

think she had a couple of dietary

changes she had some struggles with

eating and that resulted in her period

basically stopping for I think three or

four years um it's returned after sort

of three three or four years and she's

very happy about that but um lots of

people are going through irregular

period Cycles irregular menstrual

cycles what can you say to this I mean

what is what is quote unquote normal as

it relates to a normal healthy healthy

menstrual cycle into people that are

struggling what what would you advise

them and what would you tell them I love

it a normal period is one that is

regular and predictable so I'll tell a

patient you can look at a calendar and

you can say within a couple days of

certainty when you're going to have your

period now each individual person is

going to have a different cycle link

length meaning the day from the start of

your bleed that's day one of your cycle

until the last day before your next

period bleed you'll hear 28 days used a

lot that's not the average for every

single person usually it's going to be

between 24 to 35 days for the average

person can you explain this to me like

I've never heard of a menstrual cycle

before what is it what happens so the

menstrual cycle is essentially what

we've talked about with our whole eggs

right so you have your group of eggs

come out the ovary each eggs in a

follicle brain sends out follicle

stimulating hormone that egg is going to

grow develop and ovulate that's going to

put you a couple weeks into your

menstrual cycle from there it's going to

then make progesterone get you into that

back half of it that ludal phase because

the Corpus ludum is always set at two

weeks and then when you're not pregnant

you're going to bleed so bleeding is the

shutting of the lining that's your

period your ovaries are doing something

different throughout that process so

while you're bleeding and on your period

period your ovary is already starting to

grow the egg that's going to ovulate in

that month and as that egg makes

estrogen that's what stops you from

bleeding okay so when you have your

period That's the shedding of the lining

from the last month because you didn't

get pregnant and growing an egg this

month once there's enough estrogen is

going to stop that process and stabilize

that lining okay so typically when you

if if there's no other interventions if

you don't have your period it's because

you're pregnant because you're pregnant

or you didn't ovulate because you have

to have that

progesterone drop as the signal for your

body to bleed exactly so you either

problem a I didn't ovulate so that is

either I'm out of eggs I don't have any

eggs to ovulate or my brain didn't send

out the signals like we said

hypothalamic Amara that's often that OV

ex exercising or that calorie

restriction or chronic illness stress

stress sometimes I I like to think about

that one often more as hypothalamic

dysfunction like irregularity versus

absent but yes stress and then we've got

pituitary end thyroid disease prolactin

these are hormones from the pituitary

gland which is where FSH and LH come

from and if your pituitary sends a lot

of energy to making thyroid stimulating

hormone it's not going to send out FSH

quite as well and then you have

polycystic ovarian syndrome which is

going to be one of the most common

causes of female infertility and of

irregular periods and that is when your

ovary and your brain have a

miscommunication and so when we talk

about irregular Cycles because we should

dive into PCOS what we're saying is that

for one single person it's not occurring

at this regular interval for them so

maybe it's 25 days for Jill and 30 days

for Mary and 34 days for Susie but each

of those people should be able to know

when her period is coming the fertile

window for all of them is this is

different and that's why apps and cycle

tracking can be really problematic

because what the fertile window is is

going to be the 5 days before and then

the day you ovulate so an egg lives for

24 hours the five days before you

ovulate okay okay so the 5 days before

you ovulate and then the day that you

ovulate the egg lives for 24 hours it

has to be fertilized while it is in the

fallopian tube in those first 24 hours

sperm can live in the female

reproductive tract for 5 days so that is

why we will tell people to have sex

before and then during ovulation put

some of that sperm from the locker there

a little bit earlier and then get some

there right right at the time when

you're ovulating to see if you can

fertilize that

egg if we think about understanding when

your fertile window is based on your

cycle length so if we say your cycle is

the the entire process and then your

period is just the bleeding days the

entire process if your Cycles are on

average 28 days the Corpus ludum lives

14 days so 28 minus 14 you on average

would ovulate on day 14 so the 5 days

before and then day 14 are going to be

your most fertile days to try to Target

intercourse or avoid if you don't want

to be pregnant and if your Cycles are 35

days though it's very different right

because now 35 days minus 14 is going to

be 21 here you go 21 so your fertile

window or for that person is going to be

cycle day 21 so now the 5 days before

and day 21 those are very different

fertile Windows days they should be

having sex it's a lot isn't it do we

just have sex every day if we can so

absolutely like if you can have sex

every day or every other day and you

don't have to track your Cycles if they

are coming regularly and you're putting

sperm in the presence of the egg by

every day or every other day sex

absolutely and that's one of the things

that I see people do wrong the most is

have less sex in the idea that they

should save it up to put more sperm

present when the egg is arriving I have

to say I mean there's a few things I

wanted to say about this so I think

what's the first thing I wanted to say

the first thing I want to to ask is how

long on average do different age groups

need to try before they hit the Bull's

Eye if you're age 30 and you're trying

to get pregnant you have a 20% chance of

pregnancy per month okay this means that

the majority of people should be

pregnant within 6 months infertility is

defined as trying for a year and not

getting pregnant within that year so

kind of going off the curve of that

standard deviation importantly trying to

get pregnant means that you're having

intercourse you're ejaculating inside

and you're having regular periods if

you're not able to complete the active

intercourse and you're not having

regular periods people should not wait x

amount of time to come see a doctor you

should go be seen right away when my

friends tell me that they've started

trying I always think God that doesn't

doesn't that just ruin the fun you know