How Women Can Improve Their Fertility & Hormone Health | Dr. Natalie Crawford

23:34And this study was called Time to Conceive. And it was looking at women who did not have a history of infertility, who were trying to get pregnant, who were 30 and older. and then we looked at different variables of them. And one of the most startling pieces of data is that there's a huge age-related impact of fertility, right? This data set set the standards for the numbers that we quote, meaning if I will sit here and say, if you're trying to get pregnant with your first child and you're 30, you'll have a 20 % chance per month, right? The finest point we look at in natural fertility studies is called fecundability, the probability of pregnancy per month.

24:08But as you age, when you're 35 to 36, that number will be 11 to 12 % per month. At age 38, it'll be 5 % per month. And at 40 and beyond, it'll be 3 % per month. Importantly for the person hearing this, none of those numbers are zero. And so by no means do we mean you can't get pregnant. But in the group who had a child before and were trying to conceive with the same partner, that number stayed between 18 to 20 % up till age 37. And then it dropped. So we do see that there is this protective benefit for a multitude of reasons, right? You conceived with that person. So they had sperm, right? Sometimes I find out some patients, the male partner has no sperm and we didn't know all that time they were trying.

24:50Oh my goodness. Right. Oh, I've had patients try for years, be dismissed by their doctor.

24:54Andrew Huberman:Because men and women mistakenly think that because there's semen, there's sperm. Exactly. There's ejaculate. So there must be sperm inside of it. And then when we find out there's none, it's heartbreaking. It's a big reason why we can segue and say, one of the things I really hate the most right now about my field is that by definition, infertility is a failure. And we don't even recommend testing or screening or talk about a preventive approach at all until you have failed. Yet, if we look at the population and say, okay, the definition of infertility is trying to get pregnant for 12 months.

25:29And then once you've reached that point, well, now we'll check a semen analysis. Now we'll do an anatomical investigation. Now we'll check your ovarian reserve. Now we will discuss if you're ovulating. So we're making you go through this period of time where you're trying. And yes, maybe the majority of people will get pregnant. But most people who do will get pregnant the first six months. So 72 % of people will get pregnant in that first six months of trying. And only 13 % will get pregnant in the next six months of trying. That's why if you're 35 and older, we will shorten that testing interval down to six months.

26:04But sitting across from so many people who've tried and tried, went to their doctor, their doctor said, oh, you're fine, you're young, you're this, you're that, forced them to try longer and fail, and then to find out fallopian tubes are blocked. They had a birth defect of the uterus. He had no sperm. She had low ovarian reserve. And they would have intervened differently back at time period A had they had that data. really makes me feel like we have to switch how we approach infertility. In the world where infertility rates are rising, women are waiting later to get pregnant, it doesn't really make sense to make people fail first before we'll even do an investigation.

26:43We should test things. And if it's all normal, maybe you do just go try your six or 12 months. We would capture people who don't get pregnant and be able to help them at a sooner time period, which is so valuable. So to your origin question, there is data that having a child previously puts you statistically at a higher chance of getting pregnant again. But secondary infertility is real. This is where you've gotten pregnant before and now you're having a hard time conceiving your second child. I want to acknowledge that it's really hard for people who walk it because they weren't expecting it.

27:18They're a little underprepared for it because they said, oh, I got pregnant so fast before. Or they come into it just assuming it will be as easy. They watch their children have a longer age gap, a bigger age gap than they wanted. But also they don't really fit into the community, meaning there's a really robust infertility community and they support each other. And so many patients who have secondary infertility say they feel caught in between feeling guilty that their child's not enough for wanting more. Of course, they're thankful for their child, but not really fitting into that category, yet also simultaneously feeling left behind their friend group or their family group or watching their family start to look differently.

28:00And so even in women who've had a prior child, age does become impactful. It's not the only variable. We also see that, you know, sperm counts change with age. So your partner's sperm count will change with age. We see egg quality starts to change with age, largely because metabolic health changes with age as well. And then we see things like endometriosis and adenomyosis, which are tincture of time diseases. It's simply you've had more time, so there's a higher probability that these diseases could be present. So I think it's important to say, yes, you can probably take a sigh of relief that most likely you won't have trouble again.

28:35But if you've been trying those six months after and you're not pregnant, I would say kind of at the longest, go and get an evaluation. And if you're a little bit older, maybe you started your journey a little bit later, it's never too early to get an evaluation for anybody at any time because you can't make decisions on data you don't know. I'm a big fan of knowing the data and then making the choice that's right for you and your circumstance versus taking population-based data and just applying it to every single person.

29:02Andrew Huberman:All excellent points. And with respect to the sperm testing, since clearly there are men who think they're making sperm and they're not, there are at-home tests of that as well. So once again, men have it a little bit easier. They can do it at home, although I don't know how high quality the at-home tests are. There are some that are just telling you almost like a pregnancy test, plus minus, are sperm present, are sperm not. Of course, that's not really telling you the full picture. There are, though, some mail-in tests that go to a true lab that we would even take as valid. So it's called a CLIA certified lab, C-L-I-A, for somebody listening.

29:36And you can find some of these online mail-in sperm tests and collect a sample. They send you the whole kit. You mail it off. It's very valid. And you get all the sperm parameters that we would then look for. So that's a great way to get data yourself and not have to have your doctor tell you no or go to a fertility clinic. I mean, we'll do a semen analysis for anybody who calls, and most clinics will. it's usually earlier that patients are getting roadblocked, whether it's their PCP or their regular OBGYN. They're getting dismissed and just, oh, just try first. It's probably fine.

30:06Andrew Huberman:You mentioned that if a woman has had a successful pregnancy, that the probability of getting pregnant again is significantly higher, although with the caveats you mentioned. Is there any data about if someone has been pregnant and either terminated or lost the pregnancy, whether or not that's related to ability to get pregnant again later? That's a good question. Most of the data that exists is looking at prior live birth. So I think there's a couple of things. If you've gotten pregnant, regardless of the outcome of that pregnancy, if it's with the same partner, we can feel confident that they had sperm present.

30:37So that's already one leg up over never getting pregnant. If it was an intrauterine pregnancy, we know at least one fallopian tube was functioning. So that's also in the camp of we're checking some mental boxes of some of the things that we think about. and we know your body could accept an embryo implanting, at least to some degree. The top cause of pregnancy loss is going to be random genetic abnormality. This wasn't the right embryo, or the embryo didn't have the right capacity or capability to truly implant. So I think that should give you some sigh of relief, that it's probably going to be a little bit easier because certain boxes are checked.

31:14I think it's also really important to say, I mean, I had four pregnancy losses myself. I don't know if you know this. So I had four pregnancy losses.

31:20Andrew Huberman:I mean, and by the way, I really appreciate the personal story sharing in the book because it really clearly was in service to your patients and to the reader. And even as a male who can't relate certainly to certain aspects of all this, it was not only very moving, but it was really a testament to just how that sort of thing lands. And then the process of trying to sort out what's real. And it just made me even more grateful for the other information. Because otherwise, I mean, it would sort of be like if I'm talking about ovarian health, right, which I've talked about on podcast. Which we're talking about.

32:01Andrew Huberman:Yeah, with all the caveats, you know, that how – but of course, how could I possibly know? So your personal experience, while the reader and I feel and felt for you in reading it, it is super impactful because people – there's a level of trust that just comes from somebody who's been through that whole jungle. Thank you. I'll try not to cry on this show about it, which is funny because it's so long ago, right? I have two children now, had them after this journey. And it was terrible for so many different reasons. Of course, going through pregnancy loss is an emotional roller coaster. I started to have a lot of self-blame against myself.

32:38I felt like it was my own body. Something was wrong. And professionally, what I was unprepared for is I was, this was the end of OBGYN and then the beginning of my reproductive endocrinology fellowship. So I felt like, how am I going to be a fertility doctor, Andrew, if I can't even get myself pregnant, right? The professional impact of how it made me view myself in my space, I was so unprepared for, right? We, especially in an era where you separate your personal and professional life, which is, you know, what was 100 % accepted back then. You know, my last pregnancy loss was an ectopic pregnancy.

33:14My fertility nurse had to give me my methotrexate shot. I mean, everybody knew about it and I felt like a really big failure. And when I sought help to say, it'll happen, just relax, there's nothing you can do, or even just do IVF, felt so dismissive of what I felt like was true as the patient experience. Say, well, what about this symptom? Or what about this question? And just really, really pushed aside. And I'll be honest, it made my whole career different because of it, which isn't that interesting how sometimes things happen to us that are not ideal and that can be really terrible. I have the two kids I'm meant to have, but also I have forever viewed fertility differently.

33:58In fact, all my fellowship research was on natural fertility because of it. Because I said at the core, I want to know why some people get pregnant naturally and why other people don't. Like, I really want to know that. I want to do epidemiologic research. I got a master's in clinical research because that research is very complicated to understand. And most fellows do an IVF lab project, which is great, but it's a lot more of a controlled environment. And then I've been so passionate about talking about it since then. And so I think to walk back, what I wanted to say, though, is if you've gone through pregnancy loss, I don't want to ever dismiss how terrible that experience is.

34:34And sometimes it can feel that way by me sitting here as a professional and saying, oh, you had a pregnancy loss, so that could be a good sign for the future. And I don't want anybody to ever feel that hearing it, but it does tell us that certain systems are intact. On the other hand, after two pregnancy losses, you need an evaluation. The evaluation is for certain blood tests, a semen analysis, a sperm fragmentation, and a uterine and tubal evaluation. that can be moved up to one if you had heavy blood loss, you know, needed a DNC procedure, if your periods have changed afterward, if anything was really off, you can always get tested.

35:13And we never want to be in the world where we used to make women go through three pregnancy losses before they would get an evaluation. And I fell into that camp. After two, I said, shouldn't we do tests? I'm starting to fall off the curve here. Isn't something wrong? and I was told you need to have another pregnancy loss before we'll do those tests. It was the worst thing, the worst feeling that I had to fail again to a certain degree and lose a pregnancy before they would even investigate why.

35:40Andrew Huberman:Yeah, this theme it seems of like it's only menopause when you haven't had a period for a year. You have to have two pregnancy losses and then we can put you into this category of like amenable for treatment. I mean it's something really backwards about all of that. I imagine with your book and you being public facing with health information and hopefully others with you in your field that eventually this will change. I mean, if I were to draw the parallel to psychiatry, which isn't a fair one, I mean, should someone really have to be waking up at three in the morning for an entire year and have no hope for the future and be near suicidal before they get whatever the adequate treatment is?

36:19People will treat them for depression or whatever is going on. It doesn't make sense. I don't think it serves us. And I will say this too, we're starting to see a change. My big lofty hope for the book is that it changes the entire field of fertility. Like I understand why OBGYN used to take care of this. And then at some point they said, some people have infertility. Let's draw a line in the sand and have some people specialize in this, right? And I did three years of training in that after OBGYN. But at the same point, it doesn't make sense to practice that way. It doesn't make sense to force people to fail.

36:55And I might tell you, hey, the greatest likelihood is all the tests will come back normal. But we should do them because sometimes it doesn't, right? If I look across somebody who has recurrent pregnancy loss and I say 80 % of the time, every test will come back normal. But 20 % is a big number. That's a lot of people who maybe it's a simple medication. Maybe it's a procedure. Something can markedly change what they're going through. and in the same breath, the 80 % really need specialized care because what's really going on if we don't have an easy test for it? So I agree with you. I think the whole field needs to change.

37:31I think we need to change how we define terms, how we address women, how we approach reproductive health and hormones and fertility, and really in a more proactive patient-centric approach. And women and men are driving this really by talking about it. 10 years ago when I started on social media, nobody talked about fertility. And patients who did had nameless, faceless accounts. And now you see celebrities talking about IVF, talking about endometriosis, talking about their termination for genetic reasons or whatever happened. And those stories are so powerful to drop the stigma, but also highlight how wrong it is that we force women to fail before we'll even evaluate what's going on, let alone treat.

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39:31Andrew Huberman:Again, that's drinkag1 with the numeral 1 dot com slash Huberman to get six free travel packs and a bottle of vitamin D3K2 with your subscription. One theme that I heard over and over again was women would say, OK, they thought that they might have been pregnant before or they knew they had been pregnant once before. Circumstances varied, but they sort of had it in mind that they could get pregnant at one point. and that their mom had either them or a sibling, let's say at like age 42 or 43, and they're in good health themselves. And so they had it in mind that there's time. I think this is not uncommon.

40:16Andrew Huberman:And given that life is very expensive, most people in the world seem to be underpaid nowadays, and people are waiting longer to get married and have children. And the other common narrative that I was hearing was that there are people that want kids, but it's under the, well, if I found the right person, I would do it, but otherwise I wouldn't do it on my own. That's not always the case, but it's pretty. It's a true statement. It's a common theme, right? So for those women, which I think is quite a few, whether or not they're in their 20s or their 30s or their 40s, what sorts of things do you recommend they would add to that rather just kind of real-life analysis?

40:57Andrew Huberman:Those are not meaningless metrics, like how one's mother had a child, for instance. But things have changed. Microplastics, maybe certain things have gotten better, right? We're no longer eating margarine. I'm not trying to be facetious here. I think that there's so many variables. People are living longer, yet they're more environmental toxins, perhaps. I mean, people are smoking less. Are they, though? Are they? We'll talk about nicotine for sure. So for those women in their, let's say, 20s, 30s, and early 40s, what's the level of urgency that they get certain things checked out? And what should they get checked out?

41:34Andrew Huberman:Oh, and I should say that they'll say that they're having regular periods. I'd love to answer it, and I'm going to. But for the person who's maybe coming to this discussion, let's explain egg quality really quickly because it really is going to tie into what we can test and what we cannot. As you know well, women are born with all the eggs they're ever going to have. The eggs are kept, I like to think about it as in a vault inside your ovary, and so they're stored there. You have the most eggs when you're five months old inside your mom. You have six to seven million eggs. By the time that you're born, you have one to two million.

42:04By the time you start your first period, you have half a million. So you lose eggs over time. A lot of the determination of that starting number will be influenced, some by genetics, and some from your mom's health while she's pregnant with you, things she is exposed to, her current disease state. What I want people to think about is every single month you are losing eggs. So I like to imagine and describe to my patients a group of eggs is coming out of the vault. Each egg grows inside a small fluid-filled structure called a follicle. The brain sends out follicle-stimulating hormone, or FSH, well-named, gets a follicle to grow.

42:36As the follicle grows, it makes estrogen. This is called the follicular phase. Estrogen levels talk back to the brain. Remember that the brain does not see what's happening anywhere in the body. It is simply waiting for the hormone signal. That's what hormones are. They're communication signals. I like to think about it like text messages between friends. When estrogen is high enough for long enough, 200 picograms for 50 hours, and that's the level it'll tell the brain it's time to ovulate. The brain will send out a surge of LH. A follicle will then rupture. Egg will be released. It only has 24 hours to be fertilized, but that follicle will actually reform and become the corpus luteum.

43:14Now we're entering to the back half of the cycle called the luteal phase. The corpus luteum makes progesterone stimulated from LH pulses from the brain. So then it makes progesterone pulses throughout the luteal phase, can only live for about two weeks unless a pregnancy occurs. When you have an embryo come in an implant, it makes HCG, the pregnancy hormone we check in a pregnancy test. Fun nerdy fact, HCG and LH share a receptor. So HG comes into the corpus luteum and now stimulates a constant production of progesterone. But if that doesn't happen, corpus luteum will die, progesterone will drop, and you'll get a period.

43:50Okay. Also back to the vault, you have a different number of eggs that come out every month that is proportional to how many remain. So when you are younger, when you have more eggs, more eggs come out of the vault every month. As you get older and you have fewer eggs, fewer come out every month. That explains why you go from six to seven million to one to two million and why you go from one to two million to half a million because you had more, you're losing more. At some point, everybody will be out of eggs, right? We're going to call that ovarian failure and not menopause for the sake of our discussion.

44:22But so everybody will go into ovarian failure. Now, the timeline, once you have your clock is now up because at that point, There's no more eggs. You cannot get pregnant with your own genetic child. You still have a functioning uterus. It's just not being stimulated. So importantly, those women can get pregnant with donor eggs or donor embryos. They can still carry a pregnancy. That's sometimes a myth that people think about. But once you're out of eggs, that's kind of the end of your clock. Now, two things are happening with time that are really important because your eggs are inside that vault inside your ovary is that they absorb the wear and tear of your life.

45:00And your egg has many different functions. It has to respond to hormone signals and make estrogen, make progesterone, and ovulate. The mitochondria inside the egg, which everybody knows the mitochondria, the powerhouse of the cell, gets exclusively passed on to the embryo. It completely controls embryo growth and development. In fact, the male genome doesn't even kick in until day three after fertilization. Oh, those first few days are 100 % maternal. The egg also has to hold the chromosomes in correct position. So an interesting fact is that inside the egg, it is frozen in metaphase of meiosis II for whatever reason.

45:37And so the chromosomes have met in the middle and they're held apart by those meiotic spindles and they do not separate until you ovulate. And so then you get your egg that has what we think about as your 23X. The other part goes into a polar body. Okay, this means that when you're 25, your eggs have only been held in metaphase for 25 years. Your chromosomes are, for the most part, still in the right position. Your proteins are strong that are holding them apart. Most people have better generalized metabolic health. Their mitochondria are stronger. When you are 40, 40 years have passed. We've asked those chromosomes to hold there longer.

46:12I always say if I have a line of kindergartners and I ask them to stand for 40 years, like somebody's going to get out of line. So tincture of time adds up. But the other thing that happens as we get older is as a population, we get more metabolically unhealthy. So we see more chronic inflammation, more insulin resistance, more obesity. And all of those factors influence oxidative stress, mitochondrial health, DNA damage. They can damage the myotic spindles holding those chromosomes apart. So we also see more genetic abnormalities as we age. But that is worsening as metabolic health worsens too.

46:47Okay. We don't have a direct test for egg quality. That's what we call egg quality. genetic normalcy, and egg competency. How good are the mitochondria? Can it do its job? We approximate it to age, which has some faults because not all 40-year-olds are created equal. When we think about ovarian reserve, this is how many eggs you have remaining. So this is how many eggs are inside the vault. And we can approximate it with a blood test called AMH. AMH stands for antimalarian hormone. It's made from the granulose cells that surround each follicle. So in its purest form, more eggs inside the vault, more come out, more AMH.

47:24Fewer eggs in the vault, fewer come out, lower AMH. Not a perfect test. The vault also is not perfect, so there's some month-to-month variability in how many exactly get sent out. And in prolonged periods of not ovulating, AMH can be suppressed, whether it's from birth control pills, pregnancy, postpartum, whatever the reason is. So AMH is imperfect, but it is something, and it's a very simple blood test. It's not telling us if you can get pregnant or not, but it is telling us how many eggs do we have outside the vault. And the way I like to frame this is that every woman who wants to have children or understand her own reproductive timeline should get an AMH checked.

48:06That is against medical advice, meaning the American College of OBGYN says that women should not get an AMH checked unless they have infertility. This is wild to me, right?

48:16Andrew Huberman:I mean, to me as well, I mean, it just seems like this failure criteria, it just seems so – it seems just very extreme and unnecessary. Unless there's some hidden agenda to try and prevent people from maintaining fertility or having children because – and that doesn't square with at least my assumptions. The idea here is that it can be really stressful. This is what they say in their document, American College of OBGYN. It can be very stressful for a woman to find out she has a low AMH and that it doesn't predict fertility. And there's some truth to that. So let's think about two 30-year-olds.

48:52One has 20 eggs outside the vault, which would be an age-related norm, and one has five eggs outside the vault. Well, if every single other factor is the same and they each are ovulating one egg, they have the same chance of getting pregnant, right? So that's not a faulty statement. However, the person who has five eggs will not have as long to grow her family. She will not get as many eggs if we're doing advanced treatment like egg freezing or IVF because I can only get the eggs outside the vault to grow. So it's hugely impactful for what your journey may look like in treatment. But more so than that, Andrew, so many of the causes of a low AMH directly contribute to infertility.

49:31Things like autoimmune disease, insulin resistance, endometriosis, smoking cigarettes. So if there are factors, some of which you can control, some of which you can treat, if I have a woman who has a low AMH, I'm not going to sit here and say, okay, well, you can still get pregnant, no worries. I'm going to say, I don't know that you'll have infertility. But some of the reasons your AMH is low can cause infertility. You will get fewer eggs if we're freezing, your eggs are doing IVF. You will go into menopause earlier. So we need not wait, right? To your point, the woman who's 20, 30, 40 thinking about this, she might make a very different decision when she knows she's really faced with a timeline that is less than ideal.

50:14And why should we allow time to be making that decision for us instead of at least playing an active role? I sit across from women every day, find out they have a low AMH. And I say this, like, let's do the investigation and see if we can find out why. Probably 50 % of the time we find an autoimmune disease. I can't reverse the clock, but I can slow down the rate of inflammation, right? Say if it's Hashimoto's, suddenly we can do thyroid replacement. We can work on decreasing inflammation. If inflammation harms our ovary, maybe we can slow down that rate of egg loss. At least she's being treated and probably feeling better and will have improved fertility outcomes because her Hashimoto's is treated.

50:50So we should look at why. Why is it low? And treating that why very well may impact fertility. We also might say, what should we do about this? You know, I have a lot of couples who are partnered who are just waiting for the right time to get pregnant. So sometimes we say, well, we could get pregnant, but I'm in medical training. I'm going to law school. I'm doing X, Y, Z. It's not a good time. Well, when faced with their perfect time, they may not have eggs anymore. Suddenly we reevaluate where we are, and there's no one right answer. We might choose to try to get pregnant now. If we don't have a partner, we might buy donor sperm and try to get pregnant.

51:26Maybe we freeze eggs. Maybe we freeze embryos. Maybe we do none of those things. But we made the active choice, right? Sitting here saying, I chose not to pursue treatment knowing my AMH was low and that I might be an ovarian failure at the point when I was planning to have a family. And I know that makes the journey so much easier to walk because you made that active choice from a place of knowledge that was your autonomous decision versus saying, I asked my doctor for an AMH test five years ago. They told me it wasn't medically recommended because I don't have infertility. And had I known that information, then I might have done something different.

52:03That was the longest discussion to say everybody should get an AMH. I think it's a very important marker. It's a newer-ish test. We've only been checking it for about the past 10 years. It's not a perfect test. I don't have the nomogram for exactly how it should drop over time. And I like to think about it as categories. Normal, above average, below average, critically low. and based on your category, we should probably talk and do different things. If you are listening to this and you want kids one day, ask your doctor for this test. If they say no, you can order it yourself at a LabCorp request, many of the online platforms like Function Health.

52:41You can have an AMH checked through them. You can ask your doctor for it and say, well, if it's low, I know I'll talk to a fertility doctor to find out more information or call a fertility clinic and just say you want fertility testing. The end. Okay. I think it's such an important marker. It is not a test of egg quality. And we talked about what egg quality is, right? Genetics and egg competency. But it is a check of how many eggs you have. And that knowledge can be really impactful for how you view your future and your plan. So I think everybody should get an AMH. I think we've got to learn to track our cycle.

53:14And I know you said in the vignette that these women have regular cycles. Having a regular period is really good. It's much better than having an irregular period. But knowing when you ovulate and tracking ovulation is a much more sensitive health marker than simply when you bleed or when you have a period. Because tracking ovulation is going to allow us to know how long is your luteal phase and how long is your follicular phase. And ovulation disorders progress through a very predictable pattern, and we know this well. The first stage of an ovulation disorder is a luteal phase defect, meaning a shortening of your luteal phase.

53:53So you're ovulating, but the brain and ovary have a miscommunication, and we don't make progesterone long enough to sustain the luteal phase. Less than 11 days is a short luteal phase, but you'll still have regular cycles. So if I sit across from somebody and I just say, are your cycles regular? And they say yes, and we carry on, I've missed the fact that they actually have a shortened luteal phase, and that warrants further investigation. prolactin, thyroid, AMH, PCOS, looking at different causes. The second stage of ovulation disorder is a long gluteal phase. Takes the ovary longer to actually respond to the FSH stimulus from the brain.

54:35And then from there, we'll progress into irregularity and true amenorrhea or absence of periods. But those first stages, you might miss the little red flag warning sign that something's wrong inside your body because you were just tracking when your bleed is and it's every 34 days, so you think it's normal. But if we were looking at when you actually ovulated, we have more data. So learning to track ovulation as opposed to just cycle tracking, I think is one of the most important skills a woman can have for learning to listen to her own hormonal cues.

55:11Andrew Huberman:Amazing. Just, I don't say that lightly. You just explained egg quality, the biology of the ovulation cycle and how it links to the actionables. And I'm just struck. It's awesome. And it has me asking a couple of practical questions. Some people will have insurance. Some won't. What's the cost of an AMH test? Let's assume insurance doesn't cover it. Yeah. And they just have to go completely out of pocket. and before you answer, I will say whatever it is, I think it should probably be compared against what it would be to try and, I don't wanna say rescue, but not take the test. And then, you know, three years later, you're trying to harvest eggs.

55:52Andrew Huberman:It could be multiple cycles because you realize it was only five eggs per, you know, per month as opposed to age match, right? 15, right, exactly. So are we talking hundreds of dollars, thousands? $79. $79. Yeah, we're withholding a$79 test. And I feel really strongly about this. I do not view myself as the gatekeeper of information about your body. Do you want hormone levels checked? Do you want an AMH? I do not think that is the role of a physician. And now I can say your insurance doesn't cover it. You can make the decision if$79 is worth it to you. But in the age of information where that's an easy test to do, every lab runs it.

56:32and it's relatively inexpensive compared to freezing your eggs or IVF. I mean, right? Multitudes,$79. We're throwing a fit over a$79 test.

56:43Andrew Huberman:Wow. I'm going to make sure that message goes far and wide because, you know, I thought you were going to say maybe in the high hundreds or thousands, which for some people is going to be, you know, prohibitively expensive. Yes. So get AMH checked. I think I'll avoid going into too much editorializing here because I'm really just interested in how you view this. But how you describe the sort of the way your field has originated and where it's headed reminds me a little bit of, I remember in the 80s there was a genetic testing was starting to become possible. And a lot of it was happening at Stanford.

57:17Andrew Huberman:I happened to grow up near campus. And I remember hearing you could get tested for like Huntington's disease, which can be a devastating disease. And the idea was people don't want to know. People don't want to know. I think everything I've observed, I can't speak for everyone, but everything I've observed about people's interest in their own health and genetics and what genetics does and doesn't mean tells me that people are actually much more interested and they're much smarter than, let's just call it the traditional medical field, certainly medical genetic testing, gave them credit for. 100%.

57:51Andrew Huberman:It's like people aren't idiots. You can sit someone down and say, hey, listen, you have this gene. There's an X probability. Here are the things you can do to protect yourself. And but there was this assumption like people don't want to know because now they're going to live in dread and their life is going to be destroyed if they know they're going to get full blown Huntington's or something like that. It's so paternalistic. It's actually I mean, it orders on unethical. People are smart. People can take in information and they can make decisions that don't necessarily crater them on the basis of just knowledge.

58:20Andrew Huberman:I mean, it feels like we sort of treat people like children, like little children. And even little children would probably want to know certain things, although you don't want to give them genetic information. But certain things like, hey, you have a challenge with X, Y, and Z, and you can overcome it in the following ways. Look, technology's advanced. It has. How we counsel and how we approach health care needs to advance also, meaning we don't live in a universal health care system. We don't have only X dollars to spend on every single patient. And in certain circumstances, when that's the case or a patient has limited money, we do have to make very judicious decisions about the best use of those dollars.

58:56But for the majority of people who will be listening to this, they are willing to spend money on their health. And it shouldn't be a society or a physician or somebody standing in the way of getting data that can dramatically impact your life. And because you mentioned Huntington's, I should say, right, autosomal dominant disorder. People have very strong feelings on if they want to know they have it or not. And I've had patients because we can test for this with IVF. So we do genetic testing of embryos. And we often do screening to see if the chromosomes are in the right position, which we talked about for age.

59:29That can be really beneficial. But we can do single gene testing as well, PGT-M for monogenetic diseases, and Huntington's is one of them. And I've had some patients say, my mom had Huntington's. It was the worst experience to watch her go through that. I would love to test my embryos, but I've committed to myself that I don't want to know if I have it or not. And I think it's really important just to mention that disease to say, we can blind test you. You can make a probe to see if you carry it or not. You don't have to know. And we can still test the embryos. And I've had a few patients who them themselves did not want to know.

1:00:04But we went through the steps to make a probe in case they did. In both cases, the patient did carry it, didn't find out that they did. but they could assuredly transfer an embryo that did not have it because often these people have felt so strongly watching a family member die from a terrible progressive disease. They've said children are not in the cards for me or I'm not going to have genetic kids. Sometimes they'll come to me saying we have to use an egg donor or sperm donor because I might carry this and don't want to know. So again, it's the idea that that should be your own individual choice, whether you want to know or not, but it shouldn't be the society or somebody else putting this roadblock up.

1:00:44And it's such an antiquated approach in the era of technology and access where you really can get so many data points. Why should somebody be making the decision on if that information is valuable to you?

1:00:57Andrew Huberman:And I think with blood testing, the price coming down, it seems to me maybe it's just the circles I run in that people want more information as opposed to less, but I'm glad that you raised this, these cases where people don't want to know certain amounts of information. One thing that, well, I'll just pose this as a question. How many women out there do you think know? If – I have to be careful how I word this – if doing an egg harvest cycle decreases their ovarian reserve or not? The majority of patients that I sit across from will tell me I'm afraid to freeze my eggs or do IVF because I don't want to go into menopause earlier.

1:01:42So the myth that doing that is going to tap into the vault and pull out eggs is inaccurate and a fear that really does need to be busted because it doesn't. it's a limitation of the science that I can only get the eggs outside the vault to grow. If I could tap into the vault, that would change the game. But right now I am limited by the eggs you give me, the number of them controlled by whatever's outside the vault. We in IVF, we just give FSH, same hormone your brain makes, trying to stimulate more than one egg to grow. Your body doesn't want to have five kids or 12 kids or 20 kids, so it has checks and balances to prevent that from happening.

1:02:21I, however, would like every egg outside the vault to grow because in nature, you will ovulate one and everything else will die. You are constantly losing eggs no matter what. When you're pregnant, when you're breastfeeding, when you're on birth control, before you start your first period. Constantly losing them. I cannot change that right now. So doing IVF or egg freezing is not going to decrease your ovarian reserve. It is simply going to influence one month in time trying to not have all those eggs die.

1:02:49Andrew Huberman:And I think the myth is that by doing a cycle of egg freezing, that you're taking more eggs from your reserve. But as you pointed out, women are losing the same number of eggs each month or follicles each month. Regardless, you're maximizing on that process by just maturing more and taking them as opposed to letting them die. Exactly. We are not running out of eggs early. I think it's just based on, again, nobody understands basic biology. So we think in our brain, I'm just losing that one egg since I'm ovulating. We're not thinking about all the ones that were sent out of the vault who weren't chosen.

1:03:26Andrew Huberman:Yeah, and I think people also assume, because they haven't been told, that if you do an egg, you know, if you stimulate for more to mature, that you're somehow taking away from eggs that you would have had, you know, stuck around somehow. So we're hitting – we're saying the same thing three different ways. Yeah, so you're giving, I mean, it's fascinating to me if you think about it because we are allowing the possibility for you to have children in your family that likely you would not, right? Because if you were to get pregnant naturally that month, the greatest probabilities, it would just be one that you would ovulate.

1:03:58Yeah, for IVF, we can sometimes take one month's group of eggs in time and have a couple different embryos and those become a couple children for you that you have from this one exact cohort. I think it's so fascinating. You know, early IVF days, I mean, IVF's not that old. It's only been around like 46 years. I think the oldest IVF babies. We didn't have gonadotropins. We didn't have FSH that was, you know, synthetic or purified. And so we couldn't get multiple eggs to grow. So original IVF patients had to go live at their IVF clinic. And they had urinary-based hormone measurements done every day.

1:04:35so they could try to gauge when as estradiol was rising, when they were getting closer to ovulation. And in those days, this is just science, they went and they did abdominal surgery to aspirate the egg. Now we do a vaginal egg retrieval where we take a needle attached to a vaginal ultrasound. It's a minimally invasive procedure. But back in the origin IVF studies, they had to go and do an abdominal incision to put a needle in the one single follicle to get the follicular fluid in the egg out. So it was very low odds of working. It was crazy to even think of. But the advent of gonadotropins, the ability to first started by purifying FSH and LH and be able to give that to people to stimulate more than one egg, understanding this concept that there's so many more eggs that you have outside the vault every month, that has changed the game.

1:05:21And it's such an amazing advancement in science that we can leverage that physiology for egg freezing our IVF.

1:05:29Andrew Huberman:Very practical question. It's clear that the younger that a woman is, the more eggs that could be frozen in a given cycle. But I think it's fair to say that many people, either because of finances or life circumstances, that could be not having a partner and wanting a partner before having kids, this sort of thing, are waiting. Right. They're just waiting. What stands between us now in the United States and egg freezing being covered by insurance 100 percent? I don't hold any superpowers, but there are pretty powerful ways to lobby all the administrations, regardless of who happens to be in office, when that actually happens.

1:06:14Andrew Huberman:I mean, it is possible, right? The phone is a powerful tool. Advocacy is a powerful tool. I do think that things can happen if there's a lot of advocacy. So first question is, you know, what would that require? And is that a good idea? I am a fan of knowledge and options. And egg freezing is not a guarantee. So, you know, how I pose it to patients is we are going to keep the door of opportunity open longer for you. And that is our goal. If we want to compartmentalize it, as some people will falsely sit across from me and say, oh, egg freezing is an insurance policy for my fertility. And it's not because an insurance policy always pays off.

1:06:54But it's an investment in my fertility, like investing in the stock market, like probably will pay off. But depends on external factors that we don't have yet. Right. So the ROI is yet to be determined, but in general considered to be a good thing. I think it would be absolutely incredible to be in a place where egg freezing could be covered. And, you know, there's definitely countries where it is that they have said, well, the birth rate is dropping. We want to keep the reproductive lifespan open for some patients. We want to offer this. I think to be honest and transparent, the number one restriction against that that we see as a field right now is the camp of people who are ethically or morally opposed to IVF for reasons of embryo disposition.

1:07:37Andrew Huberman:Embryo disposition. Yeah, like the personhood of an embryo. Is an embryo a person? I see because embryos that are not used are going to be either kept frozen or discarded. And to those people, that's seen as essentially killing a baby. Correct. Right. That's their view. Yeah. And we should acknowledge that I have many patients right now who are donating embryos, when they're done with their family, which is an amazing way to kind of pass forward the opportunity for other couples to have a family. And I also just want to say at the top of this is that IVF is incredible. 17 million babies have been born in this world because of IVF.

1:08:14So I think this technology is great. Does that mean everybody has to do IVF? No. You are allowed to have your own feelings and decisions about anything that you do, IVF included. And there's often things we can do within the procedure for patients who might have religious or ethical concerns to limit the number of embryos that we make or only transfer embryos that are created. And that's important to know, to bring that up, if that's your line in the sand, is that we can often do things differently based on your beliefs. It might be less efficient. It might cost more money. It might have a lower rate of success.

1:08:50But I've had patients walk that road, and that's the way it felt comfortable to them. In this country, there's a camp, not to get too political, and they're really pushing something called restorative reproductive medicine, And they're opposing a lot of the American Society for Reproductive Medicine's attempt to get fertility treatment and fertility preservation covered. And their rationale, even though a lot of RRM, I'm a huge fan of. It's about teaching women cycle tracking and getting to the root cause and really supporting understanding your fertility. Like bullet point 10 on their list is that IVF is unethical.

1:09:22Andrew Huberman:But these people are ostensibly pro-child. I agree with you. I'm not – my political stance, people often speculate. Like I'll be really honest. I don't like politics. Yeah. And I'm very disappointed in the current state of politics on both sides. And I try and go issue by issue. And I realize that itself is a controversial statement you're supposed to take a hard stance for or against. But I think that as a biologist, I look at certain things and I go, all right. And I look at other things and I go, oh, my goodness. Like what Stone Age are we living in? And so I think that to argue whatever it is that one believes about, it seems to me that IVF, at least to me, maybe I just am too through my own lens, but the whole notion of freezing eggs and creating embryos seems very pro-child to me.

1:10:11Andrew Huberman:So it doesn't square with number 10 on this list. I agree with you. I agree with you. And I think a lot of the people who are a fan of RRM might actually agree with you and I. but there are definitely people who are very adamantly opposed to IVF who put number 10 in there because they have a different agenda. I'm a fertility doctor, right? I want as many people to have a family as they desire. I want you to fulfill your life's dreams. If having a child is a part of it, I want to do everything I can to help you have that. I am not here to sell IVF or force IVF. At the end of the day, it impacts me zero what you individually choose to do.

1:10:48But I believe that across the board, people deserve the tools in the toolbox. They deserve to be presented with all the choices. We could try Clomid. We could try IUI. We could try surgery. We could try IVF. Oh, you're getting older. We could freeze your eggs. They're just more tools. There's more opportunities. And then based on your circumstance, your financial, your beliefs, you should be allowed to choose. I feel very adamantly that one's own beliefs that cause you to want to put it at number 10 on the list should not be the beliefs that we enforce on everybody, especially when we know that IVF can be so powerful to help so many people have a family.

1:11:26It should be something that is offered to you if indicated and you get the choice. And so back to the origin, it would be incredible to live in a world or country where egg freezing was offered to women as we do see people are waiting longer to start their families. It would allow more people to feel less pressure, less pressure with a partnership and on their relationship, not to feel like, oh, this better work out because my clock is ticking, and be able to really feel like they could chase one dream and not at the expense of another. I think we're further in this country than we want to admit from that.

1:12:02We can't even get fertility treatments covered for patients with cancer. When we know that chemotherapy is going to deplete their ovarian reserve. We have some states that we can't even get egg freezing covered for them.

1:12:14Andrew Huberman:So this is state by state. This is state by state right now. We would love federal protection for everybody. We would love to be able to see, I don't know, to me, that's my litmus, what your state or your country would do for patients who have cancer, you know, are in this position. And if we're not even willing to move to help them, The idea that we could cover it for everybody, we're still ages away from that, I think. Yeah, because it's not – what we're talking about is forcing anyone to do anything, nor is it necessarily the destruction of an embryo. I mean, there is a world where the embryos are created and kept frozen, right?

1:12:53Andrew Huberman:There is no – Yeah, we call that embryo banking. I mean, to specify maybe for somebody who doesn't understand, right? Egg freezing, getting those eggs outside the vault to grow, taking them out of your body, and we freeze them right there at the egg state. Making an embryo is going to be thawing that egg, fertilizing it with sperm, letting it grow out to the implantation stage, which is day five or six. Not every egg will survive, fertilize, grow. There's a ton of attrition in culture. So 90 % of eggs survive the freeze thaw, 75 % will fertilize, 50 % will make it to the implantation stage. And then not everyone will be genetically normal based on your age and other factors.

1:13:32And then even a genetically normal embryo only has a 65 % chance of live birth. Like the science has come far, but we're not there all the way. With that being said, they do morally really feel like an embryo could be a potential life. And they do struggle with what to do if they have leftover embryos. And I have some patients who've told me every embryo we make, we're going to transfer. Okay, well, we want to be really mindful what we do in that circumstance. And even though it's unlikely, I have a patient right now with four children and one embryo in the freezer because we froze five, knowing that everyone shouldn't implant based on that 65 % number, but we've gone four for four.

1:14:09Okay, so like we have to know that if that's what we're doing, we're prepared for how the data may fall because data just helps us guide decisions, right? Especially when it comes to live birth, it's zero or 100. It happens or doesn't. Now, if I freeze them as eggs, for some patients who have really strong beliefs and they are afraid of that number five, we might take more time or take more money. But we might say, let's thaw them and only fertilize two. Let's leave everything else frozen. And then whatever makes its embryo, we can transfer. And yes, that's not a cost-effective way to go through the process because we might be having to pay for thawing and the fertilization and the transfer more times because there may be nothing to transfer based on that attrition.

1:14:48it can let some patients say, okay, I feel better with that process. So just freezing eggs, to your point, is not making embryos, right? And there's different things we can choose along the way to make an individual person feel comfortable, but we shouldn't be dictating how the field has to function. I think it would be incredible if we could encourage egg freezing earlier. I think it would open the door of opportunity. And not everybody who freezes eggs will need them, but the peace of mind knowing that there's a chance is really impactful on the human mind.

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1:16:29Andrew Huberman:8sleep ships to many countries worldwide, including Mexico and the UAE. Again, that's 8sleep.com slash Huberman to save up to$350. So insurance, I would think, would want to do this because covering all the other stuff is expensive too. Most insurance doesn't cover IVF. You're not wrong, right? In principle, if I freeze a 25-year-old's eggs, I will have three times as many eggs to work with, you know, than I would if she's going through IVF when she's 37. So if I'm going to pay for her to do IVF at 37, it'll take so many more cycles. I'll spend so much more money. That one cycle of egg freezing is much more cost effective if I'm covering them both.

1:17:14But we don't even cover the latter. So many times patients, this is such a hard stretch for everybody. And look, the technology is incredible. As somebody who has an IVF lab, as somebody who keeps embryos on site, it's, I mean, it's outrageously expensive. I mean, our generator alone is a million dollars, right? Because if the power goes out, like, what do we have to keep going? We always say if there's zombies coming, like, come to the clinic. The technology to keep up with all the advancements, to have trained embryologists, I mean, their micromanipulation skills, it's impressive. So it costs money to run a lab like that that will provide results.

1:17:54So the process and the technology is really, really expensive. That being said, like, I shouldn't be the one sitting here making assumptions again on what you're going to do with your money. And if somebody's in a position where they know their egg counts low and they should freeze their eggs because they're not partnered or they're not ready to get pregnant and they don't have the financial resources, we can sometimes find more money. We make decisions every day when it comes to money. We can't find more time. We can't find more eggs or more ovary. So, again, this idea that, well, what are they going to do about it if they find out they have a low AMH?

1:18:27Oh, they can't afford to freeze their eggs anyway or, oh, it's too expensive. we all make individual choices on how we leverage our different resources, which I consider to be your time, your money, your physical energy, and your emotional energy. Every day you're leveraging them. But when it comes to reproductive health, having a family, like I feel strongly, you feel strongly, which I love, that we should be giving more access and more options to people so that they can pursue this. And so the arguments across the board too, like why not check an AMH in somebody who's younger. Well, they can't afford egg freezing anyway, so what are they going to do about it?

1:19:02Again, like we shouldn't be making the assumptions of what somebody will or will not do with their resources or with their data. We should be ones helping them get the data and interpret the data, understand what resources or options exist, and then the individual has what they need to make the decision.

1:19:20Andrew Huberman:In the Bay Area, where there are a lot of tech companies, there's a, my understanding is there's an opportunity at many of these companies for female employees to freeze their eggs. That landed much more controversial than I thought it would. Isn't it crazy? Because the assumption, the sort of, to some people, the tacit message there is don't have kids now. Yeah, don't have kids now. Work for us. Work like crazy and then have them later, right? Yeah. But having known some people that worked there and froze their eggs in their late 20s or early 30s, I think they would say, the ones I know would say, yeah, I'm really grateful that I did that and that the company I worked for paid for it.

1:20:01Andrew Huberman:And they got to keep their eggs even though they don't work for the company anymore. So there's that. But it was kind of interesting. So anyway, we're getting kind of sociological here, but I think it's important. Yeah. What data supports is that when companies do leverage a fertility package and their benefits, They retain employees longer. Employees are happier. And more people utilize the service than would without it, meaning people freeze their eggs when it's offered to them through their company. And that gives them that peace of mind, understanding it's not everything, but they feel more comfortable exploring bigger opportunities.

1:20:36And they are grateful to the company. They stay with the company longer because that is an investment in your employees. I think it's incredible. In Austin, right, a lot of these tech companies have second homes. So we see a lot of these patients also. And I do think that has changed the game for so many people to be able to have access. Because for many, it's not ethical or moral, it's financial. Often the time when you would freeze your eggs, when it would give you the highest rate of return, you don't have the resources to do so. So having a company that's able to come in and do that is really, I think, impactful.

1:21:10I wish more companies would do that. Maybe we can change their minds.

1:21:12Andrew Huberman:I tend to get pretty loud and pretty consistently loud about the things that I believe in once I understand the landscape. So I plan to be vocal about it for what it's worth. You mentioned that birth control can reduce AMH levels on a month-to-month basis. Is there – and we should define birth control because it's such a broad category. But is there any evidence that taking hormonal birth control can lower chances of pregnancy when somebody comes off birth control? In my friendships and knowledge space, my – and this isn't I have a friend. I just – I know a number of people who have kids now who were on birth control, came off birth control and got pregnant right away.

1:21:56Andrew Huberman:So I think a lot of people assume that's how it works, but are there any good examples of how certain forms of birth control can actually suppress fertility in women long after women come off birth control? Excellent question. Okay, let's break the data down from big to little. Number one, big studies looking at all different types of contraception, no higher rate of infertility, again, defined as failure to get pregnant at 12 months. So you come off your contraception at 12 months later when we look, there's no higher rate of infertility than we would have on the population-based level. So that data leads us to comfortably say birth control is not causing infertility.

1:22:31Now if we go and we look more nuanced at different types of contraception. If you look at the birth control pill, what most people are talking about, the birth control pill is a combination of synthetic estrogen, ethanol estradiol, and a type of progesterone or a progestin. These work by telling the brain, essentially tricking it, so the brain doesn't send out FSH or LH. And as we described earlier, those are important in getting you to ovulate. So you don't ovulate when you have taking the birth control pill, and that's why it's a very effective contraceptive choice. However, the half-life of the birth control pill is only 28 hours, so it's actually quite short.

1:23:04So you can miss even just one pill, and you could ovulate. So when you stop the birth control pill, your period should come back that next month. So immediately you should have resumption of ovulation. A couple of problems with this one is that the birth control pill has some valid medical uses, has some non-valid ones. But very often, especially in the generation of women that we see right now, they were given the pill potentially for a valid medical reason without any investigation of what it was. So maybe a woman had irregular cycles or some acne and her doctor said, well, here, take the birth control pill.

1:23:41It will help. And it did help. But just based on that history, I would sit here and say, I bet she has PCOS. And the woman, though, never was told, I think you have PCOS. Here's what it is. You probably will not ovulate when you stop the birth control. And your acne will come back. And you should talk to a fertility doctor. And here's lifestyle things we can do to decrease insulin resistance. Never had that discussion. So in her mind, had some symptoms, started the pill. Those symptoms resolved. Now we stop the pill, and we're not getting pregnant, and we have irregular cycles. and we start to blame the pill as the reason why instead of understanding that the pill was maybe masking it or treating certain aspects of it.

1:24:19So we do see failure to get to a diagnosis in women who were prescribed the birth control pill young and then with the idea I'm gonna stop the pill and get pregnant right away. What I like to say is you're not ovulating on the pill. If ovulation and knowing when you ovulate is one of your most sensitive health markers and really essential information in trying to get pregnant. If you are trying to get pregnant, The egg only lives for 24 hours. The fertile window is the five days before and the day of ovulation, meaning sperm can live in the reproductive tract for up to five days. Most will stay around for two days.

1:24:52That's why the two days before and the day of ovulation have a 20 % to 30 % chance of getting pregnant compared to a zero day the day after ovulation, 0%. So very defined fertile window. So if you know when you're ovulating and you target intercourse, you're going to have higher odds and get pregnant faster. Data supports that very much so. but you don't know how to track your ovulation because you've been on the pill. So you don't know how to do that. So I recommend that you stop the pill three to six months before you're really wanting to start your family so you can track your cycle, learn to detect ovulation.

1:25:23And if you do have an abnormality, you're not now six months of trying or one year of trying before it's evaluated. You can say, oh, I can't detect ovulation or my cycles are irregular. Let me go get that investigated now so we're not kind of behind in our own timeline. The progesterone IUD is another one that we talk about a lot. The progesterone IUD is local progesterone that is placed inside the uterus. There's different types that can release progesterone in different amounts. It typically suppresses ovulation in the first two years, but then progesterone levels drop and it tends not to suppress ovulation.

1:25:57But that chronic progesterone exposure thins the endometrial lining to the degree that many women do not have periods anymore. That can be great. If you don't like having a period, that can decrease the chance of anemia or menstrual cramping. So it can be very lifestyle positive during those years. But when you stop the IUD, we do see a change in endometrial receptivity at least for six months after it's been removed. And it can take time to build that lining back up. So I always recommend that a progesterone IUD is removed at least six months before you want to get pregnant. Give the endometrium time to rebuild and regrow.

1:26:33And then you'll have better odds of conceiving. We do see a little bit of lower pregnancy rates in those first six months of conceiving. And women coming off of the IUD, more of them are getting pregnant in the back six months. So kind of shift your own timeline. And the birth control, I think, is always important to mention in this conversation is one that's not as common, but it's the Depo-Provera shot. So this is a high-dose intramuscular progesterone shot that can prevent ovulation for three months. On population-based levels, to use it as an effective contraceptive, must get every three months.

1:27:04But one single dose can prevent ovulation for 18 months. So this is that one exception where if you want to get pregnant potentially in the next two years, please don't get Depo-Provera. Great.

1:27:18Andrew Huberman:Incredibly thorough and clear. Is there any evidence one way or the other that intentional termination of a pregnancy can disrupt chances of getting pregnant again later? No study supports that having a termination is going to negatively impact your fertility later. One caveat I just want to mention is that any intrauterine procedure has the potential to damage the endometrium and result in scar tissue. So that could be having an IUD. It could be having a fibroid removed. It could be a prior C-section. It can be a prior DNC because you had a pregnancy loss. It could be from a termination. Where we see the greatest risk in all of these circumstances is from heavy bleeding or from an infection associated with it.

1:27:59So in general, most terminations are done early, very routine. Where we are fearful is when they are accessed in non-safe environments. We're seeing more infection or heavy bleeding, or even when women are having to travel statewide to access care, and they're getting the procedure done later with a higher risk of complication. In Texas, where I practice, there's obviously an abortion ban. And so women who need an elective termination for a medical reason, I had one patient who's been very open about her story. Her baby had anencephaly. So she went through IVF and had a baby that had no brain develop.

1:28:34And they made the decision that they wanted to terminate that pregnancy since that's not compatible with life. They don't want to have to carry the entire pregnancy. They had to travel out of state to access care. Their first appointment was canceled. So they had to make another one in a different state. It took them much longer than they wanted. had the procedure much later. And then she had residual scar tissue inside her uterus. That was because it was done at a later term that we then had to fix before she could get pregnant again. So I think it's just important to say that across the board, any intrauterine procedure poses a little bit of a risk.

1:29:07No matter what it is, if your periods are different afterward, the hallmark sign is going to be a lighter cycle. So no matter what thing on that list you had done, if your cycle is now lighter afterward, I am worried there could be scarring inside the uterus. And we'd rather evaluate that in the clinic, we can do a saline sonogram to just check and make sure there's no scar tissue because that will impact your fertility.

1:29:28Andrew Huberman:Thank you. Some practical questions about metabolic health, mitochondrial health, and egg quality. Let's do it. In your book, you go into this in some degree of detail, but when you think about the things that can really help support egg quality, aside from age. Yeah. In fact, I should say at any age. What are the, you know, top contour of those? You mentioned inflammation is the enemy, but inflammation happens all the time and we can't avoid it, but we can certainly avoid exacerbating it. So what are the things that people can do, not do, and take? We can do that. Okay, I love it. Do, not do, and take.

1:30:11Okay. So, yes, inflammation is prevalent in our world, and the goal is not to avoid all of it. In fact, acute inflammation is required for conception, right? We need acute inflammation with ovulation. If we just think real physiology, a follicle is rupturing, allowing the egg to be released, and then reforming. Like, we need our acute inflammatory response to allow that to happen to the degree that if women take NSAIDs around the time of ovulation, Advil, ibuprofen, Aleve, they'll prevent the follicle from rupturing. Really? Yes. So they will go through the hormonal changes of ovulation, but the egg will not be released.

1:30:49So that's why we recommend, and fun fact, or important to know, if you're trying to get pregnant, you can take those medications only when you're on your period. So period cramping is fine, but we don't want you taking them for the rest of the cycle because you can prevent ovulation from occurring.

1:31:03Andrew Huberman:How many people, in your experience, do you think know that? I don't think very many, honestly. Right? Right, which is wild. I feel like it's sort of like banner across the sky. Like you said, you're not going to lose eggs by doing a free cycle, a collecting free cycle. I mean. Basic facts about our biology that we are never taught. So if somebody's trying to get pregnant, NSAIDs can be problematic. They can be problematic. They can prevent the egg from being released with ovulation. So I think this is important because I will sometimes have patients say, well, if inflammation is bad, can't I just take medicine for it?

1:31:35Right? Like that, you know, brain might make sense. And I always want to say your immune system is essential for ovulation and also for implantation. So I don't want to turn off your immune system. What I want to do, though, is not have it be so burdened with what we call chronic inflammation, that constant activation where it can't even do the job that we need it to do. So I like to think about this as that inflammatory burden. And so we're all exposed to some. But how do we, to your degree, make it better? How do we add to it and make it worse? and really framing ourselves so that we can cultivate, and I like to think about it as resilience within your body.

1:32:12I mean, you're going to be exposed to inflammation. Life is going to throw things at you. But you want to cultivate these best practices of your life so that you are reducing inflammation to the degree that you had. And this goes hand in hand with insulin resistance, which we'll get into. And I usually divide it into like what I call my five non-negotiables of sleep, stress, muscle, food, and toxins. and thinking about how we leverage these to our benefit by giving people the knowledge that they can, if they understand their bodies, they can then be empowered to make choices that are in line with their goals.

1:32:48And so I really also just want to say really importantly, I hate the narrative that there's nothing you can do for your fertility or that it's all luck. Because the truth is, even if we can't control everything, we have a huge control over our metabolic and cellular health, which, as we just said, plays a huge role in our ability to get pregnant for both men and women. So taking control of what we can, I think, is really important information. And one person can take with that and make the choices they want to make. But the worst thing that I hear every single day is people sitting across from me saying, gosh, I wish I'd known that information.

1:33:22I would have made a different decision. Why do we make people go through a failed IVF cycle? They have no embryos form. and only then do they make lifestyle changes when we know the lifespan of a sperm is 90 days and sperm are so sensitive. And then we know that even though eggs are in your body your whole life, the 60 days before you get pregnant is when the egg is most susceptible to the world around you. So this is this time period that I like to call trimester zero, the time before you're getting pregnant where the choices you make can influence your egg and sperm quality the most. And what you said earlier, if we're making them even earlier in life, can we influence ovarian function longer?

1:33:57I think there is a good thought to that. But how do we leverage these choices and diving into them? Number one for me is sleep. And I think that this is an important one because it can leverage that inflammatory burden in both ways. And I know you're a big fan of sleep, so this isn't going to take much to convince you. When you sleep, this is when your body is going to get rid of some excess chronic inflammation. Lowers are inflammatory markers. We know that when we get less sleep, It's going to cause us to have more cellular stress, more oxidative stress. Your gonadotropins, so FSH and LH, are released from the brain in the early morning hours.

1:34:31So when you don't sleep long enough, you're not going to have the same hormonal response. And we know really directly, men who get less sleep, they have lower testosterone levels and lower sperm counts. Women who get less sleep get fewer eggs at IVF cycle. And we see that if you say you have poor sleep, you have double the rate of infertility. If you just subjectively say, yeah, I have poor sleep, you have double the rate. And that people who are not sleeping well, either partner, it will take them longer to get pregnant. They have lower fecundability, that month-to-month pregnancy rate. So it's not just me sitting over saying, oh, yeah, you need to sleep better.

1:35:04Like your physiology is meant to sleep. It is a sign to your brain if we go back and we view that hypothalamic response as central command station looking for clues that your life is stable enough, You're healthy enough to carry a pregnancy for a woman, which is a huge metabolic spend. It's looking to make sure you're taking care of yourself primarily. And sleep is one of the most powerful markers that we can move. Seven to nine hours. Most women need closer to seven and a half, especially in the luteal phase. Making progesterone is a big body spend. We really have to cultivate better sleep. You know, all the things you talk about.

1:35:42Dark room, sound machine, a sleep mask, a cooler temperature. It takes two to tango. So if you sleep in the bed with somebody, they need to be on board. You need to go about the same time. You need to have similar sleep practices. And we know that day-to-day consistency is also impactful in fertility. So not just the length of time, but really having that good circadian rhythm is so important for your hormones. Melatonin is obviously released before you go to bed. Low doses of melatonin supplementation can impact fertility. So doses of 1 to 3 milligrams, 30 minutes before you go to bed, can improve your odds of getting pregnant as well.

1:36:17can influence egg quality. And we know that naturally you make more melatonin when you ovulate to kind of counter some of the oxidative stress to the ovary. Really have to be careful though. A lot of over-the-counter products have like 10 times the amount of melatonin. So I always want to tread lightly with that one and recommending it to patients. Often a pediatric dose is like one milligram and that's the perfect amount just to augment. Again, we're not trying to replace your body's melatonin. We want to augment it and kind of help your body. I always like to think about like a toddler, really get good consistency with your wind down routine so that you can get enough sleep.

1:36:49Andrew Huberman:I don't want to disrupt your flow, but if a woman is already sleeping well, should she take melatonin? I would say for the average person, probably don't need to. I would say the exception to the rule would be that if we know we have increased chronic inflammation, maybe we have endometriosis or an inflammatory autoimmune disease, or we're going through IVF with unexplained infertility or ever been kind of told you of, quote, bad egg quality, then the anti-inflammatory properties of it might be advantageous. Since NSAIDs can disrupt the inflammation requirement for ovulation, I'm curious about other things that are known to potently reduce inflammation.

1:37:27Andrew Huberman:I think enough terrible things have been said about cold plunges that we don't need to add anymore, but we're seeking reality here. And I don't have, despite common belief, I don't have anything inherently attached to cold plunges, I do them sometimes, but we know that one shouldn't do them after resistance training or any kind of exercise where you want the inflammation to get the adaptation to the exercise. We know that. And it's a pretty potent inhibitor of inflammation. So is there any reason to think that in the time where somebody is trying to conceive that perhaps they should avoid the cold plunge?

1:37:59I usually recommend against them for reasons stated here. I think there's very few things we have that are going to really turn off that acute inflammatory response to the degree that NSAIDs do. but we should proceed with caution in doing those things. Most everything else is trying to just get rid of the excess inflammation we have. But if something's dampering down into that acute inflammatory response, then I think we have to be a lot more judicious in saying, yeah, go for this. So I'm not a fan of cold plunges when trying to get pregnant.

1:38:27Andrew Huberman:A lot of people will be very happy to hear that because I don't, unlike the sauna, nobody likes the cold punch. I mean, I hate a cold punch. I've tried it one time and that was one time too many. I always say if you like it, great. If you think you benefit, great, but otherwise don't worry about it. One thing that's commonly used is curcumin. Yeah. And it's a pretty potent anti-inflammatory. Do you recommend people stay away from not cooking with curcumin, but the high-dose curcumin that comes in a lot of supplements? Yeah, I don't usually recommend it in a supplement form. Like I never recommend it.

1:38:58I think if you have a doctor who's giving it for a very specific purpose, you might be a unique person who has excess inflammation they're trying to target. But that's not something that I recommend. But cooking with it is fine. NAD and NR are – I get asked about them thousands of times per week.

1:39:15Andrew Huberman:And I'm more or less a fan of NR or NMN if one is trying to – I don't know. I don't think it will extend lifespan. But it does seem to, at least in my experience, increase energy, these kinds of things. But it's – NR in particular, there are data that it can be very anti-inflammatory. So if a woman is trying to conceive, should she stay away from NMN, NAD, and NR? Because I often see it listed in fertility protocols. Animal data looks like NAD and NNM can be advantageous, especially for unexplained infertility, which to be clear is different than I just want to get pregnant, right? In unexplained infertility, you're not conceiving.

1:39:54We do the basic test, anatomy, ovulation, ovarian reserve, semen analysis, they're all fine. So I view that as chronic inflammation unless proven otherwise. And so that's a unique situation that patients may have potential benefit. But unlike certain things across the population that we can feel really comfortable recommending, I don't recommend that to everybody. So I think that there might be utility in certain subgroups who are kind of really falling off the curve. And we think there's excess inflammation that it could make sense for. So I don't ever say no, and I sometimes use it. But on like the flip hand, we could say like CoQ10, which has robust human data that is advantageous without a negative benefit.

1:40:35That's an easier place to leverage your supplement dollars if you're going to spend because most of us don't want to spend endless amounts on all the things that we can craft for our supplement list. But the human data is yet to be out, although animal data looks promising for the right patients.

1:40:50Andrew Huberman:I'm glad you mentioned coenzyme Q10. CoQ10 and L-carnitine are the two, at least I'm aware of. There's some decent data on supporting sperm and egg quality. So do you encourage patients to start taking that, what, 60 days before trying to conceive and then continuing that through pregnancy? We usually stop CoQ10 in pregnancy just because of lack of data. We're very cautious in pregnancy of not exposing you to anything additional you may not need. So we just want to be really mindful of that. But I think it's in my, like, everybody should take before you get pregnant. Yep, you're trimester zero.

1:41:25You're, hey, we want to get pregnant soon. We should take a prenatal vitamin that has folic acid. We should take CoQ10. We should take omega-3 fatty acids. We should take vitamin D. These are all going to optimize, giving you the nutrients you need for a pregnancy, helping support good mitochondrial health, which is important for egg quality, without risk of harm to any of these specific supplements. So those are the universal we're trying. And then for sperm health, L-carnitine, we like a lot. And then zinc and selenium can have benefits as well.

1:41:55Andrew Huberman:I know you cover specifics in the book, so we'll leave it to people to find it there. I have supplement charts for everybody who's very curious, based on disease state, and more info. I'd like to take a quick break and acknowledge our sponsor, Function. Function provides over 160 advanced lab tests to give you a clear snapshot of your bodily health. This snapshot gives insights into your heart health, hormone health, autoimmune function, nutrient levels, and much more. They've also recently added access to advanced MRI and CT scans. Function not only provides testing of over 160 biomarkers key to your physical and mental health, it also analyzes these results and provides recommendations for improving your health from top doctors.

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1:43:15Andrew Huberman:I'm sure there are sort of standards and a lot of communication in your field about, you know, how many follicles to try and mature if one does IVF or is pulling eggs. I don't know if that's the right term. Forgive me. There it is again. You know, pulling eggs. Taking eggs out carefully and for sake of freezing or fertilization. but how much conversation is there at the various meetings and in the journals about things like coenzyme q10 l-carnitine i'm not trying to punch holes in these i'm obviously a big fan of supplements my friends joke when people ask me which supplements do you take they just shout all of them he takes all of them which is not true i don't take all of them but i've been experimenting with them since i was in my teens and um they're not the be-all end-all but some work so how much conversation is there about things like coenzyme q10 l-carnitine um is there consensus or is there sort of a distribution of old school, new school?

1:44:12Andrew Huberman:And I am very curious, not trying to be political or politically correct, whether or not this divides on male, female fertility docs or like the culture within a field often tells us a lot. So I'm not asking you to throw any of your colleagues under the bus, but if you have to. I will say this, over the past 10 years, we've seen a huge change in how we talk about fertility, even at meetings. You know, the first ASRM, which is the American Society for Reproductive Meeting that I went to was probably 15, 16 years ago. And it was so IVF heavy. Now, to be fair, like the science was rapidly evolving, like genetic testing was just introduced for embryos.

1:44:54But as we also see more patients and the general public really curious about, well, what can I do? And I think it's such a good question because I look at people and say, IVF is incredible, but I can only work with the eggs and sperm you give me. So come to the table with the best eggs and sperm you can, right? Control all of these variables. That public curiosity drives research to a degree because if you're hearing it from your patients, that's the formation of research questions, right? That we're looking at. Now, granted, all data that exists is limited in its own form, right? In general, when we look at cohort studies, of course, people who tend to take CoQ10 have other advantageous lifestyle factors than people who do not.

1:45:35When we do randomized controlled trials, though, which we often do in the IVF subset because we can look at more distinct criteria. I can say, well, how many eggs were mature or how many embryos formed or how many were genetically normal or the pregnancy rate per embryo transfer, which is a little bit of a finer point than just how many people got pregnant per month. We definitely see robust data that certain supplementation, CoQ10, vitamin D, omega-3 fatty acids, those are clearly associated with improved reproductive outcomes. And we're starting to see more, I don't want to say fringe, but of the specifics, right?

1:46:08Inositol for PCOS, decreases insulin resistance, huge benefit. N-acetylcysteine for endometriosis or chronic inflammatory disease. So we're seeing more interest in the nuance. It's a hard question on the field, I think there's definitely an old school versus a new school approach. I've always been slightly controversial because I've always been educating. I think at the end of the day, my job's not to say, just do IVF. My job's to explain what's going on, what the options are, and help you make that decision. I think a lot of older trained physicians practiced medicine in the day where this field specifically, patients did not have knowledge and access to knowledge.

1:46:51Therefore, when a doctor said do this, they just blindly said okay. And they view that as a simpler way to practice and therefore can be very dismissive of patient questions when they say, what about CoQ10? Or any merit of the other lifestyle factors that we talk about. You know, the plethora of research that exists, which is more and more now, is that these lifestyle factors matter a lot. that decreasing inflammation can influence your fertility from how your hormones function, how your ovaries respond when you're, how many eggs you pull out to what you say, how many embryos you form, and that supplementation is one piece of the puzzle.

1:47:29It's not the end-all be-all. I think we can probably should always, you know, focus first on where we can move the needle the biggest. So those more core lifestyle practices should be tenet number one. when we feel like we've mastered those and we want to add to the puzzle, that's when we can start to say what supplements help me. And one thing that I really encourage is allowing our self-space in each patient to be their own end of one experiment. Meaning how can I get so in tune with my body that I can say, this makes me feel this way and trust that sense for yourself. Because we are all unique and our response will be different to different medications or different interventions.

1:48:08and learning to trust that instinct about what's working for you or, oh, this isn't, that's really important when it comes to optimizing your own health, regardless of what tenant of health that we're talking about.

1:48:20Andrew Huberman:If we'd been sitting here 15 years ago and I said, you know, red light therapy can be useful for skin and for offsetting age-related vision loss, any reasonable physician would be like, that's nonsense. That's bogus. I spoke to an ophthalmologist yesterday. There's been a clinical trial using red light and infrared light for what's called dry AMD, dry macular degeneration, to offset age-related vision loss. And it looks promising. I mean, it doesn't reverse age-related vision loss completely, but it seems to help the mitochondria and the photoreceptors. People are holding on to some vision that they would lose.

1:48:57Andrew Huberman:There was a cover of what I am told is the premier dermatology journal exploring the recent studies on red light and infrared light. So it's a common practice now. So it takes time, but this stuff was considered super woo niche and nonsense by most, quote unquote, traditional physicians 10, 15 years ago. In the field that you're in, how are things like red light, infrared light therapy looked at currently? And if they are used, where is it directed? Is it actually on top of the ovaries? Is that the idea or that it's more of a systemic effect? Great question. And I think, again, let's just think about the fact that chronic inflammation impacts your body when it comes to your hormones and your fertility multiple ways, right?

1:49:39So if you have chronic inflammation, it's going to interfere with hypothalamic receptivity. So your brain can interpret your hormonal signals as well. It's also going to send out signals differently. You're also going to have distinct ovarian changes in how the ovary responds. And then, of course, for the egg quality. So the bigger answer of what type of therapy matters maybe depends on the outcome that we're looking at or how we're trying to show benefit. And in short, data is inconclusive, but all appears to be beneficial for the reasons you stated, whether it is to improve ovulation patterns, which we've seen signs showing that.

1:50:11That's more the systemic, probably, right? You're sitting in front of your red light panel. That's going to decrease some whole body inflammation. That's the inflammation that's most likely contributing to some of the brain sensitivity. So you're improving the ovulatory pattern. There have been some studies looking at ovarian-directed red light therapy, so through the abdomen. But there is now, I mean, we don't have definitive data, but there's even a vaginal ultrasound wand that's got red light therapy. So we don't have data on that yet, but seeing intravaginally you're much closer to the ovaries.

1:50:40That's why we do vaginal ultrasound monitoring for IVF to try to see if directing the response closer to the ovary can have more benefit or could potentially benefit egg quality more. I think most people are going to say, you know, we don't have definitive data yet, yet everything's pointing to likely benefit. I don't know if this study could be done, but the one arm of this, my podcast company, funds research.

1:51:05Andrew Huberman:And one thing I'd love to see the experiment done is either maintaining or doing fertilization of eggs under red light. Because so much of the proper chromosomal arrangements seem to be dependent on mitochondrial health. That's a short-term exposure. But the more I learn about the different wavelengths of light and how they impact mitochondria, And I think about the horrible lab lighting that I lived under for many years of my life. I think, oh, these such precious embryos, is there a way to put them under beneficial lighting as opposed to either neutral or I'm not saying detrimental lighting?

1:51:39Andrew Huberman:But I don't know. It would be a fun study to fund if there's a way to do it. Yeah. Could it be done? It definitely could be done. Okay. I mean, we have incubators. That could definitely be done and where you fertilize too. I was going to say off topic, my daughter did her science fair project on chicken eggs, but they looked at blue light, green light, and natural light to see if they, you know, they're all fertilized, but to see if their hatchability was different. And the group that was exposed to blue light actually had the highest hatchability. Interesting. And, you know, UV light was actually the lowest.

1:52:10But in their research, what's so fascinating is that red light is really detrimental to chicken eggs. Interesting. So anyways, I think.

1:52:16Andrew Huberman:Well, that's why science is fun. Oh, congratulations to her. She should write it up. You know, there's a journal where kids can write up there. Yeah, I'll send you the link to it. You'll have to send me after she would love that. She'll be published. And that's what's so cool about science. Sometimes we think, oh, the red light is going to be the beneficial one. The UV light is going to – or the blue light is going to be the bad one. But then, you know, vitamin D production is dependent on blue and UV. So, you know, nature is mysterious. You know, that's awesome. It keeps it interesting for us.

1:52:41Andrew Huberman:Awesome. Is she going to become a scientist? Well, she's already a scientist. I mean, she's 11, but she's a scientist right now. I love it. I love it. I'll send you that link. I think it'd be cool if she would write that up. So red light, maybe. Yeah. And I should point out red light and infrared comes from sunlight. So, and of course, there's circadian, good circadian effects of getting sunlight. All circadian benefits of getting sunlight are pro-fertility, pro-hormonal health. Yes. Yeah. I don't want to give people the impression that they have to purchase a panel. There's no hidden agenda here.

1:53:11Andrew Huberman:So those are the things that one can take. The do nots, I think broadly as don't smoke, don't drink. I was shocked, but I need to ask to learn what I found was that 15, 15 % of women in the United States report having used cannabis in some form or another while pregnant. Does that concern you? Cannabis use is probably the most concerning thing that I see in clinical practice. So both, you can just say if that many are using it in pregnancy, let's extrapolate to how many are using it beforehand. and ultimately something that we are just now getting robust data on because it's hard to study something when it's illegal.

1:53:49All cannabis use is hugely detrimental to sperm, for sure, across the board, right? Both production, the quantity of sperm, testosterone production, also the quality of the sperm, specifically the DNA fragmentation inside the head of the sperm, to the degree that female partners who conceive from a male partner who's using cannabis have much higher miscarriage rates than partners who do not utilize cannabis. And I will say clinically in the IVF lab, when I see embryos halt at that male developmental stage on day three, we say, oh, here's a young couple. They've got no embryos and we were expecting them to have some.

1:54:22When we go back nine out of ten times, he is using cannabis that he previously denied. So it is one of the most movable factors right now in this country for improving, you know, fertility outcomes. For women, cannabis use in the prior year can decrease the eggs you get at egg retrieval by 25 percent and can decrease fertilization rates by 28 percent and can increase miscarriage rates, therefore decreasing live birth rates. So huge numbers in science, right? I mean, like we get excited when there's a few percentage points different. But these numbers are really high to the degree that it's really easy to sit here and say if you're trying to get pregnant the fastest, if you want to have the best pregnancy outcomes.

1:55:05or even you want to have the best hormones you can, have longevity of your ovaries, or have the best sperm counts or the most testosterone, cannabis use should not be a part of that. And THC crosses the placenta directly. And THC levels and, you know, edibles are usually the highest. So I think it's really important that sometimes people are like, oh, I don't smoke it, so I'm okay. We want to be really careful that this is not something your body is meant to be exposed to when we want to think about the core of how your body is meant to function.

1:55:38Andrew Huberman:Critical message. Thank you so much. I've been put through the ringer around this cannabis thing because I've hosted people that said it does increase the risk of psychosis in certain typically young males, although not everyone. I've been accused of all sorts of things related to that, then had someone on who confirmed that, someone who refuted it. And cannabis, I believe, is recently rescheduled from Schedule 1. no, at the federal level, it's assigned a no medical application to Schedule 3. So there's going to be a lot more cannabis use going forward. It's so critical that people hear this. And the argument I always hear, and it's always dudes, typically on X, they'll say that they smoked a lot of weed and they got their, or took edibles and they got their wife or girlfriend pregnant X number of times.

1:56:24Andrew Huberman:And it sort of becomes this sort of point of boasting. And then I never want to make the comment, but I'll make it now. And I was like, yeah, but you're talking about brain development in your kid. And I'm not saying your kid is dumb, but I'm saying they're maybe not as smart as they could be or as healthy as they could be. I'll just say that because I'm talking to the guys out there and that's how we talk to one another. Yeah, you had a bunch of kids, but they could be a lot healthier. And so I think to me, it just seems like anything that one could do, since it's ostensibly a short-term decision, certainly for the man, right?

1:56:54Andrew Huberman:The woman who's going to breastfeed should probably avoid cannabis during breastfeeding too. You see where I'm going with this. Look, the outcome is so important, right? And when we want to think about even just male cannabis use, yes, sperm count, et cetera, decreases the sperm quality. That sperm quality is important for programming of the embryo, for how the placenta develops. If the placenta is not as good, you know, association with earlier birth. I mean, it's just not worth the risk when the outcome is so important, right? We're all weighing risk every day with different decisions. To me, there's a lot harder decisions you have to make.

1:57:27But, you know, nicotine use, cannabis use, alcohol use, like the data here, none of that is advantageous for your health, especially if we're looking primarily through a fertility lens or hormone lens or even or specifically a pregnancy lens. Like there's no place for it. You can choose to do what you want with that data, right? And people will always say, I know so-and-so who did this and they got pregnant. And there will always be those people. I mean, you're the one making decisions for your journey. And the recommendation is even stronger if you are having infertility, if you are older, depending on your scenario, because you want to control what you can because you can't control everything.

1:58:05So I call those the behavioral toxins that there's really no place that we need to add these to the world if we're talking about how do we get my body to function optimally.

1:58:13Andrew Huberman:It's interesting that certain substances get politicized. You know, in the past, I experienced this thing that you can tell with some degree of friction. In the past, cannabis was associated with the left. It was like pro-cannabis was left. Now, pro-cannabis is actually very strongly correlated with the laws anyway, this rescheduling. And you watch the media just kind of pivot. And it's just very clear that they're not paying – that the media isn't – the traditional media isn't paying attention to the actual data. It's sort of like how can we use this as a weapon on both sides, on both sides. And so depending on where people get their news, it can be very confusing to people along those lines.

1:58:58Andrew Huberman:For whatever reason, nicotine has become kind of this right-wing associated thing. I know. I recently spoke to about 4 ,000 young men and women. And I would say about 30 % to 40 % of them raised their hand that they're using oral nicotine every single day. Anywhere from probably I did crude analysis by hand, so these aren't hard data, but it was somewhere between 12 and 70 milligrams of nicotine a day. It's wild. So for women in particular, is oral nicotine use detrimental to either egg quality or probability of successful pregnancy? It's definitely correlated because of how it works in the brain to, you know, ovulation, getting pregnant, hormone response.

1:59:45So it should not be something that we're adding to, you know, our day-to-day life in any form if we're trying to get pregnant. Most of the egg quality data from nicotine comes from cigarette smoking. So I think it's a little bit more nuanced because smoking directly, if we want to look at that, you know, I would say it's one of the few things that gets into the vault and decreases our egg count. I don't know if I say chronic inflammation can get in there, but, you know, nicotine, cigarette smoking definitely does. You go into menopause early, you'll get fewer eggs. The egg quality is detrimental.

2:00:15It makes sense based on what nicotine does to your body and how it kind of changes your cellular response that it probably is impacting your egg quality also, even with these oral nicotine pouches, you know, that we're seeing everybody utilize. And it's tanking sperm counts. I mean, that one's really clear.

2:00:32Andrew Huberman:and then of course everyone's talking about the reduction in in uh in just population growth which when i was growing up we were told that like the earth is going to be overcrowded now we're told that there's not going to be enough people everyone's going to be alone on their phones i don't think either extreme is true um but these are these are vitally important things for people to think about because these are easy decisions to make and they can be short-term decisions you know we make decisions every day and you don't have to be perfect and you don't have to be all or nothing. It doesn't have to be forever.

2:01:00A lot of these things, once you really start making a bunch of them and decreasing inflammation, you will tangibly feel better. I think we are creatures of our own world and humans by nature adjust to the environment we put our body into. So even things like we talked about sleep, but chronic stress, how it's directly associated with insulin resistance, how building skeletal muscle is one of the top ways you can reverse insulin resistance. It's the best mechanism for hormonal health we have is to build more skeletal muscle. These things can impact your fertility and your health long term. And so once we start to make these little decisions, eating more fiber, anti-inflammatory foods, cutting down the ultra-processed foods, removing the toxins, changing the toxic behaviors, sleeping more, really trying to manage stress in a more productive way, together when your inflammatory burden lowers, people feel better and then they get it.

2:01:54Then they say, oh, like this running on just caffeine and eating whatever food I could on the go and not getting enough sleep and then using a hundred nicotine. Like that was my body giving me a hundred red flags that it is working over time to deal with what I'm handing it. So how is it supposed to do its normal day-to-day function, which at its purest, that's where your body should try to be, especially when it comes to trying to get pregnant and have the best egg and sperm quality.

2:02:21Andrew Huberman:I would never ask you to assign any validity to something for which there's no data. But in your experience, your clinical and scientific experience, is there something that you've heard from your patients and then observed in terms of outcomes that is intriguing to you that you would like to see more science on? Yes, absolutely. And the reason I ask this is there's this incredible intuition that comes from just being in regular contact with a certain process. For instance, anytime I've spoken to an embryologist who does the kind of work that they do in your clinic, they read journals and there's a process, they learn protocols, but they also, they develop an intuition to pick that sperm, to wait just a little bit longer, maybe even, maybe even fertilizing that egg at the end of the day, even though it looks more mature than the - It's a little small, it's a little gray.

2:03:08Andrew Huberman:This is the, this is the art. It's like the Genesequois medicine. Right, the art, not the science of it. The same way, you know, cooking is chemistry, but there's an art to it too. And that nothing can replace those millions of hours in contact with the process. So you've had so many hours in this process at every level. Is there something that intrigues you and that you'd like to see more science on? I love that question. So, one thing I think I want most people to take away, then I'll answer the question, is that you can make tangible improvement in your fertility. By looking at these lifestyle factors and coming up with a plan to try to decrease your inflammatory burden, you can have a different outcome.

2:03:48And I think that conversation is even more important if you're waiting longer to get pregnant or if you're at an older age or you have lower ovarian reserve. Because knowing that you are controlling all these variables to put the best egg and sperm forward is really important. The most intriguing part of the conversation for me right now is GLP-1s and their use for potential chronic inflammatory disease like endometriosis. As a field, we quickly accepted that they are hugely powerful for PCOS and states of obvious insulin resistance for reasons that make sense to everybody. They also help, obviously, patients lose weight.

2:04:22Fat cells make estrogen. They impact the ovulatory process. Fat cells are inflammatory. So all the things that we said were negative. So by simply losing weight, we can restore ovulation, we can have improved IVF outcomes, and it is just a more effective mechanism for weight loss. So easy to jump on and say, I have a patient who needs to lose weight. I have a patient with PCOS. GLP-1 agonist can be a very powerful tool to that. Where I see right now are patients who have known endometriosis or what I call probable endo. They have unexplained infertility. 50 % of those patients will end up having endometriosis.

2:04:57Maybe, you know, one of the problems with endo is gold standards is surgical diagnosis only. We don't have a lab test for endometriosis. But when we are getting unexplained IVF outcomes that do not match what we would expect, or we have these known chronic inflammatory diseases, I will have patients go on a GLP-1 low dose for three months, wait to take, stop them, and then go through a cycle of different IVF outcomes. We will see more embryos in the lab. And we don't have to study to say that, but talking to colleagues across the country, we know that GLP-1s can be very anti-inflammatory and the way to kind of target that what appears to be that inflammatory burden.

2:05:40And I think that there will be utility there within the context of these chronic inflammatory disease that might be able to help a patient population that we've struggled with, with difficulty to get to a diagnosis or limited data points on what to do with it. So the data is not out yet, but it is a tool I add to the box, especially if we're not getting outcomes we would expect and we don't have another reason why.

2:06:03Andrew Huberman:So do you think there could be direct effects of the GLP-1s on reducing inflammation that are independent of less adipose fat tissue? I do, because some of these patients do not have much adipose tissue. So I think obviously that person is going to get even more benefit if they have adipose tissue to lose that's causing inflammation. But I think especially if we think about autoimmune disease, where people's immune system, their inflammatory response is mistriggering, I think that there's benefit for the GLP-1s in that population specifically that is giving them an added benefit to decrease inflammation in a really profound way.

2:06:39Andrew Huberman:It's really interesting because I would have thought GLP-1s reducing body fat for a woman who isn't carrying excess body fat, that might actually be detrimental to getting pregnant. It's a fair point that we have to be really careful when it comes to skinny culture. I mean, we are seeing just societal norms shift again to be very thin after being more, you know, body positive, be of a healthy weight. We're definitely seeing celebrities go back to being extremely thin. And we know at both extremes of body weight, again, the hypothalamus is your checkpoint. If you don't have enough body fat, we are worried that you cannot maintain a pregnancy.

2:07:15So it can stop how it's sending off hormones. And again, we can see like a luteal phase defect is that first warning sign before you're in true hypothalamic amenorrhea. So they want to be really careful in that patient group. And they have to be done with the right person who has a lot of experience with GLP-1s. There are super low doses. The goal is not weight loss. It's really a different goal. And again, I don't have a paper to like prove it. But we are seeing that clinical experience to say at the end of the day, because there's merit in trying to decrease inflammation, especially in people who we suspect is contributing to the circumstance they are in.

2:07:48Andrew Huberman:And you said low-dose GLP. Yeah. Are these available in generic form now, or are they still under patent where they have to be? I don't know the answer to that one. Okay. I don't know. I know compounding pharmacies are making them. I know today, the gray market for peptides in this country was shut down. So no more. You can no longer buy that just for research purposes. But compounding pharmacies seem to be protected. But I just ask because of the GLPs, at least the non-generic forms in their full dosage, My understanding is that they can be rather expensive. Yes. But the lower dosages in generic form perhaps have to be more affordable.

2:08:26One would think, yeah. And I think, again, these add-on or there's a lot of kitchen sink approach we do in fertility medicine, right? I've used human growth hormone for years and years and years, right? There's not an FDA approval to use HGH for egg quality, yet we see that it can improve egg quality in the right patient in the lab. So if somebody has a cycle and they don't get as many mature eggs or their embryos don't do as well, my partner actually did a study where she put them through the same protocol, so the same medications in a subsequent cycle. And the only change was adding human growth hormone and had improved embryo development and maturity of eggs.

2:08:59Andrew Huberman:Amazing. So this is like an IU a night or something like that, like some low dose of HGH during the ICU? Yeah, just during the stem. So it's like two weeks of use. And so now that's starting to be extrapolated and people are starting to look at it longer or before STEM, you know. And so we have to take that. I love the fact that my field's always viewed cutting-edge research. You know, it's a double-edged sword. Like there's some good and there's some bad. We really want to think about mechanistically if it could potentially help having, you know, a low threshold to attempt it in patients who are getting at the end of their journey specifically, right, when they've done all the basics.

2:09:32They're controlling the lifestyle factors. I will say one thing I dislike is this just do IVF mentality, meaning nothing you can do can impact your egg quality. Let's just do IVF and then we're compounding dollars and dollars and dollars. Yet we're not eating anti-inflammatory food and we're drinking wine every night and we're not getting enough sleep, right? So I think that we've got to really look at these, you know, five non-negotiable areas and optimize them to the degree we can. And knowing each day will be different, but building our body the resilience to be able to respond as it's appropriate to.

2:10:06Because sometimes you'll fly to Texas and get less sleep or you'll go out to eat and, you know, you'll eat differently. And your body's meant to handle those challenges, but it can't when it's constantly challenged every single day, all the moments of the day. So there's a ton of experimental stuff that we do that's really cool. And some of it will be introduced into practice in 10 years. You know, probably 15 years ago, if I had said human growth hormone, people would have scoffed. And now it's commonly added on when we're not getting the outcome we want. And that's how medicine should be. We should not be afraid to say that the perfect study doesn't have to exist.

2:10:40If the physiology makes sense, if there's suggested studies, if we explain it to the patients, we help have shared decision making with them. Because if we're always waiting for the perfect RCT, there will be thousands of patients we could have helped in the interim that we didn't.

2:10:57Andrew Huberman:What are your thoughts on platelet-rich plasma? Oh, such a good question. Which is not stem cells, by the way. Sorry to just shout out there. People think it's stem cells. Stem cells are not allowed by the FDA in the United States, a vision clinic. They were injected into the eye for macular degeneration, and the patients all went blind. And I'm very familiar with those cases. It was that specific clinic that shut down stem cell. You can't advertise stem cells online anymore. So now they just, but PRP is not stem cells. Forgive me for interrupting. PRP has two potential different mechanisms by which it can be used, and it's different.

2:11:32So one is intrauterine PRP, where we are injecting it into the uterine cavity, similar to how we put an embryo inside or how we would do an intrauterine insemination. So small catheter, not invasive, just kind of goes through the cervix right into the uterus. The other is looking at ovarian PRP, which is a more invasive procedure. This is using the same needle like we do for IVF, yet instead of extracting the follicular fluid in the eggs, I'm putting the PRP into the ovaries. Looking at it for two different reasons, implantation failure or potential Asherman's scarring of the uterus in the uterine PRP group, and looking at it for low ovarian reserve or age-related fertility in the PRP of the ovary group.

2:12:15Where it shows the most promise is intrauterine PRP, which is nice because it's less invasive. That's the minority of people who are having recurrent implantation failure. You know, most people don't have success because they don't make enough embryos. That's the rate-limiting step for most people with IVF, meaning if you have three genetically normal embryos, almost 95 % of people will have a live birth. So we're talking about a very small subset of the population here, but showing the most promised, though not universally accepted and isn't done everywhere. Ovarian PRP is a little bit more nuanced because clinics can charge a lot for it.

2:12:54It's a procedure. You need anesthesia. I'm putting a needle in the ovary. I'm always a lot more skeptical of potentially damaging the ovary or, you know, potential developing eggs, although no study has supported that it does do that. There are some more hypothetical concerns with that versus uterine where you're not really damaging any structure. You're just adding it. That being said, ovarian PRP is currently being studied. We don't have definitive data. Potentially could be something to consider if you're really approaching that end game. You know, you're really not getting the outcome you want.

2:13:25You are older. You have low ovarian reserve. There are people who have some success stories. So I think it's, again, the exception, not the rule, has potential benefit, but yet to be determined.

2:13:38Andrew Huberman:A few years back, there was more discussion about the age of the sperm and the probability of autism. Yes. Could you update me on the data? Yeah. After age 50, we see a few different increases for sperm specifically. So advanced paternal age is real, both when it comes to how you make sperm but also the quality of that sperm. We see overall on a population base increases of autism, of autosomal dominant new mutations, specifically certain types of like dwarfism or very specific diseases that are ultimately overall rare that can happen. And then you also can see an increase in some other mental health diseases like schizophrenia.

2:14:19That data is scary, not the end-all be-all. At the end of the day, when you have an opportunity to bank sperm younger, it would make sense and utilize that preferentially. You know, if somebody came to me and let's say they had big sperm and it's gone now and I have a 52-year-old man across from me, I mean, this is who we want to have children with. Then this is who we want to have children with. And we accept that risk because on a population it's still very low, right? A small percentage point increase means still the most probable chance is you're going to have a very healthy baby. It plays more into the idea that nobody's fertility is finite, that, you know, age-related impacts impact everybody.

2:14:58I would say the same thing is that if the mechanism is the DNA essentially or the quality of the sperm, then those lifestyle tenants in the 90 days prior to getting sperm or banking it or using an IVF cycle probably matter the most. And I would make sure I would want to be controlling all of those factors I was so I wasn't adding to risk.

2:15:18Andrew Huberman:No cannabis, reduced heat, all the things that mutate DNA. Exactly. Yeah. Nicotine out, that kind of thing. Yeah, it's interesting. I think about the sort of high signal to noise anecdotes. Things like, oh, you know, so-and-so smoked weed every day and has eight kids. Or, you know, so-and-so had kids when he had another kid when he was whatever. I'm thinking of some actors or something. I don't follow this stuff closely. It was when he was like 78 or something. The problem with stories like that is that they grab people's attention because they're high signal to noise. and they distract from the stuff that really matters to most everybody.

2:16:02Andrew Huberman:Like freezing eggs is not going to take more eggs out of your reserve than you need. The NSAIDs, I mean, I'm just like still wide-eyed about this NSAID thing. It's something to avoid while trying to get pregnant. Let's do another one. Biotin levels of taking a biotin supplementation of 300 micrograms or more for seven days can actually influence your lab assays for sex hormones or for any steroid hormone actually. So when I will sometimes see patients who are going through an IVF cycle and their estradiol levels are not matching what we're seeing for follicular development, if we go and talk to them and they're taking hair, skin, and nail supplements or something with a high dose of biotin because commercial supplements, like, you know, there's certain very popular hair supplements that have, you know, 10 to 30 times that amount in them.

2:16:47These is binding to the lab test. So we're getting false reads on these labs. It's not changing in your body, but it actually, this is an REI board question, oral board question, is that it binds to the steroid assay. So this can happen to estradiol, to progesterone, to HCG, to TSH, to testosterone. So if you are back where we started and you want to get data about your body, maybe you feel off or you're going through IVF or you want to get a hormone panel done. If you're taking a supplement that has more than 300 micrograms of biotin, you're going to have results that are inaccurate and we cannot trust.

2:17:19So really making sure that you're looking at what's in your supplements. And biotin is that specific one that I want to make sure we're not taking excess amounts of.

2:17:27Andrew Huberman:Wow. As long as we're talking about things that people take or put on their body. The last time we sat down and spoke, we had a conversation about endocrine disruptors. Oh, man, people really loved and hated us for that. Well, I will say, because it's tricky with comments, again, signal the noise. I think many, many more, meaning millions of people, appreciated it as opposed to had issues with it. I mean, it is – you can tell how frustrated I get with – my frustration is not with medicine or with science. It's with the lack of open ears in a certain generation of physicians and scientists. I mean, my colleagues at Stanford are very open-minded.

2:18:01Andrew Huberman:And by the way, many of them call me saying like, what should I take for this? Or like, what can I do that's not TRT for testosterone? And like – I mean, it's – they're humans too. And I think the issue around endocrine disruptors for the longest time was seen as kind of hippie science. with no data. And then now, because the environmental working group started getting really vocal about this and Shauna Swan, who's a long time researcher. Yeah. But then there was this sort of political backlash because somehow people decide to slot her and the environmental working group as kind of anti-standard science.

2:18:33Andrew Huberman:But you sit down with her, that's the furthest thing from the truth. Like she's all about data. So I think as we tip toe into this, you know, endocrine disruptor thing, I mean, I'll just say it for you. And then if you, if you want to add, None of what we're about to talk about negates anything about standard medicine. It's just ways and places to be additionally cautious about things that you are around and might go into you. You make decisions every day. Yes. You should be making it from a place of knowledge. And the things that you're exposed to more frequently matter the most, right? So a one-time exposure because you used hand soap and it had lavender or tea tree oil or whatever, I'm much less concerned about than the products you buy for your home that you're using every single day.

2:19:16Because when it comes to endocrine disruptors, a lot of it is the quantity of exposure that really adds up. And this typically comes from frequency because typically it's low levels in a variety of different products. But they absolutely can disrupt hormone function. They cause longer time to pregnancy. There's now been robust data looking at, you know, one of the biggest cohort studies we have, and it's called the Earth Study, where they're looking at different environmental compounds on reproductive health. And they're looking at cohorts of people trying to get pregnant naturally. And they did a sub-study looking at endocrine disrupting chemicals specifically of those people who went on to do IVF and showed that those who had higher levels of endocrine disrupting chemicals had a harder time getting pregnant, even with IVF and their IVF markers, fewer eggs retrieved, fewer embryos, poorer sperm counts.

2:20:02So it's definitely not hippie science at this point. It's well demonstrated that it impacts our bodies in multiple ways.

2:20:08Andrew Huberman:And as I recall, the things to be cautious of are lavender, evening primrose, or basically anything with a scent. Essential oils, for the most part, tend to be fine, but it is lavender, tea tree, and evening primrose that have more endocrine properties for them. When it comes to other products, scented products have a lot of phthalates in them, and then that's an endocrine disrupting chemical. And an important note here, which is wild to me because we see so much greenwashing on products where they'll slap a label on it and they'll say unscented. But unscented is a scent to mask other scents. Really?

2:20:44So unscented just means you've masked a scent. What you really want to look for is fragrance-free because fragrance-free means we added no fragrance to it. To be called unscented, we could have added something to counter the fragrance that was in it.

2:20:57Andrew Huberman:Amazing, amazing. And Uber drivers, I'm not saying riding in your Uber with your terrible air freshener is going to prevent people from getting pregnant or conceiving with their partner, but take the freshener out of your Uber because you might not be able to have children. But also for you. Yeah, no, I was saying for the drivers are the ones exposed to it the most. Well, for these things, you know, another, like, one of the top exposures of BPA right now is actually thermal paper, so receipts. So think about receipts at the grocery store or the airline counter. So for one of, you know, getting it one time and touching it is probably not a big deal.

2:21:30But for the people who do that job and are exposed all the time to thermal paper, that actually can be such a high level exposure so that's a good example where i say you need to use gloves if you that's your industry that you're going to be exposed to thermal paper a lot so same thing for let's say the uber driver this is what you're spending your time doing you don't need that fragrance for your own health and certainly we don't want to get in the uber with i know i'm so mean if this smells i'll like i'll i'll star them lower which because it's like i think you

2:21:59Andrew Huberman:should know you know you're paying for a service i mean i usually roll the window down stick my head out the window. If they're coughing, I hate being sick. And I'm like, I didn't pay to get sick. So I try to be polite about it. But you know, there's just, but again, we control the things we can, right? So let's control the fragrance in our home and in our products, because to your point, we can't control what's in the Uber. And so we're not going to stress about it. That's the argument I get. Number one is that you're causing people to be stressed about toxins that otherwise they wouldn't be.

2:22:28And I, again, like that's paternalistic, Like toxins are impactful to your health. I should give you the data so that you can cultivate the day-to-day life that is to the degree where you don't stress about it when you're on the plane or you're in an Uber or you're at a party because that one-off isn't such a big deal because you're not exposed to it every single day inside of your home.

2:22:47Andrew Huberman:I like to think that people want information. I realize they can feel overwhelmed by too much information. But in the end, even though what we're talking about here seems like a lot of to-dos and not to-dos, there's a logic to it. I think the logical backbone is you do what you can. You do your best to control the key variables. I mean, the point about cannabis I think is really important, especially men here, because I think most people don't know. And women don't know they should get their AMH checked. I mean, that's changing because of people like you being out there doing public education.

2:23:19Andrew Huberman:But I like to think that people want knowledge. I really do. I actually think people do want knowledge, and I don't think they're the ones giving the counterargument, to be honest, right? I think it's our colleagues who say, oh, people don't want to hear that or they make assumptions. And again, in today's world where we have data, like, why are we talking about assumptions? Let's give people data and let them make the choices they make. Yeah, ignorance is not bliss when you're running up against a health challenge. Yeah, if you haven't had your own health challenge, maybe it's hard to understand what it is.

2:23:47And for infertility, for most people, this is their first time their health is really being challenged. usually because of the age range of which it is. I mean, that was my story. A decade later, I got diagnosed with celiac disease despite having unexplained recurrent pregnancy loss. I can tell you that this collided with my fertility fellowship when I advocated for doing vitamin research and all this epidemiology. I saw the word inflammation and all of that text, yet we weren't talking about it with our patients. And I went on this journey to get rid of Teflon in our kitchen because I studied PFCs and we changed the foods that we ate, changed how we exercised and how we slept.

2:24:26And one of the things that I cut out learning to listen to my body was gluten at the time, even though I would have never said I had like GI symptoms from it. I just said, oh, I felt more inflamed, like vague symptoms, kind of headache, kind of more fatigued. And when I conceived my children before we ever had to do IVF, we got pregnant naturally in that time period when I didn't have gluten. So a decade later, get the diagnosis that was actually contributing to why we had these different pregnancy losses. So it wasn't unexplained at all. And not that everybody needs to cut gluten out, but understanding how chronic inflammation impacts our bodies and learning to listen to our body is one of the most powerful tools that we have.

2:25:09And it starts with, you know, education and knowledge, learning how to advocate for ourself, right? When you know it's normal, you can sit in front of somebody and say this isn't normal and mean it with your full heart. And then how do you optimize all the things at home? Because back to the other point, even if you need IVF, I can only work with the eggs and sperm you give me. And maybe if we're focusing on some of this stuff earlier, there's probably a subset of people who can get pregnant without IVF or who can freeze eggs and have an easier journey because they had this information and they made choices based off of it.

2:25:40Andrew Huberman:What I'm realizing hearing you today is that we need to listen to our bodies. Women need to listen to their bodies because we're mainly talking about women's health here. Men do too, but we're talking about women. But also learn to be scientists of our bodies. And when it comes to nutrition, I'm very curious because of your example, do you think there's any value to people experimenting with a, quote, unquote, cleaner diet, if for no other reason than to figure out which ingredients don't work for them? Meaning if you have granola for breakfast and a side of eggs and some toast, or one day you have eggs and the next day you have toast, or both, whatever.

2:26:15Andrew Huberman:And then for lunch, you're having a sandwich. And then for dinner, you're having some pasta with some sauce and you don't feel well. You don't know what the problem was. So I'm not advocating for, you know, a Spartan diet where it's like, you know, chicken breast next to rice next to broccoli with a tablespoon of olive oil next to it. Although that sounds pretty okay for steak, there's worse. But when you eat that way for a short period of time, the sort of cleaner and more or less individual ingredients, I do think that you can get insight into what works for you and what doesn't, independent of all the other information out there.

2:26:48Andrew Huberman:Like, for instance, there are certain forms of fibrous foods, I definitely believe in fiber, that I just don't feel well. And then my sister, who is not a scientist, she'll chuckle at that, but she had this intuition about histamine that has now been confirmed by two guests on this podcast who are MD-PhDs who work on these sorts of issues. In one case, pain, in another case, gut inflammation. and she was convinced that she had some histaminergic thing that she read about in some book, suggested I take this histamine enzyme tablet before I eat, and it's opened up this whole array of other foods that I can eat.

2:27:21Andrew Huberman:But for years, I would get super sleepy after I would eat certain foods. I'm like, this makes no sense. I like starches. I like fiber. Turns out I have a sort of mild histamine sensitivity to like four different foods. I don't think you can figure that out unless you separate out the ingredients. Absolutely. It's like I planted this question for you, even though I didn't, because I advocate, especially if you are falling off the curve, right? I think if you're trying to learn to listen to your body, you say, I want to optimize my own health for a very temporary but restrictive clean eating pattern where you're having lots of fruits and vegetables and fiber.

2:27:54and you're cutting down some of the things that cause more commonly cause certain reactions, cutting out gluten, cutting out dairy, cutting back on red meat. And then you add them back in and start to listen to how your body is functioning. But you have to really kind of eliminate first and then you can add back and see, oh, I feel better, worse, the same. Okay, well, if it's worse, that's maybe not something you should have. And then learn to listen for it. The tenants of a fertility diet are really not eye-opening, right? Fiber is hugely important for the gut microbiome and hormone health and inflammation and insulin resistance.

2:28:25So high fruits and vegetables, high fiber diet, whole grain carbohydrates, over your refined carbohydrates, ultra processed foods don't have a place in the modern diet. Added artificial sugars, those non-nutritive sweeteners, they don't have a place in this. We wanna have quality of our protein. Most people could benefit from some increased plant protein due to the increased fiber than they actually get in the standard American diet. But meat is not universally bad nor necessarily good. It's the quality of the meat that probably matters a lot. The meat data to notice is that for every serving of plant-based protein over animal, people tended to ovulate better and had higher fertility rates.

2:29:00Probably more suggestive of an overall healthier fiber-first dietary pattern on the population-based level because ultra-processed foods don't have a lot of fiber in them or any fiber in them. Animal-based products don't have fiber in them, so we want to be mindful of that ratio. Red meat's the really controversial one and increased servings of red meat. Of course, dietary studies, cortile it, lowest exposure, highest exposure. Highest exposure groups had poor embryos develop, worse outcomes with IVF, and an increase in staging of endometriosis when they went to surgery. That doesn't mean to me that all red meat is bad, but it probably is for a subset of people.

2:29:40More inflammatory, causes more IGF-1. We want to be mindful of it. The question I always get is, does source matter? I mean, probably, but we weren't looking at it in any of those studies. So I think being very mindful of where your animal-based protein is coming from is really important in today's kind of food world. Not all foods are created equal even when they fall into the same category. And it's worth saying that healthy fats are really, really important, right? Cholesterol is the backbone for steroid hormones. So you need cholesterol in your body. So we really want to encourage those monounsaturated, polyunsaturated fatty acids.

2:30:14So the nuts, olive oil, fish, algae, chia seeds, flax, those things have such, so many benefits when it comes to the omega-3 fatty acids they have, but also that they're great healthy sources of cholesterol, which your body needs. And in fact, if you don't intake enough, you're not going to make progesterone as well. We want to be really minute. You need progesterone for implantation. Don't have enough unsaturated fat in your diet. You're not going to make as much progesterone. So there's some nuance there. But to the heart of your question, I'm a huge advocate for that, especially if you're struggling with something, you're not feeling your best.

2:30:48If you say you kind of hit the marker on a lot of these inflammatory symptoms and you don't know what's going on, it can be a really helpful tool once you're controlling the other ones to try to leverage. But again, sleep, stress, building muscle, avoiding those excess toxins, like those are a huge piece of the puzzle too. And a lot of them go hand in hand, right? A lot of times we eat a food that's also wrapped in something that has, you know, toxic chemicals in it. So we really want to think about the fact that when you work from home, when you have access, whole foods is really important as always leveraging processed or ultra processed versions.

2:31:24Andrew Huberman:Would you say that what you just described, in fact, everything we talked about also pertains to perimenopause menopause? Absolutely. Absolutely. It's so fascinating because when I sit with a lot of people who just do menopause, you know, we have the same recommendations for lifestyle and decreasing inflammation because it's going to improve, you know, ovarian response. It's going to improve how your body feels, decreasing inflammation. We know that when you go into menopause, estrogen has such profound anti-inflammatory benefits that one of the biggest problems is a baseline increase in your inflammation.

2:31:56So don't wait till you're in perimenopause or menopause to start to learn these things, learn them, whatever point you are now is the perfect time where we can start to make a difference, both for hormonal health now, fertility now or later, but also your ovarian function long-term.

2:32:12Andrew Huberman:Amazing. Dr. Natalie Crawford, thank you so, so much. I mean, I can't tell you how much I learn every time you speak on this podcast and elsewhere. People should definitely get your book. Again, I've read it. I read it cover to cover. The Fertility Formula, take control of your reproductive future. Natalie Crawford, MD, did all the training, runs a clinic, is out there doing public education amidst everything else, co-managing a family, and just really expanding the field. I mean, you're taking it in new directions, which is really, to me, the most important thing, right? That you're out there teaching people, but you're also going back to the clinic and you're paying attention to the science and evolving the science because this field is just going to improve over time.

2:32:57Andrew Huberman:But you've given people so many actionable things to contemplate, to definitely do, if I may insert my own beliefs there, and just a lot to think about in terms of the general landscape of how we think about reproductive health with our own and societally. So thank you so much for coming back. We will do it again, if you're willing, and just grateful to you. Always. Thank you so much for having me and holding space for this discussion. I appreciate it. Absolutely. Absolutely. Thank you for joining me for today's discussion with Dr. Natalie Crawford. To find links to her podcast and her new book, The Fertility Formula, please see the links in the show note captions.

2:33:35Andrew Huberman:If you're learning from and or enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support us. In addition, please follow the podcast by clicking the follow button on both Spotify and Apple. And on both Spotify and Apple, you can leave us up to a five-star review and you can now leave us comments at both Spotify and Apple. Please also check out the sponsors mentioned at the beginning and throughout today's episode. That's the best way to support this podcast. If you have questions for me or comments about the podcast or guests or topics that you'd like me to consider for the Huberman Lab podcast, please put those in the comment section on YouTube.

2:34:08Andrew Huberman:I do read all the comments. For those of you that haven't heard, I have a new book coming out. It's my very first book. It's entitled Protocols, an Operating Manual for the Human Body. This is a book that I've been working on for more than five years, and that's based on more than 30 years of research and experience. And it covers protocols for everything from sleep to exercise to stress control, protocols related to focus and motivation. And of course, I provide the scientific substantiation for the protocols that are included. The book is now available by presale at protocolsbook.com. There you can find links to various vendors.

2:34:43Andrew Huberman:You can pick the one that you like best. Again, the book is called Protocols, an Operating Manual for the Human Body. And if you're not already following me on social media, I am Huberman Lab on all social media platforms. So that's Instagram, X, Threads, Facebook, and LinkedIn. And on all those platforms, I discuss science and science-related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the information on the Huberman Lab podcast. Again, it's Huberman Lab on all social media platforms. And if you haven't already subscribed to our Neural Network newsletter, the Neural Network newsletter is a zero-cost monthly newsletter that includes podcast summaries, as well as what we call protocols in the form of one to three page PDFs that cover everything from how to optimize your sleep, how to optimize dopamine, deliberate cold exposure.

2:35:28Andrew Huberman:We have a foundational fitness protocol that covers cardiovascular training and resistance training. All of that is available completely zero cost. You simply go to HubermanLab.com, go to the menu tab in the top right corner, scroll down to newsletter and enter your email. And I should emphasize that we do not share your email with anybody. Thank you once again for joining me for today's discussion with Dr. Natalie Crawford. And last, but certainly not least, thank you for your interest in science.