The Hidden Cause of Infertility Doctors Overlook | Dr. Natalie Crawford, MD

Fertility isn’t just about getting pregnant, it’s a window into your overall health.

In this episode of the Vibrant Wellness Podcast, Dr. Brooke sits down with Dr. Natalie Crawford, a double board-certified Fertility Doctor and Author of The Fertility Formula.

After experiencing 4 pregnancy losses herself, Dr. Crawford began questioning the conventional approach and what she discovered could change how we think about fertility forever.

We dive into:

• The real root causes of infertility (beyond hormones)
• How inflammation impacts egg and sperm quality
• Why “just do IVF” isn’t always the answer
• The 5 non-negotiables for optimizing fertility
• How to actually track your cycle (and why most apps are wrong)

🔗 Dr. Brooke Stubbs, MD

https://www.rootedfemme.com/

https://www.instagram.com/brookiestubbsmd

🔗 Dr. Natalie Crawford, MD

https://www.nataliecrawfordmd.com/

https://www.instagram.com/nataliecrawfordmd/

The Fertility Formula

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Transcript

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I remember after my first pregnancy loss being very academic about it, one out of four pregnancies and the loss, it's better that it didn't work out. Everything's fine. But then the second one, I was the chief resident on labor and delivery and started bleeding when I was further along. Nobody knew I was pregnant. Nobody knew we'd been trying. Nobody knew it was my second loss. So you just have to bottle it up and get back to work, right? Deliver other people's babies while I was losing mine. And I remember feeling something's wrong like this is not just coincidence. And going to my doctor and being told, well, you have to lose a third pregnancy before we'll do any testing. Welcome to the Vibrant Wellness podcast. I'm your host, doctor Brooke Stubbs Today on the podcast. I'm joined by my good friend, Doctor Natalie Crawford, a board certified ObGyn, reproductive endocrinologist, founder of Four Hour Fertility in Austin, Texas, and the author of her new book, The Fertility Formula, which comes out April 14th. Her work reframes fertility not as a single moment or diagnosis, but as a reflection of the entire physiologic environment, including inflammation, metabolic health, lifestyle, and timing. Today we're diving into what fertility actually tells us about our health, how to optimize the environment before conception, and how to think about this journey in a way that is both evidence based and compassionate. Natalie. Hi, Brooke. Thank you so much for having me. Thank you for being here. I'm so excited about the new book. Thank you. I think it'll already be out. It's out April 14th for anybody who wants to get it. It's fabulous. I can't wait to talk about all. Thank you so much. You know what a journey it's been. You've heard me talk about the book for years. And two years ago when I got the book deal, you know, you took me to dinner and celebrated. And so you've been along every piece of this journey from conceptualizing to writing. Now we're in the promoting at the most exciting stage. So thank you so much. But I was happy to be along for the journey. And still we're we've got lunch parties to celebrate all the things. This has been such a labor of love. I want to talk about the history about it, because I want people to understand how much work and education and how valuable this book is for them. And I mean, everybody knows somebody who's either trying to conceive, is trying to conceive, and so this book is for everybody. If you have a daughter who might want to be pregnant one day, be the sister, or if you're trying to conceive, this is a book you need to read because it has so many nuggets of information. And then even if you're not, what's good for fertility is good. Yes. So the things in this are really going to put you in a space to live a better life for your chronic disease, more vibrantly, all of those things. But I will say from a personal perspective, the only reason I'm sitting on this couch and I'm in an integrated space where I have left, traditional medicine job to pursue something that was more preventative is by your nudging, when I was, what was I, 31? It's crazy. That was ten years ago, right? Yeah. I was trying to conceive and I had a nutritionist, and we talked about lifestyle, and then you helped me, you know, direct me in the way of lifestyle medicine. And that has led me to where I am today. You've also had a personal health journey. So in terms of miscarriage. Talk to us about that. Talk to us about how you moving on both sides both the patient and being the physician and how that changes your perspective. Oh it's you know, absolutely the worst to go through a health challenge of any type and have that doubt of your own body and to have to be in the position to advocate for yourself and feel like your physicians on the other side maybe aren't listening or aren't getting it. And having gone through that and just questioning everything really gives you such different insight. I started trying to for my family when I was at the end of my residency, so the end of ObGyn training had taken care of tons of women, tons of people had had miscarriages, and we started having pregnancy loss very unexpectedly, I was healthy. I remember after my first pregnancy loss being very academic about it, one out of four pregnancies and the loss, it's better that it didn't work out. Everything's fine. But then the second one, I was the chief resident on labor and delivery and started bleeding when I was further along. Nobody knew I was pregnant. Nobody knew we'd been trying. Nobody knew it was my second loss. So you just have to bottle it up and get back to work, right? Deliver other people's babies while I was losing mine. And I remember feeling something's wrong like this is not just coincidence. And going to my doctor and being told, well, you have to lose a third pregnancy before we'll do any testing. And I, I knew that that era, I'll say really clearly. Currently it's two pregnancy losses before testing. But at the time I had told patients that right as an OBGYN. But to hear it felt so demeaning and the idea that I hadn't, I failed, but not bad enough to warrant testing. I was told it was just bad luck. Just keep trying again. And so that's what we did. And then lost pregnancy number three and then pregnancy number four and got to the position where now I was in my fertility fellowship and told IVF was the next option, but I was the IVF fellow so I couldn't do IVF yet. I had to wait till the end of that clinical year, which sounds crazy to people outside of medicine, but you know this too. If it's like, okay, fine, like that's the next step. I mean, obviously I wanted to be a fertility doctor, but I was so unprepared for how professionally the pregnancy losses also impacted me because of I couldn't get myself pregnant. How can I get other people pregnant? It felt like this. Not just personal failure, but a professional one. And at the same time frame, I sort of really feel like something was wrong. I'd had all the testing done by this point. It was all normal and went to my fellowship director and said, hey, I really want to study, you know, natural fertility, things like diet and environment. I've been a nutrition major back in college. And he said, well, all the fellows do lab projects. It's a lot easier to defend, right? You have to have a paper published, defend it on your oral boards. And I said, I know, but that's not, you know, where my passion lies. And so I got a master's of science, a clinical research was they told me I had to do within. That's what I studied ovarian reserve, the luteal phase, vitamin deficiencies, environmental chemicals and really started feeling like the word inflammation is in all of that literature. But at that time period in medicine specifically, this is 15 years ago, we weren't talking about inflammation pre-dating disease, right? Inflammation for us was already like in the disease. Right? Endometriosis causes inflammation, not about all the inflammation that can predate you having a problem. So I started really thinking, well, goodness, if we're going to do IVF, I know from doing IVF clinically that we can only work with the eggs and sperm were given. I don't buy this narrative of just do IVF and it will be okay. And we started really making little changes to the foods we ate, the things in our kitchen. You know, how we approached life all with this really general non directed idea of let's decrease inflammation. And you know, the long end of that is why ended up getting pregnant and staying pregnant. And one of the things I cut out when I was listening to my body was gluten. Not that I ever would have thought I had a gluten sensitivity by any means. I just felt like a little more bloated or puffy, and I was really trying to be my own end of one experiment. And then a decade later, I got diagnosed with celiac disease right And that was a very challenging journey because that diagnosis came very non classic. And it really was kind of like the cap to this entire experience where I felt so strongly that inflammation played a central role for me, even though we couldn't get to a diagnosis and that treating that really helped. It's something I've always been passionate about, at least trying to explain to patients life cells always, you know, that's a little touchy because some people feel like they're some blame metric, and that's not it. It's just data. And now there's so many studies talking about how chronic inflammation and insulin resistance they impact, the hypothalamic functioning, the ovarian response, your quality, your egg quantity, everything that goes into the ability to get pregnant and stay pregnant. So it was such a journey for me personally. And, you know, that's really the core of what the fertility formula is about, right? Chapter one is about how inflammation hijacks your fertility, just laying the groundwork to understand what that really means and then going into your hormones, your menstrual cycle, your ovarian reserve, all of the stuff that many of us don't learn until we're in the midst of infertility or trying to get pregnant in the middle part of the book, as you know, is about how do you track your cycle and what do you do in a cycle is off and what is a normal cycle? And then all the facts for getting pregnant or going through and navigating infertility. But the back half of the book is all lifestyle medicine. So my five non-negotiables is about getting sleep, managing stress, building muscle, anti-inflammatory, eating and gut health, and avoiding toxins. And really, the data that exists between those hormones, health and fertility and really actionable items so it doesn't feel scary or fear mongering, but it's things you can take away. Whether you're trying to get pregnant right now, or going through IVF, or even in the ideal world, this book was written for somebody who wants to be pregnant someday, because what we know is that these inflammatory changes add up, especially to our eggs, our existence, that our body, our entire life. So the earlier we can learn and start to incorporate an anti-inflammatory lifestyle, the easier the journey is going to be for us. Is required reading for you. Like you say, anybody who wants to be pregnant, but also for anyone going through a medical school or medical education to just have that groundwork. I know personally, how do I know what I know now about lifestyle? I don't know that I would have, right. It's interesting because I don't think the general public understand how little training even physicians get just in infertility in general. Right? So I did four years of ob gyn and three of Re, but in my ob gyn training I did six weeks of fertility as, as an OBE. Joanne. Right. And you went through internal medicine. So how much in its right. So how much infertility did you learn. Right. Despite the fact that most people, when they experience some of these symptoms, they can be really vague. They're very subtle. So when does the regular woman learn to track or cycle? When did you learn to track your cycle? Yeah, I really didn't. I had to learn on my own. Right. I don't even remember when I started, but I also, you know, was on birth control a very long time. And so I really didn't even I actually game the system. You say you had to wait for two pregnancy, three pregnancy loss in order to go to your, your fertility evaluation? Well, I told my OB we both know. And if R is our friend that I've been trying for a year, when in reality, I had only been trying for two months. But my OB, when I was 16 or 17 said, you may have a new Jersey, so I wasn't going to try for six months to a year in order to get to see you. I just said, I've been trying for a year. Can I go see now? Now I need to get in and I need to. Yes. Well, and that was smart of you. But also reflects the a patients shouldn't have to advocate that hard or lie to manipulate the system. And a core premise here is that infertility is defined as trying to get pregnant for one year without success, as you alluded to. And if you're 35 and older, we usually will say, well, let's evaluate you after six months. But in the world where chronic inflammation is rising, autoimmune diseases rising, accounts are dropping, sperm counts are dropping, and fertility rates are higher, women are waiting longer. Why are we making people still fail first, before we even talk about what is going on or getting basic data about their body, some of the hardest cases I see are people who are forced to wait an extended amount of time, and then they find out their account is super low, or their sperm count is zero, and there are things they would have started to do that can take months. And now we're a year later down the road. To me, that narrative doesn't serve anybody. It doesn't help us but know very few don't. They know very few. Medical doctors are going to say to somebody, oh, you've been trying to month, let's move on. So we really have to put it on to the patient to say, you can get fertility testing at any time. And if you think you might have endometriosis or PCOS or any sperm problems based on your medical history, like don't pass, go, go get an evaluation right now. Understand what is the sperm? Are your tubes open? Are you ovulating? Have somebody who can spend the time diving into it, because it's just data about your body rate. And there's a circumstance where maybe you could have gotten data and all could have been normal, and maybe you decided, okay, we feel more comfortable trying a little bit longer because we did all this testing and it was normal. Maybe we accelerate faster to IVF like we did in your case. So I think everybody's a little bit different and there's no one size fits all. But I really don't think that as physicians in today's world, we should be the gatekeepers of information about people's bodies anymore. I agree, and I think that you allude to the formula. There's so many things that we can do foundationally before we ever get to that point. And so don't wait, you know, to get the book. But also, what can people do if they're listening now they're in the throes of infertility. They're obviously going to go grab your book and start downloading some of this information. But like, what are the hard hitting things? Where do people need to focus their attention right out of the gate? If you're going through infertility right now? So big concept. And still they're fertility doctors. And I said this earlier, but just to double down on it, if you say just do IVF, none of the rest matters. And every single day I will sit with patients who have IVF outcomes less than desirable. And we look through how eggs looked, how they fertilized embryo development, where embryos stopped. And I can tell you right away, when the male genome kicks in, if I see poor development, we go back. One of the top things is going to be having some lifestyle factor that is influencing the DNA or the sperm quality that was previously not disclosed, because a semen analysis doesn't detect at all and there's no test for egg quality. So if we zoom out for the regular person, understand egg sperm quality are not testable factors. This means you're going to go into this and the world around you controls egg and sperm quality. Okay. So just to double down on egg quality is not just the genetic normalcy of your egg, but also the competency of it, the mitochondrial function, the ability of the egg to make hormones to respond, sperm quality is largely the DNA inside the head of the sperm. The functionality is the sperms ability to move. Chronic inflammation impacts air quality. So much impacts sperm quality too. But sperm are constantly generated. So the very nice thing for guys is that they could stop smoking cannabis right now. And in three months they're going to have sperm who were never exposed to that completely. New sperm parameters. The lifespan of a sperm takes about 72 days to make a sperm, 18 days for a sperm to then get out the ejaculatory system. So we say three months to get new sperm development for women. Eggs are in our body our whole life, so it's a little bit different. But prior to ovulation, the eggs become more sensitive. So the 300 days before you ovulate, they start to get. I like to think about it closer to the surface, but in the 60 days prior they are the most susceptible. So this does mean that regardless of what your past looks like, starting to make changes right now can make a difference. And we'll just have the caveat for women, there is some tincture of time you can't undo, right? Chromosomes have been held in a certain position, however old you are. But to me it is more empowering to say that means all the other factors you can. Controlling insulin resistance and chronic inflammation matter even more because we can't rewind the clock versus just, well, buck 41. Now, nothing you can do, right? It's saying, hey, okay, I'm getting started a little bit later. This is the age I am now. I really need to take control of the factors that I can. And so when we think about those, we really want to think about what is going to decrease inflammation, because we know that chronic inflammation is so impactful to fertility, probably the top that my patients are not doing correctly is going to be sleep okay, which I know you think this all the time to and is an interesting one because it gets very dismissed, I think by many patients they were their badge of honor that they only need five hours of sleep per night. But the reality is sleep has a very specific physiologic function, as you know. Right. This is when your body is going to heal up some of that chronic inflammation. It's when you can become more insulin sensitive so that insulin resistance doesn't play quite as profound a role. But if we want to look really statistically, your every hour of sleep, you get less, you'll get fewer eggs and IVF cycle. Men will have lower testosterone levels and lower sperm counts. So it's not just a good bonus thing. It's very tangibly tied to your outcome. And we know the circadian rhythms are trying to get the same hours of sleep a day. Also is really, really impactful. And I just think for women to understand your gonadotropin, FSH and LH is the hormones that control ovulation. They're released from the brain in the early morning, meaning after you've slept for a certain amount of time, then you get to the stage where you're going to trip and they'll be released. So we're not too short changing from an inflammation standpoint, we are also directly modifying our brains release of the hormones that control the ovary. If we're not sleeping enough, seven hours is the very minimum. Most women need seven and a half, especially if we're in the luteal phase, it takes a little bit more energy to make progesterone in the luteal phase than I thought I would think more like. I mean, certainly that's going to be ideal. But, you know, a third of Americans get less than six like crazy. That's a big, big portion of people. And that's not even getting less than seven. They're getting less than six. So we really need to drive home that. Our sleeping time is time asleep, not just time in bed. I think a lot of people get in bed. They have their phone, they don't have a good, you know, whine down routine like a toddler would, and really cultivating a good sleep environment. Dark, cool, a sleep mask, the sound machine, all the tricks that I know you are very passionate about because we've gone places and shared our hotel room. And so I know, I know how you are, but I think that's really, really important for people to say, okay, that's something I can do, starting right now, that most people can improve. And there's also evidence that melatonin, which is an antioxidant, melatonin is actually released in higher amounts around ovulation because it's so protective to the ovary, because the inflammation is higher at ovulation. And so we want to think about taking melatonin, even if you don't have difficulty sleeping, can be a supplement that can help for equality. That just during that trying I mean it's fine to take it, you know, before you want to get pregnant when you're trying to conceive. I will take it now just because it's such a potent antioxidant. The big key with melatonin is not taking too much. Okay, so we want doses at max three milligrams a night, right? One milligram is probably better, but a lot of times that's a pediatric dose actually. So you have to go look for it. We see a lot of melatonin that's ten milligrams or more just over-the-counter. So we want to be mindful of dose. If you're ready to take control of your own health. Visit Vibrant wellness.com to learn how advanced integrative lab testing can uncover root causes and guide your path to vitality. Vibrant offers one stop shop testing solutions, including the recent launch of Gut Zoomer, giving you actionable insights you can use with your health care provider or with your patients to support targeted, effective healing. Is there any concern that by taking melatonin our own natural when you're at levels higher than three milligrams. Yes. Okay. But when we're less than that we're just supplementing, not replacing. So the idea here is if we're totally replacing it, you're correct. The brain's not going to release as much natural. If we're just giving an extra boost then we're just supplementing that. And then we're getting the benefit from the antioxidant sleep number one okay. The next two are going to be stress managing stress and building muscle. And here is my very quick analogy about insulin resistance, which is the real piece to this puzzle mentioned I have I have I love it, okay, I love it and definitely will hit on it with diet. But let's just say like what is it? Because so many people will sit across from me and say, well, diabetes doesn't run in my family, so I don't need to worry about insulin resistance. What we want to think about is influenza hormone made from the pancreas. So when you eat food, your food is going to get broken down into glucose. Glucose is the fuel for your cells. I like to think about insulin being the salesman, helping glucose get into the cell. So glucose is in your bloodstream. Insulin release. It's knocking on the door of the cell. Door will open. Glucose goes in. Insulin and glucose both go down. When glucose is higher. And it can be higher for a multitude of reasons. But for this analogy, let's say it's because you're eating food that has a higher glycemic index or causes more glucose, like ultra processed food, or you're eating more constantly, or the amount gradients, you have more glucose in your blood, your body's going to respond as it needs to and release more insulin will just like you. Meaning if a salesman came to your door every single day, what are you going to do? That is you're going to like, hide inside and not open the door. And that's what your cell does to you. It says, no, I don't want to open for insulin. So it takes your body that wants glucose to get in the cell and it seizes glucose staying in your bloodstream. So it sends out more insulin. So now the salesman is banging on the door okay. Banging. So you go in and fine you open it up and you answer. And then glucose can go inside. This is insulin resistance takes a higher level of insulin to get glucose into the cell thing salesman is banging on the door. Well during that time period this becomes a really bad circuit because the cell is starved. It then send signals to break down the stored glucose from your liver into your bloodstream. So you're getting more glucose. And you can see how this is a nasty cycle. And insulin is not benign, right. It's a growth factor. We both know that it causes you to put some visceral fat on. So you can store that for later. It's very inflammatory. And high insulin directly changes how the ovary responds to its hormonal signals. So egg quality immensely impacted by that. So we want to break this insulin resistance cycle. There's many ways we can do it of course preventative with diets. One of them that we're going to touch on in a second. Getting enough sleep is one of them. Because you're going a longer interval. Your body can kind of become more insulin sensitive, respond again to the knocking and not the banging, but building and using your skeletal muscle is one of those hacks that's not talked about enough. And skeletal muscle has a lot of benefits for longevity. And I know you talk about it a lot, but if we want to be very minute and think about fertility and hormonal health, skeletal muscle has the transporter glute four, which I like to think about, is giving glucose a key to the house. We no longer need insulin. So when we're using our skeletal muscle, glucose can be used up. We don't need insulin. Therefore glucose goes down. Cells become more insulin sensitive, meaning we don't need the salesman banging on the door anymore. But the more skeletal muscle you have and the more you use it, the better this is going to be. So picking up weights, lifting weights at least three times a week should be the core of what you're doing at all phases of your cycle, whether you're trying to conceive, pregnant, postpartum, etc. so unless you've been told don't workout in this time, that should be the core of what we're doing. That doesn't mean cardio is not important or other exercise is bad, but it means building that skeletal muscle from a hormone perspective has a huge advantage. Okay, walking back to stress, well, how does that impact stress? If we think about our body, the things that we're stressed from now, as you know, are not the things that we were developed to be stress from. Right? Chronic stress plays a very strong function, especially in women. The ability to get pregnant and to grow a human is such a huge metabolic expenditure that your brain has to be really convinced that you're of the right state of health. So one thing we know is chronic stress alone and cortisol being released can shut off or blunt the brain's response. So you may not ovulate at all or you may not ovulate. Well, you may not make enough progesterone. You may ovulate early or late. So stress has a direct impact on your ability to conceive just from what is happening with your hormones. But more so than that, chronic stress causes insulin resistance. And here's, you know, I love analogies. Okay, so if you have a bear, right, you want to run from the bear. So cortisol releases. You have to activate and run from the bear. Your survival should not depend on when you ate your last meal. So when cortisol elevates, what your body does is goes back and says, let's break down glucose from the liver. This is why we stored it. So Brook can get away from the bear. So glucose gets poured into your bloodstream. Well, if you were running from the bear, you would use it all up, right? You had your muscle. All that glucose would get used up. It would go back down, you'd get to homeostasis. Everything would be great. You know, you just checked an email. There was no bear, nor did you run from it. Right? But you still got the same stress response. It was an email, a bad meeting about a doctor's appointment, a fight with somebody. There's a variety of things your to do list that you can't get to running late. All sorts activate the same response over and over and over again. And most of us, most humans, instead of using their glucose, they actually add to the burden because some of the most common behaviors when we are stress are to stress, eat or distressed, drink or scroll like we're searching for these little dopamine hits, and then we're having more glucose into our bloodstream, developing insulin resistance. So there's a couple different things to think about there. But one of them, of course, we want to set boundaries, do the things we can. We want to give our body a cortisol release every day where we have 20 minutes to really decompress. But third, and probably most important and not talked about is when we notice that when you get the bad email, if there's a way for you to activate that skeletal muscle that you have built up, you are going to return to baseline much faster, and that chronic stress is not going to contribute to insulin resistance. Okay, so ten squats a quick little walk doing something. We know we often get your blood pumping, but really it's get your muscles working. That's going to be something you can do very quickly that will help you. So you can hydrate do your squats. So stress, sleep and exercise. To me those are the foundation of your day. You make decisions every day on how you deal with those, whether you realize it or not, that do impact your fertility. And then the other two buckets are going to be your diet, okay. And that's probably the hugest one as far as where you can really move the needle. But it's the one that a lot of people have a lot of resistance to because it feels scary. Right? To change your diet. What do we know from dietary studies when it comes to hormones and fertility, first and foremost is going to be an anti-inflammatory diet. High in fiber. So fruits and vegetables of unlimited quantities in studies is a direct correlation. The higher number of servings you consume of fruits and vegetables, the faster you get pregnant. Okay, better quality. You have better sperm counts. You have. So it's not a maybe it's a yes. We know that gut health is really, really important for the gut microbiome. And what feeds the gut. As, you know, fiber. I feel like your audience knows that so well now. So we really want to make sure that we are consuming tons of fruits and vegetables, at least six servings a day is the recommended amount to have peak fertility. If you're trying to get pregnant. Okay, when it comes to everything else, probably the strongest thing is to remove ultra processed foods from the diet. They're inflammatory without nutritional benefit, and they are associated with longer time to pregnancy and poorer sperm counts. So there's no need for those, at least not in a routine diet. The other parameters are those healthy, healthy fats, right? Meats. We should probably decrease meat servings to have more plant based protein that doesn't mean you have to be plant only, but we know plant protein has an added benefit, especially in fertility studies. Every serving of animal based protein replaced by plant based protein had a higher rate of ovulating and getting pregnant, so doesn't mean you can't ever. But quality probably does matter. Nutritional studies are difficult, so we don't have that perfect study. Grass fed beef and a fast food hamburger are always going to be in the same category, at least for the data that exists right now. So there's individual nuance, but decreasing the number of animal protein servings by replacing with plant will do benefit. And then we want to avoid or tend to have more, you know, carbohydrates that are complex over those refined ones. We want to if we have dairy, we want to consume dairy that's full fat and not processed and skim and have the fat removed. We really want to get the nutritional benefit from our food. And then my last caveat, and something I work through in the book is that it's so personal and we all have an end of one response. So especially if you are in the unexplained infertility, the known autoimmune or inflammatory disorder or pregnancy loss, going through the work of removing common sensitivities from your diet, getting a new baseline and then adding them back in and seeing how you feel can be really helpful. And I walk people through this. So the two most common would be gluten and dairy. Again, it doesn't mean you can't have them, but you probably should see how you respond to them. And then endocrine disrupting chemicals would be the last bucket. So whether it's in your kitchen, your bath, beauty products, your water, your air, knowing the endocrine disruptors are correlated with lower egg counts, longer time to pregnancy, poor embryo development and IVF. It's not something to stress about. And this is the pushback that I get like, oh, well, the world is toxic. You can't control anything, so why worry about it? Look, there's so many things we can't control in this life, but learning about it because it's true, whether we want to acknowledge it or not allows you to make proactive decisions. And then you won't worry about it, because you'll know the water in your house is good, your serving dishes don't have toxins in them. You've gone through your beauty products, and when one ran out, you replaced it with one that was less toxic so that we're not constantly stressed by making these small decisions, we took the time to learn about the things that we are exposed to the most, and there's no if you don't follow this formula, you won't get pregnant, right? But the formula is trying to put together the roadmap so that you can develop body resilience. Really thinking about the fact that you're going to encounter inflammation or stress. Life is very dynamic. And if we lower your inflammatory burden, the amount of inflammation you are exposed to every single day, you'll be able to tolerate the night your child is sick and you don't get as much sleep or the cake you want to eat because it's your birthday, so you'll be in a better position. And so when you are incorporating all these things, one way we can really see this is working is by your cycle, and you talk about your cycle as a vital sign, which I totally agree with. It isn't normal to have these certain red flags which you can tell us about. Tell us about a good healthy cycle. Looks like you should be able to see the changes and you change all these fundamental things. And then talk to us about a little bit about tracking your. So one thing that I think is important for people to know is that when I ask somebody, are you tracking your cycle? And they say, yes, the majority of the time they are using an app and they are simply marking cycle day one on their phone. Okay. Well, that is using a calendar based method and it's only accurately detecting ovulation about 20% of the time. Okay. So it's highly inaccurate. Now the reason why ovulation matters outside of period. Because what happens is very often your doctor will say is your period regular? And you would say yes. And then we move on to the next question. Having a regular, predictable period is a good sign, but that alone is not enough information. Your cycle is divided into phases. So as an egg is growing, the egg grows inside the follicle. It makes us surgeon. This is the first part of the cycle called the follicular phase. After you modulate, that follicle turns into a cyst called the corpus luteum. That makes progesterone. This is the luteal phase. The length and characteristics of these phases are really giving you the most information about your cycle. So your body's giving you data. It says are we taught to listen to it. So I really want women to start tracking. When do they ovulate. And there's a few different ways that they can do that. One is going to be with urinary hormone measurements. So LH is the hormone from the brain that causes you to ovulate. So if you're tracking urinary hormones and you see an LH surge, you'll know you'll ovulate the day after that. Another way is cervical mucus. This just comes out of your body. But cervical mucus changes as estrogen rises. So as estrogen gets to its peak, your cervical mucus will be sticky, stretchy and egg white. And the last is going to be basal body temperature. Based on the idea that after you ovulate, progesterone increases your core body temperature by 4.4°F. If you detect that small shift, you can know when you ovulated. That used to be so cumbersome. Graph paper something called the cover line, a special thermometer that I would tell patients don't worry about it. But now with wearables, this has completely changed the conversation. So my favorite is Natural Cycles app. You can pair it. They have their own wearable. Or if you already have an Aura ring or an Apple Watch, you can pair it right to that. That is such a sensitive detection because it's using your core body temperature at multiple time periods during the day, accounting for changes in your heart rate and other factors, and really accurately predicting when you ovulate. So I know that's one that I love, and I'm one of their medical advisors and transparency because I really believe in the product and it's really helping, especially if you're in that time frame where you just want to leverage your period as a vital sign. Okay. So then when we know when we ovulate, we can look at these two phases. The luteal phase is typically the first thing to become abnormal if your cycle is starting to show problems. Meaning a short luteal phase is what we call a luteal phase deficiency. So the luteal phase is less than 11 days. Your corpus luteum is not able to last as long as it needs, to which many people on the back end will give somebody progesterone like, oh, that'll fix it. But the reality is the progesterone is not wrong, but it's a Band-Aid. The real problem is why is the foundation of that the follicle? Why is it not able to sustain? Because the follicle becomes the corpus luteum. So if we get you to ovulate better you often will see that improve. Okay. From there we can see changes in the follicular phase as your egg count gets lower, your follicular phase will be shorter as your eye count, maybe as high. If you have PCOS it might be longer. So understanding what your follicular phases, and especially if it's changed from what your baseline was, can also provide you some information. So I think it's very obvious for women when your period is irregular. Skipping months or you don't have a period. Okay. Yeah that's a vital sign something's wrong. But it's these subtle cycle changes when your body's waving a red flag that we're not taught to interpret, largely because many of them still happen in the context of a regular cycle. And unless we know when we're ovulating, we're not going to be able to leverage that the best. And you're going to talk to us more about that in the book with like the length of exactly. There's an entire chapter walking you through how to track your cycle, what's a normal cycle, and then a whole other chapter walking you through. Well, what if you're bleeding? Like, what if you're bleeding heavy? What if your cycle is painful? What if it is irregular? What are the labs? You should ask for the test to do? So we really break it down to help it be very actionable. So if you have painful cycles or you're bleeding late, you're like, okay, this is the top things that are going on. Let me go ask for these tests. Credible, like for putting this in a book that people can get their hands on and teach themselves these things that they're not getting taught in a doctor's office. There's no time for their physicians to go through these things, and it's going to bring a lot of joy. Oh, thank you Brock. Love you so much. Thank you for coming today. Give us leave us with some final thoughts and anything else you want people to know, either about the book or about you or about their fertility? Well thank you. The book is really, truly a labor of love. And, you know, a couple things that I just want to end with, you know, one is going to be I find it to be an empowering message that there's things that you can do that can change your outcome. At the end of the day, it's your body, it's your health, your fertility is a health marker. I mean, if you have an infertility, you are now at higher risk for other diseases later in life. And it's not that infertility causes them, but that it is representing a state of cellular or metabolic dysfunction. And if we start viewing that as a symptom, an opportunity to change, you can change the trajectory of your life not just getting pregnant now, but your health later. And your health is worth prioritizing. And I want more women to hear that and feel confident in starting to listen to themselves. Because the truth is, women get gaslit more than men. They get dismissed at the doctor's office. We have to learn the language to advocate for ourselves, but it's worth it. Yeah, I couldn't agree more. Okay, how can they find work? How can they find you? Yes, I met Natalie Crawford, M.D. online. You can find the book anywhere books are sold. You can learn more about it at Natalie Crawford IMDb.com slash book. And I practice here in Austin at four a fertility. Thank you so much for joining us today on the Vibrant Wellness Podcast. Don't forget to check back every Wednesday for more insightful conversations, inspiring health journeys, and the latest breakthroughs in integrative medicine and wellness. if you're ready to take control of your own health. Visit Vibrant wellness.com to learn how advanced lab testing can help you uncover your root causes and guide your path to lasting vitality.