Female Hormone Health, Fertility & Vitality | Dr. Natalie Crawford
Dr. Natalie Crawford, a double board-certified OB/GYN and fertility specialist, discusses female hormones, reproductive health, and fertility. The episode covers puberty, birth control, egg/sperm quality, IVF, egg freezing, nutrition, and supplements for optimizing health at all life stages.
Deep Dive Analysis
21 Topic Outline
Female Puberty Onset & Long-Term Fertility
Egg Loss, Ovulation, & IVF Egg Harvesting
Endocrine Disruptors & Puberty Acceleration
Menstrual Cycle Phases & Hormonal Regulation
Hormonal Birth Control & Ovarian Reserve
Sperm Production vs. Egg Supply & Heat Sensitivity
Fertile Window & Intercourse Timing for Conception
Impact of Lifestyle Factors on Egg & Sperm Quality
Non-Hormonal & Progesterone-Based IUDs
Risks & Benefits of Hormonal Birth Control
Ovarian Reserve Testing: AMH & Antral Follicle Count
Egg Freezing, IVF, & Age-Related Egg Quality Decline
Sperm Freezing & Paternal Age Considerations
IVF Procedure: Hormones, Retrieval, & Embryo Development
Three-Parent IVF & Embryo Storage/Donation Ethics
IVF Babies & Developmental Outcomes
Nutrition & Lifestyle for Fertility Optimization
Supplements for Female & Male Fertility
IVF Fertilization: Conventional vs. ICSI
Genetic Testing of Embryos & Embryo Banking
Menopause Transition & Hormone Replacement Therapy
10 Key Concepts
Ovarian Reserve
Refers to the number of eggs remaining in a woman's ovaries. While eggs are continuously lost from fetal development, ovarian reserve is a measure of how many eggs are available to be released from the 'vault' each month, which decreases with age and can be influenced by lifestyle factors.
Menarche
The onset of a girl's first menstrual period. It typically occurs about two years after breast development begins and marks the point where the body is considered mature enough to potentially support reproduction.
Follicular Phase
The first phase of the menstrual cycle, starting on day one of bleeding. During this phase, FSH stimulates a follicle (containing an egg) to grow, producing estrogen, which prepares the uterine lining for potential pregnancy and is associated with increased energy and focus.
Luteal Phase
The second phase of the menstrual cycle, following ovulation. The ruptured follicle transforms into the corpus luteum, which produces progesterone to stabilize the uterine lining for implantation. This phase is typically fixed at 12-14 days and is associated with lower energy and increased sleep/appetite.
AMH (Anti-Müllerian Hormone)
A hormone produced by the granulosa cells surrounding each follicle. It serves as a marker for ovarian reserve, with higher levels indicating more eggs in the 'vault' and lower levels indicating fewer. AMH levels can be temporarily suppressed by hormonal birth control.
Antral Follicle Count (AFC)
An ultrasound-based measurement of the number of small, fluid-filled follicles visible in the ovaries at a specific point in the menstrual cycle. It provides a direct visual assessment of the number of eggs currently available outside the 'vault' for potential growth.
Aneuploidy
Refers to an abnormal number of chromosomes within an egg or embryo. The rate of aneuploidy increases proportionally with a woman's age, significantly impacting egg quality and increasing the chances of miscarriage or developmental abnormalities.
ICSI (Intracytoplasmic Sperm Injection)
A procedure used in IVF where a single, visually selected sperm is injected directly into an egg's cytoplasm. This method bypasses natural fertilization, often used when sperm quality is a concern or when eggs have been frozen, as it ensures fertilization.
InvoCell
A device that allows for in-vaginal incubation of embryos. After egg retrieval and sperm placement, the device is inserted into the vagina, where the body's natural temperature incubates the embryos, offering a potentially more affordable IVF option for specific patient populations.
Perimenopause
The transitional period leading up to menopause, characterized by fluctuating hormone levels and changes in menstrual cycle patterns, such as lengthening cycles or skipped periods. It can be accompanied by symptoms like hot flashes, fatigue, and mood changes.
15 Questions Answered
No, the age at which a girl starts her period (menarche) does not impact how long her reproductive lifespan will be. Eggs are continually lost from the ovaries regardless of when puberty begins.
No, harvesting eggs for IVF or freezing does not reduce the total number of eggs a woman has or cause earlier menopause. The process only collects eggs that have already been released from the 'vault' for that month, which would otherwise be lost naturally.
Yes, exposure to endocrine disruptors like lavender, tea tree, or evening primrose oils can cause secondary sex characteristics (like breast bud development) to appear earlier, though it doesn't necessarily initiate true puberty.
A normal menstrual cycle can range from 21 to 35 days, but for an individual, it should be relatively constant. Periods should be predictable within a couple of days, and significant irregularity or a consistent shortening of cycles can signal hormonal issues or declining ovarian reserve.
No, hormonal birth control does not diminish future fertility or egg count. While it suppresses ovulation, eggs are still released from the 'vault' and then die, just as they would in a natural cycle if not ovulated. It can, however, temporarily suppress AMH levels.
While generally less fertile, it is possible to get pregnant during a period, especially if cycles are irregular or short. Sperm can live for up to five days in the reproductive tract, so if ovulation occurs soon after intercourse during a period, conception is possible.
The most fertile window is the five-day period ending on the day of ovulation. The day before and the day of ovulation are considered the two top days for the highest chance of conceiving.
Cannabis can decrease sperm production, motility, and morphology, and increase DNA fragmentation, leading to higher miscarriage rates. Alcohol, as a toxin, causes inflammation, which can negatively impact both egg and sperm quality, especially with chronic exposure.
Benefits include managing severe PMS, heavy periods, and reducing risks of endometrial and ovarian cancers. Risks include potential vaginal/vulvar changes, increased risk of blood clots (especially with Factor V Leiden mutation), and masking underlying menstrual cycle issues.
While not universally recommended by medical guidelines, checking AMH levels ($79 blood test) and Antral Follicle Count (ultrasound) can provide valuable, actionable information about future fertility, allowing women to make informed decisions about family planning or egg freezing.
Studies suggest that 32 to 33 years old is the optimal time for the average person to freeze their eggs, as it represents the intersection of still good egg quality and quantity.
While early IVF practices (fresh embryo transfers with high hormone levels) were associated with some increased risks, modern frozen embryo transfer techniques have significantly improved outcomes. Infertility itself, regardless of conception method, is associated with a slightly higher chance of birth defects. Advanced paternal age (over 50) is the strongest association with autism.
Prioritizing sleep, reducing inflammation through a diet high in fruits, vegetables, whole grains, and healthy fats (like avocados, nuts, fish, and full-fat dairy), and avoiding processed foods, added sugars, and artificial sweeteners are crucial. Maintaining a healthy weight is also important, as both being underweight and overweight can negatively impact fertility.
For women, a prenatal vitamin (with folic acid), 1000 IU of Vitamin D, 1 gram of Omega-3 fatty acids (EPA), and 200mg of Coenzyme Q10 three times a day are recommended. For men, 1 gram of L-carnitine with 1 gram of Vitamin C, a multivitamin, and CoQ10 can enhance sperm quality. Myo-inositol (2000mg) is beneficial for women with PCOS.
Menopause (ovarian failure) leads to low estrogen, increasing risks of dementia, osteoporosis, heart disease, and reduced life expectancy. HRT, initiated early in the menopausal transition, can alleviate symptoms and improve long-term health outcomes by replacing estrogen with natural-mimicking forms, often combined with progestin to prevent endometrial cancer.
29 Actionable Insights
1. Ovarian Reserve Testing
Consider getting an AMH blood test (approx. $79) and an antral follicle count (AFC) ultrasound in your late 20s/early 30s to understand your egg quantity. This information allows for informed family planning decisions, such as accelerating pregnancy attempts or considering egg freezing, especially since egg quality and quantity decline significantly after age 37.
2. Egg Freezing Does Not Diminish Fertility
Understand that harvesting eggs for freezing or IVF does not reduce the total number of eggs in your ‘vault’ or cause earlier menopause. The process stimulates the growth of eggs that would have been lost that month anyway, rather than drawing from future reserves, addressing a common misconception.
3. Optimal Egg Freezing Age
If not ready to have a family by age 32-33, consider freezing your eggs. This is the optimal time for the average person to intervene, as it offers the best intersection of good egg quality and quantity.
4. Prioritize Quality Sleep
Prioritize adequate sleep for overall reproductive health. Sleep is crucial for cellular repair and dropping inflammation levels, which are toxic to eggs and sperm and not ideal for conception.
5. Anti-Inflammatory, Plant-Forward Diet
Adopt a diet high in fruits, vegetables, and whole grains, and limit red meat consumption (not daily) and processed meats. This decreases inflammation, improves fecundability, ovulation, IVF success, and decreases miscarriage rates.
6. Avoid Added, Artificial Sugars
Avoid added sugars and artificial sugars in your diet. These cause inflammation, stress reactions, and can lead to higher rates of miscarriage.
7. Avoid Smoking, Vaping, Cannabis, Alcohol
Avoid smoking cigarettes, vaping nicotine, and cannabis (edible or smoked), and consume alcohol in moderation (1-2 drinks a week at most) if trying to conceive, and none at all once pregnant. These substances negatively impact egg and sperm quality, increase miscarriage risk, and have fetal impacts.
8. Prenatal Vitamin & Key Supplements
If in reproductive years, take a prenatal vitamin with folic acid, 1000 IU of Vitamin D, and 1 gram of Omega-3 fatty acids (EPA form) daily. If trying to get pregnant, also take CoQ10 at 200mg three times a day. These supplements support cell division, prevent neural tube defects, reduce inflammation, and improve egg/sperm quality.
9. PCOS: Myo-Inositol Supplementation
For women with PCOS, consider taking 2000mg of Myo-inositol. This supplement helps the body be more sensitive to insulin, potentially decreasing inflammation and testosterone production from the ovary.
10. Sperm Enhancement Protocol for Men
For men with any abnormal sperm parameters, consider taking a gram of L-carnitine with a gram of Vitamin C, along with a multivitamin and CoQ10. This protocol aims to improve sperm quality, motility, and reduce DNA fragmentation.
11. Menopause: Consider Hormone Replacement Therapy
If going through menopause (average age 51-52) or premature ovarian failure, consider Hormone Replacement Therapy (HRT) with estradiol and a progestin, initiated at the beginning of the transition. HRT can improve brain, bone, and cardiovascular health, and enhance quality of life by alleviating symptoms.
12. Early HRT for Premature Ovarian Failure
If diagnosed with premature ovarian failure or low ovarian reserve, understand you will likely go through menopause early and should consider HRT at the onset of symptoms. Early intervention with HRT can improve both the quality and longevity of life.
13. Birth Control Pill & Blood Clot Risk
If anyone in your family has a history of deep vein thrombosis (DVT) or pulmonary embolism (PE), get screened for clotting disorders (e.g., Factor V Leiden) before taking the birth control pill. If a clotting disorder is found, avoid the birth control pill.
14. IUD Removal Before Conception
If using a progesterone-based IUD (e.g., Mirena, Kylina, Lailetta) that has caused an absence of periods, remove it 3-6 months before trying to conceive. This allows the uterine lining to regrow sufficiently for a regular period pattern and implantation.
15. Avoid Depo-Provera if Soon Conceiving
Avoid the Depo-Provera shot if contemplating family building soon. It can prevent ovulation for up to 18 months, making it difficult to conceive quickly after stopping.
16. Use Unscented Products for Children
Use unscented products, especially with children (e.g., laundry detergent, shampoo, conditioner, soaps, body oils), and avoid rubbing lavender oil on babies. This decreases lifetime exposure to toxins and endocrine disruptors, which can accelerate puberty onset and impact development.
17. Sperm Freezing Before Vasectomy
If considering a vasectomy, freeze sperm beforehand. Life circumstances can change, and vasectomy reversals are not always successful or may not result in sufficient sperm for natural conception.
18. Daily Intercourse for Conception
If trying to conceive, have intercourse daily during the fertile window (5 days ending on the day of ovulation). Studies show this is associated with the highest chance of fecundability. If daily intercourse causes stress, aim for every other day, targeting the day before and day of ovulation.
19. Full-Fat Dairy & Healthy Fats
Consume full-fat dairy products (e.g., whole milk, yogurt, cheese) rather than processed or skim versions, and include healthy fats from sources like avocados, nuts, and fish. Healthy fats are essential for hormone production and overall reproductive health.
20. Fish Consumption During Pregnancy
Limit fish consumption to three servings per week if pregnant due to mercury concerns, and avoid raw seafood (sushi, sashimi) during pregnancy due to the risk of infectious disease.
21. Egg Retrieval Anesthesia
When going through egg freezing or IVF, ensure your clinic uses IV sedation (e.g., Propofol) for egg retrieval. This helps avoid extreme pain during the procedure.
22. IVF: Consider Embryo Genetic Testing
Consider genetic testing (PGT for aneuploidy) of embryos during IVF, especially if older. This allows for higher efficiency and success rates, reduces failed transfers and miscarriages, and helps in batching cycles for future family growth.
23. Store Frozen Embryos Indefinitely
If you have frozen embryos, keep them in storage until you are certain you are done having children. Life circumstances can change, and having embryos available can provide future opportunities for family building.
24. Avoid Minimal Stimulation IVF
For individuals with a normal egg count, do not opt for minimal stimulation protocols (low stim) during IVF unless specifically advised by a specialist. Minimal stimulation results in fewer eggs, lowering the odds of ultimate success.
25. Abstain from Intercourse During Egg Stimulation
If going through egg freezing or IVF, abstain from intercourse from approximately day 5 of stimulation until your next period (about 3 weeks). This prevents infection and avoids the risk of ovarian hyperstimulation syndrome (OHSS) if pregnancy occurs.
26. Menopausal Hormone Choice
If on Hormone Replacement Therapy, choose an estrogen that mimics estradiol (e.g., pills, vaginal inserts, patches) and combine it with a progestin. This combination helps alleviate symptoms and provides health benefits while preventing endometrial cancer.
27. Advanced Paternal Age Awareness
Men over age 50 should be aware of the increased risk of certain negative outcomes (e.g., autism, autosomal dominant disorders) associated with advanced paternal age. This information can inform family planning decisions.
28. Hydrate with Electrolytes
Dissolve one packet of Element (electrolytes without sugar) in 16-32 ounces of water when waking up and during physical exercise. This ensures adequate hydration and electrolytes for optimal brain and body function, as even slight dehydration diminishes cognitive and physical performance.
29. Utilize Meditation/NSDR for Energy
Use meditation, mindfulness training, yoga nidra, or non-sleep deep rest (NSDR) protocols. Short sessions (e.g., 10 minutes) can greatly restore cognitive and physical energy and help place the brain and body into different states.
8 Key Quotes
Your ovaries are on a pathway that you can't change. Those eggs are coming out of the vault regardless of if you're on birth control pills, you're pregnant, we do IVF. What we're modifying is one's not going to ovulate and have the rest of them die. We're going to 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 vault that month and give them a chance for later.
Dr. Natalie Crawford
Your period's a 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.
Dr. Natalie Crawford
The female brain loves estrogen, and it's protective against things like dementia.
Dr. Natalie Crawford
When on earth, besides reproduction, do we have life goals that we take the approach, 'I'll just wait and see if it's a problem later'? Never.
Dr. Natalie Crawford
The more eggs you have at a younger age, the better the ROI on this process is going to be.
Dr. Natalie Crawford
Your gametes are your eggs and your sperm. That increase, and we'll just say negative outcome from advanced paternal age, really starts to be seen at age 50.
Dr. Natalie Crawford
Sleep is probably the number one thing that people don't do that does impact their reproductive hormone system and therefore can impact egg and sperm quality because sleep is when you have cellular repair and when you can drop your inflammation levels.
Dr. Natalie Crawford
The denial of the association between what we put in and on our body and how it impacts our body's 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.
Dr. Natalie Crawford
3 Protocols
Intercourse Timing for Conception
Dr. Natalie Crawford- Identify the fertile window, which is the five-day period ending on the day of ovulation.
- For couples not having daily intercourse, aim for sex every other day throughout the fertile window, starting five to six days before anticipated ovulation.
- Prioritize intercourse on the day before and the day of ovulation for the highest chance of conceiving.
Sperm Enhancement Protocol
Dr. Natalie Crawford- Take 1 gram of L-carnitine daily.
- Take 1 gram of Vitamin C daily.
- Take a multivitamin daily.
- Take Coenzyme Q10 daily (specific dosage not provided in this protocol, but generally recommended for male fertility).
Egg Freezing/IVF Procedure (Patient Experience)
Dr. Natalie Crawford- Undergo a suppression period (e.g., with birth control pills) for a few weeks to synchronize egg follicles.
- Administer daily subcutaneous hormone injections (FSH and LH) for approximately 12-14 days to stimulate multiple follicles to grow and eggs to mature.
- Monitor follicle growth and egg maturity via blood tests (estradiol levels) and transvaginal ultrasounds.
- Take a 'trigger shot' (HCG) to induce the final stage of egg maturation.
- Undergo an egg retrieval procedure (approx. 20 minutes) under IV sedation, where eggs are aspirated from follicles.
- Abstain from intercourse from day 5 of stimulation until the next menstrual period (approx. 3 weeks) to prevent infection and hyperstimulation.