Everything He Needs to Know About His Sperm (Send him this) Dr Natalie Crawford

21:11Dr. Natalie Crawford:I live in Texas. So sometimes that's controversial. But I will have these husbands, these male partners coming in. And they'll be like, oh, the broccoli tofu stir fry with the peanut sauce last week. That was great. I made that on Wednesday. And, you know, like seeing these partners, to your point, come to the table, being willing and open to make a change. Fertility is a team sport. We should approach trimester zero, I mean our whole relationship, but especially trimester zero as a wonderful opportunity to do this together. To really say, how do we get into our healthiest state as we prepare for this really exciting life journey that's ahead of us?

21:49We keep mentioning this on the table. And on the table, we actually have five of your fertility non-negotiables. Can we go through them?

21:57Dr. Natalie Crawford:Five fertility non-negotiables. These are the things when we talk about controlling what you can. Can't control everything, but you can control a lot. This is what I want you to start saying. What do we do? So we're going to kind of go through them. My first one is sleep because we've got a sleep mask. Sleep is underrated. It is probably the number one thing that most of my patients are not doing well enough. And I live in Austin and people are super healthy. but when I really get into it, many people are not sleeping long enough. So what does that mean? At least seven and a half to eight hours of sleep, especially for women per night, having a consistent sleep-wake schedule, increase in sleep variability, meaning the hours of which you're sleeping, has been associated with taking longer to get pregnant.

22:39Dr. Natalie Crawford:For every hour less a man sleeps, he has lower testosterone and lower sperm counts. For every hour less a woman sleeps, she'll get fewer eggs in an IVF cycle. And if a couple, either member of the couple reports having poor sleep quality, it takes them longer to get pregnant. Sleep is when your body is going to clear inflammation. It is setting the stage for your entire day. For many of us, I have celiac. So you and I both have a level of inflammation that we get every single day that not everybody does, right? But that means it's even more important that these five non-negotiables I pay attention to.

23:13Dr. Natalie Crawford:And if you can't be perfect, like I will get less sleep tonight because I'm flying home, then the other ones become more important, right? We don't have to seek perfection. Instead, I really want us to think about this burden as a movable scale. So if sleep isn't going to be where it is, the others become more important. Okay, second from there, we're going to take, and I'm going to use my weight and say it's actually building muscle. So I get asked about exercise and fertility probably every single day. What most women specifically are not doing is building enough skeletal muscle. And when we think about it, skeletal muscle, so these big muscles in your body, are metabolically active.

23:54Dr. Natalie Crawford:So when you activate your skeletal muscle, glucose can enter the muscle, go into the cell without needing insulin, and you can lower blood glucose levels. It makes your cells what we call more insulin sensitive, meaning will respond to lower insulin levels when you both have more skeletal muscle and you use it. So most women I know need to pick up weights at least three times per week. It's not that any other form of exercise is quote bad, but we always need to bring more muscle building into it because it improves our hormonal health and can fight against insulin resistance. So build muscle. So we're going to sleep and we're going to build muscle.

24:33Dr. Natalie Crawford:Next, we have a journal. The journal is here about stress. and stress is really nuanced, right? And many times when I bring up stress, people will sit across from me and they'll say, oh, well, my doctor told me not to stress about being stressed. And there's certainly things about infertility that are stressful. Like we have to acknowledge the stress of questioning your future, how you saw yourself, your identity, if you identified with being a mom one day to have that questioned, of course it's stressful. But there are stressors that we have every single day. Right? Whether it's social media, the news, politics, financial stress, business stress, interpersonal stress, and all of these stressors add up.

25:16Dr. Natalie Crawford:So it's not about Maggie, avoid all stress because that advice is really not very helpful. I want to put it in twofold bucket. One is to say you will experience stress today. You will. Totally. So you need to build in to every day at least 20 minutes where you can know you are not going to have stress. And that can look different every day. It can be journaling. It's one of my favorite things. Like brain dumping everything out really helps me get a clear mind. But it can also be just a walk outside, putting your feet in the grass, meditation, mindfulness, acupuncture, yoga, therapy, a call with a friend.

25:50Dr. Natalie Crawford:Can working out be that stress relief for you or are those two separate things? It can be. Okay. So double yay for working out. If you feel that kind of post-workout release, you know, I always say you're searching for the, feeling, right? And not everybody gets it from working out and maybe not every workout gives you that, but exercise can be that and that can be helpful. So I call these the foundation of the day. Sleeping, how you manage stress, and building muscle. Every single day you deal and you make choices on what you're going to do about these three things. Sometimes you control them and sometimes you don't, but you should do your best.

26:25Dr. Natalie Crawford:The other two categories are a little harder for most people, honestly. I love this bowl. This is food, okay? You actually have really lovely food in here. Okay, so having fruits and vegetables and fiber is the number one thing most people need to do more of. Having real whole foods, lots of antioxidants, there's beautiful colors in this bowl. You're getting so many good nutrients to your body, and most of your nutrients should come from food. Fiber is really important. It is feeding the microbiome of your gut. And do you know what food doesn't have fiber in it? Processed foods. Processed foods and animal products.

27:02Dr. Natalie Crawford:So like if you are on a carnivore diet, even though not all animal products are bad by any means, a carnivore diet is not getting enough fiber in it. So we really want to make sure that we do get enough fruits and vegetables in our diet. And from a fertility standpoint, having at least three servings of fruits and vegetables a day in your diet improves your fertility versus having fewer. So try to have fruits and vegetables at every meal. To me, these have no limits on them. Eat as many as you can, as much variety as you can. But this also goes hand in hand with having healthy fats. Avocado, olive oil, nuts, seeds are a great option for your healthy fats.

27:38Dr. Natalie Crawford:We want to have more of these unsaturated fats than the saturated fats that are in some animal products. But in general, a more plant-forward diet, more servings of vegetable protein over animal protein is associated with a shorter time to pregnancy and improved embryo quality in the IVF lab. And then, is this from your kitchen? I only use glass Tupperware. I love it. I'm so proud of you. Except the top is plastic. The top is plastic too. So as long as you don't stuff it all the way, then it's fine, right? So if the plastic comes in contact with our food. So why are we talking about this? I was in fellowship back in 2013, and I'd had a lot of pregnancy losses myself.

28:17Dr. Natalie Crawford:So I had four pregnancy losses. And I remember talking to my fellowship director saying, I want to study natural fertility. I want to know why some people get pregnant and other people don't. And I did a lot of work on the luteal phase. And I did work with the EPA looking at endocrine disrupting chemicals, specifically PFCs, perfluorinated chemicals like PFAS. And I was aghast, Mikey, that there's not just suggestion of harm. There's a plethora of data that these chemicals live in your body forever, pass through the placenta, impact your fertility, your ovarian reserve, the age you go into menopause.

28:51Dr. Natalie Crawford:And yet, especially then, there was no mention of it. Like, how was I, a physician in this field, and unaware of the harm that plastics or Teflon or thermal paper was causing me? I remember my husband coming home, and I was cleaning out the kitchen. I had a whole pile. I was like, we're done with all of this, right? Like, we need to go get a stainless steel pot, glass Tupperware containers, and this is what we're using now. Because in crim-disrupting chemicals, microplastics, they actually do matter. And yet most people will say, well, they're everywhere, so why worry about it? The truth is, you can't control everything, so you owe it to yourself to control the things you can.

29:33Dr. Natalie Crawford:And what do you control most of? The things in your own home. Still waiting in line? Again? That's time you'll never get back. Save time and money with Stamps.com. Over 4 million businesses have skipped the line with Stamps.com. Join them to save up to 90 % off carrier rates from your computer or phone right now. Print postage for certified mail, registered mail, and packages in seconds. Then schedule a pickup right from your home or office. For a limited time, go to stamps.com and use code podcast for a free welcome gift. Taxes and fees apply. Hey, it's Ryan Reynolds here from Mint Mobile. Now, I was looking for fun ways to tell you that Mint's offer of unlimited premium wireless for$15 a month is back.

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32:18If you want to give this incredible oil a try, I have a special discount for my HSR Angels. 10 % off with your first order with code HSR at OseaMalibu.com. That's code HSR at OseaMalibu.com. And let me know what you think. Something that I've found really hard is there are great brands in the space for women's prenatals that have amazing marketing and amazing branding. And then you read certain clinical studies about it and, like, they're missing us an ingredient. Or they actually haven't done the clinical studies that they need to to be able to make certain claims. They have great marketing budgets.

32:57They've raised a ton of venture capital. They can hire the best influencers. So for a woman that is deciding on a prenatal, what is important? How should they be making a decision? And what are the non-negotiables for the right prenatal for them?

33:12Dr. Natalie Crawford:I love this question. I will say in the book I have a whole chart on it because it's hard, right? So we have to look at this in tiers. The number one is going to be folic acid. Folic acid is important in cell division. For a growing baby, the time where folic acid is the most important is the formation of your neural system, your spine and your brain. You need 400 micrograms, MCGs, of folic acid. That's probably the number one thing that people need to know. What else is really important? Some of the things that are really important in prenatals that are standout, one is choline. Choline has really been shown to help with brain development of your baby.

33:47Dr. Natalie Crawford:And so have omega-3 fatty acids. These are going to be labeled in the prenatal as DHA or EPA. And these are things that you can get from food, but they're a little bit harder to get from food. So omega-3 fatty acids notoriously can be found in fish. They can also be found in like chia seeds, flax seeds, seaweed. You can get choline from eggs notoriously. But some people don't eat eggs, don't eat fish. And we really want to make sure that that brain development, I mean, conception is a miracle. Great. I know. Egg and sperm come together. This embryo goes from a single cell and then it's two for a while.

34:22Dr. Natalie Crawford:By the time it implants in your body at five to six days, it's like 300. It's wild, right? The process is wild. So getting enough omega-3 fatty acids, getting enough choline, getting folic acid, those are probably like the three key. And I'll have the fourth one is going to be vitamin D. You know, vitamin D is going to be in every prenatal in different amounts. I actually recommend all my patients take an extra vitamin D just because so many people are vitamin D deficient now. I am. Yeah, I am too. and we probably both spend a decent amount of time outside, but we're still vitamin D deficient.

34:58Dr. Natalie Crawford:So it's not going to be a one-size-fits-all. There's certainly some, you know, titrating to what your body needs. We do want people to take iron, at least in the second trimester and on. Iron can make you nauseous or constipated, so I'm okay if your prenatal doesn't have iron. We can add that in in the second trimester, but it's really going to be those top three with the omega-3s, the choline, and the folic acid that sometimes are not in every prenatal, and we need to consider supplementing with an additional supplement if it's not. Is the prenatal for each patient specific? Like, do you actually assign a different one for each of your patients?

35:33Or are you like, here's a favorite brand, and if you need to add something else on, you can?

35:37Dr. Natalie Crawford:You know, I tend to give my patients like a few brands because I do find that if I say, this is my favorite one, and if you hate it, like if you feel nauseous from it, if it like, you know, you get weird fishy burps, like whatever happens from vitamins, you're going to be more likely to take nothing if I've told you this is the one, right? You're going to have poor compliance. So I like to say these are my favorite ones. Like try them and find the one that works for you in the best way with these kind of caveats. And there's occasional times where I say, hey, you really need, you're a vegan, so I know you're not eating eggs.

36:14Dr. Natalie Crawford:So I really want to make sure you have choline. And I know this prenatal has enough choline in it. So there's some specifications out there. But I really want to stress that when we give this, well, my favorite influencer uses this one, so I buy this one. You know, influencer marketing is great when it brings awareness. Yay, you know you need a prenatal, right? Which is ultimately better than not taking one. But at the end of the day, does it have the right nutrients that you need? That's a really big question that you've got to do your own due diligence to make sure that it does. I really do want to segue into the conversation about infertility.

36:47What is infertility? Okay.

36:50Dr. Natalie Crawford:Infertility is simply a population-based diagnosis, meaning let's just zoom out. OBGYN said a group of people are having a hard time getting pregnant. Where do we draw the line? They drew the line back when they decided to draw it at one year of trying to get pregnant. So infertility is officially defined as trying to get pregnant for one year without having success. That means you have periods, you're having intercourse, and you do not conceive by the one-year mark. Is infertility becoming more prevalent, or are we just talking about it more? Because it feels like it's everywhere. Both things are true.

37:25Dr. Natalie Crawford:It is becoming more prevalent. We see an increase in inflammation in the world around us. We see a drop in sperm counts. Women are being diagnosed with lower egg counts. We see a higher rate of miscarriage and pregnancy loss. And as we said earlier, infertility rates are rising. That's true. We also do have more awareness, which I think is good. To your point, I love it. Look at your bank accounts and just know, right? And this is what I tell women every day. As scary as it may be, this is fact. This is your body. This is your data. Whatever you have to deal with, I know you can deal with it. But you can't make decisions on data you don't know.

38:05Dr. Natalie Crawford:And you owe it to yourself to say, my health is important to me, regardless if you want to get pregnant. I deserve to understand how my body is working. And if I have a life goal of getting pregnant, I deserve to at least know what cards I'm playing with, right? What can I do about it? What can I change? What can I optimize? What can I not? But at least be able to make decisions from that place of knowledge is really so empowering because the hardest patients I sit across from Maggie are people who are smart, successful, educated women. And they say, if only I had known this information, I would have made different decisions, right?

38:47Dr. Natalie Crawford:When you lose the opportunity to make a decision, that is probably the worst place to be in. And so we can use low egg count. For example, we can go into AMH and egg count. Right now, the medical community does not recommend checking your egg count unless you have infertility, which I think is wild. I'm so against. I think it's paternalistic. I think it doesn't reflect what women want to know. And I think it makes a presumption. They actually stay in their statement that it's too stressful for women to know that they have a low egg count if they are not trying to get pregnant. It's like if your egg count's low, your egg count is low.

39:25Dr. Natalie Crawford:It actually is a health marker for later in life. But it allows you to look into reasons why. Do you have endometriosis? Do you have autoimmune disease? Do you have celiac disease? You might change your whole health. Forget about kids or not kids, right? Why is it low? That's important. Two, maybe you're with a partner. Maybe you find out your account is low and you're able to shift your timeline. Like, well, we were waiting until this perfect moment in my career, but knowing I don't have as long to grow my whole family, we're going to get started sooner. So you're suddenly changing what you're doing because you had that data.

39:57Dr. Natalie Crawford:Maybe you do go through IVF and freeze eggs or freeze embryos. Maybe you at least get earlier testing and find out your partner has low sperm and he starts to make life choices. or maybe you do none of the above, none of it. But you said, you know what? I had the information. I evaluated my options. And I said, none of them were right. I'm not going to make any difference. I'm going to carry on. You then made that decision, right? So if the outcome of that decision is you end up not getting pregnant later, going into menopause earlier, at least you were aware and you were the one who chose the path you were going to walk.

40:31The most successful person I know is my husband in every single way of his life. And his favorite thing is having option value, which is honestly the perfect way to introduce your vault, which I have been very afraid to do. But let's do it together. And for everyone, like, you can tell this is hard for me to sit through, but it's necessary. So let's get into it. Okay.

40:53Dr. Natalie Crawford:So we're going to use the marble in the jar. Which, by the way, beautiful marbles production. I know. Good job, team. Okay, so my favorite analogy to think about the vault is to use this jar of marbles. And I created this fault analogy because it's really hard for women to think about what's really happening in the ovary. It's wild if you really think about the fact that your eggs, let's imagine every marble is an egg, are formed inside your ovary before you're even born. When you are a five-month-old baby inside your mother's womb, you have six to seven million eggs. But by the time you're born, you only have one to two million.

41:25Dr. Natalie Crawford:By the time you start your first period, you'll have less than half a million. and you will only ovulate about 400 eggs over your lifetime at most. So that's wildly different, right? Why do we have millions if we're only going to ovulate 400? The way I like to think about it is that this is a vault and every single month you have a group of eggs that comes out of the vault. And what's really interesting is that when the vault is more full, more eggs come out every month. So you are losing more than just one. And now when we think about the menstrual cycle, What is happening is that each egg grows inside one of these nice, clear follicles, and the brain's going to send out FSH, or follicle-stimulating hormone, which is going to stimulate just one of these to grow and to ovulate.

42:08Dr. Natalie Crawford:And that's the one you'll ovulate, and everything else just dies. Now, the next month, what's going to happen? You're going to have another group coming out of the vault. Okay, so our vault is constantly getting emptier. And what's really fascinating is that when the vault is more full, you lose more every single month. But as the vault starts to get emptier, as time goes on, as we get older, we have fewer coming out every month. And why is that important? That's a really important concept for women. Because when there's fewer eggs outside the vault, it is a reflection that we're starting to get to the end of what we call our ovarian reserve or the number of eggs we have remaining.

42:48Dr. Natalie Crawford:Many women think about egg freezing or IVF as this guarantee, and I said earlier that it's not. But when we do IVF, when we do egg freezing, I'm only trying to get this one month's group of eggs to grow. I can't tap into the vault. I cannot tap into here. I cannot get more eggs out of the vault. At least not right now. That technology will probably exist in my lifetime. But right now, the reason why you have to take shots during IVF is because instead of your brain sending out enough for just one, well, I want all of those to grow. So I've got to take shots of FSH, same hormone the brain makes, so that I can override the normal checks and balances so I can get a whole group of them to grow.

43:25Dr. Natalie Crawford:But if you have fewer eggs, because you have endo or celiac or – Or you have all of them. You have all of them. Or, you know, you were exposed to more toxins. You smoked cigarettes. You were born with a lower number because your mom did whatever she did when she was pregnant with you. You can only get what is outside the vault to grow. The scary thing is if it's not all scary. But one of the scary things is that there are things that can get into the vault. I can't put more eggs in, but I can degrade them faster. So inflammation is one of those scary things that actually can get into the vault and harm your egg count.

43:59Okay?

43:59Dr. Natalie Crawford:So inflammation can steal some. Just causes them to die. And you lose some. So if we want to try to preserve our ovarian function, one, because we want fertility, but two, because we know that estrogen is the key to women's longevity. So forget about having babies, Maggie. Just you and I sitting here. if you ask me what's the number one thing if I could control that would cause me to have a longer, healthier, happier life, it would be to go into menopause later. That would mean you would need to keep eggs inside your vault longer. And emerging research is showing what if I can decrease inflammation and I'm losing eggs at a slower rate from that, I can decrease the speed of loss and maybe go into menopause slightly later.

44:48Dr. Natalie Crawford:And that slightly later is really important because every year later, maybe it doesn't sound like much to you and I right now, oh, going into menopause at 50 versus 51. But for every year later you go into menopause, you have a lower risk of mortality, lower risk of heart attack, stroke, improved health parameters across the board. So again, outside of just getting pregnant, the vault is so important for your health as a woman, and inflammation plays a role in it. When we check your egg count, there is a hormone we can check called AMH. And this is a simple blood test. And this is the one I said earlier that I think everybody should get tested.

45:22Dr. Natalie Crawford:AMH is made from the cells that surround every follicle. So if I have more follicles, I'm going to have what? A higher AMH. Higher AMH. Okay, perfect. Sucked at science, but I'm learning here. No, you're doing great. So the vault's not perfect and every month sends out a different amount, right? Like it's around the same, but it's not perfect. So AMH can fluctuate. It's not exactly linear. It can bounce around, right? Now I have seven or eight instead of five or six. So the egg count can fluctuate a little bit, and so will AMH. So I like to think about AMH as a point, not a point value, but as a category.

45:57Dr. Natalie Crawford:So is your AMH normal for your age? Is it above average? Is it below average? Is it critically low? And you can still get pregnant at all those values as long as you're still ovulating, but it is stratifying us about how worried are we, how many eggs are left in our vault, right? If your AMH is really low at a young age, are we starting to get to the end? That, number one, we have to think about, are you starting to have perimenopause, menopause signs, but also, have you completed your family? Do we need to be more aggressive? What do we need to do? If I don't have as many eggs, their quality becomes more important.

46:31Dr. Natalie Crawford:So at the end of the day, AMH is a simple blood test that's giving you a lot of information. And even if it's not a perfect test, It's not a, quote, fertility marker, right? You can have a low or high AMH and still get pregnant or struggle. It is giving you valuable information about your ovaries and how many eggs are left. They think you deserve to know. I'm in my luteal phase. We all know that point in our cycle where our body is basically like, please do not make this any harder than it needs to be. But during that time, I still want to move my body. I want to go for a walk. I want to get outside, maybe stretch.

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48:54Can we talk a little bit about the money side of things because we'll get into like egg freezing IVF, but I think it's, it is really important to talk about what things cost. This test costs$79 if you don't have insurance. If you have insurance, it could be even less. The cost of getting sperm preservation for males is around$400.

49:16Dr. Natalie Crawford:Yes. Semen analysis is usually around$100. Freezing the sperm is usually around 300 to 400. Okay. So if we talk about the relationship between money and fertility. Yes. It's an easier story for men. Is that what you're getting at? Yeah. Yeah. It's not fair. So it's$100 to test your sperm. It's$400 to preserve your sperm, put it on ice. You basically go into a room, you ejaculate. That's the process. Yep. Men can get sperm out of their own body. So it's a much easier process. For women, we're looking at a$79 test and then what happens from there? If we want to view apples to apples and say, well, men are freezing sperm, so let's use freezing eggs.

50:00Dr. Natalie Crawford:To freeze your eggs, because your eggs are inside your body, we have to take the hormone shots, so the FSH shots that I talked about. And those are really expensive. And then you have to take those for a couple weeks. And then we have to undergo a procedure under anesthesia to take the eggs out of your body, and that's egg freezing. And that at its cheapest is going to be about$10 ,000. I would say average for medication and procedure is going to be between$10 ,000 to$15 ,000 for per month that you want to do it. And because everybody's going to get a different number of eggs, they're going to have different goals, quality will differ somewhat based on age, somewhat based on other factors.

50:37Dr. Natalie Crawford:Some women need to go through more than one round or thinking about more than one month. I'm going to get the 10 eggs from this month, and then I'm going to turn around and get the 10 eggs from next month. And so that cost just compounds on itself that you have to do it again. And it's definitely not fair. This is part of where it's not the field or science being unfair. It's part of working with our biology. Also, sperm just gets frozen altogether. Like, it just gets frozen, right? Millions of sperm in one little tube, all frozen. Egg freezing is an investment. It's like playing the stock market.

51:13Dr. Natalie Crawford:You're investing your money. You have to make smart decisions. You have to understand what you're doing. But the ROI on that investment, you do not know. Maybe if you're single, you don't know the other half of the equation, right? The sperm quality. You don't know your future state of health. You don't know if any of them will make embryos or be normal. So the ROI on that investment, you do not know until later. So there is a risk stratification you have to do to say, is this risk worth it? But on the all, do we think investing your money is a smart choice? Yes. And the same thing. It is investing in your future.

51:46Dr. Natalie Crawford:And at some point, if you are at the place and you say a child is a life goal and I am not ready, this is one investment strategy where we can keep a door of opportunity open for you that will at some point otherwise close. A lot of people are not familiar with this area of medicine in terms of evaluating different providers and looking at cost analysis and things like where they're going to invest. Yeah. Is it similar to plastic surgery, which a lot of people are familiar with, where based on the doctor that you go to, the price of the service, the actual procedure should change? Yes. You know, I'll admit my own bias here, okay, because I have a co-founder and we have a two-physician-owned practice.

52:30Dr. Natalie Crawford:So we have an IVF clinic and we don't have any investors. We don't have anybody else looking at our outcomes. We put our own money into the practice. We've hired the people who are best for the job. We have the most expensive generator on planet Earth to keep your eggs and sperm and embryos safe and the liability insurance is through the roof. But you're paying for a service and you're paying for technology. And if somebody is offering you a discount, you should know what you are paying for because it is an expensive process. It's a miraculous, incredible technology to do it well, to do it safe.

53:11Dr. Natalie Crawford:It is extremely expensive. And we would do it cheaper if we could do it well and do it cheaper. And the people who are offering it cheaper are cutting other corners that make me nervous personally, right? And it's just like plastic surgery. You're paying for skill technology expertise. Or if you're shopping, right? Like there's different levels of places where you are shopping that you are going to get a different quality of a product. So there's a lot of personal decision to it. There's a lot of nuance. It's okay to get a second opinion. I see patients from all over. Nobody wants to have to get a second opinion.

53:50Dr. Natalie Crawford:But if your gut's telling you something's not right, if you're not feeling like you're in a great place, like see what somebody else says. It is too personal a field of medicine, much like plastic surgery, to just go with whoever's the closest or whoever's the cheapest. I think that's why I wanted to talk about the money side of it a little bit because I feel like it is such a big investment. And then I don't see that much information. Like I truly have been looking at this for the last five weeks like insane. Yeah. And I'm like, is the pricing standardized? Is the medication standardized? like the money side of it is so confusing.

54:30Are there resources for people to like go to different company websites and see what medication costs should be or what the average cost of actually storing it every single year should be? What are the types of questions that you love when a patient comes into your office and is asking about as it relates to the financial side of this investment?

54:50Dr. Natalie Crawford:So every clinic should have somebody directed to do financial counseling. So right away, you should – they should ask about your insurance. They should see what is covered and what is not. Like I'm in Texas, so fertility testing is covered. It's a mandated state for testing. So you want to get your AMH, semen analysis. Those things should go to insurance. But treatment is not always covered. So number one, there needs to be a point person for finances. I always think it's a red flag if, oh, my nurse is going to talk to me about money. No, like your nurse is going to talk to you about – Drying blood.

55:22Dr. Natalie Crawford:Yeah, drying blood, clinical aspects, your cycle, your calendar. not money. So who is the financial person so that you know there's somebody who can actually talk to you about money? Now, another thing what I love is when people understand what's included in the price. And this is where some clinics are really not transparent. So we do what we call a package price. So you're going to freeze your eggs or do IVF. It's going to cost this much money and you know it. Meaning there's some nuance on are you doing genetic testing? Are you not? But you know what you're getting in. And if I want to see you every single day for an ultrasound because I'm watching your ovaries really closely, I'm not going to charge you more for that.

56:01Dr. Natalie Crawford:Well, so some clinics actually don't give you a package price. And this is a little bit sneaky you got to know about. They might say like, here's the base price. But then for every ultrasound, for every blood draw, oh, if you come in on the weekend, there's a 50 % add-on differential because the staff's coming in on the weekend. And some clinics manipulate that where they bring you in more because they're charging you more. And there's all these add-ons that you're going to need because what are you going to do? If your doctor says, Mike, you got to come on Saturday for an ultrasound, you can say, okay, you're going to pay the money.

56:36Dr. Natalie Crawford:You're already in the cycle. You've already bought the medication. So I think I like a package price because I don't feel like you should be penalized if I want to see you more. Right? Like I want to make good medical decisions, not based on finances, but based on what's best for your ovaries. So know what that cost is covering. Medication costs are separate than clinic costs. So the medication costs will go through a pharmacy. And so this is an important one too, where sometimes your insurance may not be taken at the clinic you like, but they may cover your med benefit at a pharmacy. Fertility nurses are very savvy.

57:13Dr. Natalie Crawford:They're experts at like who has the lowest drug prices at what time. But there's nuance here too because if somebody can tell you your medications will be X dollars, that means they're doing a very standard protocol for everybody. Because there's different medications we use. There's different doses. What you need, what I would need if we were both going through a cycle should be different and therefore would cost different amounts. So we have to give patients like a range for what medication costs would be. And that would be standard. And we can help them navigate which pharmacies have the lowest cost at a given moment.

57:46Dr. Natalie Crawford:And then you ask a good question about yearly storage because that can seem, I think it's wild to me. I mean, how much some clinics charge for storage because they kind of get you held hostage, right? Are you going to discard your samples? No, right? Like if you went through the effort to freeze or go through IVF and you have leftover embryos, In fact, I think patients should keep their embryos for a really long time until they know for sure they would never use them. Same goes for eggs. But you should ask what the annual storage fee is. It might go up. I mean, storage does get limited. It might increase over time.

58:26Dr. Natalie Crawford:But I think it's wild when storage fees are$1 ,000 or more a year, and some places are. This is why I'm so happy we're having this conversation because my assistant just came into my office and was like, Like, did you know, Maggie, as I'm prepping for the episode, that I've been quoted or I've seen that storage fees are$1 ,000 a year? It's wild. Like, what should an average be, Dr. Natalie? I would say it's usually somewhere in the, like,$600 to$700 a year is more standard. It can even be lower in some places. And I think people should know you can send off-site storage if you know you're not using something relatively soon.

59:01Dr. Natalie Crawford:And what that means is that there are storage centers for somebody who's not going to use something soon. So let's pretend you freeze eggs. And then you get pregnant. And then you don't want to be pregnant again. So you're happy. You have your child. You're happy. But you don't want to get rid of your eggs because, like, what if you change your mind? What if something else happens? So instead of paying the$1 ,000 a year, you can send them to off-site storage that typically will be less than$500. So you'd have to pay to ship them there. But it's good quality storage. You can trust it. and it's just because it's not accessed as much.

59:37Dr. Natalie Crawford:I also think it's really important to ask your clinic about their storage policies. Okay, this is gonna blow your mind. IDF first started in veterinary medicine, right? Because we can experiment on animals easier than humans. And so the way that embryos are stored in a lot of labs is in what we call these doers. And they're, think about like a milk jug. So imagine there's this big container. I know. I told you you're going to hate it. And then the lid opens up. And then there's just layers where these little glass tubes are that have embryos with little handwritten labels at a lot of places attached to them.

1:00:18Dr. Natalie Crawford:And there's usually some, I know, I know there's some master log where they're like, okay, Maggie. And they go and they look and they're like, container three, row two, blah, blah, blah. And they go to that container, open it up, look for yours, and then pull it out. Okay. So many issues with this. First of all, to everybody else's embryos who are in here, they're getting ambient air exposure every time the lid gets open, right? The temperature is changing a little bit. Also, you know, hopefully your lab has a second person. So there's like less It's human error in checking things, right? And so, again, a super busy lab isn't always the best thing if they're not staffed in their embryology suite well enough.

1:01:02Dr. Natalie Crawford:Because there's a lot of human error. And then sometimes those little labels can fall off or the handwriting is so hard to read. So more modern labs use, you know, obviously printed labels, barcoding, different storage systems that are, we'll say it's more like a vending machine type of storage where things have their own slots so everything's not exposed. So it's worth saying, like, how are they stored? How are they labeled? And clinics should be very upfront with that information because that's your reproductive tissue. You deserve to know that it's going to be safe, right? Underline this entire discussion.

1:01:39Dr. Natalie Crawford:Egg freezing or IVF. Like, you're going to take hormones. It's expensive. We're going through a procedure. At the end of the day, we're putting hope and opportunity into the freezer for the hope that in the future, You can have a family that you desire. And there's a lot of ethical questions. Technology advances really quickly sometimes. Are embryos, how do you view embryos? Are they property? Are they people? How do you feel about discarding them? What happens if you and your partner break up? What happens if somebody dies? There's a lot of ethical questions. There's not one right answer for, but that need to be discussed.

1:02:15Dr. Natalie Crawford:But I view our job as keeping them safe for whatever you decide. You know, we make our patients decide on those ethical things before you ever, before you were ever to freeze your embryos, you would have to say, if we break up, if I die, if he dies, if we get divorced, like here's what's happening to our embryos. So that they have a disposition that you feel comfortable with. Because hearing about some of these embryo disputes, it brings a lot of questions and people are not always aligned on it. And I just think at the end of the day, you're the one who has to feel comfortable with it. But the lowest bar is knowing that they're safe in your fertility clinic.

1:02:55People think I am crazy. But in our prenup, literally, it was our discussion of Courtney's sperm on ice and embryos. And, like, what would happen if he were to die before we actually use his sperm? Like, if I have the right to use his sperm. I love you. To have a certain amount of – You're my favorite person. I honestly, I think that's what's so important about this podcast is I feel like I'm having all of these really interesting conversations and I just get a platform to talk about it with experts. But it was those types of things where even my husband, when I brought that to him during our prenup process, I was like, your sperm is on ice.

1:03:31I want your children. If, God forbid, something happens to you before we're able to actually have a child, what are my rights with the sperm that's on ice? It was like the best part of our prenup process, but also very complicated. And I think one of the other things that's very complicated is when you do add the financial aspect into it. And I still, I'm hoping you'll answer this for me, but like for a woman that's listening to this in America, what is a range of a cycle of like all of the costs added up that they can be thinking through? Like I was having breakfast with a girl last week and she was like, I saved up enough money in my savings account that I was going to be able to renovate my bathroom.

1:04:13And I want every single woman that's leaving this conversation to think, if I have enough money saved up here, I will be able to go and do one cycle of egg freezing or one cycle of embryo freezing. Like, what is that range for them?

1:04:27Dr. Natalie Crawford:$15 ,000, and it should be egg freezing. If you want to freeze your embryos with your partner, like, I'm all for it. And I have couples who do that. But I always say, why are we not doing eggs? Or why are we not doing eggs in addition? Because life is not just. And your partner can continue to make good quality sperm for much longer than you will continue to produce the same quality and number of eggs. And so if you are willing to put embryos in the bank because you want to have children with this person, I love it. I love it, right? We're starting families later. Let's do genetic testing. Let's put embryos.

1:05:08Dr. Natalie Crawford:Let's still have a big family, even if we started the game a little bit later. But why are we not covering your bases too? Why are we not putting your eggs in the freezer? Why do I not get to have one round of eggs just for you? Independent. Because life is not just. And crazy things happen and terrible things happen, right? And some of the absolute hardest situations are when a couple froze embryos and the story has changed and now she cannot use them and is out of eggs. Whether it's she had cancer, went through fertility preservation, she went into early menopause, and they are now not together.

1:05:48Dr. Natalie Crawford:And yet he can go have a family with a new partner and she cannot. Right? So if we are sitting here and we're saying, hey, I want to save up the bathroom renovation money, but I'm going to invest it in my health and future. In today's world where egg freezing is so much more successful, the rate of going from egg to embryo, we really don't have that big drop off anymore. Why are we not doing eggs initially and at least giving you that opportunity? If Courtney already has some sperm on ice, do you have eggs on ice? Like, let's put some eggs on ice before you start down your journey so that you have some opportunities still open to you.

1:06:27Is there something that we haven't talked about today that you would be sad to leave if we didn't get the chance to talk about it?

1:06:33Dr. Natalie Crawford:You know, I do talk in my new book, The Fertility Formula, a lot about everything we talked about today. But I also did talk about tracking your cycle, understanding your health and your hormones. I divided the book into three parts. So learn about your body, the facts you didn't learn, how to advocate for yourself, how to know if you have endo, PCOS, what to do if you have infertility, and then optimize, how to optimize your health and hormones with all the five non-negotiables and really talking about in a way that helps you no matter if you're trying to get pregnant now. You don't want to be pregnant.

1:07:03Dr. Natalie Crawford:You just want to understand that your fertility is a health marker and what you can do about it. So the fertility formula is available anywhere you get books. I love it. Okay, some rapid fire. Okay. Dr. Natalie Crawford, what is the last thing you put on your credit card? Last possible thing. Oh, flights to Montana that we're going next week. Oh, my God. Where? Big Sky? No, it's like a lake by glacier. I have a friend who has a lake house, and she offered us to come. And so I said, I'm in a season of yes. So I was like, yes, I'm taking the Keds, and we're going to go up. So I put plane flights to Montana on the credit card.

1:07:39Dr. Natalie Crawford:That's amazing. What is your credit card? I have an American Express Platinum. Why do you have it? I love the benefits and I love using, you know, I pay like everything through it and I love using the points for travel. I really love bougie hotels. It's like my, I have really bougie kids now, which I never intended to have. But, you know, my son's a little bit like, oh, I love when we go to the Four Seasons, mom. But it just makes travel more fun for us to stay in fun places. But hotel cost feels sticker shock to me. So when I can use the points, it's like a win. And then we get like a free moment on vacation.

1:08:15Dr. Natalie Crawford:and we're staying somewhere really nice. Girl math. I know. Okay. You can only pick one for the rest of your life, coffee or matcha. Coffee. Oh, that was fast. Okay. Yeah, that was easy. You can only do one for the rest of your life if you were to have another child, the natural birth or epidural. I mean, I had two C-sections, so I would be a C-section number three. Okay. I love that. What is the best push present you've ever seen? That's a good question. I mean, I will say the ones I love are jewelry with like birthstones in them because I feel like people, they become part of your everyday wear.

1:08:52Dr. Natalie Crawford:And I love that. Love that. True or false, are you better looking when you ovulate? Yes. Estrogen is the key to women's health. I'm ovulating right now. Yeah, you're glowing. I can tell. Okay. What is your favorite baby girl name that's in pop culture and baby baby boy name in pop culture? Okay, well, I'll tell you my favorites that we didn't use. And I don't know if they're in pop culture or not. But my favorite baby girl name is Emerson. Go by Emmy. And our favorite baby boy name, which we almost named my son but we didn't, is Archibald. Go by Archie. Love that. Just love that. And is it true or false that if you have a girl, she steals your beauty and makes you more sick?

1:09:35Dr. Natalie Crawford:I mean, I personally have one of each. I think it's so true. So true. My son was so much kinder to me. I had an easier pregnancy. I felt better. I looked better. And I was a troll when I was pregnant with my gorgeous daughter. Officially, it's a wife's tale, but I think there's truth behind it. That's crazy. I was a troll. She's gorgeous. But I hated every moment of it. I love that you just said that. Okay. I say HSR love notes to myself every day. It's my version of relieving the stress. If you could only say one thing to yourself for the rest of your life, what would it be? You can't make decisions on data you don't know.

1:10:11Dr. Natalie Crawford:I love that. I'm just a girl who wants to know, right? I can handle anything you throw at me, but the unknown, that's the scariest place. Yeah. If you had to title this season of your life, what would it be called? Yes. Must be present to win. That is how I've been approaching this season. When opportunity comes in front of you, like work, fly to LA, fly home, if you can make it happen, your presence is the most impactful thing you can give to people. So show up to win. I also have to give you your flowers because I was with some of the leading researchers and doctors last week at the endometriosis collective, the end of the cycle premiere.

1:10:49And obviously this is all very new for me. The investing, I've actually been so proud to invest in things like Alara and Bird and Bee to shout out those companies in women's health. But this consumption and overwhelming nature that endometriosis and PCOS brings is a lot. But every single researcher and doctor I talked to last week said I needed to meet you. And you got yourself on a plane in literally less than a week's notice.

1:11:14Dr. Natalie Crawford:I know. Came here to do this. So I had to just thank you on air and also share with you that the people in your space, you're obviously doing something right because they are mentioning your name and opportunities that you are not in. So I can't thank you enough for doing this. I hope that the community loves it as much as I do. and I can't wait to see I can't wait for you to meet my future babies one day I can't wait and where can people find you? I'm on Instagram at Natalie Crawford MD my new book The Fertility Formula is out which everything we talked about goes into so much more detail regardless if you're trying to get pregnant or not and in Austin I practice at Fora Fertility thank you Natalie thank you Maggie

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