The Truth About Your Biological Clock: Egg Quality, AMH and Fertility with Dr. Natalie Crawford

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Natalie Crawford, a double board certified obstetrician, gynecologist, and reproductive endocrinologist, and author of the new book The Fertility Formula. Both physicians open by sharing their own fertility journeys, including pregnancy losses and dismissal from the medical system, before turning to the science that most women are never given access to.

Dr. Crawford challenges one of the most persistent myths in women's health: that the biological clock is about running out of eggs. It is not. It is about egg quality, and those are completely different problems with completely different solutions. She explains how inflammation damages the chromosomes and mitochondria inside eggs, how chronic inflammation can actually deplete the ovarian reserve by penetrating the ovarian vault, and why the standard message to women, hurry up or give up, is not supported by the science.

The conversation moves into a clear explanation of the reproductive health system, how the brain, ovaries, and uterus communicate, where chronic inflammation and insulin resistance create static interference in that system, and why the same biology that shapes fertility in your 30s directly shapes perimenopause, metabolic health, brain health, and bone density in your 40s and 50s. The fertility story and the menopause story, Dr. Crawford argues, are the same story.

Dr. Crawford also takes on the AMH test and why ACOG's recommendation against routine testing is, in her view, taking agency away from women by deciding in advance that they cannot handle the data. She explains what AMH actually measures, why a low result at 30 should change how a woman thinks about her family planning, her perimenopause timeline, and her long term bone and cardiovascular health, and why at $79 out of pocket, withholding it is indefensible. She also shares her own diagnosis of celiac disease and how it connected to unexplained pregnancy loss, osteopenia at 41, and years of dismissed symptoms.

The episode also covers what a healthy menstrual cycle actually looks like as a vital sign, how to track ovulation beyond what most apps are offering, what a short luteal phase or shortening cycles can signal before symptoms appear, why infertility is 50% a male factor issue, and what trimester zero, the three months before trying to conceive, could mean for egg and sperm quality.

Guest links:

• Natalie Crawford, MD
  
• Natalie Crawford, MD (Instagram)
  
• Natalie Crawford, MD (TikTok)
  
• Natalie Crawford, MD (Threads)
  
• Natalie Crawford, MD (Facebook)
  
• Natalie Crawford, MD (YouTube)
  
• Natalie Crawford, MD (LinkedIn)

Books:

• “The Fertility Formula,” by Dr. Natalie Crawford
  
• “The New Perimenopause,” by Dr. Mary Claire Haver
  
• “The New Menopause,” by Dr. Mary Claire Haver
  

Articles:

• Time to pregnancy: results of the German prospective study and impact on the management of infertility (Human Reproduction)
  
• The effect of physical activity on fertility: a mini-review (F&S Reports)
  
• Association between the systemic immune-inflammation index and GnRH antagonist protocol IVF outcomes: a cohort study (Reproductive BioMedicine Online)
  
• Male Infertility (StatPearls)
  
• Male Preconception Marijuana Use and Spontaneous Abortion: A Prospective Cohort Study (Epidemiology)
  
• Clinical efficacy of PGT-A according to maternal age and embryo quality in blastocyst stage (Human Reproduction)
  
• A comparison of app-defined fertile days from two fertility tracking apps using identical cycle data (Contraception)
  
• Female fecundability is associated with pre‐pregnancy allostatic load: Analysis of a Chinese cohort (Acta Obstetricia et Gynecologica Scandinavica)
  
• Menstrual cycles and the impact upon performance in elite British track and field athletes: a longitudinal study (Frontiers in Sports and Active Living)
  
• Menstrual Disturbances in Athletes: A Focus on Luteal Phase Defects (Medicine & Science in Sports & Exercise)
  
• The Prevalence of Menstrual Cycle Disorders and Menstrual Cycle-Related Symptoms in Female Athletes: A Systematic Literature Review (Sports Medicine)
  
• High Frequency of Luteal Phase Deficiency and Anovulation in Recreational Women Runners: Blunted Elevation in Follicle-Stimulating Hormone Observed during Luteal-Follicular Transition (Journal of Clinical Endocrinology & Metabolism)
  
• Chronotype and sleep duration interact to influence time to pregnancy: Results from a New York City cohort (Sleep Health)
  
• The Association Between Periconceptual Maternal Dietary Patterns and Miscarriage Risk in Women With Recurrent Miscarriages: A Multicentre Cohort Study (BJOG)
  
• The impact of food intake and social habits on embryo quality and the likelihood of blastocyst formation (Reproductive BioMedicine Online)
  
• The effects of perfluoroalkyl and polyfluoroalkyl substances on female fertility: A systematic review and meta-analysis (Environmental Research)
  
• Return of fertility after discontinuation of contraception: a systematic review and meta-analysis (Contraception and Reproductive Medicine)
  
• Ongoing pregnancy rates in single euploid frozen embryo transfers remain unaffected by female age: a retrospective study (Reproductive BioMedicine Online)
  
• In vitro fertilization with single euploid blastocyst transfer: a randomized controlled trial (Fertility & Sterility)

Other Resources:

• Total IVF births soar to more than 13 million (Scimex)
  
• Infertility Affects 1 in 6 People Globally (JAMA Network)
  
• How Many People Have Infertility? (Resolve)
  
• Infertility: Frequently Asked Questions (Centers for Disease Control and Prevention)
  
• How common is male infertility, and what are its causes? (NIH)
  
• Age and Fertility (American Society for Reproductive Medicine)
  
• The use of preimplantation genetic testing for aneuploidy: a committee opinion (American Society for Reproductive Medicine)
  
• The Use of Antimüllerian Hormone in Women Not Seeking Fertility Care (ACOG)
  
• American College of Obstetricians and Gynecologists (ACOG)
  
• EB Research: Longitudinal Investigation of Fertility and the Environment (LIFE) Study (NIH)
  
• Per- and Polyfluoroalkyl Substances (PFAS) (EPA)
  
• Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy (ACOG)