How Women Can Improve Their Fertility & Hormone Health | Dr. Natalie Crawford

Dr. Crawford strongly advocates for all women to get an AMH (Anti-Müllerian Hormone) test, which indicates ovarian reserve (egg count). This is contrary to the American College of OBGYN's recommendation, which suggests AMH testing only for those with diagnosed infertility. Knowing one's AMH levels, even if normal, provides crucial data for future reproductive planning, as a low AMH can signal underlying issues like autoimmune disease or earlier menopause, allowing for timely intervention or different life decisions.

Dr. Crawford states, 'everybody should get an AMH test... That is against medical advice.' She notes that a low AMH often correlates with autoimmune disease (50% of cases), insulin resistance, endometriosis, or smoking, which can be treated to slow egg loss. She also highlights the low cost of the test ($79) compared to later fertility treatments.

Beyond the ability to conceive, fertility serves as a powerful health marker. Good fertility indicates robust hormonal, cellular, and metabolic health. Conversely, infertility can be an early warning sign of chronic inflammation or insulin resistance, which are linked to increased risks of metabolic syndrome, cancer, heart attack, stroke, and reduced lifespan.

Dr. Crawford explains, 'If you have infertility, you have increased rates of metabolic syndrome, cancer, heart attack, stroke, and dying early.' She clarifies that infertility doesn't cause these directly but is often the first signal 'that something is not right in their body.'

The medical field often operates on a 'failure' model, requiring significant symptoms or failed attempts before intervention. This applies to menopause diagnosis (12 months without a period) and fertility treatment (12 months of trying). Dr. Crawford advocates for 'hormone augmentation' to optimize levels within a normal range, rather than waiting for 'replacement' when levels are critically low, and for proactive fertility testing without requiring a 'failure' period.

Huberman notes the shift in men's testosterone therapy from strict cut-offs to optimizing within normal ranges. Dr. Crawford agrees, stating, 'We should at least be given the opportunity to have our symptoms evaluated, to be offered hormone therapy if we want it, and to not have to have these harsh cut offs.' She criticizes the infertility definition requiring 12 months of trying before testing, 'It doesn't really make sense to make people fail first before we'll even do an investigation.'

A common misconception is that egg freezing or IVF cycles 'use up' a woman's eggs faster, leading to earlier menopause. In reality, these procedures only stimulate the maturation of eggs that are already 'out of the vault' (recruited for a given cycle) and would otherwise naturally die off if not selected for ovulation or retrieval. Therefore, egg freezing maximizes the use of available eggs without impacting the overall ovarian reserve.

Dr. Crawford clarifies, 'The myth that doing that is going to tap into the vault and pull out eggs is inaccurate... I can only get the eggs outside the vault to grow.' She explains that in nature, only one egg ovulates, and all others die, so IVF aims to 'not have all those eggs die.'

Acute inflammation is a necessary physiological component of ovulation. Taking NSAIDs (non-steroidal anti-inflammatory drugs) like Advil or ibuprofen around the time of ovulation can suppress this acute inflammatory response, thereby preventing the follicle from rupturing and releasing the egg.

Dr. Crawford states, 'If women take NSAIDs around the time of ovulation... they'll prevent the follicle from rupturing.' She advises taking these medications only during the menstrual period if trying to conceive.

Cannabis (THC) and nicotine use are significantly detrimental to both male and female fertility. Cannabis negatively impacts sperm production, quality (DNA fragmentation), and testosterone levels in men, leading to higher miscarriage rates. In women, it decreases egg retrieval yield and fertilization rates, and increases miscarriage risk. Nicotine also harms egg count and quality.

Dr. Crawford reports that male partners using cannabis lead to 'much higher miscarriage rates.' Clinically, she observes embryos halting at the male developmental stage (day three) in 9 out of 10 cases where the male partner used cannabis. For women, cannabis use in the prior year can 'decrease the eggs you get at egg retrieval by 25% and can decrease fertilization rates by 28% and can increase miscarriage rates.' She also notes that nicotine/cigarette smoking 'gets into the vault and decreases our egg count.'

High doses of biotin (300 micrograms or more for seven days) commonly found in hair, skin, and nail supplements, can interfere with laboratory assays for steroid hormones (estrogen, progesterone, testosterone), TSH, and hCG, leading to inaccurate and untrustworthy results.

Dr. Crawford explains, 'biotin levels of taking a biotin supplementation of 300 micrograms or more for seven days can actually influence your lab assays for sex hormones or for any steroid hormone actually.' She warns that commercial supplements often contain 10-30 times this amount, causing 'false reads on these labs.'