The Pregnancy Doctor: Pregnancy Is Halved Every Year After Age 32! If You Want 2+ Children, DO THIS!

Intro (00:00:00)

• People are waiting longer to get pregnant, but fertility rates are decreasing.
• Dr. Natalie Crawford is a fertility doctor who helps people improve their fertility.
• 1 in 5 women experience infertility.
• Factors contributing to infertility include irregular or lack of menstruation, autoimmune diseases, obesity, chronic stress, and waiting to have children.
• Miscarriage chances increase to 50% at age 40.

You Need To Look After Your Fertility Even Before You Want Children (00:02:24)

• Fertility is the ability to get pregnant, while infertility is a disease defined by the inability to conceive.
• Fertility should be viewed as a state of health and wellness, and steps should be taken to prevent infertility.
• Making choices that negatively impact fertility can make it difficult or impossible to have children in the future.

We're Struggling More Than Ever To Have Children (00:04:31)

• Increased awareness of fertility issues due to social media and easier access to reproductive technology.
• Rising infertility rates, with 1 in 5 women experiencing infertility when trying to conceive for the first time in the US.
• Delayed childbearing, with more people starting their families over the age of 30, leading to increased risk of infertility.
• Societal factors such as obesity, diabetes, and environmental toxins contributing to infertility.

Are We Having Less Sex? (00:07:00)

• People are having less sex as they age within the reproductive age range.
• Marijuana use may negatively impact fertility, even if individuals are having more sex.
• Other socially acceptable factors beyond intercourse frequency influence the ability to get pregnant.

Sperm Count Is Declining At Scary Risk (00:07:47)

• Global fertility rate has decreased from 4.84 live births per woman in 1950 to 2.23 in 2021.
• It is expected to drop to 1.59 births per woman by 2100.
• Sperm counts have decreased by 50% in the last 50 years.
• The rate of decline in sperm count has doubled in the last 10 years.
• Fora Fertility Clinic was founded in 2020 in Austin, Texas.
• The clinic provides personalized fertility care.
• The most common type of patient seen at the clinic is a woman over the age of 36 who has been trying to conceive for one to two years without success.
• Patients often feel isolated and stressed due to their fertility struggles.

I Had 4 Pregnancy Losses And It's Devastating (00:10:38)

• The speaker experienced four pregnancy losses before having two children.
• She was a resident and a fellow during that time and did not take good care of herself.
• She did not tell anyone about her pregnancies until the fourth one because she wanted to wait until she was in the safe zone.
• Her fourth pregnancy was an ectopic pregnancy, which is a pregnancy that implants in the fallopian tube instead of the uterus.
• She had to receive medication to stop the pregnancy from growing and was at risk of the tube rupturing.
• She realized that she made a mistake by not sharing her pregnancy struggles with others and encourages people to let their loved ones know when they are struggling.
• Fertility declines with age, especially after age 32.
• Pregnancy rates are halved every year after age 32.
• Women who want to have two or more children should start trying earlier rather than later.
• It is important to be aware of your fertility and to make informed decisions about family planning.

The Stigma Of Infertility (00:13:36)

• Infertility carries a stigma and is often associated with feelings of inadequacy and being broken.
• Misinformation and uncertainty surrounding reproductive health make it difficult for individuals to discuss or seek help for infertility.
• Infertility can lead to an identity crisis, as individuals struggle with the potential reality of not being able to have children.
• Many individuals feel stuck and isolated while others move on with their lives.
• Fertility declines significantly with age, particularly after the age of 32.
• Each year after age 32, the chance of getting pregnant is halved.
• By age 40, a woman's chance of getting pregnant is only 5%.
• It is important for women to be aware of their declining fertility and to plan accordingly if they desire children.

Infertility Is Not Just A Female Issue, Men Are Affected Too (00:16:15)

• Infertility affects both men and women.
• It's important to remember that infertility is a shared experience and not just a female issue.
• Both partners should be involved in the diagnosis and treatment of infertility.
• Guilt and shame are common emotions for both partners, but it's important to remember that infertility is not a personal failing.
• Reframing infertility as a team effort can help to improve communication and support within a relationship.

Understanding The Basics Of Fertility (00:18:49)

• Men produce 200-300 million sperm per day and 1,500 sperm per second.
• Women are born with all the eggs they will ever have and the number of eggs decreases over time.
• Sperm lifespan is 90 days, it takes 72 days for sperm to grow across the testicle and 18 days to exit the ejaculatory system.
• Frequent ejaculation (every 3-4 days) is necessary to maintain optimal fertility as sperm are fragile and can die if not ejaculated regularly.
• Longer abstinence periods (more than 7 days) can increase the proportion of dead sperm in the ejaculate.

Environmental Factors Affecting Male And Female Fertility (00:22:26)

• Many factors in our environment can negatively impact male and female fertility.
• Some of these factors are changeable, while others are not.
• Factors that can impact fertility include:
  • Being overweight or obese.
  • Having other medical conditions like high cholesterol or diabetes.
  • Chronic stress.
  • Exposure to toxins in food, air, and household products.
  • Smoking cigarettes or marijuana.
  • Vaping.
  • Using certain types of kitchenware or putting certain things on or in our bodies.
• Smoking cigarettes and marijuana can significantly decrease fertility in both men and women.
• Cigarette smoking decreases egg count, egg quality, and increases the miscarriage rate in women.
• In men, cigarette smoking decreases sperm count, sperm motility, and sperm quality.
• Marijuana smoking can also cause DNA damage in sperm, leading to a higher chance of miscarriage, even if the male partner is the only one smoking.
• Vaping appears to be similarly harmful to fertility as smoking cigarettes, but more research is needed.

Are Phones And Laptops Bad For Fertility? (00:26:32)

• Study conducted from 2005 to 2018 on phone usage and fertility.
• Modern phones emit less radiation compared to older models.
• Frequent phone usage with older phones (2005-2010) was associated with decreased fertility, but this effect is not seen with modern phones.
• Location of the phone (pocket, back pocket, etc.) does not impact fertility.
• Heat from laptops, saunas, hot tubs, and frequent hot baths can negatively affect sperm production and testosterone levels.
• Cyclists who engage in intense cycling for extended periods may experience lower sperm counts due to heat buildup in the scrotum area.

Heat And Infertility (00:29:40)

• Heat from various sources can impact sperm production and testosterone levels.
• Daily hot baths for more than 15 minutes should be avoided.
• Intense cycling for extended periods can lead to lower sperm counts due to heat buildup in the scrotum area.

What Testosterone Replacement Therapy Does To Your Sperm (00:30:15)

• Testosterone replacement therapy (TRT) can impact sperm quality and fertility.
• TRT signals the brain that there is sufficient testosterone, leading to decreased production of hormones that stimulate sperm production.
• TRT can cause aspermia, the absence of sperm in the ejaculate, which may be irreversible in some cases.

The Egg Vault (00:31:45)

• Women are born with 6-7 million eggs, but this number decreases to 1-2 million by birth and 500,000 by puberty.
• During a woman's reproductive years, she starts with about 300,000 eggs and has less than 1,000 left by menopause.
• Women only ovulate about 400-500 eggs over their lifetime.
• The number of eggs released each month is proportional to the number of eggs remaining in the vault.
• When the vault is fuller, more eggs are released, and when it is less full, fewer eggs are released.
• Each month, a group of eggs is released from the vault and grows inside a follicle.
• The brain sends out follicle-stimulating hormone (FSH) to stimulate one egg to ovulate, while the rest die.
• FSH controls the stimulation of one follicle in women, while in men, it controls sperm production.

Egg Production And Anomalies (00:35:25)

• Women have a finite number of eggs that decreases with age, affecting their fertility.
• The average age of menopause is 51 to 52, but various factors like smoking, marijuana use, endometriosis, chemotherapy, and environmental toxins can impact egg count and quality.
• Egg freezing or IVF can preserve fertility, but success depends on the number and quality of available eggs.
• Egg quality declines with age, making it harder to conceive naturally or through assisted reproductive technologies.
• Pregnancy chances halve every year after age 32, and the risk of genetic abnormalities and miscarriage increases.
• At age 35, the miscarriage risk is 25%, rising to 50% at age 40.
• The monthly chances of getting pregnant are 10-15% at age 35 and drop to around 5% at age 40.
• Most eggs released after age 40 are likely to be genetically abnormal, reducing the chances of a live birth.

Regret, Hindsight Of Patients And What You Can Do (00:42:41)

• Regret is common among patients who realize they could have made different decisions about childbearing if they had known certain information earlier.
• Testing female fertility, specifically ovarian reserve, is important for making informed decisions about family planning.
• Ovarian reserve testing can be done through a blood test (AMH) or an ultrasound.
• Having a lower egg count does not impact the monthly chance of getting pregnant, but it does affect the overall opportunity to grow a family and the success of IVF or egg freezing.
• The American College of OBGYN recommends not checking AMH levels in women who are not trying to get pregnant or experiencing infertility, but the author disagrees.
• Knowing one's ovarian reserve can help individuals make informed choices about their reproductive health, such as freezing eggs or trying to conceive sooner.
• The author recommends discussing ovarian reserve testing with one's OBGYN as part of a comprehensive reproductive health conversation.

What Has Changed Since Our Parents (00:47:16)

• Egg freezing didn't exist when our parents were our age, so they didn't have the option to preserve their fertility.
• We now know more about the factors that impact egg count and have the ability to freeze eggs with high success rates.
• Younger generations are more curious about their health and want to understand their bodies, but there is a lot of misinformation online.
• Fertility is now being approached as a health marker, with a focus on identifying potential problems early and intervening if necessary.
• Fertility declines with age, especially after age 32.
• The number of eggs a woman has decreases with age, and the quality of the eggs also declines.
• Men's sperm count and quality also decline with age.
• Age is the most significant factor that impacts fertility.
• Other factors that can impact fertility include:
  • Weight
  • Diet
  • Exercise
  • Stress
  • Smoking
  • Alcohol consumption
  • Medical conditions
  • Medications

The Effects Of An Unhealthy Lifestyle (00:49:06)

• Unhealthy lifestyle choices, such as smoking, excessive alcohol consumption, and obesity, can reduce the quantity and quality of eggs in a woman's ovarian reserve.
• Smoking damages the DNA of eggs and reduces their lifespan, leading to earlier menopause.
• Limiting toxic behaviors, such as smoking, excessive alcohol consumption, and drug use, is essential for maintaining a healthy ovarian reserve.
• Avoiding toxins in the environment, such as plastic containers, microwave meals, and thermal paper receipts, is important to reduce exposure to harmful chemicals that can negatively impact egg quality.
• Decreasing inflammation, both acute and chronic, is crucial for maintaining a healthy ovarian reserve. Chronic inflammation can be caused by conditions such as endometriosis and other inflammatory or autoimmune diseases.

Sleep Is Crucial In Your Reproductive Hormone System (00:54:07)

• Lack of sleep can negatively impact the reproductive hormone system.
• Getting 7.5 to 8 hours of sleep per night is crucial for the body to heal and repair itself.
• Prioritizing sleep is a simple yet effective way to improve reproductive health.

How Stress Impacts Fertility (00:55:07)

• Stress can affect fertility by disrupting the brain's interpretation of hormonal signals.
• Different types of stressors exist, including acute stressors and chronic stress.
• Stress reduction techniques vary for each individual and can include activities like yoga, acupuncture, meditation, or simply taking 20 minutes daily to relax without distractions.
• Reducing stress is essential for allowing the body to respond properly to stressful situations and promote healing.

The Best Diets For Good Fertility (00:57:14)

• Processed foods, refined sugar, and processed meats negatively impact fertility.
• Processed meats are type 1 carcinogens and can directly affect a person's ability to get pregnant.
• Red meat consumption should be moderate, as excessive intake can affect sperm production and egg and embryo quality.
• A healthy fertility diet should be rich in fruits and vegetables, which provide fiber, antioxidants, and gut health benefits.
• Meatless Mondays can be an accessible way to reduce meat consumption and incorporate healthier protein sources.
• Fish is a great alternative to red meat, providing omega-3 fatty acids, but should be limited to three servings per week due to mercury risk.

How Dairy Impacts Your Fertility (00:59:11)

• Whole-fat dairy is associated with better fertility and ovulation than skim dairy products.
• Skim milk is a processed version of milk that has the fat removed and something else added to retain its milk-like appearance.
• The potential benefit of dairy is being a source of healthy fat, which is lost when the fat is removed.
• It is recommended to consume whole-fat dairy products in moderation.
• If you follow Meatless Monday, you should have one serving of meat per day for the rest of the week to increase fruit and vegetable consumption.
• One of those meals should include red meat, if desired, but not multiple times a week.
• Processed foods, sugars, processed meats, refined carbohydrates, and packaged foods should be limited and consumed rarely, if at all.

You Need To Understand The Reproductive Cycle To Know How Exercise Impacts It (01:01:05)

• The ovaries release eggs each month, and the process of one egg maturing and releasing takes about two weeks.
• Rising estrogen levels signal the brain to release LH (lutenizing hormone), which causes the follicle to open and release the egg.
• The fallopian tube captures the egg, and the follicle becomes the Corpus luteum, producing progesterone.
• Progesterone is essential for the implantation of a fertilized egg in the uterus.
• Intense exercise, eating disorders, and being overweight can disrupt the brain's interpretation of estrogen, leading to menstrual irregularities or absent periods.
• Being overweight can cause extra estrogen production, confusing the brain and preventing ovulation signals.
• Moderate exercise can benefit fertility in overweight men and women by reducing estrogen levels and improving hormone interpretation.
• Building muscle through exercise helps combat insulin resistance and other issues that interfere with hormone interpretation.
• Regular exercise improves hormone function, reduces overweight risks, enhances the brain's interpretation of signals, and lowers stress levels by reducing cortisol.
• Sufficient sleep is vital for overall well-being.
• Maintaining a regular menstrual cycle is crucial for reproductive health.

Menstrual Irregularities And What's Normal (01:10:58)

• A normal menstrual cycle lasts between 24 to 35 days and involves the release of an egg from the ovary, followed by the development of the corpus luteum and the production of progesterone.
• If pregnancy does not occur, the corpus luteum regresses, progesterone levels drop, and the lining of the uterus is shed during menstruation.
• Irregular menstrual cycles can be caused by various factors, including pregnancy, lack of ovulation, stress, pituitary and thyroid disease, prolactin issues, and polycystic ovarian syndrome (PCOS).
• The fertile window for conception is the 5 days before ovulation and the day of ovulation, as an egg lives for 24 hours and sperm can survive in the female reproductive tract for 5 days.
• To increase the chances of conception, couples should have sex every day or every other day during the fertile window.

How Long Does It Take To Get Pregnant? (01:16:57)

• For a 30-year-old, there's a 20% chance of pregnancy per month.
• Most people should be pregnant within 6 months.
• Infertility is defined as trying for a year without getting pregnant.
• Trying to get pregnant means having intercourse, ejaculating inside, and having regular periods.
• If you're not able to complete intercourse or don't have regular periods, see a doctor right away.

When Trying To Have Children Sex Can Become A Chore (01:17:50)

• Trying to conceive later in life can turn sex into a chore due to the pressure to succeed.
• Realistic goals are important, as the chances of conceiving decrease significantly with age.
• Tracking cycles and timing intercourse appropriately is crucial for older women.
• Regular sex is beneficial for overall health and can reduce the burden of conception-focused intercourse.
• Sperm can live in the female reproductive tract for up to 5 days, with most surviving for 2-3 days.
• Sexlessness is a common issue, affecting couples due to various factors such as busy schedules and stress.
• Intrauterine insemination (IUI) is an option for couples who struggle with intercourse during the fertile window or prioritize other aspects of their relationship.
• IUI involves processing and placing cleaned sperm directly into the uterus, avoiding potential inflammatory or infectious issues.

Purchasing Sperm From The Black Market (01:21:43)

• Some people resort to unconventional methods of sperm procurement, such as using tampons or turkey basters to collect sperm.
• There is a black market for sperm donation through Facebook groups and other platforms, where people connect to exchange sperm without going through traditional sperm banks.
• Sperm banks ensure that donated sperm is tested and free from infectious material, but black market sperm transactions lack such safeguards.
• Sperm donors on these platforms may change their minds and sue for custody of the child, leading to legal complications.
• Third-party options like donor sperm, gestational carriers, and donor embryos are becoming increasingly common in family building, but protecting parental rights is crucial.
• The cost of purchasing sperm from a sperm bank is approximately $1,000.
• Each cycle of intrauterine insemination (IUI) at a clinic to inseminate the sperm typically costs between $1,000 and $2,000.
• The total cost of sperm bank insemination can range from $2,000 to $3,000 per month.
• The success rate of IUI depends on the woman's age, with a 10-15% chance of success at age 35.

PCOS Explained (01:24:48)

• Polycystic ovary syndrome (PCOS) is a condition where women are born with more eggs in their ovaries, leading to hormonal imbalances and irregular cycles.
• The exact cause of PCOS is unknown, but it may be linked to factors during pregnancy or exposure to certain substances.
• PCOS can cause various symptoms, including insulin resistance, abdominal weight gain, acne, facial hair, and male pattern baldness.
• Treatment for PCOS may involve medications to induce ovulation, reduce testosterone production, or manage symptoms by providing estrogen and progesterone.
• PCOS patients have a sensitive hormonal balance that can be easily disrupted by stress or other factors.
• Being overweight can worsen PCOS symptoms, but it's not the only factor.
• Some women with PCOS may need interventions like freezing eggs, IVF, or ovulation induction to get pregnant.

PCOS Diagnosis (01:30:59)

• PCOS is diagnosed by meeting two out of three criteria:
  • Having many follicles on an ultrasound.
  • Having high androgen signs (e.g., high testosterone, acne, or excessive hair growth).
  • Having irregular or absent periods.
• The exact cause of PCOS is unknown, but it may be genetic or epigenetic (influenced by the environment in the womb).
• Being overweight can also contribute to PCOS symptoms, as fat can disrupt hormone balance and lead to insulin resistance.
• PCOS is a syndrome based on symptoms, and different cases may have different origins.
• Some people may experience complete healing from PCOS, but this is often related to age and a decrease in the number of eggs in the ovaries.
• As women age, the number of eggs in the ovaries decreases, and the brain becomes more responsive to the remaining eggs.
• Lifestyle changes can improve PCOS symptoms and help the ovaries respond to hormonal signals.
• Despite any improvements, women with PCOS still go through menopause at the same age as others, but they lose eggs at a faster pace due to having more eggs initially.

Link Between PCOS & Endometrial Cancer (01:33:50)

• Irregular periods or lack of menstruation is a leading cause of infertility, with PCOS being the primary cause.
• Not having a period without taking birth control is detrimental to health and can indicate PCOS or other underlying health issues.
• PCOS can cause irregular estrogen production, leading to an increased risk of metabolic diseases, high blood pressure, cholesterol, diabetes, and endometrial cancer.
• Progesterone is necessary to shed the uterine lining and prevent cancer development in women with PCOS who don't menstruate.
• Lack of estrogen during prolonged periods of amenorrhea, such as from excessive exercise, can have long-term negative effects on health, including increased risks of heart disease, stroke, osteoporosis, dementia, and Alzheimer's.
• Estrogen deficiency can lead to fatigue, mental fog, and decreased quality of life.
• Replacing estrogen in women whose ovaries are not producing it, whether due to brain signals or early egg depletion, is crucial for overall well-being and longevity.

What Is Endometriosis & How Do You Know You Have It (01:37:02)

• Endometriosis is an inflammatory autoimmune condition where endometrial cells migrate out of the uterus and cause an abnormal reaction in the body.
• Symptoms of endometriosis can include painful periods, pain during intercourse, and infertility.
• Endometriosis is diagnosed through surgery (laparoscopy).
• Treatment for endometriosis may involve stopping ovulation, which can make it difficult to get pregnant.
• Endometriosis affects about 10% of women of childbearing age.
• IVF can be an effective treatment for infertility caused by endometriosis as it allows for controlled egg fertilization and embryo growth.

What Happens When You Come Off The Pill And Want To Have Children (01:43:55)

• Women who have been on birth control pills for a long time do not have reduced fertility when they stop taking the pill.
• In fact, they may have higher fertility rates than women of the same age who have never taken the pill.
• This is because birth control pills suppress ovulation, which can halt the progression of endometriosis.
• If you have endometriosis, it is important to know so that you can take steps to prevent ovulation and preserve your fertility.
• Women with endometriosis run out of eggs faster than women without endometriosis because endometriosis is inflammatory and destroys the eggs inside the ovaries.
• If you have endometriosis and want to have children, it is important to talk to your doctor about how to preserve your fertility.
• One option is to take medication that suppresses ovulation, which can halt the progression of endometriosis and increase your chances of getting pregnant.

Advice For People With Endometriosis And PCOS, If They Want To Have Children (01:46:25)

• Check ovarian reserve to ensure there's not already a low egg count.
• For endometriosis patients, test fallopian tube patency and partner's sperm before trying to conceive.
• Patients with PCOS or endometriosis should approach family planning differently due to increased infertility risks.
• Consider embryo banking (IVF process) to preserve eggs and embryos for future use, especially if planning a larger family.
• Age and number of eggs are the two most important factors in fertility.
• Genetic testing can be done on embryos to identify chromosomally normal ones for future use.

Getting Started With Freezing Eggs And Embryos And Success Rate (01:49:36)

• Freezing embryos is preferable to freezing eggs as it enhances embryo development and genetic normalcy.
• The success rate of egg freezing and embryo creation declines with age, with a significant drop after 35.
• To increase the likelihood of success, it's advisable to have two to three genetically normal embryos for each desired child.
• A single genetically normal embryo implanted has a 65% chance of resulting in a live birth.
• Pregnancy chances decrease by half every year after the age of 32.
• Freezing embryos increases the chances of having multiple children, with 88% and 95% success rates after two and three embryo transfers, respectively.
• The primary challenge in IVF is the limited number of genetically normal embryos.
• The number of embryos obtained from 20 eggs is uncertain.

The Cost Of Fertility Procedures (01:55:15)

• Freezing eggs costs about half as much as IVF.
• On average, egg freezing costs around $10,000, while IVF costs around $20,000 in the US.
• In the UK, IVF costs around £3,500 on average.
• Annual storage fees for frozen eggs typically range between $500 to $1,500.

IVF Stigma (01:56:40)

• There is a stigma associated with IVF and fertility treatments.
• People may feel that undergoing fertility treatments means they are broken or that it is not natural.
• The stigma can prevent people from having important conversations about family planning and fertility preservation.
• Having open conversations about fertility treatments can help to normalize them and reduce the stigma.

Ads (01:58:42)

• Shopify is an e-commerce platform that makes it easy for people to start an online business.
• Shopify's checkout system converts 36% better compared to other platforms.
• Viewers can try Shopify for $1 a month by going to shopify.com/Bartlet.

When To Think About Fertility Treatment (01:59:32)

• The average US woman had her first baby at age 21 in 1970, which increased to age 27 by 2022.
• People are having their first baby in their late 20s due to social factors.
• There is a trade-off between having a longer career and more freedom in early life and having fewer children.
• The optimal time for the average person to intervene and start freezing their eggs is around age 32 or 33.
• If you are approaching age 32 and want to have children as a life goal, you should see a fertility doctor to discuss options such as freezing your eggs.
• Pregnancy chances are halved every year after age 32.
• If you want two or more children, it's important to start planning early.
• See a fertility doctor if you're not ready to have children but want to in the future.

Dummies Guide To IVF (02:01:54)

• IVF (in vitro fertilization) involves fertilizing eggs outside the body.
• Modern IVF includes growing eggs to embryos, genetic testing, and freezing healthy embryos.
• Genetic testing checks for chromosome number and presence/absence of each chromosome in a 5-8 cell sample from embryo biopsy.
• IVF can eliminate genetic diseases by identifying and not transferring embryos with genetic abnormalities.
• IVF can also be used to eliminate lethal abnormalities and autosomal dominant diseases from the family line.
• Pregnancy chances decrease significantly with age, especially after age 32.
• Age affects egg quality and quantity, leading to fewer genetically normal embryos.
• Genetic testing of embryos can help identify viable embryos for transfer, increasing pregnancy success rates.
• Single embryo transfer is preferred to avoid multiple pregnancies and complications.
• Identical twinning can occur in IVF, but the chances are low (0.5% overall, 2-3% in IVF).
• Putting two embryos increases the risk of triplets or quadruplets if one or both embryos split.

Myths Of Conception (02:06:38)

• There's no need to save up sperm for ovulation, as sperm can survive in the reproductive tract for up to 5 days.
• Sperm reach the Fallopian tubes within minutes, so there's no need to prop hips up or keep feet in the air after intercourse.
• Urinating after intercourse for women decreases the risk of a urinary tract infection.
• Embryos and plant eggs fertilize when a person is up and living their life, so there's no need to be horizontal for fertilization to occur.

Best Sex Position To Get Pregnant (02:08:54)

• Any sex position that allows for ejaculation is fine.
• There's no evidence that any particular sex position increases the chance of conceiving a boy or a girl.
• Female orgasm helps uterine contractions, which can help get sperm to the eggs faster.
• Penis size doesn't matter as long as the sperm can reach the cervix.

Is Birth Control Healthy? (02:10:33)

• Birth control has trade-offs, side effects, and risks.
• The birth control pill is not necessarily unhealthy.
• Overuse of the birth control pill as treatment without proper diagnosis has been a problem in women's health.
• The birth control pill itself does not cause infertility.
• The birth control pill changes metabolic parameters and vitamins, affecting individuals differently.
• The birth control pill can have medical benefits such as preventing cancer from PCOS, preventing endometriosis progression, and treating pain.
• There is a stigma associated with the birth control pill on social media, leading to misinformation.
• It is recommended to stop contraception before trying to get pregnant to understand menstrual regularity and potential issues.

What Can People Do If They Struggle With Infertility? (02:13:36)

• People should take control of what they can, such as optimizing their lifestyle and getting enough sleep.
• Seeking a second opinion is advisable if fertility treatments are not successful.
• It is important to feel comfortable with the choices being made and to have all the necessary information from the doctor.
• Irregular or painful periods, as well as a diagnosis that may affect fertility, should prompt a visit to the doctor.
• Proactive measures should be taken rather than waiting for infertility to occur.

Last Guest Question (02:15:40)

• Pregnancy can have complications, and every pregnancy carries risks.
• The speaker's most impactful conversation was with her OB after her second pregnancy loss, who encouraged her to persevere.
• The speaker believes in the world's ability to make sense, even in difficult times.
• Sometimes, the speaker must inform patients that their desired family-building plan is not feasible, necessitating the consideration of alternatives.
• The most challenging days for the speaker involve fetal death, stillbirth, or any pregnancy loss.
• The speaker expresses gratitude to Natalie, a pregnancy doctor, for her invaluable support and information provided to individuals seeking to build a family.
• Natalie's efforts in raising awareness and dispelling uncertainties about fertility and family planning are widely appreciated.
• By making fertility-related information accessible through podcasts and other platforms, Natalie reaches a broad audience, including those without direct access to fertility experts.
• The speaker believes Natalie's work positively impacts millions of lives, even those who may not directly express their gratitude.
• Natalie's willingness to discuss sensitive topics like fertility challenges helps reduce stigma and provides essential knowledge to individuals who may not actively seek it.