Ep. 81 All The Fertility Questions You’ve Been Scared To Ask with Dr Helen O’Neill

0:08Dr. Helen O 'Neill is a leading expert in reproductive science. She's a lecturer in reproductive and molecular genetics at University College London. She has a master's in prenatal genetics and fetal medicine and a PhD in stem cell biology. She is also the founder and CEO of Fertility Health, an award-winning biotech business specialising in fertility testing that has raised over£5 million since launch. Fertility is obviously a hugely sensitive topic, but it's also one that we never talk about for exactly that reason. when I started this podcast I wanted to cover the important topics that we never get taught and I learned so so much from Helen that I really couldn't believe I haven't researched or known before if you are currently struggling to conceive or have any anxiety around fertility I personally would say that this isn't the episode for you but what I would really encourage for everyone else if you do decide to listen to this episode is that I think it's really easy to hear fertility statistics around women and feel terrified and therefore feel like it's fear-mongering.

1:12You know, this is a really sensitive topic. I don't know enough about it, to be perfectly honest, but I do also think that there is this huge data gap and also huge discussion gap when it comes to women's health. And I don't think that we can, at the same time as getting incredibly angry about this data gap and about what we know about women's health and the fact that it is hugely understudied and under-researched and under-invested in, and at the same time shut down fertility statistics and learnings as complete fear-mongering. So I would just say, bear that in mind. Everyone's going to have different opinions.

1:50Everyone's going to be unique. You might be the rule. You might be the exception. What I think is incredibly important, the state of women's health is completely dire when it comes to what we know about it when it comes to what we understand about it when it comes to how we talk about it and I do think that the first step in getting closer to solving that is about having public conversations on big platforms which is what I always said that I wanted to do when I started this podcast I do want to very quickly say that in this episode women's health is used to refer to healthcare and research around female reproductive health.

2:26However, as part of that, I want to say that that is not how I personally would define being a woman. I really wanted to use this episode to just get out all of the questions that I would like to know about fertility, the things that I've been terrified to ask, the things that I wish we'd learned earlier. It's incredibly interesting, so I really hope you enjoy it. I just want to say before we get into this episode, I know you probably don't think about following and rating a podcast on an audio platform, but it does hugely help who we're able to get on the podcast, what conversations we are able to have.

2:57So I really, really appreciate if you're able to take the time out of your day to do that right now before you listen to the episode.

3:05Thank you so much for joining me today. You're welcome. As a team of young women writing this episode and going into kind of what we want to talk about, what we want to myth bust, what we want to know about was probably one of the easiest episode preparations ever. And I think that probably goes to show just how important this episode is, talking about fertility, talking about women's health. Not a lot of podcasts are on women's topics as a whole, but even hosted by women, et cetera, et cetera. There's not a lot of education we generally get on it. So I have a lot. Does it ever feel like you're a marketing professional just speaking into the void?

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4:55Visit business.warmart.com to get started. I want to ask you today. Let's go. So first of all, just to give some context on your kind of career, your background, it would be great if you could give me a little rundown of how you got to where you are today. Sure. I have worked in mostly genetics and reproduction for a long time. I have an undergrad in molecular genetics and then I did a master's in prenatal genetics and fetal medicine in UCL. And it was really that that made me just turn towards this complete fascination with how we as human beings are created. I couldn't stop talking about the aspects of fetal medicine, fertility, embryology, because every single one of us has a vested interest in how we were formed.

5:46And so from that, I did a PhD in stem cell genetics and developmental biology, specifically looking at how the ovary is formed. I can't tell you how much of a love I had for just discovery, really researching all of these amazing elements about how we function as human beings. But it's amazing that the more in-depth your knowledge becomes, the further away you become in ways from being able to apply that to day-to-day life. Then got a lectureship at UCL and I've been there for nine and a half years lecturing master's students and medical students about reproductive science, women's health, prenatal genetics.

6:26And I absolutely love teaching. I think it's the most incredible, powerful tool that you can do is to ignite a passion in learning and understanding, especially about our body. But I got to a point where all of that research and all of that teaching still wasn't serving the questions that I had about my own body. And actually, from a professional lens, you feel so equipped to do, you know, talk about female reproductive anatomy, physiology, genetics. And as a human being and as a woman, I was devoid of answers about my own biology, my own fertility. And that's a real conflicting place to be in when you're thinking about all of these statistics.

7:10Do they apply to you? Are you the exception? Are you the rule? No matter how prevalent some of those statistics are, you're thinking, am I okay? Or should I be doing something? And so I started Hurtility really trying to put an analytical lens on how we approach problem solving. And to me, I found it so strange that we have an analytical approach to most things when we solve problems, right? I always say that it really annoys me that we can plug a car into an analytic system and tells you what's wrong with the car. And we've no way of plugging ourselves into a system and finding out what's wrong with us.

7:51so much about health metrics is, you know, look, feel, touch. There's no real hardcore, you know, analysis, blood work, molecular tools behind that. And so that's really how I approached starting fertility was to say, right, if I really want to understand what my fertility is, I first need to understand general gynecology, menstrual cycles, symptoms, external factors, all of the possible variables that need to be taken into account. And so that's really what's brought me to today is trying to create a solution and spending years building. It's funny when people say like, when did you start Hurtility?

8:30I'm like, I mean, nearly 20 years ago, really, if you think about the journey I've been on in accumulating knowledge about the things that we can use to help us. We've just spent the last few years really building all of the what-ifs around women's health. And I think probably the most common thing that gets said to me is, surely this has been done before. Because it seems so obvious that this is something someone should have done, but it hasn't. I mean, it's absolutely unbelievable. Because I remember when I spoke to you the first time, and I was like, oh my God, of course, this is exactly what we need.

9:04Of course, we need one test where we can send it off and find out more for all of these different reasons as someone who's literally been battered around the nhs for about 15 years based on things like pcos and endometriosis and still got no answers even when going private even when you know being like i will do anything like anything the fact that we still have i mean endometriosis is one thing the fact that you literally can pretty much only find out about it if we have a live operation on someone all of these different things in terms of women's health and we'll come on to the dire state of women's health because you know it's something that very much needs to be talked about.

9:37But also, you know, as soon as you start shining light on the topic, and as soon as you start understanding that actually, not only do we not know anywhere near enough about women's health, but you know, there was literally nothing done on it really prior to like, when women were allowed in clinical trials in what, 1993, or whatever it was, which is just absolutely unbelievable. And even after that, in 2000, four out of five of every clinical trial didn't include a woman. And of the ones that did, two thirds of them, didn't bother stratifying or looking at the data differences between men and women.

10:09So even though some places are including a token woman here or there, they're not analysing sex-specific differences. And now we know there are huge sex-specific differences between us, but looking at the data and seeing the differences and analysing it for them and prioritising that there is a difference is still not happening. Yeah, so it's no wonder that we have such a dire state in women's health because we also don't know the things we need to know scientifically not we individually well yes we individually but more so than that as at a kind of industry and scientific level the information is not there because the investment has not been made into discovering anything so when we started fertility started as a clinical trial i applied for a grant to build predictive algorithms for gynecological pathologies in other words with my i guess my geneticist lens i thought But for genetic conditions, we screen a whole genome.

11:03We look across multiple populations and we say, these are all the people with the same mutation and they all have the same disease. So it's like, OK, we can look for patterns here. And that seems very intuitive. And yet when it comes to women's health, you know, the most prevalent of women's health conditions, there are no solutions, no answers. They're still being called elusive. And yet we have cures for some of the rarest of genetic conditions. And so it's this lack of prioritization and lack of data that really manifests within just continuing this perpetuation of poor science and poorly funded research.

11:39And so while we're speaking about this and then kind of, you know, as I said, the dire state of women's health, what are the main reasons that that is the case? Like, why is it so hard to get an accurate diagnosis as a woman or to get answers on pretty much anything when you go to the doctors, unless it's something that would be prevalent across men and women? It simply shouldn't be. We're 52 % of the planet. It is not about the fact that this is too difficult. Let's face it, we have figured out far more difficult things. We've put people in space. We have satellites going around the globe to make sure that we have telecommunications.

12:21There are far more difficult things to figure out than women's health. It's just that we do not prioritise women's health at all. And unfortunately, that is, despite the rhetoric and the ongoing talk about more investment into female founders, more investment into women's health, it doesn't actually come true. People talk more about it, but even in the last 12 months, the number of investments didn't go up, they went down. And so there's this lack of thorough financial investment, but also any other kind of investment into priority. It's like women are second class citizens. Nobody cares. And this is never more true when you come and look at every single life stage that women go through, whether it's periods, whether it's fertility, whether it's pregnancy, whether it's postnatal health, whether it's perimenopause, whether it's menopause.

13:14Women are medically marginalized and completely sidelined and nobody is building solutions across that life course. So that's really why I feel so passionately that building a longitudinal data set that is informed by women, not by necessarily just practitioners who say, oh, in my esteemed opinion, great, but let's get some data. There was a big report on ovulatory conditions and it was this huge diagnostic guide. And not once in that entire report did they use the word data. Not once did they use the word patient. And I read through, I wrote a criticism on it because it annoyed me that at what point do we ask patients?

13:54Do we ask women? Do we say, what's your experience? How can we learn from you who is the professional in your condition to build solutions for that? And how much of that do you think is because we, I mean, we know that women are more likely to be given anti-anxiety medication instead of, you know, if they're coming in with heart palpitations or whatever it might be. It's more often seen as a kind of mental case rather than as a physiological case. We know that, you know, women in general are assumed to have more hysteria around certain conditions or certain feelings. How much of that do you think has bled into the actual science in terms of, you know, you say they're not asking women about their own specific experiences.

14:37Do you think that's partly because of the way we perceive women? Yes, every bit of it is about the language that is used when describing women. Even don't use just said hysteria. that's where the word hysterectomy comes from is like that women were hysterical and to remove the womb is called a hysterectomy it's actually quite mind-blowing and there's a medical anthropologist who wrote a book and they went through the the language that we use in medical textbooks so it's cemented in as if this is okay and it's even around like the the abundance of ejaculate and sperm versus the mere egg that is produced.

15:19Well, you should be flipping the narrative saying like we have this one incredible, powerful cell, which is the largest cell in the body versus the sperm, which is the smallest cell in the body. And they need so many of them to just fertilize this one queen. And it's just so amazing how many, even down to menstrual effluent, menstrual waste, you know, not the fact that it is a fundamental part of procreation and that it sustains life. It's actually unbelievable how biased the language that is used, even in medical terminology. So when that is perpetuated and we dismiss women, it's almost like it's given a medical license, you know, like this is a medical term.

16:05And so we're qualified to call you crazy. Right. So when it's written into the narrative, kind of from the actual scientific point of view, that can obviously be justified in a practical sense. I'm not sure if this is reductive, or if there's a way to even fix this in this sense, because I do think that the onus should be on where the investment is, the onus should be on probably governmental regulation, ensuring we are covering both sexes when we are doing these specific experiments, whatever it might be. But what can, if anything, we do as consumers and people to make the landscape better when it comes to women's health?

16:45I think we need to rally. I think we need to work together as women and fight back. There's a reason we call fertility the mother of all movements and we call it the reproductive revolution, because it shouldn't be hard to find answers about our body. And we are societally under attack. And that sounds extreme. But when you look at the states and you look at what is happening, when you look the world over, we really do have to fight for the right for information about our bodies. Because while you might think that we are liberated, there are many subtle ways that when you look around, I get on the tube and I see pressing is inappropriate.

17:28Upskirting is inappropriate. Staring is inappropriate. All of these constant reminders that we are not safe in our society and that despite having created tools to help us with not getting pregnant, have those tools been used as weapons against us to control our ability to conceive? And are we looking 30 years later at an entire generation of women who suppressed their ability to conceive and are now wondering why they can't? And so I think this requires a rally where we support each other. This is not just about creating answers, but an evolution of solutions that we are working to create. And it's strange that data has become a dirty word because of companies like Meta and all of these other places who use your data against you.

18:22But I would love to see a rebrand of health data, because if all of us were to rally together and say, I will give my information for the next six months, I'm going to log. I'm going to tell you what my symptoms are. We would learn more in six months as women giving information than we would have done in the last 60 years of people sitting and saying, how do you feel? What does it look like? And that's where I think we're launching an app in the summer. And to me, I want to rally everyone to finally get some answers about why, about the symptoms, about what is causing so many of these things that really impact our lives.

18:59And yet we have so few answers for. So you received a government grant in order to be able to create this kind of test or to be able to draw lines between certain pathologies and, you know, who was having certain issues and why and what the things were to tie these things together. What is the current version of this test that you've created in order to be able to help diagnose? Yeah. So in a weird way, it almost undermines it by calling it a test. But it's more of a journey. So how it starts is with a health assessment. So this is an online health assessment where we have taken all of the international diagnostic criteria and guidelines for over 18 of most prevalent conditions that affect women, women's reproductive health.

19:45and essentially it's like creating a calculator. A lot of the symptoms that we experience can be quite insidious or hard to quantify whether it's pain, whether it's the amount you bleed, whether it's the location of the pain that you're feeling, whether it's cyclical pain and so trying to really pull apart all of the different symptoms, your menstrual cycle patterns, your previous medical history, your background because if you are black you're more prone to fibroids, if you are it used to be said that if you are white you're more prone to endometriosis I now don't believe that I feel like white women are more likely to get a diagnosis there's massive systemic racism within healthcare so removing all of that and saying how can we actually stratify somebody's risk according to their background is all in that health assessment it's a very powerful health assessment with internally embedded algorithms that help us to say actually your symptoms of this plus this plus this are a likely indicator for PCOS.

20:43So we're going to test you for all of the analytes that might give us better answers. So we actually tailor the panel of hormones that we'll test you depending on that combination of symptoms. So we'll look at various aspects of your reproductive health, whether it's your thyroid health, which many women have thyroid imbalance, whether it's your menstrual cycle health, so your how you ovulate, how you bleed, and then your ovarian reserve as well. And then anything additional like your androgens should you have those specific symptoms. So really taking into account all of the things that we should take into account in order to confirm a clinical diagnosis.

21:17We've coded over 54 ,000 clinical scenarios because we are obsessed with detail and saying, what if? What if you were this person? What if you were this person? Because unfortunately at the present time, we assume everyone's the same. And so statistics are very unhelpful to individuals when you could be, you know, what's 20 %? Is it high risk? You don't know. In the absence of knowing a thorough medical history, actually you could be in a far higher risk category. So it's about that personalization. So that journey, even though I've just given you the real back end, which is like how complex this algorithm, the clinical decision tool, the panel of floods will test you for the report.

22:00from a person's perspective. We are busy people. We built this for ourselves, knowing that going to an appointment, waiting for an appointment, speaking to a stranger, having to get your blood taken, waiting for results, being told, well, we'll call you if something's wrong, but otherwise we're not going to call you, are all hugely frustrating blockers to entry. And so it's no wonder we self-dismiss when it comes to getting help. One of the biggest reasons women say about not getting help sooner is that they say, I just, you know, I didn't think my symptoms were bad enough to warrant it. And so from the user's perspective, you can fill out this health assessment online on your phone, in bed, the test will arrive at your house the following day or the next day.

22:44You can do a blood test from your finger, no need for a venipuncture. And we validate it and have all of our regulations for every single analyte that we measure. And I've done clinical concordance studies to make sure that they are exactly matching venipuncture. The reason I give these details is because there's a lot more to making something accessible to people and making sure it's clinically valid and making sure you're regulated at the same time. And then the report says, right, you can get a blood test anywhere when you get results. It's a screening test. It'll tell you whether you're in range, out of range, but it won't tell you what those results mean in the context of your medical history, in the context of the rest of your bloods and actually what it actually means to you we kind of want the tldr on things like we want to be told like what does this mean for me what should i do and so that's really what we've worked very hard to differentiate ourselves is to say for every single thing that we've tested you what is it why did we test it what does it mean for you and then all of the actionable insights to say these are the things that you can do even though yes an element to it is a test actually it's much more of a journey and from that we then offer a full spectrum of clinical services so whether you need an ultrasound scan whether you need to freeze your eggs whether you need IVF whether you need a prescription whether you need HRT all of those things or to speak to a gynecologist or a fertility specialist there's a full full team that are there to support you no matter what and what I feel most proud about this is that you haven't really had to leave your house at all for any of this.

24:20I mean, it's completely groundbreaking. Any woman hearing about this, it sounds, do you know what? It sounds like an ad because it's so good. I know. You know, when like, as in, because I can't truly believe that we have to go through the amount we've gone through in terms of not truly knowing about our bodies, in terms of not truly knowing, okay, I have period pains. Is it worse than the majority of people? Could it mean that I have a very serious condition or could it just mean that I have a period whatever it might be thinking that you can take a blood test at home and at the very least be referred for further investigation if there is something that flags up in any way I mean to me it's it's almost ridiculous that that's seen as so groundbreaking because it shouldn't be but what you're doing and And having been able to kind of create that is just, I mean, it's incredible.

25:16It's life changing and I'm sure has been life changing for a huge amount of women. What types of results have you seen from that in terms of the kind of, you know, in terms of your customers? It's been incredible to see. I mean, every single day we have people who are so ecstatic to have a diagnosis, which sounds crazy. that someone would be so happy to be given a clinical diagnosis. And yet, as you said, you spent 15 years really with this kind of ping pong effect of going from doctor to doctor to doctor to doctor with no tangible solutions or answers. And so when someone's been on that journey and finally being given clear answers for what they need to do next, but also just knowing that it's not just them, that's one of the big things.

26:04I get quite emotional when people say about the babies that they have and that they wouldn't have if it weren't for hurtility. We had a message saying I wouldn't be holding my nine-month-old if it weren't for hurtility. And that to me is amazing for the people who had premature ovarian insufficiency. So that means they're essentially, it's kind of like in basic terms, like early menopause and display all of the symptoms of that. All of the symptoms, textbook symptoms of premature ovarian insufficiency and yet ignored because they look great. They look young. they feel I mean okay they've got no periods and they're not assessed for that so knowing that there are people for whom they wouldn't have been able to have children but we've actually helped them so early in their journey like these I mean I'm talking mid-20s 28 people who thought like I never would have even thought of having children until I was in my mid-30s and being able to help those people there will always be people on the outside who say I don't want to know and that's fine.

27:05But for the people who've always wanted to know, and that is a lot of people, it's amazing that they can finally get some answers. Right, absolutely. And I think that, you know, we, it's very classic, and it's an especially social media based response, the need for it to be tailored to yourself in terms of like, I have no doubt that when we talk about fertility in this episode, there will be some people who say, well, I don't want to know, and I'd rather not know. And And it's frustrating that I even have to know to think about these things in my mid-20s or whatever it might be. It's like, yes, absolutely correct.

27:38It's frustrating that that even could be a consideration. But at the same time, there cannot and should never be a world where we need to think about these things to some extent if we want to consider having children. In a world where we're forced to think about those things because of how much it affects everything else, even though it shouldn't, we have to have access to that type of information it it can absolutely be every single person's individual decision not to want to know something absolutely but you cannot use that as essentially an excuse to mean that no one else can find anything else out because we literally don't have the data because it's terrifying and of course it's terrifying everyone thinks about well I know I for sure think about fertility and like it scares me like I have this underlying fear that I might find something out and just know that I need to either you know can't have children or would need to have one tomorrow or you know whatever it might be and it is a pretty universal it is a universal fear it's so strange that people told us that it would only be older women or women who are you know in their 30s or women who are actively trying to conceive who would do this test.

28:53But 25 % of a very big database are between the ages of 18 and 25. We have this innate biological desire to know not just about fertility, but about our reproductive health. And it's not because it's this strange, elusive feeling that we all wonder about. It's because we get a monthly menstrual cycle. Right. We have symptoms associated. So we have a monthly reminder. And when things aren't going right, when your period doesn't come, when it comes too soon, those are all... building this, whether you acknowledge it and face it or whether you suppress it and ignore it, still this feeling of wonder about what is normal?

29:35Am I normal? What is going to be my path? You know, it's weird how it's become almost unfashionable to talk about fertility, unless in the extreme, right? We talk about contraception, whatever you do, don't get pregnant right that's the narrative from like the age of 18 before yeah literally from the age of 13 they sit you down um yes exactly from such a young age don't get pregnant don't get pregnant don't get pregnant and then that is suppressed in you are this fear and can and controlled through contraception and whether we think that's a liberation or not actually what it's led to is a real suppression of that internal signal and those innate biological cues that really should be serving us to say whether something's wrong, to say whether we're not well.

30:28Our menstrual cycles are, you know, the sixth vital sign. And they've just been added as the sixth vital sign along with your temperature, your pallor, your pulse, your breath. Your menstrual cycle is an amazing indicator of your overall health. And when we suppress or ignore that or control it, we really lose out on that pulse of our own reproductive health. I mean, it's literally the whole Barbie speech, isn't it? The fact that we're literally told from 13 onwards, like, do not get pregnant, do not even think about it. And then you're told at a point that you have to get pregnant, otherwise you're not worthy as a woman.

31:05And you're also told that if you do get pregnant, then you're probably not going to be able to do the same in all of these areas of work but if you choose to stay at home then you're bad if you choose to still work then you're not doing it right all of these different things and then at the same time throwing in there the fact that you can't find out something because we don't have the data we don't have the access if you do talk about something then it's fear-mongering but if you don't talk about something then you're ignoring it and we're not helping women's health like it's just this is my life like the amount of you who are like this is just fear-mongering and I'm there saying, I wish you heard the countless stories that I hear every single day of women saying, why did nobody tell me?

31:42Where was this information? They feel so cheated. And even me working in women's health for so many years and thinking, I'm probably fine. I'm probably fine. And then not having access to just find out. And it annoyed me, right? I dedicated my life and career to biology and it was betraying me by being like, well, you are just a woman and the biological clock will tick. And it annoyed me so badly because I thought it didn't matter my dedication, my hard work, how career focused and driven I was, the world will still look at you as being unqualified as a woman until you've reached that metric of success which is settle down, have children.

32:31And that's so unfair and it shouldn't be the case. We should have a choice and there are many women now who do not want to have children and that is incredible to know that and to understand but there are many more women who do want to have children and have had that choice taken from them. Right.

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33:38For millions of brands, that engine is Shopify, making selling seamless for them and shopping effortless for us. upgrade your business and get the same checkout aloe yoga uses sign up for your one dollar per month trial period at shopify.com retail all lowercase go to shopify.com retail to upgrade your selling today shopify.com retail for people who do want to know when should we start thinking about our fertility i mean i think that we should invest the same level of interest in our fertility as we do contraception and conception, right? From a young age, from, as you said, 13. For me, I think 18, you should be aware of your menstrual cycles.

34:27We always say track your ovaries over your calories because your ovaries are going to serve you a lot more than the day-to-day things you put in your body. But I think that it's about screening. It's about knowing your risk. Every individual woman is very different. The risks that you have versus the risks that I have are very different. The family histories that we have are very different. The exposures that we go through are very different. And so being able to understand whether it's annually, like we need an annual check-in. If it is a legal requirement to have an MOT on a car, it should be a legal requirement to have an MOT on our bodies.

35:08that we are not going towards this cataclysmic, unending abyss of misdiagnosis and misinformation and lack of understanding. We can really drive our own destiny when it comes to our health by just investing interest in it. What is the most important metric we should be looking at when it comes to fertility? I don't think there is just one important metric and that's why we never, there are a lot of people and places that measure just AMH. Some clinics will just measure your AMH, which is an anti-malarian hormone. It's essentially a hormone that is produced by each of the eggs in the ovaries. And so it gives an amazing kind of, it's an amazing surrogate marker for your relative fertility.

35:50But in the absence of knowing your medical history, your cycle history, your previous infections, if you've had chlamydia or gonorrhea, your fallopian tubes could be blocked. So it doesn't matter how within range your anti-malarian hormone is, if that egg can't get past, you're not going to be fertile. So I don't think there's any one metric that is the most important. I think we are, and this is probably the trap that medicine falls into, even when it comes to reproduction and reproductive health and women's health, is that we isolate it to below the waist. And when you spoke about mental health in the beginning, we negate the fact that our mental health has the most profound impact on our menstrual health.

36:31When we don't tie the knot and say that these are intrinsically linked, then we do a disservice to our overall health and our overall ability to interpret our health. And so for someone who might have started understanding more about their fertility and they are doing so because they are aiming to have children, are there lifestyle changes that we should make in preparation for wanting to get pregnant before you even start trying to conceive? Yes, definitely. The main things are so obvious, right? You know, nobody wants to be told, stop smoking, stop drinking, don't do drugs. But I've seen from our data set that actually many people don't stop any of those things while trying to conceive.

37:18In fact, a shocking proportion of women don't stop those things while trying to conceive and then are themselves quite confused when they aren't getting pregnant. So there's the basic kind of red flags around our vices that it makes sense to stop. It's about knowing as well, I guess the mechanics, right? This three-month life cycle that we have in terms of sperm production. Men need to get themselves sorted. They have a three-month sperm life cycle and they can radically improve the health of the sperm in three months. And with women, it's kind of a longer life cycle of ovulation and egg production.

37:55But if you think that all these eggs are in our ovaries waiting there, to give them the best possible chance of being healthy, we need to put into our bodies the most healthy things. And that sounds so obvious. And you would be amazed how few people just think, okay, I need to prepare my body nutritionally, physically, better sleep with cutting out some of the things that I'm exposing it to for the next while so that I give myself the best possible chance. There's an amazing study and it looks at alcohol consumption and depending on the time of your menstrual cycle that you drink, it impacts your ability to conceive.

38:37And it makes sense, right? If your ovaries are maturing, all of these wonderful follicles in the hopes that one of those follicles will mature and that egg will be released. What you put into your body, we always think of alcohol as affecting our liver or our kidneys and not the rest of our organs, which of course it's a systemic effect. And so that impacts your ability to conceive the following month depending on when in your menstrual cycle you drank. So just cutting it out is a really, really key thing. But to go even deeper into that, when is it worse to consume alcohol within your cycle if you do want to get pregnant?

39:15Throughout our menstrual cycle, there's key phases that are very important. There's the follicular phase, I call it the fun phase. And that's really when all these follicles are starting to develop and mature. And that's from essentially as soon as your period starts, you're in that follicular phase, right? Menstrual cycle happens and you're in that follicular phase. So from day one of your period really on to day 14, roughly. And that is really when your body is preparing for this monumental occasion, which is ovulation. And that point then is when that egg is released. And that has such a profound endocrinological effect on your body to ensure that an egg is released.

39:54And we think of that again as being a separate entity. It's a reproductive event that is happening and that the rest of our body isn't affected. But there is so much oestrogen in our bodies that is preparing for that release. It impacts, and oestrogen is very powerful. It impacts our skin. It impacts the collagen in our skin. It is impacting our cardiovascular health, our neurocognitive health. When we are devoid of estrogen, we mentally suffer. We physically suffer. Our bones suffer. And yeah, our menstruation is impacted. But there are so many more things beyond menstruation that are impacted by estrogen.

40:31And when you think about our menstrual cycles having this huge flow of our reproductive hormones and being ignorant of that, really we're missing out because at that point of ovulation, you are at your best. You will be more erudite, less clumsy. You'll be far more focused. Your skin is brighter, more radiant. Mother Nature wants you to procreate. She's like, I need you to attract someone right now. She's like, bring it in. She's doing you every favor possible at that time. And then following that we do see this big shift in our menstrual cycle hormones and this kind of drop in estrogen and then we all feel that right in the weeks leading up to our period especially in that luteal phase which is like a low teal phase right before your period you're going to witness the the impact of low estrogen people are report being more clumsy you are more forgetful your mood and energy is low.

41:29And that to me is like, okay, we're on a roller coaster here. You need to know when to hold on and when you can throw your hands in the air. And in the absence of that knowledge, I think we miss out on some of the key signals that we need to know when it comes to just harnessing our health and harnessing our hormones. At our utility, all of us describe, we'll be like, I am follicular today. Let's go. Or else it's like, forgive me, I'm luteal. And everyone's like, oh. You're like, oh, okay. We'll leave her alone. Yeah, exactly. I'll give you some peace. And I think that's how it should be, right?

42:03Right. Like we will meet people. And the first thing we talk about is the weather. Oh, the weather's for the weather. It impacts everything we do. Delayed me getting here. And I would love to see us move towards or even like, you know, sleep, right? Sorry, I haven't really slept. But it's actually impacted us on far more that stage of our menstrual cycle that we're in. So I will show up and be like, sorry, I'm luteal. So sorry. I am so luteal. Yeah. But I also just think that like, it's a huge lack of understanding. Like it's a genuine lack of understanding. I'll know. We're taught about PMS and we're taught about like how that can impact people around us.

42:42We're not even taught about how that impacts our self. Even that is a weapon. Oh yeah. We never talk about someone being ovulatory. Like, oh, this queen, she is ovulating today. Like, you know, we never use the profound, powerful aspects of women's health to be like, did you know the queen bee can suppress ovulation in every female bee in the hive? Like, think of how powerful a bee's hormones are, right? And we know that about a bee, but we don't know anything about women's reproductive hormones and how powerful they are, right? If oestrogen, when we're ovulating, is making our skin more plump, it's making our focus and our clarity even more sharp.

43:22Think how many other, you know, surrounding things that we never bothered investigating and we sure as hell didn't brand or advertise for women. But the only thing that we know about when it comes to this wonderful cycle is PMS and bleeding. You might make other people upset and you might be a horror to be around. Yeah, exactly. Don't worry about yourself. Exactly. Yeah, it's just I always say we need a rebrand. You've mentioned the idea of training for pregnancy before. Could you tell me a little bit more about that as a concept? Yeah. So pregnancy is the most powerful and incredible thing that we can do as human beings is to create life and to grow and nurture a human being.

44:06And then bring it into this world and sustain it and nurture it from our own bodies. and when you think about all of the things that your body has to do in order to do that, right, we have to reallocate space within our abdomen to make room for a very expanding uterus that is going to have a life that grows to, you know, baby size. And so all of your organs move. They have to make room. Your blood flow changes. We have to literally double the amount of blood that is being pumped around our bodies. The metabolic turnover that pregnant women are doing during pregnancy every single day is the equivalent to that of running a marathon.

44:51So when I say it's like we should prepare as if we're preparing for a marathon, a marathon is over in a day or a few hours, whereas pregnancy is this nine month journey that your body is really taking from you. And there are good things and there are bad things and there are things that we notice. You get great hair, your teeth can suffer, your skin can glow in the second trimester, it can make you puke every single day. That is a very big physiological change that your body's going to encounter. And so ensuring that you are at peak health, whether it's mental or physical, is actually really important because there is a lot of your body that is going to be really growing this human being.

45:36growing this year. I'm doing this. Here's one I made earlier. I am running a marathon as we speak. I don't know if you know. But it's just one of those things that we expect now, especially we just expect ourselves to keep going, keep working, pretend like nothing's happening, hide it. And actually, we should be really embracing it, saying, wow, this is pretty incredible what I'm doing. And then in that postnatal phase, creating milk like this whole hormonal shift that needs to happen in order for your breasts to produce milk, to feed and nurture a child. And I read this incredible book by Kat Bohannon called Eve, and it's about the evolution of women.

46:22And in it, one of the factors is about how we can't store enough omegas in our diet. We cannot get enough omegas. So from our teenage years, we start to store some of those omega fats on our hips and bum. And that you can actually determine when somebody is going to have their period as a teenager based. So they were able to predict when someone would get their period, whether we earlier or later, based on that amount of fat on their thighs and buttocks. And those who had less fat would have Menarche later. More fat would have it earlier. And all I could think was, I can't believe I spent years trying to get rid of my omegas.

47:05My body was storing those for pregnancy and it does. It stores them so that it can use them up during pregnancy and the first year after for breastfeeding. And a fascinating study that looked at the body's use of those omegas, whether you were taking supplements or not. And they compared whether the omegas in your milk came from the supplements or from your ass fat. It comes from your ass fat. Surprise! The milk prefers it to come from there. So it's just, it made me actually quite embrace my ass fat. I was so positive. I can't believe this. I was denying my future child by not saying actually this is like mother nature's first bit of ammo to say I'm getting ready I'm gonna get you ready and this is going to be a powerful thing that you can use for the future health of your child I find that so interesting because I think so much of when so you've spoken about being in peak health in order to be able to get pregnant or to prep yourself as best as possible for getting it's not just going into a blind right for sure but then we also as women our association with peak health is so often around dieting.

48:16And I think that I find that so interesting looking at those two together in the way that actually, you know, as you were saying, you were sacrificing your body's amigas by trying to lose weight around that area. There's a reason we say childbearing hips. Yeah, no, for sure. But also, then by peak health, I very much assume that you mean, so should we not be dieting in any way when coming up to trying to get pregnant? That's very dependent on someone's physiological weight and health. If someone's weight is at the level that it is going to actually impact them and actually being above a certain weight can impact your ability to conceive because it can suppress ovulation.

48:58And there are increased risk factors and maternal complications, neonatal complications that can be higher when our weight isn't healthy. So I definitely would say that everyone needs to be within a healthy weight or at least to try. And in the absence of being able to do that to better understand your risks when you embark on pregnancy for preeclampsia or any of these other gestational risk factors that you might have. So, again, investing in understanding what your own personal risk is, is important. So you talk about that risk factor you curve when it comes to fertility. Could you explain a little bit more about that?

49:40What that essentially refers to is the fact that our eggs, which we're born with, all of the eggs we'll ever have, our eggs are laid down while we are in utero. So that shows you, again, even the impact that pregnancy has. You are determining the health of your future child and potentially their future offspring and an ability to conceive during that time, which is wild. But when we look at egg health, unfortunately, there is no single test for egg health. I'm actually doing a study at the moment, which is going to look at the cloud of cells surrounding an egg. So if anyone wants to participate in this clinical trial, we're willing to look at what are the things that would determine the health of an egg.

50:25And we're comparing PCOS and non-PCOS patients. But that egg has the ability to either fertilize in a healthy way or fertilize in a non-healthy way. And what the key, the main determinant of that is the correct number of chromosomes. And as we get older, our ability for an egg to properly divide and allocate the correct number of chromosomes in each cell gets worse as we get older. But when I started in saying it was a U-curve, it's actually not great when we're really young either. You have a higher risk of chromosomally abnormal eggs when you're younger. it then goes down when you're in your 20s and 30s and as you start getting older in your 30s it goes up again.

51:12So with that in mind what would be the optimal age to have children? Ideally 25 to 30 which is very inconvenient. It is inconvenient and without the things in place in the rest of the world in order for us to be able to have children whilst also doing all the other things we need to do. But you have to remember that that is a textbook, right? I am not within that age category and I am pregnant. And I do think that each person is very different, right? Yes, we can attribute, you know, biological findings and say there are risks at younger ages and it's interesting. But at the end of the day, every single person is different.

51:50And there are some people who will be fertile at 40 there are equally some people who will be infertile at 25 so it's not about relying on what is the key age it's what is the key age for you and that is very much dependent on your own goals your own ambitions and where you are in your life and i'm really interested do men have a biological clock yes they do men are far more fertile than women as you can imagine. They're fertile 24-7. We are only fertile once a month and for a certain amount of time up to, you know, perimenopause and menopause. Men are fertile up until their 80s, 90s, which is depressing.

52:39But what we have to remember is that male fertility rates are falling at an astronomical rate. And I think a lot of this has to do with the environmental exposures that we have. And also So male sperm is deteriorating in quality as men get older. So over 35, the number of mutations that a sperm has in it is far higher than when he's younger. So the mutation rate doubles every 16 years in men. So they're accruing mutations throughout their life. And so, yes, they can get you pregnant, but it may not be as healthy. So I think this emphasis on fertility being a female issue is so wrong. You could be as fertile as you wanted, but if your partner is infertile, you're both going to go through an infertility journey and vice versa.

53:26So it really does take two individuals. And that is the most important fertility fact I want everyone to know is that fertility is only ever 50 % of the equation unless you count for the sperm and the egg. And what are the most common causes of infertility? Age is the most predominant cause of infertility is that we are just waiting too late to have babies. And that's a really easy one for us to avoid, right? To an extent. Well, to understand at least. Right, to understand. To understand. I always say that if you were given information about something, you might change your plans. Of course, yeah.

54:05If you knew, and we all do it, right? I think it's important to equate our fertility to our finances. We spend our money according to what is in our bank. The more money you have, the more money you will spend. When it comes to our fertility, we don't use that same metric. We should plan according to our ovarian reserve. If you don't have that much time, then maybe you need to shift your plans forward a little, if that's what you want to do. And that's where I guess egg freezing can be helpful to, to some extent, have a savings account. But knowing first how much time you have is a very important metric and no different to knowing how much time you can spend or money you can spend.

54:50What, with those types of things in mind, what is the most important kind of, or what is the most common fertility myth that you'd like to bust? It's probably that one side of fertility matters It's that just one person's fertility matters Or that it's a female problem It is really important to remember that fertility requires two individuals to create life Not just one It's very much seen as a women's issue as well It's seen as women's issue to fix It's seen as women's issue to think about And it's seen as women's issue to deal with once they have a baby To prevent, to create, you know, make sure we don't get, we have to ensure that we don't get pregnant, despite the fact that men can get 100 women pregnant in a day, if they wanted to.

55:39And a woman can only get pregnant once a year. But it's on us to make sure that they don't shoot that gun. I want to talk for a second about endocrine disrupting chemicals. What are they and how do they impact our fertility, but also how can we generally avoid them? When we use the term endocrine disrupting chemicals, we almost distance ourselves from it just by saying that term. But when you break it down, our endocrine system is our hormonal system. Everything that controls our hormones, they control how we look, how we feel, how we metabolize, how we sleep, how we menstruate. Our hormones control every aspect of our life.

56:18And that's your endocrine system. So if you have a chemical that is going to disrupt your endocrine system, it's a very powerful manipulator of your overall health. So when we talk about endocrine disrupting chemicals, these are literally chemicals that are found in everyday compounds, cosmetics, shampoos, in plastics, in upholstery, in our clothing, in almost every aspect of our life, we are being somewhat polluted by endocrine disrupting chemicals. And to me, I think that we cannot shout loud enough about the impact that endocrine disrupting chemicals are having on us. And we cannot be more motivated to try and eliminate some of them from our lives.

57:00And from a governmental level, so many of these compounds should be banned, but they're not. so what they do is for many of them they quite literally mimic estrogen they're called xeno estrogens and when you have a compound that you're exposed to that is mimicking estrogen in your body then the endogenous estrogen that you're producing may not have or the receptors won't have anything to bind to and so that can really cause major problems when it comes to that beautiful balance of all of our hormones being secreted and responding to other hormones within the body that they're receptors of. And so what types of products or where would we find these endocrine disrupting chemicals in order to be able to avoid them?

57:45So people always say that women have far higher levels of endocrine disrupting chemicals in their system than men. And they say that children have far higher levels than men. And the reason they say is that women wear makeup and babies chew plastic toys. And actually, if you look beyond that, it's much more than just all of the countless compounds and chemicals and cosmetics we put on our skin. But the fact that our menstrual products and nappies are made from probably the worst plastics in the world. And we literally expose our genitals to those plastics that have been derived from really cheap, poor plastic that contains all of these endocrine disruptors.

58:28So I would look at the products we use, not just on our skin, but menstrual products, nappies, some foods even, have been contaminated with endocrine disrupting chemicals. To be honest, the more you look, the more depressing it gets. And it can be a little bit isolating, but it also can be quite liberating to make small little changes, like looking at the ingredients of something that you're going to put on your skin and saying, actually, maybe I don't need that. What type of ingredients would you be looking out for? The easiest way I would say is if you can't pronounce the ingredient, don't put it on your skin.

59:00Your skin is an organ. It's constantly ingesting. Like if we know that our skin absorbs things, it's going into our system. So, and it's quite obvious. It's pretty much all, every single mainstream product, shampoo, conditioner there is, is going to have some of these compounds and chemicals in them. I can give you a full list afterwards. Things to avoid. It's like, let's scroll through this list of chemical compounds, perfumes even. And then little other minor changes like never heating plastic. Never, ever, ever heat plastic. People put microwave meals in. People use Tupperware and heat their lunches in.

59:36When you heat plastic, it releases some of these chemicals. So just use glass Tupperware. I'm terrified you now. I'm terrified you. I'm going to go re-evaluate my microwave lunch every day. Yeah, please. No, but that's so incredibly interesting. and I feel like so much of this is just not discussed it's not touched on it's not discussed it's not like we need to as women we're told to think about our fertility all the time but also never to think about it because we need to concentrate on all of these other things and we need to not get pregnant and all of these things and I just find it so fascinating the fact that we you know no matter how well versed you are in anything you know pretty much nothing when it comes to yeah all of this when it comes to fertility when it comes to women's health as a And that is depressing.

1:00:21Yes, but I do think we are at the tides. Yes, but I think the tides are turning and that we can stand with both feet on the ground and say enough. My body, my choice, my investigation. And actually, I really feel like we can either perpetuate and continue with this. Oh, we're so beat down and nobody invests in us. they don't um and nobody cares about us they don't but if we can care about ourselves and invest in each other then we can go a lot further well I think that's a great place to end thank you so much thank you you've been incredible there have been knowledge bombs dropped everywhere and I feel I feel empowered to take my fertility into my own hands thank you so much and thank you for the work you're doing thank you

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