5 Things That Are Silently Wrecking Your Fertility (Most People Do All of Them)

Crawford presents sleep as the number one factor her patients neglect. She cites research showing each hour less sleep reduces eggs retrieved in IVF, lowers testosterone and sperm count in men, and delays time to conception. Mechanistically, during sleep, inflammatory markers drop and cells become more insulin sensitive; the brain releases follicle-stimulating hormone and luteinizing hormone in the early morning, so shortened sleep blunts these signals. For women, the luteal phase is particularly energy-demanding for progesterone production, so sleep debt worsens hormonal output. She emphasizes that both partners need synchronized sleep schedules because light, sound, and temperature disruptions from one affect the other. The goal is not just surviving the day but allowing the body to fully repair and respond to reproductive hormones.

Crawford frames the stress response as designed for physical escape (running from a bear), but modern stressors are psychological, leaving unused glucose in the bloodstream. The pancreas then secretes insulin to clear that glucose, leading to higher insulin levels over time. Elevated insulin drives ovarian androgen production, lowers estrogen, and causes mitochondrial damage in eggs and sperm, while also promoting visceral fat and hypothalamic dysfunction. She notes that most people respond to a stressful day by eating comfort food or drinking alcohol, which worsens the insulin load. Instead, she advocates using the body's own mechanism by moving immediately—'do 10 squats right there.' This acute movement uses up the glucose, prevents insulin spike, and trains the body to handle stress without metabolic fallout.

Crawford explains that insulin resistance is rampant even in seemingly healthy people, fueled by diet, stress, and sedentary lifestyles. Building muscle through resistance training is one of the most effective ways to enhance insulin sensitivity because muscle cells can absorb glucose via contraction-mediated pathways that don't rely on insulin. She observes that many young women stick to yoga or Pilates, which have benefits but don't build sufficient muscle mass to counteract metabolic dysfunction. Muscle mass also serves as a metabolic reservoir that improves hormonal balance, especially in perimenopause. She ties this to fertility because high insulin prompts ovaries to produce excess androgens (testosterone) and disrupts estrogen synthesis, leading to irregular cycles and PCOS-like features. Therefore, resistance training directly improves ovarian health.

Crawford breaks down diet into practical pillars: first, ramp up fiber-rich plant foods to feed the gut microbiome, which metabolizes estrogen and maintains gut barrier integrity, reducing systemic inflammation. Second, health fats are essential because hormones are built from cholesterol; she corrects the lingering myth that low-fat is better. Third, plant-based proteins (legumes, soy) offer fiber and protein simultaneously. For animal products, eggs provide choline for fetal brain development, fish supplies omega-3s, and red meat, while not needed daily, can be quality if regeneratively raised. She emphasizes that research on red meat often lumps together all types, but high-quality unprocessed meat likely has different effects. She advises against ultra-processed foods and refined sugars because they drive insulin resistance and inflammation. For those with unexplained infertility or inflammatory symptoms, a trial elimination of gluten and dairy for a few weeks, followed by reintroduction, can unveil sensitivities. She shares that she herself removed gluten and felt dramatically better, leading to successful pregnancies.

Crawford dedicates a chapter to toxins, describing categories: endocrine-disrupting chemicals, heavy metals, plastics. She explains that these chemicals each work differently—some block androgen receptors, some mimic estrogen—and have combinatorial effects. Sources: plastic containers, cutting boards, hot to-go containers, thermal receipts, scented products. She recommends a kitchen detox: discard all plastic cutting boards because microplastic fragments embed in food; switch to glass and stainless steel; use wooden boards. For babies, glass bottles and stainless steel plates are safer. She clarifies the labeling trick: 'unscented' products may contain scent-masking chemicals that are still toxic, so look for 'fragrance-free.' She also notes that PFAS 'forever chemicals' are in non-stick cookware and some drinking water; avoid Teflon completely and use cast iron or stainless steel. While she acknowledges we can't control everything, like daycare rules requiring plastic bottles, the home is where major change happens.

Mark Hyman shares that in his 30 years of functional medicine, he found a short-term 'reboot' using a restrictive whole foods diet eliminates most symptoms in many diseases. He cites a 70% reduction in all symptoms from all diseases in 10 days. He recounts a patient whose depression and psychiatric hospitalizations resolved, and another whose lifelong issue cleared. Crawford endorses similar elimination-reintroduction strategy. This protocol is placed here because it is a practical tool that directly aligns with the anti-inflammatory diet principle. It can uncover hidden food intolerances, like gluten or dairy, that perpetuate inflammation and impair fertility.

Crawford explains that many women use apps simply inputting cycle day one, which assume a fixed 14-day luteal phase for everyone. This calendar method correctly predicts ovulation only 20% of the time, missing abnormalities like short luteal phase (less than 11 days), which signals poor progesterone output or weak ovulation. She advocates for more reliable ovulation detection: cervical mucus changes reflect rising estrogen, BBT rise confirms ovulation after the fact, and urinary LH monitors detect the surge before ovulation. By pinpointing ovulation, a woman can measure her luteal phase length and identify issues early, allowing intervention before infertility is diagnosed. This proactive tracking aligns with the menstrual cycle as vital sign concept, giving women data to advocate for themselves.

Crawford argues that when a couple first tries to conceive, it's often the first major stress test for the body's overall health. Infertility, therefore, provides a window into underlying issues like insulin resistance, chronic inflammation, and mitochondrial dysfunction. She points out that many younger women who are otherwise 'healthy' by conventional standards are actually insulin resistant or have subclinical inflammation that affects egg quality. By paying attention to menstrual cycle irregularity, luteal phase length, or early pregnancy loss, individuals can detect these problems years before they manifest as heart disease, dementia, or cancer. This reframe empowers women to see their cycle as a vital sign and take agency over their health, rather than waiting for a disease to emerge.

During her fellowship, Crawford was told lifestyle interventions wouldn't affect IVF outcomes, but her own research into fecundability showed that inflammation consistently impaired fertility. She recalls overhearing that and deciding to conduct her own experiment: she cleaned her kitchen of plastics and Teflon, eliminated gluten, improved sleep and stress management. She got pregnant naturally with her daughter, and later her son, both while avoiding gluten. Years later, a celiac diagnosis confirmed her sensitivity. This personal transformation demonstrates that even unexplained infertility can often be traced to modifiable inflammatory triggers, and patients must be their own advocates.

Crawford explains that AMH (anti-Müllerian hormone) is a blood marker of ovarian reserve, reflecting the number of eggs remaining. While a low AMH does not directly cause infertility, it is often a red flag for conditions that decrease egg count: autoimmune diseases, chronic inflammation, smoking, or undiagnosed endocrine disorders. She believes that women in their 20s and 30s who learn of low AMH can take proactive steps—like dietary changes, treating Hashimoto’s, or deciding to freeze eggs—rather than discovering it only when they fail to conceive. She also links low egg count to earlier menopause and increased risk of cardiovascular disease and dementia, making it a broader health biomarker. Her opposition to ACOG is grounded in the principle that people deserve data about their own bodies, not paternalistic gatekeeping.