Dr. Natalie Crawford: Female Hormone Health, Fertility & Vitality

Dr. Natalie Crawford: Female Hormone Health, Fertility & Vitality

Dr. Natalie Crawford (00:00:00)

Female Puberty & Growth Characteristics, Height (00:04:59)

  • A female fetus has the most eggs around 20 weeks gestation, approximately 6-7 million, but loses over half by birth.
  • Eggs are lost continually from before birth through early development until puberty.
  • Puberty in females begins with the development of breasts (thelarche) followed by menstruation (menarche) two years later on average.
  • Brain signals stimulate follicles in the ovaries to grow and produce estrogen; girls have about two years of unopposed estrogen before menstruation starts.
  • Secondary sexual characteristics like breast development, genital hair, and underarm hair appear a few years before menstruation.
  • Body odor also coincides with sexual hair development as gonads respond to brain signals but isn't directly linked to hormone levels.
  • Exposure to certain odors and endocrine disruptors might accelerate the onset of puberty.
  • Puberty is starting at younger ages, potentially impacting adult height, as final height is reached shortly after the onset of menstruation.
  • Earlier puberty can result in a shorter adult stature since estrogen closes growth plates.
  • Treatment with blockers can delay puberty and promote height growth in cases of precocious puberty.

Eggs & Ovulation, Harvesting Eggs, In Vitro Fertilization (IVF) (00:13:27)

  • Early onset of menstruation does not shorten the reproductive lifespan.
  • Egg loss occurs continuously regardless of menstruation, and ovulation is a separate process.
  • Harvesting eggs for IVF does not decrease the total egg count or future fertility.
  • Eggs are lost over time naturally; IVF involves stimulating the growth of eggs already released from the reserve for that month.
  • IVF medications are FSH and LH, identical to the hormones the body normally produces for ovulation.
  • IVF does not stimulate excessive release of eggs but optimizes the growth of those already released to either freeze or fertilize them.

Endocrine Disruptors, Fetal Development (00:17:31)

  • Exposure to endocrine disruptors like evening primrose oil can cause precocious breast bud development in males due to estrogen-like effects.
  • Such exposure may also cause early secondary sexual characteristics in girls, but it does not initiate actual puberty.
  • Pediatric endocrinologists can determine if puberty has started or if symptoms are caused by external exposures.
  • Egg quality and quantity in females can be affected by their mother’s exposure to endocrine disruptors during pregnancy, potentially leading to low ovarian reserve or fertility-related diseases like PCOS and endometriosis.
  • Male fetal development is influenced early by hormones, affecting growth of the penis and later sex organ development and brain areas linked to reproductive health.

Lavender, Tea Tree & Evening Primrose Oils, Scents, Diapers (00:21:39)

  • Lavender, tea tree, and evening primrose oils can bind to estrogen receptors or mimic its effects, potentially disrupting normal development or physiological processes.
  • Constant exposure to these oils is of more concern than infrequent contact, like hand washing in a restaurant bathroom.
  • It is recommended to use unscented products, especially for children, to limit lifetime exposure during critical developmental periods.
  • Pediatric endocrinologists often see cases where children's exposure to such substances, like lavender oil, have caused developmental issues.
  • Preferences for cloth diapers vs. non-cloth diapers often stem from concerns about chemical exposures, but no definitive evidence suggests that baby skin is more permeable or that one type of diaper is considerably safer than the other.

Breast Milk vs. Formula & Fertility (00:25:13)

  • Breast milk helps with immune system development in the first six months and is protective against diseases with known correlations to fertility issues later in life.
  • There is no direct evidence that not breastfeeding leads to fertility problems, but there is a correlation with diseases protective against by breastfeeding that may relate to fertility.

Menstruation Cycle & Hormones, Timing (00:26:04)

  • The menstruation cycle is often thought to be a consistent 28 days, but normal cycles can vary.
  • Day one is defined as the onset of bleeding, when endometrial lining is shed.
  • Follicular phase happens at the cycle's start, with eggs susceptible to FSH, leading to estrogen production and uterine lining growth.
  • Estrogen is linked to better mood and mental states due to its interaction with neuromodulators.
  • Ovulation occurs after a mature egg signals the release of LH, leading to the luteal phase marked by the formation of the Corpus luteum.
  • Corpus luteum is crucial for pregnancy, producing progesterone which moderates the implantation window.
  • Luteal phase characterized by less energy and increased protective instincts due to progesterone.
  • Follicular phase duration varies among individuals, while the luteal phase is usually stable at 12-14 days.
  • Menstrual irregularity can indicate reproductive hormone communication issues.
  • Regular periods can be an important health indicator, and sudden changes may signal ovarian reserve depletion or other hormonal concerns.

Estrogen, Progesterone & Menstrual Cycle (00:35:59)

  • Estrogen and progesterone play distinct roles in the menstrual cycle, with estrogen priming the uterus for progesterone.
  • The follicle contains the egg and upon ovulation, it ruptures, releasing the egg and then forming the Corpus luteum, which produces progesterone.
  • Estrogen promotes the uterine lining growth during the follicular phase, whereas progesterone stabilizes it for potential implantation during the luteal phase.
  • Concerns about progesterone deficiency are common, but during the follicular phase, low progesterone is normal.

Hormonal Birth Control & Ovarian Reserve, AMH Testing, Fertility (00:38:08)

  • Birth control doesn't change the release of eggs from the ovarian "vault."
  • Hormone-based birth control suppresses ovulation by preventing FSH release from the brain.
  • Ovaries remain inactive during extended use of birth control, which can lower AMH levels—a marker of ovarian reserve.
  • A low AMH level might be reversible after stopping birth control pills for some time.
  • Birth control can sometimes improve fertility, particularly where underlying conditions like endometriosis are present.
  • In IVF treatments, birth control pills can be used to synchronize the growth of the eggs from the vault.

Spermatogenesis & Testosterone; Heat: Ovaries vs Testes (00:42:42)

  • Testosterone supplementation in males reduces the production of FSH and LH, inhibiting the development of new sperm.
  • In contrast, estrogen-based birth control in females does not shut down ovarian estrogen production.
  • 25% of males on prolonged testosterone may not recover sperm production.
  • Men produce new sperm continuously, which means lifestyle changes can affect sperm quality.
  • Heat exposure affects sperm production due to testes being external and needing a cooler temperature to function properly.
  • Female ovaries, being internal, are not affected by heat concerning ovulation or egg production.

Period & Pregnancy, Conception Window (00:46:11)

  • It's generally untrue that women can get pregnant on their period if they have regular cycles.
  • However, with irregular cycles or shorter cycle windows, it's possible to conceive during a period as sperm can live up to five days inside the reproductive tract.
  • The most fertile period is the five days ending on the day of ovulation due to the sperm's lifespan and the egg's 24-hour window for fertilization.

Estrogen, Libido & Ovulation; Mittelschmerz (00:48:56)

  • Increased estrogen levels boost libido, typically peaking around ovulation as the body's natural way to encourage reproduction.
  • Some women can feel ovulation, a phenomenon known as mittelschmerz, described as a crampy pain occurring mid-cycle, which is the actual release of the egg.

Tool: Intercourse Timing & Conception; Artificial Insemination, IVF (00:51:33)

  • Daily intercourse is associated with the highest chance of fertility, especially during the fertile window.
  • However, for couples not accustomed to daily sex, this can lead to stress and sexual burnout.
  • Alternative recommendation is sex every other day during the fertile window, particularly the day before and the day of ovulation.
  • Abstaining from ejaculation for 2-3 days before sperm analysis or fertility treatments like IUI and IVF is to ensure a higher sperm count and quality for selection.

Egg/Sperm Quality, Cigarettes, Vaping, Cannabis & Alcohol (00:55:03)

  • Smoking cigarettes harms egg quality, decreases the number of eggs, brings menopause earlier, and increases the risk of miscarriages and abnormal chromosomes.
  • While less data exists for vaping, it appears to be associated with lower success rates in IVF cycles, suggesting a negative impact on egg quality.
  • Cannabis use decreases sperm production and motility, alters sperm shape, and increases DNA fragmentation, which can result in a higher risk of miscarriage.
  • Alcohol and chronic inflammation caused by regular consumption can negatively impact egg and sperm quality.
  • When trying to conceive, it's best to avoid substances that may lower the chances of success and increase the risk of complications.

Intrauterine Device (IUD), Depo-Provera & Fertility (01:03:29)

  • The copper IUD creates an inflammatory and toxic environment inside the uterus, deterring sperm and implantation while still allowing regular ovulation and menstruation unless there is a hormonal issue.
  • It is composed of a T shape with copper wires that cause this inflammatory reaction.
  • Other IUDs like Mirena, Skyla, Liletta rely on progesterone to thin the uterine lining, and half the time they do not prevent ovulation; their main function is the endometrial effect.
  • Progesterone IUDs can cause the uterine lining to become very thin, leading to an absence of menstruation for extended periods.
  • Upon removal of a progesterone IUD, it may take several months for the uterine lining to thicken enough to shed, so it's advised to remove it 3-6 months before attempting pregnancy.
  • For those not menstruating with an IUD, it's important to allow time for the uterine lining to thicken prior to pregnancy.
  • The Depo-Provera shot is a high-dose progesterone contraceptive that prevents ovulation and menstruation for three months, but it can remain active in the body for up to 18 months.
  • Users should consider discontinuing Depo-Provera 1.5 to 2 years before planning for pregnancy due to its prolonged effect.

Birth Control Risks & Benefits, Cancers, Polycystic Ovarian Syndrome (PCOS) (01:10:00)

  • Birth control, like any choice, comes with risks and benefits, as well as the need for informed consent about the potential for each.
  • Oral contraceptives consist of estrogen and progestins which can act differently than the natural hormones produced by the ovaries.
  • Continuous use of birth control can affect vaginal and vulvar health, potentially leading to atrophic vaginitis and an increased risk for yeast infections.
  • The pill can be beneficial by stabilizing hormone levels for those with severe PMS or premenstrual dysphoric syndrome, aiding mental health.
  • It can also help manage heavy menstrual bleeding, anemia, and conditions like fibroids and PCOS, preventing excessive growth of the uterine lining.
  • PCOS features an androgen-dominated hormone environment, leading to symptoms like increased body hair, acne, and male pattern baldness.
  • In PCOS, the ovaries produce testosterone due to non-ovulation, shifting body fat distribution towards more male patterns and increasing the risk of metabolic syndrome and insulin resistance.
  • Use of the pill can significantly reduce the risk of endometrial and ovarian cancer due to regulated estrogen and suppressed ovulation.
  • Conversely, there is a concern that the pill might slightly increase breast cancer risk, especially in those with predispositions like BRCA mutations.
  • The pill can mask menstrual irregularities without addressing their underlying causes, which has historically not been well-communicated to patients.
  • There is also potential association of pill use with digestive issues like leaky gut or irritable bowel syndrome (IBS).
  • Increased risk of blood clots is another concern with birth control pills due to changes in the liver's processing and resulting increase in clotting factors.

Blood Clotting & Birth Control Pill; Health Screening (01:19:39)

  • Certain individuals have mutations in Factor V Leiden, a clotting factor.
  • One mutated copy of Factor V Leiden can be exacerbated by oral contraception, potentially causing blood clots.
  • Screening for inherited clotting disorders is not typically recommended when prescribing birth control pills.
  • Regular health screens look for high blood pressure or smoking habits, as these increase the risk of stroke with birth control use.
  • After experiencing a blood clot while on the pill, extensive workups are done to check for clotting disorders.
  • It's advised to get worked up for clotting disorders if there's a family history of blood clots such as DVT or PE.
  • Those with Factor V Leiden mutations should avoid oral contraception due to how it's metabolized and affects clotting factors.
  • Other forms of contraception may still be suitable.
  • Advocating for personal health and data is important for informed decisions.
  • Screening guidelines prioritize cost-effectiveness over individual patient awareness.

Tool: AMH Testing, Ovarian Reserve, Antral Follicle Count Ultrasound (01:24:50)

  • The current guideline from ACOG advises against routine AMH testing for ovarian reserve.
  • AMH testing and antral follicle count (AFC) ultrasound provide insights into a woman's ovarian reserve.
  • Ultrasound is non-invasive, reveals the number of follicles, and indirectly indicates the number of eggs left.
  • Cost for AMH level testing is approximately $79.
  • AMH does not predict monthly fertility, but it provides an estimation of overall ovarian reserve.
  • As the ovarian reserve depletes, the body adjusts follicle release; fewer follicles suggest a lower reserve.
  • Guidelines on the number of expected follicles vary by age, with an observable decrease in numbers beginning at age 37.
  • AFC counts combine both ovaries' follicle numbers to accommodate natural asymmetries.
  • Physicians should provide the expected range for follicle counts but patient access to this information can be inconsistent.
  • Women in their late 30s onwards generally see a significant drop in follicle count, indicative of diminished ovarian reserve.

IVF, In Vitro Maturation (IVM); Early Ovarian Reserve Screening (01:29:55)

  • IVF and a newer technology IVM strive to create potential pregnancies from collected eggs without depleting ovarian reserve.
  • IVM seeks to grow eggs from "the vault" in the lab for those with fewer eggs.
  • Number of eggs per month influences the rate of egg freezing or IVF success.
  • Natural fertility and probability of pregnancy per month do not correlate directly with egg count; age is more significant.
  • ACOG argues that early screening for AMH (anti-Müllerian hormone) to predict fertility potential and ovarian reserve is not indicative of natural pregnancy odds.
  • Early detection of low ovarian reserve could influence life decisions such as starting a family sooner.
  • Information about ovarian reserve should be used for proactive family planning, similar to other life goals, rather than being dismissed to avoid undue stress.
  • OBGYNs may offer AMH blood tests during annual check-ups, advised by fertility specialists to inform women's reproductive choices.

Tools: Egg Freezing, IVF; Age & Egg Quality (01:35:40)

  • Egg freezing and IVF processes are similar, but egg harvesting has improved, with a survival rate of 90% after thawing.
  • Survival rates for embryos are higher than for eggs due to their multicellular nature.
  • As age increases, the quality and normality of eggs decrease, leading to higher chances of miscarriage and chromosomal abnormalities.
  • Clinics vary in age cutoffs for egg freezing and IVF due to egg quality concerns, with some allowing procedures up to age 45 based on informed consent.
  • The decline in both egg quantity and quality accelerates after age 37, challenging later attempts at conception.
  • Egg freezing does not reduce the number of eggs available for future ovulation.
  • The logistics and implications of egg freezing should be considered, especially for women in their late 20s to early 30s, as part of their reproductive planning.

Egg Freezing & IVF Procedures, Maternal Age, Success Rates (01:43:37)

  • Injecting synthetic mimics of FSH and LH hormones is part of egg freezing and IVF procedures, with variations like low or high stimulation protocols.
  • Platelet-rich plasma (PRP) injections into the ovarian vault are also being used.
  • Age 32 to 33 is the optimal time for egg freezing as egg quality and quantity intersect.
  • Post-freezing, 90% of eggs typically survive, of which about 75% are fertilized, and 50% reach implantation stage assuming healthy sperm.
  • Infertility and success in freezing or IVF are partly influenced by the sperm's quality and factors like the potential of future paternal smoking habits.
  • More eggs are frozen to buffer against uncertainties of fertilization outcomes.
  • Genetic normalcy of embryos decreases with parental age; at age 30, around 60-70% of embryos are expected to be genetically normal.
  • Live birth chances per embryo transfer are up to 65%.
  • Natural monozygotic twinning rates rise with IVF compared to natural conception.
  • Doctors typically implant one embryo at a time to maximize the chance of a healthy birth and avoid risks associated with multiple pregnancies.
  • The cumulative probability of pregnancy after two euploid embryo transfers is 88%, and after three, it's 95%.
  • A higher number of eggs is essential for achieving desired family size due to various unpredictable factors.

Sperm Freezing & Paternal Age, Vasectomy (01:51:30)

  • Freezing sperm is advisable for younger men as a precaution for the future, particularly since the negative outcomes from increased paternal age generally start after age 50.
  • Sperm freezing is simpler and less invasive than egg freezing, often requiring only abstention, collection into a cup, and storage.
  • Men getting a vasectomy are advised to freeze sperm beforehand as life circumstances can change.
  • Reversing vasectomies might not always lead to successful pregnancies, and sperm freezing is a cheaper alternative for preserving fertility options.

Hormones, Egg Freezing & IVF (01:55:01)

  • Egg freezing and IVF procedures are identical up to the point of egg retrieval.
  • The body naturally limits the number of eggs matured to prevent multiple pregnancies; fertility treatments override this.
  • FSH and LH hormones, essential for stimulating egg growth and maturation, are administered synthetically and naturally.
  • FSH is created in a lab, while LH is derived from the urine of menopausal women or mimicked by HCG (synthetic hormone).
  • Treatments typically involve around 12 days of hormonal injections to mature eggs.
  • Egg maturity is measured through blood estradiol levels and transvaginal ultrasound.
  • A trigger shot induces the final meiotic division in eggs, preparing them for potential fertilization.
  • The older individuals get, the more prone their egg chromosomes are to errors during this process due to degradation over time.

Three-Parent IVF, Mitochondrial DNA (02:00:42)

  • Mitochondrial DNA is crucial for cellular energy and health, and it plays a role in the mechanics of egg cell division.
  • Three-parent IVF is a technique used to address infertility and mitochondrial diseases by combining genetic material from two parents with an egg from a donor with healthy mitochondria.
  • The method has mainly been used to prevent mitochondrial diseases, which are inherited maternally and can be fatal.
  • Utilizing this technique to combat age-related fertility issues has not been proven successful yet.
  • Legal and ethical challenges in the United States obstruct innovative embryo research, largely due to diverse views on when life begins.
  • Millions of unused embryos from IVF treatments could potentially advance scientific research, but current laws limit their use mainly to training embryologists.

IVF Embryo Storage & Donation; Donor Education & Consent (02:05:21)

  • Unused IVF embryos are often kept in storage due to the relatively young age of IVF technology and improving success rates with freezing embryos.
  • Dr. Crawford advises people to keep their embryos until they are certain they will no longer need them, as circumstances such as the loss of a child may lead to a desire for more children later in life.
  • Discarded embryos can be donated for embryologist training or to others for embryo donation, a process still in its early stages and lacking regulation, often occurring through social media connections.
  • Concerns regarding egg and sperm donation include lack of informed consent about having genetic children and the impact on donors' potential future families, leading to considerations about restrictions on sperm donation to prevent a large number of half-siblings.
  • Ethical considerations are emerging due to businesses promoting the donation of eggs by young women with the offer to freeze some of the eggs for the donor's future use, raising concerns about the ethics and potential misunderstandings of fertility preservation.
  • There are calls for more rigorous ethical frameworks for embryo donation practices and discussions on the need for strict regulations in sperm banks regarding the number of families a donor can contribute to, given that anonymous donations are being exposed by consumer genetic testing.

Autism, Developmental Disorders, IVF Babies, Age (02:14:29)

  • Inquiries exist about whether IVF-conceived children have a higher incidence of autism or other developmental concerns than those conceived naturally.
  • Earlier IVF practices involved fresh embryo transfers, creating an unnatural hormonal environment for implantation, which could be associated with placental issues and developmental disorders.
  • With current IVF techniques, such as frozen embryo transfers, outcomes have improved due to a more natural uterine environment, which may mitigate earlier concerns.
  • Infertility itself may carry a higher risk for birth defects or developmental disorders, regardless of the conception method.
  • Advanced paternal age is significantly associated with autism; this risk factor often receives less attention compared to advanced maternal age.
  • Improving IVF technology and a better understanding of the factors involved may help alleviate concerns about the development of IVF-conceived children.

Tools: Sleep, Nutrition & Fertility; Dietary Fat (02:20:36)

  • Sleep is crucial for reproductive hormone function and affects egg and sperm quality.
  • Cellular repair and inflammation reduction, which occur during sleep, are important for conception.
  • Inflammation can damage eggs and sperm and impair the uterine environment.
  • Nutrition plays a significant role in fertility, ovulation, IVF success, and reducing miscarriages.
  • Studies on nutrition and fertility are challenging due to their observational nature and varying health behaviors in individuals.
  • Diets rich in fruits, vegetables, fiber, and antioxidants benefit fertility by decreasing inflammation.
  • Whole grains are beneficial unless there is a gluten intolerance, and ketogenic diets might aid weight loss related fertility improvement by reducing inflammation.
  • Obesity impacts egg quality and implantation odds due to inflammatory changes, not just weight.
  • Dairy, especially full-fat versions, are preferable for fertility over processed or low-fat dairy which can have unnatural additives.
  • Healthy fats from sources like avocados, oils, nuts, and dairy are essential as they are the backbone for hormone production.
  • Protein sources and their impact on fertility were not discussed, implying the importance of a well-rounded diet.

Protein, Meat, Tofu, Fish; Sugar, Artificial Sweeteners; Weight & Miscarriage (02:27:32)

  • Sustainably raised meats are preferred; tofu, which contains soy and acts as a phytoestrogen, does not negatively impact fertility and may even improve it due to its antioxidant properties and iron content.
  • Fish offers healthy fats and omega-3 fatty acids crucial for reproduction; however, pregnant women should limit intake to avoid mercury exposure that can affect fetal brain development, with a recommendation of three servings per week.
  • Raw seafood, such as sushi or sashimi, should be avoided during pregnancy due to the risk of infectious diseases.
  • Processed meats are considered harmful due to carcinogenic properties and negative impacts on fertility.
  • Red meat in moderation is generally fine, but excessive consumption has been linked to lower embryo development success rates in IVF studies.
  • Sugar and artificial sweeteners, including low-calorie sweeteners and Stevia, can cause inflammation, stress reactions, and higher rates of miscarriage; moderation in their consumption is advised.
  • Both underweight and overweight bodies can disrupt reproductive functions, with extremes at either end of the spectrum leading to ovulation disorders, reduced pregnancy rates, and increased miscarriage risks.
  • A balanced diet with controlled meat consumption from sustainable sources, inclusion of whole foods, and avoiding processed and artificial foods is recommended for optimal reproductive health.
  • Supplements are not regulated like medications; herbs added to supplements can impact reproduction and hormones, emphasizing the need for caution in their use.

Tools: Supplements; Prenatal Vitamins, Omega 3s, Vitamin D, Coenzyme Q10 (02:37:38)

  • Individuals should consider what is included in supplements and potential negative impacts.
  • Prenatal vitamins containing folic acid are recommended for reproductive-aged women and men to prevent neural tube defects and support cell division.
  • Folic acid stores should be built up three months before pregnancy.
  • Many people are vitamin D deficient and it affects reproduction, thus a supplement of 1000 IU is recommended.
  • Omega-3 fatty acids are important for anti-inflammatory effects and fetal brain development.
  • The dosage of Omega-3 fatty acids recommended is 1 gram per day.
  • Coenzyme Q10 (CoQ10) supports mitochondria and is beneficial for egg and sperm quality without significant harm.
  • The suggested dose of CoQ10 for those trying to get pregnant is 200 mg three times a day.

L-Carnitine & Male Fertility; PCOS & Myo-inositol; Metformin (02:42:26)

  • Oral L-Carnitine supplements can improve sperm motility, but intramuscular injections are more efficient yet painful.
  • A male fertility enhancement protocol includes 1 gram of L-Carnitine with vitamin C, a multivitamin, and CoQ10.
  • L-Carnitine is not generally recommended for women unless high inflammation is present, as in endometriosis, where it can be beneficial along with vitamins C and E.
  • For PCOS, a combination of myo-inositol and D-chiro-inositol, with a higher ratio of myo-inositol, is supportive in insulin sensitivity and reducing inflammation.
  • Metformin use in men can decrease testosterone levels and cause other unwanted side effects.
  • The notion that Metformin extends lifespan is not strongly supported by evidence and may detrimentally lower testosterone levels.
  • Women looking to enhance fertility should consider supplements like CoQ10, L-Carnitine, vitamin C, omega-3 fatty acids, and myo-inositol with a dose of 2000 mg, regardless of their desire to conceive.

Egg Retrieval, Ovarian Hyperstimulation Syndrome, Minimal Stimulation (02:47:11)

  • After egg retrieval, eggs and fresh sperm are combined, with the option to use a process called ICSI.
  • Healthy behaviors and nutrition are important when considering fertility treatments; both sperm and eggs have a 90-day cycle in which they are susceptible to lifestyle factors.
  • IVF injections are subcutaneous and typically administered for about 12 to 14 days.
  • Patients may experience pelvic pressure and bloating due to fluid redistribution during the egg growth process but mentally feel fine due to high estrogen levels.
  • The egg retrieval procedure takes about 20 minutes under IV sedation and patients wake up feeling crampy, with a period following approximately 10 days later.
  • Patients must avoid intercourse after retrieval to prevent infection risk and reduce the chances of pregnancy, which could severely increase the risk of ovarian hyperstimulation syndrome (OHSS).
  • OHSS is less common with modern protocols but can be severe when it occurs, especially if pregnancy happens during this period.
  • The amount of eggs retrieved can affect the physical and hormonal experience, with fewer eggs leading to a more tolerable process.
  • Minimal stimulation IVF may be recommended in cases with a low egg count to avoid unnecessary medication costs, but it's not optimal for everyone as it could result in fewer harvested eggs.
  • The financial incentive within the fertility industry can sometimes lead to recommendations that aren't in the best interest of the patient.
  • There are situations where minimal stimulation makes sense, particularly when a low egg yield is expected regardless of medication levels.

INVOcell (02:57:56)

  • INVOcell is a more affordable IVF process aimed at certain patient populations, particularly those with ovulation issues like PCOS, or with blocked fallopian tubes due to conditions such as chlamydia or endometriosis.
  • The method involves using a plastic device to incubate up to 10 eggs with sperm inside the vagina, using the body's temperature for incubation.
  • After 5 days, the embryo is transferred, allowing fresh transfers because the hormones levels stay lower with fewer eggs.
  • It is considered a good option for young patients with good egg quality, for same-sex couples or single parents by choice using donor sperm, and for those unable to afford traditional IVF.
  • However, success is not guaranteed and INVOcell may not be appropriate for cases where sperm is the issue, for unexplained infertility, or when there could be fertilization problems.
  • Genetic testing and embryo freezing for future family growth are not possible with INVOcell.

Egg Freezing, Intracytoplasmic Sperm Injection (ICSI), Sperm Fragmentation (03:03:12)

  • Egg freezing requires an Antro follicle count to understand the number of eggs which are then stripped of their outer cells before freezing.
  • With frozen eggs, ICSI is necessary for fertilization, selecting a morphologically normal and motile sperm for injection into the egg.
  • Current visual selection of sperm does not account for DNA fragmentation within the sperm which can affect embryo development from day three when the male genome activates.
  • ICSI was originally a costly add-on but is now a common practice to improve the chances of fertilization with a roughly 75% success rate.
  • Studies indicate that individuals with high DNA sperm fragmentation should use ICSI as it is more successful than conventional fertilization.
  • ICSI may still carry risks, but for many, it is a sound financial decision considering the high costs and emotional strain of repeated IVF cycles.
  • Data is emerging on the potential benefits for certain men of sperm extraction procedures to reduce DNA fragmentation over natural ejaculation.

Genetic Testing, IVF Transfer & Success Rate, Embryo Banking (03:11:45)

  • About half of fertilized embryos make it past day seven; they can then be genetically tested for chromosomal abnormalities.
  • Age is a significant factor in the success rate of implantation and healthy pregnancy, with genetically tested embryos having a 65% chance of live birth.
  • Without genetic testing, a 40-year-old's success rate may drop to 20-30%; testing allows for selection of normal embryos, which increases efficiency and reduces miscarriages.
  • Embryo banking can help in family planning, allowing women to preserve embryos for future use and avoid decreased fertility with advancing age.
  • Genetic testing helps in understanding the available healthy embryos, aiding in more timely and effective fertility treatments.

Menopause (03:15:10)

  • Menopause is linked to ovarian failure when eggs are depleted, signaled by increased FSH and LH from the brain and lack of ovarian hormone production.
  • No broad studies suggest an earlier onset of menopause; however, there are observations of increased premature ovarian insufficiency.
  • Modifiable factors, such as avoiding smoking, toxins, and chronic inflammation, can delay menopause onset.
  • Untreated diseases like diabetes and conditions like endometriosis can shorten ovarian reserve leading to earlier menopause.
  • Early menopause is associated with health risks like osteoporosis, heart disease, and cognitive decline, impacting longevity and quality of life.

Hormone Replacement Therapy & Menopause (03:19:47)

  • Hormone replacement therapy (HRT) is recommended to alleviate menopause symptoms and protect against health risks.
  • HRT should begin at the onset of menopause to be most effective, contrasting with delayed HRT initiation per the Women's Health Initiative study.
  • HRT involves low-dose hormones that mimic natural estrogen and often includes progestin to prevent endometrial cancer.
  • There are various methods of HRT administration, tailored to individual preferences and medical history.
  • HRT benefits women entering menopause early and helps improve longevity and quality of life.

Early-signs of Menopause (03:22:25)

  • Cycle changes, with periods first shortening and then lengthening or missing, indicate approaching menopause.
  • Symptoms like mental cloudiness, fatigue, hot flashes, decreased libido, and mood changes are indicative of low estrogen and the transition into menopause.
  • Such symptoms empower women to seek treatment and consider HRT to improve their wellbeing during this period.

Dr. Natalie Crawford's contributions educate on female hormone health, fertility, and managing menopause whilst dispelling myths and bringing awareness to reproductive medicine. She encourages informed decisions regarding women's health across different life stages.

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