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

Dr. Crawford argues that the current medical standard of waiting for a diagnosis of infertility before conducting comprehensive tests like AMH is paternalistic and detrimental. An AMH test, costing around $79, offers valuable data about a woman's egg supply, which can inform decisions about family planning, egg freezing, or early intervention for underlying issues that might be causing a low AMH (e.g., autoimmune disease, insulin resistance). Similarly, while regular periods are a good sign, detailed ovulation tracking (e.g., monitoring luteal phase length) can uncover subtle hormonal imbalances that precede overt irregular cycles. Identifying these early allows for timely investigation and potential treatment, preventing prolonged periods of unsuccessful conception attempts and empowering women to make proactive choices about their health.

Sleep is identified as one of the most powerful levers for improving fertility and hormonal health. During sleep, the body actively reduces chronic inflammation and oxidative stress, which are detrimental to egg quality and overall reproductive function. Crucially, the hormones FSH and LH, vital for ovulation, are released in the early morning, making sufficient sleep essential for their proper secretion. Dr. Crawford notes that men with less sleep have lower testosterone and sperm counts, while women experience fewer eggs in IVF cycles. Subjectively reporting poor sleep doubles the infertility rate. She emphasizes that sleep signals to the brain that the body is stable enough to support a pregnancy, which is a significant metabolic expenditure. Practical tips include maintaining a dark, cool room, using sound machines or sleep masks, and ensuring consistent bedtimes, especially for couples.

Dr. Crawford advocates for a 'cleaner' eating pattern to reduce the inflammatory burden on the body, which directly impacts fertility. This involves prioritizing high-fiber foods like fruits, vegetables, and whole grains, which are crucial for gut microbiome health, insulin sensitivity, and hormone regulation. She advises against ultra-processed foods, added artificial sugars, and non-nutritive sweeteners. While not advocating for complete vegetarianism, she notes that increased plant protein is associated with better ovulation, likely due to higher fiber intake compared to typical animal-based diets. The quality of meat is emphasized, and red meat, especially in high consumption, has been linked to poorer IVF outcomes and increased endometriosis staging. Healthy fats from nuts, olive oil, fish, and seeds are vital as cholesterol forms the backbone of steroid hormones like progesterone, essential for implantation. She also suggests a temporary restrictive clean eating pattern to identify individual food sensitivities.

Dr. Crawford identifies cannabis, nicotine, and alcohol as 'behavioral toxins' that should be completely avoided when optimizing fertility. Cannabis use, even in men, severely impacts sperm quality, leading to higher miscarriage rates. Clinically, she observes a strong correlation between male cannabis use and poor embryo development in IVF. For women, cannabis can reduce egg retrieval yield and fertilization rates. Nicotine, in any form, is detrimental to ovulation and egg quality, and cigarette smoking directly reduces egg count and leads to earlier menopause. Alcohol, as a known teratogen, should also be avoided. She stresses that while anecdotes of successful pregnancies despite substance use exist, these substances are not conducive to optimal reproductive health and carry significant risks for both parents and offspring. The 'trimester zero' period (90 days for sperm, 60 days for eggs) is crucial for making these changes.

Dr. Crawford recommends a foundational set of supplements for both partners in the 'trimester zero' period (60 days before conception). For women, this includes a prenatal vitamin with folic acid, CoQ10, omega-3 fatty acids, and vitamin D. These are chosen for their roles in providing essential nutrients, supporting mitochondrial health (critical for egg quality), and reducing inflammation. CoQ10, in particular, has robust human data supporting its benefits for reproductive outcomes. For men, L-carnitine, zinc, and selenium are highlighted for their positive impact on sperm health. While other supplements like NAD/NMN might have utility in specific subgroups with unexplained infertility and high inflammation, they are not universally recommended due to less robust human data. She cautions against high-dose biotin (over 300 micrograms) as it can interfere with accurate hormone test results.

Dr. Crawford reveals a critical, often unknown fact: NSAIDs like ibuprofen or Aleve can prevent ovulation. While acute inflammation is generally seen as negative, it is essential for the physiological process of ovulation, specifically the rupture of the follicle to release the egg. NSAIDs, by dampening this inflammatory response, can inhibit egg release. Therefore, women trying to conceive should avoid these medications from the end of their period until after ovulation has occurred. They are safe to use during menstruation for period cramping, but their use during the fertile window can directly interfere with the ability to get pregnant.

Dr. Crawford emphasizes that while complete avoidance of toxins is impossible, reducing frequent exposure to endocrine-disrupting chemicals (EDCs) is crucial for fertility and hormonal health. EDCs, found in many everyday products, can interfere with hormone signaling, leading to longer times to pregnancy, worse IVF outcomes, and poorer sperm and egg quality. She highlights that 'unscented' products often contain masking fragrances, so 'fragrance-free' is the key term to look for. Thermal paper receipts (containing BPA) are a significant source of exposure, especially for those who handle them frequently (e.g., cashiers). Microplastics are also a concern as they can accumulate in the ovaries. The cumulative effect of these low-level, frequent exposures contributes to the body's inflammatory burden, which negatively impacts reproductive function. The goal is to control what you can in your daily environment to reduce this burden.

Dr. Crawford highlights that good fertility signifies robust hormonal, cellular, and metabolic health, as successful ovulation, fertilization, and implantation require many bodily systems to function optimally. She points out that infertility is often one of the first warning signs of underlying issues like chronic inflammation or insulin resistance, which are linked to increased risks of metabolic syndrome, cancer, heart attack, stroke, and premature death. This broader view encourages women to monitor their reproductive health as a key component of their overall well-being, even if they are not actively trying to conceive or have already passed reproductive age.

Dr. Crawford suggests a distinction between 'hormone replacement' (for those out of normal range) and 'hormone augmentation' (for those at the low end of normal who wish to optimize their levels and alleviate symptoms). She draws a parallel to the evolution of testosterone therapy for men, where it's now more accepted to optimize levels within the normal range. She argues that women should have the option to augment their hormones to feel their best, especially given longer lifespans. This proactive approach could prevent prolonged suffering during perimenopause and menopause, and potentially offer cardioprotective benefits, reduce Alzheimer's risk, and protect bones.

Dr. Crawford believes that waiting for infertility to be diagnosed before testing is a disservice to patients. An AMH test, which costs around $79, provides crucial information about ovarian reserve (egg count), allowing women to make informed decisions about their reproductive timeline, egg freezing, or early intervention if a low AMH is detected. She emphasizes that a low AMH can indicate underlying issues like autoimmune disease or insulin resistance, which can be addressed. Similarly, tracking ovulation (beyond just period regularity) reveals more sensitive health markers, such as luteal phase defects, which can be early signs of hormonal dysfunction. Early detection allows for timely investigation and potential treatment, preventing prolonged periods of unsuccessful conception attempts.

Dr. Crawford observes that GLP-1 agonists, even at low doses, appear to have significant anti-inflammatory effects that could benefit patients with chronic inflammatory diseases like endometriosis or unexplained infertility. While they are clearly beneficial for PCOS and weight loss (which indirectly reduces inflammation from adipose tissue), she suggests a direct anti-inflammatory mechanism. She notes that some patients with endometriosis, who may not have significant adipose tissue, still show improved IVF outcomes (more embryos) after a short course of low-dose GLP-1s. This indicates a potential for GLP-1s to target inflammation independently of weight loss, offering a new tool for a patient population that often struggles with diagnosis and treatment.