Everything He Needs to Know About His Sperm (Send him this) Dr Natalie Crawford

Fertility doctor Natalie Crawford joins Maggie Sellers Reum on Hot Smart Rich to reveal what every woman (and man) should know about getting pregnant, fertility, forever chemicals, PFAS, egg freezing, IVF, pregnancy, male fertility, and having kids before it's too late. Natalie explains why fertility is a team sport, why 50% of infertility involves male factors, and the biggest mistakes couples make before trying to conceive. She breaks down "trimester zero," her five fertility non-negotiables, how to actually choose a prenatal vitamin, and why freezing your eggs is about protecting your options, not guaranteeing a baby. Plus, Natalie gets honest about fertility testing, ovarian reserve, IVF costs, choosing the right clinic, embryo storage, and the conversations every couple should have long before they're ready to start a family. Get unselfish access to insights that will help you own the room. Sign up now https://linkly.link/2jPXJ (00:00) Intro (02:21) Life-Changing Fertility Advice (03:39) Don't Ignore This (05:13) Male Fertility Secrets (09:57) Hidden Sperm Warning Signs (16:27) Trimester Zero Explained (20:19) 5 Fertility Non-Negotiables (28:07) Stan Ad (29:04) Osea Ad (30:04) Choosing The Right Prenatal (34:13) Why Infertility Is Rising (38:01) The Fertility Vault (44:23) Lululemon Ad (45:25) Ollie (49:30) Do IVF & Egg Freezing Prices Matter? (01:03:57) Biggest Fertility Mistakes (01:06:24) Pregnancy Beauty Myth Stan - https://ig.getstanley.ai/?ref=hotsmartrich&utm_source=podcast Osea - Use code HSR for 10% off at http://oseamalibu.com Lululemon - http://lululemon.com Ollie - Ollie: Use code HSR for 70% off at http://ollie.com/hsr Hot Smart Rich: Your Business & Culture Gossip For ambitious women wanting to own the room, gain power, and build wealth. Instagram: https://www.instagram.com/hotsmartrich/ Tiktok: https://www.tiktok.com/@hotsmartrich Maggie Sellers Reum: Instagram: https://www.instagram.com/maggiesellersreum/ Tiktok: https://www.tiktok.com/@maggiesellersreum LinkedIn: https://www.linkedin.com/in/sellersmaggie/ Locker: https://www.wantlocker.com/users/maggiesellers ShopMy: https://shopmy.us/maggiesellers Amazon Storefront: https://www.amazon.com/shop/maggiesellers/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Maggie Sellers Reum?

  If you're starting a business, there are certain things that are so fun to think about. Y'all know I love a mood board, so everything that relates to the creative, the name, the brand, the website, the vision board. But then there are the things that make you pause and ask, am I even doing this correctly? Or do I even want to be doing this? Like forming your business, getting the right documents, keeping your personal information private. This is where our sponsor, Northwest Registered Agent, is so helpful. They're a one-stop shop for founders who want to launch and legitimize their business without turning it into a giant admin spiral. They help you form an LLC or a corporation, act as your registered agent, and give you tools like a business address, operating agreement, website, phone number, professional email, and free guides.

• 0:43Maggie Sellers Reum?

  They also have real corporate guides who know your local laws. Visit northwestregisteredagent.com/hsrfree and start using free resources to build something amazing. Get more with Northwest Registered Agent at northwestregisteredagent.com/hsrfree.

• 1:03Speaker 01

  Five stocks to sell before the end of the week.

• 1:05Speaker 02

  You might be missing the opportunity of the year. Now might be the time to go all in.

• 1:10Speaker 03

  Real traders still hear the noise. They just know when to stop listening to it. Find and research opportunities to fit your strategy with Thinkorswim trading platforms from Schwab. Discover features like robust charting, nearly unlimited customization, and built-in risk management technology. Plus, get 24/7 support from real trading specialists. That's Schwab Trading. Learn more at schwab.com/trading.

• 1:33Speaker 04

  50% of infertility is due to male factors.

• 1:36Maggie Sellers Reum?

  It is exhausting being a woman and seeing all this, like, you should be freezing your eggs by this time. It's not fair.

• 1:41Speaker 04

  Because sometimes I'll have a woman say, I'm the problem. It's all me. He's fine. I've been a fertility doctor for over a decade because the hardest patients I sit across with Maggie are people who are smart, successful, educated women. And they say, if only I had known this information, I would have made different decisions. And then when we zoom out, understanding your body is really essential to be hot, smart, and rich.

• 2:05Maggie Sellers Reum?

  Okay, I love that. Can I ask you a really dumb question?

• 2:07Speaker 04

  There's no dumb questions.

• 2:08Maggie Sellers Reum?

  Are you better looking when you ovulate?

• 2:10Speaker 04

  Yes.

• 2:11Maggie Sellers Reum?

  I'm ovulating right now.

• 2:12Speaker 04

  You're glowing, I can tell.

• 2:13Maggie Sellers Reum?

  Can we go through the five of your fertility non-negotiables?

• 2:16Speaker 04

  My first one uses this. It is probably the number one thing that most of my patients are not doing well enough.

• 2:21Maggie Sellers Reum?

  This is hard for me to sit through, but it's necessary. So let's get into it.

• 2:25Speaker 04

  You would have to say, if we break up, we get divorced, like, what is happening? Because, okay, this is gonna blow your mind.

• 2:34Maggie Sellers Reum?

  Hi, angels. Did you know that subscribing to our channel is free? It doesn't cost you anything, and it is the simplest way for you to support Hot, Smart, and Rich and help us grow, so that we can bring you more of the conversations you love. Just hit the subscribe button below, and thank you.

• 2:54Maggie Sellers Reum?

  In case you missed it, you're allowed to be hot, smart, and rich. So let's get into it.

• 3:04Maggie Sellers Reum?

  Dr. Natalie Crawford, are you ready to get hot, smart, and rich?

• 3:07Speaker 04

  I am, Maggie. Thank you for having me.

• 3:09Maggie Sellers Reum?

  For someone that's just clicking in, they see a beautiful woman in a beautiful suit, what would you tell them about what we're gonna talk about today to get them to stay and listen to this conversation?

• 3:18Speaker 04

  When we're chasing other goals when we're younger, we often put our health on the back burner. We put ourselves last. We focus on these other goals or other people. And when we zoom out and we look at it, taking care of yourself, understanding your body, understanding your hormones, is really essential to be hot, smart, and rich. This is the foundation for your entire life. You have nothing if you don't have your health, and you don't realize that. It's not just something to worry about when we get there. It's something to learn about now, so that we have already armed ourself with the knowledge to make decisions from a place of data.

• 3:55Maggie Sellers Reum?

  What will happen to someone's life today, male or female, if they take what we're going to talk about today and apply it to their life?

• 4:02Speaker 04

  A couple of different things. One is, if you start learning about how your body works, you're going to start to make different decisions. Because so often, we make decisions every single day from a place of routine, habit, or what is comfortable, instead of making them from a place of knowledge and from a goal-oriented mindset. So we're gonna start to make different decisions right away. This is going to impact our health now, our health in the future. If we want to be pregnant one day, it will impact our journey on that fertility spectrum, whether we're gonna go through IVF or freeze eggs. But your fertility is a health marker, meaning I don't think fertility is just the ability to get pregnant. It is the proper communication of your hormones.

• 4:46Speaker 04

  It's a state of metabolic health. And when I say that, women who have infertility have a higher rate of chronic disease: cancer, stroke, metabolic syndrome, heart attack, early death. Really scary, big words. And none of that is because infertility causes it, but it's because infertility is representing a state of health at the cellular level that gives you the opportunity to intervene now and change your health journey later.

• 5:14Maggie Sellers Reum?

  It's fascinating, because I've listened to a lot in the last few weeks on this. And I honestly have to share with my audience that even as someone who was turning 34, married, like, fertility was something that I was thinking about, but it wasn't as rushed as it feels like it is today. But I often feel like a lot of the information is so geared towards, like, what women have to do, and like, the women conversation. And I do feel like, listen, life is not fair. Life is unjust. That will be evident by the end of this conversation, but I do really wanna talk about that relationship between male and females. And specifically for males, why they need to pay attention to this conversation today.

• 5:58Speaker 04

  Look, fertility is a team sport. It's 50/50, meaning 50% of infertility is due to male factors, and 50% is due to female factors. In addition to that, you said it, life is unjust. Women have a harder time overcoming some of the things that have happened to us as we get older. Our eggs are in our body our whole life. They accumulate, wear, and tear, and damage, and some of that we can't undo. Men make 1,500 sperm a second. A second. The sperm lifespan is under 90 days, meaning a single decision to change your life right the second for a man will give us completely new sperm three months from now. We can get the biggest bang for our buck by having your male partner start to take their

• 6:42Speaker 04

  own health and fertility seriously before you're on your trying-to-conceive journey.

• 6:47Maggie Sellers Reum?

  How do males' best do that?

• 6:50Speaker 04

  That's a great question. You know, men and women both have kind of two things that we wanna think about. There's the production of sperm, which is a hormonally derived process, very similar to how women ovulate, meaning the brain sends out hormones to the testes, and then the testes are told to make both sperm and testosterone at the same time. So number one is that this pathway can be interrupted. So one of the top things I see in clinical practice is gonna be men who are using exogenous testosterone. Maybe they go to a men's health clinic, or they have low libido, or fatigue, or they're gaining weight, and they're put on testosterone. And they can feel better, but when the male's brain sees testosterone, it assumes sperm is being made at the same time.

• 7:33Speaker 04

  So it shuts off the production of FSH and LH, those hormones to drive testosterone and sperm. So a man who's using testosterone will stop making sperm. And sometimes that can be irreversible. Irreversible. Now, oftentimes, it can come back, but it can take months, as we said, we have to generate new sperm. And this is why something that is readily given out, men can get testosterone from apps now. They don't even have to go to a doctor. They are sometimes giving testosterone without having labs checked or semen analysis. Really done in the wrong way can be detrimental. So men have to know this information as well. So this production axis is one piece of the puzzle.

• 8:14Speaker 04

  Other hormonal issues, like thyroid disease, can impact men's sperm production. Cannabis use isn't one of those that can actually interfere in the brain and stop the brain from sending out some of these signals. But then the other piece of the puzzle is that sperm are made in the body. And it's really fascinating, if we think about the testes, there's germ cells on one part of it, more than you've ever wanted to know about a testes, Maggie. And then sperm are made, and they grow across the testes. So they, like, get their head, their tail, and they grow throughout it. So if a man is exposed to a lot of inflammation, or a lot of heat, because the testes are outside the body so that they can be at a lower body temperature, then the sperm are gonna grow abnormally, or they're not gonna be made to the right degree, they're not

• 8:58Speaker 04

  gonna have the function they need to. And we have to really think about, it's pretty cool, right? Men are taking a germ cell, which is a cell that's going to put out DNA, wrap it up in a head, give it a tail, it's gonna grow across the testes for about 72 days, and then it takes about 18 days to get out the ejaculatory system. So the fact that men are constantly making these sperm over and over again is quite incredible. But they are very sensitive. That's why men make so many of them. They are easy to die, highly influenced by the environment of the man. So a lot of these things, sugar in food, environmental toxins, toxic behaviors, stress,

• 9:38Speaker 04

  not getting sleep, they all impact inflammation levels, which impact sperm quality. So we gotta think about sperm quality in addition to just making the sperm.

• 9:49Maggie Sellers Reum?

  So you said that infertility is caused 50% by males.

• 9:53Speaker 04

  Yeah.

• 9:55Maggie Sellers Reum?

  Is there data to suggest that that is increasing or decreasing? Or how has that evolved in terms of like the percentage of infertility coming from males versus females? Is this something that's growing because males are becoming more infertile? Or is just the awareness that infertility is driven by 50% male coming more to mainstream and being more in pop culture?

• 10:16Speaker 04

  Number one, infertility rates are rising. So I've been a fertility doctor for over a decade. And when I first entered the field, we would say one out of eight couples would have infertility. Now it's one out of six globally. And in the United States, for couples trying to get pregnant for the first time, it's one out of five. In the same timeframe, we see sperm counts are dropping globally. But when we see an increase in infertility across the board, we still see this about one third due to sole male factors, one third due to sole female factors, and then a third of couples will have both a male and female factor. So that's also important data, too, because sometimes I'll have a woman sit across from me and say, well, I have endometriosis, so I'm the problem. It's all me. He's fine.

• 11:01Speaker 04

  And we absolutely do not know that, right? We have to test both people. We have to presume that egg and sperm quality are important for both people, no matter what the tests show. And that's something I'm really passionate about, because there's also this narrative, oh, I can just freeze my eggs, or I can just do IVF, and that will take care of anything. But even when we're in the IVF lab every day, I can only work with the eggs and sperm that I am given. And so the quality of those eggs and sperm still matter immensely when it comes to getting to the outcome we want.

• 11:31Maggie Sellers Reum?

  Is there a way to tell sperm quality or mobility until it's in your lab and you're actually looking at it? Like, are there signs? Is like, there anything that you can be looking for to say, mm, maybe I need to start taking my sperm quality a little bit more intentionally and be doing these things to help myself have the best chance when it's already at your lab and you're trying to work with it?

• 11:52Speaker 04

  It is harder to know about the quality of sperm without doing a test, without looking at sperm under the microscope and seeing how it looks. Now, we can have some signs of low testosterone, so that first piece of the puzzle, which was the sperm production. So having low energy, gaining weight, low libido, difficulty with erections, ejaculation, especially in men who are 40 and under, that should not be the norm. And if we're starting to experience some of those, we certainly should get a workup. Just because I said earlier that taking testosterone can be detrimental, doesn't mean that there's no treatment options that exist. We can actually give medications that tell the brain to send out more signals, therefore getting the testes to make more sperm and more testosterone at the same time.

• 12:34Speaker 04

  What you should remember is that I want to get pregnant, or I want to have kids, we're trying now, or we want to have kids in the future, you should not be taking testosterone, at least not without somebody who is checking semen analysis and making sure that it's not having a negative impact on your sperm. And that's something that men need to remember, because unfortunately, there's a lot of places that will take your money and prescribe whatever you want without really asking the questions about your goals.

• 13:00Maggie Sellers Reum?

  Can I ask you a really dumb question?

• 13:01Speaker 04

  There's no dumb questions.

• 13:03Maggie Sellers Reum?

  So there's a woman listening to this. Their husband is exactly what you're just describing right now. But he has a physician that's prescribed him testosterone. Like, where is he making an appointment to have this type of a conversation, to be checking his sperm analysis and making sure that what he's taking is going to be actually able to be viable to help create a child one day? Like, is he booking an appointment with your clinic? Is he seeing an OB-GYN? Like, where is this man going?

• 13:29Speaker 04

  Good question. Number one, you can call any fertility clinic that exists and say, my husband wants a semen analysis. The end. We all do it. You don't need a referral. You can come in, get it done. You can also see a urologist, who is an expert in male hormones. So a urologist can order a semen analysis. If you happen to be sitting in front of your OB-GYN, tomorrow you go in, you can ask your OB, and she can probably give you a referral for somewhere that can check a semen analysis. But there's even online or mail-in options. So I'm a medical advisor for Fellow, which is a mail-in company, and it's a CLIA-certified lab, meaning I don't even repeat these if somebody comes in and they've done a Fellow semen analysis.

• 14:09Speaker 04

  So more often, I see a guy who maybe fits into this parameter, feels a little like less enthused about walking into a fertility clinic and having to deposit a sample and ordering something to be able to mail it in, feels like a lower lift. So there are options. Knowing is always better than not knowing. And I'll go a little against medical advice, right? Current medical advice, Maggie, is that you should try to get pregnant for a year. And if you don't have success, then you should come to a fertility clinic. And then we'll see your egg count, we'll talk about your cycles, we'll check your anatomy, see if your tubes are open, and we'll check a semen analysis. And I don't agree with any of that.

• 14:51Speaker 04

  I don't think we should have to fail in today's world, where we have access to information, where we have raising infertility rates, women are chasing big dreams and waiting longer to get pregnant. Why should you have to fail first before you even get the data? So if you and your partner want to get pregnant sometime, have him get a semen analysis. It is a relatively easy thing for him to do compared to everything that women go through, and it can have a huge impact on your journey if you want to get pregnant.

• 15:18Maggie Sellers Reum?

  Have you seen these sperm races?

• 15:21Speaker 04

  Um, no. Tell me more.

• 15:23Maggie Sellers Reum?

  So there is this new phenomenon that investors are putting money into, which is literal sperm races for males. And at first, I was like a little taken aback by it, but actually, knowing the way that, like, at least the men that I surround myself with, how competitive they are, how much they want to win, like, seeing that side of this bring awareness to sperm mobility and sperm quality, I was actually like, maybe there's some good with this. There are legitimate sperm races. There are businesses that have raised venture capital money off of racing sperm to see your mobility.

• 15:58Speaker 04

  I'm dying inside, but I love it, too. There's a lot of things where, sometimes I can't believe the world we live in right now compared to, you know, 10 years ago when I finished training and first started, in the best way. Meaning cheers to this generation of men. Cheers to the generation of men who want to check their sperm, who want to support their partners, who come to the office, who ask the questions. Like, it is refreshing. It is how it should be. We have a generation of like committed men. A decade ago, women sat alone in my office, and they took all the burden and all the blame. It was hard to get their partners even in to get a semen analysis, let alone to try

• 16:40Speaker 04

  to talk about changing their lifestyle to support sperm quality. And now I have a generation of men who say, what do I need to do? They're like, put me in coach, like, tell me the supplements, tell me what to cut out. Like, it takes two. And I am just loving that we do live in this era where we see men wanting to step up to the plate and play an active role in this, because that's how it should be. Women shouldn't have to do this alone. When you do, really burdensome. I mean, you have endo, right? So you know. Like, endo is one of the hardest things you can go through. It makes you doubt yourself, you start to not trust your own body, you question everything that your future is going to look like when it comes to your health.

• 17:21Speaker 04

  And to have a supportive partner by your side changes what you're experiencing. I'm thankful that you have that, but we just have to applaud that, I mean, sperm racing, crazy or not, yeah, if there's awareness about it, men can check their sperm, and they want to stop smoking pot and start focusing on eating vegetables and lifting weights and what they can do to improve their sperm, like, let's do that.

• 17:46Maggie Sellers Reum?

  Well, I think that's why I started the conversation about males. Because it is exhausting being a woman and seeing all this, like, you should be freezing your eggs by this time, which is, by the way, the reality, but it is something that the males should feel responsible for as well. And I've seen this obsession in pop culture recently with trimester zero. Are you familiar with this?

• 18:08Speaker 04

  Yes, yes, yes. I do like trimester zero.

• 18:10Maggie Sellers Reum?

  So do I. But I'm like, what is the male version of trimester zero?

• 18:13Speaker 04

  Oh, it's more, it should be more intense than the woman. It should be, because, right? Three months, totally new sperm count. Women's eggs are in your body your entire life, right? They absorb the wear and tear, the proteins that hold your chromosomes apart start to degrade over time, even if you live a perfect life. Now, we can slow down that by the things that we do. Lowering our inflammation can slow down some of this change. The opposite's also true. We increase our inflammation, we're going to break down even faster. So there is a piece that we control, but because our eggs are in our body our whole life, we have a limit to what we can do. Your eggs get closer to the surface of the ovary in the 90 days before you ovulate, so there's truth in this trimester zero.

• 18:55Speaker 04

  Three months before you want to start trying to get pregnant, by focusing on decreasing inflammation, you are going to have better quality eggs, kind of coming out of the vault, which is my favorite analogy that we'll talk about, that is going to prepare you for the one that you're ovulating, hopefully having a higher chance of being genetically normal, having good mitochondria, functioning normally. But if your partner in that three months is focusing on, you know, taking antioxidants, cutting out toxins, stopping toxic behaviors like marijuana and alcohol, working on eating anti-inflammatory and high fiber, getting out of the sauna, avoiding heat, that three month time period, he's going to generate the best sperm that he can.

• 19:37Speaker 04

  And so then, when you're ready to get pregnant, you are putting forth the best egg and the best sperm. And even though infertility is not fair, and it is not just, and you can do everything right and still not get pregnant. The mentality most people I see is they want to say, I'm controlling everything I can. Like, I can't control everything, but why am I leaving some things on the table? Because there are certainly factors that will negatively harm your fertility and make it harder to get pregnant.

• 20:04Maggie Sellers Reum?

  For someone that's actually listening and doesn't know trimester zero language, can we actually describe what that is?

• 20:10Speaker 04

  So trimester zero is the idea that before you get pregnant, so we'll say the three months before you start trying to get pregnant, you are setting the stage for egg quality and sperm quality. And that by paying attention to the nutrients you're putting in your body and avoiding toxins, you're going to have better egg and sperm quality, which can lead to an easier time getting pregnant, but also improved pregnancy outcomes. Lower rates of morning sickness, better placental function, lower rates of preeclampsia, better birth weights. All that stuff really matters, right? We don't want to just think about the positive pregnancy test being the end of the race. It's really just the beginning.

• 20:47Maggie Sellers Reum?

  I think that everyone listening to this conversation needs to take this now to short form and not when you're talking about trimester zero for your own body as a woman, you need to start including the husband into these conversations or the male partner into these conversations then.

• 20:59Speaker 04

  Oh, absolutely. Maggie, one of the cutest things, you know, in my patients, okay, right, I'm on social media. I have a silly little newsletter and in it, like fertility facts, but I always include some recipes and they're like high fiber, plant-based, right? And trying to get a man to cook tofu or like cut down red meat. I live in Texas, so sometimes that's controversial. But I will have these husbands, these male partners coming in and they'll be like, oh, the broccoli tofu stir fry with the peanut sauce last week? That was great. I made that on Wednesday. And you know, like seeing these partners, to your point, come to the table, being willing and open to make a change. Fertility is a team sport. We should approach trimester zero, I mean, our whole relationship, but especially trimester

• 21:42Speaker 04

  zero as a wonderful opportunity to do this together, to really say, how do we get into our healthiest state as we prepare for this really exciting life journey that's ahead of us?

• 21:54Maggie Sellers Reum?

  We keep mentioning this on the table and on the table, we actually have five of your fertility non-negotiables. Can we go through them?

• 22:01Speaker 04

  Five fertility non-negotiables. These are the things when we talk about controlling what you can. Can't control everything, but you can control a lot. This is what I want you to start saying, what do we do? So we're going to kind of go through them. My first one is sleep. Because we've got a sleep mask. Sleep is underrated. It is probably the number one thing that most of my patients are not doing well enough. And I live in Austin and people are super healthy, but when I really get into it, many people are not sleeping long enough. So what does that mean? At least seven and a half to eight hours of sleep, especially for women, per night, having a consistent sleep-wake schedule. Increase in sleep variability, meaning the hours of which you're sleeping, has been associated with taking longer to get pregnant.

• 22:43Speaker 04

  For every hour less a man sleeps, he has lower testosterone and lower sperm counts. For every hour less a woman sleeps, she'll get fewer eggs in an IVF cycle. And if a couple, either member of the couple reports having poor sleep quality, it takes them longer to get pregnant. Sleep is when your body is going to clear inflammation. It is setting the stage for your entire day. For many of us, I have celiac, so you and I both have a level of inflammation that we get every single day that not everybody does, right? But that means it's even more important that these five non-negotiables I pay attention to. And if you can't be perfect, like I will get less sleep tonight because I'm flying home, then the other ones become more important, right? We don't have to seek perfection.

• 23:26Speaker 04

  Instead, I really want us to think about this burden as a movable scale. So if sleep isn't going to be where it is, the others become more important.

• 23:35Speaker 04

  Okay, second from there, we're going to take, and I'm going to use my weight and say it's actually building muscle. So I get asked about exercise and fertility probably every single day.

• 23:48Speaker 04

  What most women specifically are not doing is building enough skeletal muscle. And when we think about it, skeletal muscle, so these big muscles in your body are metabolically active. So when you activate your skeletal muscle, glucose can enter the muscle, go into the cell without needing insulin, and you can lower blood glucose levels. It makes your cells what we call more insulin sensitive, meaning will respond to lower insulin levels when you both have more skeletal muscle and you use it. So most women I know need to pick up weights at least three times per week. It's not that any other form of exercise is quote, "bad," but we always need to bring more muscle building into it because it improves our hormonal health and can fight against

• 24:32Speaker 04

  insulin resistance. So build muscle. So we're going to sleep and we're going to build muscle. Next, we have a journal. The journals here about stress and stress is really nuanced, right? And many times when I bring up stress, people will sit across from me and they'll say, oh, well, my doctor told me not to stress about being stressed. And there's certainly things about infertility that are stressful. Like, we have to acknowledge the stress of questioning your future, how you saw yourself, your identity, if you identified with being a mom one day, to have that questioned, of course, is stressful. But there are stressors that we have every single day, right? Whether it's social media, the news, politics, financial stress, business stress, interpersonal

• 25:17Speaker 04

  stress, and all of these stressors add up. So it's not about, Maggie, avoid all stress because that advice is really not very helpful. I want to put it in twofold bucket. One is to say, you will experience stress today. You will.

• 25:32Maggie Sellers Reum?

  Totally.

• 25:32Speaker 04

  So you need to build into every day at least 20 minutes where you can know you are not going to have stress. And that can look different every day. It can be journaling. It's one of my favorite things, like brain dumping everything out really helps me get a clear mind. But it can also be just a walk outside, putting your feet in the grass, meditation, mindfulness, acupuncture, yoga, therapy, a call with a friend.

• 25:54Maggie Sellers Reum?

  Can working out be that stress relief for you or are those two separate things?

• 25:59Speaker 04

  It can be.

• 25:59Maggie Sellers Reum?

  Okay.

• 26:00Speaker 04

  So double yay for working out. If you feel that kind of post-workout release, you know, I always say, you're searching for the feeling, right? And not everybody gets it from working out and maybe not every workout gives you that. But exercise can be that and that can be helpful. So I call these the foundation of the day. Sleeping, how you manage stress and building muscle. Every single day you deal and you make choices on what you're going to do about these three things. Sometimes you control them and sometimes you don't, but you should do your best. The other two categories are a little harder for most people, honestly. I love this bowl. This is food, okay? You have really lovely food in here. Okay, so having fruits and vegetables and fiber is the number one thing most people need to do more of.

• 26:45Speaker 04

  Having real whole foods, lots of antioxidants. There's beautiful colors in this bowl. You're getting so many good nutrients to your body and most of your nutrients should come from food. Fiber is really important. It is feeding the microbiome of your gut. And do you know what food doesn't have fiber in it?

• 27:03Maggie Sellers Reum?

  Processed foods.

• 27:04Speaker 04

  Processed foods and animal products. So like if you are on a carnivore diet, even though not all animal products are bad by any means, a carnivore diet's not getting enough fiber in it. So we really want to make sure that we do get enough fruits and vegetables in our diet. And from a fertility standpoint, having at least three servings of fruits and vegetables a day in your diet improves your fertility versus having fewer. So try to have fruits and vegetables at every meal. To me, these have no limits on them. Eat as many as you can, as much variety as you can. But this also goes hand in hand with having healthy fats. Avocado, olive oil, nuts, seeds are a great option for your healthy fats. We want to have more of these unsaturated fats than the saturated fats that are in some animal products.

• 27:47Speaker 04

  But in general, a more plant-forward diet, more servings of vegetable protein over animal protein is associated with a shorter time to pregnancy and improved embryo quality in the IVF lab. And then, is this from your kitchen?

• 28:03Maggie Sellers Reum?

  I only use glass Tupperware.

• 28:04Speaker 04

  I love it. I'm so proud of you.

• 28:06Maggie Sellers Reum?

  Except the top is plastic.

• 28:07Speaker 04

  The top is plastic too. So as long as you don't stuff it all the way, then it's fine, right? So if the plastic comes in contact with our food. So why are we talking about this? I was in fellowship back in 2013 and I'd had a lot of pregnancy losses myself. So I had four pregnancy losses. And I remember talking to my fellowship director saying, I want to study natural fertility. I want to know why some people get pregnant and other people don't. And I did a lot of work on the luteal phase and I did work with the EPA, looking at endocrine disrupting chemicals, specifically PFCs, perfluorinated chemicals, like PFAS. And I was aghast, Maggie, like that there's not just suggestion of harm. There's a plethora of data that these chemicals live in your body forever, pass through the

• 28:50Speaker 04

  placenta, impact your fertility, your ovarian reserve, the age you go into menopause. And yet, especially then, there was no mention of it. Like, how was I a physician in this field and unaware of the harm that plastics or Teflon or thermal paper was causing me? I remember my husband coming home and I was cleaning out the kitchen. I had a whole pile. I was like, we're done with all of this, right? Like, we need to go get a stainless steel pot, glass Tupperware containers, and this is what we're using now. Because endocrine disrupting chemicals, microplastics, they actually do matter. And yet, most people will say, well, they're everywhere, so like, why worry about it?

• 29:31Speaker 04

  The truth is, you can't control everything, so you owe it to yourself to control the things you can. And what do you control most of? The things in your own home.

• 29:47Speaker 03

  Real traders still hear the noise. They just know when to stop listening to it. Find and research opportunities to fit your strategy with Thinkorswim trading platforms from Schwab. Discover features like robust charting, nearly unlimited customization, and built-in risk management technology. Plus, get 24/7 support from real trading specialists. That's Schwab Trading. Learn more at schwab.com/trading.

• 30:11Speaker 05

  Whenever fall comes back around, it always feels like a fresh start. This year, I've been layering in some styles from the new Lululemon fall drop because the weather is shifting and I find I have to be ready for the entire day and not just one part of it. Lululemon's fall line has some really versatile transitional pieces, so I can just wake up, throw on a matching set, add a jacket or a fleece, and head out, knowing that I'll feel comfortable enough to go wherever the day takes me. Check out the new fall arrivals in store and online now at lululemon.com.

• 30:41Maggie Sellers Reum?

  Hot take incoming. Making more money as a creator doesn't actually require you to have more followers. I see so many creators getting this wrong. And this is part of the reason why I love what our show partner Stan is doing with their V2 of their funnels and order bumps. Because if someone is already buying from you, that's a completely different moment than someone casually watching your content. It means that they trust you, they're paying attention, they're already in checkout mode. So instead of sending everyone to one link and hoping for the best, Stan helps you create a smarter buying journey. And with order bumps, someone can add something extra at checkout with one click. If you are building a creator business, this is the kind of thing you should be obsessed with, like every brand founder is.

• 31:25Maggie Sellers Reum?

  I'll let you in on one secret. The top earners on Stan all do this. Sign up today to set up your funnels and order bumps and get started with a 30-day Creator Pro trial at link.stan.store/maggy. This was the first brand I heard about when I moved to Los Angeles almost eight years ago. Osea. Now, this brand I remember hearing about because when I moved to LA and it was dry AF, someone told me about this Andaria Algae Body Oil. I started using it and fell in love with the ritual of taking care of my skin. It's wild to me that eight years later, multiple careers later, they are now a show sponsor.

• 32:07Maggie Sellers Reum?

  Their Andaria Algae Body Oil is one of their best products. Clinically shown to instantly and visibly improve skin elasticity and deeply moisturize because it's made with Andaria seaweed, known to help skin feel firmer and more youthful. If you want to give this incredible oil a try, I have a special discount for my HSR Angels, 10% off with your first order with code HSR at oseamalibu.com. That's code HSR at oseamalibu.com. And let me know what you think. Something that I've found really hard is there are great brands in the space for women's prenatals that have amazing marketing and amazing branding. And then you read certain clinical studies about it and like they're missing us an ingredient

• 32:52Maggie Sellers Reum?

  or they actually haven't done the clinical studies that they need to to be able to make certain claims. They have great marketing budgets, they've raised a ton of venture capital, they can hire the best influencers. So for a woman that is deciding on a prenatal, what is important? How should they be making a decision? And what are the like the non-negotiables for the right prenatal for them?

• 33:16Speaker 04

  I love this question. I will say in the book, I have a whole chart on it because it's hard, right? So we have to look at this in tiers. The number one is going to be folic acid. Folic acid is important in cell division. For a growing baby, the time where folic acid is the most important is the formation of your neural system, your spine in your brain. Need 400 micrograms, MCGs of folic acid. That's probably the number one thing that people need to know. What else is really important? Some of the things that are really important in prenatals that are standout, one is choline. Choline has really been shown to help with brain development of your baby. And so have omega-3 fatty acids. These are going to be labeled in the prenatal as DHA or EPA. And these are things that you can get from food, but they're a little bit harder to get from food.

• 34:01Speaker 04

  So omega-3 fatty acids notoriously can be found in fish. They can also be found in like chia seeds, flax seeds, seaweed. You can get choline from eggs notoriously, but some people don't eat eggs, don't eat fish. And we really want to make sure that that brain development, I mean, conception is a miracle, right? Egg and sperm come together. This embryo goes from a single cell and then it's two for a wild. By the time it implants in your body at five to six days, it's like 300 cells. It's wild, right? The process is wild. So getting enough omega-3 fatty acids, getting enough choline, getting folic acid, those are probably like the three key. And all the fourth one is going to be vitamin D.

• 34:44Speaker 04

  You know, vitamin D is going to be in every prenatal in different amounts. I actually recommend all my patients take an extra vitamin D just because so many people are vitamin D deficient nowadays.

• 34:54Maggie Sellers Reum?

  I am.

• 34:55Speaker 04

  Yeah, I am too. And we probably both spend a decent amount of time outside, but we're still vitamin D deficient. So it's not going to be a one size fits all. There's certainly some, you know, titrating to what your body needs. We do want people to take iron, at least in the second trimester and on. Iron can make you nauseous or constipated. So I'm okay if your prenatal doesn't have iron. We can add that in in the second trimester. But it's really going to be those top three with the omega-3s, the choline and the folic acid that sometimes are not in every prenatal and we need to consider supplementing with an additional supplement if it's not.

• 35:31Maggie Sellers Reum?

  Is the prenatal for each patient specific? Like, do you actually assign a different one for each of your patients? Or are you like, here's a favorite brand and if you need to add something else on, you can?

• 35:42Speaker 04

  You know, I tend to give my patients like a few brands because I do find that if I say, this is my favorite one. And if you hate it, like if you feel nauseous from it, if it like, you know, you get weird fishy burps, like whatever happens from vitamins, you're going to be more likely to take nothing if I've told you this is the one, right? You're going to have poor compliance. So I like to say, these are my favorite ones. Like try them and find the one that works for you in the best way with these kind of caveats. And there's occasional times where I say, hey, you really need, you're a vegan, so I know you're not eating eggs. So I really want to make sure you have choline and I know this prenatal has enough choline in it. So there's some specifications out there.

• 36:25Speaker 04

  But I really want to stress that when we give this, well, my favorite influencer uses this one, so I buy this one. You know, influencer marketing is great when it brings awareness. Yay, you know, you need a prenatal, right? Which is ultimately better than not taking one. But at the end of the day, does it have the right nutrients that you need? That's a really big question that you've got to do your own due diligence to make sure that it does.

• 36:47Maggie Sellers Reum?

  I really do want to segue into the conversation about infertility. What is infertility?

• 36:54Speaker 04

  Okay. Infertility is simply a population-based diagnosis. Meaning, let's just zoom out. OB-GYN said, a group of people are having a hard time getting pregnant. Where do we draw the line? They drew the line back when they decided to draw it at one year of trying to get pregnant. So infertility is officially defined as trying to get pregnant for one year without having success. That means you have periods, you're having intercourse, and you do not conceive by the one-year mark.

• 37:23Maggie Sellers Reum?

  Is infertility becoming more prevalent? Or are we just talking about it more? Because it feels like it's everywhere.

• 37:28Speaker 04

  Both things are true. It is becoming more prevalent. We see an increase in inflammation in the world around us. We see a drop in sperm counts. Women are being diagnosed with lower egg counts. We see a higher rate of miscarriage and pregnancy loss. And as we said earlier, infertility rates are rising. That's true. We also do have more awareness, which I think is good. To your point, I love it. Look at your bank accounts and just know, and this is what I tell women every day. As scary as it may be, this is fact. This is your body, this is your data. Whatever you have to deal with, I know you can deal with it. But you can't make decisions on data you don't know.

• 38:09Speaker 04

  And you owe it to yourself to say, my health is important to me regardless if you want to get pregnant, I deserve to understand how my body is working. And if I have a life goal of getting pregnant, I deserve to at least know what cards I'm playing with, right? What can I do about it? What can I change? What can I optimize? What can I not? But at least be able to make decisions from that place of knowledge is really so empowering because the hardest patients, I sit across from Maggie, are people who are smart, successful, educated women. And they say, if only I had known this information, I would have made different decisions, right?

• 38:51Speaker 04

  When you lose the opportunity to make a decision, that is probably the worst place to be in. And so we can use low egg count. For example, we can go into AMH and I count. Right now, the medical community does not recommend checking your account unless you have infertility, which I think is wild. I'm so against. I think it's paternalistic. I think it doesn't reflect what women want to know. And I think it makes a presumption, actually stay in their statement, that it's too stressful for women to know that they have a low egg count if they are not trying to get pregnant. So if your egg count's low, your egg count is low. It actually is a health marker for later in life, but it allows you to look into reasons why.

• 39:35Speaker 04

  Do you have endometriosis? Do you have autoimmune disease? Do you have celiac disease? You might change your whole health. Forget about kids or not kids, right? Why is it low? That's important. Two, maybe you're with a partner and maybe you find out your egg count is low and you're able to shift your timeline. Like, well, we were waiting until this perfect moment in my career, but knowing I don't have as long to grow my whole family, we're going to get started sooner. So you're suddenly changing what you're doing because you had that data. Maybe you do go through IVF and freeze eggs or freeze embryos. Maybe you at least get earlier testing and find out your partner has low sperm and he starts to make life choices. Or maybe you do none of the above, none of it. But you said, you know what? I had the information, I evaluated my options, and I said, none of them were right.

• 40:19Speaker 04

  I'm not going to make any difference, I'm going to carry on.

• 40:23Speaker 04

  You then made that decision, right? So if the outcome of that decision is you end up not getting pregnant later, going into menopause earlier, at least you were aware and you were the one who chose the path you were going to walk.

• 40:35Maggie Sellers Reum?

  The most successful person I know is my husband in every single way of his life, and his favorite thing is having option value, which is honestly the perfect way to introduce your vault, which I have been very afraid to do. But let's do it together. And for everyone, like, you can tell this is hard for me to sit through, but it's necessary. So let's get into it.

• 40:57Speaker 04

  So we're gonna use the marble in the jar.

• 41:00Maggie Sellers Reum?

  Which, by the way, beautiful marbles production.

• 41:03Speaker 04

  I know, good job, team. Okay, so my favorite analogy to think about the vault is to use this jar of marbles. And I created this vault analogy because it's really hard for women to think about what's really happening in the ovary. It's wild if you really think about the fact that your eggs, let's imagine every marble's an egg, are formed inside your ovary before you're even born. When you are a five-month-old baby inside your mother's womb, you have six to seven million eggs. But by the time you're born, you only have one to two million. By the time you start your first period, you'll have less than half a million. And you will only ovulate about 400 eggs over your lifetime at most. So that's wildly different, right? Why do we have millions if we're only gonna ovulate 400? The way I like to think about it is that this is a vault, and every single month,

• 41:48Speaker 04

  you have a group of eggs that comes out of the vault. And what's really interesting is that when the vault is more full, more eggs come out every month. So you are losing more than just one. And now, when we think about the menstrual cycle, what is happening is that each egg grows inside one of these nice, clear follicles, and the brain's gonna send out FSH, or follicle stimulating hormone, which is gonna stimulate just one of these to grow and to ovulate. And that's the one you'll ovulate, and everything else just dies. Now, the next month, what's gonna happen? You're gonna have another group coming out of the vault. Okay, so our vault is constantly getting emptier. And what's really fascinating is that when the vault is more full, you lose more every single month.

• 42:30Speaker 04

  But as the vault starts to get emptier, as time goes on, as we get older, we have fewer coming out every month. And why is that important? That's a really important concept for women. Because when there's fewer eggs outside the vault, it is a reflection that we're starting to get to the end of what we call our ovarian reserve, or the number of eggs we have remaining. Many women think about egg freezing or IVF as this guarantee, and I said earlier that it's not. But when we do IVF, when we do egg freezing, I'm only trying to get this one-month group of eggs to grow. I can't tap into the vault. I cannot tap into here. I cannot get more eggs out of the vault, at least not right now. That technology will probably exist in my lifetime.

• 43:12Speaker 04

  But right now, the reason why you have to take shots during IVF is because instead of your brain sending out enough for just one, well, I want all of those to grow. So I've gotta take shots of FSH, same hormone the brain makes, so that I can override the normal checks and balances, so I can get a whole group of them to grow. But if you have fewer eggs, because you have endo, or celiac, or...

• 43:34Maggie Sellers Reum?

  Or you have all of them.

• 43:35Speaker 04

  You have all of them, or, you know, you were exposed to more toxins, you smoked cigarettes, you were born with a lower number because your mom did whatever she did when she was pregnant with you, you can only get what is outside the vault to grow. The scary thing is if it's not all scary. But one of the scary things is that there are things that can get into the vault. I can't put more eggs in, but I can degrade them faster. So inflammation is one of those scary things that actually can get into the vault and harm your egg count. Okay? So inflammation can steal some, just causes them to die, and you lose some. So if we want to try to preserve our ovarian function, one, because we want fertility, but two, because we know that estrogen's the key to women's longevity.

• 44:18Speaker 04

  So forget about having babies, Maggie, just you and I, sitting here. If you asked me what's the number one thing, if I could control, that would cause me to have a longer, healthier, happier life, it would be to go into menopause later.

• 44:32Speaker 04

  That would mean you would need to keep eggs inside your vault longer. And emerging research is showing, what? If I can decrease inflammation, and I'm losing eggs at a slower rate from that, I can decrease the speed of loss and maybe go into menopause slightly later. And that slightly later is really important, because every year later, maybe it doesn't sound like much to you and I right now, oh, going into menopause at 50 versus 51. But for every year later, you go into menopause, you have a lower risk of mortality, lower risk of heart attacks, stroke, improved health parameters across the board. So, again, outside of just getting pregnant, the vault is so important for your health

• 45:15Speaker 04

  as a woman, and inflammation plays a role in it. When we check your egg count, there is a hormone we can check called AMH. And this is a simple blood test, and this is the one I said earlier that I think everybody should get tested. AMH is made from the cells that surround every follicle. So if I have more follicles, I'm gonna have what?

• 45:33Maggie Sellers Reum?

  More, higher AMH.

• 45:34Speaker 04

  Higher AMH. Okay? Perfect.

• 45:36Maggie Sellers Reum?

  Sucked at science, but I'm learning here.

• 45:37Speaker 04

  No, you're doing great. So the vault's not perfect, and every month sends out a different amount, right? Like, it's around the same, but it's not perfect. So AMH can fluctuate, it's not exactly linear, can bounce around, right? Now I have seven or eight instead of five or six. So the egg count can fluctuate a little bit, and so will AMH. So I like to think about AMH as a point, not a point value, but as a category. So is your AMH normal for your age? Is it above average? Is it below average? Is it critically low? And you can still get pregnant at all those values, as long as you're still ovulating. But it is stratifying us about how worried are we? How, how many eggs are left in our vault? Right? If your AMH is really low at a young age, are we starting to get to the end?

• 46:23Speaker 04

  That, number one, we have to think about, are you starting to have perimenopause, menopause signs? But also, have you completed your family? Do we need to be more aggressive? What do we need to do? If I don't have as many eggs, their quality becomes more important. So at the end of the day, AMH is a simple blood test that's giving you a lot of information. And even if it's not a perfect test, it's not a, quote, fertility marker, right? You can have a low or high AMH and still get pregnant or struggle. It is giving you valuable information about your ovaries and how many eggs are left that I think you deserve to know.

• 46:57Maggie Sellers Reum?

  I'm in my luteal phase. We all know that point in our cycle where our body is basically like, please do not make this any harder than it needs to be. But during that time, I still wanna move my body. I wanna go for a walk, I wanna get outside, maybe stretch, but I am not forcing a high-intensity workout when my body is asking for something kinder and softer. And that is where Lululemon just gets it so right. And their Groove Relaxed Cinch Pant is exactly the kind of thing I wanna wear on those days. It has this oversized, relaxed fit, so there's actually space for your body to move and breathe. Nothing feels too tight or restrictive. It's perfect for that lower-impact movement. It's made with their Nululemon fabric and has a super-soft, barely-there feeling.

• 47:41Maggie Sellers Reum?

  I only just learned that when Lululemon does colors, they do it with limited drops, and they sell out so much faster than I realized. Lululemon offers free returns, too, so there's never a risk if you decide to change your mind. So head to lululemon.com to get your hands on their Groove Relaxed Cinch Pant. One thing that Courtney and I keep arguing about, now that we're married, is not when we're gonna try for a baby. We're aligned on that. We argue about when we're getting a dog. No joke. My vote, baby first, then a puppy. Because realistically, I'll be the one doing all the work. But I know that when it comes to feeding our future puppy, we're both very aligned on using today's sponsor, Ollie. Ollie makes the highest-quality, fresh food, developed by real chefs and backed by veterinary nutritionists.

• 48:25Maggie Sellers Reum?

  From the second you start your subscription, everything is tailored to your dog. All meals are perfectly portioned, so much so that you even get a pup tainer and a scoop for easy storing and serving. And through the Ollie app, you can track your dog's health, too. If you want this level of health for your puppy, head to ollie.com/hsr and tell them all about your cute little dog. And if you enter HSR at checkout, you'll get 70% off your welcome kit when you subscribe. Plus, Ollie's obsession guarantee means that if you're not completely obsessed, like you are with my show, you'll get your money back. Can we talk a little bit about the money side of things? Because we'll get into, like, egg freezing, IVF, but I think it's, it is really important to talk about what things cost.

• 49:10Maggie Sellers Reum?

  This test costs $79 if you don't have insurance.

• 49:13Speaker 04

  If you have insurance, it could be even less.

• 49:14Maggie Sellers Reum?

  The cost of getting sperm preservation for males is around $400?

• 49:20Speaker 04

  Yes, semen analysis is usually around $100. Freezing the sperm is usually around $300 to $400. Okay, so if we talk about the relationship between money and fertility.

• 49:35Maggie Sellers Reum?

  Yes, it's an easier story for men.

• 49:38Speaker 04

  That's what you're getting at?

• 49:39Maggie Sellers Reum?

  Yeah.

• 49:40Speaker 04

  Yeah, it's not fair.

• 49:41Maggie Sellers Reum?

  So it's a hundred dollars to test your sperm, it's four hundred dollars to preserve your sperm, put it on ice, you basically go into a room, you ejaculate, that's the process.

• 49:49Speaker 04

  Yep, men can get sperm out of their own body, so it's a much easier process.

• 49:54Maggie Sellers Reum?

  For women, we're looking at a seventy-nine-dollar test, and then what happens from there?

• 49:59Speaker 04

  If we want to view apples to apples and say, well, men are freezing sperm, so let's use freezing eggs. To freeze your eggs, because your eggs are inside your body, we have to take the hormone shots, so the FSH shots that I talked about, and those are really expensive. And then you have to take those for a couple of weeks, and then we have to undergo a procedure under anesthesia to take the eggs out of your body, and that's egg freezing. And that, at its cheapest, is going to be about ten thousand dollars. I would say average for medication and procedure is going to be between ten to fifteen thousand dollars for per month that you want to do it. And because everybody's going to get a different number of eggs, they're going to have different goals, quality will differ somewhat based on age, somewhat based on other factors.

• 50:41Speaker 04

  Some women need to go through more than one round, or thinking about more than one month. I'm going to get the ten eggs from this month, and then I'm going to turn around and get the ten eggs from next month. And so that cost just compounds on itself that you have to do it again. And it's definitely not fair. And this is part of where it's not the field or science being unfair, it's part of working with our biology. Also, sperm just gets frozen altogether, like it just gets frozen, right? Millions of sperm in one little tube, all frozen. Egg freezing is an investment, it's like playing the stock market. You're investing your money, you have to make smart decisions, you have to understand what you're doing, but the ROI on that investment, you do not know.

• 51:24Speaker 04

  Maybe if you're single, you don't know the other half of the equation, right? The sperm quality, you don't know your future state of health, you don't know if any of them will make embryos or be normal. So the ROI on that investment, you do not know until later. So there is a risk stratification you have to do to say, is this risk worth it? But on the all, do we think investing your money is a smart choice? Yes, and the same thing, it is investing in your future. And at some point, if you are at the place and you say, a child is a life goal, and I am not ready, this is one investment strategy where we can keep a door of opportunity open for you that will at some point otherwise close.

• 52:04Maggie Sellers Reum?

  A lot of people are not familiar with this area of medicine in terms of evaluating different providers and looking at cost analysis and things like where they're going to invest.

• 52:12Speaker 04

  Yeah.

• 52:12Maggie Sellers Reum?

  Is it similar to plastic surgery, which a lot of people are familiar with, where based on the doctor that you go to, the price of the service, the actual procedure should change?

• 52:25Speaker 04

  Yes, you know, I'm, I'll admit my own bias here, okay? Because I have a co-founder, and we have a two-physician-owned practice. So we have an IVF clinic, and we don't have any investors, we don't have anybody else looking at our outcomes, we put our own money into the practice, we've hired the people who are best for the job, we have the most expensive generator on planet Earth to keep your eggs and sperm and embryos safe, and the liability insurance is through the roof. But it, you pay, you're paying for a service, and you're paying for technology. And if somebody is offering you a discount, you should know what you are paying for, because it is an expensive process.

• 53:10Speaker 04

  It's a miraculous, incredible technology to do it well, to do it safe, it is extremely expensive. And we would do it cheaper if we could do it well and do it cheaper. And the people who are offering it cheaper are cutting other corners that make me nervous, personally, right? And it's just like plastic surgery, you're paying for skill, technology, expertise. Or if you're shopping, right? Like, there's different levels of places where you are shopping that you are going to get a different quality of a product. So there's a lot of personal decision to it, there's a lot of nuance. It's okay to get a second opinion, I see patients from all over.

• 53:53Speaker 04

  Nobody wants to have to get a second opinion, but if your gut's telling you something's not right, if you're not feeling like you're in a great place, like, see what somebody else says. It is too personal a field of medicine, much like plastic surgery, to just go with whoever's the closest or whoever's the cheapest.

• 54:11Maggie Sellers Reum?

  I think that's why I wanted to talk about the money side of it a little bit, because I feel like it is such a big investment, and then I don't see that much information. Like, I truly have been looking at this for the last five weeks like insane.

• 54:26Speaker 04

  Yeah.

• 54:26Maggie Sellers Reum?

  And I'm like, is the pricing standardized? Is the medication standardized? Like, the, the money side of it is so confusing. Are there resources for people to like, go to different company websites and see what medication cost should be, or what the average cost of actually storing it every single year should be? What are the types of questions that you love when a patient comes into your office and is asking about as it relates to the financial side of this investment?

• 54:54Speaker 04

  So every clinic should have somebody directed to do financial counseling. So right away, you should, they should ask about your insurance, they should see what is covered and what is not. Like, I'm in Texas, so fertility testing is covered, it's a mandated state for testing. So you want to get your AMH, semen analysis, those things should go to insurance, but treatment is not always covered. So number one, there needs to be a point person for finances. I always think it's a red flag if, oh, my nurse is going to talk to me about money. No, like, your nurse is going to talk to you about-

• 55:26Maggie Sellers Reum?

  Dry blood.

• 55:26Speaker 04

  Yeah, dry blood, clinical aspects, your cycle, your calendar, not money. So who is the financial person that you know there's somebody who can actually talk to you about money? Now, another thing, what I love is when people understand what's included in the price, and this is where some clinics are really not transparent. So we do what we call a package price, so you're going to freeze your eggs or do IVF. It's going to cost this much money, and you know it. Meaning, there's some nuance on are you doing genetic testing, are you not? But you know what you're getting in. And if I want to see you every single day for an ultrasound, because I'm watching your ovaries really closely, I'm not going to charge you more for that. Well, so some clinics actually don't give you a package price, and this is a little bit sneaky you got to know about.

• 56:11Speaker 04

  They might say like, here's the, the base price, but then for every ultrasound, for every blood draw, oh, if you come in on the weekend, there's a fifty percent, you know, add-on differential, because the staff's coming in on the weekend. And some clinics manipulate that, where they bring you in more because they're charging you more, and there's all these add-ons that you're going to need, because what are you going to do? If your doctor says, Maggie, you got to come on Saturday for an ultrasound, you can say, okay, you're going to pay the money, you're already in the cycle, you've already bought the medication. So I think I like a package price, because I don't feel like you should be penalized if I want to see you more, right? Like, I want to make good medical decisions, not based on finances, but based on what's best for your ovaries.

• 56:55Speaker 04

  So know what that cost is covering. Medication costs are separate than clinic costs, so the medication costs will go through a pharmacy. And so this is an important one, too, where sometimes your insurance may not be taken at the clinic you like, but they may cover your med benefit at a pharmacy. Fertility nurses are very savvy, they're experts, like, who has the lowest drug prices at what time? But there's nuance here, too, because if somebody can tell you, your medications will be X dollars, that means they're doing a very standard protocol for everybody. Because there's different medications we use, there's different doses. What you need, what I would need, if we were both going through a cycle, should be different, and therefore would cost different amounts.

• 57:40Speaker 04

  So we have to give patients like a range for what medication costs would be, and that would be standard, and we can help them navigate which pharmacies have the lowest cost at a given moment. And then you ask a good question about yearly storage, because that can seem, I think a lot, I'm, I think it's wild to me, I mean, how much some clinics charge for storage? Because they kind of get you held hostage, right? Are you going to discard your samples? No, right? Like, if you went through the effort to freeze or go through IVF and you have leftover embryos? In fact, I think patients should keep their embryos for a really long time, until they know for sure they would never use them, same goes for eggs. But you should ask what the annual storage fee is, it might go up.

• 58:25Speaker 04

  I mean, storage does get limited, it might increase over time. But I think it's wild when storage fees are a thousand dollars or more a year, and some places are.

• 58:36Maggie Sellers Reum?

  This is why I'm so happy we're having this conversation, because my assistant just came into my office and was like, did you know, Maggie, as I'm prepping for the episode, that I've been quoted or I've seen that storage fees are a thousand dollars a year?

• 58:48Speaker 04

  It's wild.

• 58:49Maggie Sellers Reum?

  Like, what should an average be, Dr. Natalie?

• 58:51Speaker 04

  Uh, I would say it's usually somewhere in the like, six to seven hundred dollars a year is more standard, it can even be lower in some places. And I think people should know, you can send off-site storage if you know you're not using something relatively soon. And what that means is that there are storage centers for somebody who's not going to use something soon. So let's pretend, let's pretend you freeze eggs, and then you get pregnant. And then you don't want to be pregnant again. So you're happy, you have your child, you're happy, but you don't want to get rid of your eggs, because like, what if you change your mind, what if something else happens? So instead of paying the a thousand dollars a year, you can send them to off-site storage that typically will be less than five hundred dollars.

• 59:33Speaker 04

  So you'd have to pay to ship them there, but it's good, quality storage, you can trust it. And it's just because it's not accessed as much. I also think it's really important to ask your clinic about their storage policies. Okay, this is going to blow your mind.

• 59:50Speaker 04

  Idea first started in veterinary medicine, right? Because we can experiment on animals easier than humans. And so the way that embryos are stored in a lot of labs is in what we call these doers. And they're, think about like a milk jug. So imagine there's this big container. I know, I told you, you're gonna hate it. And then the lid opens up. And then there's just layers where these little glass tubes are that have embryos with little handwritten labels at a lot of places attached to them. And there's usually some, I know, I know, there's some master log where they're like, okay, Maggie. And they go and they look and they're like, container three, row two, blah, blah, blah.

• 1:00:33Speaker 04

  And they go to that container, open it up, look for yours, and then pull it out.

• 1:00:39Speaker 04

  Okay, so many issues with this. First of all, to everybody else's embryos who are in here, they're getting ambient air exposure every time the lid gets open, right? The temperature is changing a little bit. Also, you know, hopefully your lab has a second person. So there's like less human error in checking things, right? And so, again, a super busy lab isn't always the best thing if they're not staffed in their embryology suite well enough. But because there's a lot of human error. And then sometimes those little labels can fall off or the handwriting is so hard to read. So more modern labs use, you know, obviously printed labels, bar coding, different storage systems that are, we'll say it's more like a vending machine type of storage where things have their own slot.

• 1:01:23Speaker 04

  So everything's not exposed. So it's worth saying like, how are they stored? How are they labeled? And clinics should be very upfront with that information because that's your reproductive tissue. You deserve to know that it's going to be safe, right? Underlying this entire discussion, egg freezing or IVF, like you're going to take hormones. It's expensive. We're going through a procedure. At the end of the day, we're putting hope and opportunity into the freezer for the hope that in the future, you can have a family that you desire. And there's a lot of ethical questions. Technology advances really quickly sometimes. Our embryos, how do you view embryos? Are they property? Are they, are they people?

• 1:02:08Speaker 04

  How do you feel about discarding them? What happens if you and your partner break up? What happens if somebody dies? There's a lot of ethical questions. There's not one right answer for, but that need to be discussed. But I view our job as keeping them safe for whatever you decide. You know, we make our patients decide on those ethical things before you ever, before you were ever to freeze your embryos, you would have to say, if we break up, if I die, if he dies, if we get divorced, like here's what's happening to our embryos. So that they have a disposition that you feel comfortable with. Because hearing about some of these embryo disputes, it brings a lot of questions and people are not always aligned on it.

• 1:02:50Speaker 04

  And I just think at the end of the day, you're the one who has to feel comfortable with it, but you, the lowest bar is knowing that they're safe in your fertility clinic.

• 1:02:59Maggie Sellers Reum?

  People think I am crazy, but in our prenup, literally it was our discussion of Courtney's sperm on ice and embryos and like what would happen if he were to die before we actually use his sperm? Like if I have the right to use his sperm to have a certain amount of-

• 1:03:15Speaker 04

  You're my favorite person.

• 1:03:17Maggie Sellers Reum?

  I honestly, I think that's what's so important about this podcast is I feel like I'm having all of these really interesting conversations and I just get a platform to talk about it with, with experts. But it was those types of things where even my husband, when I brought that to him during our prenup process, I was like, your sperm is on ice. I want your children. If God forbid, something happens to you before we're able to actually have a child, what are my rights with the sperm that's on ice? It was like the best part of our prenup process, but also very complicated. And I think one of the other things that's very complicated is when you do add the financial aspect into it. And I still, I'm hoping you'll answer this for me, but like for a woman that's listening

• 1:03:58Maggie Sellers Reum?

  to this in America, what is a range of a cycle of like all of the costs added up that they can be thinking through? Like I was having breakfast with a girl last week and she was like, I saved up enough money in my savings account that I was going to be able to renovate my bathroom. And I want every single woman that's leaving this conversation to think, if I have enough money saved up here, I will be able to go and do one cycle of egg freezing or one cycle of embryo freezing. Like what is that range for them?

• 1:04:31Speaker 04

  $15,000 and it should be egg freezing. You, if you want to freeze your embryos with your partner, like I'm all for it and I have couples who do that. But I always say, why are we not doing eggs? Or why are we not doing eggs in addition? Because life is not just. And your partner can continue to make good quality sperm for much longer than you will continue to produce the same quality and number of eggs. And so if you are willing to put embryos in the bank because you want to have children with this person, I love it. I love it, right? We're starting families later. Let's do genetic testing. Let's put embryos. Let's still have a big family, even if we started the game a little bit later.

• 1:05:16Speaker 04

  But why are we not covering your bases too? Why are we not putting your eggs in the freezer? Why do I not get to have one round of eggs just for you? Independent, because life is not just. And crazy things happen and terrible things happen, right? And some of the absolute hardest situations are when a couple froze embryos and the story has changed and now she cannot use them and is out of eggs. Whether it's she had cancer, went through fertility preservation, she went into early menopause and they are now not together. And yet he can go have a family with a new partner and she cannot.

• 1:05:59Speaker 04

  Right? So if we are sitting here and we're saying, hey, I want to save up the bathroom renovation money, but I'm going to invest it in my health in future. In today's world where egg freezing is so, so much more successful, right? The rate of going from egg to embryo, we really don't have that big drop off anymore. Why are we not doing eggs initially and at least giving you that opportunity? And if Courtney already has some sperm on ice, do you have eggs on ice? Like let's put some eggs on ice before you start down your journey so that you have some opportunities still open to you.

• 1:06:31Maggie Sellers Reum?

  Is there something that we haven't talked about today that you would be sad to leave if we didn't get the chance to talk about it?

• 1:06:37Speaker 04

  You know, I do talk in my new book, The Fertility Formula, a lot about everything we talked about today. But I also did talk about tracking your cycle, understanding your health and your hormones. I divided the book into three parts. So learn about your body, the facts you didn't learn, how to advocate for yourself, how to know if you have endo, PCOS, what to do if you have infertility. And then optimize, how to optimize your health and hormones with all the five non-negotiables. And really talking about it in a way that helps you no matter if you're trying to get pregnant now, you don't want to be pregnant, you just want to understand that your fertility is a health marker and what you can do about it. So The Fertility Formula is available anywhere you get books.

• 1:07:13Maggie Sellers Reum?

  I love it. Okay, some rapid fire.

• 1:07:15Speaker 04

  Okay.

• 1:07:16Maggie Sellers Reum?

  Dr. Natalie Crawford, what is the last thing you put on your credit card? Last possible thing?

• 1:07:20Speaker 04

  Oh, um, flights to Montana that we're going next week.

• 1:07:25Maggie Sellers Reum?

  Oh, my God, where?

• 1:07:26Speaker 04

  Um, I have a-

• 1:07:27Maggie Sellers Reum?

  Big Sky?

• 1:07:28Speaker 04

  Um, no, it's like a lake by glacier. I have a friend who has a lake house and she offered us to come. And so I said, I'm in a season of yes. So I was like, yes, I'm taking the Keds and we're going to go up. So I put plane flights to Montana on the credit card.

• 1:07:43Maggie Sellers Reum?

  That's amazing. What is your credit card?

• 1:07:45Speaker 04

  I have an American Express Platinum.

• 1:07:48Maggie Sellers Reum?

  Why do you have it?

• 1:07:49Speaker 04

  I love the benefits and I love using, you know, I pay like everything through it and I love using the points for travel. I really love bougie hotels. It's like my, I have really bougie kids now, which I never intended to have. But you know, my son's a little bit like, oh, I love when we go to the Four Seasons, mom. But it just makes travel more fun for us to stay in fun places. But hotel cost feels sticker shock to me. So when I can use the points, it's like a win. And then we get like a free moment on vacation and we're staying somewhere really nice.

• 1:08:20Maggie Sellers Reum?

  Girl math.

• 1:08:21Speaker 04

  I know.

• 1:08:22Maggie Sellers Reum?

  Okay, you can only pick one for the rest of your life, coffee or matcha?

• 1:08:27Speaker 04

  Coffee.

• 1:08:28Maggie Sellers Reum?

  Oh, that was fast. Okay.

• 1:08:29Speaker 04

  Yeah, that was easy.

• 1:08:29Maggie Sellers Reum?

  Um, you can only do one for the rest of your life if you were to have another child, a natural birth or epidural?

• 1:08:37Speaker 04

  I mean, I had two C-sections, so I would be a C-section number three.

• 1:08:41Maggie Sellers Reum?

  Okay, I love that. What is the best push present you've ever seen?

• 1:08:46Speaker 04

  Um, that's a good question. I mean, I will say the ones I love are jewelry with, with like birth stones and, um, because I feel like people, they become part of your everyday wear and I love that.

• 1:08:57Maggie Sellers Reum?

  Love that. True or false, are you better looking when you ovulate?

• 1:09:02Speaker 04

  Yes, estrogen is, is the key to women's health.

• 1:09:06Maggie Sellers Reum?

  I'm ovulating right now.

• 1:09:07Speaker 04

  Yeah, you're glowing, I can tell.

• 1:09:09Maggie Sellers Reum?

  Um, okay, what is your favorite baby girl name that's in pop culture and favorite baby boy name in pop culture?

• 1:09:17Speaker 04

  Okay, well, I'll tell you my favorites that we didn't use. And I don't know if they're in pop culture or not, but my favorite baby girl name is Emerson, go by Emmy. And our favorite baby boy name, we almost named my son, but we didn't, is Archibald, go by Archie.

• 1:09:31Maggie Sellers Reum?

  Love that.

• 1:09:32Speaker 04

  Just love them.

• 1:09:33Maggie Sellers Reum?

  And is it true or false that if you have a girl, she steals your beauty and makes you more sick?

• 1:09:39Speaker 04

  I mean, I personally have one of each. I think it's so true, so true. My son was so much kinder to me. I had an easier pregnancy. I felt better, I looked better and I was a troll when I was pregnant with my gorgeous daughter. Officially, it's a wife's tale, but I think there's truth behind it.

• 1:09:55Maggie Sellers Reum?

  That's crazy.

• 1:09:56Speaker 04

  I was a troll. She's gorgeous, but I hated every moment of it.

• 1:10:01Maggie Sellers Reum?

  I love that you just said that. Um, okay, I say ages for love notes to myself every day. It's my version of this, relieving the stress. If you could only say one thing to yourself for the rest of your life, what would it be?

• 1:10:12Speaker 04

  You can't make decisions on that, you don't know.

• 1:10:15Maggie Sellers Reum?

  Love that.

• 1:10:17Speaker 04

  I'm just a girl who wants to know. Right? I can handle anything you throw at me, but the unknown must the scariest place.

• 1:10:23Maggie Sellers Reum?

  Yeah. If you had to title this season of your life, what would it be called?

• 1:10:27Speaker 04

  Yes, must be present to win. That is how I've been approaching this season. When opportunity comes in front of you, like work, fly to LA, fly home. If you can make it happen, your presence is the most impactful thing you can give to people. So show up to win.

• 1:10:44Maggie Sellers Reum?

  I also have to give you your flowers because I was with some of the leading researchers and doctors last week at the Endometriosis Collective, the End of the Cycle premiere. And obviously, this is all very new for me. The investing, I've actually been so proud to invest in things like Alara and Burden B, to shout out those companies in women's health. But this consumption and overwhelming nature that endometriosis and PCOS brings is a lot. Every single researcher and doctor I talked to last week said, I needed to meet you. And you got yourself on a plane in literally less than a week's notice.

• 1:11:18Speaker 04

  I know.

• 1:11:19Maggie Sellers Reum?

  Came here to do this. So I had to just thank you on air and also share with you that the people in your space, you're obviously doing something right because they are mentioning your name and opportunities that you are not in. So I can't thank you enough for doing this. I hope that the community loves it as much as I do. And I can't wait to see, I can't wait for you to meet my future babies one day.

• 1:11:40Speaker 04

  I can't wait.

• 1:11:41Maggie Sellers Reum?

  And where can people find you?

• 1:11:43Speaker 04

  I'm on Instagram at Natalie Crawford M.D. My new book, The Fertility Formula, is out, which everything we talked about goes into so much more detail, regardless if you're trying to get pregnant or not. And in Austin, I practice it for fertility.

• 1:11:55Maggie Sellers Reum?

  Thank you, Natalie.

• 1:11:56Speaker 04

  Thank you, Maggie.

• 1:12:07Maggie Sellers Reum?

  If you're starting a business, there are certain things that are so fun to think about. Y'all know I love a mood board. So everything that relates to the creative, the name, the brand, the website, the vision board. But then there are the things that make you pause and ask, am I even doing this correctly? Or do I even want to be doing this? Like forming your business, getting the right documents, keeping your personal information private. This is where our sponsor, Northwest Registered Agent, is so helpful. They're a one-stop shop for founders who want to launch and legitimize their business without turning it into a giant admin spiral. They help you form an LLC or a corporation, act as your registered agent, and give you tools like a business address, operating agreement, website, phone number, professional email, and free guides.

• 1:12:51Maggie Sellers Reum?

  They also have real corporate guides who know your local laws. Visit northwestregisteredagent.com/hsrfree and start using free resources to build something amazing. Get more with Northwest Registered Agent at northwestregisteredagent.com/hsrfree.

• 1:13:11Speaker 06

  When fall comes back around, there's a sense of a reset. And new pieces from Lululemon's fall drop are an inspiration to push your goals and elevate your routines. As your calendar fills, easy-to-layer styles meet the demands of your day. And as you challenge yourself to try even more, versatile sets transition with you. The Lululemon fall lineup brings new levels of comfort and confidence, whether you're starting something fresh or starting something over. Check out the latest arrivals in store and on lululemon.com now.

• 1:13:41Speaker 07

  This fall, discover why there are two sides to every pancake story at Cracker Barrel. The edgy side, created by the golden crispy edges, and the softer side, made up of those warm fluffy centers. So slow down. Make time to bring in the family, day or night, and try the new Sweet Cream Caramel Apple Pancakes. Three of the world's best buttermilk pancakes, topped with fried cinnamon apples, caramel drizzle, and sweet vanilla cream. Then dig in and write your own breakfast story. Welcome home to Cracker Barrel. Where some see heroes and others see egos. Bloomberg sees the era of billionaire athletes. While others follow the noise, we follow the money. Learn more at Bloomberg.com.