Dr. Natalie Crawford: Female Hormone Health, Fertility & Vitality
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Welcome to the huberman lab podcast, where we discuss science and science space tools for everyday life. I am a huberman and i'm a professor, neurobiology and optimal gy and stanford school of medicine. My guess today is doctor nately crawfurd. Doctor nately crafter d is a medical doctor specializing in obstetrics and gynecology, reproductive and chinoises, and infertility. SHE also holds a degree in nutrition science.

Doctor craford runs a clinical practice seeing patients daily well as being actively involved in public education, both through social media and through her popular podcast entitled as a woman today, doctor profit teaches us about all aspects of female hormones and hormones, health and fertility, beginning as far back as in utero when we were still in our mother's womb, and extending as far forward as menopause. We discuss topics such as the timing of puberty and what the timing of puberty in girls means for their fertility. And we discussed birth control, both hormonal and non hormonal forms of birth control, and how birth control mayor may not relate to long term fertility and different aspects of female health.

We also talk extensively about measuring fertility that is account. We also talk about, agree, trivial A K freezing one's eggs as well as individual fertilization. And we also take a deep dive into the popular and important topics of nutrition and supplementation as they relate to fertility, as they relate to pregNancy, but also how they relate to female hormonal health generally.

Indeed, doctor crawford provides us with a master class on female hormones and fertility, one that I know that all women are to benefit from and that men would benefit from listening to as well. Before we begin, i'd like to emphasize that this podcast is separate from my teaching and researchers at stanford. IT is, however, part of my desired effort to bring zero cost to consumer information about science and science related tools to the general public.

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Thank you so much for having me and honor to be here.

Well, i've paying attention to your content for a long time, and I find IT to be incredibly clear, informative and for many people, actionable. So today i'd like to talk about both fertility and of course, more mones. But as we both know, fertility is not limited to to a discussion about hormones and actually relates the things like behaviors, sex behaviors and other behaviors, nutrition supplement, so will get into all of IT.

But if we could just back up developmentally and talk a little bit about female puberty, because I think pretty much everything will talk about today is related to what happens puberty forward, mostly in females. But we will also discuss male fertility formed a bit. And the question I have is, is there anything about a woman's timing, or let's just say, patterns of puberty, right? How frequently demonstrated early on what the timing of adminstration is a in terms of the age? He said a that provides hints, or maybe even facts or directives about her future fertility, or how long her fertility .

might last. This is a great question, and I think defining some terminology before we begin as helpful. So we go all the way back to win your ffs inside drama.

So when there's a female feet is insider mom, you have the most eggs you're ever going to half IT about twenty weeks just station about six to seven million eggs by the time you're born. You've already lost more than half of those and you continually lose out all the time. So the analogy that I always use and you do to, is imagining that there's a volt inside the over where all your eyes are kept.

And every single month since the moment you have an over, you lose a group of these eggs. And when there's more inside, you're losing more. So you're losing all of these eggs throughout early fetal development and then up until the time period, even of puberty, when you reach puberty, you have a listening of the number of eggs and you're over to the point where you can start to respond to the signals from the brain.

So we think about puberty, arms set and females. First, we have really feel lucky, which is the development of breasts. So that happens about two years on average, before you have monarchy, which is your period starting.

So what happens is the brain, as we know from the hypothenuse since of genre age, and then we have F S H coming now, which really starts to stimulate those followers. So fsa profile stimulating hormone named hormones for the female. Of course, men have IT too, and it's less well named for them.

But IT starts to get those followers which house the eggs to grow and make extra gen. Women have about two years of astrological exposure alone, so unopposed with no progesterone because they're not yet audio ating. And that's when you start to see breast budding and you start to see the development of some of those secondary sex characteristics before you actually have a period.

What are some of the other secondary sex characteristics that proceed? monarchy? He said, breast, but the development, and then breast development on average, about two years before.

two years before you have sexual hair development. So actually, aderke is one of the first usually comes right before at the same time with breast buds. So two to three years before you will .

see your period general .

hair underarm here exactly I do.

And getting right down to the weeds here, which is good. Um know a goal of this podcasts to Normal alist all aspects of health including sexual health and and a reproductive health um is that commenter also with um the development of body older you know because as a Young boy who eventually pick your video became a Young man and now I sport in middle age forty eight, I can tell you that the the locker room smell a lot different before and after middle school right right like the in other words, boys started to smell stinky do yes and that's usually .

around the same time of sexual hair development is when you start to have those lanes around the hair, making some of those orders that started produce things.

Do they reflect hormones themselves?

你 能把 this like the smell， the actual smell doesn't actually reflect levels of hormones or anything like that. IT is just that your body, you're go nuts, whether IT is tests or over, is are now starting to respond to those brain signals. The brain has turned on. They're starting to respond in your body, starting to mature in a way to get to the point where I can support reproduction.

The reason I ask that question is not to get people thinking about stinky smells but and by the way, some people love the musty smell of of their own but ARM pets or others you know here were referred to adults by the way. Um but the reason I ask is that there is a wealth of data in animal models, including non human primates, suggesting that um exposure to the orders of others can either um stimulate or accelerate puberty. Is there any evidence for that in humans?

So there's smiled evidence and it's monkey because we also know that anything that could be an indecent disrupt, a lot of since or figurantes are also can accelerate the onset of puberty by disrupting part of this system. And so we know that toxics and you know sons and a lot of the world that were exposed to is part of the reason why we're seeing puberty happy at such a Younger age. Now in females specifically, but in both, but in females than we have before, we have Young girls seeing their onset of monarch, their period. I am much Younger age.

How much Younger? I've seen the various grass for different countries. But can we say that you know, ten years ago, on average, girls in the united states, in northern europe were hitting monarchy at about, what, twelve to thirteen years old.

yeah. So you start use monarchy for the purpose of this. So having your period, know, ten, twenty years ago, you will see most data with a thirteen to fifteen would have been kind of the average age.

And now we really seen a shift to be starting at ten to eleven and completing by thirteen, fourteen. So most. Are definitely going through the puberty change earlier. And the other thing to note is that most girls get their final high growth right before they start their period, too.

So not only are we seen a change and is getting starting earlier, but we're also seeing as probably some reduction and height from having gone through puberty at an earlier process. Because once you start actually monstrat, once the overall have really started to learn how to respond to that fsh and grow the and IT gets to the point where you can start audio ating. So about two years later, then that oba tory period, those high levels of extradition are going to go and they're going to close those growth plate.

So you really started to limit t your final adult height as well when you go through puberty earlier. And that's definitely something that's a huge concern for precocious puberty or very Young puberty, right? And we can use blockers when there are children who start to exhibit signs of puberty. And one of the main reasons people do that is to try to get them to a greater adult height if they are really starting to go through puberty at a very Young age.

Is that also true for males?

That is happening earlier.

earlier. Poverty means that your growth spurt a as terms of height is going .

to be a true, not the same. And you ably, most men say, oh, but I had my groser, you know, kind of after I started having some of the puberty change that happened. But because IT is this estrogen related process and women that we see that growth, but really your final height is within that year of when your period starts.

Interesting this discussion certainly not about me, but I was one of these. But I thought I was kind of an odd duck. I hit you really about thirteen, fourteen, like to say. I knew I did, but I didn't shave until I was after college. My grow spirt between freshman and sofa here I grow for right I was like you know a group full foot but I was the same weight. I was like real tar real skinny or preta you know real skinny then IT seems like um you know some people my life, what are argue that you really still occuring for me? I feel like it's very long and protracted IT, which leads me to A A, A very specific question, if puberty arrives this, again, defined as monarchy, for sake of a discussion right now, if puberty arrives early in a girl, does that mean that her fertility will shut down earlier as well?

Question IT does not. So the age of which you start the onset of your period does not impact how long you're going to have a reproductive lifespan. And that's because you have the eggs inside that volt, you're losing them every month no matter what.

So you lost them all those years before your period started, no matter if your period came at ten or at fifteen. It's just about when did they start allowing your body to audio ate determined by being able to Carry a baby. Your body now thinks you can be pregnant. I think this .

is so important. Highlight because IT puts together what you said earlier about the loss of ex in as a feed as um I think most people sort of assume that the reduction in eg count is due to evolution and the fact that no one egg ovl ates typically, but that other eggs are deployed in that obvious tory cycle. Those those basically are taken out of the volt and out of the opportunity for feriz ation.

But what you're saying is that the eggs are constantly being called from the volt, starting from early embro ic development. And that violation is A A distinct step in some sense unrelated to the the loss of eggs. I think this is going to be very important for our discussion later about potential egg harvest because I think some people have IT in mind the .

lot of conceptions that you're losing eggs from your fault and that's not the case. You're just accessing the outside.

So you're so we can just answer this. Now perhaps IT seems, if I understand correctly, that if one were to harvest eggs for ibf or for embro genesis in addition or set aside later or freeze them for later um if they want to use them eggs or or for lizer embro, that one is not reducing the total number of eggs any more than they would. They just let their their cycles proceed naturally. That such an important point. I think I think a lot of people believe the opposite.

They probably the number one thing that patients fear when they come talk to me about egg zen or going through ibf is I don't want to harm my future fertility. I don't want to cause myself to run out of eggs earlier or going to minimize earlier. And it's explaining this process to them that your overs are on a pathway that you can change.

Those eggs are coming out of the vult regardless of if you're on birth of control pills, your pregnant. We do. Ibf, what if we're modifying is one is not gonna gully and how the rest of them die. We're gonna try to give you medication to get them all to grow so we can take all of the ones that have been released from the volt that month and give them a chance for later. And the next month you'll another group out.

So I V F is not about stimulating hyper release or excessive release of eggs. It's about stimulating the growth of the ones that have been released that they can be frozen s stage either for later feriz, ation or feriz in addition.

and frozen as embrace is right exactly. And we just use the hormones that your body Normally makes in a different way, the medications. We use our fsa and alledge to get the extra grow. So people will say, I don't want to take all these weird hormones or strange medications, but we're just manipulating the Normal process that happens in the natural mental cycle in order to say, hey, this month, let's get all these extra grow. Let's try to improve the efficiency of finding which eggs are going to be Normal or not and help you along this process.

I think a good number of people are now going to head to the ibf clinic. I think again, I really want to highlight this. I think most people that have spoken to assume that the process of harvesting eggs for freezing for feriz ation then or later is going to diminish their for because they're basically pulling more out of the savings account, so to speak. Okay.

so making withdraw no matter what.

Well such an important point for people to know and and propagate um getting back to puberty a little bit later on I wanted to get into underground disruptions and things that sorry but since you brought IT up um you i've heard things such as okay things like evening primaries oil if mom is putting evening primary oil owner has IT in her shampoo that i've heard of Young males getting a precocious breast pod development and keep in mind folks that some transient rest per development is characteristic ics of some Normal puberty and males and sometimes shows up and goes I knew some kids like that in neighbor od they got teases a little bit and then they stop getting teeth hofus ly.

Now they they don't teach kids. But when I was growing up those kids got tears not, I mean, but by other people. But IT was Normal in IT past for for some right IT occurred Normal and in the past but i've heard that things like exposure to evening primary oil, maybe even just through contact with mom, can um increase the the frequency or degree of that male breast by development. Is IT also true that Young girls can undergo precaution ous puberty or as to say accelerator exacerbated puerility um through contact with things like evening primary oil which is that I think has some soda estrogen like properties.

It's important to differentiate that the secondary sex characteristics we see like rsp d development are from exchanging but it's not really puberty being initiated when it's from an underground disrupting chemical. So taking you being exposed to evening premies or lavender or tea oil in a mail isn't going to cause them to start to go into puberty.

But IT is going to expose him to extra jan when his body is not and therefore stimulate some breath. Bad development. Same thing can happen in Young girls, meaning they could show some of the secondary sex signs earlier than they Normally would. And this is why, if that's happening at a really Young age, can should go to a pediatric and chongqing, who are going to check things like bone age and see if you really started the puberty process or not, or is IT an outside exposure, which is causing that interesting ly about the Young child exposure and development?

The other thing to say that's really interesting and relevant in my field is that when we think about how many excess in the volt and everybody's born with this different number, and i'm sure we'll talk about ovarian reserve, what we now know is that the volt your over is are most acceptable to whatever your mother does when she's pregnant with you and that that epi genetic, that programming which is happening is pretty disposing Young women to probably having some of them low over an reserve, some of them having diseases we associate with immortal ity like pcs or indeede OS. And we haven't yet. Character is what all they are. But if we look at the incidents of some of these, we see now what we do know is that the time period which these people were pregnant, the eighties and nineties, was not the healthy st time when IT comes to underground structure and plastic exposure and chemicals and all of this processed stuff, let's just say, that people have been exposed to. They were really seen that those that are various acceptability to egg quality and quantity happens in that beetle development period is interesting .

because there are some a parallels to male fetal development like the the fact that of these early organizing effects of hormones like dye drost stop drone, which essentially stimulate the growth of the piano, but also then establish A A propensity for cormon's during puberty to activate growth of the sex organs, but also activate the brain areas are responsible for a host of different things so I only mention that because what i'd like to kind of illustrate in the background here is that um basically a reproductive health begins really prior to conception, really is dependent on mom and dad.

But certainly to a great degree on on mom um but then fetal development and is going to be important. So sort of um us being able to pick our parents, I I do have a couple questions about lavender teacher oil and evening primaries. Well, I was aware that evening primaries oil oil, excuse me, can um somehow bind extra gyor setters IT or mimic a some of the extra dialer or something similar to IT? I wasn't aware of tree oil lahaina der here.

Are we talking about oils? What about omas? And how concerned do people have to be about this stuff? Because, I mean, you know, you're go into a restaurant, bathroom, they'll be pope.

I some people were perfume. I mean, we don't want to set up paranoia, but but I think people should know about this stuff. Teachers .

in a natural, some people love them though. Constant exposure is very different than a one time hand washing in the bathroom. And I think that the big difference for everything, when we talk about chemicals or toxins or exposure in the world, you can't live in a toxin free world, but choosing what you put in and on your body on a regular basis does set the tone for certain physiologic changes.

And so, you know, using incentive products, especially with children, is a really important thing because we want to make sure that there are lifetime exposure to some of these things, especially doing critical times is much less. And so you'll see people recommend things like your laundry to charge, you know what sensor in your laundry detergent. The same poo and conditioner are a big one, and the soap s that you use on a data day basis in your house, or the oils you put on your body.

Lavender is huge because there's this whole community of people. They want to rub lavender oil on their babies, feed and help them sleep. But really, we can see, and if somebody goes in shadows of p dio cri c technical logic for a day, they'll see some kids come in. And this will be the reason why.

What about cloth diverse versus non cloth dips? I've i've heard you know that you have, you're like very strong cloth driver proponents, right? And because they seem to um feel or believe that um non clock debris somehow contain things that can get into baby skin. And and maybe there's a bigger question here. Is baby skin more premium than I don't .

know that baby skin is more and I .

don't either. I just I mean, IT seems that seems like I would be hard to imagine IT is but but babies do seen how this incredible skin, right their skin is so smooth, one squeeze their cheeks and all this kind of stuff. But yeah, the idea that will be more premium.

I think it's more that their development is this time is very important and setting the stage for a lot of what happens later verses an adult d those stepwise developmental processes already happened. So I think that's why we pay so much attention to what happens in the you know childhood period of time because we are now learning about those later consequences of what you're exposed to.

It's not that no regular die pers versus claw whatever we want to say that once necessarily Better than the other. It's more honestly a personal preference. Babies are exposed to them a lot, and there's been a lot of attention to that.

But similarly, somebody could use cloth and wash IT with the detergent that then you know has certain chemicals in IT. So there hasn't been a study shown that this one thing is an exposure for a baby that somebody needs to be worried about. There is definitely companies now which are promoting and talking about no traditional diapers that they are making sure have less toxins and them. And I always think anytime you can decrease toxin exposure to a child is going to be very important.

Is there any evidence for um you know breast milk verses formula in terms of impact on future reproductive development of or reproductive status of a child?

That's a complicated question because grass milk exposure, at least for the first six months of a child's life, certainly helps with the immune system development. And we know that poor immunity velocity ment can lead to higher risk of auto mune disease later, what people call liquid a. And some of those diseases certainly are car later with fertility. So I wouldn't say we've gone so far to say that if you don't breast video a child, they're going to have fertility issues. But we do know that there's an in between correlation with things that breast feeding is protective against and how those diseases themselves may relate to fertility in the female later on.

okay. So we're um thinking about a Young girl slash woman because we were turning up puberty, right? So I don't know what exact nomenclature is there, my experience and and somebody no matter what but a girl who undergo puberty, right?

So Young woman whose may be thirteen or so so she's early teens undergoes puberty and therefore is continuing to lose eggs from the volt um but now is undergoing presume ly roughly every twenty eight days managing. But let's talk about this twenty eight days thing because I think a lot of people think that um quote on quote Normal monsters tion is always twenty eight days and and we know that's not true. So what is the the range of uh Normal a duration between um monsters tion a cycles or duration of demonstration cycle? And let's also define when the ministration cycle starts, probably for the males .

mostly in the so let's think through the cycle will do a quick one over and answer the questions. So what we think of a cycle day one, or when you're going to say this starts is going to the day you start bleeding. So that's actually shutting the indeede al lining from what grew the last time.

So any spotting even would be considered day one.

okay. So IT is we can get back to there's problematic give you a lot of spotted before that full flow starts a day or so can be really Normal just as the bodies are just into the drop and protest around. But less is started the beginning day one, you have a period of mensem.

This is when you're actually bleeding at this time period. We like think about all of those new eggs being out of the vault, being acceptable to that. F, which of course, that will named turmoil because it's stimulate a folko to grow in each other as an a follow that ex starts to grow and makes extra gen.

That extra on stimulates the proliferation of the lining of the uterus and preparation for potentially that pregNancy that may come. And also that extradition makes you feel really great. That's the policy lar phase named. So because that policy is growing and it's an F H dominant phase where you have a lot of estrogen .

and people feel great when they have a lot of .

estrogen because women feel good with rage .

because of the relationship between str gen and like dopamine and serotonin and and is that happening in parallel? Or they somehow related, like is asteria en controlling the release of serotonin somehow advice first a or they just kind of coincidentally happening in parallel?

We definitely think that there's more of a correlation, causation and just student because we know there's time periods of people are more depressed within your cycle correlation with those low emergent levels. And we know that when you go into mini pods are you run out of eggs and you're now in a low external phase, we see a lot more than depressed the mood.

And you know, ana Donna, a lack of response to things which would Normally give you pleasure happens more frequently. The female brain loves s rogen, and its protective against things like dementia. So this is a time period where women are going to be more energetic.

They are going to have more energy, more focus. This is the extradition dominant base of the cycle. And when you have seen that extra gen at its high levels, which is only made from a mature follow, and it's very specific, two hundred kilograms per man eaters for fifty hours, that's the brain's clue.

okay? We must have a mature egg. And they can send out that surge of L. H. aluminized. And now you ebulis. And when you ebulis, the follow opens up, releases, closes back, and then it's the corpus ludie and we've end the ludie phase. And the corporation dia.

as the name suggests, the corpus is like a body that's specially the it's basically the the corpse of what essenic yeah and cheat the egg before and IT what I find so amazing, I mean biology so beautiful, right? Instead of just taking that tissue and saying OK like, let's just discard this or that becomes the trigger for the next space .

of IT is essential for life, right? The corpus ludie, which makes projection, opens and closes the implantation window. IT is what allows somebody to get pregnant and for our species to continue.

So it's extremely fascinating and that corpus dian gets stimulated to produce production impulses throughout the entire ludie phase because it's still controlled by the brain unless you get pregnant. And then in that ludie phase process on is fascinating. It's trying to protect you from things which could potentially harm your baby.

So suddenly now you've less energy, you wanted sleep more, you wanna eat more, you maybe do not wants to have sex as much because your body is suddenly saying, let's just protect to this potential implementation that you're going to have. If that pregNancy doesn't come, the corpus ludie can only live twelve to fourteen teen days that has a very distinct lifespan. And then IT dies.

Your estrogen and projection both drop, you bleed, starting over the next cycle. And a new group of folk les comes out to be released. And the reason why walking through that very simply, but is important when you're asking how long is the Normal cycle because the studio phase is pretty set at twelve to fourteen days.

The particular phase can vary in person to person. And what we know though is for one individual, if your mental cycle, your reproductive permanent are working right, IT should be relatively constant for you. And so if your periods are every twenty four days, but they've ve always been every twenty four to twenty five days, then that's not concerning.

And if your periods are every thirty three days, but theyve always been every thirty three days, then that's not concerning. But we do get concerned when there's a change in your period or we get concerned when people have what I like to say is irregularly regular periods because what you'll see textbooks tell you is that your periods could be as short as twenty one days, as long as thirty five days, and that can all be Normal. But people will hot between them.

And they have one cycle that is twenty four days and links from day one to the last day before the next day than the nex cycles, thirty two and then it's twenty six and then it's thirty four. And that's not Normal. That's two irregular. And that can be a sign that something is not communicating correctly within your reproductive hormones.

So what I told patients is, in general, your period to be less than thirty five days apart, and you should be able to look at a calendar and with your finger, put a finger on the date and within a couple days of accuracy, be able to predict when your periods coming. And if you can't, there could likely be something that is in referring with the hormonal signals between the brain and the and one of the biggest, really one of the only things we see as women start to have fewer eggs in the world. Is a shorting of their cycles.

So you have a regular period and suddenly now you have less eggs in the volt, so lesser coming out each month. And when the brain sends out that F S H signal, now there's fewer eggs. So it's not getting as deut, and you have one starting to respond sooner.

So suddenly your evil ating shorter, faster in your cycle, your obviating on cycle day nine instead of fourteen, your ludie faces still said, but the person who comes to see me and says, my periods have always been twenty eight to thirty days, but now they're every twenty four. I just figures, no big deal. I am, have red flags going off everywhere.

Because i'm not really concerned that potentially their Operating reserve has dropped to a point where we are starting to see clinical changes. Now of course, things like diode and protecting and other hormones can also cause such changes, but that's why you will hear most reproductive technologies say your periods of vital sign. And what we really mean is the regularity at which IT comes. And the predictability of IT is telling us if your hormones are all communicating in a Normal fashion, or if something could potentially be off.

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Come slash huberman to get the five travel packs and the year supply a vitamin d, three, k, two. Let me see if I have this correct. We ve got this thing that we call the menstrual cycle, the observatory cycle.

The there is two phases, a fleur phase in alluvial phase. Flip lar precedes the ludie phase. The ludie phase s tends to be, I heard correctly, fairly fixed about fourteen days. The political phase can vary duration, maybe tend to fourteen days, maybe even ten to eighteen days, depending on something about their brain to over communication.

For those that um aren't familiar with this, the I always learned that s rogen primes projects around the really basic top onto description of the observatory cycle that inter gen is gna slowly climb toward the the point of violation and and then there's there's a peak and then a drop and then progesterone is going to dominate in the studio face the second half. You said that estrogen is associated with with a psychological level and a physio gc level, more energy um feelings of vitality. And some of that estrogen increase is actually coming from the one egg that got stimulated the most.

The one that got selected picked for the team potentially for the team, but got picked potentially for fertilization. And that egg shed its corporate ludibria, which is this piece of this of the egg that then triggers the progesterone that dominates the ludi. Your face do OK .

in which the g grows right? When you abdulle IT ruptures, the sist burst a followers assist, assist as a fluid field structure, followers of fluid l structure that holds an egg. So when you emulate and you get that L H surge, the sist burst that opens up and the egg comes out of IT, and then IT reheated and becomes the corpus ludie IT.

So just a little bit different and timing, and you're right with s rogen prime projection. But really, we think about at the layer of the uterus because extradition stimulates the growth of that lying and then project stabilizes IT and allows and plantation to occur. But the sequence of events of when your emergent dominant and progesterone deficient, which is the policy lar phase, and people will come in having loves drawn randomly.

Ly, and they're all concerned that they don't have protest around. And when you talk to them about where they are and they are cycle, you say you are not supposed to have protest. That's your futile lar phase. This is perfectly Normal.

A great thanks for that clarification.

I get a lot .

of questions about birth control, but on my social media handles.

don't you going to be clear?

It's a vast topic exploration, but a long line is what we're talking about. Now i've heard and I suspect IT may not be true. But tell me, is there any evidence that taking birth control can disrupt the process that you just described in?

When we talk about birth control, we should probably define what we so there are um hormone based birth controls. A K the pill. There are also horton bed birth controls that are not in pill form.

Um there are R U D that are copper R U D. There are other R U D. Let us talk about hormone based contraception in females OK a if, which many of them, as I understand, are estrogen ics or estrogen themselves that suppress violation. Do they diminish or increase the number of eggs that are taken from the vote?

Fantastic question. Let's talk about what people say is the pill. So let's specifically talk about combined oral contra action.

The pill, which has Ethanol air dial in some type of protestant no contracts tion does not change the release of eggs out of the wall. They are occurred at the same process and the same pathway. Your not auditioning because that extradition does prevent fsa from coming from the brain.

So you have the group of eggs still come out of the world. There's no F S. H. They just all die. The next group comes out.

So when you are saying, are you gonna n out of eggs faster? Are onna harm your fertility? Does birth control impair the process? The answers, no, but there's a couple of important caveats.

One is that the birth control pills, especially if you take them continuously or for a prolonged period of time, the the body smart and the always start to say we're not really doing anything. And one of those markers of a very reserve we have is A M H. And that's antimalarial harmon.

And A M H is made from the grainy loss of cells of the cells that surround every follow. So in the shortest way possible, more example, more come out every month, higher amh. Fewer example, fewer come out, lower amh.

Your amh is being suppressed because of the birth control pill because it's decreasing the activity of those granier loses cells. You might get a low a image value when you been on the birth control al, for a long time. That is completely reversible, but I can be significant.

So if somebody is wanting to get an image level, let's say somebody comes to my clinic, they're not trying to get pregnant and their on the pill and they're considering freezing their eggs. So we're going to check their own in reserve. If we draw IT, I always say this, A M H may be up to thirty percent lower and somebody who is on the birth control pill so we can still draw IT.

And if IT comes back in the Normal range, we feel good. But if IT does come back, so we're onna have to make a decision, are we going to stop the birth control pill for a period of some months, use alternative contract action if you don't want to be pregnant, and then repeat this test to see if this is a true low, because we do see that Young women do have little very reserve sometimes. Or was this just suppressed because you are on the birth control? Pm, so we see IT impact some of the hormone testing that we can do.

And the thing that's an important distinction, and we can see that the longer you take IT, that potentially IT might actually improve your fertility if you had underline in the metro s or some medical conditions that we see associated with infertility. So prolonged pill users can potentially improve their fertility versus people who are trying to get pregnant that same who were not on the pill. Those studies are complicated, right, because of selection bias.

Because if you have been on the pill for ten years or a little bit older, so is that they were preventing pregNancy and the other group potentially had some exposures. So they were inherently more inferable than the group that was on the pill. But we do know that the pill doesn't cause infertility. And I use that all the time.

All the time in ibf cycles, we put people on the birth control pill because we can actually synchronize that group of eggs that comes out of the volt to grow together because your body doesn't want to have twenty babies at one time, right? And what we're trying to do with ivf get two eggs to grow. If that was out of the volt, really goes against the check and baLance of the human body to not have twenty .

babies at once. Why is IT that males who take testosterone anthemic testoon IT shut down their own testosterone production and sperm production, but females who take estrogen in the form of birth control pills that doesn't shut down estrogen production by the covers?

So I love this question. You know the answer. So I like IT extra because I know you're asking spermatogenesis is a constant and ongoing process, right?

So in women, you're born with all the eggs ever going to have. And what we're talking about is if we stop fsa at that moment, we're just impacting the ability to auditor at that time. But we're not changing this constant loss without the vault spermatogenesis, right?

The sperm is made every single day you're making bring new sperm. So seventy two days for the sperm to be created in the testes, and eighteen days to find their way out, the eject tory system. And so exposure that you have, that stop the production of F, S, H and h inhibit the development, the creation of new spam.

So somebody who's been on testoon will tell the brain, the brain doesn't know is when you're taking IT. IT says, hey, we have plenty of burn. We're good.

We don't need anymore so the brain then gets suppressed and doesn't make that F, S, H, an ally. Therefore not stimulating both further test of production because you don't need that, but tests production and sperm production go hand in hand. So therefore, you're no longer making new farm.

And and in fact, the longer you're on test to own, the harder they may be to get burn production to come back. And in twenty five percent of people, they may not get IT back if theyve been on prolonged to SaaS n exposure. So it's really because of what women will sometimes say is unfair, which is the fact that you're born with all these eggs and you run out of them.

They accumulate the war in here of your life, right, with the equality being a huge issue and female production. Yet men get to have news spam every ninety days. They get to wash away whatever bad deeds they did and can change their lifestyle, their exposure and have very different firm. But because that same process, things that shut off the production of F S H L age really impact firm quite significantly.

You mention bad deeds um for sperm um not by sperm, I said for sperm and you we know that heat is is your a prety dramatic insult to the to this prediction cycle sonus and hot tubs and what not. I did receive the question as to whether or not um heat exposure sonus hot tubs that are they um detrimental to emulation or eg production in any way. I mean obviously things are more internal in female is the over are internal. But so any evidence for that I mean.

the body does heat up yeah IT doesn't harm the obligatory period of that over reason. Just like we know the reason why the tests are so acceptable is because they are proposed to be at a cooler temperature. That's why they're in the screw on outside the body.

That's why the tests are so acceptable to heat changes. But the over as being inside the body, they're not in the same way now when somebody's pregnant. Important distinction, right? We know that the development, especially organ development, of an ebro, can be more sensitive to certain things, and that he exposure at that time, whether it's hot abuse or extreme revers, even can make a difference in development of a fus. But women coming to the other story cycle, a hormone g production heat in the female, doesn't make any difference.

I want to be clear before I asked the next question, that I don't want to be responsible for any unwanted pregnancies. But when I was in high school, they told us that women can get pregnant even while they have their period. Is that true? Seems like a lie based on everything you're saying, but I don't want anyone to run out and test that hypotheses without having the facts first.

So in general, if somebody has extremely regular cycles, then that's a complete that you can get pregnant on your period. The reason why they tell us this is one, especially when you're Younger, your experience I goals tend to be irregular. They're not your body hasn't fully matured to have that regulatory and that we know that sperm do live in the republic of track for much longer than the egta, so sperm can live there for up to five days.

So if somebody did have a shorter period window, let's say their Normal periods are going to be twenty four days. They're ov late on cycle day ten. If they have a regular period that's five or six days, they could potentially have in a course that end part of that period, the spring could live for five days and be right there when you have the egg and route.

So it's not the most feral time for shower. And in most people, that is considered a time when you're not going to get pregnant, but especially when you're Young and you have more irregularities. Or in people who have a short cycle window .

that might not be the case. So by extension, um can we conclude then that the most further time is going to be when sperm me egg, let's a save timing of inner course for for the time being. But because there's can be a layer there a when sperm at egg on obviously day of violation or day a day after day of .

day of the anglers for twenty four hours. So the egg can only be fertilized for twenty four hours. Violet in the fbi's tube, once the eggs under the uses IT can't be fertilized anymore.

So IT has a very short window of time where IT will allow sperm to enter IT. Now spring can live for five days. So we'll say the feral window is this five day period in the on the day of violation.

You will hear a lot of us, a lot of doctors say the day after education, because do you really know exactly what time you ogula ted on? And if the eggs twenty four hours, then that extra day could potentially be helpful. But really, it's five days ending on the day of violation.

And people with very regular cycles or who can track them, and they know when that violation is happening the day before in the day of education. Those are the two top heading days. So if you're kind of not in the mood to have lots of sex, those are going to be the days you target to have the highest chance of conceding.

And what is the relationship between emersion libido and ova tion and females?

The hire your estrogen is the increased libido that you're going to have. And of course, you see those peak extradition levels, which are going to trigger that a surge so the body is made to get pregnant. You're going to have that peak emerging, that peak lib to right before and right at that adulatory time periods so that hopefully you also want to have in our course and get pregnant.

I've heard before, let's to say that some people, to be careful here, can sense the literally the deployment of of the eg, the violation, the report that they can feel. Let's just say that the departure of the of the egg. Is that an imaginary thing? I mean, I always like, I always like that image that people can know when that happened.

Men .

generally know when, when there, when their spare are leaving the ride. Lets hope they do. But why wouldn't that there be an internal sense for women also of what's going on? I mean, we have terrace action. There's a ton of nerve innovation of that area doesn't .

communicate to the brain excEllent as far as tracking to where that sensation is. But you're right. I D said ordination is the rupture of assist, right? IT IT is rupturing and the August being released.

And those particular fluid is also exciting and going into the patti al cavity. And so there is a group of women who can feel that, especially people who are very in tune with their body. And he has a name is called middlemarch. The pain almost feels like a crampy pain that happens in the middle of the cycle, and that is your obligatory pain interest.

What is IT .

called middle smart?

Okay, we will put them the shown at captions and whoever does is going to have to get the spelling right. Amazing amazing um amazing and foreign me but for obvious ous reasons ah but amazing i'm always astonished in um how incredibly well orchestrated this whole processes is. Is just an incredible feat of biology. I mean the number of things that have to be time correctly and the use and and say reuse, but the the the purpose of tissues for different things and like it's what what an incredible thing that is just amazing.

I mean, i'm so nerdy because I just love how everything has to communicate just perfectly IT makes you in all of all the pregnancies that just happened just all the time because really things have to synchronize really at the wonderful time period. And even though this isn't what we're talking about, I heard you say this. So I want to say this, people always ask every single day, or how much sex should you have?

When should you have sex as there are too much sex, and what we know is that you definitely should not decrease your sexual in our course interval. So if you are in a relationship and you are sex everyday, people have a sex day, you will hundred percent hit inner course throughout your entire photo window. On the day that you ebulis, you're depositing the same firm there because you're not generating new spam, is whether the road went half and half and half and half or if I went in one big group.

But if you're constantly putting more sperm out there, you have a higher chance. And so studies go back and always say daily and accuse as as there were the highest chance of accountability, especially during the feral window. However, for couples who are not sex everyday people, that idea can cause a lot of stress.

Stress, of course, impact the system in a lot of different ways. You can also cause sexual burnout where they no longer feel like being intermet or having sex on the day that actually oculina because they've been doing at this whole time leading up. And that's where the time period of saying have sex every other day throughout the photo window to starting five or six days before you think you're going to obvious ate and then try to target having another course on the day before and the day of observation. And the reason why people said every other day or a few days is prior kind of get some sperm exposure there in case you violated early, but really to try to prevent some of that increased stress that can happen when you're trying to conceive, especially if you have programmed or timed in our course, that needs to happen on an everyday in noval. But the odds of getting crag nant by saving up sperm for two or three days, that's not higher.

Curious then why if let's just say hypothetically, someone is donating or freezing sperm or doing ibf, why they instruct the mail to not ejaculates for forty eight to seventy two hours prior to this? Just say depositing permit is a funny word, but he works.

So two points. One, if we're doing a seen analysis now, we're trying to evaluate this farm in any test has certain Normal parameters. And these are all based on a forty eight, seven, two, our absence period. So yes, if you edit late more frequently, you're going to have less Spark and that can be very Normal. But if we're looking at a test was set Normal parameters that are based on two to three days of not having inner course, that's why we want you to do IT for that.

If we're doing, let's say, I U I or tributor examination, also known as artificial insemination, or where we take the sperm and put IT in a catheter and put IT in the uterus, we're trying to get more players further on the field. And in that case, I know when you ovulate because i'm timing IT perfectly and I I am trying to get as many possible in this process because we're not just having them deposited in the vagina. We're trying to get him further.

So we want more because as part of that treatment process, and similarly with if I want to have as many spread as possible to sort through and pick out the best looking, the most moral, the most Normally shaped ones. So we're trying to get just a Better simple. And by having these Normal guidelines were able to judge, this is low for what I should be, which can also be a clue to other problems.

I definitely want to talk about chemistry, both of interpersonal chemistry and literally uh ejaculate in vagina inal chemistry before we do that. Um i'm curious whether not we can just touch on a few of the things that a lot of people wonder about in terms of egg quality. And if they touch on sperm quality, maybe we can also just mention that.

But for instance. Does cannabis, either by edible or by smoking cannabis, impact equality in either direction? Alcohol would be the next. And then i'm going to assume, and I have to do, this is strictly because of what I understand about you, drugs abuse like cocaine. And effet ine matthee amine that none of those can be good for systems of the body because they provide, they create so much stress for the body. But this is a alcohol and cannabis.

Um I read a statistic when researching epsom on cannabis that shocked me, which is that fifteen percent, one five percent at one point five fifteen percent of american women, at least this one study survey reported having consumed or smoke cannabis during known pregNancy, which is wide unless of course i'm just naive and c is not harmful to the us. But I have a hard time believing that. So what gives? I mean, here were, and there I actually just threw an federal development. So is cannabis, is alcoa bad for equality? So there are different things .

that do the same thing in wine. So let's answer them each individually. So we'll go with the one that everybody knows and has accepted now that they would have accepted forty years ago, right?

Smoking cigarettes, so that's obviously bad, decreases the number of eggs you have in the volt. Smoking cigarettes actually isn't to revolt. Decreases the number that you have.

You have a higher chance of going into minipad earlier, and IT increases the risk of having abNormal chroma somes, which is what we really think about. We think about equality, right? Those my other penders inside the eggs, which hold the crimson es and their perfect position, they are associated. They get wearing tear from things that cause inflation, tion, or are toxic. So cigaret smoke, we know, decreases equality as quantity, increases miscarriage.

and, of course, has fetal impact. I talk to nick, which itself is not curse and gently. And then there's the smoking process, which brings in a bunch of other things. The question I know is burning in everybody's mine is vapor. Yeah right? Because vapor is i'm i'm very bullish on this and it's very clear that the chemicals associated with vapor are just oh so bad for everybody's health, but it's distinctly different from saying that nickel is bad for one's health and I can be but without doing too much of a deep dive, is are there any data that show that vapor is bad for equality?

Of course, there's not as much data because he just hasn't been around as long. But yes, baby definitely has chemicals. S that looks like it's associated with poor success rates and ibf cycles. And that's really kind of one of the most finite measures of equality we can see because we're really testing the egg at a level in a lab versus just are you getting pregnant naturally?

And I started to project again. But any time a conversation like this comes up, especially between two people and health science space, um there are these shouts because I hear them literally where people say, well, listen, I ve ped everyday and i've had three babies. And I think that my response is always okay. There's going to be a distribution of responses.

And then of course, how much healthier could your babies have been had you not vae during pregNancy or vapor prior to pregNancy? Or I think I think these are the key issues that like you can't you can't rewind the clock as much as I know right on the absence of time machine, you can't rewind the clock. So um I mean, basically everything you're saying is that smoking cigarettes or raping negative just can't be good for that.

We know that it's not good for getting pregnant. We know that is not good for storm. And therefore, we also was going to impact pregNancy rates.

You know, things like cannabis, right? Decreases burn production, decreases burn motility, changes burn mythology. The shape of IT changes the DNA and increases the fragmentation of the DNA. If your partner uses cannabis and you get pregnant, you have a higher chance of miscarriage because of this firm association .

with .

the kind of edible, because you can study something that's illegal. So a lot of this data is just more new and a lot of it's going to be observational.

And instead, like colorado and california, you know canvas is essentially legal. I am assuming they're more data, but okay. So um smoking and door weapon nicky, cannabis either edible or smoke very likely detrimental to eg quality and sperm quality, which is not to say that one can conceive that just means that the quality of your baby, your child will not be as high as the quality of that baby.

If you didn't do that, is that right? And I am trying to demonize anyone that did did do this during cragg's. Cy, a lot of people didn't know, but this is this is really about people trying to make choices in anticipation of future pregNancy yeah.

And when you're trying to set yourself up for success because we know infertility becoming more common, we don't always know who is going to have IT. And when you find yourself in that position specifically, you know want to optimize everything you can.

So if there's something that is going to make these firm quality worse and the egg quality worse, and you are success with treatment lower and your mission rerate higher, we're gonna recommend that you not do IT if you're trying to get pregnant naturally. All these things core late over. But of course, there's always going to be outliers and exceptions.

I'm onna. Sit here and tell you that the odds being pregnant at age forty three are less than three percent per month. And every single persons going to be like, but my ant, barbra or I know this person who did, because three persons.

not israel .

nature. K right? But yes, so people will get pregnant. People will have healthy children who do have exposures to negative in to cannabis, even to alcohol, even though we know that alcohol can cause fetal alcohol syndrome, zero percent of alcohol should be the acceptable level and pregNancy.

And then does alcohol impact fertility? Such a complicated question. And this is probably due to the amount you consume in the frequency of what you consume IT alcohol is a toxin that your liver must filter out.

And we know IT causes inflation tion. Anybody who's had a fun night with alcohol knows they can wake up the next day and they feel different. Their body is processing that alcohol and that inflation tion, especially if its chronic, chronic exposure.

We know chronic information is one of the things that we see impacting equality and sperm quality. So certainly, if you enjoy alcohol, IT should be something that is an in moderation. One or two drinks a week at the most. And you should not do IT at all once you find out your pregnant.

When we are talking about birth control, I unfortunately move us forward and and forgot to ask about I U D. So a minor changes that the copper iud works by creating a sort of not actually electric, but a kind of a electric fence that kills sperm. Sperm don't like copper, like copper.

Copper likes to kill spam. There's some interesting history I ve been reading about the history of medicine of people who know for whatever reason we're forced into or chose to be in the sexy prostitutes using um inserting copper coins into the regional track to trying kill sperm. But to varying degrees of success, obviously there's a whole.

So your economic landscape around that. So um think it's obviously i'm referring to, but um very interesting but that's just one form of I U D. Right there is a mother, the ids.

And then there's, of course, the ring. We didn't talk about that and maybe we just touch on a few those in within the context of whether not IT orders, equality and or future fertility. When one takes the ring out, takes the iud out. This is a great question.

because a lot of people don't know this, and I all roll through a few of the top of control methods and just thinking through copper iud. As usually said, no horr mal involvement. IT causes information in a toxic environment inside the uterus. Isolated does cause sometimes have your periods, but they should still be regular if they are irregular, that a sign of a hormonal issue, because you still ordinate with the corporate.

Really a copper .

wire woven in the I, U, D is is a little tea, and the arms are, have copper wires rapped .

around them. They, those are, they grow into the upper and lining.

They don't grow into the utter n lining. Are you do just sit in there. And just the presence of that copper causes that inflammatory reaction in that toxic environment .

and is IT toxic to the environment in ways that are detrimental to the woman or just a sperm.

both. I mean, implantation is not going to occur likely, right? I mean, no, nothing has one hundred percent successful, but it's much harder for embryo to implement .

within that highly inflammation. People figure out laboratories.

right? Let's just put some cop in some users .

and see what happened. IT really speaks to the the urgency that must have existed to preventing pregNancy and that they are .

just have costly, biologically and pregnant, not health neutral IT. Somebody needs to be in a right health or IT can be a deadly circumstances when we get back to other I U D. So iid, that more people are more familiar with are the project room based ids.

This is going to be a marana CarOlina like letter. They have a bunch of different names based on the amount of projection and how long they last for these work. Mostly by thinning out the un.

Lining, as we ready said, for just own compacts, the un. Lining, to prepare IT for implantation in a Normal cycle. But if you have constant exposure to protest on what is going to happen, is going to prevent the utter lining from growing.

And IT gets IT very, very fun. Not all I U D, in fact, most of them don't prevent violation. Only about fifty percent of people do they actually prevent violation. So their main mechanism action is this indeede al effect. When you remove the I U D, especially if you are ready ebulis, no problem.

The problem we do see in some people with production I U D, that maybe isn't talked about as much, is that this prolonged protesters in exposure, because people are putting iud san for five to seven years and not having a period for that links of time because the indeede um has become so a trophy or non existent that you're no longer bleeding despite the fact that you may be emulating. You can take a while for that lining to grow back. And so it's not uncommon to have an I, U.

D. In place. And if you have no period, you're going to say, this is great.

I don't have a period. wonderful. You get IT removed and now your period hasn't come back. And at least people to sometimes be concerned that the iud causing them, not to argue, or they have this infertility caused by the I U. D.

But really, what IT is, is that the lines becomes so, so thin that I can take many months of that unopposed estrogen exposure on the fully cured phase. To get IT thick enough to finally bleed when you're automating. So I do tell people they have a projection I U D to get IT removed three to six months before they want to get pregnant.

Use some other former contract action, but give their body time to make sure they have that regular period pattern back. Important distinction if you're still educating and having a period on an ud. And this is gonna less of a concern because if you're growing enough of the lining to then shut IT, we're less worried about IT.

But if you are a mina read or have absence of your periods with an I U D, we need to think about removing IT for a period of time before you get pregnant so that your body can grow out lining again. When IT comes to some of the other things that you mentioned, what you didn't ask that I want to mentioned is the double previa shot. The double previous shot is a hypos of production high enough to actually prevent violation.

So in that circumstances are not violating. And therefore, if you don't obviates, you're not going to get pregnant. Double prevails, proven to prevent abuse tion for three months.

So when you take IT, you need to get IT every three months to have a proven contracts of benefit. However, IT can last in your system for eighteen months and prevent violation for up to eighteen months. So I will see people who liked that option for contracts tion.

And now they haven't a period a long time, but their last double shot was six months ago. And they are all frustrated IT by the fact when I tell them, well, you still may not have another period for a year plus, because this high level of producing that you already injected into your system can last a substantial al amount of time. So that is a contraceptive option that I tell people to discontinue a year and a half to two years before they want to get pregnant, which sometimes people don't know that. And so that's something that can be contraceptive option from, if you're very remote from money to have a child, but in people who are in their childbearing years contemplating family buildings. And soon, that is not my favorite option.

So you haven't mentioned because I have been asked any negative consequences of birth control of any kind, and i'm not encouraging you to if you don't believe in them.

I know that this is a very controversial topic, but you know, one of the more popular studies discuss on social media, one that I ve spent some time with the paper, in a few of the papers, that stemmed from IT, not a huge study, but describing that how women rate the faces of men as either more essentially, what happens is there seems to be, at least in this study there was a statistically significant bias for women to select particular male faces as attractive and those male faces tended to be of the more you know square jaw A K masculine features in air quotes right this is what the study found um but that when women were on oral contracts tion personably estrogen progestin type oral contra action that that effect um was smear, they had not a statistically significant tendency to uh choose the cotton cut more masculine face. I have to be very careful with my language here because it's easily get description of my study like this wrong. And that has made a lot of people to think that birth control is gone to throw off their partner choice.

Now of course, this is a small study. Studies like IT are are not always so well controlled um but is there any evidence that birth control l oral exchanging protestant based birth control is to keep IT specific, can increase rates of cancers, can decrease rates of cancers, can lead to um any sorts of disrupt tions in um bodily a function or health that that's really like a rock solid result. It's been seen by multiple studies, clinical trials or we still just in the dark about the other stuff.

okay. So nothing is without risk. Getting pregnant, not without risk. Taking the worth control pill is not without risk. We do see that there's been a lot of not informed consent in people who are taking the birth control pill, meaning maybe they weren't educated about what all of their options were, the positives and the negatives about each one of them.

If we're going to reference the combo to the pale estrogen, progesterone, pale important, understand that neither the estrogen nor the progesterone are the same as rogen project on that over make right it's Ethanol air dial with your brain and interpret as an extra, but other parts of your body may not. And then its various types of protesters, some of which have even androgens or male hormone like properties and some of which do not. So there is a ton of variation, even the amount of Ethanol air dial, that each poll has with your low, low and your low pills having less, and even with the modern day average poll having a lot less extradition than I used to when you're on the birth control pl, your office aren't making asta dio.

And that astro dial is important in growing the U. N. Lining, but also for the general structures. And so we think about baggini health, involve our health. We certainly see that is especially with continue as you. So we distinguished you take the pill for twenty one days and you have a seven day break where you might bleed, or you take sugar pills and then you take them again. A lot of people now were taking continuously where you have exposure to these compounds every single day.

So in in like the the the wheel, the pouch with the wheel of different coloured pills. They've seen these on on the count. Previous relationships that um and then there's the ones that sometimes we will just opt not to take because those are the not the play sugar pills over like that. There's no need to take emergent during that phase and then and then they repeat, okay, but some people are taking .

yesterday en continuously very common right now. So people and they're not wrong. They say, well, why have a period in these little brakes? It's not really a reflections of my hormones start, which is accurate.

And so they're taking them continuously. You also have less pill failure pregNancy. So if you're using the pill for contract action, that can be a great strategy.

But the longer you take them, we do see some vaginal, our changes, right? And so a tropic vagina ates, people who notice, increase sensitivity, decrease elasticity, increase to convert with inner course, increase in the east infections that can sometimes B, C, because that environment is different. Now that is one thing that can come from the pill.

We also see the pill be life saving for either people they have terrible you know P M S or premature disportes S N drome, where their mental health, when they change from hydro estrogen, always the change in astrogation that interference can cause some people to really have mental health issues that are so severe that having that stable hormonal level is helpful. And so the po can be extremely beneficial for some people when IT comes to mental health. IT can be beneficial for people who have issues with very heavy periods in anima and set of getting blood transfusions.

Now, taking the birth control pill might prevent the lining of the U. S. From growing so much.

They've leads so much. Same thing with vibrates people with pcs. Pcs is policy.

Cal varian sydney, if we want to put IT very simply, you have a lot of eggs and in your revolt, so you release a lot of eggs every month. And what this does is the fs h signal gets deluded. And so you're not responding to the Normal signal, and you don't obviate.

And because the over is a hormone making factory, IT is really bored when IT can't make estrogen because that egs not growing. So I started to make us astro one. So you started to see this androgen dominant environment associated with lack of observation and having a lot of followers inside the over that are .

not really finding that, excuse me, indigenisation of other tissues like like body hair deepen .

ing of typically the level of taste made in P C O S isn't truly depending voice IT can, if there is, and varying tumor making to saw strong or certain other conditions. But typically with pcs, you see increase and body hair increase in action y and you can see some even like male pattern boardings and temporal boardings of women. So some hair loss.

the people.

yeah the winter peking. And then sitting out in these two areas, and then we see an increase and body composition towards the male level. So we think about a male body holding your fat in your abdominal region.

And if we think about the traditional female body holding more fat in the hips and size area, we see that when this hormone shifts in CS, you tend to get more dominant fact distribution, which then leads to further instant resistance and metabolic syndrome. But in pcs, because you're not educating and those over is each little follow makes a tiny amount of tra. Jon, we will say each little follow when it's not responding will make you know one, two peak grams of but if you have fifty of them each month, you're having some constant estrogen exposure.

So that lining of the u is being constantly stimulated to grow and you're never getting the progesterone to stabilize or the progesterone withdraw to bleed. So indeed, trial cancers much higher, and people pcs who don't obvious ly and the birth control pill can prevent that any unopposed estrogen situation, because the body is made to have both estrogen and projection. So we see in a mense decrease and indeede al cancer and a mense drop in a varian cancer.

A varian cancer comes from the remodeling of the over. So every time of a falle grow and IT ruptures and IT makes the corpus ludie and then IT heals up. Those are opportunities for those cancer cells to go away in that remodeling process and lead to wearing cancer.

And because you're not obligating on the pill, your incidents of a varying cancer drops dramatically. Ten years of people use has dropped the chance you get a varying cancer by more than ninety percent. And of course, of varying cancer is super hard to diagnose because the innovation of the petroleum system is poor and you don't have any outward signs, often till late stage disease. That being said, could you potentially have an increase embraced cancer in some people .

by in the .

pill taking the pal? That's a concern, especially people who might be pretty exposed to this .

for some other reason you are like that.

And then is there a situation where the pill certainly masks what's going on with your menstrual cycle? And I really think this is where women's health has a huge history. And Peter nal ism, meaning doctors will just tell people this is what you're going to do.

So your periods are a regular here is the birth control pill and they're not explaining why or the process comes to IT. And what happened is people are not being taught how their bodies work. And now they are because of your podcast amongst thers.

And now they're able to know that my periods of vital sign, and I don't know what IT is because the pill is producing a different environment. The pills also been associated with potentially development of things like leaky gut or ibs. And so there is a definite change in your environment when you're on the back control poll, increased risk of blood quotes because of how it's proceed .

in the liver, increasing your coding factors um that A A fair fairly high percent of people have mutations, in fact likes a clotting factor. Um fewer people are, as we say, how much I guess have two fictional ent copies, milton copies I should say um but there are many people out there that have one mutation copy effect of five living in my understanding is that oral contraceptive females can really exacerbate the factor five line mutation. Do you suggest that people get get their factor five light and genetics analyzed and it's pretty inexpensive to do right? I think on a standard blood text, you can just ask for the factor five an analysis and it's not like A A really indebt thing.

You want to fly us yeah you to I .

don't want to fly another country. You you know like you do for many things.

it's important thing that's not the norm, right? Like that's not the recommendation. When you're talking about putting somebody on the birth control pill, you want to make sure they don't have high blood pressure because I can increase their blood pressure. You want to make sure they don't smoke cigarettes, because the combination of the pale and cigarette smoking can increase the risk of a stroke.

But the recommendations not to screen them to see if they have any inherit cotting disorders said, if you ever have a blood clot on the birth control pill because you're traveling on a plane or you're just on the pill or live in your life, you're now going to get this extensive work up to find out if you do have, that is by no means wrong. And specifically, you should. If anybody in your family has ever had A D, V, T, so a deep vein thrown boss or block, cutting their leg, or a prominent embed, sm or A P, E, so anybody in your family is had one of those, you should one hundred percent get worked up for clotting disorders.

And if you have something like that, you Carry factor five. You should no longer take the birth control pill, and specifically the pill, because it's an oral pill. And how it's metabolite ed in the liver is actually what is causing to change in those quoting factors because that's where they are made as well.

So IT doesn't mean you can't take any former contraction tion, but we do want to make sure that we council you appropriate. I never think it's wrong to be an advocate how or to ask questions. It's important to know that screening, I mean, i'll get on my show box because we think about screening for a wearing reserve and IT is one hundred percent not recommended even though I .

think I should be the my next question be about testing an image levels. yes. And and we've returned to that for those hear that and and IT sounds cyp tic as well as getting an ultron just seeing basically how many many eggs are likely to be in, in the volt on on both sides OK.

So we have to remember that screening recommendations come from at what point in the population does that make sense to spend the money to test for a disease based on the likelihood of finding IT. So if we think about right, that's what your pops mere guidelines and your colonography and your magic ms, everything is all based on.

When are you going to find enough cases at some age to make IT worthwhile testing, which is a crazy principle, especially in the us, because the government not pain for our health care. So why should these guys lines be based on when is the cost effective to do testing? Well.

i'll put in IT if this is going to sound a little bit conspirator oral, but it's not I mean, I think that given that for people who have insurance, private haid insurance or through their work that there's a cost of doing these tests of any kind, corn hit ta.

And they must have figured out the optimal point on the graph with which they can reduce their payout to people who princess get calling cancer if they didn't get the calling Oscar, be at forty five as supposed to fifty, as opposed to six years opposed to twenty five. I mean, this is, I mean, the reality we know is that the more information you have, the Better choices you can make. I mean, the only copy out to that would be that a for some, not all, but for some people, some of the hyperconnected tic type, sometimes more information leads to more aniele, which leads more problems.

But that's a rare instance. I always think that, in general, data is always good, I agree, having the information at hand about your body and being able to make educated choices verses being in a position where you say, I had no idea that I had factor five light and and I had this terrible blood clot, because for minibuses, ms. Can kill people.

We all know that, right? So we talk about this rare thing, but I can happen, but this is really where I can be tough. IT can be tough to find.

Even a doctor who made, like we said, factor five is a blood test and relatively inexpensive. So that one is not hard. But physicians live in a weird world where, you know, they have recommendations based on screening, based on the likelihood of finding disease that they follow.

And when they go off of those, they start introducing themselves to why are you're not following medical guidelines? But for an individual, this is really tough to advocate for yourself. And the one thing that i'll say to this is why paying attention to your body is so important, right?

Understanding your store habits and what's norm and what's not, so that you can catch early signs of things and present for that colonoscopy earlier. The current screening guideline for should you get your ovarian reserve track is that you should not a og, the american college of O B G I N has an entire practice balloon situation saying there's no utility and screening for ham h, okay, I mean, I totally disagree. But lad.

you disagree em to me IT just seems not I or over rather. I mean, the the amh is a blood raw, the blood, a blood draw. One could opt to do the ultra sound as well, which is of course more invasive. But but a women who are seeing their O E G I N are probably familiar with colic exams.

Yeah I mean something that's not alter sound but it's not painful.

not painful but different than a blood raw just for info this closure. So um and you know i've heard of women in their early thirties going in getting their h lap was checked during their ultra and then going, oh my goodness they're down to like, you know I I don't want to throw out numbers because this actually can get tRicky um you know theyll say oh you have whatever you know four folk les and then someone in their early four days will have twenty four aces and then people started is that sort becomes a score keeping thing and and of course, follow quality. There are bunch of other other things and you can tell more about those. But let's say someone did not have insurance or or insurance permission to um to get this pay for what is the approximately cost of getting once A M H levels analyzed.

seventy nine dollars.

seventy nine dollars to find out essentially where you're overy in reserve.

Is that so let's talk about this. I just say this, my soul back, so a clog says you shouldn't screen IT because A M H does not predict your accountability, right? Your body's ability to get pregnant in that month is independent of your and for the most part that's true, right? Because let's say you have a person and therefore thirty of two people, one has low very reserves. They have five eggs coming out of the volt and this one has Normal of very reserve and theyve twenty ex coming out of the ball.

And we should provide clarify that the number of because you said this earlier, but the number of exits come out. The volt is an indirect measure of how many eggs in the volt when the number is is going down IT means the number of eggs in the wall is likely going down as well, like your body starts to take smaller withdrawls as you start to run out .

of the war wants to be like equilibrium, right? IT really wants to be in the middle ground. So when you have too many IT shoots out more every month.

It's too crowded. IT doesn't want that. And then when IT r see at low IT, get scared about being empty and since out fewer per month. So what you see outside the volt, and that has made an animal final counter. And afc, it's an ultra sound based measurement of how many eggs you have outside the vault at one point in time.

And the ultrasound, if one looks this is gna shop, is so what look like little hollow spaces. Like, so not great stuff, but holo bodies.

I see chocolate chips and the chocolate chip cookie. If we can imagine that over. Yeah like looks like a chocolate chip cookie. The chocolate chips, small, little, dark, fluid, full politics, each one of those houses and eggs.

some bigger than others, because they are more mature than .

others based on when you check in the cycle. So if you are looking in that early fleur phase, when somebody dies on their period, they all should be small because nothing been stimulated. If i'm looking very oiled ory, i'll see that dominant policles. It's about to ebulis and then everything else will be small.

And is there a graph that people can look out that we could link to that says, okay, that the average with the distribution of, you know, standard or on either side for, let's say, a twenty eight year old woman or a thirty seven year old women are a forty five year old woman of the number of followers on the right and left side. And as I understand, a symmetry are common, tends to be know like as something goes in and you get six followers on the left side and twelve on the other side, are they how do people gauge what?

What one? Because their doctor should tell them. But that doesn't always happen. But yes, we we add these counts together to get your annual account because there is often a but what we should expect to, lets say in somebody who's thirty is you should have in the sixteen and twenty .

range of total followers per month .

back o when you're thirty five, that number is closer to like fourteen to sixteen. So starting to drop is still pretty good when you're forty eight, eight to ten, when you're forty four, two to four, right? So you started to have this immense drop. That exponentially starts to increase really around age thirty seven. So things started to kind of get into this severe zone really after age thirty seven.

And we didn't really talk about ages eighteen to twenty five. But there are people who get pregnant in that age bracket are is the follow account very, very high as the service is a non near drop off? Or yeah the follow count .

would be higher? And I mean, I occasionally a patients who were very Young but infertility or one of freeze their eggs, I also patients and that a drain who are in premature variant failure, right? Because there can be things that go wrong even early.

And but we should provide highlight again something that you said earlier. But gosh, you know this like contradict so much of what out there, which is that even if you have low follow count, if you collect eggs, you're not changing what's in the world. You're not pulling from the world, right? That there was egg spent. You you now have the opportunity .

to turn them into potential dove into ibf. But that's the next wave of technology, is what we call IBM. In beta maturation, people are trying to figure out how can you get eggs from the volt and get them to grow in the lab because that would open up possibilities for people who have fewer eggs to have a higher efficiency of this process.

Because one of the limiting factors when you're doing fertility and you're doing a freezing or ibf is how many eggs can you get per month. And that's why some people have to do cycle after cycle because they can only get five x or five eggs. But if we circle back to what we were saying when we got off on this beautiful agent is that no matter if if you have five or you have two eggs outside the ball, you're ob illness one.

So you're trying to get pregnant naturally. That's what accountability is, probability of getting pregnant permanent naturally. You have the same chance if you have the same age, regardless of if you have five bags s or you have twenty eggs and that's why A O came and said, well, A M H does an impact.

Accountability IT doesn't predict your ability to get pregnant or who's gonna infertility and who's not gonna have infertility. So there's no utility and screening for IT in people. Now for one, some speed less.

I mean that that argument makes sense through the lens of just probabilities of pragmatic cy um through natural conception. But IT completely raises the very, very, very real situation where people are making choices about, for instance, when they're not to stay with a given partner, where leave a given partner, they're not to accelerate process .

of building a family.

Like there are so many factors that this american college of hover, whoever like completely .

you going in like there are big deal, but they're crazy and that's what I say. They they argue in their statement that finding that you .

have I an analogy that doesn't fail. But it's like if you can it's just like saying, okay, if you can walk now, great. There's no reason to test for this inevitable paralysis that's going to happen at different rates in different people.

And there are things that you can do to offset. In other words, you could like take a little bit of some tissue that will allow you to walk in the future. But we're I can do that because if you can walk now.

you can walk now.

that's absurd.

That's really what IT is. And they say, well, finding not that you have low over any reserve at a Young age is going to cause undo stress. That is unwarranted because most people don't have infertility. And so they're purely putting IT through the lens of you're likely have to get a mate. What will stress exactly if they .

were just stressed? Like, hey, guess what you know I know people who have family members with hunting, consumer stations, and some up to not know whether not they themselves have have the hunting and mutation and and it's a very personal choice, right? But here that were as unfortunately, there still is a cure for hunting. And holly, someday there will be now come would. But in the meantime, there is essentially A A cure for this situation, which is the harvest and potential feriz ation.

at least an opportunity. And this is what I say. And of course, you and I feel somebody, education and data like being the one to make the choice is an extremely important distinction, is having IT happened to you.

So if you were Young and you find out you have a low overy, an reserve is like gona make a difference and IT very well. Might you might now freeze your eggs when you wouldn't have? Otherwise you might now start to try to get pregnant if you're partner when you otherwise, we're just waiting the .

conversation with your partner because a lot of people think they can wait.

I'm only thirty, I can totally wait. But if you have a low of van reserve, then that you may lose the opportunity for parent hood. And for a lot of people this is a life goal.

And this is what wild to me. When on earth, besides reproduction, do we have a life calls that we take the approach. I'll just wait and see if its a problem later.

Never right. If you want to become a doctor, you want to become an athlete, you are constantly working towards that goal or understanding what is going to take to get there. But why does the goal of parent hood? The attitude is completely i'm not going to think about IT until later, and then i'll deal with that if he becomes a problem.

Because you could make change choices. You could freeze your eggs, you could try to get pregnant sooner. You could evaluate for reasons of low over pressure.

You have a genetic mutation or an auto omi disease. Why is IT low? It's not just always a big unknown.

There can be some actual things that potentially might be impacted for your health. Long good term. So I think it's wild that this is the current conversation. And I will say I know personally a lot of O B G I N who one hundred person will draw a amh blood task if you're at your annual and you ask, and I recommend all of my O B friends, because I see people at a different state dry when they see me. They're strugling to get pregnant or they want to freeze their eggs.

But when we talk about this, I say, hey, just like you say, are you trying to get pregnant now? And if somebody says no, and your follow up question is, what do you want to be on birth control? The same question should be, well, do you want to be pregnant at some point? And if so, should you consider freezing your eggs or getting this blood test checked? And very often people will make a different decision with that information.

So glad that you're highlighting this because my understanding is, at least in the state of california, I don't know about other states or if IT even varies by state, that the opportunity to harvest eggs uh and freeze them, there's a hard cut off at age. I think IT is forty two private age forty two they'll do IT. After forty two, they'll do IT if and only if you're willing to do in vitro feriz ation actually feriz and then they'll freeze embryos, but they're far more reluctant to collect eggs after age forty two.

Yeah yes and no. So when you think about eggs and and ibf are really the same process, right? When you're going to the exact same thing, you're taking the exact of the body and then you're either just freezing them as an egg or you're fertilizing them in the lab and that ibf and making an embryo right away.

X zine has changed dynamically over the past ten years, wherein years ago, survival rate of eggs in the lab was forty percent really terrible. And so we really didn't offer IT to many people. IT wasn't something that was talked about and now IT feels trendy, but it's really just the tech has gone so much Better, Better.

Yeah, ninety percent of x now survive the freestyle. So ninety percent is not a low number by any means. Embryos are much stronger, right? And eggs, a single soul is single.

And embro, when we freeze in embro that stay five or six is three hundred plus cells. So it's so much stronger, those embro survived the freeze. Thought ninety nine percent at the time.

So yes, there's a nine percent difference. That being said, making number goes is a lot more expensive. Eggs is cheaper. You could do two rounds of eggs and have just as many eggs, or we have more eggs then if you'd made them in to embryo s right away.

So I never recommend that somebody commit to a farm source that they don't want to have a child with, unless that the sperm source they want to have a child. And this has changed because when ebro survival was so much greater than egg survival, especially if you had few eggs or you are older, making embryos was the only option. What we do know is that equality decreases immensely as we get older.

And we've touched on this. What we haven't really mentioned that. So not only do you have your eggs as you get older, the criticisms inside start to lose their position in ing. And so we think about equality, we think about genetic Normalcy, and we know that the rates of annual logy or abNormal chromosomes increases proportionally to your aid.

which for people that don't know where are going to predisposed, not always um to miscarriages if they're implanted or potentially even at the formation of a feed that Carries, for instance, tries to mies. So missing, repeat or um lack of lack of certain criminals. Ms, this could be deadly or they could be um capable Carrying to term and then but have undetectable to mild to severe developmental abNormalities.

Correct correct this this is why you have a lower probability of pregNancy per month as you get older. So we look at your natural accountability. It's not because you have fewer eggs, because we already said your eggs per month that doesn't impact your probability getting pregnant.

It's because the Normal sea of those chrome zones has changed so dramatically that the odds that your body's randomly choosing the good one to emulate become so low. And that's why those natural fertility rates are so low, because most genetically abNormal eggs do not fertilize or implant. But if they do, they have a significantly higher chance of this care.

Just forty percent at eight forty, right? So you have a much lower chance, are seeing the positive pregNancy test, but then your chance of losing that pragmatic cy is significantly higher as well. So when we are canceling somebody about egg freezing, what we know is that not every egg is going to fertilize with firm, going to make an embro, going to be genetically Normal, or even implant when IT is genetically Normal.

There is huge loss and human reproduction, meaning the more eggs you have at a Younger age, the Better the rally on this process is gonna be IT doesn't mean you don't do IT when people get older. But every clinic does have a cut off and every clinics can be a little bit different. A lot of different reasons why we actually probably older cut off. So we will let somebody to go through I B, F or freeze their exact forty five.

And it's a lot about informed consent and having the approach that you're smart enough that if I give you the odds and I walk you through how many eggs you are and the likelihood of them making into embryos, you can say yb t four eggs or ten eggs is way more than zero based on my circumstance, and that is worth IT to me because IT gives me the opportunity to potentially have a child when otherwise my opportunity is going to be zero. So a lot of this is rooted in pretty nal ism that people can't, as a patient, understand these odds and they have unrealistic expectations. And there's a huge shift and reproduction medicine to really counselling patients and giving them autonomy and some of these decisions.

But there does become a point where there's the likelihood of finding a Normal egg is so, so low that the money or the expense of the process doesn't make sense and people should utilize eg. Donation or other opportunities for conception. This drop in both the number of eggs and the equality, they really start to become so profound at age thirty seven and on. And that's when we really start to see both these things are overlapping at the same time.

So if you're waited till age thirty five, thirty six for your first kid, but you want two or three, we've got to really look forward about is that is that strategy makes sense? Well, what is your ih one? Or you gonna run out of eggs before then to how what other issues could be going on? Is the sperm fine of the tubes open? Because we are seen that when people start families later, when people have more chronic illness and auto mune disease on obesity, that is much harder to get pregnant. And so the birth rates, right for the first time in a long time across the board are dropping and infertility is rising because of all of these factors combined.

So based on everything you just said and and if someone to say IT of five time because of misconception about this is one of the primary reasons why people avoided harvesting eggs, not the only reason, but when you harvest eggs, freeze them now sounds like the viability of those exit is quite, quite strong compared a few years ago. So that's great.

Ninety percent recovery when they for them is not going to diminish the number of eggs in the volt. Such a critical point. And post the age thirty seven, there's a sounds like an online ear drop off in equality for most .

of these are averages.

Everyone, people, pregnant, healthy kids there forty years. Yes, we hear you. congratulations. We're happy. But this speaks to the end of the the logic. Anyway, we're not putting any emotion or circumstances on this, but the logic of somebody in there, let's say, late one years, early thirties, getting their amh levels through us, roughly eighty dollar blood draw.

And then perhaps based on their life goals and circumstances, doing either one or several rounds of eg collection in freezing, especially since IT sounds like you don't need to fertilize those eggs. So if one doesn't have a partner is concerned about what they're going to do, who's who's going to be a who's going to provide this firm? You know, because, of course, some people choose to raise kids on their own, but parenting is a whole other issue.

But they could do that later. So that raises the question of what are the health risks of any pain levels, if any, and then include psychological pain of eg. harvest.

I I mean, so going back to what you said earlier, this is going to be injecting synthetic myrick of F S H um falk stimulating hormone and noising hormone on maybe some growth hormones. I hear nowaday there's also the practice of injecting um uh is are essentially plate IT rich plasma P R P A T rich plasm excuse me, P R P. And perhaps even into the overinvolved, we can get back to that.

So there's a bunch of stuff that's being done to someone. There's low stem where people are getting like low doses of these drugs. There's high stem words like a full blast maybe could walk us through that procedure and just sort of general contact.

As you know, I would require a lot of time to go through IT, all in detail. But is this a horrible thing to go through? Is IT mild. To go through is IT like a walk in the park.

Let's walk through at all. So I, I love this and this, my bread and Better. And this is what I do. Day studies tell us that if you are not ready to have a family by age thirty two to thirty three, that is optimal time for the average person to in intervene and freeze their eggs.

It's not up for debate, is when you have both, the intersection is still a good egg quality and good egg quantity on average. And so that is Younger than a lot of people are thinking about having families. And the reason why is we really think about what happens to the egg afterward.

That's what's really critically important. So when to answer the question about what you go through, but just thinking we ready said you freeze your eggs. Ninety percent of them are gonna vive, the freestyle. About seventy five percent will be fertilized by sperm, and about fifty percent of those will even make IT to an implantation stage .

embro or assuming healthy sperm. So first note DNA excessive DNA fragmentation in on the head.

One of the biggest issues with egg is I don't know the future. I don't know if this farm is going to be great or not. I .

don't .

smoke, but we don't know, right? So we have this future yer firm source. So I am going to assume you're going to fall average on these data points that we're going to walk through.

But the reality is you buffer the risk by having more eggs frozen, and that's why people are going through multiple rounds or cycles because we don't know we don't know how that fertilization will be. If you have twenty eggs and eighteen survive the freestyle and fourteen fertilized and seven make IT to the glasses a stage. If your age thirty, we would anticipate around sixty to seventy percent of them are gonna be genetically Normal and you're Young.

That's that's arty, kind of a big hit at that age. So let's say of the seven, four of them are genetically Normal. When I go to transfer them, I have a best a sixty five percent chance of live birth per ebro, which is really good when you put in the lens of accountability, and peak .

success tends to be .

close to twenty percent.

and you've to.

people ask for two doctors will do to IT IT lowers live birthrates if we are looking at giving each embro the healthiest opportunity of becoming a baby. Number one, embryo s with iba have a slightly higher chance of monos. I got a twenty rites of twenty for tunnel twin comes.

If you educate two eggs, they both get fertilize. So each baby is completely different. Genetically own egg on sperm monos. I got IT is from an embroidered t because of the ibf process, likely putting the embro in the catheter, maybe having that, you know, outer surface touched predisposes IT to split in after you put IT into the bodies.

So more identical twins, yes. One three percent .

chance of month. I ve got twins with ibf. And the natural chances point of three percent, so significantly higher, even though ultimately not a probable outcome. I'm going to a have a couple patients a year who are going to have month. I got twins. And if I put two embryos, an i've now won, taken this from a potential twenty pregnant to a trip, litter, even a quad if they both split.

So I hence presuming like the opm cases and things out .

when they just literally put eight and inside. But that's a whole memetic ical practice. But really, most of the time when we're talking about embryos, we're talking ing about people with infertility or people who spend a significant amount of money, a huge portion of fertility as embro quality, right?

The competency of the embryo of the genetics of the embro is expensive to go through, eg freezing and ibf. Yet the eur environment is another component. IT doesn't make sense to waste. Multiple emerges in the same ur environment statistic does not make sense. IT also doesn't make sense to make your embryos compete .

against each other. So will people put one embryo into, let's just say, DNA mom, right? And one into surrey mom and and try and get two siblings simultaneously. I've definitely .

done that and had patients to do that. It's not common because serez acy using logistic rational career is so expensive and there's such a limited supply, it's very hard to find somebody who wants to go through the act of Carrying a child for somebody else.

But that definitely is a strategy that some people utilize, especially if they are older or they're concerned that they might have a lower chance of implantation, but they want to to give themselves as a try. But if we look at one ebro, sixty five percent chance of success, humility, probability, after the second is eighty eight percent, okay, almost everybody's pregnant after two, and these are employed, genetically Normal. embrace.

okay. And then if you go to the third, so cute, timely. After three, you played embryo transfers, each one being a single embryo, ninety five percent of people have a baby in their arms, meaning the incidence of a current implantation failure is actually pretty low.

Five percent. But how many Normal embers do you need for what family size if you're freezing your eggs because you got twenty x and eight thirty example I gave, and you just made four Normal embryos, right? So that's really unlikely to make three or four kids IT would IT has a really good chance of making wine, gives you the opportunity for a second.

But that also presume everything happened perfectly, that the sperm is not pot smoking sperm, but you know not bad quality sperm. There's not other environmental issues when IT comes to your own health, when you're trying to get fragment ant or other diseases you may have. So we really need a higher number of eggs, specifically when we don't know what the equation will truly look like for one individual person when they go through the process.

And one of the only added benefits of ember, especially if you are partnered, if you're with somebody who you do want to have children with, you just don't want to have them yet, is that I know the downstream, I know the number. I know how many embryos I have. And if it's not enough to give you a high chance of what you want your family to be, you can intervene now, right? Because by definition, with egg, zy were not wanting to be pregnant for years. So if you're doing this with a partner and you are making embryos, and now I say we only got one genetically Normal, you have the opportunity to choose to either go through more cycles and store more embryos for later to maybe try to get pregnant sooner because there's some underline issue with your fertility. You can make a choice because you're selling off the curve there.

Could I ask a question? So this, uh, you mention age about thirty two, three, three. In ideal circumstance, with the finances, there is set a one with harvest maxon less. They are already starting a family through natural means.

What about for sperm? I think we've all heard the studies that with increased stage of the sperm that there's a higher, although still statistically pretty small, intense of things like spectrum conditions. Um so do you recommend to Young ger males, men in their late twenty early thirties, to free sperm?

I mean, it's never gonna wrong to save your game. It's because we don't have crayon balls for the future rights. Your gametes are your eggs in your sperm.

That increase in will just say negative outcome from advanced potential. Age really started ts to be seen at age fifty. So most men are not looking at primarily starting their family after that age.

However, what iron into all the time is maybe you're working on a second family or maybe life has gone on a different pathway and now you're with a partner who potentially is Younger and wants to conceive, and you now have older sperm having sperm. The bank is so cheap and easy to free sperm eggs. I have any answers to your .

primary question. And the process of collecting sperm, well, well, not entirely without its issues .

is is for it's embarrassing best.

but it's simple, simpler is generally doesn't required more injections, although you know maybe for rare instance, ces where people are hygd add or something.

But if you're going to freeze your spam, you're right. You typically you're going to get some blood word done because most places that stores sperm per f eight guidelines have to make sure that if you Carried an infective disease is stored in a special tanks. So i'll to get blood word done, you have to have stained for your two to three days.

collect into a cup. You are done, which, by the way, guys you can do at home and bring IT in. Sperm so stable you've never done, just bring IT in.

It's a little my friend did this and told me but you know it's it's kind of rage ously easy in the sense that you just bring IT in and they're like, take IT out in the lobby like is that your name? And they're like the very different in the eg. collection.

So here's here's what I say about the and but I wish more man new such more in dead. If you're gna get of, accept me because you are choosing that, you don't want to have kids. And we see many men who do this.

They say they don't want have kids. They want to go get of access to me. Yet later on in life, you don't have a Christal ball about. Life is dynamic and things can change. If you're going to get of access to me.

go free spin first. Why are so many en getting activists?

I don't have the answer to that.

I think now a .

lot of them are getting activities even. I think they just take control over not having child out there when they don't want to.

So maybe this explains the drop in birthday that so many people.

even if you're in your family, that you have two kids and you're decided you're gonna get the vet to me so that you don't have any more children. Things happen, terrible things happen. Life changes.

There might be a circumstances, ces, where you potentially would have another kid if something really bad happened, or you just change your mind. Freezing firm is so easy and so much easier than if you don't. Not all of the sector.

My universals work, especially the longer that it's been reversed, the lower the likelihood that is actually going to work. And very often, if IT does, you don't get sperm and sufficient levels for a time in our course. And you're seeing .

me in the office and in freezing sperm, cheap and it's .

relatively cheap, like four hundred dollars, right? So it's it's much, much cheaper all in than the entire egg freezing process. So to answer the original question, when you go through eg freezing, most people do fantastic and will just use egg zy and ivf and are changeability here.

Because what you as a person is going through to harvest your eggs or should take them out of your body is exactly the same. The distinction between a freezing and ibf is all about what happens on the lab end of IT after they would ve come out your body. So if we have this group of eggs that comes out of the volt, your body doesn't want to allow them multiple w even if it's a low number, right? That's the checking baLance to not have so many kids.

So we need to overwrite that process. And what we tend to do with this is to use a combination of formal medications, and very often I described to patients as suppressing your body and then stimulating IT. So if I can temporarily ily stop the production of F, S, H, and you have a group of eggs come out of the volt, and we can imagine that fsa is their food, and there is no food because you're taking the birth control.

L, for three weeks, these eggs are going to synchro ze, be very small, be very hungry, for a lack of a Better word, the F S H receptors are going to open all up. It's like a nest of baby birds that are all starving instead of the hungry burgess, the warm. So now we go with the suppression period.

For a few weeks, we can come in and give good editor bes, which is F S H and L H. F S H is now esthetically made in a lab very easy as synthetic compound that mixes the structure of the brain. F H, we actually can't synthetically make L A very interesting. We don't have a way to make IT yet. And so we use the purified eura of mental puzzle women because when you're in mini pause, your f and L H levels are naturally so high because they're trying to get egg to make some extra jam.

So here some that we've covered me from one health before um and there's been a discussion of H C G human korean ic at a trope in and which is essentially mystic L H .

but the receptor .

IT does yes right? So is um dragon al at human korean ic canada or open? Is IT purified from postman apostle women's you're in? Or is it's synthetic?

Hcg is synthetic .

and so .

it's called manipur appear is a combination of F, H and l. The reason why we give hcg to men to try to stimulate the super meat genesis process, which of course, if we could just give valid, we'd give valid. It's the same reason why we give hcg for a trigger if we are going to go through fertility treatments.

And we're trying to mimic that A H third, which naturally would cause eola's. We actually are giving hcg because IT does mimic, allege when IT comes to the reception action of IT. But when IT comes to really, especially in getting folicur development and the relationship between A H and fs h, meaning l is really providing some of the hormones substrate that we need to be able to make air dam.

And so you really need some L H in a lot of people, depending on your protocol. Or if you're older and you're naturally making less the example, the issue would be like the P C O S patient who has some naturally high L H. Sometimes they don't actually need alleged and .

their protocol. Who are these postman .

and women that are .

supplying their earn? They're parent. Yeah, yeah.

Go to the menu paid .

to you in IT.

IT is called manipur. Like it's purified, many puzzle and right, wild. Most people don't know that. They know now, now they know. And so we use afa sation, Alice will just say, and lack of Better terms.

Those are the two primary compounds that we're giving over the course of, on average, a twelve period to get the folk les to grow and the estimator so you can measure act maturity by blood levels of extradition and by transformational ultra sound. So when you're going through egg freezing or if you're taking these hormone shots of F, L, H, and they are getting those policles to start to grow, the eggs are starting to mature. We are monitoring them along the way, trying to determine the time period where we think most of the eggs will be in the mature range.

These acts have gotten to maturity. You then are going to take a trigger shot which allows that final stage of my osa. So those chromos ones can separate, right? We think about the egg.

We remember that Normal female genetics, forty six xx. And I always think about in the egg that these chromosomes are lined up, your eggs are frozen inside your body when you're born, and your eggs are in metaphors of milosis. So that's when great metaphors crimson s meet in the middle, and they're held apart by these biotic penders.

And this is why eggs are so stinking fragile, because they are healed like this. And those my ox penders just absorb the wear and tear of your life. But when you use that trigger shot, that lh surge naturally, or that hcg in a cycle, that's when you're going to get that final separation into half the eggs. You hf those criminals es into the eggs.

So for people living to think about um like a zipper and you pulling a part of of a zipper, that then you now have the chromosomes, just one one you know have ha the chromosomes. Because why? Because in successful realization, the other chromosomes are going to come from.

And that's why this process has more error. The older you are and the longer your criminals have been sitting there because those spindles are going to breakdown and we're gona have that increasing and employ, like we already said, purely because of this impact.

Can ask a question about that because I think that would be the right time to ask, which is that understanding is that a lot of the dynamics of pulling apart of this is impera like thing these chromosomes and then um is related to medical al DNA because there a lot of means we're literally talking about an ex splitting .

itself in half and .

power house yeah the market and so meta condi aal health is a big topic these days um and so we sure to touch on nutrition supplementation, prescription drugs that impact my a country of health. I've heard of a new procedure um called three parent um I V F where they're taking basic the DNA from. The intended mom, the D N A from intended dad um and then putting IT into us a surrogate.

I have a donor egg that is where the DNA has been sucked out and then because IT has held healthy eer Younger uh my control DNA. So you're essentially um less that you've got A A couple in there like the thirties early days and they're not getting successful in rio or implantation tions or whatever things aren't working. They'll take the DNA for mom and dad and the merger with a third parent um in capitation that there are clinics that do this.

I know that um a lot of this has actually been done in yesterday, europe until until recently, uh mexico offers is their places in mexico that do this. Uh in england it's been used to um solve uh my kind of this function um but in the U S is still not legal. Is that right?

yes. So the purpose of what you're talking about essentially we think about utilizing um a donor meta contra donor egg. The point of that technology existed to help cure my condo al diseases, which are a hundred percent fatal.

And so you would have the subset of people who would, because if you are the mom, you always pass on your meta contra to all of the offspring. So if there's disease inherent in your, my country, everybody's going to get IT. And these are very severe diseases. So the idea of this was first to say, hey, can we overcome this, my country of disease, and give up people? The opportunity wicket has done that right now.

So IT works went done properly .

when done properly, especially for that purpose. Now that purpose is distinct because those people aren't in feral, right? There's something else going on within their meter. Onal disease, utilizing this technology to overcome anger related changes in the eggs has not been successful yet.

Are we hopeful that I can? Will people charge you money for IT in certain places? Yes, but you you're hitting on a really important topic is that the political environment of embro research in the united states makes IT extremely hard for us to be the pioneers of new technology in this space. And that is because a lot of views about an embro or windows life began that happens here in the us. That results in limiting the availability and the possibility of doing research in a meaningful way on human EMS, right?

Because they would require the destruction of a lot of, and IT would also. And I looked into this a little bit as IT from an academic perspective um to be clear, um IT would also require that um the abortions be performed differently because section abortions destroy embro in ways that extraction versions don't so that there's S A very controversial topic. I mean, it's um it's only that maybe we return to an episode about stem cells.

Yeah it's fascinating because especially if you look at ibf, the whole separate issue is that there's millions of emerges that people are no longer using because they have had success. They had extra embrace in the bank. They got to force a variety of reasons, and a lot of people would like to donate their embers to science, feel like, hey, I don't want to have this embro implemented.

I don't want to Carry this child. But potentially, could something good or could have help advances the field. But that's not really a tangible option. And when people do that, what is actually happening as their embryos are being utilized to train embryologists, which is valid, right, to teach them how to buy in freeze and biopsy and do different things. So it's so useful, but it's not in a meaningful way like we d really love to be able to utilize to advance the science, especially for these embryos that have been created yet people no longer need them for family growth.

So what happens to all the embryo that .

people don't use anti s right now? They said in storage, this is, well, this is a new problem. Okay, ibf is only forty eight years old, embryo freezing alone, right?

The first ivf, we have anyone gone to the whole process, but the first I V F baby, there's no F S H, allege to stimulate. More of the eggs are outside about to grow. So they followed the single follow, and they didn't have the procedure, which we do now, which is a minimum impassive procedure, to extract eggs.

We go vaginally with a needle attached to the ultrasound, and we enter into each follow le, and we drain IT. The very first idea, you followed one policy, and you were in abdominal with a surgery to give that needle into the follow and drain IT out and give that just one egg chance. And then, of course, there was no emeria freezing originally.

So the field is still rather Young to understand some of this. And as technology rapidly improves, we see things like Better success rates with freezing and dying embryos, Better process of getting more embryos to grow. But now with a lot of embryos in storage, that mayor may not be used. I personally tell people, bom, you should keep your embryos. You should pay the storage fee until no matter what the worst thing on planet of happens to you, you're done having children.

Because sadly, I live in a spectrum with my field row, see a lot of sadness and people who maybe you have lost a child, something else has happened and they have maybe a sibling who they feel like they really want to give the sibling child the chance to be a sibling again. And often you're much older when you experienced in this. And if you had had embryos frozen that you could have used, but you've got rid of them, you can be really upset if you find yourself in that circumstance.

So I say you should save them as well. You know that you are not going to need them. And then what do you do with them? Most people just discard them. Some people will donate them to labs s which is called for research, but mostly it's for embro logic training to get .

Better at doing.

which is important. Um but embro donations a new thing. So being able to just like we have people who donate spam and donate eggs, ebro donation is the next evolution of an opportunity to allow more people to become parents. It's a little bit of the wild west people finding people in facebook groups and connecting as this whole other dynamic when IT comes to what we call third party reproduction or you know what do you do with known donors and things like that, but its a very interesting concept. So this problem is emerging as the technology is getting Better.

I'm realizing now remembering rather that when I was in college and graduate school, you'll see these ads in the student paper for eggs ors and sperm donors supermarket generally throughout the lifespan. So that's a of less controversial issue. But this is now not allowed most places to advertise for for eggs or on college campuses.

That's my understanding. Um the eggs ors were often paid whatever whatever they were paid. I I say I was reasonable milor because I don't I don't recall what they were paid. Everyone circumstances are different, but the argument that most people use against this is oh, these these people are giving up bags that they could otherwise use but we now know that not true so to have any knowers like what what was the draw for for for limiting the recruitment of a donors um anyway have not are going forward again st I just is no longer supported based on what you said by the by the argument that they're losing eggs, they would otherwise be able to see .

some others about proper inform consent. Especially at an age where the financial incentive can be very persuade without understanding not that IT harms your fertility later, but that you're going to have genetic children out there and you might potentially, and we are seeing this now. We don't know if you individually will have infertility for a variety of reasons because you're not trying to have a family until much later.

The same concern doesn't seem to exist for men who are donating experiment.

I mean, should there's this whole donor conceived community where people are really talking about putting new restrictions on, will you sperm donation? For example, there are sperm donors who have hundreds of children, hundreds, right? There are these sibling pods because it's been so unlimited.

And sperm banks are a business that worked to make money, and they make money by selling more sperm. But that's not healthy. One for a population, you need genetic versy, but also it's not healthy necessarily for one person of all these have siblings. And to just not know when you're going to run in to somebody who could potentially be your sibling, is that this guy at the bar that you like? You have to worry about that if you're donor conceived.

So we're starting to sea sparing banks finally started to real back and put limitations on how many families total children's terrify because one family might have a child and you want them to be able to have sibling children, but at least for how many families that, that donor can contribute to. And we're seeing sperm donors deal with the fact that now there is no anonymous donation, we can act like anonymous donation exists, meaning IT is not identified at the time that somebody y's utilizing this firm. But with direct consumer testing for genetics like twenty three and me and necessary people are being connected with their sperm donors, with their eg donors, with their sibling pods.

And we have to believe that technologies is only going to improve over time. So what people do for money, especially when they are Young, I think, without understanding the potential rain a fictions, and I don't want to act like sperm donation or examination are bad. They give people the opportunity to become parents that otherwise might not be able to.

And that is a lovely and a beautiful gift. But you need to understand what that might mean and how that might impact your own potential shell later, too, to know that there have genetic captions out there. Egg donation people do get compensated much Better than firm donation.

There are certain charteris tics that are hard to find that IT get compensated even more so. And certainly ethnicity, doctor degrees and things like that, where somebody can only pay for their education by donating their eggs. It's it's a dilema because what you'd love to say is like freeze eggs for you too.

If you're gonna that you're at the perfect age to freeze your own eggs. And there has been strategies to try to mitigate this. And I don't want to get off too much on attention, but it's a really fine line that you walk with what people understand. So there is a company, and I won't name them, but they are promoting that Young women donate their eggs, and they will freeze half of them for you, and half of them will go and become donor eggs. No interesting business model.

but I could see the potential ethical concerns.

So I think ethically, this sounds good because you get to freeze. Gg, but I think more people will donate eggs than otherwise would have for some of the reasons we previously stated. And I also think you would get more money by simply donating your eggs and then turn around in pain for us round to freezing your own eggs.

You would get paid more and you'd have more eggs. Because one of the issues is, do do you now falsely believe that you have enough eggs in the bank because you did this split, but you don't really have enough because we already walk to the math at twenty eggs doesn't really result in such a high probability of having a multi child family. So you know there's a lot of ethical debate in gami and embro donation.

IT definitely is the wild west and there's a uncharted territory even in embryo donation. There's places who are very unethical about IT who will only allow people to have embed if they are had a sexual and married for three years, make a certain income, submit to a home study, yet they let the people have no say over the embryo that are transferred, be at how many, what stage, what quality. And they're taking people's money and putting terrible embroils inside of them and really wasting their resources.

which could have been used another way.

Dangers of profit of biology. I mean, entering spaces is amazing. But also technology starts to advances before studies, right? Tag is gonna become has more finance backing, then we see scientific that cap.

I feel like one of the major questions out there is whether not ivf babies just call them that have a higher incidence of things like spectrum conditions or other developmental factories, let's call them. And i'm not trying to be politically correct, but you, I think, notice that the word disorder has to be like really carefully examine when considering any neurologic and syria ric situation had discussions about this song, this poddar ast before. But but a lot of people are wondering, just to be direct, a lot of people are wondering, do more ibf babies have autism then non ibf babies?

This a good question, and it's changed over time in couple different ways. And I think this is important. understand. So if we just think about the hormonal environment with natural conception, and you know you have a peak extra gen, let's I have two hundred and something you have produce them being made. The plant is in planting.

And what is the main difference with ibf babies? And a lot of IT has been tied back to the you an environment, especially in what we call fresh embro transfers, which is really not a common practice anymore. So in a fresh embryo transfer, i'm going to take the exotic, your body vertical ism in the lab and grow out embryos.

And then i'm going to put the best embro back in your body five days later at the natural time of implantation. And if we rewind the clock, that's how ibf was done, right when you couldn't freeze embryo s very well and they didn't survive and you would put lots of embryos inside because they won't survive. And that's the early days of ibf when you saw a lot of multiples, a lot high order multiples. And of course, multiples have their own distinct issues that put them at higher risk for developmental disorders and issues with development and birthrate in general.

They're a gbp fair they are commonly refer to as as disorders. I just think around autism in particular that there is there is a camp, a growing camp out there that um what want you referred to differently, we have cover this at any time this comes up. I bring up both just a highlight of that, that yes, we are aware and sensitive to that emerging issue right now.

Unfortunately for sake of conversation, there's no new naming creature so we could easily get caught down in in the in the attempt to try and like you know, i'm smooth over everything with everybody and and as a consequence, confuse everybody so I think will go for clarity forward with the understand that the nomenclatures is changing. Can you say alcohol anymore because it's alcohol use disorder? And I don't have a problem with that. But a lot people wonder those are two different things.

It's confusing. And we want to simplify .

science for people. So feel free.

So when we first do in abf, we're putting embryos back in extremely unnatural environment. If you have two eggs growing and each egg makes two hundred pek grammes of surgin, suddenly now you have these extremely high super physiologic emerging levels, higher protesters on levels, because there is more crop s ludibria. And this environment is not the Normal for how the plant to would invade into that maternal blood circulator.

And a lot of these issues that are commonly associated became so because of pluto issues. So a lot of things like growth restriction, small projection, age return, birth, which further put you at risk for other developmental disorders, were associated with these fresh transfers. The fields is change.

We do a lot of frozen and embro transfers on a lot of IT. For this reason, we see huge improvement in united outcomes when you lead off that high hormonal utter n environment and then we grow the lining of the uterus and a hormonal level that's more natural and then transfer the embro and we see completely different beetle outcomes. So that's fantastic as far as looking at the change over the field.

But of course, if you take all ibf babies over all time, it's a little markey because you have modern practice and old practice. We also know that infertility people, if you get diagnosed with infertility, so you are under age thirty five and you try to get pregnant with regular periods for one year and have not had success, or you're thirty five and older and you have tried for six months and you've not had success, you meet the medical definition for infertility when that happens. You now statistically, regardless if you get pregnant naturally in the next month or you do ibf, you have a one percent higher chance of earth effects and you have a slightly higher chance of developmental disorders.

So is IT more population based versus procedure base? And there's probably something to that to underlying a lot of potentially what goes on or what can cause and fertility when IT comes to, you know, quality of eggs or you turn an environment or things that we're still learning about. When IT comes to autism specifically, the number one strongest association we have is advanced ternate age.

So when you look at the people and the male sperm comes from an event lation after age fifty, that one does have the highest significance associated with autism, and also with some other very interesting autism dominant disorder ters. So we don't want to take advances poterne age likely, although IT does get so much less attention than what we call advanced maternal age or being over age thirty five and a woman. And that is purely because of the differences and the firm and the egg environment and how their quality is impacting.

Thank you for that answer. I think um it's really important for people to hear that because you know the law out there is that ivf higher incidents of autism and ivf babies but sounds like a good percentage of those um could be because of isolated factors um as well as technology related factors that um and that the technology is getting Better all the time.

Um if I understood correctly, we didn't complete the discussion of of ivf and I want to do that talk about X, C. And a few other things. I know that that stuff in your whales before we do that, can we inject a little sub conversation um around this because I neglected to bring this up earlier and I know there's a lot of curiosity about this.

And then and then finish off I B, F. Can we do that or of a pause in the ibf? So the eggs are out the frozen, sperm out the frozen or maybe they can put lifespan m on a non frozen, excuse me, sperm directly onto those unfrozen eggs will pause their intermission for those potential embryos.

Um and talk about something that you've been um very a open about which is um and a lot of people are not Frankly in your profession. So I really appreciate this, which is nutrition and supplementation to optimize the health of equality and and not just for people want to get pregnant, but but for people who believe that futility is a proxy for overall health. So I mean, are there there are things that people should eat and not eat on, things that people should supplement and not supplement in order to optimize their fertility? I mean, this is definitely .

interests of mine, right? All my fellowship research echoes around for the ability and natural fertility. And I think we really do a disservice by how medicine really is categorized by organ systems because we act like things in one place don't impact the other, right? But if you have a body and your body, and specially your cormon's change and fluctuate in their minto, they are meant to be a dynamic ic system.

But the world in the environment of which you are subjecting your body to has proven changes on both hormonal function and also when IT comes to egg and sperm quality. And so if you are somebody who just wants to live your healthiest life and have your most regular periods and have your hormones as well baLanced as they can be for a lack of a Better word, will just say that that means that they're functioning Normally. Then paying attention to the things that you do are really important.

And so I know this is a big one for you. Sleep is probably the number one thing that people don't do that doesn't act their reproduction formal system, and therefore can impact against gram quality. Because sleep as win, you have cellular repair.

And when you can drop your inflamed tion levels, we know that information is just toxic to eggs, and firm IT is inflammatory environment is not ideal for conception. And then for a female, you have to deal with the fact that you have your equality, but you also have how inflation tion or what you're exposed to impacts your u. Turn environment.

So you have a two old situation here. So none of this should be shocking news when IT comes to nutrition, but IT is not talk about enough. You're rate decreasing inflation tion by the foods that we put in our body is consistently shown with an improvement in accountability, an improvement and ovulation and improvement in success with f in a decrease in miscarriage, right?

Huge studies have did these. Now the VC caviar is that nutrition and studies are super hard, because people who consume flax, for example, tend to have other good health behaviors that sometimes make IT hard to identify what flax did versus their general health, versus somebody who eats fast food every day. So nutrition studies have to be observational, and fertility studies are really hard to, because what in point are you using? Is that getting pregnant? Is that live birth? Are you looking at via? Are you looking at natural fertility? And we have a lot of different overlap that makes both of these a little bit difficult.

And so there are all cohorts, base or population based studies, where you analyze how people perform when IT comes to fertility treatments or getting pregnant naturally based on their exposures to certain things. Diet high in fruits, vegetables are good for you, right? Fiber, any accidents, fruit is not bad for you.

Got this really bad reputation. Look for two. But people think that IT has sugar.

and that is bad for you.

but not that type of sugar is not bad for you. If we can just agree on the fact that fruit has a lot of nutritional benefit, especially when IT comes to vitamins and any accidents, that can be extremely beneficial in decreasing implementation grains. So whole Greens, especially that your body, you can provide a lot of great fiber.

So of course, if you have fully agree you're gluten tolerant, you a different category. But there were so much focus on kito and people eliminating grains as a food group overall. And even though that might be utilized in a dietary strategy to lose weight and losing weight can improve fertility, likely because of inflation, tion be in the primary driver because we know that even in studies where I take donor eggs and I transfer that embro into somebody who's overweight, they have lower odds of success.

And if they were a Normal BMI, so we can act like that, causation is just on equality for mob city, right? There's also some inflammation and clamming changes that act the body's ability or desire to allow an embryo to implement. So fruit, veggies, whole grains are all good. Interestingly, you know, dairy iry tends to be okay in most studies, but what we do see is that if you're gonna have dairy, have whole, have the real thing, the process dairy, the skin milk, that actually decreases your fertility. And likely because the processing to make IT still look like milk when you take out the fat is add things that are unnatural, potentially .

impacting your fertility and I add, I I wasn't trying to at all, but um IT was just delicious. Um but so cheeses um hope for fat milk.

Yoo T O yeah but don't .

choose .

the skin one and choose the actual one that comes with some of the milk. fat. Fat is not bad for you. There's also this rate hopefully are getting away from up.

But there's been such a low fat craze, or this real attention that fat is so bad, but fat comes in so many important forms, overcoats and oils and nuts. Theory, meat fat in collection ol are the backbone for all hormones for eight. So you need that in order for your body to make the astro on.

But IT needs to allow this whole process to happen. And so there's this idea that those are bad for you. This was really not so healthy, fat, whole grains, fruits, vegetable.

And what about proteins to meet? Because I think within those categories, you, I might be fanned of sustainably, you know, like raised meets of, if, but if possible, some people choose not teach me.

But fish eggs love IT all okay. So let's just go through the meat and the myth and the fact. So what do you tou? So there is a big issue that I would, tofu has soi, and that too much soy can be bad, because I can be a fight.

Extra tofu does not negatively impact for tilly, even in men. In fact, IT can improve IT because IT does have some any oxide like properties. Lots of iron when IT comes to fish.

Fish are fantastic sources of healthy facts and mogi vi acids, which are very crucial in the reproductive process. We do worry about, if you're pregnant, having too much fish and over exposure to mercury, and how that can impact fetal brain development. So the general recommendation is three servings per week.

Guess the serving is like four to six islands is post like a real human if you you know six day baLances.

right? And I think it's important to say, even though people will tell you that when you're trying to get pregnant with the idea, we don't know when you're going to be pregnant, if you're going through things like eg, freezing our f and you know when you're going to be pregnant, I wouldn't feel like you have to restrict yourself on the consumption of seafood during those time periods when you know you're not pregnant t yet because really the concern is about that mercury. And what I could potentially do to a feeder .

brain and rossi food, correct. Well.

when you're pregnant, correct? And that's mostly because of the risk of infectious disease that can cause severe brain development and other issues. Where are? I don't know.

I don't live there. They are ly laugh at this. They probably do laugh at us. They probably .

do laugh at been pregnant in .

japan or .

conceived in japan. Tell us, don't tell us the story, conception. Tell us, tell us.

Did you have me? Overall, meat is a really brought category and study, study IT differently. Like, is that all me? Are you distinguishing now red me and chicken, are you putting IT all together? Me, obviously, I think we can all come to the agreement. That process means are not good for a variety of different reasons. In addition to be in personal gene, those tokens do negatively impact fertility.

Now, so delhi, meet. no.

So yeah, but specifically those things like the bag and the like, the things that are really highly process hot dogs, sorry, the force of I hot dog picnic. But those things really do not provide nutritional advantages and only harm, especially then when we have red meat. For the most part, red meat, when isolated individually, in most circumstances in moderation, tends to be fine.

I usually tell my patients, I went them, you a plant forward diet, but that doesn't mean no meat. But I say, look at your meat, sorry, means I don't want to read meat every single day because there was a study looking at idea and looking at embryos. And the more surveys, a lot of nutritional studies based things on cortile. So who eats the lowest and the second moves? And the third most, the top most in people who ate in that top cortile of red me had lower progression of embrace through the culture, so less embryos that developed, less Normal embryos and lower success rates.

And what do we know anything about the how that meat was arriving? Howk said.

wonderful. But that doesn't mean that they don't hold merit. And helping us died counselling.

But no, that one was how many servings of red meat do you eat in a week? right? So we don't really know.

Does the really ethical source, the grasped, you know, this environment, which we feel like is much less toxic than partially, I say, like a cattle factory where the cows are injected with all source of things. Is there a difference and how those impact your reproduction? Probably, right. If this cows getting injected with a lot of hormones, why are we thinking that it's not impacting the meat that you're then interesting into your body?

No, I think our audience will certainly subscribed to that idea. I think most of them, well, I mean the notion that like the pollutants y breathing the air somehow or not, the the error that you breathe here long as is just like completely, and the idea fell.

and they hold strongly to this idea that you can't be this thing that I love that is causing this problem, right? The denial of the association between what we put in and on our body and how IT impacts our body is function is really strong in some people.

And I think it's really just lack of education and awareness because the medical community for so long did not address these factors, right? Your doctor never talks to be to you about nutrition. And and so IT just became this idea that I must not matter, otherwise your doctor would talk to you about IT. I think sugars, the last exit mention, but added sugar and artificial sugars are bad for you.

Artificial sures, artificial sugars to including stevie or plant base low calory sweep itself .

hasn't been studied as much as the other one, things like sweet, low and all of those. But what we do know is that they interfere the cause inflation tion inside the body, and then they also cause and cause a stress reaction, and they can cause higher rates of miscarriage when you intake more sugar and artificial sugar, there's A A lot to wrap your head around. And I see the same thing to every patient, one cake, one, there's one hot dog.

And in those things individually are not going to make a differences, right? It's the choices that you make every single day that are going to set you up to be your healthy itself or not. And so you should make choices in line with how you wanted treat yourself.

You want to be in your best health. You want your hormones functioning the best. And if that added helps you get pregnant when you want to, helps you have a Better chance of success with ibf. Oh my gosh, a fantastic benefit. But that doesn't mean you can enjoy some of these bad things here and there as long as you've set yourself up on the day to a day where you are giving your body lots of nutritious food that IT needs to make cormon's similarly being a very underway in calories restricting, we all know, is really terrible for your reproductive system and can cause the brain to totally shut down or violation, because it's senses that you can have a pregNancy if people miss Carry.

Excuse me, for by virtue of being underweight, does the body like like I learned some years ago, I think this is still true that one of the signals for the onset of puberty and females is that left in a horn is created from body fat um that then signals to the brain to the pothole is like, okay, there's enough reserves to create environment. It's a signal about environmental .

yeah there's enough extra fact .

to have a baby and there's personally enough food around to sustain that baby right? Are miscarriages and lack of body fat correlated .

on both tons of the spector rates? The lack of body fact and being overweight, we see decrease and getting cragley per month, and we see increased and losing pregnancies.

So certainly, there is a healthy medium where your body has what IT needs that makes sense because if you have, I likes even say hypothermic disfunction, so maybe your brain is not totally shut off, words do not no hormones and you're not obvious you're not getting pregnant that circumstances. But certainly regulation disorders are on a spectrum where you go from a perfectly synchy cycle, two, one that prolongs, get short together than prolongs, and you have nothing. There is the spectrum of this function, which is your hormones not being necessarily perfect, and that can have impacts on the pleasant, trying to grow into the uterus.

I think the person is fascinating, right? An entire talk just on the person. But IT has IT is an incredible job where your body has to not reject IT yet, allow IT to eat away at the side of your uterus and grow into your blood vessels.

But that requires a very specific criminal environment for IT to be done and to be done, right? I think in the same breathe of all of this, what you are also asking is, okay. So that's eating healthy. None of that's really new news for most people. A lot of things.

I thank you. I think. I'm rarely, if ever, do we hear somebody so physician, be really directed about, like to listen some red me. Yes, not excessive amounts, ideally from sustainable sources, whole fat, no products, grain, fruits, vegetables. I mean, that was kind of straight to you seem like straight or directives are are actually pretty rare in the landscape of of public health discussion because more often than not people talk about nutrition and these kind of elimination diet type things like, you know, eliminate all the grains or eliminate all the me to liberate all the milk, milk fats, when in reality, I think people forget that, like most people out their own divorce, and they can make Better choices about, not deli meat, you know, less bacon, if any bacon, right?

Some buddies with your lunch, right? You can make Better choices on the day to day. I think that is a great point. I think there's a place for supplements. I think that a big disclaimer that everybody's going to say with supplements is that they are not regulated like the way medications are right. And I will say supplements and urbs are different things rate supplement. But many companies are adding urbs to their supplements and that can get into really merged territory, especially when IT comes to have some of these urbs do have extra in projection like properties and can impact reproduction and hormones.

even an endroit ic.

ah yeah so we can act like everything's created equal. So I was people, if I recommend you take a supplement or your doctor is your due diligence is to look at what is also included and make sure he doesn't have these extra added things that they're are unaware of because sometimes they can have negative impact at one stage of your life for another, depending on on where you are. Certainly, you know a preventive agent which has folic acid. We all know that folic acid is really important to prevent neural tube defects, but it's also important and sell division and how the over is growing politics and growing eggs.

So should people, women, but also men, be taking a vitamin with the acid even when they're trying to conceive.

There's no harm in having IT, but very often pregnancies occur when you're not trying to conceive. And that is a store that needs to be built up three months. I had a time.

So we really need you to be taking that ahead of getting pregnant. So not just let's get pregnant right now, i'm going to start this prenatal vitamin. So I recommend anybody who's in their reproductive years take a preventive vite.

We also know that many, many people are vite d deficient, and vision d does impact reproduction. And so I usually say a thousand international units of amin d is not going to be harmful. And anybody is going to be helpful for most people.

Some people definitely need higher levels. So we scream everybody with a vitam indeed to see who needs to have extra. But you know, a blanket statement that extra biting mini is going to be helpful.

Omega three fat asses, also extremely important. And one being entire inflammatory, but two brain development of a fears. So most pronouns now actually do have those mega family assets in them. But if they don't, I recommend a patient take those.

I just have a question assertion there. The there's a laboratory up at the university after you sent a barber that's post some really interesting data showing that essentially brain weight, which is just a one indirect measure of a brain health, but brain weight in a at birth seems to be correlated, at least in some positive way, with the amount of essential fatty assets that mom consuming during pregNancy.

Does that sound? Is that the and because my studies about mice are smarter when they have diets, you know, with negative facets when they are in utero, right? So the exposure on the time period is very important. No, mega is have a lot of help benefits when IT comes to there. Any accident properties, especially in like an indeed trios as diseases that are very highly, they can be very beneficial.

We're definitely to talk about your work about after baby is arrived in an impact of essential fats is but what would you say is the dosage cut off on this podcast before I ve thrown out numbers like one one to two grams per day of the E, P. A form essential fatty acid. And we have hold discussion, I might get through, you make a six ratios, but do you think there is a upper limit? Is, is is truly that, you know let's take up to four grams per day of E P A, is without be advantageous as a Better than one gram.

I people, a gram, a gram.

So that's an aligned with pretty much what we've talked about before.

So that's what I recommend. You know, when I give my hand out to my patients and they are trying to get pregnant is A A thousand I use of vitamin d gram of mega threes and in cocytus. So cocytus, which essentially in general is trying to help the meta country, that's the whole idea here that IT is helping provide support across the body.

A lot of different ways is right. Like coq son has used a lot of different areas, the body, but IT one comes to reproduction when IT comes to myo sis and cell division and violation and equality and even farm quality. There's a place for a coco o ten showing benefit without harm, right? And so no, is that really nothing without any harm or any risk harm? But very, very little.

So I usually recommend if you're trying to get pregnant at you, take good time, a dose of two and immigrant three times a day. So this kind of a higher dose than sometimes simple are on, often printed. Oes now have just like two hundred and total in IT.

And so the expensive ingredients are usually that the the lower concentrations .

and just enough so .

they did on we include ten. Does the form of coco ten matter? Because you'll find them in jail capture, you'll also find them in powdered capsules.

I always say, I mean, there might be for the individual person. I mean, absorption of medication is really depends on a lot on gut health and other factors. But the number one issue with supplementation is that people don't stick to IT. So I always say whatever one you're going to consistently take is going to be the Better form.

I question about l carnet and researching bit for this episode and oh say you ora il carney has been associated with some improvements in ford mortality in the maybe equality. But we know that a very small percentage of the oil of current team that one in just is actually utilize that some people actually purchase and news injectable county, which is kind of painful because its in an alcohol base suspension. So not not comfortable.

It's got to be done for musical. But my read of the data is what kind of impressive I want to say, super impressive. Are you ever injecting patients are having them inject themselves with l carnet. Um this would be both male, female or male patients are both um .

or using or a low ans, you have any animal sperm parameter. And so that is kind of what we consider. These are enhancement protocol.

And so just that with a multivariate, those two with a multivitamin and coco o time. So that kind of like the male protocol. Of course, there's different specifics for one individual percent. I don't tend to recommend IT for most females. That being said, those who have indeed trio sis fAllen to a unique category where inflation tion is so high that usually it's a different environment where we recommend l Carina and A L sixteen vitam cne. They kind of fall into a different category because they're known in flamma disease. But if we're just talking about the person at whole who maybe wants to take some supplements for their reproductive health that have very little side effects and for the most part can potentially be helpful, is going to be know coco o ten l carnet invitation sea can be helpful, especially for the mail, for the female partner. We're gona be looking at that extradited, indeed, in addition to the prenatal with politics.

And what about a woman with P, C, O, S? I get so many questions about CS. So and there are we talking my oita or the what is that the d Carol, do I have that right?

You do know that, right? Mionoseki, the main driver of anothah and how IT can be helpful if you most blends are going to have a combination of both of them, but a much higher ratio of my oinos o to d caro. And so my own and hostile s probably the one that really is doing the world.

And pcs, what is IT doing? IT is definitely helping the body when IT comes to insulin and sugar, helping the body be more sensitive to insulin or less resistant to IT, essentially helping you respond to what you eat in a Better way. And IT also looks like IT does potentially decrease some of that information pathway in P C O S. In P C O S, this instant resistance corals with this test aste ROM production from the meaning even met t form and alone can decrease test also own levels based on some of the change that IT has in .

the overnight te men, so many guys taking net form or burberry, thinking of this is great. I'm a lower my blood sugar, mimic fasting and live longer and and then these are also the same people who are writing to me. How come when I take mp form and I either have headaches because I know essentially I hy 因为 but also their testosterone levels are are getting crush， not every case but happens.

And I think those are thinks people just don't think about they read that a supplement that might be beneficial for this one thing that doesn't apply to them. And they started taking IT.

So also, the evidence of that form extending life, we had Peter to talk about this. The evidence that is like, oh, so poor is just not really that convincing and may change. But then now all the excitement is about rap of my son.

And so extending your life while pluming your test stone. You know, I mean that actually that strategies have been tried in the launch. Every computer there was a focus ration.

I oh yeah.

this was like the heaven's gate cult where they castrate themselves and well they end up committing mass suicide so so um that you know they ended the experimental um know yeah so in any event, um going back to your supplements so I can help myself supplements that women can potentially IT just in increase their fertility even if they don't want to get pregnant as just kind of creating a mill.

You of health you touch about the nutrition, you touch about coco ten, maybe our carnet va and see um the essential fat assets going at least one gramm of E P A. So that might require taking two grams of official to get the the E P A my on us at all. So how much talking about .

I ty thousand.

Okay, taken before sleep or doesn't matter, I want doesn't .

matter that one doesn't matter.

Thank you for covering the topic of supplements and supplementation. Um this is probably good point to return back to those harvest eggs. And so eggs are out um and there's a collection of them frozen um maybe just maybe life. They're always a .

live start fresher m the fresh, the fresh firm .

they are not always like some fortunately eject ate is going to be that spring right some life some four moles and none for motel. The twitchers I read is the name of, and so, okay, they gonna wash the the sperm.

why? Because yeah, most of what people see as a jaculation or no, excuse me, as a jaculation is not actually the sperm, right? Okay, so but experiment, wash there in one compartment, you, the eggs out you you or is your embryologist that your clinic is then going to at some point decided to combine them? So is IT is IT a sperm race? Or you um maybe could explain X, Y and and why would one want why would one opt for X, Y? And is are there any risks with xc? Because there you're really at some level this is the only place where I can sit back acting okay, somebody neural development like some level you're saying, hey, that permit looks good where as when you ve run a sperm race nature saying, hey, this spam really did be all the .

other sperm so let's say way first, because I think this is nice because a question I get us all the time. We talk about nutrition and supplements and all of that is to you now you're doing ivf or you're freezing your eggs. And what if what behaviors are good or bad? Of course, all of the same ones are, but about how long do you need to do them.

And this is why if you live healthy, most of the days IT doesn't really matter. That's how you're living. But we already know this firm cycle is about ninety days.

And the eggs, I like to say, in the vault, they become they started lining up, getting ready to exit the vult and become more acceptable table to the things you're doing in that ninety day window. And we know that to be true as well. So they started to be crease selected for who's coming out the next month.

They start to line up. And so making these changes as you start thinking about getting pregnant, doing fertility treatments is still extremely beneficial. People will often say, well, I haven't been doing that, so why start now? It's not going to make .

a difference.

But truly, I can. I'll drink up until the week.

until the people I glass, which actually quite six glasses as a wine, when you measure out the volume right up until the week before getting brighter or something.

But no, so so people always ask, what should I be doing? Is these heavy behaviors? And you should be doing, you know, this all time when we do ivf.

And I might get all the things you just ask, but earlier you said, well, how tolerable is that? The truth is you gave taking shots. These are subcutaneous shots during the growth process.

So yeah.

the valley and like how diabetic gives ensuin a very small needle. I mean, nobody loves shots, but they're not a big into muscular shot. It's not like a flu shot .

or something like that s in .

the taxi mosquitoes .

there we were .

on exactly. So you're going to use those medications for about twelve, fourteen days. You're going to have your finically grow. You're going to feel that you're going to politic pressure as your eagen rises.

You're also going to third space or fluid, which means your fluid, your water component of your blood is going to start to just eat out a little bit and you're gna get more bloat at you have more water weight going to feel puff. Er and that is very common just because of getting the eggs to grow. You're gonna mentally be fine because the memo grain loves high astern, so you're doing fine as that.

One of the main concerns is how emotional will I be. And during this phase of the process, people do great when we take the exact of the body is about a twenty minute proceed. Germ IT is usually done under ib station, like prop of in that now. And we are watching while we drain those vocals and get tested bes full of the eggs.

Do some people up to not use any and say I hear the word fan and all i'm sure a lot of people like wait fan or crisis and I know obviously if I knows A A drug that has its uses valid uses in the medical community um does anyone just kind of up for you know, just I mean, we have .

anesthesiologists who is really talking to the patience. I mean proper follow the base of IT. Certainly, there are some patients who may want to avoid narcotic usage, and they use different strategies.

I mean, there was this huge right, the retrieval s podcast came out from, like the new york times, when a deep dive into a fertility clinic, yale, where a nurse was sighing off, fatal herself for herself, and replacing that with sAiling and giving patient saying these, this clinic did not do anesthesia based program ale, so they were susumu sed to just get fit, no, and have kind of a less pain environment, not a no pain environment. And not not just a few hundreds of women reported extreme pain. Extreme pain through the procedure really speaks largely to pain not being taken seriously. When they went and found this out.

what happened to again now? But what happened? This a technician.

well, I mean.

yeah, there there are trying to find that behind bars.

yeah. I mean, and what is you just hard to you like? I mean, I can't imagine, I can't imagine doing.

I do this procedure like all the time, right? I have thousands and thousands in my career, and I can't imagine having people being pain during that. So it's but is important to that. Some clinics don't use I V situation, or they don't use program, or they don't put you to sleep understanding what your clinic is using is really, really important to set the expectation or to note, am I going to be awake or am I going to .

be asleep of patient ask you to what specific drugs are you .

going to give me to kill him? And I mean, some clinics only do one like I am not going to do a retrieve under no sedation. Now some clinics would allow that, some clinics that all that they do.

But you that's a huge piece of puzzle that you need to know if you're a patient, are you going to be feeling pain, not feeling pain, what's going to be like? I'll see most clinics use proper file and put patients to sleep. And so you take a nice little nap for fifteen to twenty minutes.

The eggs are retreated from the followers under direct visualization, the test tubes, you wake up and you're gona feel cramb and you'll get a period tenison days later. But this is when you'll feel you're worse. This is just the one thing I want .

to say about tolerability gnant.

Yeah, yeah, yeah. There's case report of an actor who donating her eggs and SHE had sex with her boyfriend. And because not every eg is always retreat from the followers, or some small ones could regulate to. And SHE got pregnant quin tablets.

Okay, so you have to really tell people not to have in her course one from an infectious and point, because we really are poking a pretty large gage needle through the vaginal mu kosa into the party anal cavity. So we don't want to enter duce infection, but also for a pregNancy in that time period. And if you ve got pregnant, your risk of what we call a very in hyper stimulation syndrome, A O H S, is very profound.

So what is Normally happening is, after the retrieval, your emergent and protestor, you're onna drop, you're gonna feel a severe pms for lack of a Better word. So you'll be more emotional. You're still pretty bloat IT until this all heels, if you get A H, which is very uncommon in modern practice.

But when you did fresh embro transfers or people who don't utilize some of the modern protocols, this means that H C G continues to encourage all those followers to make extradition and products around. And if you are pregnant, he just going to a constant yet exponential increase in hcg. And so this is going to get worse and worse. So we really don't want people to get pregnant that time period.

So when during that time before they avoid sex. So is that in the a few days .

before the extraction? So typically I usually say it's from like day five of your stimulation, okay. So usually the earliest agrico voles are kind of around cycle day nine or ten if somebody goes fast until your next period comes. So it's usually about a three week time period where we want you to obtained from in our course. So for the most part though, the more eggs you have, the more you're gonna about this hormonal and physical shift than the fewer eggs that you have.

So if you have a low eg count and you need to do ibf or freeze your eggs and you might do multiple cycles around, you're gonna tolerate actually pretty fine because you're not going to have these huge shifts physically, you're gona feel fine. And that's always a big concern when you mentioned earlier about different stimulation types. People have this idea that things that are more natural or Better, or just like this human thought, that natural is good and sthetic is bad.

Naturally, you ebulis one egm when we're trying to get exert of your body. The success is determined by how many eggs I can get and how Young you are. So IT doesn't make sense in most circumstances to do a minimal stimulation protocol, meaning purposefully and stimulating somebody by saving the money in medication cost in order to purpose sly get fewer eggs because they're odds of getting the ultimate success of what they want is going to be so much lower is there?

I don't want you to be in the position of I don't want to put you rather in the position of and like having to demonize your your colleagues in your professional. But I can see others a pretty significant financial incentive for people really desperate to have children or or who just simply might want have children down the road to. Um the here lost tim is Better.

We're talking multiple lost tim cycles. They might be um even a fraction of the cost of the first stem cycle. But then there many, many more steam cycles can make a lot more money .

by doing things that are not in the best interest of the patient. And I mean that's not uncommon in my field, which is very sad. But that does mean that because reproduction and ibf are so foreign unknown, so many people walk in blind, not knowing if what there being told really makes sense for their situation.

There are a couple situations where minimal stimulation make sense. If you're only going to make three eggs, you only going make eg. I don't need all the drugs in the world to tell your body to make three eggs because there's only three. And so that is a senior where minimal stimulation does make sense.

And then there's the scenario where there's something called in vocal as your research expose you to this info sale is a way to try to take ibf into making IT more financially accessible for certain patient populations, mainly people who don't ovulate like you're very refractory pcs patient who doesn't respond to medication or you have tubal factor and fertility, right? So your pillows an tubes are blocked because of limited a or and demetrios. And we just have a problem here that against firm can get together because you're not violated or your tubes are blocked in in vocal is a device that is plastic and you can fit after ten eggs in IT.

And there's a little middle chAmber where the sperm can go. And so you go through this ibf process with the goal to only get a to ten eggs because that's what fits in the device. And then you put the sperm middle love IT, and then you put IT inside your vagina, and you hold IT in place with a dire frame, and the vagina is the right temperature to incubate.

And so you incubate your embryos in this little invoice container insider of china. And then five days later, you come in and we take IT out and we take the best embro and we transfer IT and you can do a fresh transfer. Because you didn't make so many eggs on your hormones weren't so high.

Do people like this precedent there, something that seems like that exam proximity to this man egg like your taking at home?

okay. So I love this procedure and certain some circumstances, and I applied often in the wrong case and that that can be frustrated because it's still not cheap. Even if it's cheaper than ivf, IT is still not inexpensive and any means.

And so patient election, like most things in this field, are so important. 这个 是谁？ If you've had no like the spare, if the sperms the problem, then it's probably not smart to just presume that the experiment I will be fine in there, right?

Like that might be a case where you really do need help with a system fertilization or if you have unexplained infertility, if we don't know why you haven't been able to get pregnant and because everything looks good on paper, what if fertilization is the issue? And these are circumstances where you pull out in info, sell and there is no embroils and you don't really know where went wrong. Was IT the fertilization step? Was IT the growth step of the embryos in culture.

So you do have less data, notably, I like data. You can't do genetic testing. And this isn't really a strategy that allows you to freeze embryos for future family growth, dubbin said. The Young patient who's got great that quality, who might have really bad P C, O, S.

Or tube disease, I can certainly allow them the opportunity for a child at a lower Price point when they still have many reproductive years to finalize their family IT all also is a lovely option for people who need donor sperm to conceive, because the success rates with this are so much higher than an I U. I, which is what a lot of people use and intrigued, or insemination, or putting the spare in the uterus. So now we're able to improve this outcome.

So like our same sex couples or are single parents by choice, if it's a single woman who's trying to become a parent, then they need to buy donors from and go to the process. Anyway, this often can improve that efficacy through the process, pending their age and other factors. There was a study that was just fully need. There was a lesbian couple, and one of them, the eggs came out of, and the other one invited the umbrella, and then the other one had the embryo transfer. So what I gave both partners a way to feel a little more involved in the process, which I just think is always, or really cool way when you have these different .

options with reproduction, seems also, that is a more three dimensional environment. They always imagine that the beach dish is not uh approach um is that so two dimensional compared to the body and all these things are having done sell culture before cultured neurons and things that sort like there's all these concerns about like the concentration of co two and the thing or you got forbid if there's A A fluctuation and you have back up generators and things. But in the electrical flow of the incubators that disrupted the natural environment of the body, even though fluctuations in temperature is, I mean, this is evolved over you have tens of thousands, if not, you know, hundreds of thousands of years, to be the process by which embryo are created. So there seemed so here's where I sort of default in my mind anyway, to the kind, like, I like, IT seems more natural.

They're incubating in the world are the same. What why are you having infertility if you're an infertility patient, right? So if you need donor sperm, you maybe don't have infertility or if you have couple disease, you've a very defined reason why we don't think that there is this huge inflammatory issue in your body or something unknown.

So again, i'll see you applied to people who really are bad candidates for IT based on their age or based on their diagnosis. And so it's not always Better. But for the right patient, I mean, I had patients have babies that way who otherwise may not be able to.

So they can you can really open up the door. So that's the most minimal of the minimal stimulation, right then. We have minimal stimulation because you don't have many eggs, so you don't really need that.

But for the vast majority of people who go through egg es in our ibf, we are really trying to get as many eggs as you potentially have. Everybody has a different number, but whatever you have, whatever that antil volcanoes for you, is what we're trying to get. And that's what this combination of medications is trying to do when the eggs come into the lab.

If you have egg freezing, very important to know is, before we get into the exceed discussion, the eggs are stripped of their outer cells, which is called the cumulo. That's what the sperm has to to in order to to fertilize, in order to freeze the eggs, the cumulus cells stripped off, the egg frozen. You have to do xc so if we're onna lead into this xc conversation, if you're freezing your eggs, you're having sexy when you fatalities them.

So I don't want some of you to ever not know that if that is what they are choosing an xc is. You can tell us, yes, xc sends for its icsi or interested to plasmic sperm injection. IT is taking a sperm that under the microscope looks Normal in shape and moves well and you're pulling IT up into a little needle and you're intially using a little laser on the side of the egg or the zona pollution of the egg, and you're injecting that one sperm into that exact plasm .

and you're picking that sperm on the basis of shape mortality. You're picking what you think is, is the best firm in the batch, obviously.

Yeah, you're picking I mean, there's give me one sperm, prog. So there's multiple sperm that are chosen, but you're picking burn that look like .

they have the highest potential in my understanding is that there's a range from very low to potentially high, but hopefully not high of DNA fragmentation. And pretty much every cell the bite, like the cells always repairing ing its DNA. So when visually selecting a sperm for for xc, it's based morphology, shape and motility, right?

You can see the DNA damaging like the head of the the DNA itself.

We soon have a technology where you could actually like get a die that could label DNA fragmentation and and select because I feel like so much like when we target with them biology not to get too far down in the ds but um like the the methods of selecting eggs and selecting sperm, I mean these are the same methods that have been using biology for like since the one thousand hundred and thirties.

Like all this one looks good, that one looks good. And the skilled and rios can really develop a real talent at over time, like knowing what core laide with healthy pregNancy and offspring. But I do like technology. You would think they're by now twenty, twenty three that someone would have some die that you could drop on this firm go well, like that one has a lot of of DNA fragmentation in that one.

No, there should be Better ways to choose which firm. There's definitely people are trying things. Nothing has proven to be helpful so far. There's definitely some interest in this because we're starting to get more insight as we have become Better at embro culture, getting embryos to grow, doing genetic testing on to understand that male genome kicks in a day three.

And there is a subset of people who have beautiful feriz, ation and embro growth day zero to three, and that's all in the egg. And then as soon as that male genome kicks and you have this huge drop off in your embro number, and even some of this is in the context of Normal sperm parameters, right? So things aren't really Normal though, or there's something underlying IT.

And that every embro failure on day three post realization.

not, but IT definitely means that none of the ones before that can be blamed on the sperm. And once after that, there's definitely still maternal and sperm contribution.

Don't want to create any couple disputes around this.

but there can be in an insight when you're trying to look through somebody y's ibf cycle about potentially modifiable factors rate. Can you improve sperm quality by some of these lifetime le measures? I mean, the debatable thing about a DNA sperm raggedy.

So what is that? IT is not a Normal semen analysis, but IT is like that as far as a they firm sample that is then sent off to be evaluated. How much fragmentation or abNormal DNA is in the heads of the sperm? The studies have shown that people who have abNormal DNA representation should do.

Xy, okay, let's like the point of the study. Now IT is become very common place. So X, C, choosing the sperm to put into the egg originally didn't exist, right? So what's the alternative? Conventional fertilization? This is having your petry dish.

Your eggs are on IT. You got your spam. You cover IT.

You have put in the invite. You didn't mean you score your spirit, detect the .

where .

the sperm.

and then post IT out and the next day sees by which eggs and sperm fertilized well, it's really devastating to put out the dish, have no fertilization and IT definitely is a cause of infertility and IT can be very hard to know that because fertilization is not chAllenged on a cellular level until you chAllenged IT. So X I used to be an at on cost. IT used to be a separate thing because IT was harder to find embryologists you could do IT.

It's so standard that a lot of clinics do IT the majority of the time, purely because you often don't know all the variables that are impacting fertilization and you're trying to give somebody as many opportunities as possible. Xi has in a lot of those original ibs studies, got some of the bad reputation of being the problem with why you might see that one percent rise of earth effects. And so X, I took the brunt from a lot of that. We really don't see that when we're growing out and we're doing freezing the embryos, doing frozen transfers. And I mean, I do exit almost every patient and I say, everyone.

I probable of the .

probable success. And when you get to this point, and so few people have insurance coverage, so they're spending there are money. They're getting second mortgage, they are taking out loans. If there's one decision that you say what I don't know, you could have zero ex fertilized or I could have the embryologist pick the best firm and put them inside the egg and we expect to seventy five percent since CER fertilization. That makes sense for the majority of people .

and that that makes sense to me. I um because i'm session with data, the blood work fairly regularly, not obsessively, but very on twice a year. So now I didn't always do that. I actually did one of these DNA fragmentation tests that they're .

pretty expensive.

There are more in the twelve dollars, fifty hundred dollars or so, at least the one that I did IT was very informative, like I was relieved to see not abNormal levels of DNA rag mentation. But I will say that based on everything you just said, IT seems like he might be the lower cost option because, you know, the alternative is to go through repeated cycles, survival, and it's fAiling and that certainly much more expensive.

And I mean, I will say that there are some current thought by my neurology colleagues, right? So i'm not a neurologist, but definitely when I have a male who you know needs a firm extraction may be had a prior, but acting me, maybe he's got very low sperm count.

And we're going and we're doing a firm extraction procedure that potentially, if you have a patient who has an abNormal DNA firm fragmentation and even with X, C has this drop off and embroglio after day three, because this problem are still be made the same way, rather, they still fragmented, that potentially the adjective tory process could cause some of that fragmentation. And certain men, and by going in and doing a sperm extraction and not suspecting those sperm to the rigors of evacuation, for lack of a Better word, could potentially less than their fragmentation and improve outcomes. And I have some patients to we've gone down that road and that has helps them clear to say there's not a study that's not the point of DNA burn rag is to try to distinguish if potentially xc could be a helpful technology.

But a lot of doctors are offering or doing xc because we want you to fertilize your eggs when they grow in culture, as we taught. But I, B, F, changing the metal abc needs of the embryo, you know, change throughout the process. And so embro culture has become so much more successful. But even in those best case scenarios, we're looking at fifty percent progressions. So you're gonna a have lost throughout that culture process no matter what.

fifty percent projections. So half of the fertilized embryos that make IT past a little a day, seven, then they're screen for common al abNormalities. So then okay, that that you've got the two or three or those and maybe to many, how many egs were rested age and then an age? Yes, thank you. And then and then you said of those that are implanted into little a woman forty five or Younger, you're looking at about anywhere from thirty to sixty five percent successful implantation and pregny would like be healthy baby is usually .

sixty five percent chance of life birth of is a genetically tested in burgoo. That as track is the ef, and that's why you're going to see such varying ibs access rates because if you don't do genetic testing of embryos, let's use the forty year old who makes four embryos and I send them off for genetic testing. I anticipate SHE has one Normal embro.

If I do genetic testing, which takes called P G T prem play genetic testing I am testing for annually as the traditional testing mini. Does that have the right number? Chroma oes? You can also importantly test for single gene disorders like fistic viruses or honeymoons.

But if we're just doing P G T for employ, I expect an age related proportion of your eggs to be Normal or abNormal. So at eight forty, I expect twenty to twenty five percent Normal. So I can choose that one and put IT in you and have a sixty five percent chance that you have a baby. I could not do IT. I saw the same for that one is in there.

But if I go and transfer them each independently, i'm now going to have closer to a twenty to thirty percent chance of success, right? So IT is not getting changing the umbro by testing IT, but i'm allowing myself to have higher utility of success, higher efficiency, putting somebody through less failed transfers, which is extremely important and less misCarries because those also take time. And one of the most important things is that you have the opportunity to understand how many potential Normal embryos you have in batch cycles so you could go into another cycle.

Because i'm forty, I just met my person. I really want to have two kids, because my siblings is really important in my life. Yet naturally, by the age I would be for that second child, it's going to be very hard to conceive.

I can go through ibf and batch some embro so I could save two or three for that second baby that i'm not gona transfer a for a few years. And that's called embed banking. And that is changing the ways that people can potentially grow their family at later ages.

But you don't know that unless you know what's Normal or not. And IT also gives you a chance to go and intervene right now. Because right now, especially if you're older, I I have a higher chance of success.

Then if I am for transfers down the road, and maybe there was one miscarriage in there, two, we're suddenly now eight months down the road before I can go to another cycle and get more eggs. Verses, if I found out that none of those were genetically Normal, the average body year old might have zero to one if they have average ovarian reserve per cycle. So they're going to need multiple cycles is not that it's impossible, but it's just studying that route of expectation for them. But if I don't get any Normal embryos, I can turn right around and go get more. So I am using what's left that a very involved each month to try to get to that opportunity of a pregNancy for you, and a much more efficient way by utilizing genetic testing of .

these embryos. This is where we can put in a lip sin and so healthy baby right and maybe in the future, if we're lucky, you'll come back and talk us about um healthy pregNancy and healthy baby honored.

That would be a fun and important set of discussions I would like to touch on the I don't call the issue but the topic of many pause, which I assume is defined as the station of mencius um but they are i'm guessing and i'm guessing it's a conStellation of things that happened um and I have a very straight question which is, is there an acceleration of the onset of menai? Are we seeing that nowadays? Um are good data on that? Should people try to delay menopause? What are some of the things that you talk to patients about terms of their considerations of ways to ease that transition or maybe be an offset that transition with coral replacement therapy or other?

But these are great questions. And I do think this is going to be a huge interest in upcoming years as we have learned more about the monopolized transition and the health risks really associated with being hyo estrogens or having low ao. Many options if we do find IT as a varian failure.

So your overall now have no eggs or so few eggs that they are refractory to the brain sending out F, S, H. So your brain is sending out all the F, S, H. And all that I can, you're over is done and not making any extradition or products around anymore in this time period.

What we know is, one, are we seeing a population base increase in earlier in us? There's not been a study to say that observational clinically, I would say yes because I see so many Younger women having low Operating reserve or having premature ovarian failure or premature avery, an insufficiency, which is the more politically correct way of saying IT. But when we think about what this is, is there arent modifiable factors, right?

If running out of eggs as a variable, we ready said certain things like smoking cigarettes and exposure to toxics and likely colonic inflation tion and untreated disease. We know that having diabetes, those things increase your risk going into antabuse earlier. So paying attention to the lifestyle that you have when you're not concerned about your fertility, right, when you're in your Younger years and maybe you're not worried about getting pregnant yet or you're not worried about mini PaaS, but those choices that you're making in those time periods, at least for women, your eggs are gone to hold on to them so they have an influence later.

Similarly, trying to live a lower inflammatory life and getting sleep and avoiding toxins of which you can is some of the best that you can do to try to naturally prolonged. You'll go through mini POS with a huge covered that everybody is truly born with a different number and you do not control that. You don't.

And so you might have been born with a lower number and you can't change that trajectory. And you might have cancer and be exposed to chemotherapy, which also will deeply your ovarian reserve. But so do things like enemy trios, especially if it's not being treated in any fashion.

So that's where we think the birth control pill or process an exposure or surgery ways to going decrease the inflation tion. It's that inflation tion associated with indeede asus that's really causing these women to have low evan reserve in going to menopause early. So not only is that impacting you know fertility and how many acts you get in how long you have to grow your family, but when you go in to monopoles earlier, you have lower life expectancy than people who go into menopause later.

And that's why you even set up earlier, fertilize this variable kind of reflecting longevity and like health overall. So what we do know about mini pose is that having that low astrogation, whether that happens at the average of minimise at fifty one, fifty two or at an earlier time period. It's not good for the brain, you know, higher rise of dementia, increased risk of ossia arosa, increased risk of heart disease and stroke, and essentially higher rise of death.

And that's not even to talk about the impact on your life. What IT can be like to have hot flashes, heating cold and sensitivity, to have profound volver and bagging al atrophy to the point that you no longer want to have inner course in end of the changes that I can even have on your gut and your union system. So we, as a community, you know, of doctors, especially O B G Y N S, really recommend hormonal replacement, the therapy and women who are going through menopause.

And the key here is to initiate, right at the beginning, that big women's health initiative study, which came up forever ago and showed all this harm with hormone replacement therapy. The big issue there was that these people were hypo estrogens for ten plus years in one group and then started back on the hormones. And in that circumstance, they'd already been put into this highest category, and their body had adJusting to not having the hormones.

And when we exposed, they had more adverse al events. But if you are starting on estrogen in replacement and IT, IT can be various, but onest ly, the astrogation that we try to replace in this time period, much more mimic asteroid with asteroid pills. If you can have vaginal inserts, you can patches.

So IT depends on what's going to work for your life. But IT is not the birth control pill most often ended in some people. That might be. That's what they choose.

What we really are trying to pick an asteroid that is extra dial or mythically that natural structure, and you can't have unopposed extra gen without reaching the risk of indeede al cancer. And so that's why we need to have some protesters. So some people will choose a daily protestant.

Some will choose a sync for Justine and still have periods. Some will put in an R, U, D at this time period and then take their daily trojan. There's a lot of different options.

We are trying to find the lowest, those of commons that relieves your symptoms, to provide you relief from some these lifestyle issues, but also helps you not just live longer, right? We're not just trying to live longer. We want to be healthy longer.

We want to have a Better quality of life. And certainly women's health has for long stop at this manpower. Al, period. And then it's been, you're on your own kid. And this is when we're really going to see that intervening at that place, especially for women who going to over in fail early.

So those people who have a little very in reserve who I diagnosed, I tell all of them, hey, if you don't freeze your eggs or I never see you again, you are going to go through menopause early. And when you do, I want you to go see somebody. I don't want you to just ignore IT and suffer with these symptoms, which is something that does commonly happen. So it's just making sure that women are empowered red to know that these symptoms are what happens is what happens naturally, but by giving their bodies more estrogen and not crazy hy doses, but just these physiologic levels can really improve with the quality and the longevity of their life.

Is IT just the presence of these symptoms that signals sea onset of of of menopause? Or is is other additional accuse? Like for instance, if their cycle is getting shorter.

longer, you certainly will have cycle changes. And we consider that the piano puzzle period where you're starting to really search, seeing a spacing out of your period so there are no longer come in and that perfect ovl laty pattern when you get into the low over and resort, but you're still August ating regularly theyve birth shorten, as we said earlier.

But then when they start lengthening and you start skipping months, that's a real big clue that, that things are not going in the right direction. And if you find out you have a very, very low, very pressure, you're approaching that parameter pose period, you're going to start to have more prolonged periods of low estrogen and you'll feel m mentally cloudy, fatigue, more headaches, more hot flashes, lack of beto, those volva vaginal symptoms overall, more likely who d have depressed mood. And that a lot.

a lot. Well, sadly, doctor crawfurd, I want to extend a huge thank you on myself. I've learned so much from you today about fertility, about hormonal health for women, and you also touch a number of important issues about hormones, alth and fertility for men along the way has truly been A A master class in fertility and hormones and and really touched on topics that are so essential to everybody, even if people aren't seeking to conceive, maybe think they don't want to. There's so many considerations that really extend back once teens.

And if one is beyond their teams, like whatever age people are, essentially they need to think about these issues and make important decisions. And you really also clarified a lot of the what I think are quite destructive, miss that that are prominent out there about for the since eg harvest and what that does to one's fertility. So first of all, thank you for joining us today.

I know you're extremely busy run a clinic of image of family as well. Uh how manage of family I believe but um you know this is the sort of of knowledge that is so chAllenging to find in one place and yet you also have a number of really spectacular avenues that you deliver information, instagram, podcast books and things that that what we were for everyone anted to those links. I've learned so much from you over the years really um in falling your content and today you just a like far exceeded at at all already high expectation. So thank you ever so much. Thank you for .

having me and just thank you for giving a space to talk about women's health and fertility and reproduction medicine. IT means a lot to me, and IT means a lot to the people who really are trying to do their best every day.

So we appreciate that. We appreciate you. And with some luck, committee, come back and talk and bit more on some of the topics that we move through quickly. Thank you.

Thank you. Thank you for joining .

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