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    Huberman Lab

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

    Mon Nov 13 2023

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    Chapters

    1. Female Hormones, Hormone Health, and Fertility
    2. Puberty in Females and Its Impact on Fertility
    3. Impact of Puberty Onset and Egg Count on Reproductive Lifespan
    4. Impact of Fetal Development and Environmental Exposures on Fertility
    5. Menstrual Cycle and Its Impact on Fertility
    6. Menstrual Cycle Regularity and Factors Affecting Fertility
    7. Contraception and Its Impact on Fertility
    8. Fertility Window and Factors Affecting Conception
    9. Optimizing Intercourse for Pregnancy
    10. Impact of Lifestyle Factors on Fertility
    11. Birth Control Methods and Their Effects on Fertility
    12. Ethical Considerations in Reproductive Technologies
    13. Health Risks and Benefits of Birth Control Pills
    14. Understanding Ovarian Reserve and Fertility Testing
    15. Egg Freezing and In Vitro Maturation
    16. Egg Freezing and Embryo Freezing
    17. Optimizing Fertility Treatments and Embryo Transfer
    18. Family Planning and Fertility Preservation
    19. Fertility Treatments and Hormone Manipulation
    20. Advancements in Reproductive Technologies
    21. Ethical Considerations in Reproductive Technologies
    22. Impact of Reproductive Technologies on Developmental Outcomes
    23. Inflammation, Nutrition, and Fertility
    24. Impact of Diet and Lifestyle on Fertility
    25. Nutrition and Supplements for Fertility
    26. Supplements for Male and Female Fertility
    27. Lifestyle Factors and Fertility
    28. Optimizing Fertility Treatments and Egg Retrieval
    29. In Vitro Fertilization (IVF) and Reproductive Options
    30. Factors Affecting Embryo Development and Fertilization
    31. Pre-implantation Genetic Testing and Embryo Banking
    Summary
    Transcript

    Female Hormones, Hormone Health, and Fertility

    00:00 - 06:45

    • The podcast is a discussion between Andrew Huberman and Dr. Natalie Crawford about female hormones, hormone health, and fertility.
    • Dr. Crawford specializes in obstetrics and gynecology, reproductive endocrinology, and infertility.
    • They discuss various topics including the timing of puberty in girls and its implications for fertility.
    • The conversation also covers different forms of birth control and their relationship to long-term fertility and overall female health.
    • Measuring fertility, specifically egg count, is extensively discussed along with egg retrieval (freezing eggs) and in vitro fertilization.
    • Nutrition and supplementation are explored in relation to fertility, pregnancy, and female health.

    Puberty in Females and Its Impact on Fertility

    06:19 - 13:14

    • Female fetuses have the most eggs at around 20 weeks gestation, but they continually lose eggs throughout development.
    • Puberty in females is marked by the development of breasts (thelarche) before the start of menstruation (menarche).
    • Follicle stimulating hormone (FSH) stimulates follicles to grow and produce estrogen, leading to breast budding and other secondary sex characteristics.
    • Secondary sex characteristics that precede menarche include genital hair and underarm hair development.
    • The onset of puberty is associated with the development of body odor in both males and females.
    • Exposure to odors can potentially accelerate or stimulate puberty, but there is limited evidence in humans.
    • Endocrine disruptors, including fragrances, may play a role in disrupting the puberty system.
    • Girls are experiencing puberty at a younger age now compared to before, with menarche starting as early as 10 to 11 years old.
    • Early puberty may result in reduced

    Impact of Puberty Onset and Egg Count on Reproductive Lifespan

    12:57 - 19:52

    • Puberty onset does not impact the length of a person's reproductive lifespan.
    • Eggs are constantly being culled from the vault starting from early embryonic development, and ovulation is unrelated to the loss of eggs.
    • Harvesting eggs for IVF or embryo genesis does not reduce the total number of eggs a person has.
    • The fear of harming future fertility through egg freezing or IVF is unfounded, as these procedures do not affect the natural process of egg release.
    • IVF stimulates the growth of released eggs for later use, rather than excessive release of eggs.
    • Hormones used in IVF are manipulating the normal menstrual cycle to improve efficiency in finding normal eggs.
    • The process of harvesting eggs for freezing or fertilization does not diminish fertility.
    • Exposure to endocrine disruptors like evening primrose oil can stimulate breast bud development in males and accelerate puberty signs in young girls, but it does not initiate puberty itself.
    • Young children showing signs of puberty should be

    Impact of Fetal Development and Environmental Exposures on Fertility

    19:33 - 26:33

    • Exposure during fetal development can affect ovarian reserve and increase the risk of infertility-related diseases like PCOS or endometriosis.
    • The 80s and 90s were a time of unhealthy exposures to chemicals and toxins, which may have contributed to variations in egg quality and quantity.
    • Early organizing effects of hormones during male fetal development can impact the growth of sex organs and activate brain areas responsible for various functions.
    • Constant exposure to chemicals or toxins is different from one-time exposure, and choosing unscented products can reduce lifetime exposure, especially for children.
    • Using cloth diapers versus non-cloth diapers is a personal preference, as there is no clear evidence that one is better than the other in terms of potential skin permeability or toxin exposure.
    • Baby skin may be more permeable during development, making it important to pay attention to what they are exposed to during childhood.
    • Breastfeeding for the first six months helps with immune system development, which can indirectly impact fertility by

    Menstrual Cycle and Its Impact on Fertility

    26:05 - 32:42

    • The menstrual cycle starts on the first day of bleeding.
    • The follicular phase is the first phase of the menstrual cycle, characterized by the growth of a follicle and high estrogen levels.
    • Estrogen has a positive effect on mood and energy levels.
    • Low estrogen levels can lead to depressed mood and lack of pleasure response.
    • Ovulation occurs when estrogen reaches its peak and triggers the release of luteinizing hormone (LH).
    • After ovulation, the follicle becomes the corpus luteum, which produces progesterone.
    • Progesterone prepares the body for potential pregnancy and can cause changes in energy levels, appetite, and sex drive.
    • If pregnancy doesn't occur, the corpus luteum dies, leading to a drop in estrogen and progesterone levels.
    • The length of the menstrual cycle can vary from person to person, but it should be relatively constant for each individual.
    • Irregularly regular periods, where cycle lengths

    Menstrual Cycle Regularity and Factors Affecting Fertility

    32:21 - 39:19

    • The regularity and predictability of a woman's menstrual cycle can indicate if her reproductive hormones are communicating correctly.
    • A shortening of the menstrual cycle may be a sign of decreased ovarian reserve, where fewer eggs are being released each month.
    • Changes in thyroid and prolactin levels can also affect the menstrual cycle.
    • High-quality nutrition, including vitamins, minerals, probiotics, and fiber, is important for physical and mental health.
    • Getting enough servings of fruits and vegetables per day can be challenging, which is why some people turn to supplements like AG1 for their nutritional needs.
    • AG1 provides foundational nutrition to support optimal mental and physical health.
    • The menstrual cycle consists of two phases: the follicular phase (around 14 days) and the luteal phase.
    • Estrogen plays a role in energy levels and vitality, while progesterone dominates the luteal phase.
    • The follicle ruptures during ovulation, releasing an egg that becomes

    Contraception and Its Impact on Fertility

    38:52 - 45:43

    • Contraception in females, such as the pill, does not change the release of eggs from the ovaries.
    • The estrogen in birth control pills prevents FSH from coming from the brain, which leads to the group of eggs dying instead of ovulating.
    • Birth control pills can suppress AMH (anti-mullerian hormone) levels, which is a marker of ovarian reserve. This suppression is reversible but can be significant.
    • If someone on birth control pills wants to check their ovarian reserve, their AMH levels may be up to 30% lower. If it comes back low, further testing may be needed after stopping the pill for some months.
    • Prolonged use of birth control pills may potentially improve fertility in individuals with underlying endometriosis or certain medical conditions associated with infertility.
    • The pill does not cause infertility and is commonly used in IVF cycles to synchronize egg growth.
    • Testosterone shuts down testosterone and sperm production in males because sper

    Fertility Window and Factors Affecting Conception

    45:17 - 52:10

    • Heat exposure does not harm ovulation or egg production in females, unlike the testes which are susceptible to heat changes.
    • Women can potentially get pregnant even while they have their period, especially if they have irregular cycles or a shorter cycle window.
    • The most fertile time for conception is when sperm meets the egg on the day of ovulation or the day after.
    • The egg can only be fertilized for 24 hours while it's in the fallopian tube, but sperm can live for up to five days.
    • The fertile window is considered to be a five-day period ending on the day of ovulation.
    • Estrogen levels increase libido and trigger the LH surge during ovulation, making it an optimal time for intercourse and pregnancy.
    • Some women can feel the sensation of ovulation, known as "middle schmertz," which is a crampy pain in the middle of their cycle.
    • The whole process of reproduction is incredibly well orchestrated and synchronized,

    Optimizing Intercourse for Pregnancy

    51:47 - 58:45

    • Having daily intercourse during the fertile window increases the chances of pregnancy.
    • However, for couples who do not have sex every day, having intercourse every other day throughout the fertile window is recommended to reduce stress and prevent sexual burnout.
    • Saving up sperm for two or three days does not increase the odds of getting pregnant.
    • For semen analysis and certain fertility treatments like IUI and IVF, abstaining from ejaculation for 48 to 72 hours prior is advised to ensure a better sample of sperm.
    • Smoking cigarettes negatively impacts egg quality, quantity, and increases the risk of abnormal chromosomes and miscarriage.
    • Vaping has chemicals associated with poor success rates in IVF cycles but there is less data available compared to smoking cigarettes.
    • There may be individual variations in response to vaping or smoking, but overall negative effects on health and fertility are observed.

    Impact of Lifestyle Factors on Fertility

    58:22 - 1:05:00

    • Smoking cigarettes or vaping nicotine can have a negative impact on egg quality, sperm quality, and pregnancy rates.
    • Cannabis use, whether smoked or consumed as edibles, can decrease sperm production, motility, and morphology, increase DNA fragmentation, and lead to a higher chance of miscarriage.
    • The data on the effects of cannabis is limited due to its legal status in many places.
    • Alcohol consumption should be done in moderation during pregnancy as it can cause inflammation and impact egg and sperm quality.
    • Chronic inflammation is known to affect fertility.
    • Alcohol consumption should be avoided once pregnancy is confirmed.
    • Birth control methods such as copper IUDs work by creating an environment that kills sperm. Copper IUDs do not alter egg quality or future fertility.
    • Other birth control methods like the ring may have different effects on egg quality and future fertility when discontinued.

    Birth Control Methods and Their Effects on Fertility

    1:04:37 - 1:11:26

    • Copper IUD is a birth control method that does not involve hormones and causes inflammation and a toxic environment inside the uterus.
    • Progesterone-based IUDs, such as Marina, Kailina, and Lyletta, work by thinning out the uterine lining.
    • Most IUDs do not prevent ovulation; their main mechanism of action is the endometrial effect.
    • Prolonged progesterone exposure from IUDs can lead to a thin uterine lining, causing absence of periods even if ovulation still occurs.
    • It is recommended to remove a progesterone IUD three to six months before trying to conceive to allow the lining to grow back.
    • The depot pervara shot is a high dose of progesterone that prevents ovulation for three months but can last in the system for up to 18 months.
    • Birth control methods can have negative consequences, such as affecting women's perception of attractive male

    Ethical Considerations in Reproductive Technologies

    1:11:04 - 1:18:04

    • A small study suggests that birth control may have a tendency to influence partner choice towards more masculine faces, but caution is needed in interpreting the results.
    • Birth control pills, specifically those containing oral estrogen-progestin, have been shown to have both benefits and risks.
    • Informed consent regarding the options and potential side effects of birth control pills is important.
    • The composition of birth control pills can vary, with different types of estrogen and progestins.
    • Continuous use of birth control pills can impact vaginal health and may lead to changes such as increased sensitivity, decreased elasticity, discomfort during intercourse, and yeast infections.
    • Birth control pills can be beneficial for mental health by providing a stable hormone level for individuals with severe pre-menstrual dysphoric syndrome (PMDD).
    • Birth control pills can also be helpful for managing heavy periods, anemia, fibroids, and polycystic ovarian syndrome (PCOS).
    • PCOS is characterized by a lack of ovulation

    Health Risks and Benefits of Birth Control Pills

    1:17:35 - 1:24:32

    • The use of birth control pills can significantly decrease the risk of endometrial and ovarian cancer.
    • Ovarian cancer risk is reduced because the pill prevents ovulation, which eliminates opportunities for cancer cells to develop.
    • Breast cancer risk may increase in individuals with certain genetic predispositions who take the pill.
    • The pill can mask irregular periods and prevent women from understanding their own menstrual cycles.
    • Taking the birth control pill can potentially lead to the development of leaky gut or irritable bowel syndrome (IBS).
    • There is an increased risk of blood clots while on the pill, especially for individuals with factor 5-Liden mutations.
    • It is recommended to analyze factor 5-Liden genetics before starting oral contraception, although it is not a standard recommendation.
    • Individuals with high blood pressure or who smoke cigarettes should avoid taking the birth control pill due to increased health risks.
    • If a person experiences a blood clot while on the pill, further testing for clotting disorders

    Understanding Ovarian Reserve and Fertility Testing

    1:24:10 - 1:30:40

    • Physicians often follow medical guidelines and may be hesitant to deviate from them, making it difficult for patients to advocate for themselves.
    • Paying attention to your body and understanding what is normal can help catch early signs of disease.
    • The American College of OB/GYN advises against screening for AMH (Anti-Mullerian Hormone) levels as a measure of ovarian reserve, but some disagree with this recommendation.
    • AMH levels can be checked through a blood test or a vaginal ultrasound, with the latter being more invasive but not painful.
    • The number of eggs coming out of the vault (ovaries) is an indirect measure of the number of eggs in the vault. As this number decreases, it indicates a decrease in ovarian reserve.
    • An ultrasound-based measurement called an "antropholical count" (AFC) shows how many eggs are outside the vault at a given time.
    • The AFC can vary between individuals and may show asymmetry between the right and

    Egg Freezing and In Vitro Maturation

    1:30:16 - 1:36:57

    • IVM (in vitro maturation) is the next wave of technology in fertility treatment, allowing eggs to be grown in the lab.
    • The number of eggs obtained per month is a limiting factor in fertility treatments like IVF and egg freezing.
    • ACOG argues that AMH (anti-Mullerian hormone) does not predict infertility or impact the probability of getting pregnant naturally.
    • ACOG's argument overlooks the psychological impact and personal choices related to low ovarian reserve.
    • Knowing about low ovarian reserve at a young age can lead to proactive decisions like egg freezing or early attempts at pregnancy.
    • Delaying consideration of parenthood until later can result in missed opportunities for those with low ovarian reserve.
    • There are actionable steps individuals can take if they have low ovarian reserve, such as freezing eggs or evaluating potential causes.
    • Many OBGYNs recommend AMH blood tests for women who want to understand their fertility options.
    • In California, there is a cut

    Egg Freezing and Embryo Freezing

    1:36:39 - 1:43:36

    • The viability of freezing eggs has improved significantly, with 90% of eggs now surviving the freeze-thaw process.
    • Embryos are much stronger than eggs, with a 99% survival rate after freezing.
    • Making embryos is more expensive than freezing eggs, and multiple rounds of egg freezing can yield just as many eggs as making embryos.
    • It is important to choose a sperm source that one wants to have a child with, as committing to a different sperm source can have implications in the future.
    • Egg quality decreases and the risk of chromosomal abnormalities increases as women get older, leading to lower pregnancy rates and higher chances of miscarriage.
    • Natural fertility rates decrease due to changes in chromosome normalcy rather than a decrease in egg count per month.
    • Not every egg will fertilize or implant successfully, resulting in significant loss during human reproduction.
    • The ROI (return on investment) for egg freezing is better at a younger age when there are more eggs available.

    Optimizing Fertility Treatments and Embryo Transfer

    1:43:17 - 1:50:03

    • Freezing eggs at age 32 to 33 is optimal for preserving both egg quality and quantity.
    • Around 90% of frozen eggs survive the freeze, with about 75% being fertilized by sperm.
    • Approximately 50% of fertilized eggs make it to the blastocyst stage.
    • The success rate of live birth per genetically normal embryo is around 65%.
    • Implanting one embryo at a time is recommended for the healthiest chance of pregnancy.
    • There is a slightly higher chance of monozygotic twins (2-3%) with IVF compared to natural conception (0.03%).
    • Putting two embryos increases the risk of multiple pregnancies, including triplets or quads if both embryos split.
    • Embryo quality and uterine environment are important factors in successful implantation.
    • Using a gestational carrier or surrogate mother can be an option for some individuals, but it is expensive and limited in availability.
    • Cumulative

    Family Planning and Fertility Preservation

    1:49:39 - 1:56:12

    • Freezing eggs at age 30 and making four normal embryos is unlikely to result in three or four kids.
    • The number of eggs needed for a desired family size is uncertain due to various factors such as sperm quality, environmental issues, and individual health conditions.
    • Freezing embryos can provide the opportunity to assess the number and quality of embryos available for future pregnancies.
    • It is recommended for young males to save their gametes (sperm) as advanced paternal age can lead to negative outcomes starting at age 50.
    • Collecting and freezing sperm is a simpler process compared to egg freezing, usually not requiring hormone injections.
    • Blood work and abstaining from ejaculation are typically required when freezing sperm.
    • Freezing sperm before getting a vasectomy allows for potential future use if circumstances change or if a reversal is unsuccessful.
    • Freezing sperm is relatively cheap compared to the entire egg freezing process.
    • Egg freezing and IVF involve similar procedures, with the distinction being what happens in

    Fertility Treatments and Hormone Manipulation

    2:02:11 - 2:09:37

    • FSH and LH are hormones used in fertility treatments to stimulate follicular development and egg maturation.
    • FSH is synthetically made in a lab, while LH is obtained from the purified urine of menopausal women.
    • HCG is a synthetic hormone that mimics LH and is used in fertility treatments.
    • The combination of FSH and LH is sometimes given as a medication called Menopure.
    • Blood levels of estradiol and transvaginal ultrasound can be used to measure egg maturity during egg freezing or IVF.
    • A trigger shot, either an LH surge or HCG, is administered to allow the final stage of meiosis in the eggs.
    • Chromosomal separation during meiosis can be affected by age and the fragility of eggs due to wear and tear on meiotic spindles.
    • Mitochondrial DNA plays a role in the dynamics of chromosomal separation during meiosis.

    Advancements in Reproductive Technologies

    2:09:08 - 2:16:27

    • Utilizing donor mitochondrial or donor egg technology helps cure mitochondrial diseases, which are 100% fatal.
    • The technology has been successful in overcoming mitochondrial diseases, but it has not been successful in addressing age-related changes in eggs.
    • The political environment of embryo research in the United States limits the availability and possibility of meaningful research on human embryos.
    • Embryos that people no longer use are currently stored indefinitely.
    • There is a need for more options to utilize unused embryos for scientific advancement.
    • Embryo donation is emerging as a new opportunity for more people to become parents.
    • Advertising for egg donors on college campuses is now limited due to concerns about informed consent and financial incentives.

    Ethical Considerations in Reproductive Technologies

    2:16:08 - 2:23:29

    • There are concerns about proper informed consent and the potential impact of egg donation on fertility later in life.
    • Sperm donation is also a topic of concern, with issues related to genetic diversity and the number of half-siblings.
    • Sperm banks are starting to put limitations on the number of families a donor can contribute to, and advancements in technology are connecting donors with their biological children.
    • Egg donation offers better compensation than sperm donation, particularly for certain characteristics like ethnicity and education level.
    • Ethical concerns arise when companies promote young women donating their eggs and freezing half for themselves while using the other half as donor eggs.
    • The profitization of biology and technology entering reproductive spaces raises ethical questions about embryo donation.
    • There is a debate surrounding whether IVF babies have a higher incidence of conditions like autism compared to non-IVF babies.
    • The hormonal environment during natural conception differs from IVF procedures, which may contribute to differences in developmental outcomes.

    Impact of Reproductive Technologies on Developmental Outcomes

    2:23:03 - 2:29:56

    • In the early days of IVF, multiple embryos were often implanted, leading to a higher risk of developmental disorders and birth complications.
    • Some people want autism to be referred to differently due to emerging issues, but there is currently no new nomenclature.
    • Frozen embryo transfers have significantly improved neonatal outcomes compared to fresh transfers in IVF.
    • Infertility diagnosis increases the risk of birth defects and developmental disorders, regardless of whether pregnancy occurs naturally or through IVF.
    • Advanced paternal age is strongly associated with autism and other autosomal dominant disorders.
    • The quality of eggs and sperm, as well as the uterine environment, can impact fertility and overall health.
    • Sleep is crucial for cellular repair and reducing inflammation levels, which are important for egg and sperm quality.

    Inflammation, Nutrition, and Fertility

    2:29:30 - 2:36:25

    • Inflammation can affect both conception and the uterine environment.
    • Nutrition plays a significant role in fertility, but it is not discussed enough.
    • Decreasing inflammation through diet has been shown to improve fecundability, ovulation, success with IVF, and decrease miscarriage.
    • Nutrition studies are challenging due to confounding factors like other health behaviors.
    • Diets high in fruits and vegetables are beneficial for decreasing inflammation.
    • Whole grains provide fiber and can aid in weight loss, which improves fertility.
    • Dairy is generally okay, but processed dairy and skim milk may decrease fertility due to unnatural additives.
    • Healthy fats from avocados, oils, and nuts are essential for hormone production and should not be avoided.
    • Tofu does not negatively impact fertility; it can actually improve it due to its antioxidant properties and iron content.
    • Fish is a great source of healthy fats and omega-3 fatty acids but should be consumed in moderation during pregnancy due to mercury

    Impact of Diet and Lifestyle on Fertility

    2:36:06 - 2:42:56

    • Processed meats are not good for fertility and can be carcinogenic.
    • Red meat, when consumed in moderation, is generally fine for fertility.
    • A study found that higher consumption of red meat was associated with lower success rates in IVF and embryo development.
    • The source and quality of the meat may impact its effects on reproduction.
    • Artificial sugars, including low-calorie sweeteners like Stevia, can cause inflammation and stress reactions in the body, potentially leading to higher rates of miscarriage.
    • Making healthy choices every day is important for overall reproductive health.
    • Being underweight or calorie restricting can negatively affect the reproductive system and ovulation.
    • Lack of body fat is correlated with decreased chances of getting pregnant and increased risk of miscarriage.
    • Hormonal imbalances can impact the growth of the placenta in the uterus during pregnancy.

    Nutrition and Supplements for Fertility

    2:42:33 - 2:48:46

    • Eating healthy involves consuming whole fat milk products, grains, fruits, and vegetables.
    • Supplements are not regulated like medications, so it's important to do research on what is included in them.
    • Taking a prenatal vitamin with folic acid is recommended for both men and women in their reproductive years.
    • Many people are vitamin D deficient, and taking a thousand international units of vitamin D is generally helpful.
    • Omega 3 fatty acids are important for brain development in fetuses and can be found in most prenatals or taken as a supplement.
    • Consuming essential fatty acids during pregnancy may positively impact brain weight at birth.
    • The dosage cut off for essential fatty acids is typically around one gram per day of the EPA form.
    • CoQ10 supplementation can benefit reproduction without much harm and a dose of 200 milligrams three times a day is recommended when trying to conceive.
    • The form of CoQ10 doesn't matter as much as consistency in taking it.

    Supplements for Male and Female Fertility

    2:48:24 - 2:54:23

    • Orl-L carnitine has shown some improvements in sperm motility and egg quality, but only a small percentage of it is actually utilized.
    • Injectable L-carnitine is sometimes used, but it can be painful due to the alcohol-based suspension.
    • A gram of L-carnitine with a gram of vitamin C is used for male patients with abnormal sperm parameters.
    • For females with endometriosis, Elkharnatine, en acetylcysteine, vitamin C, and E are recommended due to high inflammation levels.
    • Co-cutent, Elkharnatine, and vitamin C can potentially be helpful for reproductive health in both males and females.
    • Myo-inositol helps improve insulin sensitivity and decrease inflammation in PCOS.
    • Metformin may lower testosterone levels in men and should be used cautiously.
    • The evidence for metformin extending life is not convincing.
    • Supplements like CoQ10, L-carn

    Lifestyle Factors and Fertility

    2:54:07 - 3:00:56

    • The sperm cycle is about 90 days, and changes in lifestyle and behavior during this time can have a significant impact on fertility.
    • Healthy behaviors should be practiced throughout the entire process of trying to conceive or undergoing fertility treatments.
    • During IVF, subcutaneous shots are taken for about 12 to 14 days, causing pelvic pressure and bloating due to the growth of follicles.
    • The eggs are retrieved from the body in a 20-minute procedure under IV sedation, usually with propofol and fentanyl.
    • Some clinics may use different strategies for anesthesia during egg retrieval, but it's important for patients to know what to expect.
    • Most clinics use propofol and put patients to sleep during egg retrieval.
    • After the procedure, patients may feel crampy and get their period around ten days later.
    • It is advised not to have intercourse during this time period due to the risk of infection and potential pregnancy.

    Optimizing Fertility Treatments and Egg Retrieval

    3:00:31 - 3:06:53

    • It is important to avoid intercourse during the egg retrieval process in IVF to prevent infection and minimize the risk of ovarian hyperstimulation syndrome (OHS), which can worsen if pregnancy occurs.
    • The recommended period of abstaining from intercourse is usually from day five of stimulation until the next period, which is approximately a three-week timeframe.
    • The hormonal and physical shifts experienced after retrieval are more pronounced with a higher egg count, while those with a low egg count may tolerate it better.
    • Minimal stimulation protocols, which intentionally stimulate fewer eggs to save costs, are generally not recommended as they lower the chances of success in most cases.
    • There can be financial incentives for clinics to promote minimal stimulation cycles, but it's important for patients to understand what makes sense for their specific situation.
    • Minimal stimulation may be appropriate when only a few eggs will be retrieved or in certain cases like Invocell, where it aims to make IVF more financially accessible for patients who don't ov

    In Vitro Fertilization (IVF) and Reproductive Options

    3:06:32 - 3:13:06

    • The use of in vitro fertilization (IVF) can provide a lower-cost option for young patients with good egg quality who have conditions like PCOS or tubal disease.
    • IVF with donor sperm has higher success rates compared to intrauterine insemination (IUI), making it a better option for same-sex couples, single parents by choice, and single women trying to conceive.
    • IVF allows both partners in a lesbian couple to feel more involved in the reproductive process.
    • The natural environment of the body is considered more ideal for embryo development compared to the two-dimensional environment of a petri dish used in IVF labs.
    • Minimal stimulation is used when there are fewer eggs, while maximum stimulation aims to retrieve as many eggs as possible during egg freezing or IVF.
    • Before egg freezing, the outer cells of the eggs called cumulus are stripped off, and intracytoplasmic sperm injection (ICSI) is used during fertilization.
    • ICSI

    Factors Affecting Embryo Development and Fertilization

    3:12:36 - 3:19:48

    • Embryo failure on day three post fertilization cannot be blamed on the sperm, but there can still be maternal and sperm contribution after that point.
    • Lifestyle measures may potentially improve sperm quality.
    • DNA sperm fragmentation is not a normal semen analysis, but it evaluates the amount of abnormal DNA in the heads of sperm.
    • Studies have shown that people with abnormal DNA sperm fragmentation should consider using Ixsee.
    • Ixsee used to be an add-on cost in IVF, but it has become standard practice due to its potential impact on fertilization success.
    • Freezing embryos reduces the risk of birth defects compared to conventional fertilization methods.
    • Ixsee increases the probability of successful fertilization and is a recommended option for those undergoing IVF with limited financial resources.
    • DNA fragmentation tests are expensive but may be a lower-cost option compared to repeated cycles of IVF if they indicate normal levels of fragmentation.
    • Sperm extraction without subjecting the sperm to ejaculation may reduce

    Pre-implantation Genetic Testing and Embryo Banking

    3:19:30 - 3:26:00

    • Pre-implantation genetic testing (PGT) can be used to test for aneuploidy and single gene disorders in embryos.
    • PGT for aneuploidy can increase the chances of a successful pregnancy and reduce the risk of failed transfers and miscarriages.
    • Embryo banking allows individuals to save embryos for future pregnancies, especially at later ages when conceiving naturally becomes more difficult.
    • Knowing the number of potential normal embryos through genetic testing helps in making informed decisions about fertility treatments.
    • Menopause may be occurring earlier in some populations, possibly due to factors like smoking, exposure to toxins, chronic inflammation, untreated diseases, and diabetes.
    • Lifestyle choices made earlier in life can impact menopause timing, such as avoiding toxins, getting enough sleep, and living a lower inflammatory life.
    • Some conditions like endometriosis can lead to early menopause if left untreated. Birth control pills or surgery may help
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