Toxins, Stress, and What They're Doing to Your Hormones with a Top Reproductive Endocrinologist

23:42Dr. Mary Claire Haver:Dietary studies are very limited based on we don't control all dietary factors. And all red meat is grouped together. And all red meat is not created equal when it comes to quality of the meat. But when we look at quartiles, so women who ate the least versus women who ate the most, the more red meat you consumed and it was linear in direction, you had poor embryo quality, lower pregnancy rates, worse stage of endometriosis. All the fertility metrics that we look at are worse in the context of people who are eating more red meat. Doesn't mean it's inherently bad. I tell my patients don't eat it every day.

24:15Dr. Mary Claire Haver:And we live in Texas. We live in Texas. So we have to say that. I do. I do have patients who eat it every day. And so we want to really leverage other protein-based sources. We already talked about plant-based protein, but fish is underutilized, even in Texas, right? It has a lot of great omega-3 fatty acids in it. It doesn't have some of the trans fats that we see and the saturated fat and some of the other animal products. So swapping out some of that red meat for fish, if we like to consume animal-based meats, can be one way that we can get to those protein goals in a more nutritious way. Let's talk about toxins.

24:48Dr. Mary Claire Haver:Let's talk about toxins. You have a chapter on endocrine disrupting chemicals that I think is genuinely alarming. And so what are the top offenders that most women have no idea are in their daily lives? Mary Claire, when I was in my fellowship, still going through my infertility, I started meeting with my program director about my fellowship project. And we have to have a thesis. So you have to be published in a journal and you have to defend it at your REI oral boards. So just like you have to go through your surgical cases and your others, you get an entire hour and a half to talk about your research project.

25:21Dr. Mary Claire Haver:And most people do an IVF project. And I wanted to do something that related to natural fertility, why some people get pregnant and why others don't. And I started studying endocrine disrupting chemicals with the EPA and looking at ovarian reserve time to get pregnancy and thyroid levels. And diving into the data, looking at endocrine disruptors, chemicals that either mimic or block or change. Essentially, they're interfering with the walkie-talkies one way or another, and many of them impact your gut health and cause inflammation directly. What they do to your fertility. This was well over 10 years ago, and I was alarmed by what I was reading.

25:59Dr. Mary Claire Haver:Not just suggestive data, but things like PFCs, perfluorinated chemicals, forever chemicals that come out of plants, leach into our soil and our water. They're in nonstick pans. How we see BPA and what's in our plastics and how plastics also cause fibrosis in the ovary, get passed through the placenta. Looking at phthalates and fragrances. And in that time, I remember coming home one day and completely cleaning out our kitchen. And my husband walking in, Jason saying, what are you doing? I'm a fellow. We don't have tons of money to go buy an entirely new kitchen. I said I can't believe we're living in the world where there's data talking about how bad these teflon pans are these non-stick pans and yet we cook off them every day like why don't I know and the plastic Tupperware I would take my food in to work every day and heat it up and heat it up.

26:48Dr. Mary Claire Haver:I said, this isn't just maybe bad, like this is known bad, yet nobody's talking about it. Other countries are regulating it and we are not. Toxins are scary and I get the most pushback on it because the world is toxic. In America, this is highly unregulated and people deserve to understand that so that you cannot obsess over it, but that you can control the exposures at hand, especially what you're exposed to most often, which is going to be usually in your home. thinking about what you prepare your food on, how you cook your food, how you store it, your air, your water, your bathroom products, the things that you're exposed to most of the time.

27:28Dr. Mary Claire Haver:And what about cosmetics? Yeah, cosmetics are a big player. One of the things that I talked about recently that got a lot of attention is just showing not only is our system not protecting us by limiting chemicals, we're allowing marketing practices that are really deceitful. For example? For example, there's a big difference in unscented and fragrance-free. Unscented is actually a scent masking another scent. So the net of that is I can smell this and I don't smell anything, but I can have toxic phthalates and chemicals inside of it. I've just neutralized them with some other chemical so you don't smell them versus fragrance-free, which has no fragrance in it.

28:10Dr. Mary Claire Haver:So you might be going to the store, looking at your laundry detergent, for example, something that's going to go on your clothes. And you're choosing unscented, thinking that you're making a good choice. But in fact, there are still toxic chemicals in there because it's not fragrance-free. That scent has just been neutralized. That's wild to me that consumers don't know it and that corporations are allowed to get away with that. I did not know this. So when you're choosing products, for the most part, fragrance is one of the biggest offenders of phthalates that we have. And so phthalates are known endocrine disruptor.

28:42Dr. Mary Claire Haver:And this is even more important for women when you're trying to get pregnant. Yes, you're pregnant. But also think about perimenopause menopause. Why do we want to interfere with our hormone system? Make this even harder for us. So it's really important to start thinking about what is in our bathroom and what are these products? What are some simple swaps? Like what if I'm going to go in like low talks my life, I start in the kitchen and start in the kitchen. So the kitchen is going to be the first place to start. So the biggest offenders are going to be, you know, a plastic cutting board's got to go.

29:09Dr. Mary Claire Haver:We really want to have a wooden cutting board looking at what you're cooking in. So getting rid of Teflon nonstick, stainless steel is going to be a better option for the pants that you're cooking in. We should get rid of all plastic in the kitchen. Want to save this extra for people who are parents, right? Because a lot of plastic comes in when we have children. Maybe we're grandparents. We have kids coming over. Stainless steel plates and little cups are a much better option, even for children. Glass bottles over plastic bottles. I mean, think about the plastic bottles you put in the warm. I put in all the baby's bottles.

29:42Dr. Mary Claire Haver:It's really important to be aware and to make the changes you can. And I'll use an example from my own life. My daughter, I was into this toxin world when she was born and we had glass baby bottles. And I remember crying when I took her to daycare because she had to go to daycare because I was a medical trainee. And they didn't allow any glass, so they had to be plastic. And being just like really distraught, thinking about how bad plastics are and they're going to heat up the plastic. you control what you can because you can't control everything and that's really the overarching premise here when it comes to toxins i'm gonna control what she's exposed to in my home because i can't expose what she's controlled exposed to in the whole world right yeah that's parenthood in a nutshell but so some of the other biggest offenders in the kitchen to go food so a lot of us are ordering to go food we're door dashing food we don't want to cook and to save time doing dishes.

30:30Dr. Mary Claire Haver:We're just eating it out of that black plastic container. The food is warm when heat activates chemicals coming out of plastic, getting into our food. So that's an opportunity for us to say, if you're door dashing the food, you don't control what the restaurant puts it in, but put it onto a plate when it gets to your house. Yeah. Or put it into a glass dish to put in the oven if you're not eating it yet. So make the mindful choice when you can. And then processed foods, even those that appear healthy, think about protein bars as a big example here. These are often wrapped in ways that can have toxins in them.

31:04Dr. Mary Claire Haver:Don't eat protein bars when you're at your home. Save those for if you need them when you're traveling, when you're at work, when you don't have the opportunity to have other food. So make smarter food choices when you're there, leveraging whole foods when you can instead of those that come in a package.

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31:56Dr. Mary Claire Haver:so if i have a woman who's 35 or doesn't matter how old she is who's been trying to get pregnant for six months and is scared to seem impatient when she asks for an evaluation i mean what should she be asking for what can she do on her own first and foremost you can come see us anytime you can come see me a fertility doctor without a referral from your physician you don't need to wait for your OBGYN to say, and you could say, I'd like fertility testing. And that is allowed and permitted regardless if you haven't started trying or if you have infertility. So this idea that you can get your ovarian reserve checked, we can check your anatomy, we can check a semen analysis.

32:30Dr. Mary Claire Haver:I love seeing patients like this. Everything might be normal. You might then go on your way and we'll decide how long you should try, talk about what you should be doing. And based on your family goals, talk about when you need to come back or we need to advance care. But I'll tell you this, about one third of the time when these people come to me, we will find something that changes what they're doing. Whether it's a low sperm count or we go to a urologist or whether it's, oh, thyroid disease that now we go and we get treated or a uterine septum that thank goodness we repaired before she went on to have three miscarriages before it got diagnosed.

33:06Dr. Mary Claire Haver:a uterine septum is a birth defect of the uterus, has about an 80 % association with a miscarriage, but that can be simply corrected by a pretty easy surgical procedure. So why should we have to go through the failure again, right? You don't have to, and that's important for people to know. Your doctors have been notified that if you haven't gotten pregnant by one year, or if you're 35 by six months, then we definitely should do an evaluation. But I'm really trying to pivot this to say you can ask for it early, and you're not going to seem impatient and that's within your right. And I think that data is really helpful, especially as you are getting older and getting started.

33:42Dr. Mary Claire Haver:So what can you know about yourself? Start to track your ovulation before you want to get pregnant, not just relying on when your period's coming, but are you ovulating and how long is your luteal phase specifically? Because that's an opportunity where we can usually make a big difference in helping you get pregnant. And coming off contraceptive, if you want to get pregnant when you stop birth control is going to be really important as far as having the highest rates of success. Huge study. There's no higher rate of infertility from any type of birth control, and that's really important. Wait, what do you mean by that?

34:17Dr. Mary Claire Haver:So that means that at 12 months of trying to get pregnant after stopping any method of contraception— So IUD, birth control pill, whatever. Same amount of people are pregnant at 12 months as use no contraception. Okay, so good. But what's missing from that discussion is that doesn't mean that your fertility is the exact same once you stop that birth control. IUD is one of the most important ones to discuss here. Progesterone IUD works by having progesterone in the uterus. It gets absorbed systemically. Usually at its start, it prevents ovulation. But these can last for many years, up to five or seven years.

34:50Dr. Mary Claire Haver:And so at that point, ovulation is usually resumed because progesterone levels are lower. But you've had this progesterone exposure to the uterus every single day for years. Again, the uterus is usually only exposed to progesterone for half the cycle, not the whole time. And we know that progesterone IUDs can change the receptivity of the uterus, the genetic expression of estrogen progesterone receptors, for up to six months after removal. And we see lower pregnancy rates in those first six months. They catch up, so by one year it's no different. But if you're sitting across from me saying, I want to do everything I can to have the highest chance of pregnancy, let's remove that IUD six months before you want to start trying, so that you have those months to learn to track your cycle, let it come back, but also let the uterine lining get back to a normal.

35:36Dr. Mary Claire Haver:I used to tell patients, well, as soon as you have what you would consider a normal period, you can start trying again. Once we removed a progestin-containing IUD, you know, because I knew that their lining was thin and they were higher chance of miscarriage if they conceive because there's not enough cushion, right? To support the baby in a very simplistic way. So I'm like, once you have like a normal period, you're good to go. Is that completely wrong? It's not completely wrong. I would say the bigger problem in today's day and age is that these women have never had a normal period. Many women are getting progestin IUDs at a really young age, or they're hopping from birth control or the implant to the IUD, and their period's not a vital sign to them.

36:17Dr. Mary Claire Haver:So they don't know what's supposed to be normal and how much blood is normal. When do you know if that has repaired? Another thing I see after IUDs, you know, I see scar tissue inside the uterus and I see a very select group of patients, but this is going to be higher in women who have a really traumatic insertion. We can talk about pain in our fields and how it's been, you know, under addressed for such a long time. But if you had a very painful experience getting your IUD in or out, and then specifically if you're not having periods after it's removed or they seem extremely light, it's normal for their light for a few months because the lining does have to grow back.

36:55Dr. Mary Claire Haver:But I should say after three months, you should start to see it grow back more and have a more normal bleed. If you don't, I'm worried there could be some scar tissue inside the lining. I have a handful of patients that that was what was causing their infertility. And we went in and took out the scar tissue and then they got pregnant. But again, should they be forced to wait for a year before we even find out that that's going on? No. Talk to me about egg freezing. What is it? I love egg freezing as an opportunity for women to invest in themselves in their future. It is not an insurance plan for their fertility.

37:30Dr. Mary Claire Haver:And that's an important distinction. What does that mean? So an insurance plan is always gonna pay off, right? You wreck your car, car insurance is gonna kick in and cover you. If you invest in the stock market, you think it's a good idea, but the ROI on that investment depends on when you pull your money out and things that you don't know yet. And that's what egg freezing is. A smart thing to do, but we have to understand that there's risk involved and we don't know the return on that investment till later. In its simplest form, egg freezing is trying to get one month's group of eggs all to grow, take them out of the body.

38:01Dr. Mary Claire Haver:What egg freezing is not is tapping into the vault. When the field advances and we can tap into the vault, it will change fertility science forever. It'll be coming. When we can mature immature eggs in the lab completely, we will have a dramatically different outcome for older women who are trying to get pregnant because one of the things that's hard for us is that as you get older, if you only have five eggs coming out of the vault, I can only get five eggs in that month, in that cycle. And then the next month I can do another cycle, hopefully get another group of five. But that's why some women have to do many, many cycles.

38:32Dr. Mary Claire Haver:If you were an average 30 year old, I could do one cycle and get 20 eggs. It's hugely different. That's why egg freezing is easier when you are younger and you have more eggs. And in general, their egg quality is going to be better. But it really does depend on how many eggs that you have and your future family goal to know, should you do it? Is it worth it for you? If we look at population-based data and cost, which I don't think is always the best way to make a decision, but in cost-effectiveness studies, looking at, is this money good for you to spend because the odds that you will need them is going to increase.

39:08Dr. Mary Claire Haver:For a woman who's 32 to 34 and not ready to start her family yet and wants more than one child, it is cost-effective to freeze her eggs. So, you know, young 30s is a good time because you'll tend to get a good grouping of eggs and you know you're not ready to be in a position to try them. But your 20s are even better if you know you want to have kids and specifically if you don't have a partner or you're on a crazy career path like we are. Putting eggs in the freezer when you have more of them and they are of better quality is going to give you not just a peace of mind, but an opportunity for later.

39:43Dr. Mary Claire Haver:It's not a guarantee those eggs will turn into a baby, but it is going to dramatically change what your family planning will look like, specifically if you want to have more than one child. If I tell you the odds of getting pregnant naturally at age 30, 20 % per month. At age 35, it's 11 to 12 % per month. At 38, it's 5 % per month. And at 40, it's less than 3 % per month. Again, that's not zero and that's not everybody and people will have success, but you can see why it's markedly harder at that age. What I see so often is a woman coming to me at 36 with her new husband, they're really excited and they want three kids or four kids.

40:21Dr. Mary Claire Haver:They want a big family. Even if we get pregnant today, right? We have to be pregnant, recover, get pregnant again. We know we're gonna be having one or two of those kids or hoping to have them at a time where it is going to be harder to conceive them. So if we have eggs in the freezer when you're younger, we're saving them. The kindergartners are still in alphabetical order because they're your younger eggs. And it's going to give us an opportunity to make this easier for you as time goes on. How old is too old? I mean, is there an age at which, you know, for egg freezing? Because I hear it's heavily marketed.

40:53Dr. Mary Claire Haver:I heard this yesterday from someone. I was asking them about their opinion on egg freezing. You're not asking me. Well, I'm asking you now. And so here's what their take was. That it's being marketed to women who it's not going to be successful for. And it generates a lot of money for a practice. And first of all, I don't even know what it costs. That would be important to talk about. But that it's really should be done in younger patients. and women are coming in too late, but they're doing it anyway, knowing that they're not going to have good outcome. I think one of the biggest issues in my field is not explaining things to women and giving them the autonomy to make the choice.

41:26Dr. Mary Claire Haver:I can give you really bad odds. I mean, this is just women's health altogether. I can give you really bad odds, but if it's 0 % versus 2 % and you decide it's worth your time, money, physical, emotional energy, because you want to say, I did everything I could to have the outcome I wanted. I believe that should be your choice. I can break down the odds of what it's going to be for somebody's age. The oldest patient I've had freeze her eggs has a baby in her hand right now, frozen at 43. Okay. So she was going through a divorce. You know, I mean, there were a lot of life circumstances that led her to that place to be freezing eggs at age 43, but she now has a child from it.

42:02Dr. Mary Claire Haver:Is that going to be the story for every 43-year-old? No. Right. But she, did she have to do more than one cycle? Also, yes. But she made that decision and said, I need to do this for me. And if it doesn't work out, I understand where the math falls. And I think women can handle really bad news. And I think we can make decisions in line with our priorities if we give them the data to do so. And so I think this generalized statement that it should only be done in young women is presuming that we are going to say it's not worth the money, cost, time, emotional, physical energy. You take away the decision from the patient.

42:37Dr. Mary Claire Haver:You should be the one making the decisions that impact your reproductive future. somebody else, another physician, an organization, or time shouldn't be making it for you. So we're going to wrap up, but I want to talk about the book. You dedicated it to two people. Not trying to make you cry. We're going to start and end this episode. Campbell and Rhett, who are they? They're my rainbow babies. So, you know, Campbell's 11 and Rhett is 10. They're really close in age. And And I love being a mom more than anything. You know, it fuels me every day when I see patients sitting in a hard spot to know that I have such a hard job.

43:16Dr. Mary Claire Haver:You know, a single genetically normal embryo will have a 65 % chance of success. It's incredible compared to the numbers I said earlier for natural fertility rates. But one of my best friends is an orthopedic surgeon. And she said if I had a 65 % chance of success with my ACL repairs, like I would never be able to do this. and to know that not everybody will always leave with a child. The good news is that the field is really successful if we keep going, which can be limited by a variety of factors. But my kids have changed how I do everything. You know, they also give you an extra fuel for taking care of yourself.

43:49Dr. Mary Claire Haver:And it's been my biggest dream that the information I wish I had had earlier that I can give to people earlier and that maybe it will change the trajectory of their health journey. But it's been really sweet to write the book with them and to see them be supportive of it too. Go from, let's say the book was like a four-letter word for a while. Mom has to write the book. You know, they spend all the time writing and pouring into it. And then when the first box came to our house and they opened it, you know, my son who's 10, I mean, he took his first copy and like propped it up in his room. He's got, you know, my pink and blue book like up on his shelf.

44:21Dr. Mary Claire Haver:And he's so proud of it. It's really, it's something special to have your kids. I think a lot of times working women specifically worry about that mom guilt or the balance. but to be able to chase your dreams and bring your kids along and have them be so proud of you you know i'd like to give that message if somebody younger is where i was saying when will i have kids when's the perfect time in my career like don't worry about the perfect time in your career because there is none like when you feel ready to have children start trying to have children because it's not a guarantee for any of us and the more time we have to work with like the more opportunity will have.

44:58Dr. Mary Claire Haver:It's also dedicated to the worst club with the best members. Every woman who has doubted her future, questioned her health and longed for answers. Why'd you say that? You know, this is affectionately what the infertility community calls ourselves, like the worst club with the best members. That's an extremely supportive community, both from, you know, patients online, sharing their stories, helping share education, helping women advocate for themselves for too long. Women went in. IVF is hard to understand. And doctors would say, just do IVF and not explain it at all. And yet it's so high stakes, right?

45:35Dr. Mary Claire Haver:Physical energy, emotional energy, financial, right? And then time. It takes some of your potentially last reproductive years into a process. And so that community has rallied behind me. I'll say the patient advocates and the women sharing their stories. I started my Instagram account 10 years ago. My field, the colleagues weren't thrilled, right? They thought patients didn't need this information. Some of the older guard thought it would make their jobs harder to have patients questioning them more. In fact, I won an award in 2019 by Resolve, who is the National Infertility Association nonprofit for patient education.

46:13Dr. Mary Claire Haver:And I sat next to a past president of ASRM who said, can you believe the winner of this award got it because of social media? Isn't that ridiculous? and I said I'm gonna go accept it right now you can listen to my speech you know connecting with patients where they are and women sharing their stories has been so insightful I mean I was in that club and it changed how I thought about my own health I realized the questions I had I didn't learn the answers to them in my own training as a fertility doctor and I dedicated part of the book to them because they've shown up for me from day one online rallying behind me and I will cry now thinking about, you know, this book just came out and how these women and men have shown up to events and bought the book and shared it with each other and people who are past needing it, but recognize the fact that their own journey could have been different had they had it and are so excited to share it with other people.

47:06Dr. Mary Claire Haver:It's really quite powerful and emotional. And what do you want women to take from this book? Women and men, really. You do not have to fail first. Your health, whatever lens we're looking from, but specifically your fertility, it is worth having the data about your own body and it's worth making decisions from a place of knowledge. And you deserve that knowledge about your body. Dr. Natalie Crawford. Awesome. And thanks for coming on Unpause. Thank you for having me. Dr. Crawford's new book, The Fertility Formula, is available now wherever you buy books. You can find her on Instagram, YouTube, and threads at NatalieCrawfordMD, also on her website, NatalieCrawfordMD.com.

47:51Dr. Mary Claire Haver:I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at ThePawsLife.com. My new book, The New Perimenopause, is available now everywhere and anywhere you buy books and through our website. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can find full episodes on YouTube at Dr.

48:27Dr. Mary Claire Haver:Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver.

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