Peter Attia· MD
But, you know, finding ways to cope with the stress is really what we're talking about. And that can be different for different people. For some people, it could be exercise, for some people it could be meditation, for some people, you know, whatever mindfulness, whatever it is. But definitely, I think it it's important. same as sleep and um we talked about diet you know exercise is is important and do you caution women or do we know anything about too much exercise for women who are trying to conceive I mean we certainly hear stories about you know college athletes and women who are doing a lot are actually having difficulty even maintaining a a regular menstrual cycle so if you if you're dealing with a with a woman who's when you're taking that social history and you're trying to understand what are what are some clues to you that her exercise might might actually be too much uh and that might be impacting her fertility. Right. Right. So extreme exercise can be associated um with fertility issues. Although I think for for most patients the benefits of exercise as we know Yeah. But how what what is extreme for this? So if it causes any change in a person's cycle so for some of the most more extreme athletes sometimes they'll their periods will stop altogether. Uh there's a condition called reds. It's relative energy deficiency in sport. And basically the body is very smart. If it thinks like there's not enough energy around to support a pregnancy because we're expending it all on this exercise, we're just going to like shut the whole thing down. And it works really well, but the patient stops menrating. So obviously they're going to have difficulty getting pregnant if they're not ovulating. If you're not menrating means you're not ovulating. Also has other implications though for things like bone health, right? because the ovary in addition to making eggs also makes estrogen and estrogen is super important for bone health. So yeah definitely if if you know one lesson for the listeners keep track of your we talked about semen analysis being kind of a marker of other health outcomes. Your periods are also a marker. Of course if you're on hormonal contraception you might not know what your natural cycle is doing. Um, but if your cycles are irregular or if you're not having them at all or if they're super painful or they're super heavy and sometimes you don't know what's super painful or super heavy because nobody talks about anything, you know, but thankfully this generation of young women is talking more and there's the internet, etc. But don't wait till you're ready to try to get pregnant to figure that out. You know, there may be something important you need to know way ahead of time. And we've already talked about obesity, but on the other side of that, is there a certain body fat level beneath which uh fertility is also impacted? Yeah, there's not like a cut off, but certainly being overweight or obese can impact fertility and being severely underweight. But for the underweight people, there's a similar mechanism. If you know, if your brain thinks there's just not enough, it's usually going to manifest through amenorhea. Exactly. Exactly. Yeah. So healthy weight, healthy diet, exercise, sleep, you know, sleep can also disrupted sleep could affect ovulation and fertility. Stress we mentioned all these things, all the things you mentioned in your book as well are all the same things that are important for fertility. Lastly, what do you what do you think is the most um promising area of research? And if we're sitting here in 10 years and we're looking back at the last decade, uh what do you imagine you will be most excited about from an innovation perspective? Yeah, it's a very exciting field of medicine. There's always sort of innovations happening. I think let's see genetic testing will continue to evolve as we learn more about genetics. I think that'll play a bigger role. um automation in the lab. You know, a lot of the steps we talked about earlier are like literally embryologists sitting at the microscope doing these things, but now there's some companies developing these like lab on a chip concepts where like you put in the egg, put in the sperm, an embryo comes out. So micrfluidics or Yeah, micrfluidics. It the whole process being automated which I think is it's very interesting, right? And it could potentially improve access if you could put these labs. So do you see this as more of a cost reduction or more of a success improvement? Uh maybe both because you know reduce error potentially. Um, usually the cost of things tends to go up before anytime anytime there's an innovation before it comes down. Maybe ultimately it'll come down but I I imagine costs will increase. Um, so that's kind of an exciting area. in vitro maturation. That's where the eggs are like maturing in the petri dish instead of a in a woman's body. So potentially in the future, a woman wouldn't have to take all these injections and you just take the immature eggs, put them in the petri dish, and then give the petri dish the the medications, if you will. Um, that's in very sort of early stages, not quite as successful as conventional IVF yet. So, we're not quite there. I assume because it's difficult to harvest unmature follicles and even that maturation process, we haven't quite gotten it down like it happens in the body. Um, other things, a real gamecher would be something like in vitro gamtoenesis, which is making eggs and sperm potentially from skin cells. So even if you run out of eggs, if we could take like a skin biopsy and you know reprogram that cell to make an egg, then potentially you know any where are we in that? Very early. I think we'll see it eventually. It's been done in mice. Um, so we're probably 10 to 20 years away. What's the what's the uh what's the