The Fertility Formula: How to Boost Fertility, Balance Hormones & Understand Your Body with Dr. Natalie Crawford

23:06Dr. Natalie Crawford:And two things happen at once now. One is that we don't run from the bear. You know, our stress situation is an email and we sit here and we get an email and it's really stressful and our brain spins about it and glucose gets freed up and we don't go use it. So we are kind of propagating this inflammatory insulin resistant system by these stressful exposures because they're not managed. So number one, acknowledge that when you have stress, a short burst of movement can be hugely advantageous for helping you recover from that stress. So if you say, Hey, I'm going to like go take a quick walk or do some squats at my desk or just something that's going to use up that glucose that's been released.

23:48You are now using your physiology in a positive way because the idea of Laura, you should just avoid stress because

23:56Dr. Natalie Crawford:it's bad for your fertility is almost a laughable concept because stress is, it's inherent, right? Like it, the world is stressful. So instead of saying like, I'm going to have better stress mechanisms. So one will say, Hey, when I have these events, I'm going to go move my body in some way, use up some glucose, acknowledge that, you know, drinking alcohol or eating more food, stress eating are actually the worst things that we can do for this process, right? Instead, I'm going to use some of that glucose that's been freed, kind of get a nice reset, and you'll recover from the stressful event faster.

24:31Dr. Natalie Crawford:I also think we have to build in stress reduction techniques because the world is stressful. And yes, there's a place for saying no to things you don't need and try to craft an environment that is less stressful. I think that's good for us all in hustle culture to kind of think about that we don't have to say yes to everything. But there's seasons of life where you have things that are stressful you don't have control over or that you do need to say yes to things. And so acknowledging that I need to have a cortisol reduction and I need to like not be on my phone, you know, whether this is meditation, mindfulness, acupuncture, yoga, a walk, sitting outside with the birds.

25:09Dr. Natalie Crawford:I mean, we're all wired different and all of those things can achieve the goal of that feeling. And so, you know, these three things right here, my like foundation of the day, that's step number one. That didn't require a huge, oh, I have to learn about toxins and get new beauty products or change the foods I eat. I mean, those things are important and hugely impactful. But before we even start those, we should start looking at how we're setting up our day, because we're probably making choices on these foundational tenets that are harming us without even acknowledging how inflammatory they are.

25:46Well, on top of life stress, trying to get pregnant. Infertility stress. IVF was one of the most stressful, emotional, mental things I've ever gone through. So how do you help your clients or your patients navigate that?

26:05Dr. Natalie Crawford:You know, infertility stress has been likened to getting, you know, a cancer diagnosis. And as far as the stress that it causes to you personally and to your family. And I think it makes sense because nothing causes you to question your life, who you are, what your life is going to look like, you know, as going through infertility and being faced with a reality. that you almost didn't even know was possible. I think for infertility stress, it's multifactorial on how to approach it. Number one, walking through a forest blind will always be harder than walking through with a map. So have whoever is leading your journey, your doctor, your clinic, trust them.

26:46That doesn't mean we blindly follow their advice, but if you have questions that are never getting answered,

26:50Dr. Natalie Crawford:if you never can get face time with your team, if you don't know that they have your interests at heart, please go get a second opinion first and foremost you know having a map knowing what you're doing and why you're doing it can make the process less stressful even if you know that doesn't always cover you know the outcome it's going to be a lot easier of a journey so so trust where you are and you're not married to your fertility doctor if that is not the place for you please please please get a second opinion i think from there you know knowing that you are controlling what you can. So when we do talk about a lot of these, you know, lifestyle factors and decreasing inflammation, man, do them.

27:29If you have infertility, like don't, don't spin your wheels, wasting time thinking like, should I do this? Or shouldn't I do this? Just say, you know what,

27:37Dr. Natalie Crawford:in this season of life, I don't have the mental band space to be questioning all these decisions. So I am just going to start to live a more anti-inflammatory life and know that I'm doing the best that we can possible and not let that stress me out. But number three, I always tell people to do what I didn't do. And this would mean that please consider telling the people in your life who would show up for you what you are going through. And I know that is a huge vulnerability and that's very hard. When I went through pregnancy loss and infertility, I didn't tell anybody. It made it so much harder.

28:13And I was in this, oh, I didn't tell, tell you I was pregnant. How am I going to call you and tell you I'm miscarrying?

28:19Dr. Natalie Crawford:I just felt very alone. It's already so isolating to watch your friends and family get to a life stage you want to be at. And so allow them to show up for you. Somebody can't show up for you if they don't know what you're going through. And this doesn't mean you have to share your story on the internet. People can, And that's incredible and vulnerable. But think about, you know, your best friend, your mom, your sister, that coworker you're so close with. When you open up and you do share with them, you know, most people will show up in ways that, you know, you need, right? If you tell your best friend at work, like they're going to be more apt to be able to say, oh, you're, you have, you know, your retrieval next week.

28:59Dr. Natalie Crawford:Let me cut, let me be the lead on that project or let me do this. And so we have to give people the benefit of a doubt and a little bit, but let some of them in. The contrast to this, I will say, is if you are listening and you have somebody in your life going through infertility or you've been through it and now somebody is going through, I think one of the most impactful things we can do is show up in meaningful ways by making it yes for somebody to say yes to our help. Because the text that says, oh, my gosh, Laura, I'm so sorry you're going through IVF. Let me know what I can do. I mean, that's so sweet.

29:30But now the burden's on you. And you have to say, what is too big of an ask? Or what am I going to ask them to do? or are they available and it feels too much. So instead, I always tell people like, show up in a very tangible, make it an easy yes. Laura, I'm driving through Starbucks. Can I grab you something and drop it by? Or, hey, I would love to take you to dinner on Thursday night to this place. Or if your partner is out of town, I know they're out of town next week, I'm free to go with you to the doctor and write down, take notes for you, right? Give somebody something you're willing to do that you can do and show up for, but make it easy for them to say yes to that help because it is very meaningful.

30:07But too often people put the burden on the person going through infertility and you're already juggling so much

30:15Dr. Natalie Crawford:and trying to make all of these decisions and choices that that can feel like too much to the cup as well. And then you're not getting support that you could get. Yeah, that's great advice. What's up everybody, it's Bretzky and America is turning 250. And I can't think of a better way to celebrate that than playing on an American-owned social casino, spinquest.com. With all of your favorite games, live craps, bubble craps, live blackjack, there's no better place to play for free and win real cash prizes, spinquest.com. SpinQuest is a free-to-play social casino. Avoid where prohibited. Visit spinquest.com for more details.

30:57I want to know what you think about when a woman should be tested early fertility testing should we be doing it in our 20s to get ahead of the eight ball when when should a woman do it yeah i you know frequently say i

31:15Dr. Natalie Crawford:think the entire fertility industry is wrong and we should be revising how we're doing everything i don't think we need to be as reactive we should be proactive if you want to have children one day but not yet. So you say you're in your twenties, you say this is a life goal. I think every woman should consider testing their AMH, which is a marker of their ovarian reserve. And I think that we should, you know, really learn how to track our cycles. Now, obviously when it comes to cycle tracking, if you're on hormonal contraception, you can't track your cycle. So there's seasons of life, right? And if the priority is preventing pregnancy and a hormonal contraceptive is the best choice for you, good, right?

31:51Dr. Natalie Crawford:That's fine. but presuming that that's not usually most women their entire 20s learning how to track your cycle so that you can get an earlier evaluation for cycle abnormalities even if that means you know taking a break from contraception if that makes sense in your social life so that you can kind of see how your cycle is your period gives you a lot of warning signs when it comes to both ovulation and egg count and other markers but we don't ever learn to leverage that i have to admit amh testing is for some reason extremely controversial. So let's dive into this. AMH is a blood test. It's not very expensive and it's very easy to do.

32:27Dr. Natalie Crawford:It is a hormone made from the cells that surround each follicle. So your eggs grow inside follicles, inside your ovary, you're born with all your eggs every month. I like to think about your eggs kept in a little vault inside your ovary. And every month, a group of eggs is sent out of the vault. And so you see all these follicles. One of these will be chosen to ovulate, the rest of them die the next month, another group. Core concept is when you have more eggs remaining, more come out every month. And as we start to get older, fewer come out every month. Eventually we'll be out of eggs. And this is ovarian failure or menopause.

33:01Dr. Natalie Crawford:Well, our ovary does have kind of some period abnormalities between brain and ovary connection at both high egg counts and low egg counts, right? It's meant to work right here in the middle. And this is why our cycle can be very enlightening to us. But AMH is made from the cells surrounding all the follicles outside the vault. So in a very simplistic form, if you have more eggs remaining, you can do a blood test, you'll have a higher AMH. And if you have fewer eggs remaining, you'll have a lower AMH. To me, this sounds like a no-brainer, right? Like we should check this. And if you're low, especially as a young woman, and you want to have kids one day and not yet, you might absolutely do different things if you find out this information.

33:41Dr. Natalie Crawford:Because twofold, one, why is it low? And two, like, should you consider freezing eggs? Or maybe, maybe you'd be like me, maybe you were married young, but you're just, were waiting for a family. But theoretically, you could start earlier if you knew you had less time to grow your family. The reason why it's controversial is the American College for OBGYN says that you shouldn't check AMH until somebody has infertility because it's not a great marker of natural fertility. And what they mean is that people with both a high and a low AMH can still get pregnant, right? If we think about if you have five eggs outside the vault and you have 20, if you're ovulating one egg, you still have the same chance of getting pregnant based on your age.

34:24So why stress women out about a test that's not, they say that's not going to cause infertility.

34:31Dr. Natalie Crawford:And a high AMH doesn't mean you'll have no problem getting pregnant, right? Because that's just one piece of the puzzle. I think that's such a paternalistic view because they're making an assumption with what you'll do with that data. They're making the assumption that it's too stressful. And the bigger overarching question for me is, well, why is it low? If a 25-year-old has a low AMH, there certainly could be something that is causing a low AMH that also could cause infertility that her story might look very different if she knows this information now. Let's say autoimmune thyroid disease or endometriosis, you know, smoking cigarettes, you know, maybe she makes change.

35:08Maybe she gets a diagnosis. Maybe she freezes her eggs. Maybe she doesn't.

35:12Dr. Natalie Crawford:But what I find is that by allowing you as an individual to make hard choices, you are going to tolerate the outcome of that decision, even if it's unfavorable, much better than being never in a position to have the choice in front of you. because if I look at a 25 year old and I say, Hey, you have extremely low AMH and you are probably going to go into ovarian failure before your planned time of getting pregnant at age 35. You know, you might say, I not going to do anything about this. Like I'm not, I don't have a partner. I don't want to freeze my eggs. Okay. So be it. But at least you got to make that choice because if we let time make it and you just pop into my office at 35 and the time has passed, now we don't know what you would have done, right?

35:56You don't get the opportunity to make that choice.

35:59Dr. Natalie Crawford:Most women will actually do something different. There's no one right or wrong thing. I've had people freeze their eggs. I've had them start trying to get pregnant earlier. I've had them change their entire lifestyle, but I have definitely had women in their twenties find out that they are in premature ovarian failure. And the, one of the hardest things is to, to both that they never got the choice. They never got the opportunity to conceive, you know with their own eggs and even more so when they do say that they had period changes one of the top signs of having a lower egg count is starting to ovulate earlier so if you say i used to have cycles that were every 30 31 days now they're every 24 25 days the simple explanation is when less eggs come out of the vault the brain doesn't know this and sends out the same amount of the hormone fsh follicle stimulating hormone to get you to ovulate so it's a stronger signal right It's getting divided amongst five eggs instead of 20 and you tend to ovulate faster.

36:55Dr. Natalie Crawford:So when women say, I, you know, my period started getting closer together and I went to my doctor and I got dismissed about it. That to me is also heartbreaking because that's the moment when your body was trying to give you that red flag. You, you weren't taught about it. You didn't know you got dismissed. You did everything you could. So this narrative of not checking your AMH until you have infertility, I find to be very harmful. I think, you know, you can choose to do what you want with the information once you have it. There's no reason why we should presume what you would do. Like, we should just find out the data.

37:29Dr. Natalie Crawford:We can acknowledge the limitations of a test, right, and say it doesn't mean you'll be fertile and it doesn't mean you'll have infertility. But understanding that's one piece of the fertility puzzle that we can actually test, I think is so important. And it's something that I do think women in their 20s should get tested if they want to have kids one day. And if they want to have kids, when should they freeze their eggs? So, I mean, my standard answer is, hey, the moment you're asking the question is the best time to freeze your eggs because you're never going to be as young as you are now, which means your eggs are going to be great quality and you're going to have more of them because over time we have less eggs.

38:08Dr. Natalie Crawford:The scientific answer is that for the majority of people, we see that age 30 to 32, if you not ready to have a child, this tends to be statistically when there's a, you know, cost effectiveness. I mean, you still get a good number of eggs. The genetic normalcy is still high. And, you know, your tendency to need to use them tends to be higher. So there's no one answer. I think, you know, I definitely have women in their twenties or, you know, they're going to mud school or grad school and they just want to kind of freeze eggs. I mean, they are then freezing them when they are young and have excellent egg quality and have a good number.

38:43Dr. Natalie Crawford:So they have a very high ROI on that investment. I always say that egg freezing is not like an insurance policy for your fertility. A lot of people mistakenly say that. You know, I would say an insurance policy pays off, right? This is an investment. It's like playing the stock market, which really depends on the environment when you go to pull the money on what the ultimate outcome will be, which has some variables that you can't control. And that is how I frame egg freezing. So the ROI on this investment, We try to use the data to make the best guess we can. Generally, is it good to invest your money?

39:18Yes. Does it pay off for most people? Yes. Will it always pay off for you? We don't know. There's some risk involved. And so framing it that way kind of allows women to gauge what makes sense for them. But I also say we don't have to view it as a one-time thing, meaning very often it makes sense. You want to have kids as a life goal. You're pursuing some other path or you don't have a partner yet. let's freeze a group of eggs. Now, the longer we wait till you're ready to have your family or the longer, you know, time is going by until you want to use them, the higher the likelihood you need them is.

39:52So suddenly you might say, maybe I should do another cycle as I get older, right? Like as more time passes, we can always add to that. So, you know, I've had women very old freeze eggs and had success. I've had women as old as 42, 43 freeze eggs and ended up having success for them. I've had women, I mean, I've diagnosed 15 and 16 year olds in ovarian failure. So, you know, you don't know what you don't know.

40:15Dr. Natalie Crawford:And I think it is, we can make a lot of presumptions about what happens on average, but by definition, average means some, some people have it better. Some people have it worse and getting your own personalized data and thinking about your own goals is going to help you make the best decisions for your future, which ultimately I'd rather you make that choice. Even if it ends up, you know, not working out for you, you can say, you know what? I knew my AMH was low. I wasn't in a position to do anything about this. This is where I am. And I can live with that versus what I hear is, gosh, I wish I'd known this information.

40:51Dr. Natalie Crawford:I would have made a different decision. This is really interesting because there's women. I mean, we are, our age group here listening to this podcast is pretty much the majority are between 35 and 55. I would say 95%. So you have some women going through this, but then there's a heck of a lot of women that for somebody like me that I'm like, well, what do I want to tell my 21 year old daughter? Because if we, you know, did they have it right 80 years ago when people were having babies at 18 and 17 and, you know, starting families and that's what you did. Like it's how do we shift that? Because that's really hard too.

41:32When I had, I started having my children in my twenties. And so it was really easy for me, but I had a partner and that worked out, but that's not what it's like for the majority of, we're getting married later. We're having more careers. Like for the female, it's this short, like it's hard because you're like, well, I have this biological clock ticking. And then I have these other goals of independence and what I want for my one wild, beautiful life. You know, how do we coincide those? Is it always better to get, I mean, it's definitely easier, it sounds like to get pregnant when you're in your 20s, obviously, versus maybe your late 30s.

42:15But when does that geriatric, doesn't the geriatric pregnancy start at 34? I want to say I was 34. And I was in that category. 35. Yeah. So if you were going to be 35 when you delivered, you would have carried that lovely advanced maternal age or geriatric pregnancy kind of title. We have to remember that some of these things, you know, medicine's so interesting because it existed in a time before the current technology we have. And so sometimes certain labels or ways that we did things made sense in context of how the world was, and it doesn't necessarily still make sense today. And we have to view it through that lens.

42:50So advanced maternal age, we knew people had higher pregnancy complications or more losses, and we didn't really know why. Now we know it's because more of our eggs are genetically abnormal. We're overall less healthy when we're over age 35. That doesn't mean that you as an individual are going to have a hard time or you shouldn't get pregnant, but it definitely means, do we need to pay more attention to our overall health? If we're carrying a pregnancy at 40, then maybe a 20 year old can get away with more. Absolutely. But that doesn't mean you're universally going to have bad outcomes. But from a medical standpoint, that title allows us to screen for more things and test for more things and kind of make sure you're not having some of these bad outcomes.

43:29And I think ultimately that's good, even though the name of things can be kind of bad and scary. Oh, I have had no luck lately. Wait, lady luck? Ritsky, I got you. I've had so much luck on spinquest.com. They have all of my favorite games, slot games, live blackjack craps and bubble craps. You can even get a$30 coin pack for just 10 bucks. 10 bucks for 30? I'm headed over to spinquest.com right now. SpinQuest is a free-to-play social casino. Avoid where prohibited. Visit spinquest.com for more details.

44:04Dr. Natalie Crawford:I think a few different things. You know, most women are learning to track their cycles. Like we'll say the listeners of your show when they're going through perimenopause is when they're now done with their family. maybe they don't need to be on kind of contraception anymore or their partner has a vasectomy and so they're kind of off contraception trying to learn to track their cycles or their cycles being wonky or they're asking is it perimenopause or menopause there is absolutely no reason why we should be learning that information age 35 to 55 right we absolutely need to be learning about our cycle and what's normal and abnormal younger so i think when it comes to my own daughter like when she is older, you know, making sure that even though hormonal contraception, like it gave me a lot of freedom.

44:47I loved it. I'm not an anti-birth control person, but the idea that like we should just use hormonal contraception for a decade without ever like checking into our body.

44:56Dr. Natalie Crawford:I don't love that. So, you know, I would say making sure she knows what a normal period is. She knows how to track hers and that she takes breaks from contraceptive when it makes sense from her.

45:10So You know, I think getting testing for her fertility, like checking an AMH when she's young, she'll probably, I think if you are a parent and you can help your daughter freeze her eggs when she's like graduating college or grad school, if that's something she's doing, that is one of the best gifts you can give because you are helping achieve a goal that feels financially really high for a 20 year old to drop, you know, 10 grand or so on egg freezing feels like a lot. so as a you know as a parent that would be something that I would say gosh instead of giving my daughter you know jewelry or trip or this or that like that would be an amazing kind

45:48Dr. Natalie Crawford:of gift to gift your daughter upon graduation or a life event especially if they are chasing other dreams that as parents we want to support I don't want to see our kids get you know maybe pregnant in their early 20s we'd love for them to chase these dreams but trying to help that feel like an easier way to do so. I also think that, you know, having open discussions about reproductive health in general from a young age or even going on is really important to know like that your child can turn to you, you know, also that we as a society can say, you, if you want to have kids one day, you know, how do we help you?

46:27How do we not? I see so many people suffering and suffering in silence or not knowing information. Things like you can get genetic carrier screening to make sure you and your partner don't carry the same genetic disease before you try to get pregnant.

46:40Dr. Natalie Crawford:And that's a medical recommendation that so few people do because they don't know. And then I will end up seeing people who co-carry the same terrible disease. They don't find out until they have a child who's very sick or unfortunately who might die and then they come in for IVF with genetic testing. So preconception testing, so things like genetic testing, which is going to change immensely, I'm sure, in the next decade, testing ovarian reserve in our 20s, considering freezing our eggs, but learning how to track our cycle. These are the discussions to be had. I do think we're doing a false disservice to somebody who wants to have multiple kids to act like there is no biological clock, right?

47:20Because we know that it gets harder to get pregnant as we get older, that starts to become most apparent around age 38 and older. So if we say, okay, I'm waiting to have my whole, my first kid until I'm 35 and I want three kids, that math is going to be really tough statistically without needing IVF. And so that opens the discussion. IVF is a heck of a lot easier if you have younger, better quality eggs, that's where egg freezing earlier can make a huge difference for people later so there's no one right or wrong but i think if we're thinking about this through the lens of our daughter

47:56Dr. Natalie Crawford:empowering reproductive health discussions talking about how healthy living impacts egg quality and sperm quality later so that we we all want our kids to be healthy and live a long time but kind of empowering them that starting that early is only going to be more helpful um and And having been an open place for these discussions, I think can be really helpful. That's great. I love that, you know, giving it as a gift. But do you see, so for families that are like, well, I, you know, I'm the parent and I don't have$10 ,000. I would love to give that to my child, but I don't have it. Is this, do you think it's going to get more achievable as far as finances?

48:41that there will be different options. Do you see that on the horizon or it's still worth this uphill battle with funds? I mean, yeah, that would be on my fertility wish list that it could be something that is really accessible. I think this is something to think about depending on line of work, you know, too. So we'll use an example, very competitive industries like tech industry right now, fertility benefits are a large part of their recruitment packages. So if you're going to go work at some tech company, most of them are going to have coverage for egg freezing. And that's great. You should absolutely do it.

49:13If your employer has benefits for fertility testing and treatment and you say, I want to have a kid one day, but not now, like leverage the benefit because the next job may not have it. Um, I would, you know, I would love to live in a world where I thought that this would become a universal health benefit, or I thought that the administration's current plan was going to make this truly more accessible. the reality is like there's there already are workplace benefits that exist until we really incentivize businesses to include them probably with tax breaks or other breaks which which is not a part of the current plan it's going to be hard pressed to see universal adoption of this across different workplace benefits um so i would love to see that in the future i mean i it's hard to get some states to even cover egg freezing for cancer patients, right?

50:09And so if we're living in a world where it's hard to get something approved for people with cancer, who we know their fertility is going to be impacted by their cancer treatment, I think it's hard to imagine that we'd be in a

50:19Dr. Natalie Crawford:place where we have, you know, universal coverage for it, even though I would love that. It's on my wish list, but I think realistically, I don't see it, but I would say there are, you know, companies that do leverage fertility benefits. And so that is definitely something to be aware of, especially if like maybe if you have a daughter and they're interviewing for jobs, like say, hey, this should be on the questions. You ask human resources, like do you have fertility benefits included? Do they cover egg freezing? And, you know, I think we need to help empower them that it's okay to hold those discussions as well.

50:51What about the cost of IVF? Do you ever see the cost of the medications or IVF itself going down? So let's talk about, you know, recently there has been administrative focus on IVF and on a pro. EMD Sirono has agreed to start manufacturing some drugs here in the U.S., which should help some. And there should be some benefit to people of the lowest socioeconomic group to save some money on medications. I mean, to be fair, they'll probably save one or two thousand dollars, which is amazing. But drugs cost way more than that, as you know. and it is the minority of people who benefit. I mean, you think you have to make less than like$80 ,000 to even qualify for that drug benefit.

51:35So it's a step in the right direction. I mean, manufacturing drugs in our company, speeding up FDA approval of novel medications can be advantageous. But I think that the technology for IVF is incredible. As somebody who owns an IVF lab, the equipment's crazy expensive. The skills of a good embryologist, I mean, it's crazy, right? So the overhead is so high. And if you don't want to sacrifice quality of care, it is it's probably not going to be a less expensive process because tech is improving. That's great. New equipment costs more money. I think we'll see some decrease in drug prices if we can really manufacture them here.

52:16And that will be good. But I do think for the majority of people, that's not going to feel very impactful based on how expensive the whole process is. And that's tough. there have been states who have very successfully implemented, you know, mandated fertility care coverage where they get up to three cycles of IVF. You know, any employer in that state has to offer it. And that can be. Whether it's slots or live dealers, spinquest.com has the fun and action you're looking for with SpinQuest exclusives, Blackjack, Roulette, Baccarat, and even live dice with craps and bubble craps. The games never stop, so you don't have to.

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53:09Dr. Natalie Crawford:I can hugely change somebody's fertility journey, right? I do have to say that even in those states, we see the number, we see that people still drop out of fertility care. And the reason why is emotional resilience, right? So the top reason why somebody walks away from a fertility journey is not financial. It's not physical. It's not, it took too long. It is that, you know, mentally and emotionally, I could no longer put myself through this. And I think that should tell us that financial is a huge piece of the puzzle, but there's a lot more we need to do in how we support people who are walking this journey.

53:43I agree. And when you do go through it and you realize what a miracle it is and the science behind it and what you are doing, you kind of don't think about the money because it's truly a miracle what you guys are able to do and achieve. so I just it does break your heart when people aren't able to do it because of the cost so that's why I wanted to ask that question um what would you say if I was your patient and for anyone around my age she's 48 well actually I'm 47 all right all right don't Don't up-ager. Don't up-ager. So I'm 47 and I have a good egg left, right? Yeah, I think there's statistics exist to help us understand the most likely scenario.

54:45When it comes to fertility and pregnancy in general, you know, one of my fellowship mentors always said,

54:52Dr. Natalie Crawford:I can give you any statistic I want, but for you, it'll be zero or a hundred. And I think that's really, really important, right? That we talk about numbers, like this is a continuous variable, but for us as an individual, it is a yes or a no. And so we have to keep that in mind, right? Because even if I say 1 % chance, which sounds like zero, it is in fact not zero. And that means that there is a chance and we always have to kind of look it through the lens of if that's a goal for us or not. if we are not having periods anymore at age 47 48 then it might be a zero chance because at some point your ovaries do run out of eggs and we are starting to approach that transition where the ovary may not respond if you are not having periods or you have extremely irregular periods and we check blood and your brain's fsh that hormone that gets an egg to grow is higher than 40 that is a sign that i may not be able to get your eggs to grow with medications because the medication we give is FSH.

55:50So if we kind of think about ovarian failure in menopause, your brain is sending out all the FSH it can to beg the ovary to make an egg and it's not doing it. So then we can't overcome everything. And that's why at some point your ovary will stop responding. And once it does, then we are out of options for your own eggs. And we can look at donor eggs or alternative options to grow a family, but everybody does reach that critical point. And sometimes it's like a flip

56:17Dr. Natalie Crawford:switches, you know, that you did one cycle and you responded and two months later, it's a different story. So as we start to get into that really low egg count, we know we're kind of approaching the end. If we are older, I say there is some age-related accumulation of genetic changes inside our eggs from wear and tear over time. Our eggs are in our body our whole life, can't change that. But that's only half the puzzle when it comes to egg quality because the competency, the metabolic health of the egg controls how it divides the mitochondrial health that gets passed onto the embryo. So to me, like those are factors we should absolutely do everything we can for.

56:54So the older we are, if we can't change our age, which nobody can, then we need to say, hey, these lifestyle factors that we talked about earlier, plus right, eating diets high in fruits and vegetables and fiber and limiting processed foods and limiting adding sugar and, you know,

57:09Dr. Natalie Crawford:reducing environmental toxins and chemicals and sub toxic substances like marijuana and alcohol and smoking, those things only become more important because of, you know, the age related quality factor that we cannot change. So, and then I think realistic, you know, goals are really important. There's this another place where I say there's no one right or wrong choice for somebody, but, you know, getting the data you can is really important. Optimizing what you can, And sometimes financially, it may not make sense for you to do IVF, right? If you only are going to have one egg per month, you know, if you have a really low egg count, you might look at this and say, I don't have an endless pot of money.

57:49This doesn't make sense for me. But ultimately, I think that that decision should be yours. And so getting the data, doing what you can. But we all know stories of slash we all see people who are older who have been told there's a zero percent chance who then get pregnant naturally, right? And I think that's because we can have a low overall population-based odds, and that becomes really important when we're trying to stratify decisions and how we spend our money and our time and our emotional energy. But that doesn't mean that it's a 0 % chance. So if you're still cycling, it still can happen.

58:23Focusing on lifestyle is really important. IVF can absolutely be a strategy as we're older, because if we're not in menopause and

58:29Dr. Natalie Crawford:we do have multiple eggs per month, it is using the rest of the time better by getting them out of your body. And by doing genetic testing, trying to find those normal embryos can be a more efficient use of the time that you have. So the last thing I'll say here is we'll say just in general, if you're 40 and over, I recommend getting a fertility evaluation right away. So if you are at a stage and you want to be pregnant and you're 40 and over, do not just try to get pregnant for X amount of time and then come to us. We know that statistically you have a higher odds of having certain things wrong.

59:00Dr. Natalie Crawford:So let's get testing done right away so that you can make these decisions from a place of power and knowledge versus kind of having to go through that failure first. Wow. I'm so excited for your book to come out. And I'm not even in the fertility world anymore, but I feel like this is super helpful. As I said, as I, as I have an older daughter that isn't anywhere near that right now, but knowing it's one in five, I mean, that number might go down to one in four. I don't know. So yeah, I think if we don't make changes as a society, we are going to see, you know, that this rate of infertility is only going to get worse.

59:37Yeah. Oh, well, you give a lot of support and freebies when people purchase your book. It's on pre-order right now. Correct. Yes. Yeah. So the book is for, is pre-order. You can pre-order it right now. It comes out in April of 2026 and it's called the fertility formula. So You can get it at nataliecrawfordmd.com book. But because there's irony, you know, traditional book publishing, love and hate, right? Big reach. It's incredible. It takes a long time. So the irony of them saying this book goes for pre-order nine months before you could be held in print, not lost on me for a fertility book. And because it is something that, you know, if you hear all this and you want to make changes now, you don't necessarily want to wait until the book is in hand.

1:00:23So anybody who pre-orders, there's a hormone guide. you can get immediate access to. I have an IVF course that I've had for a long time, really talking about nitty gritty of protocols and questions to ask that you get access to. And then we're doing a pre-order book club where I have made modules from the book chapters to kind of give you this information now and do a deep dive on it. And then monthly Q &A calls. So trying to support people who are supporting me and buying the book, which is, you know,

1:00:50Dr. Natalie Crawford:fulfilling one of my life dreams by helping them get this information sooner in anticipation of the book coming to their hands in April. So exciting. That's such a blessing because when you are going through IVF, you do have so many questions and you need support. And to get it from a doctor who's a leader in the space is such a gift. Oh, well, thank you. It's a hard road to walk, you know, and I think unfortunately, I wish everybody just had, I wish all fertility clinics were created equal. We'll just say that. But the truth is, I know that they're not. And I think trying to help, you know, elevate this fund of knowledge for everybody who is walking this road is one of the things that I can do that can hopefully help impact change.

1:01:38Fantastic conversation today, Natalie. Thank you so much for your time and for your gifts and skill set that you are sharing with the world. We are so happy to see some of these big, important and emotional topics get to broader audiences through podcasts and all of the YouTubes and information that you're sharing. So thank you for joining us today and sharing with our listeners all of your information.

1:02:08Dr. Natalie Crawford:Thank you guys so much for having me, truly. Thanks for listening, everyone. If you enjoyed this episode, please consider giving us a five-star rating and sharing the body pod with your friends.

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