How to Improve Female Fertility at Any Age | Dr. Natalie Crawford & Dr. Andrew Huberman

0:00 When you think about the things that can

0:02 really help support egg quality aside from age.

0:06 Yeah.

0:07 In fact, I should say at any age.

0:10 What are the you know, so top contour of those.

0:14 You mentioned inflammation is the enemy,

0:16 but inflammation happens all the time and we can't avoid it,

0:20 but we can certainly avoid exacerbating it.

0:22 So, what are the things that people can do not do and take?

0:26 We can do that in those three things.

0:28 Do, not do and take.

0:29 Okay.

0:30 So, yes, inflammation is prevalent in our world

0:34 and the goal is not to avoid all of it.

0:36 In fact, acute inflammation is required for conception, right?

0:41 We need acute inflammation with ovulation.

0:43 If we just think real physiology,

0:46 a follicle is rupturing allowing the egg to be released and then reforming.

0:51 Like, we need our acute inflammatory response to allow that to happen.

0:54 To the degree that if women take NSAIDs around the time of ovulation,

0:57 Advil, ibuprofen, Aleve, they'll prevent the follicle from rupturing.

1:02 Really?

1:02 Yeah, so they will go through the hormonal changes of ovulation,

1:05 but the egg will not be released.

1:07 So, that's why we recommend, and a fun fact or important to know,

1:11 if you're trying to get pregnant,

1:12 you can take those medications only when you're on your period.

1:15 So, period cramping fine,

1:16 but we don't want you taking them for the rest

1:18 of the cycle because you can prevent ovulation from occurring.

1:21 How many people in your experience do you think know that?

1:24 I don't think very many, honestly, right?

1:27 Which which is why like banner across the sky.

1:30 Like, you should You're not going to lose

1:31 eggs by doing a free cycle collecting free cycle.

1:34 The I mean Basic facts about our biology that we are never taught.

1:39 So, if somebody's trying to get pregnant, NSAIDs can be problematic.

1:42 They can be problematic.

1:43 They can prevent the egg from being released with ovulation.

1:46 [clears throat]

1:47 So, I think that this is important because I will sometimes have patients say,

1:50 "Well, if inflammation's bad, can I just take medicine for it?" Right?

1:54 Like that you know, our brain might make sense.

1:57 And I was going to say,

1:57 "Your immune system is essential for ovulation and also for implantation." So,

2:01 like you know, I don't want to turn off your immune system.

2:04 What I want to do though is not have

2:06 it be so burdened with what we call chronic inflammation,

2:08 that constant activation where it can't even do the job that we need it to do.

2:13 So, I like to think about this is that inflammatory

2:15 burden and it's a we're all exposed to some,

2:18 but how do we to your degree make it better?

2:21 How do we add to it and make it worse?

2:24 And really framing ourselves so that we can cultivate and I

2:27 like to think about it as resilience within your body.

2:30 I mean, you're going to be exposed to inflammation.

2:32 Life is going to throw things at you,

2:34 but you want to cultivate these best practices

2:37 of your life so that you are reducing inflammation

2:39 to the degree that you had and this goes

2:41 hand in hand with insulin resistance which we'll get into.

2:44 And I usually divide it into like what

2:46 I call my five non-negotiables of sleep, stress, muscle,

2:50 food and toxins and thinking about how we leverage these to our benefit

2:54 by giving people the knowledge that they can if they understand their bodies,

3:01 they can then be empowered to make choices that are in line with their goals.

3:06 And so, I really also just want to say

3:08 really importantly I hate the narrative that there's

3:10 nothing you can do for your fertility or that it's

3:12 all luck because the truth is even if

3:14 we can't control everything we have a huge control

3:18 over our metabolic and cellular health which as we

3:20 just said plays a huge role in our ability

3:22 to get pregnant for both men and women.

3:25 So, taking control of what we can,

3:28 I think is really important information and one person can

3:31 take with that and make the choices they want to make,

3:34 but the worst thing that I hear every

3:35 single day is people sitting across from me saying,

3:37 "Gosh, I wish I'd known that information.

3:40 I would have made a different decision." Why do

3:42 we make people go through a failed IVF cycle,

3:44 they have no embryos form and only then do they make lifestyle changes when

3:48 we know the lifespan of a sperm is 90 days and sperm are so sensitive.

3:52 And then we know that even though eggs are in your body your whole life,

3:55 the 60 days before you get pregnant is when

3:58 the egg is most susceptible to the world around you.

4:00 So, this is this time period that I like to call trimester zero,

4:04 the time before you're getting pregnant where the choices you

4:07 make can influence your egg and sperm quality the most.

4:10 And what you said earlier, if we're making them even earlier in life,

4:13 can we influence ovarian function longer?

4:15 I think there is a good thought to that.

4:17 But, how do we leverage these choices and diving into them?

4:21 Number one for me is sleep and I think that this is an important one because it

4:24 can leverage that inflammatory burden in both ways

4:26 and I know you're a big fan of sleep,

4:28 so this isn't going to take much to convince you.

4:30 When you sleep, this is when your body's

4:32 going to get rid of some excess chronic inflammation,

4:34 lowers our inflammatory markers.

4:37 We know that when we get less sleep it's

4:40 going to cause us to have more cellular stress, more oxidative stress.

4:44 Your gonadotropins, so FSH and LH are released

4:47 from the brain in the early morning hours.

4:49 So, when you don't sleep long enough,

4:51 you're not going to have the same hormonal response.

4:53 And we know really directly, men who get less sleep,

4:56 they have lower testosterone levels and lower sperm counts.

4:59 Women who get less sleep get fewer eggs at IVF cycle.

5:03 And we see that if you say you have poor sleep,

5:06 you have double the rate of infertility.

5:07 If you just subjectively say, "Yeah,

5:08 I have poor sleep." You have double the rate.

5:11 And that people who are not sleeping well,

5:13 either partner, it will take them longer to get pregnant.

5:16 They have lower fecundability, that month-to-month pregnancy rate.

5:19 So, it's not just me sitting over here saying, "Oh, yeah,

5:21 you need to sleep better." Like your physiology is meant to sleep.

5:25 It is a sign to your brain,

5:27 if we go back and we view that hypothalamic response as central

5:30 command station looking for clues that your life is stable enough,

5:36 you're healthy enough to carry a pregnancy

5:38 for a woman which is a huge metabolic spend.

5:41 It's looking to make sure you are taking care of yourself primarily

5:44 and sleep is one of the most powerful markers that we can move.

5:48 7 to 9 hours.

5:49 Most women need closer to 7 and 1/2 especially in the luteal phase.

5:53 Making progesterone is a big body spend.

5:56 We really have to cultivate better sleep.

5:59 You know, all the things you talk about.

6:00 Dark room, sound machine, a sleep mask, a cooler temperature.

6:04 Takes two to tango.

6:05 So, if you sleep in the bed with somebody, they need to be on board.

6:08 You need to go to bed at the same time.

6:09 You need to have similar sleep practices.

6:11 And we know that day-to-day consistency is also impactful in fertility.

6:16 So, not just the length of time,

6:17 but really having that good circadian rhythm is so important for your hormones.

6:22 Melatonin is obviously released before you go to bed.

6:25 Low doses of melatonin supplementation can impact fertility.

6:28 So, doses of 1 to 3 mg 30 minutes before you

6:31 go to bed can improve your odds of getting pregnant as well.

6:35 Can influence egg quality.

6:37 And we know that naturally you make more melatonin when you ovulate

6:40 to kind of counter some of the oxidative stress to the ovary.

6:43 Really have to be careful though.

6:44 A lot of over-the-counter products have like 10 times the amount of melatonin,

6:47 so I always want to tread lightly with that one in recommending it to patients.

6:51 Often a pediatric dose is like 1 mg

6:53 and that's the perfect amount just to augment.

6:56 Again, we're not trying to replace your body's melatonin.

6:58 We want to augment it and kind of help

7:00 your body I always like to think about like a toddler.

7:02 Really get good consistency with your wind-down

7:05 routine so that you can get enough sleep.

7:07 I don't want to disrupt your flow,

7:08 but if a woman is already sleeping well, should she take melatonin?

7:12 I would say for the average person, probably don't need to.

7:15 I would say the exception to the rule would

7:17 be that if we know we have increased chronic inflammation,

7:19 maybe we have endometriosis or an inflammatory

7:22 autoimmune disease or we're going through IVF

7:24 with unexplained infertility or ever been kind

7:27 of told you have quote bad egg quality,

7:30 then the anti-inflammatory properties of it might be advantageous.

7:34 Since NSAIDs can disrupt the inflammation requirement for ovulation,

7:41 I'm curious about other things that are known to potently reduce inflammation.

7:45 I I think enough terrible things have been said about

7:48 cold plunges that we don't need to add any more,

7:50 but we're seeking reality here and I don't have it and despite common belief,

7:55 I don't have anything inherently attached to cold plunges.

7:58 I do them sometimes,

7:59 but we know that one shouldn't do them after resistance training or any kind

8:03 of exercise where you want the inflammation

8:06 to get the adaptation to the exercise.

8:07 We know that.

8:08 And it's a pretty potent inhibitor of inflammation.

8:11 So, is there any reason to think that in the time where

8:14 somebody's trying to conceive that perhaps they should avoid the cold plunge?

8:17 I usually recommend against them for reasons stated here.

8:20 I think there's very few things we have that are going to really

8:23 turn off that acute inflammatory response to the degree that NSAIDs do,

8:27 but we should proceed with caution in doing those things.

8:30 Most everything else is trying to just

8:32 get rid of the excess inflammation we have,

8:35 but if something's dampening down into that acute inflammatory response,

8:38 then I think we have to be a lot more judicious in saying, "Yeah,

8:41 go for this." So, I'm not a fan of cold plunges when trying to get pregnant.

8:45 A lot of people will be very happy

8:47 to hear that because I don't Unlike the sauna, nobody likes the cold plunge.

8:50 I hate a cold plunge.

8:51 I tried it I tried it one time and that was one time too many.

8:54 I would say if you if you like it, great.

8:56 If you think you benefit, great, but otherwise don't worry about it.

8:59 Um, one thing that's commonly used is

9:01 um curcumin and it's a pretty potent anti-inflammatory.

9:05 Do you recommend people stay away from let's not cooking with curcumin,

9:09 but the high dose curcumin that comes in a lot of of supplements.

9:13 usually recommend it in a supplement form.

9:14 Like I I I never recommend it.

9:16 I think if you have a doctor who's giving it for very specific purpose,

9:19 you might be a unique person who

9:21 has excess inflammation they're trying to target,

9:24 but that's not something that I recommend.

9:25 But, cooking with it is fine.

9:27 NAD and NR are I get asked about them thousands of times per week and I'm

9:34 more or less a fan of NR or NMN if one is trying to I don't know.

9:39 I don't think it'll extend lifespan,

9:40 but it does seem to at least in my experience increase energy,

9:44 these kinds of things.

9:45 Um but it's NR in particular,

9:48 there are data that it can be very anti-inflammatory.

9:50 So, if a woman is trying to conceive, should she stay away from NMN, NAD and NR?

9:55 Cuz I often see it listed in in fertility protocols.

9:59 Animal data looks like NAD and N and M can be advantageous,

10:04 especially for unexplained infertility,

10:06 which to be clear is different than I just want to get pregnant, right?

10:10 In unexplained infertility, you're not conceiving, we do the basic test,

10:13 anatomy, ovulation, ovarian reserve, semen analysis, they're all fine.

10:18 So, I view that as chronic inflammation unless proven otherwise.

10:22 And so, that's a unique situation that patients may have potential benefit.

10:27 But unlike certain things across the population

10:30 that we can feel really comfortable recommending,

10:33 I don't recommend that to everybody.

10:34 So, I think that there might be utility

10:37 in certain subgroups who are kind of really

10:40 falling off the curve and we think there's

10:41 excess inflammation that it could make sense for.

10:43 So, I I don't ever say no and I sometimes use it.

10:46 But on the like the flip hand, we could say like CoQ10,

10:49 which has robust human data that is advantageous without a negative benefit,

10:53 that's an easier place to leverage

10:55 your supplement dollars if you're going to spend,

10:57 because most of us don't want to spend endless amounts

11:00 on all the things that we can craft for our supplement list.

11:02 But the human data is yet yet to be out,

11:05 although animal data looks promising for the right patients.

11:08 I'm glad you mentioned CoQ10.

11:10 CoQ10 and L-carnitine are the two Lisa I'm aware of uh

11:14 there's some decent data on supporting sperm and egg quality.

11:18 Um so, do you encourage patients to start taking that what

11:22 60 days before trying to conceive and then continuing that through pregnancy?

11:26 We usually stop CoQ10 in pregnancy just because of lack of data.

11:30 We're very cautious in pregnancy of not exposing

11:34 you to anything additional you may not need.

11:36 So, we just want to be really mindful of that.

11:39 But I think it's in my like everybody should take before you get pregnant.

11:42 Yeah, but your trimester zero, your hey, we want to get pregnant soon.

11:46 We should take a prenatal vitamin that has folic acid, we should take CoQ10,

11:49 we should take omega-3 fatty acids, we should take vitamin D.

11:53 These are all going to optimize,

11:54 make giving you the nutrients you need for a pregnancy,

11:57 helping support my good mitochondrial health,

11:59 which is important for egg quality,

12:01 without risk of harm to any of these specific supplements.

12:05 So, these are the universal we're trying.

12:07 And then for sperm health,

12:08 L-carnitine we like a lot and then zinc and selenium can have benefits as well.

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