STOP Inflaming Your Body: The #1 Enemy to Egg Quality and Conception

23:38And if you are constantly challenging it by adding additional inflammation, right? There's inflammation in the world every day. The air we breathe, the water we drink, but the stress levels we take on, the foods that we eat. And alcohol is one that is only straining your body with absolutely no benefit to you, in addition to being a poor, you know, stress coping mechanism and straining your body more. Cannabis too, and cannabis more directly, has even more literature showing such harm. For men and women? For men and women. Dramatically for men, again, sperm quality is easier to test than egg quality, so we have to understand the limitations.

24:14I can have a man ejaculate in a cup and I can check his sperm quite easily. For women to evaluate their eggs, I've got to go through a procedure and take them out of your body. So we just have more literature on men. But we know that cannabis can downregulate the brain. So you start to send out less FSH and LH. Same hormones in men control sperm and testosterone production. So men suddenly are having lower testosterone with cannabis, lower sperm production, decreased motility of sperm, and increase in abnormal shapes. And a fascinating study even showed that men who use cannabis, even if their partner does not, their partner has a higher rate of miscarriage.

24:46Which I wanted to ask you, what are some of the risks of miscarriage? You mean some of the risk factors for having miscarriage? I'm somebody who had four miscarriages myself. So I say this from a place of it's a terrible thing to go through and nothing makes you doubt your own body, like getting pregnant and losing a pregnancy or not being able to continue a pregnancy. It makes you re-question and look at everything that you're doing. Yeah, it's devastating. It's devastating. So there's some things that you might have no control over that are risk factors. So there's certain genetic scenarios.

25:16You know, your chromosomes, you can inherit what's called a translocation, which predisposes to a high risk. You can have a uterine birth defect. A uterine septum is one of them. Or if you have a septum or this birth defect, uterus is fascinating. It's actually formed in two different pieces, and then it fuses together, and the midline portion reabsorbs. And if that midline portion fails to reabsorb the entire way, you can have a piece of avascular tissue almost dangling inside the uterus. And women who have a uterine septum have up to an 80 % chance of a pregnancy loss. So what do they do? If it's diagnosed, it's easily correctable.

25:48We can go to surgery and take it out, and then they have a normalized rate of loss. But many women don't know that they have this until we do an evaluation for repetitive pregnancy loss. But so there's genetic factors. There's uterine birth defect factors. There's clotting disorders. But a lot of the true risk factors, as we know, autoimmune disease. Meaning thyroid? thyroid, diabetes, insulin resistance, I have celiac disease, which I did not know during my own infertility journey, PCOS. A lot of these things, though, increase the miscarriage rate through that same inflammatory mechanism. And we have to remember that inflammation is so nuanced when it comes to conception because acute inflammation or the body's ability to heal itself is really important in ovulation.

26:32A follicle grows an egg, it ruptures, allows the egg out, And then it has to reform. Inflammation is so crucial to ovulation that if you take NSAIDs or anti-inflammatory medication like Motrin, Aleve, Niproxin, you can actually prevent the follicle from rupturing, prevent the egg from being released. And then inflammation is also really important for implantation when a pregnancy is trying to invade. And your immune system is modified based on estrogen and progesterone. But we know that chronic inflammation is really detrimental and especially to that side of the process where an embryo is highly sensitive.

27:09So that's going to be early embryo growth and before the placenta is fully grown in around nine weeks. And so that's when your environment does really matter. And we have to start understanding that we can't control everything. And I never sit here and say that I caused my miscarriages, but I certainly didn't know everything that I could have known. and I wasn't making choices from a place of knowledge where I could say, I know that I'm optimizing my health and having the best environment that I can for pregnancy purely because I didn't know about it and we didn't talk about it. And when you treat, say, celiac, so for those listening, celiac is someone who cannot tolerate gluten.

27:45It creates a cascade of inflammation, to say the least. Terrible. Once you treat that, so you remove gluten and anything that would be seen as some kind of cross contaminant or antigen, is an individual able to then overcome that milieu of miscarriage? Yes, because you have treated what the underlying cause of the inflammation was. And this is another place where we have - Even if, sorry to interrupt, even if celiac disease, so for example, individual with celiac, it never goes away. So it never goes away. And there's many other chronic inflammatory disorders too. And so some of them you can, you have to treat the disease to the best you can.

28:24But even more important in some ways is to make sure that you're not adding to your inflammatory burden. Meaning I'm going to have more baseline inflammation than somebody like me who doesn't have celiac disease. That's how my body is wired. I have an autoimmune disease. So I need to be extra cautious that I am getting enough sleep.

28:45Cautious about the food I put in my body, not just from a gluten standpoint, but from an inflammation standpoint. because I have more baseline inflammation and I'm more prone to it and my body's more sensitive. But it's rare that you're gonna be able to fully get rid of any inflammation in any one individual. So we have to understand how do we mitigate risk by lowering this, lowering our inflammatory burden as much as possible. And knowledge is the way to do it. Yeah, acknowledge this is what we're doing. And my story is so interesting because I got diagnosed with celiac 10 years after I had my losses.

29:16And during the time when I had pregnancy loss, I was told the very classic, just keep trying, you're just stressed, you're in residency and fellowship, and all my testing came back normal, I feel like I knew something was wrong, right? You get that feeling that things aren't right, and a very classic female experience to feel gaslit by the providers that you're going to see. And at the same time, I was doing my fellowship research, which in reproductive endocrinology fellowship, we do a year and a half of research and a year and a half of clinical work. And most fellows do IVF research, right?

29:47They do the lab, It's a very controlled environment, a great project to go sit for your oral boards. And I went up to my mentor and said, I want to study natural fertility. I want answers to the questions that I have. I want to know what influences our ability to get pregnant and stay pregnant. Those are the questions my patients have. And they said, well, no fellow does a project like that. It's too hard to defend. Epidemiology is too complicated. I was very stubborn. They said, well, you'll have to get a master's in clinical research. And I said, sign me up. Right, sign me up. I want to learn all about it.

30:14And that's when I started diving in to the world of natural fertility and fecundability and saw this common thread of inflammation so often in the literature. But in medical school, we learned about inflammation only in a disease process, right? Oh, inflammation contributes to infertility because of endometriosis, right? Never as this almost standalone, what is contributing to some of our underlying body function or health optimization. Thank you to Bond Charge for sponsoring this episode of the show. And if you've been following me for a while, you know that I take light exposure seriously. Why?

30:52Because it impacts your sleep, your hormones, your mood, your ability to recover and focus. It doesn't just affect you, but it also affects your kids. And that's why I use Bond Charge. They've created science-backed tools that help balance our modern industrialized lives from harsh indoor lighting to too much screen time. Their blue light blocking glasses are a nightly ritual for me and my kids borrow mine. They help calm my nervous system, protect my circadian rhythm, especially if I just happen to look at my screen, which we all know that never happens. I also love their red light lamp. I turn them on as soon as it gets dark and I use the big panels 10 to 20 minutes each day.

31:33They are some of the best red light products I have ever used, low EMF on the market, and right now Bond Charge is having their holiday sale. So you can save a massive 25 % off. Just head to bondcharge.com and your 25 % off code will automatically be added to your order. The sale will end on the 31st of December, 2025. So hurry and don't miss this chance to save on your favorite bond charge products. So I did my own in one experiment, changing our whole life. The things in our kitchen, how we moved, the sleep we got, the foods we ate. But what I really tell people, and I know you have this approach too, is you've got to leave space for rules and then what works for you.

32:17And learning to understand your body is probably one of the key tools that women are never really taught. Because we are dismissing gaslit, we don't learn how to lean into that, something's wrong and I know it's wrong, right? And so learning to say, this causes me to feel worse. This causes inflammation in me and therefore I'm not going to be exposed to it. And when I got pregnant and stayed pregnant with my kids, I actually was avoiding gluten because I was really leveraging this, what makes me feel bad and what makes me feel good. And then 10 years later, I got diagnosed with celiac. And now I think that if an individual is able to connect with the right provider, you can do a whole host of autoimmune.

33:00We do autoimmune panels. We're living in a different world right now, thankfully. And I will say this just on the topic of miscarriage before we move on, that the guidelines have changed. You used to have three miscarriages before you would get an evaluation for recurrent pregnancy loss, and now it is two. So if you are having multiple pregnancy losses and somebody dares to tell you, you must lose another pregnancy before we'll test you for anything, go somewhere else. Yeah, that would be terrible. What about thyroid? Now, Hashimoto's is an autoimmune condition of the thyroid. And when we are talking about, you know, as I was thinking about this, the 12 month prep plan for getting pregnant for conceiving, we think about the biggest factors that we can move the needle on which you had said our sleep and mitochondrial health and obviously exercise avoiding toxins, which we're going to kind of circle back, but also addressing this inflammation, which you've really been talking about this for years.

33:56This is not, you know, we're talking about it because we're talking about it here and highlighting your book, but the reality is you have been studying and talking about it forever. And I do want to highlight that. Inflammation comes in many different forms. Hashimoto's, which is autoimmune condition of the thyroid, I just want to touch on the impact of thyroid and fertility. I have a love affair with the thyroid. I'll just admit my bias here. I've written chapters and books about it. I've given grand round talks about it because I think it is such a prevalent disease in reproductive age women.

34:30And let's just step back for a minute. For the vast majority of my patients, infertility is the first medical problem that they have. They have only gone to the doctor for health preventive measures. They've talked maybe about birth control or contraception. This is the first moment where things are really going wrong. And I'll admit there's a big debate about do you screen for thyroid, do you not? And I leverage what the Endocrine Society says and what I know in my own clinical practice is that your thyroid gland is meant to function in a state of perfect harmony. So the brain sends out a hormone called TSH, thyroid stimulating hormone.

35:04The thyroid gland sends out circulating thyroid hormones called T3 and T4. and those talk back to the brain. And one thing that I think is really important for people to understand is that we often screen thyroid disease with a very simple blood test, just TSH. Many physicians, that'll be the first thing that they check. And it's not giving you the full picture, but it's giving you a glimpse of the picture. TSH is an interpretation of your brain's ability to say, do I have enough or do I not have enough thyroid hormone? And you get this really big thyroid range for TSH, 0.5 to 4 is what most labs will say is normal.

35:36But if you're functioning at the high end of that range, meaning your brain is already feeling like it's trying to get your thyroid gland to make a little bit more thyroid hormone, and I tell you the moment you get pregnant, the moment HCG or the pregnancy hormone from the embryo starts circulating in your body, you need 30 % more thyroid hormone made. Your brain's already telling me it's not going to be able to achieve that load. It doesn't have the capacity to do so. So I really view normal lab ranges are one thing and optimization of health is another. Thyroid issues can cause period problems, irregular cycles, luteal phase deficiency or low progesterone levels, miscarriages, infertility, and decreased success rates with fertility outcomes.

36:17So I'm a big believer in screening the thyroid and treating the thyroid. Now, even more so than that, because the incidence of autoimmune disease is only rising in people and because Hashimoto's or autoimmune hypothyroidism is the leading cause of autoimmune disease in women, I screen my patients. Now my patients have infertility. I screen them with a thyroid panel. What I find is especially a lot of women with unexplained, all your normal tests, so your semen analysis is fine, your uterus is normal, your fallopian tubes are open, come back normal and you're having a regular cycle. So you really get dismissed or put in this box of unexplained infertility.

36:55Unexplained infertility to me is just undiagnosed. It's hard to diagnose. So we're going to acknowledge the weaknesses here. You're in a unique category. But a lot of the things, almost all of the things in that category are inflammatory. So I tell my patients, hey, this is chronic inflammation, autoimmune disease until proven otherwise. We're going to test what we can, which includes an autoimmune panel. And regardless of what it's showing us, we're going to look in the detail about how you ovulate because a lot of these women have ovulatory dysfunction, but they're still having regular cycles.

37:26They're just not optimally ovulating and their luteal phase isn't as great. So to pause and kind of lay this out for individuals, they could still appear to be getting a regular period, which they are, but they're not releasing an egg. Is that right? They're either not releasing an egg or not releasing it at the optimal time or this luteal phase. So the first half of the cycle is called the follicular phase. The follicle is growing the egg. It's an estrogen dominant phase. Estrogen triggers the brain to ovulate. So the brain sends out LH or luteinizing hormone and then you'll ovulate. And that same follicle that ruptures, reforms, becomes the corpus luteum that makes progesterone at the direction of the brain.

38:07So LH pulses continue to make progesterone pulses. And I think a big failure of my field is people say, Gabrielle, your period's regular. And you'll say, yes. And there's no more questions. That is it. Besides looking at, well, how long is your luteal phase? Where in the cycle are you ovulating? Are you having any spotting or abnormal bleeding in between? Are you having any pain with your periods? So very often, we don't really learn how to track our cycles. We don't learn how to track our ovulation. All the apps that we have are just telling us, you know, they're using a calendar method and nothing about your actual body to determine when you're ovulating.

38:43But my nuance here with the thyroid is we'll see subtle changes in your period that if we learn to leverage that period as a vital sign, we can detect these abnormalities. And that can be something we can correct and help you get pregnant. And back to the topic of autoimmune thyroid disease or any autoimmune disease in general. Autoimmune disease means your body is attacking itself in some form or format, right? And those are what antibodies are that we are testing. But a lot of the tests, you know, have to have your antibodies to a certain level to test positive. and there's something called the preclinical phase of autoimmune disease and this is where things are not functioning normally but you are an otherwise healthy person trying to make change to this and you're not sick enough to get a diagnosis yet.

39:25The earlier we can detect these changes, let's say your thyroid antibodies are a little bit elevated, they're not through the roof, this is where we really can leverage lifestyle changes as well to decrease inflammation because you now get to fall into the same camp with me which is autoimmune disease, you're going to be more sensitive to inflammation. And the last thing here is if antibodies are attacking your thyroid gland, that's a highly inflammatory process. Sometimes taking synthetic thyroid hormone can be helpful. One, it's going to give your body extra support to have extra circulating thyroid gland because again, if you get pregnant, can the thyroid gland uptick that 30 % if it's constantly being attacked?

40:04But also, I see antibodies decrease when you're on thyroid hormone replacement and the reason why is that suddenly these cells don't need to be as active to make thyroid hormone. We're kind of quieting them down because you're taking some thyroid hormone and the antibodies don't have as much to attack. So thyroid treatment with medication, in addition to lifestyle changes, both are very important when it comes to thyroid management. I'm really happy to hear you say that because that has been our approach for years. Thank you to Noble for sponsoring today's episode. I travel a lot and I didn't realize how vulnerable most luggage is until someone showed me this.

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41:57Head to nobletravel.com for 58 % off your entire order. That's N-O-B-L travel.com for up to 58 % off your purchase. And if they ask you where you heard about it, tell them I sent you. When I started, I was very interested in integrative medicine. And people were coming on, coming into the practice on animal-derived. Do you know what I'm talking about? Animal-derived. Picked thyroid. Yeah. And it was making everything worse. Antibodies were going up. My patients didn't feel better. Regardless of what we were hearing, kind of the hearsay, we took everybody off and put them on either tyrosine or some kind of synthase, and they responded so much better.

42:41It's definitely more controlled and more reliable. And I always acknowledge there's place for one-offs, right? And we have an individualized response to medication. But just because your mom, sister, or friend really did well with this animal-derived thyroid hormone replacement, for the most part, it's also going to contain other things and be less reliable than a more regulated synthetic version. And that was the whole thing. Yeah. And synthetic hormones, we give synthetic a bad name, but really it's just structurally the same as your body would make. Synthetic hormones are also bioidentical hormones.

43:12Exactly. We've got to rebrand the synthetic thing. Yeah. That was a, just to clarify, synthetic hormones are still and can still be bioidentical hormones. Your body actually usually tolerates them much better because it's structurally the same as the hormone that you would make. Just to be clear, are you recommending, because we do, that people screen for all, we screen always for autoimmunity. We screen for celiacs. We screen for thyroid. You know, we typically do an autoimmune panel at least once. You know, this is against the classic recommendation for infertility, but especially if you have unexplained infertility, I think that there is merit to checking for autoimmune disease, at least the ones that we can easily screen for.

43:53And, you know, I know rheumatologists don't love an ANA level, but you can do a reflex if it comes back positive to so many different antibodies. But I screen all of those patients for autoimmune thyroid disease, celiac, and then do a reflex ANA. Which makes me think about environmental exposures. Tell me about the impact of environmental toxins. I bet you 10 years ago, you started thinking about this, right? You know, I presented research probably 12 years ago about PFCs, perfluorinated chemicals. And their impact on ovarian reserve and fecundability at, you know, the American Society of Reproductive Medicine.

44:26Before you tell me more, did people look at you like you were crazy? Oh, for sure. I had an oral presentation and it was, you know, looped in with all these other ones. And people literally said, so you want me to get rid of things in my kitchen or you want me not to drink out of plastic? Like I was a crazy human. Same, same. Get some, girl. Okay. Here we are. Talk to me about these environmental toxins, endocrine disruptors. You know, we actually threw out everything in our kitchen a couple years ago. I was like, oh, nonstick. See you later. You do the same thing. Toodaloo, Teflon, right? Yeah, exactly.

45:01What we know, what does the evidence show? And where do we think that that is going as it relates to infertility? You know, there is robust evidence that environmental toxins play a huge role in your fertility on multiple levels, right? So we have to just think about toxins are so pervasive, right? There's 0 % chance that you can avoid every toxin in the world. And we start focusing on this. It can feel so overwhelming that often patients want to do an ostrich approach, right? Head in the sand and I'm just going to change nothing because it feels too overwhelming. But this is where we have to start looking at how different toxins influence our health.

45:35And it can be largely through endocrine disruptors, by name and definition, interfere with how your endocrine system functions. So if you want to be pregnant, you are pregnant. You want to influence the health of your unborn child. You want to have your ultimate egg supply and not go into menopause early. Thinking about the things that influence this hormonal system are really hugely important. We also have to think that a lot of endocrine disruptors are highly inflammatory to the gut as well, right? So they also can contribute to high levels of inflammation and insulin resistance. So you get this double hit.

46:08And what are they? If you were to say, okay, I'm going to go in your house. I'm going to throw out the Teflon. I'm going to throw out your stuff from plastic water bottles. There's a lot of different ones, and that's what's so complicated, right? So we have, you know, BPA, perfluorinated chemicals, phthalates, and they get these big fancy names, and they seem very overwhelming. Here's where I tell people to start. The things that you're exposed to every single day is where you can leverage the most. So let's kind of go back to the foundation and the adding on. The air you breathe, the water you drink, right?

46:35These are things that we need every single day. You can go to, you know, EPA.gov and you can look up the water quality in your own home. And you can also look up what type of water filtration system is going to give you the best to filter out what is in your area. There's this nuance where people think, well, bottled water is better. And I always just want to say it's usually not. There have been studies showing it's not, especially bottled water that's packaged in plastic. And we just have to think back. We know that plastics have a lot of different chemicals. Even if they're labeled BPA-free, they're now replaced with other plastics, which are also endocrine disruptors.

47:10And when plastic gets hot or really anything gets hot, that allows the chemical to leach into your food or your water even more so. Think about a truck full of plastic water bottles being shipped across the country. I'm totally with you. Stored in storage buildings. So I always say let's just start in our home. So how's the air where you live? Do you live in a city? So we always use air filters. Yeah, same. We always use air filters. And like air filtration systems. And, you know, there was data presented this year at the American Society of Reproductive Medicine looking at the California wildfires and how it changed air quality.

47:43Oh, yeah. And how it changed fertility, egg and sperm quality. Oh, man. Right? So that's, of course, an extreme example. But we can take those examples and studies and leverage it back to say, well, I need to control the environment inside my house. meaning, of course, no smoking, cigarettes or cannabis, you know, anything that's going to damage your own air quality, but also air filtration systems, water filtration, and make sure that you're using something that's going to target what's in your area. That's really good advice. Then I want to look at our kitchen, right? And so looking at our kitchen, the things that you use frequently are going to be most important.

48:15So what are you drinking out of? What are you cooking on? And what are you eating from? And so we don't want plastics. We don't want Teflon or nonstick. We really want to be careful, especially about things that are getting heated. So I'll often hear this argument, oh, I take this for work. So it's plastic and I put it in the microwave. Get something glass. I mean, bro, that was 1980. We don't do that anymore. We have evolved, right? You can easily get really great, you know, glass containers if you do need to be able to heat it up at work or some other environment that are going to keep your food safer because it's not going to be able to leach those toxins in.

48:50I want to make sure that I ask this because there's lots of parents. They're with this removal of, quote, environmental toxins. There are always companies that pop up. Yeah. And they will say, this is bamboo. It's reusable bamboo. It's BPA-free, stainless steel. Are those okay? Are there certain materials that we feel comfortable with that are known to not be endocrine disruptors? Yeah, I can tell you what we use for my own kids. Like stainless steel and glass tend to be what we're using largely. Usually, bamboo does appear to be safe. And I think with everything, you want to be mindful about how you're using it and in what environment, right?

49:29We still have, and we had them from when the kids were young, all these stainless steel plates, right? And it's still their favorite thing to grab with stainless steel bowls. It's just easy to put snacks in, easy to clean. And it's something that's going to be good. Now, you have to acknowledge where you are, right? So maybe your kids go to daycare and maybe you can't send glass bottles and you have to send something in plastic, right? You have to control the exposures you can because you can't control everything. And so if let's say that's you and you're going to send your kids milk to school in bottles, you can say, okay, well, what can we do when we're not at school so that we can make sure we're lowering that burden?

50:07With all environmental chemicals, studies are looking at total body burden. And so one-off exposures, we should free ourselves from saying, I can't control what happens at daycare? I have to play by the rules. I have to go to work. But also, you know, you don't know unless you ask. So can I send it in a glass bottle or can you heat it in a glass bottle and transfer it? You know, maybe the answer is no, but every school is built differently. And I think it's really important to leverage what you can for your children, because we grew up in a more toxic world than our parents and our kids are growing up in a more toxic world than we did.

50:42And so we have to lower that burden wherever possible. And I do think the last tenant here. So we've got kitchen or while we're on kitchen, I think a big one I see right now is processed foods. They come in packaging that have a lot of endocrine disruptors in them. Meaning the plastic. The plastic or the wrapper, you know, the sealants on different things get into the food over time, but also take out. We're living in a world where - Oh darn, are you serious? I mean, I door dash food, right? We're busy, but here's the key, right? They are going to put it in plastic or styrofoam or whatever. They're a restaurant.

51:14A lot of places are not putting their food into a hormone-friendly container when it's being picked up by the delivery driver to your house. Does the length of time it sits in the container matter? It does. So when you get this, don't ever eat out of that to-go container. Transfer it to, you know, dishes right away. Let's say you're getting food and your kids are busy and you're not eating dinner yet. Put it in glass or some other container and then, you know, store it heated on warm in the oven in that. So really modifying when you're getting the food because that's the moment you can, right?

51:46So make the difference where you can make the difference. You can't control everything. Yeah. And that's very practical. That is practical advice. I noticed that you didn't talk about makeup or skincare. Yes. That's the next thing that... Because I don't know if I want to hear it. I just want to be happy in my abyss. But... Look, the things you use every day are the things of biggest potential detriment. And a lot of this does come to us through fragrance. And I love fragrances, but we really have to acknowledge that fragrance can be a huge endocrine disruptor. And through other... Through smelling or getting into your skin?

52:19Usually through things that you're putting on your skin, like rubbing it on your skin, you know, your shampoo. And so smelling it can be problematic, but things like the laundry detergent you're using, the soap that you're using on your hands, the perfume you're spraying around, the products you use every day are the ones you need to pay most attention to. So if you have a special date night perfume that you love, you're not using that one enough to go obsess over it. You're like, honey, smell it and it's going to stay in the bottle and let's go out. But I think that the things that we are doing over and over again, you know, how we're washing our clothes and then we're wearing those clothes and we're letting that, you know, get into our skin.

52:53Your skin is an organ system as well. But it is not the largest organ. Nope, that's the muscle. But it is highly absorptive one. It is. Right. And we know that. And so we want to just leverage that to our benefit. And so this is a good place where if you run out of shampoo, maybe instead of just reflexively, because we're all creatures of habit, we just buy the same shampoo. Maybe we say, hey, how is this one? And there are different websites that we can, you know, look at to try to determine like, is this great? Is this not great? Think Dirty is one or the Environmental Working Group. And you can search different products and learn about them.

53:27And then in the fertility formula, I do have a big chart where you have some ingredients because there are big names where you can look at and you can see, okay, this one's harmful and this one is less so, so that we can make mindful change on those products that we're using every day. And I think it's simple to do that and to begin to switch things over from your kitchen to improving the water quality, to improving the air quality. And then over time, those don't seem like big deals. Right. It's incremental change. And the truth is, it's the sum of all these choices that really matter. So give yourself grace if you were somewhere and you were exposed to something or you're not ready to change that yet.

54:05Say, okay, changing my moisturizer is going to be a really big deal. So I'm not ready. I'm not ready, but I'm going to pay more attention to my kitchen right now. That feels more attainable. So make the moves where you can and work towards that incremental change so that some of these choices can be those that are helping your body and not harming it. As we talk about fertility, we cannot have a conversation about fertility without having a conversation about sex. Correct. How much sex do we need to have? Look, this is a great question and there's a few different ways to think about it. Number one, there is no reason to have less sex if you're trying to get pregnant.

54:38Meaning if you are in a relationship and you have sex every day or multiple times a day, great. Just keep on going at it. One of the biggest mistakes I see is people trying to abstain and save up with this idea. I'm going to put more sperm there at the right time. But really that's not how the male body is made. And frequent ejaculation actually can be more beneficial because sperm die, they get a lot of debris, and prolonged abstinence periods, meaning not ejaculating sooner than every four days, but especially more than seven, really can be harmful to the ejaculate. Okay. So we have to pause.

55:12We did an episode. Do you know Tobias Kohler? Yes. Okay. So we had an episode with Tobias and he was talking about the penis can shrink if you don't use it. I mean, just like the vagina can contract as well. Yes. That was on my list. I don't think we're going to get to it today. But okay, actually, now that you said that you have to explain to us what you mean. So you said that the vagina can contract, you know, your vaginal tissues and mucosa, and it's highly estrogen sensitive, but also it has a lot of collagen in it. And it stretches, it has great vascular blood supply. But if you're not bringing blood supply to it, if you're not using it, you're going to notice that you're going to have higher likelihood of having vaginal strictures, you're going to have atrophy of your vagina, and it actually can then make intercourse more painful.

55:56And this becomes a really circular process. How long does that take? It's going to be faster when we're in a state of low estrogen. And a lot of us say, okay, well, that's menopause, right? So I'll worry about that in menopause. But what we forget is that sometimes we're in low estrogen states from postpartum, from prolonged breastfeeding, from the type of contraception that we are using. And we actually can see vaginal syndromes of birth control as well, because the estrogen component in birth control is actually different than the estrogen that your ovaries are making, and it can influence how your vagina feels, how it expands the collagen, the integrity of the vaginal tissue.

56:31But having sex can be a great way to counter that, even regardless of your hormone state, because it does keep that blood flow going, and it stresses that vaginal tissue to a point that it's good in using that collagen. So Tobias Kohler said that three months of no sex, just no erection, no sex. Shrinks the penis. Yeah. Shrinks the penis. Okay. It's very specific, but. And I'm just curious, is that the same for the vagina or do we not know? You know, I don't know the answer there, but I do think that's an interesting question. Yeah. Someone is going to definitely message. Someone's going to come tell us.

57:04But what you said before that, I mean, you dropped the bomb of vaginal stricture. So we had to go there. But men should ejaculate every seven days. Anything beyond seven days? Did I hear you right? Yeah, you did. I mean, really beyond four, we start to see changes in sperm perimeters. And seven is definitely harmful. Meaning, if you're trying to get pregnant, first of all, if you're trying to get pregnant, sex is an important part of this, right? So more sex, the merrier. There's no need to save up sperm. Sperm are meant to be created and to be ejaculated. I mean, simply, if you're timing your ovulation, there's a lot of different nuance to help you get pregnant faster about trying to have sex the day you're ovulating or the day before.

57:47How does someone know that? Because it's inconvenient to go to the lab to get a blood test, but there's gotta be home lab testing that you recommend. There's a few different things. So the egg lives for 24 hours, sperm can live for five days, so we wanna get sperm before or then. What are the best ways to know that you're ovulating? These are called fertility awareness methods, and they're using your body's own physical signs and symptoms to detect ovulation. So here are my favorite three. First is cervical mucus, completely free. You don't have to spend a single dime on it. As your - That's exactly what it sounds like.

58:15Yes, it is. As your estrogen rises, it changes the integrity of your cervical mucus. It is meant to protect the cervix as the opening of the uterus. So it's meant to prevent anything from getting inside the uterus, except for sperm and only when you're ovulating. So peak estrogen levels, which trigger the brain to ovulate, also change the integrity of the cervical mucus and they make it sticky, stretchy, like an egg white. That's called type four cervical mucus. If you have intercourse with type four cervical mucus, you have a 32 % chance of getting pregnant that month, which is much higher than on a day without type four cervical mucus.

58:48And that's sperm. So let's say you have sex when you have type four cervical mucus, that egg will last for 24 hours. So if you had sex anywhere within that span of, is it safe to say five days? Five days before the day of ovulation. So we consider the fertile window that six-day period. But cervical mucus, I do want to say this. People kind of get a face when we talk about cervical mucus. You don't have to put any fingers inside or do anything. Hey, man, it's going to be a lot worse once you deliver that kid. So get ready for it. But truly, this is supposed to be an external evaluation. So just wipe with toilet paper.

59:20See what's there. I always say it's slimy, sticky, stretchy, and you know it when you have it. That's your target time. So type 4 cervical mucus is one way to know that you're ovulating. Second is going to be with ovulation predictor kits. or urinary hormone measurements. OPKs are one that are just checking LH or that luteinizing hormone. Again, the follicular phase is a naturally low LH time. And then when estrogen levels rise, that triggered the brain to release a surge of LH. Now, then on LH will rise and fall. So we're really just trying to detect that first surge of LH. LH is released from the brain in the early morning hours.

59:56You urinate on these strips one time per day. I recommend between 10 a.m. to 2 p.m. and the day you get a positive is the day before you ovulate because you're detecting the surge. So target intercourse the day of the positive and the next day. And if someone could do a blood spot test, would that be the same diagnostic as urine if they just happen to be able to get that? Yeah, I'll check patients all the time right now. I mean, I live in a different world where I do an ultrasound, I check labs. You do it right then and then. Yeah, and I can see their LH is surging and I say, okay, great, you're going to ovulate tomorrow.

1:00:26tomorrow. So those urinary-based systems are highly predictive of what serum is going to be. And there are fancier ones that are checking FSH, LH, estrogen, progesterone. And that can be really fascinating. It's definitely overkill. I don't want somebody to feel like they have to spend hundreds of dollars on a system to check all of these hormones to get pregnant. Now, I'm a data nerd, so I love such things. We do too. Yeah, but you don't have to, right? So a simple urinary-based LH strip only, as soon as you get a positive, don't waste your money. You don't need to test anymore, you know that that's your ovulation.

1:00:58And then the last thing here is going to be basal body temperature. When your body makes progesterone, so after you ovulate, progesterone, as you know, completely changes your metabolism. And one thing that it does is raises your core body temperature by at least 0.4 degrees Fahrenheit. And so if we are checking and following our temperature, we can confirm when ovulation has happened. And we know now that your temperature actually drops as the follicle ruptures, and then it's going to raise when progesterone is made. So if you're proactively looking, you can detect this shift. At the start of my career, I used to say, do not do this.

1:01:32It causes more stress. I've spent hours of my own life when I was trying with a thermometer and graph paper and very difficult, but we have to acknowledge this is where technology has improved immensely because there's wearable methods that work with other apps that can detect your temperature over so many different time points that it's so sensitive and it's with an algorithm that can be much more predictive. So we've really seen a change where aura rings, Apple watches, whoops, natural cycles, there's so many different options now to proactively use your temperature and leverage that as an opportunity to get pregnant.

1:02:06Well, Dr. Natalie Crawford, I know that you've impacted so many people's fertility journey, and I'm really grateful that you were able to share it with our audience. And just, it's just been so much fun chatting with you. Thank you. Well, thank you for having me. And I feel like we could talk all day long. Yes, we could. And till next time, thank you so much. Thank you. you