Egg Quality, Egg Quantity and Age: What You Need Know about Age and Fertility

You may not realize that you are born with all the eggs that you're ever going to have. So before you've ever ovulated,

to have. So before you've ever ovulated, you have lost the majority of your eggs.

Everybody will run out of eggs.

Everybody will go into menopause or ovarian failure. But it's not the

ovarian failure. But it's not the running out of eggs that limits most of us from getting pregnant as we age. It

is actually your egg quality. The longer

our eggs have been inside our body, the more that our eggs are absorbing the wear and tear of the world around us.

And those distractions are inflammation.

And this is why when we think about egg quality and genetics, age is a top component, but it's not the only component. Everything is reliant on the

component. Everything is reliant on the eggs capacity for cell division and for normal function. You can't undo age-

normal function. You can't undo age- related changes in the genetics of your eggs. That's true. But you should

eggs. That's true. But you should absolutely be controlling all of the inflammatory and metabolic factors that you can so that you can putting forth

the best quality of eggs as possible.

[Music] Welcome back to the Asoman podcast, where we dive into fertility hormones and your formula for health. I'm your

host, Dr. Natalie Crawford, and today we're talking about something I get asked about every single day. Your eggs,

how many you have, how good they are, and what age really means for your fertility. In this episode, I'll explain

fertility. In this episode, I'll explain the difference between egg quality and egg quantity. how we evaluate ovarian

egg quantity. how we evaluate ovarian reserve and what's really happening as you age and what you can do and can't do in order to support your egg health. If

you've ever been confused by AMH, wondered if you have waited too long or felt anxious about your biologic clock, then this episode is for you. And you

can get more information if you are interested in egg quality by checking out my debut book, The Fertility Formula, which you can pre-order right now. And you will get the pre-order

now. And you will get the pre-order bonus of the 7-day hormone reset. This

is only available exclusively to pre-orders. You'll get it immediately so

pre-orders. You'll get it immediately so that you can start learning how to improve your egg quality right away.

That's at natalie crawfordmd.com/book.

Let's start by talking about our egg quality. You may not realize that you

quality. You may not realize that you are born with all the eggs that you're ever going to have. We actually have the highest number of eggs when you are a baby inside your mother's womb. So, at

about 20 weeks gestation, when your mom is pregnant with you, you will have 6 to 7 million eggs. What is wild and crazy is that by the time you're born, that number has dramatically dropped. And at

birth, you're only going to have 1 to 2 million eggs. And you're going to lose

million eggs. And you're going to lose even more eggs between then and when you start puberty, at which time you'll have 300 to 500,000 eggs. So before you've ever ovulated, you have lost the

majority of your eggs. And this is such an interesting and fascinating concept.

But I think it's also important to realize that if you have a low egg count, this means much of this damage occurred at a time period well before you were in control. So, number one,

before we even dive in, you should take off any blame if you have found yourself in the position of finding out that you have a low egg count or a low number of eggs. However, that doesn't mean that we

eggs. However, that doesn't mean that we shouldn't try to slow the rate of decline and try to improve your egg quality as much as possible. And that's

what we're really going to be diving into in this episode. These are concepts that I talk about every single day. And

although they relate to age, age is not the only factor that's at play.

Similarly, you can be really healthy, but everybody cannot outrun their age.

At some point, age does become a really important factor. So, we're going to

important factor. So, we're going to talk about your egg quantity, your egg quality, and your age, and what you should do about it. When it comes to your egg quantity, let's talk about

ovarian reserve. Ovarian reserve is the

ovarian reserve. Ovarian reserve is the measure of how many eggs you have available. My favorite analogy, if we

available. My favorite analogy, if we talk about your eggs, is to think about all those eggs that you were born with being in a vault inside your ovary. When

you're born, that vault is full. And

throughout your life, eggs come out of the vault. And one day, the vault is

the vault. And one day, the vault is going to be empty. And that's

essentially when you're going to be in menopause. What actually happens is

menopause. What actually happens is every single month, you have a group of eggs sent out of the vault. And those

are the eggs available to you in that month. Each egg grows inside a small

month. Each egg grows inside a small fluid fil structure known as a follicle.

And your brain is going to send out FSH or follicle stimulating hormone, which is well named to get one follicle to grow. As that follicle grows, the egg is

grow. As that follicle grows, the egg is going to mature and make estrogen. It's

going to send out the trigger to ovulate. And then the rest of the eggs

ovulate. And then the rest of the eggs that month that were outside the vault are going to die. And then next month, you have another group of eggs outside the vault. So every single month, your

the vault. So every single month, your body is pre-selecting the eggs that are available. And even when we do things

available. And even when we do things like egg freezing or IVF, I can only work with the eggs I have outside the vault. Meaning, I can't tap into the

vault. Meaning, I can't tap into the vault for those procedures. and I can't get your body to release more eggs. So,

we are limited even when we do fertility treatments by the number of eggs you send out of the vault. Well, testing

these eggs is part of what ovarian reserve testing is. And what I find is so fascinating is that when you have more eggs in the vault and the vault is more crowded, more eggs come out every

month. So, if we think about when you're

month. So, if we think about when you're younger, when you are younger, you're going to have more eggs in the vault and so more are coming out. Even if you're not ovulating, that means you're losing more eggs. And as the vault starts to

more eggs. And as the vault starts to get emptier and you have fewer eggs available, fewer are going to come out of the vault. So the number of eggs we have out of the vault or the number of eggs we have available in a given month

is directly proportional to the number of eggs we have remaining. This explains

how we go from 6 to 7 million to 1 to 2 million from a 20we fetus to birth.

Because when we have more, we lose more.

When we check your egg count, I don't have a way to check inside the vault.

That's not what I'm doing. But I can check the eggs that are available this month. So, when I'm checking the eggs

month. So, when I'm checking the eggs that are available this month, I'm getting an idea of how many eggs you have available. Therefore, how many eggs

have available. Therefore, how many eggs are going to be remaining in the vault.

And there are age related norms because everybody does run out of eggs at some point. It's also important to understand

point. It's also important to understand that your egg count's not going to be perfect. So, if you are 30 and I say an

perfect. So, if you are 30 and I say an average egg count for a 30-year-old would be 18 to 20 eggs total outside the vault in a given month, that is not

going to look like 20 20. Your body is not perfect, not sitting out the same number every single month. What is

actually happening is that vault can vary by 20 to 30% monthtomonth. So you

might have 18 eggs, 16 eggs, 19 eggs, 22 eggs, 21 eggs, 17 eggs. And the average is perfectly in that 18 to 20. But if I

look at a month where you might have 16, I don't know in that one single month, is that number 16 eggs that I see, is that a low number, like a random low in

the example I just gave, is that your average, which would be slightly lower than age related norm, but not concerning, or is that your highest month ever, and your real average is actually lower than there, of which we

would be quite concerned. A one-time

glimpse at your follicles is called an AFC or an antal follicle count. An AFC

is an ultrasound determination of your follicles. So, exactly what it sounds

follicles. So, exactly what it sounds because one egg grows inside a follicle.

Eggs are microscopic, but we can see those follicles. We're simply counting

those follicles. We're simply counting in a given month how many we see. Well,

an AMH is a blood test. It's a hormone.

Antimalaran hormone is a hormone that's made from the cells that surround all of the eggs outside the vault. So, when you have more eggs inside the vault, you're going to have more coming out every month. and you're going to have higher

month. and you're going to have higher levels of AMH. AMH is going to live in your bloodstream a little bit longer than that one given month. So, it's

giving us more of an average of, let's say, the past few months. That's why AMH and an antropholical count are both so important because AMH is giving us a little bit more information than just

this exact minute. But importantly, both of these numbers can go up and both of these numbers can go down. Meaning, if

you had an AMH checked and it was high, a year later it was lower, that does not mean that you're on a linear drop and that you're about to be out of eggs.

Instead, if we did check your AMH every single month, which we would not do, but if we did, we would expect it to bounce around and to vary some. It is going to

stay within a norm. But eventually in everybody, that does start to drop. When

we're checking your ovarian reserve, we're trying to do so to figure out where you are on the pathway of running out of eggs. Everybody will run out of eggs. Everybody will go into menopause

eggs. Everybody will go into menopause or ovarian failure. Some women are destined to do this earlier than others.

And specifically, we're trying to figure out who that is and why that might be happening to you so that you can know what you may need to do about this differently. Also, your ovarian reserve

differently. Also, your ovarian reserve does correlate with how many eggs we could get with fertility treatment. This

is going to impact your expectations and your outcomes. And that's really

your outcomes. And that's really important information. But having a low

important information. But having a low AMH or having a low egg count does not mean you can't get pregnant because if you are still ovulating, your body doesn't care if you have five eggs

outside the vault or 20. You are going to be ovulating one. So you have the same odds of getting pregnant as your age related odds. At least when you first start to try. The one asterk, the

one caveat that I always say here is, but why is your AMH low? Because having

a low AMH, maybe you were just born with fewer eggs, maybe it was some insult when you were a baby. Maybe it's

genetic. But is there some underlying disease? We'll use endometriosis, which

disease? We'll use endometriosis, which is a chronic inflammatory disorder, which that inflammation is contributing to your low egg count. And endometriosis

also can contribute to infertility. So,

I always think it's a little simplistic to just say a low AMH doesn't cause infertility.

It's not exactly a cause, but absolutely both things can have the same underlying cause. So, we shouldn't be so quick to

cause. So, we shouldn't be so quick to dismiss it like a lot of fertility doctors are. But, it is important to

doctors are. But, it is important to know that it is just one data point that is helpful in the entirety of your fertility evaluation.

When it comes to getting older, even though everybody will run out of eggs at some point, you can be on totally different timelines, but it's not the running out of eggs that limits most of

us from getting pregnant as we age. It

is actually your egg quality. So quality

is a very genetic term that most of the time we're talking about age related genetic normaly. But I actually like to

genetic normaly. But I actually like to step back from quality and I like to think about it in twofold. Yes, there is the chromosome complement of our eggs and having abnormal genetics or abnormal

chromosomes is a huge component to egg quality. And this is one thing that is

quality. And this is one thing that is very hard to overcome with age because to everybody, the longer our eggs have been inside our body, the more that our eggs are absorbing the wear and tear of

the world around us. I like to think about your chromosomes. Imagine that

they are a line of kindergarteners and we have asked them to stand in line and they're in perfect alphabetical order.

The longer I ask them to stand there, the higher the odds that somebody's going to get out of line. But also, the more distractions I put to the picture.

If there's puppies and candy and all kinds of things that those kindergarters could go do, there's an increased odds that they are going to get out of line.

And those distractions are inflammation.

And this is why when we think about egg quality and genetics, age is a top component, but it's not the only component because there's other things that can contribute to the genetic

normaly of our eggs as well. In addition

to just genetics, we should not ignore the metabolic importance of eggs. This

is because your egg has a really big job. It has mitochondria inside. It has

job. It has mitochondria inside. It has

to accept a sperm, accept that fertilization. And the egg components of

fertilization. And the egg components of metabolism control the first few days of embryo development. That male genome

embryo development. That male genome doesn't even kick in until day three.

Everything is reliant on the eggs capacity for cell division and for normal function. So the metabolic impact

normal function. So the metabolic impact and quality of our eggs is important as well. And this is really where

well. And this is really where decreasing inflammation and paying attention to our lifestyle can play a big role in our egg quality. This is

another place where I feel like sometimes fertility doctors are a little dismissive and they say, "Oh, well, you can't do anything about it because you're older. You can't undo age related

you're older. You can't undo age related changes in the genetics of your eggs."

That's true. But you should absolutely be controlling all of the inflammatory and metabolic factors that you can so that you can putting forth the best

quality of eggs as possible. It's

actually the genetic normaly of eggs and these metabolic function of our eggs that changes our ability to get pregnant when we get older. Not that we're out of

eggs. It's that at age 35, what a lot of

eggs. It's that at age 35, what a lot of people will refer to as advanced maternal age or geriatric pregnancy.

This is the state where suddenly now half of your eggs are genetically normal and half are abnormal in addition to whatever metabolic functions we can have. To put the metabolic importance of

have. To put the metabolic importance of an egg or an embryo in another light, let's just remember that one genetically normal embryo. So, it's an embryo. It's

normal embryo. So, it's an embryo. It's

an egg that's been fertilized. It has

grown out to an implantation stage, and we've done genetic testing on it, and we know that it has the right number of chromosomes. Well, what's our live birth

chromosomes. Well, what's our live birth rate with that genetically normal embryo? It's only going to be 65 to 70%

embryo? It's only going to be 65 to 70% even in the best scenario, in the best lab. Meaning even genetically normal

lab. Meaning even genetically normal embryos do not result in a baby every single time. Why is that? I always say

single time. Why is that? I always say it's embryo competency or metabolism.

It's just showing us that the structure of these cells and the world that we are exposed to and what we are exposing our eggs and our sperm and our embryos to does play a big role in our ability to

get pregnant. So, we shouldn't be so

get pregnant. So, we shouldn't be so dismissive of the world when it comes to looking at these lifestyle factors. As

we get older, two things are happening that are both important. One, our eggs have been inside the vault longer, absorbing the wear and tear of our body.

Yes. So, we have increase in chromosome abnormalities. Second, we are running

abnormalities. Second, we are running out of eggs. These two things are happening in tandem. What this results in is when you get older, really

starting at 35, but most profoundly after age 37, you start to find yourself in the position where most of your eggs are genetically abnormal. Your body has absorbed more wear and tear from living.

Your metabolic factors don't tend to be as good, and you have fewer eggs to work with. This means that even if we're

with. This means that even if we're going to do IVF, I can't get as many eggs because I can only get the eggs that are outside the vault to grow. This

is why it becomes harder to get pregnant as you get older and why you have an increased odds of miscarriage when you age. If you are 40 trying to get

age. If you are 40 trying to get pregnant for the first time, your odds of getting pregnant per month are going to be 5%. Compare this to somebody who might be 30 who's going to have closer

to about a 20% chance per month. That's

a really big difference. But even more profound than that is the change in miscarriage. Because of some of these

miscarriage. Because of some of these egg quality issues, we see a profound increase in the rate of pregnancy loss as we age. Meaning women who are over age 40 can have as much as 40 to 50% of

their pregnancies result in a miscarry.

Compare that to somebody who's 30 who might only have 20 to 25%.

This is resulting overall in a much lower rate of live birth. And this is why understanding your ovarian reserve and understanding your egg quality is so important if you want to get pregnant,

especially if you're waiting to get pregnant until you are older. IVF

doesn't always work, but there are things you can do to have an increased odds of IVF working and to improve your chance of success. And that's something that I really want to dive in and I want you to think about so that you don't

just passively go through the process, but that you're making active choices based on data because you can't make decisions on data you don't know. I want

to think about this idea that your egg quality and your egg number dictate your ability to get pregnant. I had a patient who came to see me and she had been on the birth control pill for a profound

period of time. Important side note is that the birth control pill is a combined pill of a type of estrogen and a type of progesterone. The pill works to tell the brain not to send out FSH.

If you don't send out FSH, you're not going to ovulate. So, in those months, eggs came out of the vault just like normal. But no egg was stimulated to

normal. But no egg was stimulated to grow or to ovulate. So, all the eggs just died. That doesn't change the

just died. That doesn't change the trajectory of egg loss. That doesn't

impact your fertility. And that doesn't cause long-term fertility issues. So,

the idea that the birth control pill is going to cause fertility problems is false. However, it doesn't mean that the

false. However, it doesn't mean that the birth control pill is benign. It

definitely has some side effects. But

more importantly than that, in my opinion, is the fact that women are often placed on the birth control pill for true medical problems and they never get to the root cause or the diagnosis.

Maybe they had menstrual abnormalities or irregularities because they were developing a lower egg count. But

instead of finding out that their egg count was low, they actually just got put on the birth control pill to regulate their cycle. And they didn't get that data until a much later time in

life. They lost the ability to make

life. They lost the ability to make changes or choices based on that information because they didn't have the information. So I had a patient who came

information. So I had a patient who came to see me and she'd been on the birth control pill for over 6 years. She was

placed on the pill because she was having some irregular bleeding. So she

was put on it for a real reason. No

cause was found. I don't actually know if they even looked for a cause, but she was put on the pill and she was happy on it. She didn't have any side effects. It

it. She didn't have any side effects. It

was great. She stopped the pill because she recently got married and they wanted to get pregnant soon. And she didn't have a period. So, she waited 3 months.

Still no period. She went to her doctor who was told her, "Wait just a little bit longer. It's a side effect of the

bit longer. It's a side effect of the pill. It takes a while to get out of

pill. It takes a while to get out of your body." Which is actually false. It

your body." Which is actually false. It

doesn't take a while to get out of your body. But she waited longer and guess

body. But she waited longer and guess what? She still didn't have a period.

what? She still didn't have a period.

She went to go see a fertility doctor who wasn't me and she had some testing done and she was found to have an AMH level of essentially zero. Was an

undetectable AMH, meaning there was no AMH that was really circulating or could be detected. Her antrol follicle count,

be detected. Her antrol follicle count, meaning the follicles she saw was recorded as a one. And she was told at the age of 32 that she had to get pregnant with donor eggs. and that was

her only option. And this is a young girl who was on the pill, never tried to get pregnant, never done any fertility treatments, and told there was no treatment she could do. So, she heard

one of my podcasts and came to see me for a second opinion. Well, it turns out all of that was accurate, meaning she did have an undetectable AMH and she didn't have many follicles. But I knew

that based on her age, she was young, her egg quality would still be favorable from a genetic standpoint. and we talked about how she could mitigate other causes, what could be contributing to her low ovarian reserve, and how we

could combat that. Turns out that she had an autoimmune thyroid disease, so we put her on thyroid medicine. Her

autoimmunity is the reason why she had such profoundly low ovarian reserve. And

we talked about other ways to decrease inflammation from her world. But we also said that's not enough because what we know is no matter what you are at the very bottom of your egg pool and your

ovaries no longer responding to your brain signals. So we need to see can we

brain signals. So we need to see can we get any eggs to grow. We decided to immediately do IVF. She never even tried to get pregnant, never ovulated, but we wanted to come in and see if we could

override what was happening between her brain and ovaries at this moment. And we

were able to get eggs to grow. She had a great result when it came to embryos.

Her first cycle, we got three eggs and she made two embryos and both were genetically normal. We did a second

genetically normal. We did a second cycle and she got two eggs and had one genetically normal embryo. And so here is a young woman who now has had her first baby and has two genetically

normal embryos in the freezer for baby number two who was told somewhere else that because of her low ovarian reserve despite never being able never trying to

get pregnant that she could not have genetic children. And even though that

genetic children. And even though that is the truth for some people not all fertility treatments work. I'm a strong believer that I should be able to give you the data, tell you the road that we're up against, and you should be able

to be the one to make the decision. I

understand that means my clinic might have to take the bad success rate if it doesn't work. But I believe you deserve

doesn't work. But I believe you deserve the opportunity if you know what you're up against and you choose to do so. I

had a really honest conversation with her and I told her, "This may not work.

We might need donor eggs. That probably

is a cheaper way to get pregnant in your scenario, but you're young. If you're

willing to do the work to put yourself in the healthiest position possible, I'm willing to give you the chance and see if we can get your ovaries to respond. I

didn't guarantee that it would happen. I

don't try to pretend like I have 100% success rates, but I gave her the opportunity to be the one to make the choice. and she and her husband told me

choice. and she and her husband told me they'd be okay if it didn't work, that they would be okay to explore other options of parenthood, but they didn't want to do that without giving

themselves all the opportunity that they could. And so, this is just an example

could. And so, this is just an example that yes, even though ovarian reserve matters, it is not everything. You are

not defined by one low AMH value. You

are not defined by what one clinic says.

It's really important to be your own advocate on your health journey. If

somebody gives you information that's bad, why do it every single day? It's

really important that you're able to ask them questions about why and they are able to explain it to you in a way that makes sense. And if it doesn't or they

makes sense. And if it doesn't or they can't, you should not hesitate to go get a second opinion. At the end of the day, it's your life. It's your family. And

you are the one who has to feel really confident in the decisions that you and your care team are making. and making it off one single AMH value is not my

opinion the right move especially as we are younger. When we're older it gets

are younger. When we're older it gets harder. Our ovaries become more

harder. Our ovaries become more unpredictable as we age. I always tell patients they're more stubborn. So as we get older our ovaries become more stubborn. They get adjusted to seeing

stubborn. They get adjusted to seeing higher doses of FSH from the brain and they don't respond quite as predictably in our youth. In addition, we can't roll back the clock. I can't undo all the

wear and tear that I've exposed my body to. I can't undo genetic changes that

to. I can't undo genetic changes that may have already happened inside my eggs. But that doesn't mean that every

eggs. But that doesn't mean that every little decision I make in a positive way doesn't matter. Looking at my life and

doesn't matter. Looking at my life and looking at each opportunity to decrease inflammation and improve my success rates is really important. And you owe

it to yourself to hear this information and to make the decision for yourself.

We will all reach a point where our age does cap us from being able to get pregnant, at least in a predictable way.

We'll all reach a point where our ovaries will no longer respond to stimulation medication. The idea that I

stimulation medication. The idea that I can just do IVF when I'm 50 is completely false. And most clinics do

completely false. And most clinics do have an upper age limit because it's unethical to take money from somebody if it has a 0% chance of working. But we're

all a little bit different and we have to look at what is going on for you and what your scenario is to make the decisions that are right for you. So,

what should you do with all of this information and how can this help you?

Number one, I believe that you should always be able to get your ovarian reserve checked at any age if you are interested. I'm going to put the

interested. I'm going to put the disclaimer right here that this goes against what ACOG or the American College of OBGYn recommends. They have a lot of different reasons why they do not

recommend AMH screening in patients who are not infertile. And some of this is emotional distrust or the idea that AMH doesn't reflect your fertile potential.

And I think this is a little short-sighted because it doesn't allow you to be the one to make the decision.

It doesn't allow us the opportunity to change your future or intervene. And it

doesn't allow us to go and look at the root cause about why an AMH may be low.

I've seen enough patients who have missed their window of opportunity who would have loved to know at a younger age that their fertility future plan may need to look different. And for a

professional organization to just blanket say that this is bad or wrong, I think is completely false. In fact, I tell all my OB/GYN friends that in the same breath where you ask a patient, "What do you want to do for

contraception?" We should also be

contraception?" We should also be asking, "Do you want to have kids one day?" And we should be having an honest

day?" And we should be having an honest discussion that it gets harder to conceive as you get older and that your ovarian reserve changes and we could test that for you. Having a normal AMH

blood test doesn't mean you can get pregnant. It doesn't mean you're

pregnant. It doesn't mean you're fertile, just like it doesn't mean that you can't. But if you find out that your

you can't. But if you find out that your AMH is lower, what will you do with that information? Might you consider getting

information? Might you consider getting to a root cause or evaluating for other medical problems? Might you freeze your

medical problems? Might you freeze your eggs? Maybe you'll try to get pregnant

eggs? Maybe you'll try to get pregnant sooner. Maybe you will explore other

sooner. Maybe you will explore other options for parenthood. It might

actually change your entire future plan when it comes to your family. And I'm of the strong opinion that that should be your choice and not mine. Especially in

today's society, you deserve to be armed with all the information. If you're on birth control, hormonal contraception can decrease AMH. So can any period of

profound suppression of the ovaries. So

things like pregnancy, breastfeeding, you also can have a lower AMH. Now, it's

not that those things have harmed you and you have fewer eggs. It's that the cells that make AMH, if they've been suppressed for a while, might not make as much. This is very temporary. About 3

as much. This is very temporary. About 3

months after will recover. But it's one thing to keep in mind. Let's say if you are on the birth control pill and you're checking an AMH while you're still on the pill. I don't believe that everybody

the pill. I don't believe that everybody has to come off the pill in order to try to check your ovarian reserve because you should be the one to be able to protect yourself from a pregnancy. That

is equally important. So, if you're happy on the pill, but you want to know about your ovarian reserve, you can still check an AMH blood test. And the

majority of people, it will still be normal and you'll at least feel confident that right now you're not running out of eggs any faster. But if

it's low, you can make a decision. You

should probably be referred to a fertility doctor like me. We'll do an antrolollicle count. We'll talk about

antrolollicle count. We'll talk about stopping your contraception and trying to see if this looks a little bit different in a couple months. We'll

discuss where you are in your life and your goals. Should we consider freezing

your goals. Should we consider freezing eggs? Should we consider doing a more

eggs? Should we consider doing a more comprehensive fertility evaluation?

Should we try to get to the root cause?

Having that one data point low actually can set off a series of other tests that might put you in the position to find out you do have something else going on.

If you're trying to get pregnant and you're older, if you're 35 and older, it's important to know that the definition of infertility is different.

Meaning, if you're less than age 35, we recommend that if you haven't gotten pregnant after one year of trying, that you go see a fertility doctor for a fertility evaluation. Importantly, 72%

fertility evaluation. Importantly, 72% of people will be pregnant in the first 6 months, so you don't have to wait a year. But if you're 35, because it is

year. But if you're 35, because it is harder to get pregnant, you'll have fewer eggs, and egg quality is not as good, you should not be trying longer than 6 months. And if you've not had success, you should go get a fertility

evaluation. We want to see you sooner.

evaluation. We want to see you sooner.

And if you're 40 or older, honestly, I would love to see you before you even start to try or at maximum trying for 3 months. There's no reason why we should

months. There's no reason why we should just be trying if we have some major thing preventing us from getting pregnant. If you're trying to get

pregnant. If you're trying to get pregnant at an older age, you deserve all the information. Also, we really have to think about if you're starting your family at 35 and older, how many kids do you want? And does this make

sense? If you would like to have four

sense? If you would like to have four kids and you're starting your family at 38, it is going to be very impossible to do so for the average person without intervention, without freezing eggs or

embryos or thinking about a different strategy for family building. It may not be impossible, but if that is your dream and maybe you just got started on it later because you were busy chasing

other plans or dreams or a career or found your person later, we should be the one to be able to talk you through what those success rates look like and at a minimum test to make sure everything is normal before you just go

blindly trying monthtomonth. And the

older you are, I think the more important it is to know your cycle better, know that ovulation is happening and happening at a reliable and predictable time. And then to support

predictable time. And then to support your egg quality, we really want to think about this metabolic and inflammatory factors. This again cannot

inflammatory factors. This again cannot undo age, but we know chronic inflammatory diseases, toxins like smoking and BPA, high stress levels, not

getting sleep. These things actually can

getting sleep. These things actually can impact your egg quality, your ability to get pregnant, and your ovarian reserve.

So looking at these lifestyle tenants isn't just woo woo medicine. It's

actually us trying to say what can you do so we can put some power back in your hands. I like to recommend CoQ10 at 200

hands. I like to recommend CoQ10 at 200 milligrams a day, three times a day. So

a total dose of 600 which is an antioxidant which is very rich for the mitochondria and helps support the metabolism of the cells of the eggs. I

also like to think about all the things that can cause inflammation and how do we decrease that? That's going to be a plant-forward diet, high in fruits and vegetables and fiber, reducing added

sugars, trying to decrease insulin resistance. Then we also want to think

resistance. Then we also want to think about avoiding toxins, avoiding the plastics, avoiding non-stick cookware, really paying attention to your products and thinking about how do we reduce some

of these exposures. And then don't forget the foundation of your day. Every

single day, stress, sleep, and exercise impact the world around you. And we

shouldn't be ignoring these factors that really control the baseline inflammation that we allow ourselves to have exposure to. I have an entire section of the book

to. I have an entire section of the book going into these. So, part three of the fertility formula dives into all of these factors to impact your fertility and your egg quality in detail. And in

part four, I'm giving you my plan so that you can really learn what you should be doing. And if you pre-order the book now at nataliecrawfordmd.com/book,

nataliecrawfordmd.com/book, you will see a place where you can submit your order and you can get my primer, this exclusive handout that I created. It's not even a handout, it's

created. It's not even a handout, it's an entire chapter where we're talking about how you can optimize your fertility and reset your hormones by looking at these different lifestyle aspects and giving you very tangible

tools. So, that's called the 7-day

tools. So, that's called the 7-day hormone reset and only available if you pre-order the book. You shouldn't

hesitate to see a fertility doctor and learn more about freezing your eggs. I

always say the time to freeze your eggs is the time that you're thinking about it and at least that's the time where you should get more information. You can

always choose not to do it, but you should find out the real facts and the data yourself and you should be the one to actively make that decision. You

can't turn back the clock. We all will reach a place where we can't get pregnant. The biological clock ticks for

pregnant. The biological clock ticks for all of us. But you actually have a lot more control over your egg quality than many people realize. And it's not about being perfect or not. It's the sum of

these choices that play a big role in your fertility now, your hormone function in the future, and your reproductive health. So, you are the one

reproductive health. So, you are the one in charge of your fertility to a much greater extent than we like to talk about. You deserve data and clarity when

about. You deserve data and clarity when it comes to your body. You deserve to have your egg quantity checked by test of ovarian reserve. and you deserve to understand how your egg quality might be playing a role. I break down these age

related norms in the book in detail and you should not hesitate to really look at your life and do an audit for what factors you can control. Thank you guys so much for being here. I appreciate you supporting the new season of the Asoman

podcast. Please ask any questions that

podcast. Please ask any questions that you have or comment and share this episode with a friend. And until next week, thank you friends.

Thank you for listening to the Asoman podcast. If you're ready to take control

podcast. If you're ready to take control of your reproductive health, my new book, The Fertility Formula, is your next step. It's a sciencebacked guide to

next step. It's a sciencebacked guide to understanding your hormones, optimizing your fertility, and owning your reproductive future. You can order your

reproductive future. You can order your copy and learn more at nataliemd.com/book.

nataliemd.com/book.

And as always, follow along at nataliecardmd for even more support.

Because knowledge is power, and your health deserves a formula made just for you as a woman.