Dr. Natalie Crawford: Female Hormone Health, Fertility & Vitality

Natalie Crawford 博士：女性荷尔蒙健康、生育力和活力

2023-11-13 | 官方页面 YouTube 官方音频

Andrew Huberman:

安德鲁·休伯曼：

Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.

欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

My guest today is Dr. Natalie Crawford.

今天我的客人是娜塔莉·克劳福德博士。

Dr. Natalie Crawford is a medical doctor specializing in obstetrics and gynecology, reproductive endocrinology, and infertility.

Natalie Crawford 博士是一位专攻妇产科、生殖内分泌学和不孕症的医生。

She also holds a degree in nutrition science.

她还拥有营养科学学位。

Dr. Crawford runs a clinical practice, seeing patients daily, as well as being actively involved in public education, both through social media and through her popular podcast entitled "As a Woman." Today, Dr. Crawford teaches us about all aspects of female hormones and hormone health and fertility, beginning as far back as in utero, when we were still in our mother's womb, and extending as far forward as menopause.

克劳福德医生负责临床实践，每天接诊患者，并通过社交媒体和她的热门播客“作为一个女人”积极参与公共教育。今天，克劳福德博士向我们讲述女性荷尔蒙以及荷尔蒙健康和生育能力的各个方面，从子宫内（当我们还在母亲的子宫里时）开始，一直延伸到更年期。

We discuss topics such as the timing of puberty and what the timing of puberty in girls means for their fertility.

我们讨论的话题包括青春期的时间以及女孩的青春期时间对其生育能力的影响等。

And we discuss birth control, both hormonal and non-hormonal forms of birth control, and how birth control may or may not relate to long-term fertility and different aspects of female health.

我们讨论节育，包括激素和非激素形式的节育，以及节育与长期生育能力和女性健康的不同方面可能或可能不相关。

We also talk extensively about measuring fertility, that is egg count.

我们还广泛讨论了测量生育力，即卵子数。

We also talk about egg retrieval, AKA freezing one's eggs, as well as in vitro fertilization.

我们还谈论取卵，又称冷冻卵子，以及体外受精。

And we also take a deep dive into the popular and important topics of nutrition and supplementation as they relate to fertility, as they relate to pregnancy, but also how they relate to female hormone health generally.

我们还深入探讨了营养和补充的流行和重要话题，因为它们与生育、怀孕有关，而且还与女性荷尔蒙健康有关。

Indeed, Dr. Crawford provides us with a master class on female hormones and fertility, one that I know that all women ought to benefit from and that men would benefit from listening to as well.

事实上，克劳福德博士为我们提供了一堂关于女性荷尔蒙和生育能力的大师课，我知道所有女性都应该从中受益，男性也会从聆听中受益。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。

It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public.

然而，我的愿望和努力的一部分是向公众提供有关科学和科学相关工具的零成本消费者信息。

And now for my discussion with Dr. Natalie Crawford.

现在我与娜塔莉·克劳福德博士进行讨论。

Dr. Crawford, welcome.

克劳福德博士，欢迎。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Thank you so much for having me.

非常感谢你邀请我。

I'm honored to be here.

我很荣幸来到这里。

Andrew Huberman:

安德鲁·休伯曼：

Well, I've been paying attention to your content for a long time, and I find it to be incredibly clear, informative, and for many people, actionable.

嗯，我长期以来一直关注您的内容，我发现它非常清晰、内容丰富，而且对很多人来说都是可行的。

So today, I'd like to talk about both fertility and, of course, hormones.

But as we both know, fertility is not limited to a discussion about hormones.

It actually relates to things like behaviors.

它实际上与行为等事情有关。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Sex behaviors and other behaviors, nutrition, supplementation.

性行为和其他行为、营养、补充。

So we'll get into all of it.

所以我们将深入探讨这一切。

But if we could just back up developmentally and talk a little bit about female puberty, because I think pretty much everything we'll talk about today is related to what happens puberty forward, mostly in females, but we will also discuss male fertility and hormones a bit.

但是，如果我们能从发展的角度来讨论一下女性青春期，因为我认为我们今天讨论的几乎所有内容都与青春期提前发生的事情有关，主要是在女性中，但我们也会讨论一下男性的生育能力和激素。

And the question I have is, is there anything about a woman's timing or, let's just say, patterns of puberty, right?

我的问题是，女性的青春期时间或者青春期模式是否有什么关系，对吗？

How frequently they menstruate early on, what the timing of menstruation is, in terms of their age, et cetera, that provides hints or maybe even facts or directives about her future fertility or how long her fertility might last?

他们月经提前的频率、月经的时间、年龄等等，这些都提供了关于她未来生育能力或她的生育能力可能持续多长时间的暗示，甚至可能是事实或指示？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

This is a great question, and I think defining some terminology before we begin is helpful.

So if we go all the way back to when you're a fetus inside your mom, so when there's a female fetus inside her mom, you have the most eggs you're ever going to have at about 20 weeks gestation.

所以，如果我们一直追溯到你还是妈妈体内的胎儿时，那么当妈妈体内有女性胎儿时，你在怀孕 20 周左右时拥有最多的卵子。

You have about six to seven million eggs.

你大约有六到七百万个鸡蛋。

By the time you're born, you've already lost more than half of those, and you continually lose eggs all the time.

当你出生时，你已经失去了一半以上的卵子，而且你一直在不断地失去卵子。

So the analogy that I always use, and you do too, is imagining that there's a vault inside the ovary where all your eggs are kept, and every single month, since the moment you have an ovary, you lose a group of these eggs.

因此，我经常使用的类比（你也这样做）是想象卵巢内有一个保险库，里面保存着你所有的卵子，从你拥有卵巢的那一刻起，每个月你都会失去一组卵子。

And when there's more inside, you're losing more.

当内心有更多东西时，你就会失去更多。

So you're losing all of these eggs throughout early fetal development and then up until the time period even of puberty.

因此，在整个胎儿发育早期，甚至直到青春期，您都会失去所有这些卵子。

When you reach puberty, you have a lessening of the number of eggs in your ovary to the point where it can start to respond to the signals from the brain.

当您进入青春期时，卵巢中的卵子数量会减少到可以开始对来自大脑的信号做出反应的程度。

So when we think about puberty onset in females, first we have really thelarchy, which is the development of breasts.

因此，当我们考虑女性青春期的开始时，首先我们会看到真正的乳房发育，即乳房的发育。

So that happens about two years on average before you have menarche, which is your period starting.

因此，这种情况平均发生在月经初潮（月经初潮）之前两年。

So what happens is the brain, as we know from the hypothalamus, sends out GnRH, and then we have FSH coming out, which really starts to stimulate those follicles.

正如我们从下丘脑得知的那样，大脑会发出 GnRH，然后 FSH 就会释放出来，真正开始刺激这些卵泡。

So FSH or follicle-stimulating hormone, well-named hormone for the female.

FSH 或卵泡刺激素，女性荷尔蒙的俗称。

Of course, men have it too, and it's less well-named for them.

当然，男人也有，只是对他们来说不太好听。

But it starts to get those follicles, which house the eggs, to grow and make estrogen.

但它开始让那些容纳卵子的卵泡生长并产生雌激素。

Women have about two years of estrogen exposure alone, so unopposed estrogen with no progesterone because they're not yet ovulating.

女性大约有两年的时间单独接触雌激素，因此雌激素没有对抗，没有黄体酮，因为她们还没有排卵。

And that's when you start to see breast budding and you start to see the development of some of those secondary sex characteristics before you actually have a period.

就在那时，您开始看到乳房萌芽，并且在真正来月经之前开始看到一些第二性征的发育。

Andrew Huberman:

安德鲁·休伯曼：

What are some of the other secondary sex characteristics that precede menarche?

初潮之前还有哪些其他第二性征？

So you said breast bud development and then breast development, on average, about two years before menarche.

所以你说乳芽发育，然后乳房发育，平均大约在初潮前两年。

Dr. Natalie Crawford:

About two years before.

大约两年前。

You have sexual hair development, so actually adrenarche is one of the first, usually comes right before or at the same time with breast buds, so two to three years before you'll see your period.

您有性毛发发育，所以实际上肾上腺初现是第一个，通常在乳芽出现之前或与乳芽同时出现，因此您会在月经前两到三年出现。

And then-

然后——

Andrew Huberman:

安德鲁·休伯曼：

So genital hair, underarm hair, typically.

通常是生殖器毛发、腋毛。

Dr. Natalie Crawford:

Exactly.

正是如此。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, genital hair usually first, and then underarm hair.

是的，通常先是生殖器毛发，然后是腋毛。

Andrew Huberman:

安德鲁·休伯曼：

And we're getting right down into the weeds here, which is good.

我们正在深入这里的杂草，这很好。

A goal of this podcast is to normalize all aspects of health, including sexual health and reproductive health.

该播客的目标是使健康的各个方面正常化，包括性健康和生殖健康。

Is that commensurate also with the development of body odor?

这是否也与体臭的发展相称？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Because as a young boy who eventually hit puberty and became a young man, and now I suppose I'm in middle age, I'm 48, I can tell you that the locker room smelled a lot different before and after middle school, right?

因为作为一个最终进入青春期成为年轻人的小男孩，现在我想我已经是中年了，我已经48岁了，我可以告诉你，中学前后更衣室的味道有很大不同，对吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

In other words, boys start to smell stinky, right?

换句话说，男孩子身上开始有臭味了，对吧？

Dr. Natalie Crawford:

They do, yes.

他们确实这样做，是的。

And that's usually around that same time of sexual hair development is when you start to have those glands around the hair making some of those odors that start to produce stink, for lack of a better-

这通常是在性毛发发育的同时，头发周围的腺体开始产生一些气味，开始产生臭味，因为缺乏更好的-

Andrew Huberman:

安德鲁·休伯曼：

Do they reflect hormones themselves?

它们本身反映荷尔蒙吗？

Dr. Natalie Crawford:

Not the smell.

不是气味。

The actual smell doesn't actually reflect levels of hormones or anything like that.

实际的气味实际上并不反映激素或类似物质的水平。

It is just that your body, your gonads, whether it is testes or ovaries, are now starting to respond to those brain signals.

只是你的身体、你的性腺，无论是睾丸还是卵巢，现在开始对这些大脑信号做出反应。

The brain is turned on, they're starting to respond, and your body's starting to mature in a way to get to the point where it can support reproduction.

大脑被打开，它们开始做出反应，你的身体也开始成熟，达到可以支持繁殖的程度。

Andrew Huberman:

安德鲁·休伯曼：

The reason I ask that question is not to get people thinking about stinky smells.

我问这个问题的原因不是为了让人们想到臭味。

And by the way, some people love the musty smell of their own- ...

顺便说一句，有些人喜欢自己的霉味——......

armpits or others-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

To each their own

给每个人自己的

Andrew Huberman:

安德鲁·休伯曼：

...

here we're referring to adults, by the way.

顺便说一下，这里我们指的是成年人。

But the reason I ask is that there's a wealth of data in animal models, including non-human primates, suggesting that exposure to the odors of others can either stimulate or accelerate puberty.

但我问的原因是，包括非人类灵长类动物在内的动物模型中有大量数据表明，接触他人的气味可以刺激或加速青春期。

Is there any evidence for that in humans?

在人类中有任何证据证明这一点吗？

Dr. Natalie Crawford:

So there's mild evidence, and it's murky because we also know that anything that could be an endocrine disruptor, which a lot of scents or fragrances are also, can accelerate the onset of puberty by disrupting part of this system.

因此，有温和的证据，但也很模糊，因为我们还知道，任何可能干扰内分泌的东西（许多气味或香水也是如此）都可以通过破坏该系统的一部分来加速青春期的到来。

And so we know that toxins and scents and a lot of the world that we're exposed to is part of the reason why we're seeing puberty happening at such a younger age now in females specifically, but in both, but in females than we have before.

因此我们知道，毒素、气味以及我们所接触的许多世界是我们现在看到青春期在女性中如此年轻发生的部分原因，但两者都是如此，但女性比以前更早。

We have young girls seeing their onset of menarche or their period at a much younger age.

我们有一些年轻女孩在更年轻的时候就开始了初潮或月经。

Andrew Huberman:

安德鲁·休伯曼：

How much younger?

I've seen the various graphs for different countries, but can we say that 10 years ago, on average, girls in the United States and Northern Europe were hitting menarche at about, what, 12 to 13 years old of age?

我看过不同国家的各种图表，但我们是否可以说，10 年前，美国和北欧的女孩平均在 12 至 13 岁左右初潮？

Dr. Natalie Crawford:

Yeah.

是的。

So, we'll use menarche for the purpose of this, so having your period.

因此，我们将利用初潮来达到此目的，以便月经来潮。

10 to 20 years ago, you will see most data would say, oh, 13 to 15 would've been the average age.

10到20年前，你会看到大多数数据都会说，哦，13到15岁就是平均年龄。

And now we're really seeing it shift to be starting at 10 to 11 and completing by 13, 14.

现在我们确实看到它从 10 点到 11 点开始，到 13 点、14 点结束。

So most girls are definitely going through the puberty change earlier.

所以大多数女孩肯定会提前经历青春期的变化。

And the other thing to note is that most girls get their final height growth right before they start their period, too.

So not only are we seeing a change in this starting earlier, what we're also seeing is probably some reduction in height from having gone through puberty at an earlier process.

因此，我们不仅看到这种情况从更早开始发生了变化，而且我们还看到，由于在较早的过程中经历了青春期，身高可能有所下降。

Because once you start actually menstruating, once the ovaries have really started to learn how to respond to that FSH and grow the follicle, and it gets to the point where you can start ovulating, so about two years later, then that ovulatory period, those high levels of estrogen, are going to go, and they're going to close those growth plates.

因为一旦你真正开始月经，一旦卵巢真正开始学习如何对 FSH 作出反应并生长卵泡，并且达到可以开始排卵的程度，所以大约两年后，排卵期，那些高水平的雌激素就会消失，它们会关闭那些生长板。

So you've really started to limit your final adult height as well when you go through puberty earlier.

因此，当您提前进入青春期时，您实际上也开始限制您的最终成年身高。

And that's definitely something that's a huge concern for precocious puberty or very young puberty, right?

And we can use blockers when there are children who start to exhibit signs of puberty, and one of the main reasons people do that is to try to get them to a greater adult height if they're really starting to go through puberty at a very young age.

当孩子开始表现出青春期迹象时，我们可以使用阻滞剂，人们这样做的主要原因之一是，如果他们真的在很小的时候就开始经历青春期，那么试图让他们达到更高的成年身高。

Andrew Huberman:

安德鲁·休伯曼：

Is that also true for males?

对于男性来说也是如此吗？

Dr. Natalie Crawford:

That it's happening earlier?

是说事情发生得更早吗？

Andrew Huberman:

安德鲁·休伯曼：

That earlier puberty means that your growth spurt, in terms of height, is going to be truncated.

青春期提前意味着你的身高突增期将会被缩短。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Not the same.

不一样。

And most men will say, "Oh, but I had my growth spurt kind of after I started having some of the puberty change that happened." But because it is this estrogen-related process in women that we see that growth spurt, really your final height is within that year of when your period starts.

大多数男人会说，“哦，但我的生长突增是在我开始发生一些青春期变化之后。”但是，由于女性正是这种与雌激素相关的过程，我们看到了生长突增，因此您的最终身高实际上是在月经开始的那一年内。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

Yeah, this discussion is certainly not about me, but I was one of these what I thought was kind of an odd duck.

是的，这个讨论当然不是关于我的，但我就是其中之一，我认为这是一种奇怪的鸭子。

I hit puberty about 13, 14.

我大约13、14岁进入青春期。

Let's just say I knew I did, but I didn't shave until I was after college.

My growth spurt between freshman and sophomore year, I grew a foot.

Dr. Natalie Crawford:

Right.

对。

Andrew Huberman:

安德鲁·休伯曼：

Right?

对吗？

So I grew a full foot, but I was the same weight, so I was real tall, real skinny, or pretty tall, real skinny.

所以我长了一足，但体重相同，所以我很高，很瘦，或者很高，很瘦。

And then it seems like some people in my life would argue that puberty's still occurring for me.

然后，我生活中的一些人似乎会认为我的青春期仍在发生。

But it feels like it's very long and protracted.

但感觉却很漫长，很漫长。

Which leads me to a very specific question.

这让我想到一个非常具体的问题。

If puberty arrives, let's again define as menarche for sake of our discussion right now.

如果青春期到来，为了我们现在的讨论，让我们再次定义初潮。

If puberty arrives early in a girl, does that mean that her fertility will shut down earlier as well?

如果女孩的青春期提前到来，是否意味着她的生育能力也会提前终止？

Dr. Natalie Crawford:

Great question.

很好的问题。

It does not.

事实并非如此。

So the age of which you start the onset of your period does not impact how long you're going to have a reproductive lifespan, and that's because you have the eggs inside that vault.

因此，月经开始的年龄不会影响您的生殖寿命，因为卵子就在您的储存库内。

You're losing them every month, no matter what.

无论如何，你每个月都会失去它们。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So you lost them all those years before your period started, no matter if your period came at 10 or at 15.

因此，无论您的月经是在 10 岁还是 15 岁，您在月经开始前的所有几年中都会失去它们。

It's just about when did they start allowing your body to ovulate, determined by being able to carry a baby.

这只是关于他们什么时候开始允许你的身体排卵，这取决于你是否能够怀上孩子。

Your body now thinks you can be pregnant.

您的身体现在认为您可以怀孕。

Andrew Huberman:

安德鲁·休伯曼：

I think this is so important to highlight because it puts together what you said earlier about the loss of eggs even as a fetus.

我认为强调这一点非常重要，因为它综合了您之前所说的关于胎儿时期卵子丢失的情况。

I think most people sort of assume that the reduction in egg count is due to ovulation, and the fact that one egg ovulates typically, but that other eggs are deployed in that ovulatory cycle, and then those basically are taken out of the vault and out of the opportunity for fertilization.

我认为大多数人都认为卵子数量的减少是由于排卵造成的，事实上，一个卵子通常会排卵，但其他卵子会在该排卵周期中部署，然后这些卵子基本上就被从卵子库中取出，失去了受精的机会。

But what you're saying is that the eggs are constantly being culled from the vault, starting from early-

但你的意思是，从很早开始，鸡蛋就不断地被从金库中剔除——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes

是的

Andrew Huberman:

安德鲁·休伯曼：

...

embryonic development, and that ovulation is a distinct step, in some sense unrelated to-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

To the loss of eggs

Andrew Huberman:

安德鲁·休伯曼：

...

to the loss of eggs.

导致卵子流失。

Dr. Natalie Crawford:

Correct.

正确。

Andrew Huberman:

安德鲁·休伯曼：

I think this is going to be very important for our discussion later about potential egg harvest-

我认为这对于我们稍后讨论潜在的卵子收获非常重要 -

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes

是的

Andrew Huberman:

安德鲁·休伯曼：

...

because I think some people have it in mind that-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

There's a lot of misconceptions-

有很多误解——

Andrew Huberman:

安德鲁·休伯曼：

Yeah

是啊

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

that you're losing eggs from your vault, and that's not the case.

你的金库中的鸡蛋正在丢失，但事实并非如此。

You're just accessing the ones outside.

你只是访问外面的。

Andrew Huberman:

安德鲁·休伯曼：

Got you.

明白你了。

So we can just answer this now, perhaps.

所以也许我们现在就可以回答这个问题。

It seems, if I understand correctly, that if one were to harvest eggs for IVF or for embryogenesis in a dish to set them aside later or freeze them for later-

如果我理解正确的话，似乎如果一个人要在培养皿中收获用于体外受精或胚胎发生的卵子，然后将它们放在一边或冷冻起来以备后用-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm

嗯嗯

Andrew Huberman:

安德鲁·休伯曼：

...

if they want to use them, eggs or fertilized embryos, that One is not reducing their total number of eggs any more than they would had they just let their cycles proceed naturally.

如果他们想使用它们，卵子或受精胚胎，那么他们并不会减少卵子的总数，而只是让他们的周期自然进行。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Exactly.

正是如此。

Andrew Huberman:

安德鲁·休伯曼：

Oh, that's such an important point.

哦，这是非常重要的一点。

I think a lot of people believe the opposite.

我认为很多人的看法恰恰相反。

They think that-

他们认为——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's probably the number one thing that patients fear when they come talk to me about egg freezing or going through IVF is, "I don't want to harm my future fertility.

当患者来找我谈论卵子冷冻或进行体外受精时，他们担心的第一件事可能是，“我不想损害我未来的生育能力。

I don't want to cause myself to run out of eggs earlier or go into menopause earlier." And it's explaining this process to them that your ovaries are on a pathway that you can't change.

I don't want to cause myself to run out of eggs earlier or go into menopause earlier."它向他们解释了这个过程，你的卵巢处于一条你无法改变的路径上。

Those eggs are coming out of the vault regardless of if you're on birth control pills, you're pregnant, we do IVF.

What we're modifying is one's not going to ovulate and have the rest of them die.

We're going to try to give you medication to get them all to grow, so we can take all of the ones that have been released from the vault that month and give them a chance for later.

我们将尝试给你药物让它们全部生长，这样我们就可以取出当月从保险库中释放的所有那些，并给它们一个稍后的机会。

And the next month, you'll have another group come out.

Andrew Huberman:

安德鲁·休伯曼：

So IVF is not about stimulating hyper-release or excessive release of eggs.

It's about stimulating the growth of the ones that have been released so that they can be frozen at that stage, either for later fertilization or fertilized in addition, then frozen as embryos.

这是为了刺激已释放的胚胎的生长，以便它们可以在该阶段被冷冻，以便以后受精或另外受精，然后冷冻为胚胎。

Is that right?

是这样吗？

Dr. Natalie Crawford:

Exactly, and we just use the hormones that your body normally makes in a different way.

The medications we use are FSH and LH to get the eggs to grow.

So people will say, "I don't want to take all these weird hormones or strange medications," but we're just manipulating that normal process that happens in the natural menstrual cycle in order to say, "Hey, this month, let's get all these eggs to grow.

所以人们会说，“我不想服用所有这些奇怪的激素或奇怪的药物，”但我们只是操纵自然月经周期中发生的正常过程，以便说，“嘿，这个月，让我们让所有这些卵子生长。

Let's try to improve the efficiency of finding which eggs are going to be normal or not, and help you along this process."

Andrew Huberman:

安德鲁·休伯曼：

I think a good number of people are now going to head to the IVF clinic.

Again, I really want to highlight this.

我真的想再次强调这一点。

I think most people that I've spoken to assume that the process of harvesting eggs for freezing for fertilization then or later is going to diminish their fertility because they're basically pulling more out of the savings account, so to speak.

我认为与我交谈过的大多数人都认为，当时或以后收集卵子进行冷冻受精的过程会降低他们的生育能力，因为可以这么说，他们基本上从储蓄账户中提取了更多资金。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

So we-

所以我们——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

You're making the withdrawal no matter what.

无论如何，你都会提款。

Andrew Huberman:

安德鲁·休伯曼：

Great.

太棒了。

Well, such an important point for people to know and propagate.

Getting back to puberty, a little bit later on I wanted to get into endocrine disruptors and things of that sort, but since you brought it up, I've heard things such as, okay, things like evening primrose oil.

回到青春期，过了一会儿，我想研究内分泌干扰物之类的东西，但自从你提出这个问题以来，我听说过诸如月见草油之类的东西。

If Mom is putting evening primrose oil on or has it in her shampoo, that I've heard of young males getting precocious breast bud development.

Keep in mind, folks, that some transient breast bud development is characteristic of some normal puberties in males.

It sometimes shows up and goes.

它有时会出现并消失。

I knew some kids like that in the neighborhood.

我认识附近有一些这样的孩子。

They got teased a little bit, and then they stopped getting teased.

他们被戏弄了一点，然后就不再被戏弄了。

Hopefully, nowadays, they don't tease those kids.

But when I was growing up, those kids got teased, not by me, but by other people.

但在我成长的过程中，那些孩子们被嘲笑，不是被我，而是被其他人。

But it was normal, and it passed for some.

但这是正常的，对某些人来说就过去了。

It occurred normally and then passed.

正常发生，然后就过去了。

But I've heard that things like exposure to evening primrose oil, maybe even just through contact with Mom, can increase the frequency or degree of that male breast bud development.

但我听说，接触月见草油，甚至只是通过与妈妈接触，就可以增加男性乳芽发育的频率或程度。

Is it also true that young girls can undergo precocious puberty or, let's just say, accelerated or exacerbated puberty through contact with things like evening primrose oil, which I think has some pseudo-estrogen-like properties?

年轻女孩是否也会因接触月见草油等物质而出现性早熟，或者，我认为月见草油具有一些类似雌激素的特性，从而加速或加剧青春期？

Dr. Natalie Crawford:

It's important to differentiate that the secondary sex characteristics we see, like breast bud development, are from estrogen, but it's not really puberty being initiated when it's from an endocrine-disrupting chemical.

重要的是要区分我们看到的第二性征（例如乳芽发育）来自雌激素，但当它来自内分泌干扰化学物质时，青春期并不是真正的开始。

So being exposed to evening primrose or lavender or tea tree oil in a male isn't going to cause him to start to go into puberty, but it is going to expose him to estrogen when his body is not, and therefore stimulate some breast bud development.

因此，男性接触月见草油、薰衣草油或茶树油不会导致他开始进入青春期，但会在他的身体尚未进入青春期时让他接触雌激素，从而刺激一些乳芽发育。

Same thing can happen in young girls, meaning they could show some of those secondary sex signs earlier than they normally would.

And this is why if that's happening at a really young age, kids should go to a pediatric endocrinologist who are going to check things like bone age and see if you've really started the puberty process or not, or is it an outside exposure which is causing it?

这就是为什么如果这种情况发生在很小的时候，孩子们应该去看儿科内分泌科医生，他们会检查骨龄等信息，看看你是否真的已经开始青春期过程，或者是否是外部暴露导致的？

Interestingly, about the young child exposure and development, the other thing to say that's really interesting and relevant in my field is that when we think about how many eggs are in the vault, and everybody's born with this different number, and I'm sure we'll talk about ovarian reserve, what we now know is that the vault, your ovaries are most susceptible to whatever your mother does when she's pregnant with you.

有趣的是，关于幼儿的暴露和发育，另一件在我的领域中真正有趣且相关的事情是，当我们考虑金库中有多少个卵子时，每个人出生时都有这个不同的数量，我相信我们会谈论卵巢储备，我们现在知道的是，金库，你的卵巢最容易受到你母亲在怀孕时所做的任何事情的影响。

And that epigenetic, that programming which is happening, is predisposing young women to probably having some of them low ovarian reserve, some of them having diseases we associate with infertility, like PCOS or endometriosis.

这种表观遗传，即正在发生的编程，使年轻女性中的一些人可能患有卵巢储备功能低下，其中一些人患有我们与不孕症相关的疾病，如多囊卵巢综合症或子宫内膜异位症。

And we haven't yet characterized what all they are, but if we look at the incidence of some of these diseases that we see now, what we do know is that the time period of which these people were pregnant, the '80s and '90s, was not the healthiest time when it comes to endocrine disruptors and plastic exposures and chemicals and all of this processed stuff, let's just say, that people have been exposed to, that we're really seeing that ovarian susceptibility to egg quality and quantity happens in that fetal development period.

我们还没有描述它们的全部特征，但如果我们看看我们现在看到的一些疾病的发病率，我们确实知道的是，这些人怀孕的时期，即 80 年代和 90 年代，在内分泌干扰物、塑料接触和化学物质以及所有这些加工过的东西方面，并不是最健康的时期，我们可以说，人们已经接触过，我们确实看到卵巢对卵子质量和数量的敏感性发生了变化。在那个胎儿发育时期。

Andrew Huberman:

安德鲁·休伯曼：

It's interesting because there are some parallels to male fetal development, like the fact that you have these early organizing effects of hormones like dihydrotestosterone, which essentially stimulate the growth of the penis, but also then establish a propensity for hormones during puberty to activate growth of the sex organs but also activate the brain areas that are responsible for a host of different things.

这很有趣，因为与男性胎儿的发育有一些相似之处，例如双氢睾酮等激素的早期组织作用，它本质上刺激阴茎的生长，但随后也会在青春期建立激素的倾向，以激活性器官的生长，同时也激活负责许多不同事物的大脑区域。

So I only mention that because what I'd like to illustrate in the background here is that basically our reproductive health begins really prior to conception, really.

所以我只是提到这一点，因为我想在背景中说明的是，基本上我们的生殖健康实际上在受孕之前就开始了。

It's dependent on Mom and Dad, but certainly to a great degree on Mom.

这取决于爸爸妈妈，但很大程度上取决于妈妈。

But then fetal development is going to be important, so sort of us being able to pick our parents.

但胎儿的发育将变得很重要，因此我们能够选择我们的父母。

Dr. Natalie Crawford:

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

I do have a couple questions about lavender, tea tree oil, and evening primrose oil.

我确实有几个关于薰衣草、茶树油和月见草油的问题。

I was aware that evening primrose oil ...

我知道月见草油...

oil, excuse me, can somehow bind estrogen receptors or mimic some of the estradiol or something similar to it.

对不起，油可以以某种方式结合雌激素受体或模仿一些雌二醇或类似的东西。

I wasn't aware of tea tree oil or lavender.

我不知道茶树油或薰衣草。

Here, are we talking about oils?

在这里，我们谈论的是油吗？

What about aromas?

香气怎么样？

And how concerned do people have to be about this stuff?

人们对这些东西有多关心？

Because you'll go into a restaurant bathroom, there'll be potpourri.

因为你会走进餐厅的浴室，那里会有花香。

Some people wear perfume.

有些人喷香水。

We don't want to set a paranoia.

我们不想引起偏执。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

No, no.

不，不。

Andrew Huberman:

安德鲁·休伯曼：

But I think people should know about this stuff.

但我认为人们应该了解这些东西。

Tea tree oil is in a lot of those natural shampoos-

很多天然洗发水中都含有茶树油-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

A lot of the shampoos

很多洗发水

Andrew Huberman:

安德鲁·休伯曼：

...

the ones that burn.

那些燃烧的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes, the one that tingle your scalp.

是的，就是那种头皮发麻的感觉。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, I don't like those.

是的，我不喜欢那些。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Some people love them, though.

不过，有些人喜欢它们。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Constant exposure is very different than a one-time hand washing in the bathroom, and I think that's the big difference for everything when we talk about chemicals or toxins or exposures in the world.

持续接触与在浴室一次性洗手有很大不同，我认为当我们谈论化学物质、毒素或世界上的接触时，这对所有事情都有很大的不同。

You can't live in a toxin-free world, but choosing what you put in and on your body on a regular basis does set the tone for certain physiologic changes.

你不可能生活在一个没有毒素的世界，但定期选择摄入体内和体内的物质确实为某些生理变化奠定了基调。

And so using unscented products, especially with children, is a really an important thing because we want to make sure that their lifetime exposure to some of these things, especially during critical times, is much less.

因此，使用无味产品，尤其是对于儿童来说，确实是一件很重要的事情，因为我们希望确保他们一生中接触其中一些东西的机会，特别是在关键时期，要少得多。

And so you'll see people recommend things like your laundry detergent, what scents are in your laundry detergent.

所以你会看到人们推荐一些东西，比如你的洗衣粉，你的洗衣粉中有什么香味。

The shampoo and conditioner are a big one, and the soaps that you use on a day-to-day basis in your house or the oils you put on your body.

洗发水和护发素是其中的一大类，还有您在家中日常使用的肥皂或涂在身上的油。

Lavender is huge because there's this whole community of people, they want to rub lavender oil on their baby's feet and help them sleep.

薰衣草的规模很大，因为有一整群人，他们想在宝宝的脚上擦薰衣草油，帮助他们入睡。

But really, we can see, and if somebody goes and shadows a pediatric endocrinologist for a day, they'll see some kids come in, and this will be the reason why.

但实际上，我们可以看到，如果有人去跟踪儿科内分泌科医生一天，他们会看到一些孩子进来，这就是原因。

Andrew Huberman:

安德鲁·休伯曼：

Hmm.

嗯。

What about cloth diapers versus non-cloth diapers?

布尿布与非布尿布相比如何？

I've heard that you have your very strong cloth diaper proponents, right?

我听说你们有非常强烈的布尿布支持者，对吗？

And that because they seem to feel or believe that non-cloth diapers somehow contain things that can get into babies' skin.

这是因为他们似乎感觉或相信非布尿布在某种程度上含有可以进入婴儿皮肤的物质。

And maybe there's a bigger question here.

也许这里有一个更大的问题。

Is baby skin more permeable than adult skin?

婴儿皮肤比成人皮肤更容易渗透吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, I guess I don't know if baby skin is more permeable or not.

哦，我想我不知道婴儿皮肤是否更透气。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, I don't either.

是的，我也不。

To me, it seems-

对我来说，似乎——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I think it's probably-

我想这可能是——

Andrew Huberman:

安德鲁·休伯曼：

...

it seems like it'd be hard to imagine it is, but babies do seem to have this incredible skin, right?

似乎很难想象，但婴儿似乎确实拥有这种令人难以置信的皮肤，对吧？

Their skin is so smooth-

她们的皮肤好光滑啊～

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's very soft

非常柔软

Andrew Huberman:

安德鲁·休伯曼：

...

and you want to squeeze their cheeks and all this kind of stuff.

你想捏捏他们的脸颊之类的东西。

But, yeah, the idea they would be more permeable.

但是，是的，他们的想法会更具渗透性。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I think it's more that their development is this time is very important in setting the stage for a lot of what happens later.

我认为更重要的是，他们这次的发展非常重要，为以后发生的很多事情奠定了基础。

Versus in adulthood, those stepwise developmental processes have already happened.

与成年期相比，这些逐步的发展过程已经发生了。

So I think that's why we pay so much attention to what happens in the childhood period of time, because we're now learning about those later consequences of what you're exposed to.

所以我认为这就是为什么我们如此关注童年时期发生的事情，因为我们现在正在了解你所经历的事情的后续后果。

It's not that regular diapers versus cloth, whatever we want to say, one's necessarily better than the other.

这并不是普通尿布与布尿布的比较，无论我们想说什么，一个都一定比另一个好。

It's more honestly a personal preference.

更诚实地说，这是个人喜好。

Babies are exposed to them a lot, and there's been a lot of attention to that.

婴儿经常接触它们，因此引起了很多关注。

But similarly, somebody could use cloth and wash it with a detergent that then has certain chemicals in it.

但类似地，有人可以使用布并用含有某些化学物质的清洁剂清洗它。

So there hasn't been a study shown that this one thing is an exposure for a baby that somebody needs to be worried about.

因此，还没有一项研究表明，这对婴儿来说是一种需要担心的暴露。

There's definitely companies now which are promoting and talking about traditional diapers that they are making sure have less toxins in them, and I always think any time you can decrease toxin exposure to a child is going to be very important.

现在肯定有一些公司正在推广和谈论传统尿布，他们确保其中的毒素较少，而且我始终认为，任何时候可以减少孩子接触毒素的机会都将非常重要。

Andrew Huberman:

安德鲁·休伯曼：

Is there any evidence for breast milk versus formula in terms of impact on future reproductive development or reproductive status of a child?

是否有任何证据表明母乳与配方奶粉对儿童未来生殖发育或生殖状态的影响有关？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

That's a complicated question because breast milk exposure, at least for the first six months of a child's life, certainly helps with the immune system development, and we know that poor immune development can lead to higher risk of autoimmune disease later, what people call leaky gut, and some of those diseases certainly are correlated with fertility.

这是一个复杂的问题，因为至少在孩子出生后的前六个月，接触母乳肯定有助于免疫系统的发育，而且我们知道，免疫发育不良会导致以后患自身免疫性疾病的风险更高，即人们所说的肠漏症，其中一些疾病肯定与生育能力有关。

So I wouldn't say we've gone so far to say that if you don't breastfeed your child, they're going to have fertility issues, but we do know that there's an in-between correlation with things that breastfeeding is protective against and how those diseases themselves may relate to fertility in the female later on.

所以我不会说我们已经过分说如果你不母乳喂养你的孩子，他们就会出现生育问题，但我们确实知道，母乳喂养可以预防的事情以及这些疾病本身与女性以后的生育能力之间存在着中间相关性。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

So if we're thinking about a young girl/woman, because we're talking about puberty, right?

因此，如果我们正在考虑一个年轻女孩/女人，因为我们正在谈论青春期，对吧？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Sure.

当然。

Andrew Huberman:

安德鲁·休伯曼：

So I don't know what the exact nomenclature is there.

所以我不知道确切的术语是什么。

My experience is I'll offend somebody no matter what.

我的经验是，无论如何我都会冒犯别人。

But a girl who undergoes puberty, right?

但一个正在经历青春期的女孩，对吗？

So a young woman who's maybe 13 or so, so she's early teens, undergoes puberty and therefore is continuing to lose eggs from the vault, but now is undergoing, presumably, roughly every 28 days, menarche.

一位大约 13 岁左右的年轻女性，即十几岁出头的女性，正在经历青春期，因此卵子会继续从储存库中流失，但现在大约每 28 天就会经历一次初潮。

But let's talk about this 28 days thing, because I think-

但我们来谈谈这 28 天的事情，因为我认为——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, yeah

是啊是啊

Andrew Huberman:

安德鲁·休伯曼：

...

a lot of people think that, quote, unquote, "normal menstruation" is always 28 days, and we know that's not true.

很多人认为，无论引用还是不引用，“正常月经”总是 28 天，我们知道这不是真的。

So what is the range of normal durations between menstruation cycles or duration of the menstruation cycle?

那么月经周期之间的正常持续时间或月经周期持续时间的范围是多少呢？

And let's also define when the menstruation cycle starts, probably for the males mostly in the audience, right?

我们还可以定义月经周期何时开始，可能对于大多数观众中的男性来说，对吧？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Sure, sure.

当然，当然。

So let's think through the cycle.

因此，让我们仔细考虑一下这个循环。

We'll do a quick one over and then answer the questions.

我们将快速回顾一遍，然后回答问题。

So what we think of as cycle day one, or when you're going to say this starts, is going to be the day that you start bleeding.

因此，我们所说的周期第一天，或者当你说周期开始时，就是你开始流血的那一天。

So that's actually shedding the endometrial lining from what grew the last time.

所以这实际上是使上次生长的子宫内膜脱落。

Andrew Huberman:

安德鲁·休伯曼：

So any spotting even would be considered day one?

那么任何发现都将被视为第一天吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

We can get back to it, but there's problematic if you have a lot of spotting before that full flow starts.

我们可以回到它，但是如果在整个流程开始之前你有很多发现，就会出现问题。

A day or so can be really normal, just as the body's adjusting to the drop in progesterone.

一天左右可能是非常正常的，就像身体正在适应黄体酮的下降一样。

But let's just start at the beginning.

但让我们从头开始吧。

Day one, you have a period, a menses.

第一天，你来月经了。

This is when you're actually bleeding.

这是你真正流血的时候。

At this time period, we like to think about all of those- New eggs being out of the vault, being susceptible to that FSH, which of course is that well-named hormone because it stimulates a follicle to grow, and each egg is in a follicle.

在这个时期，我们喜欢考虑所有这些——新的卵子从保险库中出来，容易受到 FSH 的影响，FSH 当然是众所周知的激素，因为它会刺激卵泡生长，并且每个卵子都在卵泡中。

That egg starts to grow and makes estrogen.

那个卵子开始生长并产生雌激素。

That estrogen stimulates the proliferation of the lining of the uterus in preparation for potentially that pregnancy that may come.

雌激素会刺激子宫内膜的增殖，为可能到来的怀孕做好准备。

And also, that estrogen makes you feel really great, right?

而且，雌激素会让你感觉非常好，对吧？

That's the follicular phase, named so because that follicle is growing, and it's an FSH-dominant phase where you have a lot of estrogen.

这就是卵泡期，之所以这样命名是因为卵泡正在生长，这是一个 FSH 占主导地位的阶段，其中含有大量雌激素。

When-

当——

Andrew Huberman:

安德鲁·休伯曼：

And people feel great when they have a lot of estrogen?

当人们拥有大量雌激素时会感觉很棒吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Because-

因为——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Women feel good with estrogen

女性对雌激素感觉良好

Andrew Huberman:

安德鲁·休伯曼：

...

because of the relationship between estrogen and other neuromodulators like dopamine, serotonin?

因为雌激素和其他神经调节剂如多巴胺、血清素之间的关系？

And is that happening in parallel, or are they somehow related?

这是同时发生的，还是有某种关联？

Is estrogen controlling the release of serotonin somehow and vice versa, or are they just kind of coincidentally happening in parallel?

雌激素是否以某种方式控制血清素的释放，反之亦然，或者它们只是巧合地同时发生？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

We definitely think that there's more of a correlation causation than just coincidence.

我们绝对认为这其中存在更多的相关因果关系而不仅仅是巧合。

Because we know there's time periods where people are more depressed within your cycle correlating with those low estrogen levels, and we know that when you go into menopause or you run out of eggs and you're now in a low estrogen phase, we see a lot more of a depressed mood and anhedonia, lack of response to things which would normally give you pleasure, happens more frequently.

因为我们知道，在您的周期中，在某些时期，人们会更加抑郁，这与雌激素水平较低有关，而且我们知道，当您进入更年期或卵子用完并且您现在处于雌激素水平较低的阶段时，我们会看到更多的抑郁情绪和快感缺乏，对通常会给您带来快乐的事物缺乏反应，这种情况会更频繁地发生。

The female brain loves estrogen, and it's protective against things like dementia.

女性大脑喜欢雌激素，它可以预防痴呆症等疾病。

So this is a time period where women are going to be more energetic.

所以这个时期是女性比较有活力的时期。

They're going to have more energy, more focus.

他们将会有更多的精力，更加专注。

This is the estrogen dominant phase of the cycle.

这是周期中雌激素占主导地位的阶段。

And when you have seen that estrogen at its high levels, which it's only made from a mature follicle, and it's very specific, 200 picograms per milliliter for 50 hours.

当你看到雌激素水平很高时，它只由成熟的卵泡产生，而且非常具体，每毫升 200 皮克，持续 50 小时。

That's the brain's clue, "Okay, we must have a mature egg," and it can send out that surge of LH, or luteinizing hormone, and now you ovulate.

这就是大脑的线索，“好吧，我们必须有一个成熟的卵子”，它可以发出大量的 LH（黄体生成素），现在你就排卵了。

And when you ovulate, the follicle opens up, releases, closes back, and then it's the corpus luteum, and we've entered the luteal phase.

当你排卵时，卵泡打开、释放、关闭，然后就是黄体，我们就进入了黄体期。

Andrew Huberman:

安德鲁·休伯曼：

And the corpus luteum, as the name suggests, a corpus, it's like a body that's basically the-

黄体，顾名思义，一个体，它就像一个身体，基本上是-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's a fatty body, yeah.

是的，身体很胖。

Andrew Huberman:

安德鲁·休伯曼：

It's basically the corpse of what-

它基本上是尸体——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's the dead follicle.

这是死去的毛囊。

Yes

是的

Andrew Huberman:

安德鲁·休伯曼：

...

essentially it sheath, yeah.

本质上是它的鞘，是的。

It sheathed the egg before.

它之前把鸡蛋套在壳里了。

And what I find so amazing, biology is so beautiful, right?

我发现如此令人惊奇的是，生物学是如此美丽，对吗？

Instead of just taking that tissue and saying, "Okay, let's just discard this," or that becomes the trigger for the next phase of the-

不要只是拿起那张纸巾然后说：“好吧，我们把它扔掉吧”，或者这会成为下一阶段的触发因素——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It is essential for life, right?

这是生命所必需的，对吗？

The corpus luteum, which makes progesterone, opens and closes the implantation window.

产生黄体酮的黄体打开和关闭着床窗口。

It is what allows somebody to get pregnant and for our species to continue.

它让人们能够怀孕，也让我们的物种得以延续。

So it's extremely fascinating.

所以这是非常令人着迷的。

And that corpus luteum gets stimulated to produce progesterone in pulses throughout the entire luteal phase because it's still controlled by the brain, unless you get pregnant.

在整个黄体期，黄体都会受到刺激，以脉冲形式产生黄体酮，因为它仍然由大脑控制，除非您怀孕了。

And then in that luteal phase, progesterone is fascinating.

然后在黄体期，黄体酮是令人着迷的。

It's trying to protect you from things which could potentially harm your baby.

它试图保护您免受可能伤害您宝宝的事物的影响。

So suddenly now, you have less energy.

现在突然之间，你的精力减少了。

You want to sleep more.

你想睡得更多。

You want to eat more.

你想吃更多。

You maybe do not want to have sex as much because your body is suddenly saying, "Let's just protect this potential implantation that you're going to have." If that pregnancy doesn't come, the corpus luteum can only live 12 to 14 days.

您可能不太想发生性行为，因为您的身体突然说：“让我们保护您即将进行的潜在植入。”如果没有怀孕，黄体只能存活 12 至 14 天。

It has a very distinct lifespan, and then it dies.

它有一个非常明显的寿命，然后就会死亡。

Your estrogen and progesterone both drop.

你的雌激素和孕激素都会下降。

You bleed starting over the next cycle, and a new group of follicles comes out to be released.

您在下一个周期开始流血，并且释放出一组新的卵泡。

And the reason why walking through that very succinctly but is important when you're asking how long is the normal cycle.

当您询问正常周期有多长时，为什么要非常简洁地进行说明，但很重要。

Because the luteal phase is pretty set at 12 to 14 days.

因为黄体期大约为 12 至 14 天。

The follicular phase can vary in person to person.

卵泡期因人而异。

And what we know, though, is for one individual, if your menstrual cycle, your reproductive hormones are working right, it should be relatively constant for you.

但我们知道，对于一个人来说，如果你的月经周期、你的生殖激素工作正常，那么你的月经应该相对稳定。

And so if your periods are every 24 days, but they've always been every 24 to 25 days, then that's not concerning.

因此，如果您的月经周期是每 24 天一次，但一直以来都是每 24 到 25 天一次，那么这并不重要。

And if your periods are every 33 days, but they've always been every 33 days, then that's not concerning.

如果您的月经周期是每 33 天一次，而且一直以来都是每 33 天一次，那么这并不重要。

But we do get concerned when there's a change in your period, or we get concerned when people have what I like to say is irregularly regular periods.

但是，当您的经期发生变化时，我们确实会感到担忧，或者当人们的月经周期不规律时，我们会感到担忧。

Because what you'll see textbooks tell you is that your periods could be as short as 21 days, as long as 35 days, and that can all be normal.

因为你会看到教科书告诉你，你的经期可以短至21天，长至35天，这都是正常的。

But people will hop between them, and they'll have one cycle that is 24 days in length from day one to the last day before the next day one.

但人们会在它们之间跳跃，并且他们将有一个周期，从第一天到第二天之前的最后一天，长度为 24 天。

Then the next cycle's 32, and then it's 26, and then it's 34, and that's not normal.

然后下一个周期是32，然后是26，然后是34，这不正常。

That's too irregular, and that can be a sign that something is not communicating correctly within your reproductive hormones.

这太不规则了，这可能表明您的生殖激素内某些东西没有正确沟通。

So what I tell patients is, in general, your period should be less than 35 days apart, and you should be able to look at a calendar, and with your finger, put a finger on the date, and within a couple days of accuracy, be able to predict when your period's coming.

所以我告诉患者的是，一般来说，你的月经间隔应该在35天以内，你应该能够看日历，用手指点一下日期，在准确的几天内，能够预测你的月经何时到来。

And if you can't, there could likely be something that is interfering with the hormonal signals between the brain and the ovary.

如果不能，则可能有某种物质干扰了大脑和卵巢之间的荷尔蒙信号。

And one of the biggest, really one of the only things we see as women start to have fewer eggs in the vault, is a shortening of their cycles.

随着女性的卵子数量开始减少，我们看到的最大的事情之一，实际上是唯一的事情之一，就是她们的周期缩短。

So you have a regular period, and suddenly now you have less eggs in the vault, so less are coming out each month.

所以你的月经是规律的，突然间你储存在库里的卵子减少了，所以每个月排出的卵子也减少了。

And when the brain sends out that FSH signal, now there's fewer eggs, so it's not getting as dilute, and you have one starting to respond sooner.

当大脑发出 FSH 信号时，现在卵子数量减少了，所以它不会变得那么稀，而且你的卵子开始反应得更快。

So suddenly, you're ovulating shorter, faster in your cycle.

突然之间，您的周期中排卵时间变短、变快。

You're ovulating on cycle day nine instead of 14.

您的排卵日是月经周期的第 9 天，而不是第 14 天。

Your luteal phase is still set, but the person who comes to see me and says, "My periods have always been 28 to 30 days, but now they're every 24.

你的黄体期还没有到来，但是来找我的人说：“我的月经一直是 28 到 30 天，但现在是每 24 天一次。

I just figure it's no big deal." I have red flags going off everywhere because I'm now really concerned that potentially their ovarian reserve has dropped to a point where we are starting to see clinical changes.

我只是觉得这没什么大不了的。”我到处都有危险信号，因为我现在真的很担心他们的卵巢储备可能已经下降到我们开始看到临床变化的程度。

Now, of course, things like Thyroid and prolactin and other hormones can also cause such changes, but that's why you'll hear most reproductive endocrinologists say your period's a vital sign.

当然，甲状腺、催乳素和其他激素等激素也会引起此类变化，但这就是为什么您会听到大多数生殖内分泌学家说您的经期是一个生命体征。

And what we really mean is the regularity at which it comes and the predictability of it is telling us if your hormones are all communicating in a normal fashion or if something could potentially be off.

我们真正的意思是它出现的规律性和它的可预测性告诉我们你的荷尔蒙是否都以正常方式交流，或者是否有什么东西可能会出现问题。

Andrew Huberman:

安德鲁·休伯曼：

Let me see if I have this correct.

让我看看我的说法是否正确。

We've got this thing that we call the menstrual cycle or the ovulatory cycle.

我们称之为月经周期或排卵周期。

There's two phases, a follicular phase and a luteal phase.

有两个阶段，卵泡期和黄体期。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

Follicular precedes the luteal phase.

卵泡出现在黄体期之前。

The luteal phase tends to be, if I heard correctly, fairly fixed, about 14 days.

如果我没听错的话，黄体期是相当固定的，大约 14 天。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

The follicular phase can vary in duration, maybe 10 to 14 days, maybe even 10 to 18 days.

卵泡期的持续时间可能有所不同，可能为 10 至 14 天，甚至可能为 10 至 18 天。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Depending on-

取决于-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

The person

那个人

Andrew Huberman:

安德鲁·休伯曼：

...

something about their brain to ovary communication.

关于他们的大脑与卵巢通讯的一些东西。

For those that aren't familiar with this, I always learned that estrogen primes progesterone.

对于那些不熟悉这一点的人，我总是知道雌激素会引发黄体激素。

That's kind of the really basic top contour description of the ovulatory cycle, that estrogen is going to slowly climb toward the point of ovulation, and then there's a peak, and then a drop, and then progesterone is going to dominate in the luteal phase, the second half.

这是排卵周期的基本顶部轮廓描述，雌激素将慢慢攀升至排卵点，然后出现一个峰值，然后下降，然后黄体酮将在黄体期（后半期）占主导地位。

You said that estrogen is associated with, at a psychological level and a physiological level, more energy, feelings of vitality, and some of that estrogen increase is actually coming from the one egg that got stimulated the most.

你说雌激素在心理层面和生理层面上与更多的能量和活力感相关，而雌激素的增加实际上来自于受刺激最多的一个卵子。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

The one that got selected.

被选中的那个。

So it picked for the team- ...

所以它选择了团队 - ...

potentially for the team, but got picked potentially for fertilization, and that egg sheds its corpus luteum, which is this piece of the egg, that then triggers the progesterone that dominates the luteal phase.

可能适合该团队，但被挑选出来可能用于受精，并且该卵子会脱落黄体，即卵子的这一部分，然后触发黄体期的黄体酮。

Do I have that right?

我有这个权利吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mostly.

主要是。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Yeah, please correct me where I'm wrong.

是啊，有说错的地方请指正。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

The follicle in which the egg grows, when you ovulate, it ruptures.

卵子生长的卵泡在排卵时会破裂。

The cyst bursts.

囊肿破裂。

A follicle is a cyst.

卵泡是一个囊肿。

A cyst is a fluid-filled structure.

囊肿是一种充满液体的结构。

Follicle is a fluid-filled structure that holds an egg.

卵泡是一种充满液体的结构，可容纳卵子。

So when you ovulate and you get that LH surge, the cyst bursts, it opens up, and the egg comes out of it, and then it re-heals and becomes the corpus luteum.

因此，当您排卵并且黄体生成素激增时，囊肿会破裂，打开，卵子会从中出来，然后它会重新愈合并成为黄体。

Andrew Huberman:

安德鲁·休伯曼：

Got it.

明白了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So just a little bit different in timing.

所以只是时间上有点不同。

And you're right with estrogen primes progesterone, but really we think about it at the layer of the uterus because estrogen stimulates the growth of that lining, and then progesterone stabilizes it and allows implantation to occur.

你说的雌激素启动孕激素是正确的，但实际上我们在子宫层考虑它，因为雌激素刺激子宫内膜的生长，然后孕激素稳定它并允许植入发生。

But the sequence of events of when you're estrogen dominant and progesterone deficient, which is the follicular phase, and people will come in having labs drawn randomly, and they're all concerned that they don't have progesterone.

但是，当你雌激素占主导地位而黄体酮缺乏时，即卵泡期，人们会随机抽取实验室，他们都担心自己没有黄体酮。

And when you talk to them about where they are in their cycle, you say, "You're not supposed to have progesterone.

当你和他们谈论他们在周期中的位置时，你会说，“你不应该有黄体酮。

That's your follicular phase.

那是你的卵泡期。

This is perfectly normal."

这是完全正常的。”

Andrew Huberman:

安德鲁·休伯曼：

Okay, great.

好的，太好了。

Thanks for that clarification.

感谢您的澄清。

I get a lot of questions about birth control-

我收到很多关于节育的问题 -

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm

嗯嗯

Andrew Huberman:

安德鲁·休伯曼：

...

on my social media handles.

在我的社交媒体手柄上。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Don't we all?

我们都不是吗？

Andrew Huberman:

安德鲁·休伯曼：

To be clear.

要明确的是。

It's a vast topic for exploration, but along the lines of what we're talking about now, I've heard, and I suspect it may not be true, but tell me, is there any evidence that taking birth control can disrupt the process that you just described?

这是一个值得探索的广阔话题，但按照我们现在谈论的内容，我听说过，我怀疑这可能不是真的，但告诉我，是否有任何证据表明采取节育措施可以扰乱你刚才描述的过程？

And when we talk about birth control, we should probably define what we're talking about.

当我们谈论节育时，我们或许应该定义我们所谈论的内容。

So there are hormone-based birth controls, AKA the pill.

因此存在基于激素的避孕措施，又称避孕药。

There are also hormone-based birth controls that are not in pill form.

还有非药丸形式的基于激素的避孕措施。

There are IUDs, there are copper IUDs, there are other IUDs.

有宫内节育器，有铜宫内节育器，还有其他宫内节育器。

Let's just talk about hormone-based contraception in females.

我们只谈谈女性的激素避孕。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay.

好的。

Andrew Huberman:

安德鲁·休伯曼：

Which many of them, as I understand, are estrogen mimics or estrogen themselves that suppress ovulation.

据我了解，其中许多是雌激素模拟物或雌激素本身，可以抑制排卵。

Do they diminish or increase the number of eggs that are taken from the vault?

它们会减少还是增加从金库取出的鸡蛋数量？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Fantastic question.

很棒的问题。

Let's talk about what people say is the pill.

我们来谈谈人们所说的药丸。

So let's specifically talk about combined oral contraception, the pill which has ethinyl estradiol and some type of progestin.

因此，让我们具体谈谈复合口服避孕药，即含有乙炔雌二醇和某种孕激素的药丸。

No, contraception does not change the release of eggs out of the vault.

不，避孕不会改变卵子从保险库中的释放。

They are occurring at the same process and the same pathway.

它们发生在相同的过程和相同的途径。

You're not ovulating because that estrogen does prevent FSH from coming from the brain, so you have the group of eggs still come out of the vault.

你没有排卵，因为雌激素确实会阻止 FSH 从大脑中排出，所以你的卵子仍然会从保险库中出来。

There's no FSH.

没有 FSH。

They just all die.

他们都死了。

The next group comes out.

下一组出来了。

So when you are saying, "Are you going to run out of eggs faster?

所以当你说：“你的鸡蛋会更快用完吗？

Is it going to harm your fertility?

它会损害你的生育能力吗？

Does birth control impair the process?" The answer's no. But there's a couple important caveats.

节育会损害这个过程吗？”答案是否定的。但有一些重要的警告。

One is that the birth control pills, especially if you take them continuously or for a prolonged period of time, the body's smart, and the ovaries start to say, "Well, we're not really doing anything." And one of those markers of ovarian reserve we have is AMH, and that's anti-Müllerian hormone.

一是避孕药，特别是如果你连续或长时间服用，身体会变得聪明，卵巢开始说：“好吧，我们并没有真正做任何事情。”我们拥有的卵巢储备标志物之一是 AMH，即抗苗勒氏管激素。

And AMH is made from the granulosa cells or the cells that surround every follicle.

AMH 由颗粒细胞或每个卵泡周围的细胞组成。

So in the shortest way possible, more eggs in the vault, more come out every month, higher AMH.

因此，以尽可能短的方式，储存更多的卵子，每月产出更多的卵子，从而提高 AMH。

Fewer eggs in the vault, fewer come out, lower AMH.

库里的卵子越少，出来的卵子就越少，AMH 就越低。

If your AMH is being suppressed because of the birth control pill, because it's decreasing the activity of those granulosa cells, you might get a low AMH value when you've been on the birth control pill for a long time.

如果您的 AMH 由于避孕药而受到抑制，因为它会降低颗粒细胞的活性，那么当您长期服用避孕药时，您的 AMH 值可能会较低。

That is completely reversible, but it can be significant.

这是完全可逆的，但可能意义重大。

So if somebody is wanting to get an AMH level, let's say somebody comes to my clinic, they're not trying to get pregnant, and they're on the pill, and they're considering freezing their eggs, so we're going to check their ovarian reserve.

因此，如果有人想要获得 AMH 水平，假设有人来到我的诊所，他们并没有试图怀孕，他们正在服用避孕药，他们正在考虑冷冻卵子，所以我们要检查他们的卵巢储备。

If we draw it, I always say this, AMH may be up to 30% lower in somebody who is on the birth control pill.

如果我们画出来，我总是这么说，服用避孕药的人 AMH 可能会降低 30%。

So we can still draw it, and if it comes back in the normal range, we feel good.

所以我们仍然可以画它，如果它回到正常范围内，我们感觉很好。

But if it does come back low, we're going to have to make a decision.

但如果它确实回到低位，我们将不得不做出决定。

Are we going to stop the birth control pill for a period of some months, use alternative contraception if you don't want to be pregnant, and then repeat this test to see if this is a true low?

我们是否要停止服用避孕药几个月，如果您不想怀孕，请使用替代避孕措施，然后重复此测试，看看这是否是真正的低值？

Because we do see that young women do have low ovarian reserve sometimes.

因为我们确实看到年轻女性有时卵巢储备确实较低。

Or was this just suppressed because you were on the birth control pill?

或者这只是因为您服用避孕药而被抑制？

So we see it impact some of the hormone testing that we can do, and I think that's an important distinction.

所以我们看到它影响了我们可以进行的一些激素测试，我认为这是一个重要的区别。

And we can see that the longer you take it, that potentially it might actually improve your fertility if you had underlying endometriosis or some medical conditions that we see associated with infertility.

我们可以看到，如果您患有潜在的子宫内膜异位症或我们认为与不孕相关的某些疾病，您服用的时间越长，它实际上可能会提高您的生育能力。

So prolonged pill users can potentially improve their fertility versus people who are trying to get pregnant that same age who were not on the pill.

因此，与同龄试图怀孕但未服用避孕药的人相比，长期服用避孕药的人可能会提高生育能力。

Those studies are complicated, right, because of selection bias.

由于选择偏差，这些研究很复杂，对吧。

Because if you've been on the pill for 10 years, you're a little bit older, so is it that they were preventing pregnancy and the other group potentially had some exposure, so they were inherently more infertile than the group that was on the pill?

因为如果你已经服用避孕药 10 年了，你的年龄就有点大了，所以他们是在避孕，而另一组可能有一些暴露，所以他们本质上比服用避孕药的那组更不孕？

But we do know that the pill doesn't cause infertility.

但我们确实知道避孕药不会导致不孕。

And I use it all the time.

我一直使用它。

All the time in IVF cycles, we put people on the birth control pill because we can actually synchronize that group of eggs that comes out of the vault to grow together.

在体外受精周期中，我们一直让人们服用避孕药，因为我们实际上可以同步从保险库中出来的那组卵子一起生长。

Because your body doesn't want to have 20 babies at one time, right?

因为你的身体不想同时生20个孩子，对吧？

And what we're trying to do with IVF, get 20 eggs to grow if that's what's out of the vault, really goes against the check and balance of the human body to not have 20 babies at once.

我们试图通过试管受精（IVF）做的事情，如果那是从保险库里取出来的，那么让 20 个卵子生长，这确实违背了人体不能同时生育 20 个婴儿的制衡机制。

Andrew Huberman:

安德鲁·休伯曼：

Why is it that males who take testosterone, synthetic testosterone, it shuts down their own testosterone production and sperm production, but females who take estrogen in the form of birth control pills, it doesn't shut down estrogen production by the ovaries?

为什么服用睾酮（合成睾酮）的男性会关闭自己的睾酮生成和精子生成，而服用避孕药形式的雌激素的女性却不会关闭卵巢的雌激素生成？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So I love this question.

所以我喜欢这个问题。

You know the answer, so I like it extra because I know you're asking.

你知道答案，所以我特别喜欢它，因为我知道你在问。

Spermatogenesis is a constant and ongoing process, right?

精子发生是一个持续不断的过程，对吧？

So in women, you're born with all the eggs you're ever going to have.

因此，对于女性来说，您生来就拥有将要拥有的所有卵子。

And what we're talking about is if we stop FSH at that moment, we're just impacting the ability to ovulate at that time.

我们所说的是，如果我们在那一刻停止 FSH，我们只会影响当时的排卵能力。

But we're not changing this constant loss throughout the vault.

但我们并没有改变整个金库的持续损失。

Spermatogenesis, right, the sperm is made every single day.

精子发生，对，精子每天都会产生。

You're making brand new sperm.

你正在制造全新的精子。

So 72 days for the sperm to be created in the testes and 18 days to find their way out the ejaculatory system.

因此，精子在睾丸中产生需要 72 天，需要 18 天才能离开射精系统。

And so exposures that you have that stop the production of FSH and LH inhibit the development, the creation of new sperm.

因此，停止 FSH 和 LH 产生的暴露会抑制新精子的发育和产生。

So somebody who's been on testosterone will tell the brain-- The brain doesn't know it's from your taking it.

因此，服用睾酮的人会告诉大脑——大脑不知道这是因为你服用了睾酮。

It says, "Hey, we have plenty of sperm.

它说：“嘿，我们有很多精子。

We're good.

我们很好。

We don't need any more." So the brain then gets suppressed and doesn't make that FSH and LH, therefore not stimulating both further testosterone production because you don't need that, but testosterone production and sperm production go hand in hand, so therefore you're no longer making new sperm.

我们不再需要了。”因此，大脑会受到抑制，不会产生 FSH 和 LH，因此不会进一步刺激睾酮的产生，因为你不需要它们，但睾酮的产生和精子的产生是齐头并进的，因此你不再产生新的精子。

And in fact, the longer you're on testosterone, the harder it may be to get sperm production to come back.

事实上，您服用睾酮的时间越长，恢复精子生成的难度就越大。

And in 25% of people, they may not get it back if they've been on prolonged testosterone exposure.

25% 的人如果长期接触睾酮，可能无法恢复睾酮。

So it's really because of what women will sometimes say is unfair, which is the fact that you're born with all these eggs and you run out of them.

所以这实际上是因为女性有时会说这是不公平的，那就是你生来就有这么多卵子，但后来却用完了。

They accumulate the wear and tear of your life, right?

它们积累了你生活中的磨损，对吗？

We see egg quality being a huge issue in female reproduction.

我们认为卵子质量是女性生殖的一个大问题。

Yet men get to have new sperm every 90 days.

然而男性每 90 天就会产生新的精子。

They get to wash away whatever bad deeds they did and can change their lifestyle and their exposures and have very different sperm.

他们可以洗掉自己所做的任何坏事，可以改变他们的生活方式和暴露的环境，并且拥有截然不同的精子。

But because of that same process, things that shut off the production of FSH, LH really impact sperm quite significantly.

但由于同样的过程，阻止 FSH、LH 产生的因素确实对精子产生相当显着的影响。

Andrew Huberman:

安德鲁·休伯曼：

You mentioned bad deeds for sperm.

你提到了对精子的坏行为。

Not by sperm.

不是通过精子。

I said for sperm.

我说的是精子。

And we know that heat is a pretty dramatic insult to the spermatogenesis cycle, saunas and hot tubs and whatnot.

我们知道，高温对精子发生周期、桑拿浴室、热水浴缸等来说是一种相当严重的伤害。

I did receive the question as to whether or not heat exposure, saunas, hot tubs, et cetera, are they detrimental to ovulation or egg production in any way?

我确实收到了这样的问题：热暴露、桑拿、热水浴缸等是否对排卵或产卵有任何损害？

Obviously things are more internal in females.

显然，女性的事情更加内在。

The ovaries are internal.

卵巢是内部的。

But is there any evidence for that?

但有证据证明这一点吗？

The body does heat up.

身体确实发热。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

It doesn't harm the ovulatory period or the ovaries.

它不会损害排卵期或卵巢。

And just like we know the reason why the testes are so susceptible is because they're supposed to be at a cooler temperature.

就像我们知道睾丸如此敏感的原因是因为它们应该处于较低的温度。

That's why they're in the scrotum outside the body.

这就是为什么它们位于体外的阴囊中。

That's why the testes are so susceptible to heat changes.

这就是为什么睾丸如此容易受到热变化的影响。

But the ovaries being inside the body, they're not in the same way.

但卵巢在体内，它们的情况并不相同。

Now when somebody's pregnant, important distinction, right?

现在，当有人怀孕时，重要的区别，对吧？

We know that the development, especially organ development of an embryo, can be more sensitive to certain things, and that heat exposure at that time, whether it's hot tub use or extreme fevers even, can make a difference in development of a fetus.

我们知道，胚胎的发育，尤其是器官的发育，可能对某些事物更加敏感，而当时的热暴露，无论是使用热水浴缸还是极度发烧，都会对胎儿的发育产生影响。

But when it's coming to the ovulatory cycle or hormone production, heat in the female doesn't make any difference.

但当涉及到排卵周期或激素产生时，女性的热量并没有任何影响。

Andrew Huberman:

安德鲁·休伯曼：

Well, I want to be clear before I ask the next question that I don't want to be responsible for any unwanted pregnancies.

好吧，在问下一个问题之前，我想澄清一下，我不想对任何意外怀孕负责。

But when I was in high school- ...

但当我上高中的时候——

they told us that women can get pregnant even while they have their period.

他们告诉我们，女性即使在月经期间也可以怀孕。

Is that true?

这是真的吗？

Seems like a lie based on everything you're saying.

从你所说的一切来看，这似乎是一个谎言。

But I don't want anyone to run out and test that hypothesis without having the facts first.

但我不希望任何人在没有先了解事实的情况下就去检验这个假设。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So in general, if somebody has extremely regular cycles, then that's a complete lie.

所以一般来说，如果某人的周期非常规律，那就完全是谎言。

You can't get pregnant on your period.

来月经的时候是不可能怀孕的。

The reason why they tell us this is one, especially when you're younger, your period cycles tend to be irregular.

他们告诉我们的原因之一是，尤其是当您年轻时，您的月经周期往往不规律。

Your body hasn't fully matured to have that regularity, and that we know that sperm do live in the reproductive tract for much longer than the egg does.

你的身体还没有完全成熟到具有这种规律性，而且我们知道精子在生殖道中存活的时间确实比卵子长得多。

So sperm can live there for up to five days.

因此精子可以在那里存活长达五天。

So if somebody did have a shorter period window, let's say their normal periods are going to be 24 days, they're ovulating on cycle day 10.

因此，如果某人的经期窗口确实较短，假设他们的正常经期为 24 天，那么他们的排卵期为周期第 10 天。

If they have a regular period that's five or six days, they could potentially have intercourse that end part of that period.

如果她们有五六天的规律经期，她们可能会在该经期结束时发生性行为。

The sperm could live for five days and be right there when you have the egg en route.

精子可以存活五天，并且当您在途中获得卵子时，精子就在那里。

So it's not the most fertile time for sure, and in most people, that is considered a time when you're not going to get pregnant.

所以这肯定不是最容易受孕的时间，而且对大多数人来说，这被认为是不会怀孕的时间。

But especially when you're younger and you have more irregularity, or in people who have a short cycle window, that might not be the case.

但尤其是当您年轻并且月经不规律的情况较多时，或者对于周期窗口较短的人来说，情况可能并非如此。

Andrew Huberman:

安德鲁·休伯曼：

So by extension, can we conclude then that the most fertile time is going to be when sperm meets egg, let's save timing of intercourse for-

因此，推而广之，我们是否可以得出结论，最受孕的时间是精子与卵子相遇的时间，让我们把性交的时间留到——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yep

是的

Andrew Huberman:

安德鲁·休伯曼：

...

for the time being, because there can be a delay there.

暂时，因为那里可能会有延迟。

When sperm meets egg on obviously day of ovulation or day after?

当精子在排卵日或排卵后一天与卵子相遇时？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Day of.

日.

Andrew Huberman:

安德鲁·休伯曼：

Day of.

日.

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

The egg lives for 24 hours.

鸡蛋可存活 24 小时。

So the egg can only be fertilized for 24 hours while it's in the fallopian tube.

因此，卵子在输卵管内的时间只有24小时才能受精。

Once the egg has entered the uterus, it can't be fertilized anymore.

一旦卵子进入子宫，就无法再受精。

So it has this very short window of time where it will allow sperm to enter it.

因此，精子进入的时间非常短。

Now, sperm can live for five days, so we'll say the fertile window is this five-day period ending on the day of ovulation.

现在，精子可以存活五天，所以我们说受孕窗口是指排卵日结束的这五天时间。

You will hear a lot of us, a lot of doctors, say the day after ovulation because do you really know exactly what time you ovulated on?

您会听到我们很多人、很多医生说排卵后的第二天，因为您真的知道自己排卵的具体时间吗？

And if the egg has 24 hours, then that extra day could potentially be helpful.

如果鸡蛋有 24 小时，那么额外的一天可能会有所帮助。

But really, it's five days ending on the day of ovulation.

但实际上，排卵日结束还有五天。

And people with very regular cycles or who can track them and they know when that ovulation is happening, the day before and the day of ovulation, those are the two top hitting days.

月经周期非常规律的人或者可以追踪周期的人，他们知道排卵何时发生，排卵前一天和排卵当天，这是两个最热门的日子。

So if you're kind of not in the mood to have lots of sex, those are going to be the days you target to have the highest chance of conceiving.

因此，如果您没有心情进行大量性行为，那么这些日子将是您受孕机会最高的日子。

Andrew Huberman:

安德鲁·休伯曼：

And what is the relationship between estrogen, libido, and ovulation in females?

女性雌激素、性欲和排卵之间有何关系？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

The higher your estrogen is, the increased libido that you're going to have.

您的雌激素越高，您的性欲就越强。

And of course, you see those peak estrogen levels, which are going to trigger that LH surge.

当然，您会看到雌激素水平达到峰值，这将引发 LH 激增。

So the body is made to get pregnant.

所以身体是为了怀孕而生的。

You're going to have that peak estrogen, that peak libido, right before and right at that ovulatory time period, so that hopefully you also want to have intercourse and get pregnant.

在排卵期之前和期间，您的雌激素和性欲会达到峰值，因此希望您也想进行性交并怀孕。

Andrew Huberman:

安德鲁·休伯曼：

I've heard before, let's just say, that some people, have to be careful here- ...

我以前听说过，这么说吧，有些人，必须要小心——......

can sense literally the deployment of the egg, the ovulation.

可以从字面上感觉到卵子的部署，即排卵。

They report that they can feel-

他们报告说他们能感觉到——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

let's just say, the departure of the egg.

就说蛋的离开吧。

Is that an imaginary thing?

这是想象出来的东西吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

No, that's very real.

不，那是非常真实的。

Andrew Huberman:

安德鲁·休伯曼：

I always like that image, that people can know when that happens, right?

我总是喜欢那个形象，人们可以知道什么时候发生，对吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's so real it has a name.

它是如此真实，它有一个名字。

Andrew Huberman:

安德鲁·休伯曼：

I mean, after all, men generally know when their sperm are leaving their body.

我的意思是，毕竟，男人通常知道他们的精子何时离开身体。

Let's hope they do.

让我们希望他们能做到。

But why wouldn't there be an internal sense for women also of what's going on?

但为什么女性对正在发生的事情没有一种内在的感觉呢？

I mean, we have interoception.

我的意思是，我们有内感。

There's a ton of nerve innervation of that area.

该区域有大量的神经支配。

But-

但是——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It doesn't communicate to the brain excellent as far as tracking to where that sensation is, but you're right.

就跟踪感觉的位置而言，它无法与大脑进行良好的沟通，但你是对的。

I already said ovulation is the rupture of a cyst, right?

我已经说过排卵就是囊肿破裂，对吗？

It is rupturing and the egg is being released, and those follicular fluid is also exiting and going into the peritoneal cavity.

它正在破裂，卵子正在被释放，那些卵泡液也正在离开并进入腹膜腔。

And so there is a group of women who can feel that, especially people who are very in tune with their body, and it has a name.

所以有一群女性能够感受到这一点，尤其是那些与自己的身体非常协调的人，并且它有一个名字。

It's called Mittelschmerz.

它的名字叫“米特尔施默茨”。

The pain almost feels like a crampy pain that happens in the middle of the cycle, and that is your ovulatory pain.

这种疼痛几乎感觉就像是在月经周期中间发生的痉挛性疼痛，这就是排卵疼痛。

Andrew Huberman:

安德鲁·休伯曼：

Oh, interesting.

哦，有趣。

What is it called?

它叫什么？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mittelschmerz.

米特尔施默茨。

Andrew Huberman:

安德鲁·休伯曼：

Okay, we'll put that in the show note captions-

好的，我们会把它放在节目注释标题中 -

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

and whoever does it is going to have to get the spelling right.

无论谁做这件事都必须确保拼写正确。

Mittelschmerz.

米特尔施默茨。

Amazing.

惊人的。

Amazing.

惊人的。

Amazing and foreign to me, but for obvious reasons, but amazing.

对我来说令人惊奇和陌生，但出于显而易见的原因，却令人惊奇。

I'm always astonished in how incredibly well-orchestrated this whole process is.

我总是对整个过程的精心策划感到惊讶。

It's just such an incredible feat of biology.

这真是生物学上令人难以置信的壮举。

I mean, the number of things that have to be timed correctly, and the use and, I don't want to say reuse, but the repurposing of tissues for different things.

我的意思是，必须正确计时的事物数量，以及使用，我不想说重复使用，而是将纸巾重新用于不同的事物。

What an incredible dance.

多么令人难以置信的舞蹈啊。

It's just amazing.

这真是太棒了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's beautiful.

很漂亮。

I mean, I'm so nerdy because I just love how everything has to communicate just perfectly.

我的意思是，我是如此书呆子，因为我只是喜欢一切都必须完美地沟通。

It makes you in awe of all the pregnancies that just happen, just all the time, because really things have to synchronize really at the wonderful time period.

它让你对所有刚刚发生的怀孕感到敬畏，一直都是这样，因为事情确实必须在美好的时间段同步进行。

And even though this isn't what we're talking about, I've heard you say this, so I want to say this.

尽管这不是我们正在讨论的内容，但我听你这么说过，所以我想说这个。

People always ask, every single day, "Well, how much sex should you have?

人们每天都会问，“那么，你应该有多少性行为？

When should you have sex?

你应该什么时候发生性行为？

Is there too much sex?" And what we know is that you definitely should not decrease your sexual intercourse interval.

是不是性生活太多了？”我们知道的是，你绝对不应该缩短性交间隔。

So if you are in a relationship and you are sex every day people, have sex every day.

因此，如果您处于恋爱关系中并且每天都做爱，那就每天都做爱。

You will 100% hit intercourse throughout your entire fertile window on the day that you ovulate.

在排卵当天，您将在整个受孕窗口内 100% 进行性交。

You're depositing the same sperm there because you're not generating new sperm.

你将相同的精子放在那里，因为你没有产生新的精子。

It's whether the load went half and half and half and half, or if it went in one big group.

问题在于负载是否一半一半一半一半，或者是否集中在一大堆中。

But if you're constantly putting more sperm out there, you have a higher chance.

但如果你不断地释放更多的精子，你的机会就会更高。

And so studies go back and always say daily intercourse associated with the highest chance of fecundability, especially during the fertile window.

因此，研究总是说日常性交与最高的受孕机会相关，尤其是在受孕窗口期。

However, for couples who are not sex every day people, that idea can cause a lot of stress.

然而，对于那些不是每天都有性生活的夫妇来说，这种想法可能会造成很大的压力。

Stress, of course, impacts the system in a lot of different ways.

当然，压力会以多种不同的方式影响系统。

It can also cause sexual burnout, where they no longer feel like being intimate or having sex on the day they're actually ovulating because they've been doing it this whole time leading up.

它还可能导致性倦怠，即她们在实际排卵日不再感觉亲密或做爱，因为她们在排卵前一直在这样做。

And that's where the time period of saying have sex every other day throughout the fertile window.

这就是在整个受孕窗口期间每隔一天发生性行为的时间段。

So starting five or six days before you think you're going to ovulate, and then try to target having intercourse on the day before and the day of ovulation.

因此，在您认为自己将要排卵之前五六天开始，然后尝试在排卵前一天和排卵当天进行性交。

And the reason why people said every other day or a few days prior, to kind of get some sperm exposure there in case you ovulated early, but really to try to prevent some of that increased stress that can happen when you're trying to conceive, especially if you have programmed or timed intercourse that needs to happen on an everyday interval.

这就是为什么人们说每隔一天或几天前，是为了让精子接触到那里，以防你排卵过早，但实际上是为了防止你试图怀孕时可能会发生的一些增加的压力，特别是如果你已经计划或定时性交，需要每天进行一次。

But the odds of getting pregnant by saving up sperm for two or three days, that's not higher.

但将精子保存两三天怀孕的几率并不高。

Andrew Huberman:

安德鲁·休伯曼：

I'm curious then why if, let's just say hypothetically, someone is donating or freezing sperm or doing IVF, why they instruct the male to not ejaculate for 48 to 72 hours prior to, let's just say, depositing sperm.

我很好奇，如果假设有人捐献或冷冻精子或进行体外受精，为什么他们会指示男性在存精之前 48 至 72 小时内不要射精。

It's such a funny word.

这是一个多么有趣的词啊。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It is.

是的。

Andrew Huberman:

安德鲁·休伯曼：

But it works, so

但它确实有效，所以

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Two points.

两点。

One, if we're doing a semen analysis, now we're trying to evaluate the sperm, and any test has certain normal parameters, and these are all based on a 48- to 72-hour abstinence period.

第一，如果我们正在进行精液分析，现在我们正在尝试评估精子，任何测试都有一定的正常参数，而这些都是基于 48 到 72 小时的禁欲期。

So yes, if you ejaculate more frequently, you're going to have less sperm, and that can be very normal, but if we're looking at a test with set normal parameters that are based on two to three days of not having intercourse, that's why we want you to do it for that.

所以，是的，如果你射精更频繁，你的精子就会减少，这可能是非常正常的，但如果我们正在考虑一项基于两到三天没有性交的设定正常参数的测试，这就是为什么我们希望你这样做。

If we're doing, let's say, IUI, or intrauterine insemination, also known as artificial insemination, or where we take the sperm and put it in a catheter and put it in the uterus, we're trying to get more players further down the field.

如果我们正在进行宫腔内人工授精（IUI）或宫内授精，也称为人工授精，或者我们将精子放入导管中并放入子宫，我们正在努力吸引更多的参与者进入该领域。

And in that case, I know when you ovulate because I'm timing it perfectly, and I am trying to get as many possible in this process because we're not just having them deposited in the vagina, we're trying to get them further.

在这种情况下，我知道你什么时候排卵，因为我的时间安排得很完美，而且我试图在这个过程中获得尽可能多的排卵，因为我们不只是让它们沉积在阴道中，我们还试图让它们走得更远。

So we want more because that's part of that treatment process.

所以我们想要更多，因为这是治疗过程的一部分。

And similarly with IVF, I want to have as many sperm as possible to sort through and pick out the best looking, the most motile, the most normally shaped ones.

与体外受精类似，我希望有尽可能多的精子来分类并挑选出最好看、最有活力、形状最正常的精子。

So we're trying to get just a better sample, and by having these normal guidelines, we're able to judge this is low for what it should be, which can also be a clue to other problems.

因此，我们试图获得更好的样本，通过这些正常的指导方针，我们能够判断这个值低于应有的水平，这也可以成为其他问题的线索。

Andrew Huberman:

安德鲁·休伯曼：

I definitely want to talk about chemistry, both sort of interpersonal chemistry and literally ejaculate and vaginal chemistry.

我绝对想谈谈化学，包括人际化学以及射精和阴道化学。

But before we do that, I'm curious whether or not we can just touch on a few of the things that a lot of people wonder about in terms of egg quality.

但在此之前，我很好奇我们是否可以谈谈很多人对卵子质量感到好奇的一些问题。

And if they touch on sperm quality, maybe we can also just mention that.

如果它们涉及精子质量，也许我们也可以提一下。

But for instance, does cannabis, either by edible or by smoking cannabis, impact egg quality in either direction?

但例如，大麻，无论是通过食用还是通过吸食大麻，都会从两个方向影响鸡蛋质量吗？

Alcohol would be the next.

酒精将是下一个。

And then I'm going to assume, and I have to do this strictly because of what I understand about drugs of abuse like cocaine and amphetamine, methamphetamine, that none of those can be good for systems of the body because they create so much stress for the body.

然后我会假设，我必须严格这样做，因为我对可卡因、安非他明、甲基苯丙胺等滥用药物的了解，这些药物都不会对身体系统有好处，因为它们会给身体带来很大的压力。

But let's just say alcohol and cannabis.

但我们只说酒精和大麻。

I read a statistic when researching the episode on cannabis that shocked me, which is that 15%, 1-5%, not 1.5, 15% of American women, at least in this one study, a survey, reported having consumed or smoked cannabis during known pregnancy, which is wild.

在研究有关大麻的事件时，我读到了一项令我震惊的统计数据，即 15%、1-5%，而不是 1.5、15% 的美国女性，至少在这项研究、一项调查中，报告说在已知的怀孕期间消费或吸过大麻，这是疯狂的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Wild.

狂野。

Andrew Huberman:

安德鲁·休伯曼：

Unless, of course, I'm just naive and THC is not harmful to the fetus, but I have a hard time believing that.

当然，除非我只是天真，四氢大麻酚对胎儿不会有害，但我很难相信这一点。

So what gives?

那么什么给出呢？

And there I actually just threw in fetal development.

我实际上只是把胎儿的发育投入其中。

So is cannabis, is alcohol bad for egg quality?

那么大麻、酒精对卵子质量有害吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So they're different things, and they're the same thing in one.

所以它们是不同的东西，但又是同一个东西。

So let's answer them each individually.

因此，让我们分别回答它们。

So we'll go with the one that everybody knows and has accepted now that they wouldn't have accepted 40 years ago, right?

因此，我们将选择每个人都知道并已接受的方案，而在 40 年前他们是不会接受的，对吧？

Smoking cigarettes.

抽烟。

So that's obviously bad.

所以这显然很糟糕。

Decreases the number of eggs you have in the vault.

减少金库中鸡蛋的数量。

Smoking cigarettes actually gets into your vault, decreases the number that you have.

吸烟实际上会进入你的金库，减少你拥有的数量。

You have a higher chance of going into menopause earlier, and it increases the risk of having abnormal chromosomes, which is what we really think about when we think about egg quality, right?

您提前进入更年期的机会更高，并且增加了染色体异常的风险，这才是我们在考虑卵子质量时真正考虑的问题，对吗？

Impacting those meiotic spindles inside the eggs which hold the chromosomes in their perfect position.

影响卵子内的减数分裂纺锤体，这些纺锤体将染色体保持在完美的位置。

They are associated, they get wear and tear from things that cause inflammation or are toxic.

它们是相关的，它们会因引起炎症或有毒的物质而磨损。

So cigarette smoke we know decreases egg quality, egg quantity, increases miscarriage, and then of course has fetal impacts.

因此，我们知道，香烟烟雾会降低卵子的质量和数量，增加流产率，当然还会对胎儿产生影响。

Andrew Huberman:

安德鲁·休伯曼：

Could I just ask you?

我可以问你一下吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Because when we talk about, there's nicotine, which itself is not carcinogenic, and then there's the smoking process, which brings in a bunch of other things.

因为当我们谈论时，有尼古丁，它本身并不致癌，然后是吸烟过程，它带来了一堆其他东西。

The question I know is burning in everybody's mind is vaping.

我知道每个人都在思考一个问题：电子烟。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Let's-

让我们-

Andrew Huberman:

安德鲁·休伯曼：

Right?

对吗？

Because vaping is-- I'm very bullish on this.

因为电子烟是——我非常看好这一点。

It's very clear that the chemicals associated with vaping are just oh so bad for everybody's health.

很明显，与电子烟相关的化学物质对每个人的健康都非常有害。

But it's distinctly different from saying that nicotine is bad-

但这与说尼古丁不好有明显不同——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Correct

正确

Andrew Huberman:

安德鲁·休伯曼：

...

for one's health.

为了一个人的健康。

And it can be, but without doing too much of a deep dive, are there any data that show that vaping is bad for egg quality?

确实有可能，但在不做太多深入研究的情况下，是否有任何数据表明电子烟对卵子质量有害？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Of course there's not as much data because it just hasn't been around as long.

当然，没有那么多数据，因为它存在的时间不长。

But yes, vaping definitely has chemicals that looks like it's associated with poor success rates in IVF cycles, and that's really kind of one of the most finite measures of egg quality we can see because we're really testing the egg at a level in a lab versus just are you getting pregnant naturally.

但是，是的，电子烟中肯定含有化学物质，看起来它与体外受精周期的成功率较低有关，这确实是我们能看到的最有限的卵子质量衡量标准之一，因为我们实际上是在实验室中测试卵子，而不是自然怀孕。

Andrew Huberman:

安德鲁·休伯曼：

And sorry to interject again, but anytime a conversation like this comes up, especially between two people in the health science space, there are these shouts, because I hear them literally, where people say, "Well, listen, I vaped-

很抱歉再次插话，但是每当出现这样的对话时，尤其是在健康科学领域的两个人之间，都会有这些喊叫，因为我确实听到了他们的声音，人们说，“好吧，听着，我吸了——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, yes

哦，是的

Andrew Huberman:

安德鲁·休伯曼：

...

every day and I've had three healthy babies." And I think that my response is always, okay, there's going to be a distribution of responses, and then of course, how much healthier could your babies have been-

每天，我都生下了三个健康的婴儿。”我认为我的反应总是，好吧，反应会有一定的分布，当然，你的宝宝会健康得多——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Have been

曾经有过

Andrew Huberman:

安德鲁·休伯曼：

...

had you not vaped during pregnancy or vaped prior to pregnancy or-

您是否在怀孕期间或怀孕前没有吸过电子烟，或者-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Well, sure, and these-

嗯，当然，还有这些——

Andrew Huberman:

安德鲁·休伯曼：

I think these are the key issues that you can't rewind the clock as far as I know, right?

我认为这些是据我所知无法倒转的关键问题，对吗？

In the absence of a time machine, you can't rewind the clock.

在没有时间机器的情况下，你无法让时钟倒转。

So, basically everything you're saying is that smoking cigarettes or vaping nicotine just can't be good for egg quality.

所以，基本上你所说的一切都是吸烟或电子烟尼古丁对卵子质量没有好处。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

We know that.

我们知道这一点。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

We know that it's not good for getting pregnant.

我们知道这对怀孕不利。

We know that it's not good for sperm.

我们知道这对精子不利。

And therefore, we also know it's going to impact pregnancy rates.

因此，我们也知道这会影响怀孕率。

Things like cannabis, right?

像大麻这样的东西，对吗？

Decreases sperm production, decreases sperm motility, changes sperm morphology, the shape of it, changes the DNA, increases the fragmentation of the DNA.

减少精子产量、降低精子活力、改变精子形态、改变 DNA、增加 DNA 碎片。

If your partner uses cannabis and you get pregnant, you have a higher chance of miscarriage because of the sperm association with the cannabis.

如果您的伴侣使用大麻而您怀孕了，那么您流产的可能性会更高，因为精子与大麻有关。

Now-

现在——

Andrew Huberman:

安德鲁·休伯曼：

Edible cannabis as well as smoke cannabis

食用大麻和吸食大麻

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

I don't know, right?

我不知道，对吧？

Because you can't study something that's illegal, so a lot of this data is just more new, and a lot of it's going to be observational.

因为你无法研究非法的东西，所以很多数据都是新的，而且很多都是观察性的。

Andrew Huberman:

安德鲁·休伯曼：

And in states like Colorado and California, where cannabis is essentially legal-

在科罗拉多州和加利福尼亚州等州，大麻基本上是合法的——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm

嗯嗯

Andrew Huberman:

安德鲁·休伯曼：

...

I'm assuming there are more data.

我假设还有更多数据。

But okay, so smoking and/or vaping nicotine, cannabis, either edible or smoked, very likely detrimental to egg quality and sperm quality.

但是，好吧，所以吸烟和/或吸食尼古丁、大麻，无论是食用还是熏制，很可能对卵子质量和精子质量有害。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Which is not to say that one can't conceive.

这并不是说不能怀孕。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

No.

不。

Andrew Huberman:

安德鲁·休伯曼：

It just means that the quality of your baby, your child, will not be as high as the quality of that baby if you didn't do that.

这只是意味着，如果你不这样做，你的宝宝、你的孩子的质量将不会像那个宝宝的质量那么高。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And certain-

并且确定——

Andrew Huberman:

安德鲁·休伯曼：

Is that right?

是这样吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes, and certain-

是的，并且肯定——

Andrew Huberman:

安德鲁·休伯曼：

And I'm not trying to demonize anyone that did do this during pregnancy.

我并不是想妖魔化那些在怀孕期间做过这种事的人。

A lot of people didn't know, but this is really about people trying to make choices in anticipation of future pregnancy.

很多人不知道，但这确实是人们在预期未来怀孕时试图做出的选择。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, and when you're trying to set yourself up for success, because we know infertility is becoming more common.

是的，当您试图为自己的成功做好准备时，因为我们知道不孕症正变得越来越普遍。

We don't always know who is going to have it, and when you find yourself in that position specifically, you now want to optimize everything you can.

我们并不总是知道谁会拥有它，当你发现自己处于这个位置时，你现在想要优化一切。

So if there's something that is going to make the sperm quality worse and the egg quality worse, and your success with treatment lower and your miscarriage rate higher, we're going to recommend that you not do it.

因此，如果有什么事情会导致精子质量和卵子质量变差，导致您的治疗成功率较低、流产率较高，我们建议您不要这样做。

If you're trying to get pregnant naturally, all these things correlate over.

如果您想自然怀孕，所有这些因素都会相互关联。

But of course, there's always going to be outliers and exceptions.

但当然，总会有异常值和例外情况。

I'm going to sit here and tell you that the odds of getting pregnant at age 43 are less than 3% per month, and every single person is going to be like, "But my Aunt Barbara," or, "I know this person who did," because 3% is not zero.

我要坐在这里告诉你，43 岁时怀孕的几率每月不到 3%，每个人都会说，“但是我的芭芭拉阿姨”，或者“我认识这个怀孕的人”，因为 3% 不是零。

Andrew Huberman:

安德鲁·休伯曼：

And you're talking about natural pregnancy there.

你说的是自然怀孕。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Natural.

自然。

Andrew Huberman:

安德鲁·休伯曼：

By intercourse.

通过交往。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Having-- Old-fashioned way, yes.

有——老式的方式，是的。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

But yes, so people will get pregnant.

但是，是的，所以人们会怀孕。

People will have healthy children who do have exposures to nicotine, to cannabis, even to alcohol, even though we know that alcohol can cause fetal alcohol syndrome.

人们会生出健康的孩子，但他们确实接触过尼古丁、大麻，甚至酒精，尽管我们知道酒精会导致胎儿酒精综合症。

0% of alcohol should be the acceptable level in pregnancy.

0% 的酒精含量应该是怀孕期间可接受的水平。

And then does alcohol impact fertility?

那么酒精会影响生育能力吗？

Such a complicated question, and this is probably due to the amount you consume and the frequency of which you consume it.

这是一个复杂的问题，这可能是由于您消耗的量和消耗的频率造成的。

Alcohol is a toxin that your liver must filter out, and we know it causes inflammation.

酒精是一种肝脏必须过滤掉的毒素，我们知道它会引起炎症。

Anybody who's had a fun night with alcohol knows they can wake up the next day and they feel different.

任何一个喝过酒度过愉快夜晚的人都知道，他们第二天醒来时会感觉不一样。

Their body is processing that alcohol.

他们的身体正在处理酒精。

And that inflammation, especially if it's chronic, chronic exposure, we know chronic inflammation is one of the things that we see impacting egg quality and sperm quality.

炎症，尤其是慢性暴露，我们知道慢性炎症是影响卵子质量和精子质量的因素之一。

So certainly, if you enjoy alcohol, it should be something that is done in moderation, one or two drinks a week at the most, and you should not do it at all once you find out you're pregnant.

所以当然，如果你喜欢喝酒，就应该适量，每周最多喝一到两杯，一旦发现自己怀孕了，就根本不应该喝酒。

Andrew Huberman:

安德鲁·休伯曼：

When we were talking about birth control, I unfortunately moved us forward and forgot to ask about IUDs.

当我们谈论节育时，不幸的是我把我们推进了一步，忘记询问宫内节育器的问题。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, yeah.

哦，是的。

Andrew Huberman:

安德鲁·休伯曼：

So, my understanding is that the copper IUD works by creating a sort of, not actually electric, but a kind of an electric fence that kills sperm.

所以，我的理解是，铜宫内节育器的工作原理是创造一种实际上不是电的，而是一种杀死精子的电围栏。

Like sperm don't like copper.

就像精子不喜欢铜一样。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I love that analogy.

我喜欢这个比喻。

Yeah, I love that one.

是的，我喜欢那个。

Andrew Huberman:

安德鲁·休伯曼：

Sperm don't like copper.

精子不喜欢铜。

Copper likes to kill sperm.

铜喜欢杀死精子。

There's some interesting history.

有一些有趣的历史。

I've been reading a lot on the history of medicine, of people who, for whatever reason, were forced into or chose to be in the sex trade, prostitutes inserting copper coins into their vaginal tract to try and kill sperm-

我读了很多关于医学史的书，了解那些出于某种原因被迫或选择从事性交易的人，妓女将铜币插入阴道试图杀死精子——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Kill sperm

杀死精子

Andrew Huberman:

安德鲁·休伯曼：

...

but to varying degrees of success.

但取得了不同程度的成功。

Obviously, there's a whole socioeconomic landscape around that.

显然，这涉及整个社会经济格局。

So, I think it's obvious what I'm referring to, but very interesting.

所以，我认为我所指的内容很明显，但也很有趣。

But that's just one form of IUD.

但这只是宫内节育器的一种形式。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Right?

对吗？

There are some other IUDs, and then there's, of course, the ring.

还有其他一些宫内节育器，当然还有环。

We didn't talk about that.

我们没有谈论这个。

So maybe we just touch on a few of those within the context of whether or not it alters egg quality and/or future fertility when one takes the ring out, takes the IUD out.

因此，也许我们只是讨论其中的一些问题，即当人们取出环、取出宫内节育器时，它是否会改变卵子质量和/或未来的生育能力。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

This is a great question because a lot of people don't know this, and I'll roll through a few of the top birth control methods and just thinking through.

这是一个很好的问题，因为很多人不知道这一点，我将介绍一些顶级的节育方法并进行思考。

Copper IUD, as you already said, no hormonal involvement.

铜宫内节育器，正如您已经说过的，没有激素参与。

It causes inflammation and a toxic environment inside the uterus, isolated.

它会导致子宫内炎症和有毒环境，被隔离。

Does cause sometimes heavier periods, but they should still be regular.

有时确实会导致月经量增多，但仍应保持规律。

If they are irregular, that's a sign of a hormonal issue because you still ovulate with a copper IUD.

如果它们不规则，那就是荷尔蒙问题的征兆，因为您在使用含铜宫内节育器时仍然会排卵。

Andrew Huberman:

安德鲁·休伯曼：

Is it literally a copper wire woven into the tissue of the uterus?

它真的是一根编织到子宫组织中的铜线吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Well, the IUD is a little T, and the arms have copper wires wrapped around them.

嗯，宫内节育器是一个小 T 形，手臂上缠绕着铜线。

Andrew Huberman:

安德鲁·休伯曼：

And those, they grow into the uterine lining?

那些，它们长进子宫内膜？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They don't grow into the uterine lining.

它们不会长入子宫内膜。

The IUD just sits in there, and just the presence of that copper causes that inflammatory reaction and that toxic environment.

宫内节育器就放在那里，仅仅铜的存在就会引起炎症反应和有毒环境。

Andrew Huberman:

安德鲁·休伯曼：

And is it toxic to the environment in ways that are detrimental to the woman or just to sperm?

它对环境的毒性是否会损害女性或仅损害精子？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Both.

两者皆有。

Implantation is not going to occur, likely, right?

植入可能不会发生，对吗？

Nothing is 100% successful, but it's much harder for an embryo to implant within that highly inflammatory environment.

没有什么是 100% 成功的，但胚胎在高度炎症的环境中植入要困难得多。

Andrew Huberman:

安德鲁·休伯曼：

To me, amazing that people figured this out before-

对我来说，令人惊讶的是人们之前就发现了这一点-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, it's fascinating

哦，真迷人

Andrew Huberman:

安德鲁·休伯曼：

...

the advent of laboratories.

实验室的出现。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

Let's just put some copper in some uteruses and see what happens.

让我们将一些铜放入一些子宫中，看看会发生什么。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

It really speaks to the urgency that must have existed to preventing pregnancy, and just how costly biologically and-

这确实说明了预防怀孕的紧迫性，以及生物学上的代价有多大——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

A pregnancy is, right

怀孕是对的

Andrew Huberman:

安德鲁·休伯曼：

...

financially pregnancy is.

经济上怀孕是。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And pregnancy is not health neutral, so it is something that somebody needs to be in of right health, or it can be a deadly circumstance.

怀孕对健康并不是中性的，所以怀孕时必须保持健康，否则可能会致命。

When we get back to other IUDs, so IUDs that more people are more familiar with are the progesterone-based IUDs.

当我们回到其他宫内节育器时，更多人更熟悉的宫内节育器是基于黄体酮的宫内节育器。

This is going to be your Mirena, Kyleena, Liletta.

这将是您的 Mirena、Kyleena、Liletta。

They have a bunch of different names based on the amount of progesterone and how long they last for.

根据黄体酮的含量和持续时间，它们有很多不同的名称。

These work mostly by thinning out the uterine lining.

这些主要通过使子宫内膜变薄来起作用。

As we already said, progesterone compacts the uterine lining to prepare it for implantation in a normal cycle.

正如我们已经说过的，黄体酮会压缩子宫内膜，为正常周期的着床做好准备。

But if you have constant exposure to progesterone, what is going to happen is it's going to prevent the uterine lining from growing, and it gets it very, very thin.

但如果你持续接触黄体酮，将会发生的情况是它会阻止子宫内膜生长，并且使它变得非常非常薄。

Not all IUDs, in fact, most of them don't prevent ovulation.

事实上，并非所有宫内节育器都不能阻止排卵。

Only in about 50% of people do they actually prevent ovulation.

只有大约 50% 的人能够真正阻止排卵。

So their main mechanism of action is this endometrial effect.

所以它们的主要作用机制就是这种子宫内膜效应。

When you remove the IUD, especially if you are already ovulating, no problem.

当您取出宫内节育器时，特别是如果您已经排卵，则没有问题。

The problem we do see in some people with progesterone IUDs that maybe isn't talked about as much is that this prolonged progesterone exposure, because people are putting IUDs in for five to seven years, and not having a period for that length of time because the endometrium has become so atrophic or nonexistent, that you're no longer bleeding despite the fact that you may be ovulating.

我们确实在一些使用黄体酮宫内节育器的人中看到的问题可能没有被太多谈论，那就是这种长时间的黄体酮暴露，因为人们将宫内节育器放置五到七年，并且由于子宫内膜变得如此萎缩或不存在而在那么长的时间内没有月经，以至于尽管您可能正在排卵，但您不再出血。

It can take a while for that lining to grow back.

该衬里可能需要一段时间才能重新长出来。

And so it's not uncommon to have an IUD in place, and if you have no period, you're going to say, "This is great.

因此，放置宫内节育器并不罕见，如果您没有月经，您会说：“这太棒了。

I don't have a period.

我没有月经。

Wonderful." You get it removed, and now your period hasn't come back.

太棒了。”你把它取出来，现在你的月经还没有回来。

And that leads people to sometimes be concerned that the IUD's causing them not to ovulate, or they have this infertility caused by the IUD.

这导致人们有时担心宫内节育器导致他们不排卵，或者他们因宫内节育器而导致不孕。

But really what it is, is that the lining's become so, so thin that it can take many months of that unopposed estrogen exposure in the follicular phase to get it thick enough to finally bleed when you're ovulating.

但实际上，内膜变得非常非常薄，以至于在卵泡期需要数月的无对抗雌激素暴露才能使其足够厚，最终在排卵时出血。

So I do tell people if they have a progesterone IUD to get it removed three to six months before they want to get pregnant, use some other form of contraception, but give their body time to make sure they have that regular period pattern back.

因此，我确实告诉人们，如果他们有黄体酮宫内节育器，请在想要怀孕前三到六个月将其取出，使用其他形式的避孕措施，但给他们的身体时间以确保他们恢复正常的月经模式。

Important distinction, if you're still ovulating and having a period on an IUD, then this is going to be less of a concern, because if you're growing enough of a lining to then shed it, we're less worried about it.

重要的区别是，如果您仍在排卵并且正在使用宫内节育器来月经，那么这就不那么令人担忧，因为如果您的内膜生长得足够多，然后会脱落，我们就不会那么担心。

But if you are amenorrheic or have absence of your periods with an IUD, we need to think about removing it for a period of time before you get pregnant so that your body can grow that lining again.

但如果您闭经或因使用宫内节育器而停经，我们需要考虑在怀孕前将其取出一段时间，以便您的身体可以再次长出内膜。

When it comes to some of the other things that you mentioned, one you didn't ask that I want to mention is the Depo-Provera shot.

当谈到你提到的其他一些事情时，你没有问我想提的是 Depo-Provera 镜头。

The Depo-Provera shot is a high dose of progesterone, high enough to actually prevent ovulation.

Depo-Provera 注射液含有高剂量的黄体酮，高到足以真正阻止排卵。

So in that circumstance, you are not ovulating, and therefore, if you don't ovulate, you're not going to get pregnant.

因此，在这种情况下，您不会排卵，因此，如果您不排卵，您就不会怀孕。

Depo-Provera's proven to prevent ovulation for three months.

Depo-Provera 已被证明可以阻止排卵三个月。

So when you take it, you need to get it every three months to have a proven contraceptive benefit.

因此，当您服用它时，您需要每三个月服用一次，才能获得经过验证的避孕效果。

However, it can last in your system for 18 months and prevent ovulation for up to 18 months.

然而，它可以在您的系统中持续 18 个月，并阻止排卵长达 18 个月。

So I will see people who liked that option for contraception, and now they haven't had a period in a long time, but their last Depo shot was six months ago, and they're all frustrated by the fact when I tell them, "Well, you still may not have another period for a year plus," because this high level of progesterone that you've already injected into your system can last a substantial amount of time.

所以我会看到那些喜欢这种避孕方法的人，现在他们已经很长一段时间没有来月经了，但他们最后一次注射 Depo 是在六个月前，当我告诉他们“好吧，你可能一年多都不会再来一次月经”时，他们都会感到沮丧，因为你已经注射到你的系统中的这种高水平的黄体酮可以持续很长一段时间。

So that is a contraceptive option that I tell people to discontinue a year and a half to two years before they want to get pregnant, which sometimes people don't know that yet.

因此，这是一种避孕选择，我告诉人们在想要怀孕前一年半到两年停止使用，有时人们还不知道这一点。

And so that's something that can be a contraceptive option if you're very remote from wanting to have a child.

因此，如果您非常不想要孩子，那么这可以作为一种避孕选择。

But in people who are in their childbearing years contemplating family-building soon, that is not my favorite option.

但对于处于育龄期、考虑尽快建立家庭的人来说，这不是我最喜欢的选择。

Andrew Huberman:

安德鲁·休伯曼：

So you haven't mentioned, because I haven't asked, any negative consequences of birth control of any kind.

所以你没有提到，因为我没有问过，任何形式的节育的负面后果。

And I'm not encouraging you to if you don't believe in them.

如果你不相信它们，我不会鼓励你这样做。

I know that-

我知道——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

噢

Andrew Huberman:

安德鲁·休伯曼：

...

this is a very controversial topic.

这是一个非常有争议的话题。

But one of the more popular studies discussed on social media is one that I've spent some time with the paper, and a few of the papers that stemmed from it.

但社交媒体上讨论的一项更受欢迎的研究是我花了一些时间研究这篇论文以及由此衍生的一些论文。

Not a huge study, but describing that how women rate the faces of men as either more...

这不是一项大型研究，但描述了女性如何评价男性的面孔……

Essentially what happens is there seems to be, at least in this study, there was a statistically significant bias for women to select particular male faces as attractive, and those male faces tended to be of the more square jaw, aka masculine features, right?

本质上发生的情况是，至少在这项研究中，女性在选择特定男性面孔作为有吸引力时存在统计学上的显着偏见，而这些男性面孔往往具有更方下巴，也就是男性特征，对吗？

In air quotes, right?

空中引号，对吗？

This is what the study found.

这就是研究发现的。

But that when women were on oral contraception, presumably estrogen and progestin type oral contraception, that that effect was smeared.

但当女性服用口服避孕药（大概是雌激素和孕激素类口服避孕药）时，这种效果就被抹去了。

They had not a statistically significant tendency to choose the quote-unquote "more masculine face." So I have to be very careful with my language here because it's easy to get description of a study like this wrong.

他们没有统计上显着的倾向去选择“更男性化的面孔”。所以我在这里必须非常小心我的语言，因为很容易对这样的研究进行错误的描述。

And that has led a lot of people to think that birth control is going to throw off their partner choice.

这让很多人认为节育会影响他们对伴侣的选择。

Now, of course, it's a small study.

当然，现在这只是一项小型研究。

Studies like it are not always so well-controlled.

类似的研究并不总是那么受到良好的控制。

But is there any evidence that birth control, oral estrogen, progestin-based birth control, just to keep it specific, can increase rates of cancers, can decrease rates of cancers, can lead to any sorts of disruptions in bodily function or health that's really a rock-solid result, that's been seen by multiple studies, clinical trials, or are we still just in the dark about a lot of this stuff?

但是，是否有任何证据表明节育、口服雌激素、基于孕激素的节育，只是为了保持其特异性，可以增加癌症发病率，可以降低癌症发病率，可以导致身体机能或健康的任何形式的破坏，这确实是一个坚如磐石的结果，这是多项研究、临床试验所证实的，还是我们对这些东西仍然一无所知？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay, so nothing is without risk.

好吧，所以没有什么是没有风险的。

Getting pregnant's not without risk.

怀孕并非没有风险。

Taking the birth control pill is not without risk.

服用避孕药并非没有风险。

We do see that there's been a lot of not informed consent in people who are taking the birth control pill, meaning maybe they weren't educated about what all of their options were, the positives and the negatives about each one of them.

我们确实看到，服用避孕药的人中有很多人没有知情同意，这意味着他们可能没有接受过有关所有选择的教育，以及每一种选择的积极和消极方面的教育。

If we're going to reference the convo to the pill, estrogen, progesterone pill, important to understand that neither the estrogen nor the progesterone are the same estrogen and progesterone that your ovaries make, right?

如果我们将避孕药称为雌激素、黄体酮药丸，那么重要的是要了解雌激素和黄体酮与卵巢产生的雌激素和黄体酮不同，对吧？

It's ethinyl estradiol, which your brain interprets as an estrogen, but other parts of your body may not.

它是乙炔雌二醇，您的大脑将其解释为雌激素，但您身体的其他部位可能不会。

And then it's various types of progestins, some of which have even androgenic or male hormone-like properties, and some of which do not.

然后是各种类型的孕激素，其中一些甚至具有雄激素或类似雄性激素的特性，而另一些则没有。

So there's a ton of variation, even the amount of ethinyl estradiol that each pill has with your low-low and your low pills having less, and even with the modern-day average pill having a lot less estrogen than it used to.

因此，存在很大的差异，甚至每种药片中乙炔雌二醇的含量也存在差异，低药丸和低药丸的含量较少，即使现代普通药丸的雌激素含量也比以前少得多。

When you're on the birth control pill, your ovaries aren't making estradiol, and that estradiol is important in growing the uterine lining, but also for the genital structures.

当您服用避孕药时，您的卵巢不会产生雌二醇，而雌二醇对于子宫内膜的生长很重要，而且对于生殖器结构也很重要。

And so we think about vaginal health and vulvar health.

因此，我们会考虑阴道健康和外阴健康。

We certainly see that, especially with continuous use.

我们当然看到了这一点，特别是在持续使用的情况下。

So if we distinguish You take the pill for 21 days, and you have a seven-day break where you might bleed, or you take sugar pills, and then you take them again.

因此，如果我们区分您服用药丸 21 天，并且您有 7 天的休息时间，可能会出血，或者您服用糖丸，然后再次服用。

A lot of people now are taking continuously, where you have exposure to these compounds every single day.

现在很多人都在连续服用，每天都会接触到这些化合物。

Andrew Huberman:

安德鲁·休伯曼：

So in the wheel, the little pouch with the wheel of different colored pills.

所以在轮子里，小袋子里装着不同颜色的药丸。

May have seen these on the counter shop in previous relationships.

可能在以前的关系中在柜台商店见过这些。

And then there's the ones that sometimes people just opt not to take.

还有一些有时人们只是选择不接受。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Because those are the pl-

因为那些是 pl-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

The placebos.

安慰剂。

Andrew Huberman:

安德鲁·休伯曼：

Not the placebo, the-

不是安慰剂，是——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They are.

他们是。

They're sugar pills

它们是糖丸

Andrew Huberman:

安德鲁·休伯曼：

...

sugar pills.

糖丸。

There's no need to take estrogen during that phase.

在此阶段不需要服用雌激素。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

Andrew Huberman:

安德鲁·休伯曼：

And then they repeat.

然后他们重复。

Is that-

难道是——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Exactly.

正是如此。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

But some people are taking estrogen-

但有些人正在服用雌激素——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Continuously

不断地

Andrew Huberman:

安德鲁·休伯曼：

...

all the way around the dial.

一直围绕表盘。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's very common right now.

现在这种情况很常见。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And they're not wrong.

他们并没有错。

They say, "Oh, well, why have a period in these little breaks?

他们说：“哦，好吧，为什么要在这些小休息时间里安排一段时间呢？

It's not really a reflection of my hormone status," which is accurate.

这并不能真正反映我的荷尔蒙状态，”这是准确的。

And so they're taking them continuously.

所以他们不断地服用它们。

You also have less pill failure pregnancies.

避孕药失败怀孕的情况也会减少。

So if you're using the pill for contraception, that can be a great strategy.

因此，如果您使用避孕药来避孕，这可能是一个很好的策略。

But the longer you take them, we do see some vaginal and vulvar changes.

但服用时间越长，我们确实会看到一些阴道和外阴的变化。

And so atrophic vaginitis, people who notice increased sensitivity, decreased elasticity, increased discomfort with intercourse, increase in yeast infections, that can sometimes be seen because that environment is different.

因此，萎缩性阴道炎，人们会注意到敏感度增加、弹性下降、性交不适增加、酵母菌感染增加，有时会因为环境不同而出现。

Now, that's just one thing that can come from the pill.

现在，这只是药丸可以带来的一件事。

We also see the pill be life-saving for other people.

我们还看到这种药丸可以挽救其他人的生命。

They have terrible PMS or premenstrual dysphoric syndrome, where their mental health, when they change from high to low estrogen, it's always the change in estrogen that interferes, can cause some people to really have mental health issues that are so severe that having that stable hormone level is helpful.

他们患有严重的经前综合症或经前烦躁综合症，当他们从高雌激素变为低雌激素时，他们的心理健康总是受到雌激素变化的干扰，可能会导致一些人确实出现严重的心理健康问题，因此保持稳定的激素水平是有帮助的。

And so the pill can be extremely beneficial for some people when it comes to mental health.

因此，在心理健康方面，避孕药对某些人来说非常有益。

It can be beneficial for people who have issues with very heavy periods and anemia.

对于月经过多和贫血问题的人来说可能是有益的。

Instead of getting blood transfusions, taking the birth control pill might prevent the lining of the uterus from growing so much that they bleed so much.

服用避孕药可能会阻止子宫内膜过度生长而导致流血过多，而不是输血。

Same thing with fibroids.

肌瘤也是如此。

People with PCOS.

患有多囊卵巢综合症的人。

PCOS is polycystic ovarian syndrome.

PCOS 是多囊卵巢综合症。

If we want to put it very simply, you have a lot of eggs in your vault, so you release a lot of eggs every month.

如果我们想很简单地说，你的金库里有很多鸡蛋，所以你每个月都会释放很多鸡蛋。

And what this does is the FSH signal gets diluted, and so you're not responding to the normal signal, and you don't ovulate.

这会导致 FSH 信号被稀释，因此您不会对正常信号做出反应，并且不会排卵。

And because the ovary is a hormone-making factory, it gets really bored when it can't make estrogen because that egg's not growing, so it starts to make testosterone.

因为卵巢是一个制造激素的工厂，当它因为卵子不生长而无法制造雌激素时，它会感到非常无聊，所以它开始制造睾酮。

So you start to see this androgen-dominant environment associated with lack of ovulation and having a lot of follicles inside the ovary that are not really responding.

因此，您开始看到这种雄激素主导的环境与排卵不足以及卵巢内有大量卵泡没有真正做出反应有关。

Andrew Huberman:

安德鲁·休伯曼：

And the androgenization of other tissues, like body hair-

其他组织的雄激素化，如体毛——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

deepening of voice.

声音加深。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Body hair.

体毛。

Typically, the level of testosterone made in PCOS isn't truly deepening voice.

通常，多囊卵巢综合症患者产生的睾酮水平并不能真正降低声音。

It can if there is an ovarian tumor making testosterone or certain other conditions.

如果存在产生睾酮激素的卵巢肿瘤或某些其他病症，则可能会出现这种情况。

But typically with PCOS, you see increase in body hair, increase in acne, and you can see some even male pattern balding, some temporal balding of women, so some hair loss.

但通常患有多囊卵巢综合症，你会看到体毛增加，痤疮增加，甚至可以看到一些男性秃顶，一些女性颞秃，所以有些脱发。

Andrew Huberman:

安德鲁·休伯曼：

Temporal.

暂时的。

So like-

所以就像-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

the widow's peaking?

寡妇的巅峰？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, the widow peaking-

是啊，寡妇达到巅峰了——

Andrew Huberman:

安德鲁·休伯曼：

Yeah

是啊

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

and then thinning out in these two areas.

然后在这两个区域进行稀疏化。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And then we see an increase in body composition towards a male level.

然后我们看到身体成分向男性水平增加。

So if we think about a male body holding your fat in your abdominal region, and if we think about the traditional female body holding more fat in the hips and thighs area, we see that when this hormone shifts in PCOS, you tend to get more abdominal fat distribution, which then leads to further insulin resistance and metabolic syndrome.

因此，如果我们考虑一下男性身体在腹部区域储存更多脂肪，如果我们考虑传统女性身体在臀部和大腿区域储存更多脂肪，我们就会发现，当这种激素在多囊卵巢综合症中发生变化时，您往往会分布更多的腹部脂肪，从而导致进一步的胰岛素抵抗和代谢综合征。

But in PCOS, because you're not ovulating, and those ovaries, each little follicle makes a tiny amount of estrogen.

但在多囊卵巢综合症中，因为你不排卵，而卵巢中的每个小卵泡都会产生微量的雌激素。

We'll say each little follicle, when it's not responding, will make one to two picograms of estrogen.

我们会说，每个小卵泡在没有反应时会产生一到两皮克的雌激素。

But if you have 50 of them each month, you're having some constant estrogen exposure, so that lining of the uterus is being constantly stimulated to grow, and you're never getting the progesterone to stabilize or the progesterone withdrawal to bleed.

但如果你每个月有 50 次，你就会持续接触雌激素，这样子宫内膜就会不断受到刺激生长，而你永远不会让孕激素稳定下来，也不会因为孕激素撤退而导致出血。

So endometrial cancer is much higher in people with PCOS who don't ovulate, and the birth control pill can prevent that, any unopposed estrogen situation, because the body is made to have both estrogen and progesterone.

因此，在不排卵的多囊卵巢综合症患者中，子宫内膜癌的发病率要高得多，而避孕药可以预防任何雌激素不受抑制的情况，因为身体天生就含有雌激素和黄体酮。

So we see an immense decrease in endometrial cancer, an immense drop in ovarian cancer.

因此，我们看到子宫内膜癌的发病率大幅下降，卵巢癌的发病率也大幅下降。

Ovarian cancer comes from the remodeling of the ovary.

卵巢癌来自卵巢的重塑。

So every time you have a follicle grow, and it ruptures, and it makes the corpus luteum, and then it heals up, those are opportunities for those cancer cells to go away in that remodeling process and lead to ovarian cancer.

因此，每当卵泡生长、破裂、形成黄体，然后愈合时，这些癌细胞就有机会在重塑过程中消失并导致卵巢癌。

And because you're not ovulating on the pill, your incidence of ovarian cancer drops dramatically.

而且由于服用避孕药后您不再排卵，卵巢癌的发病率会急剧下降。

Ten years of pill use has dropped the chance you get ovarian cancer by more than 90%.

十年服用避孕药已使您患卵巢癌的几率降低了 90% 以上。

And of course, ovarian cancer is super hard to diagnose because the innervation to the peritoneal system is poor, and you don't have any outward signs often till late stage disease.

当然，卵巢癌非常难以诊断，因为腹膜系统的神经支配很差，而且通常直到疾病晚期才出现任何外在症状。

That being said, could you potentially have an increase in breast cancer in some people?

话虽如此，某些人的乳腺癌发病率是否可能会增加？

Andrew Huberman:

安德鲁·休伯曼：

By taking the pill?

通过吃药？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

By taking the pill.

通过服用药丸。

That's a concern, especially in people who might be predisposed to this for some other reason.

这是一个令人担忧的问题，尤其是对于那些可能因其他原因而容易出现这种情况的人。

Andrew Huberman:

安德鲁·休伯曼：

So they might have BRCA mutations-

所以他们可能有 BRCA 突变 -

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Exactly

正是如此

Andrew Huberman:

安德鲁·休伯曼：

...

or something like that.

或类似的东西。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And then is there a situation where the pill certainly masks what's going on with your menstrual cycle?

那么是否存在一种情况，即避孕药确实掩盖了您的月经周期的情况？

And I really think this is where women's health has a huge history in paternalism, meaning doctors would just tell people, "This is what you're going to do.

我真的认为这就是女性健康在家长作风中有着悠久历史的地方，这意味着医生只会告诉人们，“这就是你要做的。

So your periods are irregular.

所以你的月经不规律。

Here is the birth control pill." And they're not explaining why or the pros and cons to it.

这是避孕药。”他们没有解释原因或这样做的利弊。

And what happens is people are not being taught how their bodies work, and now they are because of your podcast, amongst others, and now they're able to know that my period's a vital sign, and I don't know what it is because the pill is producing a different environment.

发生的情况是，人们没有被教导他们的身体如何运作，现在他们因为你的播客等而知道，现在他们能够知道我的经期是一个生命体征，而我不知道它是什么，因为避孕药正在产生不同的环境。

The pill's also been associated with potentially development of things like leaky gut or IBS, and so there is a definite change in your environment when you're on the birth control pill.

该药还可能与肠漏或肠易激综合征等疾病的发生有关，因此当您服用避孕药时，您的环境会发生明显的变化。

Increased risk of blood clots because of how it's processed in the liver, increasing your clotting factors.

由于血液在肝脏中的处理方式会增加凝血因子，因此血栓的风险会增加。

Andrew Huberman:

安德鲁·休伯曼：

Can I just-

我可以-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

interrupt there?

打断那里？

I'm aware that a fairly high percentage of people have mutations in factor V Leiden, a clotting factor.

我知道相当高比例的人存在凝血因子 V Leiden 突变。

Fewer people are, as we say, homozygous, have two deficient copies, or mutant copies, I should say.

我应该说，正如我们所说，纯合子、有两个缺陷拷贝或突变拷贝的人越来越少。

But there are many people out there that have one mutant copy of factor V Leiden, and my understanding is that oral contraception in females can really exacerbate the factor V Leiden mutation.

但有很多人体内都有一种 V 因子莱顿突变体，我的理解是，女性口服避孕药确实会加剧 V 因子莱顿突变。

Do you suggest that people get their factor V Leiden genetics analyzed?

您是否建议人们对莱顿 V 因子进行遗传学分析？

It's pretty inexpensive to do.

做起来非常便宜。

I think on a standard blood test you can just ask for the factor V analysis, and it's not a really in-depth thing.

我认为在标准的血液测试中，你可以只要求进行 V 因子分析，这并不是一个真正深入的事情。

You don't have to fly to some other place to-

你不必飞往其他地方-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, it's a blood test.

是的，这是验血。

Easy peasy.

简单易行。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

You don't have to fly to another country like you do for many things.

您不必像许多事情一样飞往另一个国家。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's important to say that's not the norm.

重要的是要说这不是常态。

That's not the recommendation.

这不是建议。

When you're talking about putting somebody on the birth control pill, you want to make sure they don't have high blood pressure, because it can increase their blood pressure.

当您谈论让某人服用避孕药时，您需要确保他们没有高血压，因为它会增加他们的血压。

You want to make sure they don't smoke cigarettes, because the combination of the pill and cigarette smoking can increase the risk of a stroke.

您要确保他们不吸烟，因为药物和吸烟的结合会增加中风的风险。

But the recommendation's not to screen them to see if they have any inherited clotting disorders.

但建议不要对他们进行筛查以确定他们是否患有任何遗传性凝血障碍。

That said, if you ever have a blood clot on the birth control pill because you're traveling on a plane, or you're just on the pill, or you're living your life, you're now going to get this extensive workup to find out if you do have that.

也就是说，如果您因乘坐飞机旅行而服用避孕药后出现血栓，或者您只是服用避孕药，或者您正在过着自己的生活，那么您现在将接受广泛的检查，以确定您是否确实患有这种情况。

It's by no means wrong, and specifically you should if anybody in your family has ever had a DVT, so a deep vein thrombosis, so a blood clot in their leg, or a pulmonary embolism, or a PE.

这绝不是错误的，特别是如果你家里有人患有深静脉血栓、深静脉血栓、腿部血栓、肺栓塞或肺栓塞，你就应该这样做。

So anybody in your family has had one of those, you should 100% get worked up for clotting disorders.

因此，您家里的任何人都患有其中一种疾病，您应该 100% 因凝血障碍而感到紧张。

And if you have something, like you carry factor V, you should no longer take the birth control pill.

如果您患有某些疾病，例如携带 V 因子，则不应再服用避孕药。

And specifically the pill, because it's an oral pill, and how it's metabolized in the liver is actually what is causing the change in those clotting factors, because that's where they're made as well.

特别是药丸，因为它是一种口服药丸，它在肝脏中的代谢实际上是导致这些凝血因子发生变化的原因，因为它们也是在肝脏中产生的。

So it doesn't mean you can't take any form of contraception, but we do want to make sure that we counsel you appropriately.

因此，这并不意味着您不能采取任何形式的避孕措施，但我们确实希望确保为您提供适当的建议。

I never think it's wrong to be an advocate for your own health or to ask questions.

我从来不认为倡导自己的健康或提出问题是错误的。

It's important to know that screening-- I'll get on my soapbox, because we'll talk about screening for ovarian reserve, and it is 100% not recommended, even though I think it should be.

重要的是要知道筛查——我会在演讲台上发言，因为我们将讨论卵巢储备筛查，100%不推荐，尽管我认为应该这样做。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

My next question-

我的下一个问题——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right

右

Andrew Huberman:

安德鲁·休伯曼：

...

was going to be about testing AMH levels.

是关于测试 AMH 水平。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

And we'll return to that for those that hear that and it sounds cryptic, as well as getting an ultrasound.

对于那些听到这个消息并且听起来很神秘的人，我们将回到这个话题，以及进行超声波检查。

Just seeing basically how many-

只是看看基本上有多少-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right

右

Andrew Huberman:

安德鲁·休伯曼：

...

eggs are likely to be in the vault on both sides.

鸡蛋很可能在两侧的金库中。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay.

好的。

So we have to remember that screening recommendations come from at what point in the population does it make sense to spend the money to test for a disease based on the likelihood of finding it.

因此，我们必须记住，筛查建议来自于人群中的哪个阶段，根据发现疾病的可能性花钱进行疾病检测才有意义。

So if we think about, that's what your Pap smear guidelines, and your colonoscopy, and your mammograms, everything is all based on when are you going to find enough cases at some age to make it worthwhile testing, which is a crazy principle, especially in the US, because the government's not paying for our healthcare.

因此，如果我们考虑一下，这就是您的子宫颈抹片检查指南、结肠镜检查和乳房X光检查，一切都取决于您何时能在某个年龄段找到足够的病例以使其值得进行检测，这是一个疯狂的原则，尤其是在美国，因为政府不支付我们的医疗费用。

So why should these guidelines be based on when is it cost effective to do testing?

那么为什么这些指南应该基于何时进行测试具有成本效益呢？

Andrew Huberman:

安德鲁·休伯曼：

Well, this is going to sound a little bit conspiratorial, but it's not.

嗯，这听起来有点阴谋论，但事实并非如此。

I think that given that for people who have insurance, private paid insurance or through their work, that there's a cost to doing these tests of any kind, colonoscopy, AMH, et cetera.

我认为，考虑到对于有保险、私人付费保险或通过工作的人来说，进行任何类型的检查、结肠镜检查、AMH 等都是有成本的。

And they must have figured out the optimal point on the graph with which they can reduce their payout to people who, for instance, get colon cancer if they didn't get the colonoscopy at 45, as opposed to 50, as opposed to 60, as opposed to 25.

他们必须找出图表上的最佳点，通过该点，他们可以减少对那些患有结肠癌的人的支付，如果他们在 45 岁、50 岁、60 岁、25 岁时没有接受结肠镜检查。

The reality we know is that the more information you have, the better choices you can make.

我们知道的现实是，您拥有的信息越多，您就能做出更好的选择。

The only caveat to that would be that for some, not all, but for some people, sort of the hypochondriatic type, sometimes more information leads to more anxiety, which leads to more problems.

唯一需要注意的是，对于某些人（不是所有人），但对于某些疑病症类型的人来说，有时更多的信息会导致更多的焦虑，从而导致更多的问题。

But that's a rare instance.

但这是一个罕见的例子。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

That is.

也就是说。

I always think that in general, data is always good.

我一直认为，总的来说，数据总是好的。

Andrew Huberman:

安德鲁·休伯曼：

I agree.

我同意。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Having the information at hand about your body and being able to make educated choices, versus being in a position where you say, "I had no idea that I had factor V Leiden, and I had this terrible blood clot." Because pulmonary embolisms can kill people.

掌握有关您身体的信息并能够做出明智的选择，而不是处于这样的境地：“我不知道我患有 V 因子莱顿，而且我有这种可怕的血栓。”因为肺栓塞可以致命。

We all know that.

我们都知道这一点。

So we talk about this rare thing, but it can happen.

所以我们谈论这种罕见的事情，但它可能会发生。

But this is really where it can be tough.

但这确实是困难的地方。

It can be tough to find even a doctor who may-- Like we said, factor V is a blood test and relatively inexpensive, so that one is not hard, but physicians live in a weird world where they have recommendations based on screening, based on the likelihood of finding disease that they follow, and when they go off of those, they start introducing themselves to why are you not following medical guidelines.

甚至很难找到一位医生可以——就像我们说的，V因子是一种血液测试，而且相对便宜，所以这并不难，但医生生活在一个奇怪的世界，他们根据筛查、发现他们遵循的疾病的可能性提出建议，当他们放弃这些建议时，他们开始向自己介绍为什么你不遵守医疗指南。

But for an individual, this is really tough to advocate for yourself.

但对于个人来说，为自己辩护确实很难。

And the one thing that I'll say, too, this is why paying attention to your body is so important.

我还要说的一件事是，这就是为什么关注你的身体如此重要。

Understanding your stool habits and what's normal and what's not, so that you can catch early signs of things and present for that colonoscopy earlier.

了解您的大便习惯以及哪些是正常的，哪些是不正常的，以便您可以发现早期迹象并尽早进行结肠镜检查。

The current screening guideline for should you get your ovarian reserve checked is that you should not.

目前关于是否应该检查卵巢储备的筛查指南是不应该进行。

ACOG, the American College of OBGYN, has an entire practice bulletin situation saying there's no utility in screening for AMH.

ACOG（美国妇产科学院）有一份完整的实践公告，称筛查 AMH 没有任何用处。

Okay.

好的。

Andrew Huberman:

安德鲁·休伯曼：

I-

我-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I totally disagree, but-

我完全不同意，但是——

Andrew Huberman:

安德鲁·休伯曼：

I'm glad you disagree.

我很高兴你不同意。

To me, it just seems nuts.

对我来说，这似乎很疯狂。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay.

好的。

Ugh.

啊。

Andrew Huberman:

安德鲁·休伯曼：

Or ovaries, rather.

或者更确切地说是卵巢。

The AMH is a blood draw.

AMH 是抽血。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

AMH is a blood test.

AMH 是一项血液检查。

Andrew Huberman:

安德鲁·休伯曼：

It's a blood draw.

这是抽血。

One could opt to do the ultrasound as well-

人们也可以选择做超声波检查——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm

嗯嗯

Andrew Huberman:

安德鲁·休伯曼：

...

which is, of course, more invasive.

当然，这更具侵入性。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

But women who are seeing their OBGYN are probably familiar with Pelvic exams.

但接受妇产科检查的女性可能熟悉骨盆检查。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Presumably.

大概。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I mean, it's a vaginal ultrasound-

我的意思是，这是阴道超声波检查-

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm

嗯嗯

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

but it's not painful.

但这并不痛苦。

Andrew Huberman:

安德鲁·休伯曼：

Not painful.

不痛。

But different than a blood draw.

但与抽血不同。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Sure.

当然。

Andrew Huberman:

安德鲁·休伯曼：

Just in full disclosure.

只是完全披露。

And I've heard of women in their early 30s going in, getting their AMH levels checked, getting their ultrasound, and then going, "Oh my goodness." They're down to...

我听说 30 岁出头的女性会去检查她们的 AMH 水平，进行超声波检查，然后说：“天哪。”他们要...

I don't want to throw out numbers because this actually can get tricky.

我不想丢弃数字，因为这实际上会变得很棘手。

They'll say, "Oh, you have," whatever, "four follicles." And then someone in their early 40s will have 20 follicles, and then people start to, it sort of becomes a scorekeeping thing.

他们会说，“哦，你有，”无论如何，“四个卵泡。”然后 40 岁出头的人会有 20 个卵泡，然后人们开始这样做，这有点成为记分的事情。

And of course, follicle quality.

当然，还有卵泡质量。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

There are a bunch of other things.

还有很多其他的事情。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

And then you can tell us more about those.

然后您可以告诉我们更多有关这些的信息。

But let's say someone did not have insurance or insurance permission to get this paid for.

但假设有人没有保险或保险许可来支付这笔费用。

What is the approximate cost of getting one's AMH levels analyzed?

分析 AMH 水平的大约费用是多少？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

$79.

79 美元。

Andrew Huberman:

安德鲁·休伯曼：

$79 to find out essentially where your ovarian reserve is at.

79 美元即可基本了解您的卵巢储备状况。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm.

嗯嗯。

So let's talk about this.

那么我们来谈谈这个吧。

I already said this is my soapbox.

我已经说过这是我的肥皂盒。

So ACOG says you shouldn't screen it because AMH does not predict your fecundability, right?

所以 ACOG 说您不应该进行筛查，因为 AMH 无法预测您的生育能力，对吧？

Your body's ability to get pregnant in that month is independent of your AMH.

您的身体在该月怀孕的能力与您的 AMH 无关。

And for the most part, that's true, right?

在大多数情况下，这是真的，对吧？

Because let's say you have a person and they're both 30.

因为假设你有一个人，他们都 30 岁了。

You have two people, one has low ovarian reserve, so they have five eggs coming out of the vault, and this one has normal ovarian reserve, and they have 20 eggs coming out of the vault.

你有两个人，其中一个卵巢储备低，所以他们有 5 个卵子从保险库中出来，而这个人的卵巢储备正常，他们有 20 个卵子从保险库中出来。

Andrew Huberman:

安德鲁·休伯曼：

And we should probably clarify, because you said this earlier, but the number of eggs coming out of the vault is an indirect measure of how many eggs is in the vault.

我们可能应该澄清一下，因为你之前说过，但从金库中出来的鸡蛋数量是对金库中有多少鸡蛋的间接衡量。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

When that number is going down-

当这个数字下降时——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes

是的

Andrew Huberman:

安德鲁·休伯曼：

...

it means the number of eggs in the vault is likely going down as well.

这意味着金库中的鸡蛋数量也可能会减少。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Is also down.

也下来了。

Correct.

正确的。

Andrew Huberman:

安德鲁·休伯曼：

Sort of like your body starts to take smaller withdrawals as you start to run out of-

有点像当你开始用完时，你的身体开始进行较小的提款——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

The vault wants to be at equilibrium, right?

金库想要保持平衡，对吗？

It really wants to be in this middle ground.

它真的想处于这个中间立场。

So when you have too many, it shoots out more every month.

所以当你有太多的时候，它每个月都会射出更多。

It's too crowded, it doesn't want that.

太拥挤了，它不想要这样。

And then when it starts to get low, it gets scared about being empty and sends out fewer per month.

然后，当它开始变低时，它会害怕空了，并且每月发送的数量减少。

So what you see outside the vault, and that is called an antral follicle count, or an AFC.

所以你在穹窿外看到的，就是所谓的窦卵泡计数，或 AFC。

It's an ultrasound-based measurement of how many eggs you have outside the vault at one point in time.

这是一种基于超声波的测量方法，用于测量某个时间点在保险库外有多少鸡蛋。

Andrew Huberman:

安德鲁·休伯曼：

And on the ultrasound, if one looks, this is going to show up as sort of what look like little hollow spaces.

在超声波上，如果有人观察，就会发现它看起来像是一些小空洞。

So not gray stuff, but hollow bodies.

所以不是灰色的东西，而是空心的物体。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

I say chocolate chips in the chocolate chip cookie.

我说的是巧克力饼干里的巧克力片。

If we can imagine the ovary-

如果我们能想象卵巢——

Andrew Huberman:

安德鲁·休伯曼：

Beautiful image.

美丽的形象。

Yeah

是啊

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

yeah, looks like a chocolate chip cookie.

是的，看起来像巧克力饼干。

The chocolate chips, small, little, dark, fluid-filled follicles.

巧克力片，很小，很小，黑色，充满液体的毛囊。

Each one of those houses an egg.

每一个都有一个鸡蛋。

Andrew Huberman:

安德鲁·休伯曼：

Some bigger than others because they're more mature than others.

有些人比其他人更大，因为他们比其他人更成熟。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Based on when you check in the cycle.

基于您签入周期的时间。

So if you're looking in that early follicular phase when somebody's on their period, they all should be small because nothing's been stimulated.

因此，如果您在某人经期时观察卵泡早期阶段，它们都应该很小，因为没有任何刺激。

If I'm looking periovulatory, I'll see that dominant follicle that's about to ovulate, and then everything else will be small.

如果我在排卵期观察，我会看到即将排卵的优势卵泡，然后其他一切都会很小。

Andrew Huberman:

安德鲁·休伯曼：

And is there a graph that people can look at or that we could link to that says, okay, the average, with a distribution of standard error on either side, for, let's say, a 28-year-old woman, or a 37-year-old woman, or a 45-year-old woman of the number of follicles on the right and left side.

是否有一个人们可以查看或我们可以链接到的图表，上面写着，好吧，平均值，两侧都有标准误差分布，比方说，一名 28 岁女性、一名 37 岁女性或一名 45 岁女性左右两侧的卵泡数量。

And as I understand, asymmetries are common.

据我了解，不对称现象很常见。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Tends to be, if someone goes in and you've got six follicles on the left side and 12 on the other side.

往往是这样，如果有人进去，你的左侧有 6 个毛囊，另一侧有 12 个。

How do people gauge where they're at?

人们如何判断自己所处的位置？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Fantastic points.

很棒的点。

One, because their doctor should tell them, but that doesn't always happen.

一，因为他们的医生应该告诉他们，但这并不总是发生。

But yes, we add these counts together to get your antral follicle count because there is often asymmetry.

但是，是的，我们将这些计数加在一起以获得窦卵泡计数，因为通常存在不对称性。

But what we should expect, let's say in somebody who's 30, is you should have in the 16 to 20 range of total follicles per month.

但我们应该期望的是，假设一个 30 岁的人每月的卵泡总数应该在 16 到 20 个范围内。

Andrew Huberman:

安德鲁·休伯曼：

Right and left side combined.

右侧和左侧合并。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Combined.

合并。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay?

好吧？

When you're 35, that number is closer to 14 to 16.

当你 35 岁时，这个数字接近 14 到 16。

So starting to drop, but still pretty good.

所以开始下降，但仍然相当不错。

When you're 40, it's 8 to 10.

当你40岁的时候，就是8到10。

When you're 44, 2 to 4, right?

当你44岁的时候，2到4，对吧？

So you start to have this immense drop that exponentially starts to increase really around age 37.

因此，在 37 岁左右，你的体重开始大幅下降，并开始呈指数级增长。

So things start to kind of get into this severe zone really after age 37.

因此，37 岁之后，事情就开始真正进入这个严重的区域。

Andrew Huberman:

安德鲁·休伯曼：

And we didn't really talk about ages 18 to 25, but there are people who get pregnant in that-

我们并没有真正讨论 18 至 25 岁的年龄，但有些人会在这个年龄段怀孕——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

There are

有

Andrew Huberman:

安德鲁·休伯曼：

...

age bracket.

年龄段。

Is the follicle count very, very high?

卵泡数量是否非常非常高？

Is there sort of a non-linear drop-off or?

是否存在某种非线性下降？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Their follicle count would be higher.

他们的卵泡数量会更高。

And I occasionally have patients who are very young but have infertility or want to freeze their eggs.

我偶尔也会遇到一些非常年轻但患有不孕症或想要冷冻卵子的患者。

I've also had patients in that age range who are in premature ovarian failure, right?

我也遇到过那个年龄段的卵巢早衰患者，对吗？

Because there can be things that go wrong even early.

因为甚至很早就可能会出现问题。

Andrew Huberman:

安德鲁·休伯曼：

But we should probably highlight again something that you said earlier, but gosh, this contradicts so much of what's out there, which is that even if you have low follicle count, if you collect eggs, you're not changing what's in the vault.

但我们可能应该再次强调您之前所说的一些事情，但是天哪，这与现有的很多内容相矛盾，也就是说，即使您的卵泡数量很少，如果您收集卵子，您也不会改变保险库中的内容。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Exactly.

正是如此。

Andrew Huberman:

安德鲁·休伯曼：

You're not pulling from the vault.

你不是从保险库中取出来的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

You can't.

你不能。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Those eggs are spent.

这些鸡蛋都用完了。

You now have the opportunity to turn them into potential pregnancies.

您现在有机会将它们转化为潜在的怀孕。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Correct.

正确。

Side note, right, we haven't even dove into IVF, but that's the next wave of technology, is what we call IVM, in vitro maturation.

顺便说一句，我们甚至还没有深入研究 IVF，但这是下一波技术浪潮，就是我们所说的 IVM，体外成熟。

People are trying to figure out how can you get eggs from the vault and get them to grow in the lab, because that would open up possibilities for people who have fewer eggs to have a higher efficiency of this process.

人们正在试图弄清楚如何从保险库中获取卵子并让它们在实验室中生长，因为这将为拥有较少卵子的人提供更高效率的这一过程的可能性。

Because one of the limiting factors when you're doing fertility, when you're doing egg freezing or IVF, is how many eggs can you get per month, and that's why some people have to do cycle after cycle, because they can only get five eggs or five eggs.

因为当你进行生育、进行卵子冷冻或试管受精时，限制因素之一是你每个月能得到多少个卵子，这就是为什么有些人必须一个又一个周期地进行，因为他们只能得到五个卵子或五个卵子。

But if we circle back to what we were saying when we got off on this beautiful tangent, is that no matter if you have five or you have 20 eggs outside the vault, you're ovulating one.

但如果我们回到我们在这条美丽的切线上所说的，那就是，无论你在保险库外有 5 个还是 20 个卵子，你都会排卵。

So you're trying to get pregnant naturally.

所以你正在尝试自然怀孕。

That's what fecundability is, probability of getting pregnant per month naturally.

这就是生育能力，即每月自然怀孕的概率。

You have the same chance if you're the same age, regardless of if you have five eggs or you have 20 eggs.

如果您的年龄相同，无论您有 5 个鸡蛋还是 20 个鸡蛋，您都有相同的机会。

And that's why ACOG came in and said, "Well, AMH doesn't impact fecundability.

这就是为什么 ACOG 进来并说：“嗯，AMH 不会影响生育能力。

It doesn't predict your ability to get pregnant or who's going to have infertility and who's not going to have infertility.

它不能预测您怀孕的能力或谁会不孕以及谁不会不孕。

So there's no utility in screening for it in people." Now-

因此，在人类中筛查它没有任何用处。”现在——

Andrew Huberman:

安德鲁·休伯曼：

For one, so I'm speechless.

其一，我无言以对。

That argument makes sense through the lens of just probabilities of pregnancy through natural conception.

从自然受孕的怀孕概率来看，这一论点是有道理的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm

嗯嗯

Andrew Huberman:

安德鲁·休伯曼：

But it completely erases the very real situation where people are making choices about, for instance, whether or not to stay with a given partner, whether or not to leave a given partner, whether or not to accelerate the process of building a family.

但它完全抹去了人们做出选择的真实情况，例如是否与某个特定的伴侣在一起，是否离开某个特定的伴侣，是否加速建立家庭的进程。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Should I freeze my eggs?

我应该冷冻卵子吗？

Should I have a baby now?

我现在应该要孩子吗？

Andrew Huberman:

安德鲁·休伯曼：

Oh my goodness.

天哪。

There's so many factors-

有很多因素——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

These life choices

这些人生选择

Andrew Huberman:

安德鲁·休伯曼：

...

that this American College of whoever is completely-

这所美国学院完全是——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

OBGYN

妇产科

Andrew Huberman:

安德鲁·休伯曼：

...

psychologically divorced from.

心理上脱离了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They're a big deal, but they're crazy.

他们是大事，但他们很疯狂。

And that's what I say.

这就是我所说的。

They argue in their statement that finding that you have...

他们在声明中辩称，发现你......

Sorry, I'm reeling it in.

抱歉，我正在把它卷进去。

Andrew Huberman:

安德鲁·休伯曼：

No, I'm trying to think of an analogy that doesn't fail, but it's like saying, "Okay, if you can walk now, great.

不，我试图想一个不会失败的类比，但这就像在说：“好吧，如果你现在能走路了，那就太好了。

There's no reason to test for this inevitable paralysis that's going to happen at different rates in different people, and there are things that you can do to offset it." In other words, you could take a little bit of some tissue that will allow you to walk-

没有理由对这种不可避免的瘫痪进行测试，这种瘫痪在不同的人身上会以不同的速度发生，但你可以采取一些措施来抵消它。”换句话说，你可以拿一点纸巾来让你走路——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right

右

Andrew Huberman:

安德鲁·休伯曼：

...

in the future, but we're not going to do that because if you can walk now, you can walk now.

将来，但我们不会这样做，因为如果你现在能走路，你现在就可以走路。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's good now.

现在好了。

Andrew Huberman:

安德鲁·休伯曼：

That's absurd.

这太荒谬了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And that's really what it is.

事实就是如此。

And they say, well, finding out that you have low ovarian reserve at a young age is going to cause undue stress that is unwarranted because most people don't have infertility.

他们说，好吧，在年轻时发现自己的卵巢储备能力较低，会导致不必要的过度压力，因为大多数人都没有不孕症。

And so they're purely putting it through the lens of your likelihood to get pregnant.

所以他们纯粹是从你怀孕的可能性的角度来考虑的。

Andrew Huberman:

安德鲁·休伯曼：

But it's actionable stress.

但这是可行的压力。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Exactly.

正是如此。

Andrew Huberman:

安德鲁·休伯曼：

If it were just stress like, "Hey, guess what?" I know people who have family members with Huntington's mutations, and some opt to not know-

如果只是压力，比如“嘿，你猜怎么着？”我知道有人的家庭成员患有亨廷顿突变，有些人选择不知道——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

That's a great conversation

这是一次很棒的谈话

Andrew Huberman:

安德鲁·休伯曼：

...

whether or not they themselves have the Huntington's mutation.

他们本身是否患有亨廷顿突变。

And it's a very personal choice, right?

这是一个非常个人的选择，对吧？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Sure.

当然。

Andrew Huberman:

安德鲁·休伯曼：

But here, whereas unfortunately there still isn't a cure for Huntington's, hopefully someday there will be, knock on wood, but in the meantime, there's essentially a cure for this situation, which is the harvest and potential fertilization.

但不幸的是，尽管目前还没有治愈亨廷顿舞蹈症的方法，但希望有一天能够治愈，但与此同时，基本上有一种方法可以治愈这种情况，那就是收获和潜在的施肥。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

There's at least an opportunity.

至少还有机会。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And this is what I say, and of course you and I feel similarly, education and data, being the one to make the choice is an extremely important distinction versus having it happen to you.

这就是我所说的，当然你和我也有类似的感受，教育和数据，让你做出选择与让它发生在你身上是一个极其重要的区别。

So if you're young and you find out you have low ovarian reserve, is that going to make a difference?

那么，如果你很年轻，发现自己的卵巢储备能力较低，这会有所不同吗？

And it very well might.

这很可能。

You might now freeze your eggs when you wouldn't have otherwise.

您现在可以冷冻卵子，否则您就不会这样做。

You might now start to try to get pregnant if you're partnered when you otherwise were just waiting, but now you know.

如果您有伴侣，您现在可能会开始尝试怀孕，否则您只是在等待，但现在您知道了。

Andrew Huberman:

安德鲁·休伯曼：

It might change the conversation with your partner, too.

这也可能会改变你与伴侣的谈话。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

You might-

你可能-

Andrew Huberman:

安德鲁·休伯曼：

Because a lot of people think they can just wait.

因为很多人认为他们可以等待。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I know, you'd be like, "Oh-"

我知道，你会说，“哦——”

Andrew Huberman:

安德鲁·休伯曼：

Because of age.

因为年龄。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

"No, I'm only 30.

“不，我才30岁。

Andrew Huberman:

安德鲁·休伯曼：

We're in our 20s or in our 30s and-

我们二十多岁或三十多岁，而且——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I can totally wait."

我完全可以等待。”

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But if you have a low ovarian reserve, then you may lose the opportunity for parenthood.

但如果你的卵巢储备功能低下，那么你可能会失去为人父母的机会。

And for a lot of people, this is a life goal, and this is what's wild to me.

对于很多人来说，这是一个人生目标，而这对我来说是疯狂的。

When on earth, besides reproduction, do we have life goals that we take the approach, "I'll just wait and see if it's a problem later?" Never, right?

在地球上，除了繁衍之外，我们是否还有生活目标，我们采取的方法是“我就等着看以后会不会有问题？”从来没有，对吧？

If you want to become a doctor, you want to become an athlete, you are constantly working towards that goal or understanding what it's going to take to get there.

如果你想成为一名医生，你想成为一名运动员，你就会不断地朝着这个目标努力，或者了解如何才能实现这一目标。

But why does the goal of parenthood, the attitude is completely, "I'm not going to think about it until later, and then I'll deal with it if it becomes a problem." Because you can make choices.

但为什么为人父母的目标，态度完全是，“我以后才考虑，如果出现问题我再处理。”因为你可以做出选择。

You could freeze your eggs.

你可以冷冻你的卵子。

You could try to get pregnant sooner.

你可以尝试早点怀孕。

You could evaluate for reasons of low ovarian reserve.

您可以评估卵巢储备功能低下的原因。

Do you have a genetic mutation or an autoimmune disease?

您是否患有基因突变或自身免疫性疾病？

Why is it low?

为什么低？

It's not just always a big unknown.

这并不总是一个巨大的未知数。

There can be some actual things that potentially might be impactful for your health long term.

有些实际的事情可能会对您的健康产生长期影响。

So I think it's wild that this is the current conversation, and I will say I know personally a lot of OBGYNs who 100% will draw an AMH blood test if you're at your annual and you ask.

所以我认为目前的谈话很疯狂，我会说我个人认识很多妇产科医生，如果你在每年的年度检查中提出要求，他们 100% 会进行 AMH 血液检查。

And I recommend all of my OB friends, because I see people at a different stage.

我推荐我所有的OB朋友，因为我看到人们处于不同的阶段。

When they see me, they're struggling to get pregnant or they want to freeze their eggs.

当他们看到我时，他们正在努力怀孕，或者他们想冷冻卵子。

But when we talk about this, I say, "Hey, just like you say, 'Are you trying to get pregnant now?'" And if somebody says no, and your follow-up question is, "Well, do you want to be on birth control?" The same question should be, "Well, do you want to be pregnant at some point?

但当我们谈论这个时，我说，“嘿，就像你说的那样，‘你现在想怀孕吗？’”如果有人说不，你的后续问题是，“那么，你想节育吗？”同样的问题应该是：“那么，你想在某个时候怀孕吗？

And if so, should you consider freezing your eggs or getting this blood test checked?" And very often people will make a different decision with that information.

如果是这样，您是否应该考虑冷冻卵子或进行血液检查？”人们常常会根据这些信息做出不同的决定。

Andrew Huberman:

安德鲁·休伯曼：

I'm so glad that you're highlighting this because my understanding is, at least in the state of California, I don't know about other states or if it even varies by state, that the opportunity to harvest eggs and freeze them, there's a hard cutoff at age, I think it is 42.

我很高兴你强调这一点，因为我的理解是，至少在加利福尼亚州，我不知道其他州的情况，或者甚至每个州都有所不同，收获卵子并冷冻它们的机会，有一个严格的年龄限制，我认为是 42 岁。

Prior to age 42, they'll do it.

42岁之前，他们会这样做。

After 42, they'll do it if and only if you're willing to do in vitro fertilization to actually fertilize, and then they'll freeze embryos.

42岁以后，当且仅当你愿意进行体外受精并真正受精时，他们才会这样做，然后他们会冷冻胚胎。

But they're far more reluctant to collect eggs after age 42.

但 42 岁以后他们就更不愿意收集卵子了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes and no. So when you think about egg freezing and IVF are really the same process.

是和不是。所以当你想到卵子冷冻和试管受精实际上是相同的过程。

You're going through the exact same thing.

你正在经历完全相同的事情。

You're taking the eggs out of the body and then you're either just freezing them as an egg or you're fertilizing them in the lab, and that's IVF, and making an embryo right away.

你将卵子从体内取出，然后要么将它们作为卵子冷冻，要么在实验室中使它们受精，这就是体外受精，并立即形成胚胎。

Egg freezing has changed dynamically over the past 10 years.

过去十年来，卵子冷冻发生了动态变化。

Whereas 10 years ago, survival rate of eggs in the lab was 40%.

而10年前，实验室里的卵子存活率为40%。

Really terrible.

真的很可怕。

And so we really didn't offer it to many people.

所以我们确实没有向很多人提供它。

It wasn't something that was talked about.

这不是谈论的事情。

And now it feels trendy almost.

现在感觉几乎很时髦。

But it's really just the tech has gotten so much better.

但这实际上只是技术已经变得更好了。

Andrew Huberman:

安德鲁·休伯曼：

And cheaper.

而且更便宜。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

90% of eggs now survive the freeze-thaw.

现在 90% 的鸡蛋能够在冻融过程中存活下来。

So 90% is not a low number by any means.

所以90%无论如何都不是一个低数字。

Embryos are much stronger.

胚胎要坚强得多。

An egg is a single cell.

卵子是一个单细胞。

It's a single cell.

这是一个单细胞。

An embryo, when we freeze an embryo that's day five or six, is 300 plus cells.

当我们冷冻第五天或第六天的胚胎时，胚胎有 300 多个细胞。

So it's so much stronger, and those embryos survive the freeze-thaw 99% of the time.

所以它的强度要大得多，而且这些胚胎在 99% 的时间里都能在冻融过程中存活下来。

So yes, there's a 9% difference.

所以是的，有 9% 的差异。

That being said, making embryos is a lot more expensive.

话虽如此，制造胚胎要昂贵得多。

Eggs is cheaper.

鸡蛋比较便宜。

You could do two rounds of eggs and have just as many eggs, or have more eggs, than if you'd made them into embryos right away.

与立即将它们制成胚胎相比，您可以进行两轮鸡蛋，并获得同样多的鸡蛋，或者更多的鸡蛋。

So I never recommend that somebody commits to a sperm source that they don't want to have a child with, unless that's the sperm source they want to have a child.

因此，我从不建议某人选择他们不想生孩子的精子来源，除非那是他们想要孩子的精子来源。

And this has changed because when embryo survival was so much greater than egg survival, especially if you had few eggs or you were older, making embryos was the only option.

这种情况已经发生了变化，因为当胚胎存活率远高于卵子存活率时，特别是如果你的卵子很少或你年龄较大，制造胚胎是唯一的选择。

What we do know is that egg quality decreases immensely as we get older.

我们所知道的是，随着年龄的增长，卵子质量会大大下降。

And we've touched on this, but we haven't really mentioned it.

我们已经谈到了这一点，但我们还没有真正提到它。

So not only do you have fewer eggs as you get older, the chromosomes inside start to lose their positioning.

因此，随着年龄的增长，卵子不仅会减少，而且内部的染色体也开始失去其位置。

And so when we think about egg quality, we think about genetic normalcy, and we know that the rates of aneuploidy or abnormal chromosomes increases proportionally to your age.

因此，当我们考虑卵子质量时，我们会考虑遗传正常性，并且我们知道非整倍体或异常染色体的比率与您的年龄成正比增加。

Andrew Huberman:

安德鲁·休伯曼：

Which, for people that aren't aware, are going to predispose, not always, to miscarriages if they're implanted, or potentially even the formation of a fetus that carries, for instance, trisomies, so chromosomal repeats, or lack of certain chromosomes.

对于那些不知道的人来说，如果植入的话，会（并非总是）容易流产，甚至可能形成携带三体性、染色体重复或缺乏某些染色体的胎儿。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

These could be deadly, or they could be capable of carrying to term, but have undetectable to mild to severe developmental abnormalities.

这些可能是致命的，或者它们可能能够足月，但具有无法检测到的轻度至严重的发育异常。

Correct?

正确的？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Correct.

正确。

And this is why you have a lower probability of pregnancy per month as you get older.

这就是为什么随着年龄的增长，每月怀孕的可能性会降低。

So if we look at your natural fecundability, it's not because you have fewer eggs, because we already said your egg count per month doesn't impact your probability of getting pregnant.

因此，如果我们查看您的自然生育能力，这并不是因为您的卵子数量较少，因为我们已经说过您每月的卵子数量不会影响您怀孕的可能性。

It's because the normalcy of those chromosomes has changed so dramatically that the odds that your body's randomly choosing the good one to ovulate become so low.

这是因为这些染色体的正常状态发生了如此巨大的变化，以至于您的身体随机选择好的染色体进行排卵的可能性变得如此之低。

And that's why those natural fertility rates are so low, because most genetically abnormal eggs do not fertilize or implant.

这就是自然生育率如此低的原因，因为大多数基因异常的卵子不会受精或着床。

But if they do, they have a significantly higher chance of miscarriage.

但如果这样做，流产的可能性就会显着增加。

It's 40% at age 40.

40岁时这个比例是40%。

So you have a much lower chance of seeing the positive pregnancy test, but then your chance of losing that pregnancy is significantly higher as well.

因此，您看到妊娠试验呈阳性的机会要低得多，但流产的机会也会明显更高。

So when we are counseling somebody about egg freezing, what we know is that not every egg is going to fertilize with sperm, going to make an embryo, going to be genetically normal, or even implant when it is genetically normal.

因此，当我们向某人提供关于卵子冷冻的咨询时，我们知道并不是每个卵子都能与精子受精，形成胚胎，基因正常，甚至在基因正常时植入。

There is huge loss in human reproduction, meaning the more eggs you have at a younger age, the better the ROI on this process is going to be.

人类生殖损失巨大，这意味着你在年轻时拥有的卵子越多，这个过程的投资回报率就越高。

It doesn't mean you don't do it when people get older, but every clinic does have a cutoff, and every clinic's going to be a little bit different.

这并不意味着当人们变老时就不再这样做，但每个诊所确实都有一个界限，而且每个诊所都会有点不同。

A lot of different reasons why.

有很多不同的原因。

We actually probably have an older cutoff, so we will let somebody go through IVF or freeze their eggs up to age 45, and it's a lot about informed consent and having the approach that you're smart enough that if I give you the odds and I walk you through how many eggs you have and the likelihood of them making into embryos, you can say, "Yeah, but four eggs or 10 eggs is way more than zero based on my circumstance, and that is worth it to me because it gives me the opportunity to potentially have a child when otherwise my opportunity is going to be zero." So a lot of this is rooted in paternalism, that people can't, as a patient, understand these odds and they have unrealistic expectations.

我们实际上可能有一个较旧的截止日期，所以我们会让某人在 45 岁之前进行 IVF 或冷冻卵子，这在很大程度上取决于知情同意和采取足够聪明的方法，如果我给你一个几率，并告诉你你有多少个卵子以及它们形成胚胎的可能性，你可以说，“是的，但根据我的情况，四个卵子或 10 个卵子远远大于零，这对我来说是值得的，因为它给了我生孩子的机会，否则我的机会将为零。”因此，这在很大程度上源于家长作风，作为病人，人们无法理解这些可能性，并且他们有不切实际的期望。

I think there's a huge shift in reproductive medicine to really counseling patients and giving them autonomy in some of these decisions, but there does become a point where the likelihood of finding a normal egg is so, so low that the money or the expense of the process doesn't make sense, and people should utilize egg donation or other opportunities for conception.

我认为生殖医学发生了巨大的转变，真正为患者提供咨询并给予他们在某些决定中的自主权，但确实存在这样一种情况：找到正常卵子的可能性是如此之低，以至于这个过程的金钱或费用没有意义，人们应该利用卵子捐赠或其他受孕机会。

This drop in both the number of eggs and the egg quality, they really start to become so profound at age 37 and on, and that's when we really start to see both these things are overlapping at the same time.

卵子数量和卵子质量的下降，在 37 岁及以后才真正开始变得如此严重，那时我们才真正开始看到这两件事同时重叠。

So if you're waiting till age 35, 36 for your first kid, but you want two or three, we've got to really look forward about does that strategy make sense?

因此，如果你等到 35、36 岁才生第一个孩子，但你想要两个或三个孩子，我们必须真正期待这个策略是否有意义？

Well, what is your AMH?

那么，你的 AMH 是多少？

One, are you going to run out of eggs before then?

第一，在那之前你的鸡蛋会用完吗？

Two, what other issues could be going on?

二、还有哪些其他问题可能发生？

Is the sperm fine?

精子还好吗？

Are the tubes open?

管子是否打开？

Because we are seeing that when people start families later, when people have more chronic illness and autoimmune disease and obesity, that it's much harder to get pregnant.

因为我们发现，当人们较晚组建家庭时，当人们患有更多慢性疾病、自身免疫性疾病和肥胖时，怀孕就变得更加困难。

And so the birth rates, for the first time in a long time across the board, are dropping, and infertility is rising because of all of these factors combined.

因此，出生率长期以来首次全面下降，而由于所有这些因素的综合作用，不孕率正在上升。

Andrew Huberman:

安德鲁·休伯曼：

So based on everything you just said, and yes, I'm going to say it a fifth time because the misconception about this is one of the primary reasons why people avoid harvesting eggs.

因此，根据您刚才所说的一切，是的，我要说第五次，因为对此的误解是人们避免收获鸡蛋的主要原因之一。

It's not the only reason, but when you harvest eggs, freeze them, now it sounds like the viability of those eggs is quite strong compared to a few years ago.

这不是唯一的原因，但是当你收获鸡蛋并冷冻它们时，现在听起来这些鸡蛋的生存能力与几年前相比相当强。

So that's great.

那太好了。

90% recovery when they thaw them.

解冻后可恢复 90%。

Is not going to diminish the number of eggs in the vault.

不会减少金库中鸡蛋的数量。

Such a critical point.

这样一个临界点。

And post age 37, there's sounds like a nonlinear drop-off in egg quality for most, and these are averages.

37 岁以后，大多数人的卵子质量似乎呈非线性下降，而这些只是平均值。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Of course.

当然。

Andrew Huberman:

安德鲁·休伯曼：

Right?

对吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Always going to be exceptions.

总会有例外。

Andrew Huberman:

安德鲁·休伯曼：

So the people that got pregnant with healthy kids in their late 30s and 40s, yes, we hear you.

所以那些在 30 多岁和 40 多岁怀上健康孩子的人，是的，我们听到了。

Congratulations.

恭喜。

We're happy.

我们很高兴。

But this speaks to the logic anyway.

但这无论如何都符合逻辑。

We're not putting any emotion or circumstances on this, but the logic of somebody in their, let's say, late 20s, early 30s, getting their AMH levels through a roughly $80 blood draw, and then perhaps based on their life goals and circumstances, doing either one or several rounds of egg collection and freezing.

我们并没有对此施加任何情感或环境，而是根据某人的逻辑，比如说，20 岁末、30 岁出头，通过大约 80 美元的抽血来获取他们的 AMH 水平，然后可能根据他们的生活目标和情况，进行一轮或多轮卵子采集和冷冻。

Especially since it sounds like you don't need to fertilize those eggs, so if one doesn't have a partner or is concerned about what they're going to do, who's going to provide the sperm.

特别是因为听起来你不需要让这些卵子受精，所以如果一个人没有伴侣或者担心他们要做什么，谁来提供精子。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

Andrew Huberman:

安德鲁·休伯曼：

Because of course, some people choose to raise kids on their own, but parenting is a whole other issue.

当然，有些人选择自己抚养孩子，但养育孩子则是另一个问题。

But they could do that later.

但他们可以稍后再做。

So that raises the questions of what are the ...

这就提出了一个问题：什么是......

health risks, if any, pain levels, if any, and that includes psychological pain of egg harvest.

健康风险（如果有）、疼痛程度（如果有），其中包括采卵时的心理痛苦。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, yeah.

哦，是的。

Andrew Huberman:

安德鲁·休伯曼：

So going back to what you said earlier, this is going to be injecting synthetic mimics of FSH and LH, follicle-stimulating hormone and luteinizing hormone, maybe some growth hormone.

回到你之前所说的，这将注射 FSH 和 LH 的合成模拟物、卵泡刺激素和黄体生成素，也许还有一些生长激素。

I hear nowadays there's also the practice of injecting, these are essentially platelet-rich plasma, PRP, perhaps even into the ovarian vault.

我听说现在也有注射的做法，这些基本上是富含血小板的血浆、PRP，甚至可能注射到卵巢穹窿中。

We can get back to that.

我们可以回到这一点。

So there's a bunch of stuff that's being done to someone.

所以有人正在对某人做很多事情。

There's low stim, where people are getting low doses of these drugs.

低刺激，人们服用低剂量的这些药物。

There's high stim, where it's like a full blast.

刺激感很强，就像爆炸一样。

Maybe you could walk us through that procedure in a just sort of general contour, because it would require a lot of time to go through it all in detail.

也许您可以大致引导我们完成该过程，因为详细地完成所有过程将需要大量时间。

But is this a horrible thing to go through?

但这是一件可怕的事情吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

No.

不。

Andrew Huberman:

安德鲁·休伯曼：

Is it mild to go through?

经历起来温和吗？

Is it like a walk in the park?

这就像在公园散步吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Let's walk through it all.

让我们来回顾一下这一切。

So I love this, and this is my bread and butter, and this is what I do every day.

所以我喜欢这个，这是我的面包和黄油，这就是我每天所做的事情。

Studies tell us that if you are not ready to have a family by age 32 to 33, that that is the optimal time for the average person to intervene and freeze their eggs.

研究告诉我们，如果您在 32 至 33 岁之前还没有准备好组建家庭，那么这就是普通人进行干预和冷冻卵子的最佳时机。

It's not up for debate.

这没有争议。

It's when you have both the intersection of still a good egg quality and good egg quantity on average.

当您同时拥有良好的卵子质量和良好的平均卵子数量时。

And so that is younger than a lot of people are thinking about having families.

因此，这比许多人考虑组建家庭的年龄还要年轻。

And the reason why is when we really think about what happens to the egg afterward, that's what's really critically important.

原因是当我们真正考虑鸡蛋之后会发生什么时，这才是真正至关重要的。

So I'm going to answer the question about what you go through, but just thinking, we already said you freeze your eggs, 90% of them are going to survive the freeze thaw.

所以我要回答关于你经历过什么的问题，但只是想一想，我们已经说过你冷冻你的卵子，90% 的卵子会在冻融后存活下来。

About 75% will be fertilized by sperm, and about 50% of those will even make it to an implantation stage embryo or a blastocyst.

大约 75% 将通过精子受精，其中大约 50% 甚至会进入植入阶段胚胎或囊胚。

Andrew Huberman:

安德鲁·休伯曼：

And we're assuming healthy sperm.

我们假设精子健康。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Of course.

当然。

Andrew Huberman:

安德鲁·休伯曼：

Sperm, no excessive DNA fragmentation.

精子，没有过多的DNA碎片。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

You've already hit the nail on the head.

你已经击中要害了。

One of the biggest issues with egg freezing is I don't know the future.

卵子冷冻的最大问题之一是我不知道未来。

I don't know if this sperm is going to be great or not.

我不知道这个精子是否会很棒。

I don't under-

我不低于-

Andrew Huberman:

安德鲁·休伯曼：

It could be from a pot smoker.

它可能来自吸大麻的人。

Just kidding, pot smokers

开玩笑，抽烟的人

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Not kidding, pot smokers.

不是开玩笑，吸大麻的人。

We're not.

我们不是。

But we don't know, right?

但我们不知道，对吧？

So we have this future yet undetermined sperm source.

所以我们有这个未来尚未确定的精子来源。

So I am going to assume you're going to fall average on these data points that we're going to walk through.

因此，我假设您将在我们将要讨论的这些数据点上达到平均值。

But the reality is you buffer the risk by having more eggs frozen, and that's why people are going through multiple rounds or cycles because we don't know.

但现实是，你可以通过冷冻更多的卵子来缓冲风险，这就是为什么人们会经历多个轮次或周期，因为我们不知道。

We don't know how that fertilization will be.

我们不知道受精会如何。

If you have 20 eggs, and 18 survive the freeze thaw, and 14 fertilize, and seven make it to the blastocyst stage, if you're age 30, we would anticipate around 60% to 70% of them are going to be genetically normal.

如果你有 20 个卵子，其中 18 个在冻融后存活下来，14 个受精，7 个进入囊胚阶段，如果你 30 岁，我们预计其中大约 60% 到 70% 的基因是正常的。

And you're young, so that's already kind of a big hit at that age.

而且你还年轻，所以这在那个年纪已经很受欢迎了。

So let's say of the seven, four of them are genetically normal.

假设这七人中，有四人基因正常。

When I go to transfer them, I have at best a 65% chance of live birth per embryo, which is really good when you put in the lens of fecundability, and peak success tends to be closer to 20%.

当我去移植它们时，每个胚胎最多有 65% 的活产机会，当你考虑到生育能力时，这真的很好，最高成功率往往接近 20%。

Andrew Huberman:

安德鲁·休伯曼：

And you're going to implant one embryo at a time.

而且您一次将植入一个胚胎。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

100%, we're going to implant one embryo at a time now.

100%，我们现在一次植入一个胚胎。

Andrew Huberman:

安德鲁·休伯曼：

Does anyone ask for two?

有人要两个吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

People ask for two.

人们要求两个。

Doctors will do two.

医生会做两个。

It lowers live birth rates.

它降低了活产率。

If we're looking at giving each embryo the healthiest opportunity at becoming a baby, number one, embryos with IVF have a slightly higher chance of monozygotic twinning, right?

如果我们正在考虑为每个胚胎提供最健康的机会成为婴儿，那么第一，体外受精胚胎的同卵双胞胎的机会略高，对吗？

So fraternal twinning comes if you ovulate two eggs, they both get fertilized, so each baby is completely different genetically, own egg, own sperm.

因此，如果您排卵两个卵子，它们都会受精，那么异卵双胞胎就会出现，因此每个婴儿的基因完全不同，拥有自己的卵子，自己的精子。

Monozygotic is from an embryo split.

单合子来自胚胎分裂。

Because of the IVF process, likely putting the embryo in the catheter, maybe having that outer surface touched, predisposes it to splitting after you put it into the body.

由于体外受精过程，可能会将胚胎放入导管中，可能会接触到外表面，使其在放入体内后容易分裂。

So-

所以——

Andrew Huberman:

安德鲁·休伯曼：

So more identical twins-

所以更多的同卵双胞胎——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, we have a two-

是的，我们有两个——

Andrew Huberman:

安德鲁·休伯曼：

...

monozygotic, I think

我认为是单卵双生

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

2% to 3% chance of monozygotic twins with IVF, and the natural chance is 0.03%.

同卵双胞胎接受 IVF 的几率为 2% 至 3%，自然几率为 0.03%。

So significantly higher, even though ultimately not a probable outcome.

尽管最终这不是一个可能的结果，但明显更高。

I'm going to have a couple patients a year who are going to have monozygotic twins.

每年我都会接待几个病人，他们将生出同卵双胞胎。

And if I put two embryos in, I've now, one, taken this from a potential twin pregnancy to a triplet or even a quad if they both split.

如果我放入两个胚胎，我现在就可以将其从潜在的双胞胎怀孕变成三胞胎，甚至四胞胎（如果它们都分裂的话）。

Andrew Huberman:

安德鲁·休伯曼：

So hence, presumably, like the octomom cases and things like that.

因此，大概就像 octomom 案例之类的事情一样。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Well, that one, they just literally put eight embryos inside, but that's a whole-

嗯，那个，他们实际上只是把八个胚胎放进去，但那是一个整体——

Andrew Huberman:

安德鲁·休伯曼：

Whoa, okay

哇哦，好吧

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

I mean, that's medical malpractice, right?

我的意思是，这属于医疗事故，对吗？

But really most of the time when we're talking about embryos, we're talking about people with infertility or people who've spent a significant amount of money.

但实际上，大多数时候，当我们谈论胚胎时，我们谈论的是不孕症患者或花费了大量金钱的人。

A huge portion of fertility is embryo quality, right?

生育力的很大一部分是胚胎质量，对吗？

The competency of the embryo, the genetics of the embryo.

胚胎的能力，胚胎的遗传学。

It's expensive to go through egg freezing and IVF.

进行卵子冷冻和试管受精的费用很高。

Yet the uterine environment is another component.

然而子宫环境是另一个组成部分。

It doesn't make sense to waste multiple embryos in the same uterine environment.

在同一个子宫环境中浪费多个胚胎是没有意义的。

Statistically, it doesn't make sense.

从统计上看，这是没有意义的。

It also doesn't make sense to make your embryos compete against each other.

让胚胎相互竞争也是没有意义的。

Andrew Huberman:

安德鲁·休伯曼：

So will people put one embryo into, let's just say, DNA mom, right, and one into surrogate mom, and get two siblings simultaneously?

那么人们是否会将一个胚胎放入DNA妈妈中，对吧，然后将一个胚胎放入代孕妈妈中，并同时得到两个兄弟姐妹？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I've definitely done that and had patients do that.

我确实这么做过，也让病人这么做过。

It's not common because surrogacy, using a gestational carrier, is so expensive, and there's such limited supply.

这种情况并不常见，因为使用代孕妈妈的代孕费用非常昂贵，而且供应也非常有限。

It's very hard to find somebody who wants to go through the act of carrying a child for somebody else.

很难找到愿意为别人怀孩子的人。

But that definitely is a strategy that some people utilize, especially if they're older or they're concerned that they might have a lower chance of implantation, but they want to give themselves a try.

但这肯定是一些人使用的策略，特别是当他们年龄较大或他们担心自己植入的机会可能较低时，但他们想尝试一下。

But if we look at one embryo, 65% chance of success.

但如果我们观察一个胚胎，成功的几率为 65%。

Cumulative probability after the second is 88%, okay?

第二次之后的累积概率是88%，好吗？

Almost everybody's pregnant after two, and these are euploid, genetically normal embryos, okay?

几乎每个人在两岁之后就怀孕了，而且这些都是整倍体、基因正常的胚胎，好吗？

And then if you go to the third, so cumulatively after three euploid embryo transfers, each one being a single embryo, 95% of people have a baby in their arms, meaning the incidence of recurrent implantation failure is actually pretty low, 5%.

然后，如果你转到第三个，那么累计经过三个整倍体胚胎移植后，每个都是单个胚胎，95％的人怀里怀着孩子，这意味着反复着床失败的发生率实际上非常低，只有5％。

But how many normal embryos do you need for what family size if you're freezing your eggs?

但是，如果您要冷冻卵子，对于多大的家庭规模需要多少个正常胚胎呢？

Because you got 20 eggs at age 30 in the example I gave, and you just made four normal embryos, right?

因为在我举的例子中，你在30岁时获得了20个卵子，而你刚刚产生了四个正常的胚胎，对吗？

So that's really unlikely to make three or four kids.

所以这真的不太可能生出三四个孩子。

It has a really good chance of making one, gives you the opportunity for a second, but that's also presuming that everything happened perfectly, that the sperm is not pot-smoking sperm, but you know what I mean, not bad quality sperm.

它确实有很好的机会制造一个，给你一秒钟的机会，但这也是假设一切都发生得很完美，精子不是吸大麻的精子，但你知道我的意思，不是质量差的精子。

There's not other environmental issues when it comes to your own health when you're trying to get pregnant, or other diseases you may have.

当您尝试怀孕时，不存在其他影响您自身健康或可能患有其他疾病的环境问题。

So we really need a higher number of eggs, specifically when we don't know what the equation will truly look like for one individual person when they go through the process.

因此，我们确实需要更多数量的鸡蛋，特别是当我们不知道一个人经历这一过程时的方程式到底是什么样子时。

And one of the only added benefits of embryos, especially if you are partnered, if you're with somebody who you do want to have children with, you just don't want to have them yet, is that I know the downstream, I know the number, I know how many embryos I have, and if it's not enough to give you a high chance of what you want your family to be, you can intervene now.

胚胎唯一的额外好处之一，特别是如果你是伴侣，如果你和一个你确实想生孩子的人在一起，但你只是还不想生孩子，那就是我知道下游，我知道数量，我知道我有多少个胚胎，如果这还不足以让你有很大机会实现你想要的家庭，你现在就可以干预。

Right?

正确的？

Because by definition, with egg freezing, we're not wanting to be pregnant for years.

因为根据定义，通过冷冻卵子，我们不想在多年内怀孕。

So if you're doing this with a partner and you're making embryos, and now I say we only got one genetically normal embryo, you have the opportunity to choose to either go through more cycles and store more embryos for later to maybe try to get pregnant sooner because there's some underlying issue with your fertility.

因此，如果您与伴侣一起做这件事并且正在制造胚胎，而现在我说我们只有一个基因正常的胚胎，那么您有机会选择经历更多周期并储存更多胚胎以供以后尝试更快怀孕，因为您的生育能力存在一些潜在问题。

You can make a choice because you're falling off the curve there.

你可以做出选择，因为你正在从那里掉下来。

Andrew Huberman:

安德鲁·休伯曼：

Could I ask you a question?

我可以问你一个问题吗？

So you mentioned age about 32, 33 in an ideal circumstance with the finances there, et cetera, one would harvest eggs.

所以你提到32岁、33岁左右，在理想的情况下，有经济条件，等等，可以收获鸡蛋。

Unless they're already starting a family through natural means.

除非他们已经通过自然方式组建了家庭。

What about for sperm?

那么对于精子呢？

We've all heard the studies that with increased age of the sperm, that there's a higher, although still statistically pretty small, instance of things like spectrum conditions.

我们都听说过这样的研究：随着精子年龄的增加，光谱条件等情况的发生率会更高，尽管在统计上仍然很小。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

So do you recommend to younger males- ...

那么您是否向年轻男性推荐——...

men in their late 20s, early 30s, to freeze sperm?

20岁末、30岁出头的男性适合冷冻精子吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's never going to be wrong to save your gametes because we don't have crystal balls for the future, right?

保存你的配子永远不会错，因为我们没有未来的水晶球，对吧？

So your gametes are your eggs and your sperm.

所以你的配子就是你的卵子和精子。

That increase, and we'll just say negative outcome from advanced paternal age really starts to be seen at age 50.

这种增加，我们只能说，高龄父亲带来的负面影响在 50 岁时才真正开始显现。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So most men are not looking at primarily starting their family after that age.

因此，大多数男性并不会考虑在这个年龄之后开始组建家庭。

However, what I run into all the time is maybe you're working on a second family, or maybe life has gone down a different pathway and now you're with a partner who potentially is younger and wants to conceive, and you now have older sperm.

然而，我一直遇到的情况是，也许你正在为第二个家庭工作，或者也许生活已经走上了不同的道路，现在你和一个可能更年轻并想要怀孕的伴侣在一起，而你现在有年龄较大的精子。

Having sperm in the bank, it's so cheap and easy to freeze sperm.

银行里有精子，冷冻精子既便宜又容易。

Eggs, I haven't even answered your primary question.

蛋蛋，我还没回答你的首要问题呢。

Andrew Huberman:

安德鲁·休伯曼：

And the process of collecting sperm-

还有收集精子的过程——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

while not entirely without its issues, is far simpler.

虽然并非完全没有问题，但要简单得多。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's embarrassing at best-

充其量就是尴尬——

Andrew Huberman:

安德鲁·休伯曼：

Right

右

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

but it's much simpler, right?

但它更简单，对吧？

Andrew Huberman:

安德鲁·休伯曼：

Yeah, it's much simpler.

是的，这更简单。

It generally doesn't require hormone injections, although maybe for rare instances where people are hypogonadal or something, but-

它通常不需要注射激素，尽管可能在极少数情况下，人们性腺功能低下或其他什么情况，但是-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

If you're going to freeze your sperm, you're right.

如果您要冷冻精子，那么您是对的。

Typically, you're going to get some blood work done because most places that store sperm, per FDA guidelines, have to make sure that if you carried an infectious disease, it's stored in a special tank.

通常情况下，您需要进行一些血液检查，因为根据 FDA 的指导方针，大多数储存精子的地方都必须确保，如果您患有传染病，则将其储存在特殊的储罐中。

So you'll have to get blood work done, then you'll have to abstain for your two to three days, collect into a cup, you're done.

所以你必须完成血液检查，然后你必须禁欲两到三天，收集到杯子里，你就完成了。

Andrew Huberman:

安德鲁·休伯曼：

Which by the way, guys, you can do at home and bring it in.

顺便说一句，伙计们，你可以在家做，然后把它带进来。

Sperm are so stable.

精子非常稳定。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

If you've ever done this, you just bring it in.

如果您曾经这样做过，那么您只需将其引入即可。

It's pretty-- Listen, I'm-

很漂亮——听着，我——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Carry it in the little bag

放在小包里随身携带

Andrew Huberman:

安德鲁·休伯曼：

...

a little bit of, I think I'm not going to feign that my friend did this and told me.

一点点，我想我不会假装是我的朋友做了这件事并告诉我的。

But it's kind of outrageously easy in the sense that you just bring it in and they'll take it out in the lobby and be like, "Is that your name?" And they'll do it very different than the egg collection procedure.

但这是非常简单的，因为你只要把它带进来，他们就会在大厅里把它拿出来，然后问，“这是你的名字吗？”他们的做法与卵子收集程序非常不同。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

So here's what I'll say about sperm and what I wish more men knew/more men did.

以下是我要说的关于精子的内容以及我希望更多的男人知道/更多的男人所做的事情。

If you're going to get a vasectomy because you are choosing that you don't want to have kids, and we see many men who do this-

如果你因为选择不想要孩子而要接受输精管结扎术，我们看到很多男人这样做-

Andrew Huberman:

安德鲁·休伯曼：

Really?

真的吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

they say they don't want to have kids.

他们说他们不想生孩子。

They want to go get a vasectomy.

他们想去接受输精管结扎术。

Yet later on in life, you don't have a crystal ball about life is dynamic and things can change.

然而，在以后的生活中，你并没有水晶球知道生活是动态的，事情会改变。

If you're going to get a vasectomy, go freeze sperm first.

如果您要进行输精管结扎术，请先冷冻精子。

Andrew Huberman:

安德鲁·休伯曼：

Why are so many men getting vasectomies?

为什么这么多男性接受输精管结扎术？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I don't have the answer to that.

我对此没有答案。

I think they-

我认为他们——

Andrew Huberman:

安德鲁·休伯曼：

I hadn't heard this.

我没听说过这个。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

A lot of men are getting vasectomies, even to just take control over not having a child out there when they don't want to.

许多男性正在接受输精管结扎术，甚至只是为了在他们不想生孩子的时候控制住自己的孩子。

So-

所以——

Andrew Huberman:

安德鲁·休伯曼：

Maybe this explains the drop in birth rates.

也许这可以解释出生率下降的原因。

No, I'm just kidding.

不，我只是开玩笑。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But I do think-

但我确实认为——

Andrew Huberman:

安德鲁·休伯曼：

It's multifactorial

这是多因素的

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

but so many people, even if you're in your family, let's say you have two kids and y'all decided you're going to get the vasectomy so that you don't have any more children, things happen, terrible things happen, life changes.

但很多人，即使你在你的家庭中，假设你有两个孩子，你们都决定要进行输精管结扎术，这样你就不会再有孩子了，事情发生了，可怕的事情发生了，生活发生了变化。

There might be a circumstance where you potentially would have another kid if something really bad happened, or you just changed your mind.

在某些情况下，如果发生了非常糟糕的事情，或者您只是改变了主意，您可能会再生一个孩子。

Freezing sperm is so easy and so much easier than if you don't.

冷冻精子非常简单，而且比不冷冻精子要容易得多。

Not all vasectomy reversals work, especially the longer that it's been reversed, the lower the likelihood that it's actually going to work.

并非所有的输精管结扎术都有效，尤其是逆转的时间越长，它真正起作用的可能性就越低。

And very often if it does, you don't get sperm in sufficient levels for timed intercourse, and you're seeing me in the office.

通常情况下，如果确实如此，你就无法获得足够水平的精子来进行定时性交，而且你会在办公室见到我。

Andrew Huberman:

安德鲁·休伯曼：

And freezing sperm is cheap.

而且冷冻精子很便宜。

It's relatively cheap.

它相对便宜。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's like $400, right?

好像是400美元吧？

So it's much, much cheaper all in than the entire egg freezing process.

因此，它比整个卵子冷冻过程要便宜得多。

So to answer the original question, when you go through egg freezing, most people do fantastic.

因此，要回答最初的问题，当您进行卵子冷冻时，大多数人都做得很棒。

And we'll just use egg freezing and IVF interchangeably here, because what you as a person is going through to harvest your eggs or to take them out of your body is exactly the same, right?

我们在这里将卵子冷冻和体外受精互换使用，因为作为一个人，你在收获卵子或将卵子从体内取出时所经历的过程是完全相同的，对吧？

The distinction between egg freezing and IVF is all about what happens on the lab end of it after they've come out of your body.

卵子冷冻和试管受精之间的区别在于它们从您的身体中出来后在实验室一端发生的情况。

So if we have this group of eggs that comes out of the vault, your body doesn't want to allow them all to grow, even if it's a low number, right?

因此，如果我们有这组从保险库中出来的卵子，您的身体不会让它们全部生长，即使数量很少，对吧？

That's the check and balance to not have so many kids.

这就是不生那么多孩子的制衡。

So we need to override that process, and what we tend to do with this is to use a combination of hormonal medications.

所以我们需要推翻这个过程，我们倾向于使用激素药物的组合。

And very often I describe it to patients as suppressing your body and then stimulating it.

我经常向患者描述它是抑制你的身体然后刺激它。

So if I can temporarily stop the production of FSH, and you have a group of eggs come out of the vault, and we can imagine that FSH is their food, and there is no food because you're taking the birth control pill for three weeks.

因此，如果我可以暂时停止 FSH 的产生，并且您有一群卵子从保险库中出来，我们可以想象 FSH 是它们的食物，而没有食物，因为您服用了三周的避孕药。

These eggs are going to synchronize, be very small, be very hungry.

这些蛋将会同步，非常小，而且非常饥饿。

For lack of a better word, their FSH receptors are going to open all up.

由于找不到更好的词来形容，他们的 FSH 受体将全部开放。

It's like a nest of baby birds that are all now starving instead of the hungry bird gets the worm.

这就像一窝小鸟现在都在挨饿，而不是饥饿的鸟儿吃虫子。

So now we go with this suppression period for a few weeks.

所以现在我们要进行几周的抑制期。

We can come in and give gonadotropins, which is FSH and LH.

我们可以进来给予促性腺激素，即 FSH 和 LH。

FSH is now synthetically made in a lab.

FSH 现在是在实验室合成的。

It's very easy.

这很容易。

It's a synthetic compound that mimics the structure of the brain FSH.

它是一种模仿大脑 FSH 结构的合成化合物。

We actually can't synthetically make LH.

我们实际上无法合成 LH。

Very interesting.

非常有趣。

We don't have a way to make it yet.

我们还没有办法做到。

And so we use the purified urine of menopausal women, because when you're in menopause, your FSH and LH levels are naturally so high because they're trying to get that egg to make some estrogen.

所以我们使用更年期女性的纯化尿液，因为当你处于更年期时，你的 FSH 和 LH 水平自然会很高，因为它们试图利用卵子来产生一些雌激素。

Andrew Huberman:

安德鲁·休伯曼：

So, we've covered male hormone health before, and there's been a discussion of hCG, human chorionic gonadotropin, which essentially mimics LH.

因此，我们之前讨论过雄性激素健康，并且讨论过 hCG（人绒毛膜促性腺激素），它本质上模仿 LH。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

In the receptor it does, yes.

在受体中确实如此，是的。

Andrew Huberman:

安德鲁·休伯曼：

All right.

好吧。

So is human chorionic gonadotropin, is it purified from post-menopausal women's urine?

那么人绒毛膜促性腺激素是从绝经后妇女的尿液中纯化出来的吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

No.

不。

Andrew Huberman:

安德鲁·休伯曼：

Or is it it's synthetic?

还是说它是合成的？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

hCG is synthetic.

hCG 是合成的。

Andrew Huberman:

安德鲁·休伯曼：

And so why can't-

那么为什么不能-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Well, I'm talking about, it's called Menopur.

嗯，我说的是，它叫 Menopur。

Andrew Huberman:

安德鲁·休伯曼：

Menopur.

梅诺普尔。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Menopur is a combination of FSH and LH.

Menopur 是 FSH 和 LH 的组合。

The reason why we give hCG to men to try to stimulate the spermatogenesis process, which of course, if we could just give LH, we'd give LH.

我们为什么给男性提供 hCG 来尝试刺激精子发生过程，当然，如果我们可以只提供 LH，我们就会提供 LH。

It's the same reason why we give hCG for a trigger.

这与我们给予 hCG 作为触发因素的原因相同。

If we are going to go through fertility treatments and we're trying to mimic that LH surge which naturally would cause ovulation, we actually are giving hCG because it does mimic LH when it comes to the receptor action of it.

如果我们要进行生育治疗，并且我们试图模仿自然会导致排卵的 LH 激增，我们实际上会给予 hCG，因为当涉及到 LH 的受体作用时，它确实会模仿 LH。

Andrew Huberman:

安德鲁·休伯曼：

Got it.

明白了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But when it comes to really, especially in getting follicular development and the relationship between LH and FSH, meaning LH is really providing some of the hormone substrate that we need to be able to make estrogen.

但当谈到真正的问题时，尤其是在卵泡发育以及 LH 和 FSH 之间的关系方面，这意味着 LH 确实提供了我们制造雌激素所需的一些激素底物。

And so you really need some LH in a lot of people, depending on your protocol or if you're older and you're naturally making less.

因此，很多人确实需要一些黄体生成素，具体取决于您的治疗方案，或者如果您年纪较大，自然会产生较少的黄体生成素。

The example or the offshoot would be the PCOS patient who has some naturally high LH.

这个例子或分支是多囊卵巢综合症 (PCOS) 患者，其 LH 天然较高。

Sometimes they don't actually need LH in their protocol.

有时他们的方案中实际上并不需要 LH。

But the-

但是——

Andrew Huberman:

安德鲁·休伯曼：

So who are these post-menopausal women that are supplying their urine?

那么这些供尿的绝经后女性是谁呢？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I don't know.

我不知道。

Andrew Huberman:

安德鲁·休伯曼：

They're paid?

他们有报酬吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right?

对吗？

Andrew Huberman:

安德鲁·休伯曼：

Yeah, I sort of imagine them on some island someplace.

是的，我有点想象他们在某个岛上的某个地方。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

当你长大后，报名参加这项研究。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Interesting.

有趣的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Go to the menopause-

进入更年期——

Andrew Huberman:

安德鲁·休伯曼：

Getting paid to urinate.

去小便要付钱。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And it's called Menopur.

它的名字叫Menopur。

It's purified menopausal urine, right?

这是纯化的更年期尿液，对吗？

Andrew Huberman:

安德鲁·休伯曼：

Amazing.

太棒了。

I did not-

我没有-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's wild

很狂野

Andrew Huberman:

安德鲁·休伯曼：

...

know that.

知道这一点。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Most people don't know that.

大多数人不知道这一点。

Andrew Huberman:

安德鲁·休伯曼：

They know now.

他们现在知道了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Now they know.

现在他们知道了。

And so we use FSH and LH, we'll just say in lack of better terms, those are the two primary compounds that we're giving over the course of, on average, a 12-day period to get the follicles to grow and the eggs to mature.

因此，我们使用 FSH 和 LH，我们只能说，缺乏更好的术语，这是我们在平均 12 天的时间内给予卵泡生长和卵子成熟的两种主要化合物。

So you can measure egg maturity by blood levels of estradiol and by transvaginal ultrasound.

因此，您可以通过血液雌二醇水平和经阴道超声来测量卵子成熟度。

So when you're going through egg freezing or IVF, you're taking these hormone shots of FSH and LH.

因此，当您进行卵子冷冻或 IVF 时，您需要注射 FSH 和 LH 激素。

They are getting those follicles to start to grow.

他们正在让这些卵泡开始生长。

The eggs are starting to mature.

卵子开始成熟。

We are monitoring them along the way, trying to determine the time period where we think most of the eggs will be in the mature range.

我们一路上对它们进行监测，试图确定我们认为大多数卵子处于成熟范围的时间段。

These eggs have gotten to maturity.

这些蛋已经成熟了。

You then are going to take a trigger shot, which allows that final stage of meiosis so those chromosomes can separate, right?

然后你将扣动扳机，使减数分裂的最后阶段得以实现，以便这些染色体可以分离，对吗？

We think about the egg.

我们想到了鸡蛋。

We remember that normal female genetics, 46XX, and I always think about in the egg that these chromosomes are lined up.

我们记得正常的女性遗传学，46XX，我总是想到在卵子中这些染色体是排列好的。

Your eggs are frozen inside your body.

您的卵子被冷冻在体内。

When you're born, your eggs are in metaphase of meiosis.

当你出生时，你的卵子正处于减数分裂中期。

So that's when metaphase chromosomes meet in the middle, and they're held apart by these meiotic spindles.

这就是中期染色体在中间相遇的时候，它们被这些减数分裂纺锤体分开。

And this is why eggs are so stinking fragile, because they're held like this, and those meiotic spindles just absorb the wear and tear of your life.

这就是为什么鸡蛋如此脆弱，因为它们是这样固定的，而那些减数分裂纺锤体只会吸收你生活中的磨损。

But when you use that trigger shot, that LH surge naturally, or that hCG in a cycle, that's when you're going to get that final separation into half those chromosomes into the egg.

但是，当您使用扳机时，LH 自然激增，或者周期中的 hCG 激增，此时您将最终将一半的染色体分离到卵子中。

Andrew Huberman:

安德鲁·休伯曼：

So for people listening, think about like a zipper.

因此，对于聆听的人来说，请像拉链一样思考。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, I love that.

哦，我喜欢那个。

Andrew Huberman:

安德鲁·休伯曼：

You're pulling a part of a zipper that then you now have the chromosomes, just you now have half of the chromosomes, because why?

你拉动拉链的一部分，然后你现在有了染色体，只是你现在有了一半染色体，因为为什么？

Because in successful fertilization, the other chromosomes are going to come from sperm.

因为在成功受精时，其他染色体将来自精子。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

The sperm.

精子。

And that's why this process has more error the older you are and the longer your chromosomes have been sitting there because those spindles are going to break down, and we're going to have that increase in aneuploidy, like we already said, purely because of this impact.

这就是为什么你年龄越大，染色体在那里停留的时间越长，这个过程就会有更多的错误，因为这些纺锤体将会分解，我们将看到非整倍性的增加，就像我们已经说过的，纯粹是因为这种影响。

Andrew Huberman:

安德鲁·休伯曼：

Can I ask a question about that specifically?

我可以具体问一下这个问题吗？

I think now would be the right time to ask-

我想现在是时候问了——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

which is that my understanding is that a lot of the dynamics of pulling apart of this zipper-like thing, these chromosomes, and then is related to mitochondrial DNA, because there are a lot of mechanics.

我的理解是，许多像拉链一样的东西，这些染色体，被拉开的动力学，然后与线粒体DNA有关，因为有很多力学。

We're literally talking about an egg splitting itself-

我们实际上是在谈论鸡蛋自行分裂-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

in half.

一半。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

The mitochondria is its powerhouse.

线粒体是其动力源。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, and the mitochondria.

是的，还有线粒体。

And so mitochondrial health is a big topic these days, and so we'll be sure to touch on nutrition supplementation and prescription drugs that impact mitochondrial health.

因此，线粒体健康现在是一个大话题，因此我们一定会涉及影响线粒体健康的营养补充剂和处方药。

But I've heard of a new procedure, called three-parent IVF, where they're taking basically the DNA from the intended mom, the DNA from intended dad, and then putting it into a surrogate, like a donor egg that is where the DNA has been sucked out, and then because it has healthier, younger mitochondrial DNA.

但我听说过一种新程序，称为三亲体外受精，他们基本上从准妈妈那里获取DNA，从准爸爸那里获取DNA，然后将其放入代孕者中，就像捐赠的卵子一样，DNA已被吸出，然后因为它具有更健康、更年轻的线粒体DNA。

So let's say you've got a couple in their, let's say late 30s, early 40s, and they're not getting successful embryos or implantations or whatever.

假设你有一对 30 岁末、40 岁出头的夫妇，他们没有获得成功的胚胎或植入或其他什么。

So the things aren't working.

所以事情不起作用。

They'll take the DNA from mom and dad, and they'll merge it with a third parent encapsulation.

他们将从妈妈和爸爸那里获取 DNA，并将其与第三个亲代封装合并。

There are clinics that do this.

有诊所可以做这件事。

I know that a lot of this was actually being done in Eastern Europe until recently.

我知道直到最近，很多这样的事情实际上都是在东欧进行的。

There are places in Mexico that do this.

墨西哥有些地方这样做。

In England, it's been used to solve mitochondrial dysfunction.

在英国，它被用来解决线粒体功能障碍。

But in the US, this is still not legal, is that right?

但在美国，这仍然不合法，对吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

So the purpose of what you're talking about, essentially, when we think about utilizing a donor mitochondrial or a donor egg, the point of that technology existed to help cure mitochondrial diseases, which are 100% fatal.

所以你所说的目的，本质上是，当我们考虑利用捐赠的线粒体或捐赠的卵子时，该技术的意义在于帮助治愈线粒体疾病，这种疾病是 100% 致命的。

And so you would have this subset of people who would-- Because if you're the mom, you always pass on your mitochondria to all of the offspring.

所以你会有这样的人——因为如果你是母亲，你总是会把你的线粒体传给所有的后代。

So if there's disease inherent in your mitochondria, everybody's going to get it, and these are very severe diseases.

因此，如果线粒体存在固有疾病，那么每个人都会患上这种疾病，而且这些都是非常严重的疾病。

So the idea of this was first to say, "Hey, can we overcome this mitochondria disease and give people the opportunity?" Which it has done that, right?

所以这个想法首先是说，“嘿，我们可以克服这种线粒体疾病并给人们机会吗？”它已经做到了这一点，对吗？

Now-

现在——

Andrew Huberman:

安德鲁·休伯曼：

So it works when done properly

所以如果做得正确的话它会起作用

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

when done properly, especially for that purpose.

如果做得正确，尤其是为了这个目的。

Now, that purpose is distinct because those people aren't infertile, right?

现在，这个目的很明确，因为这些人并不不育，对吗？

There's something else going on within their mitochondrial disease.

他们的线粒体疾病还存在其他问题。

Utilizing that technology to overcome age-related changes in the eggs has not been successful yet.

利用该技术来克服鸡蛋与年龄相关的变化尚未成功。

Are we hopeful that it can?

我们希望它能实现吗？

Will people charge you money for it in certain places?

在某些地方人们会向您收取费用吗？

Yes.

是的。

But you're hitting on a really important topic, is that the political environment of embryo research in the United States makes it extremely hard for us to be the pioneers of new technology in this space.

但你谈到了一个非常重要的话题，那就是美国胚胎研究的政治环境使我们很难成为这个领域新技术的先驱。

And that is because a lot of views about an embryo or when does life begin, that happens here in the US, that results in limiting the availability and the possibility of doing research in a meaningful way on human embryos.

这是因为在美国，关于胚胎或生命何时开始的许多观点限制了对人类胚胎进行有意义的研究的可用性和可能性。

Andrew Huberman:

安德鲁·休伯曼：

Right, because it would require the destruction of a lot of-- And I looked into this a little bit from an academic perspective, to be clear.

是的，因为这需要破坏很多——为了清楚起见，我从学术角度对此进行了一些研究。

It would also require that the abortions be performed differently because suction abortions destroy embryos in ways that extraction abortions don't.

它还要求以不同的方式进行流产，因为抽吸流产会以提取流产不会的方式破坏胚胎。

So this is a very controversial topic.

所以这是一个非常有争议的话题。

It's something that maybe we'll return to in an episode about stem cells in the future.

也许我们会在未来有关干细胞的一集中再次讨论这一点。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

It's fascinating because especially if you look at IVF, a whole separate issue is that there's millions of embryos that people are no longer using because they have had success, they had extra embryos in the bank, they got divorced, a variety of reasons.

这很有趣，因为特别是如果你看看体外受精，一个完全独立的问题是，人们不再使用数百万个胚胎，因为他们已经取得了成功，他们在银行里有多余的胚胎，他们离婚了，等等。

And a lot of people would like to donate their embryos to science.

很多人愿意将他们的胚胎捐赠给科学。

Feel like, "Hey, I don't want to have this embryo implanted.

感觉就像，“嘿，我不想植入这个胚胎。

I don't want to carry this child, but potentially could something good or could it help advance the field?" But that's not really a tangible option.

我不想生这个孩子，但可能会带来一些好处或者有助于推动这一领域的发展吗？”但这并不是一个真正切实可行的选择。

When people do that, what is actually happening is their embryos are being utilized to train embryologists, which is valid, right, to teach them how to thaw and freeze and biopsy and do different things.

当人们这样做时，实际上发生的是他们的胚胎被用来培训胚胎学家，这是有效的，正确的，教他们如何解冻、冷冻和活检以及做不同的事情。

So it's still useful, but it's not in a meaningful way like we'd really love to be able to utilize to advance the science, especially for these embryos that have been created, yet people no longer need them for family growth.

所以它仍然有用，但它并不是以一种有意义的方式，就像我们真正希望能够利用它来推进科学一样，特别是对于这些已经创造出来的胚胎，但人们不再需要它们来促进家庭成长。

Andrew Huberman:

安德鲁·休伯曼：

So what happens to all the embryos that people don't use?

那么人们不使用的所有胚胎会怎样呢？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, it's a fantastic question.

哦，这是一个很棒的问题。

Right now, they sit in storage.

现在，它们被存放在仓库里。

This is-

这是——

Andrew Huberman:

安德鲁·休伯曼：

Forever?

永远？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Well, this is a new problem, okay?

嗯，这是一个新问题，好吗？

IVF is only 40-ish years old.

IVF只有40岁左右。

Embryo freezing alone, right?

胚胎单独冷冻，对吗？

The first IVF-- We haven't even gone through the whole process, but the first IVF baby, there's no FSHLH to stimulate more of the eggs outside the vault to grow, so they followed the single follicle, and they didn't have the procedure which we do now, which is a minimally invasive procedure to extract eggs.

第一个IVF——我们甚至还没有经历整个过程，但是第一个IVF婴儿，没有FSHLH来刺激更多的卵子在穹窿外生长，所以他们遵循的是单个卵泡，他们没有我们现在做的程序，这是一种提取卵子的微创程序。

We go vaginally with a needle attached to the ultrasound, and we enter into each follicle, and we drain it.

我们用一根连接超声波的针进入阴道，进入每个卵泡，然后将其排出。

The very first IVF, you followed one follicle, and you went in abdominally with a surgery to put that needle into the follicle and drain it out and give that just one egg a chance.

And then, of course, there was no embryo freezing originally.

当然，最初并没有胚胎冷冻。

So the field is still rather young to understand some of this, and as technology rapidly improves, we see things like better success rates with freezing and thawing embryos, better process of getting more embryos to grow.

But now we have a lot of embryos in storage that may or may not be used.

但现在我们储存了很多可能会使用也可能不会使用的胚胎。

I personally tell people, "You should keep your embryos.

我个人告诉人们，“你应该保留你的胚胎。

You should pay the storage fee until no matter what the worst thing on planet Earth happens to you, you're done having children." Because sadly, I live in a spectrum with my field where I see a lot of sadness and people who maybe have lost a child, something else has happened, and they have maybe a sibling who they feel like they really want to give this sibling child the chance to be a sibling again.

你应该支付保管费，直到无论地球上最糟糕的事情发生在你身上，你都不再要孩子了。” Because sadly, I live in a spectrum with my field where I see a lot of sadness and people who maybe have lost a child, something else has happened, and they have maybe a sibling who they feel like they really want to give this sibling child the chance to be a sibling again.

And often you're much older when you're experiencing this, and if you had had embryos frozen that you could've used, but you got rid of them, you're going to be really upset if you find yourself in that circumstance.

So I would say you should save them until you know that you are not going to need them.

所以我想说你应该保存它们，直到你知道你不再需要它们为止。

And then what do you do with them?

然后你用它们做什么？

Most people just discard them.

大多数人只是丢弃它们。

Some people will donate them to labs, which is called for research, but mostly it's for embryologist training.

有些人会将它们捐赠给实验室，这被称为研究，但主要是用于胚胎学家培训。

Andrew Huberman:

安德鲁·休伯曼：

To get better at doing IVF.

为了更好地进行体外受精。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

To get better, which is also important.

变得更好，这也很重要。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But embryo donation's a new thing.

但胚胎捐赠是一件新鲜事。

So being able to, just like we have people who donate sperm and donate eggs, embryo donation is the next evolution of an opportunity to allow more people to become parents.

It's a little bit of the Wild West.

这有点狂野西部的感觉。

People finding people in Facebook groups and connecting.

人们在 Facebook 群组中寻找好友并建立联系。

It's this whole other dynamic when it comes to what we call third-party reproduction, or what do you do with known donors and things like that.

当谈到我们所说的第三方复制，或者你如何处理已知的捐赠者和类似的事情时，这完全是另一种动态。

But it's a very interesting concept.

但这是一个非常有趣的概念。

So this problem is emerging as the technology's getting better.

所以随着技术的进步这个问题也随之出现。

Andrew Huberman:

安德鲁·休伯曼：

I'm realizing now- remembering rather, that when I was in college and graduate school, you would see these ads in the student paper-

我现在意识到——更确切地说，当我在大学和研究生院时，你会在学生报纸上看到这些广告——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

To freeze your sperm

冷冻你的精子

Andrew Huberman:

安德鲁·休伯曼：

...

for egg donors and sperm donors.

对于卵子捐赠者和精子捐赠者。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

Sperm are generated throughout the lifespan, so that's a kind of less controversial issue, but this is now not allowed most places to advertise for egg donors on college campuses.

That's my understanding.

这是我的理解。

These egg donors were often paid whatever they were paid.

这些卵子捐赠者通常会得到报酬。

I'm not going to say it was reasonable amounts or not, because I don't recall what they were paid, and everyone's circumstances are different, but the argument that most people use against this is, "Oh, well, these people are giving up eggs that they could otherwise use," but we now know that's not true.

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

Andrew Huberman:

安德鲁·休伯曼：

So, do you have any knowledge as to what was the rationale for limiting the recruitment of egg donors?

那么，您是否知道限制捐卵者招募的理由是什么？

Anyway, I'm not arguing for or against, it's no longer supported based on what you've said, by the argument that they're losing eggs they would otherwise be able to keep.

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Some of it's about proper informed consent, especially at an age where the financial incentive can be very persuasive without understanding-

其中一些是关于适当的知情同意，尤其是在经济激励在不理解的情况下可能非常有说服力的年龄——

Andrew Huberman:

安德鲁·休伯曼：

That makes sense

这是有道理的

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

not that it harms your fertility later, but that you're going to have genetic children out there.

并不是说它会损害你以后的生育能力，而是你会生出遗传孩子。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And you might potentially, and we are seeing this now, we don't know if you individually will have infertility for a variety of reasons because you're not trying to have a family until much later.

您可能会，我们现在看到这一点，我们不知道您个人是否会因各种原因而患有不孕症，因为您要等到很久以后才能尝试组建家庭。

Andrew Huberman:

安德鲁·休伯曼：

But the same concern doesn't seem to exist for men who are donating sperm.

但对于捐献精子的男性来说，似乎并不存在同样的担忧。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It should.

应该的。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

There's this whole donor-conceived community where people are really talking about putting new restrictions on, well, use sperm donation, for example.

There are sperm donors who have hundreds of children.

有些精子捐献者拥有数百个孩子。

Hundreds, right?

数百个，对吗？

There are these sibling pods because it's been so unlimited, and sperm banks are a business that work to make money, and they make money by selling more sperm.

But that's not healthy, one, for a population, you need genetic diversity, but also it's not healthy necessarily for one person to have all these half siblings and to just not know when you're going to run into somebody who could potentially be your sibling.

Is it this guy at the bar that you like?

酒吧里的这个人是你喜欢的吗？

Do you have to worry about that if you're donor-conceived?

如果您是捐赠者受孕，您需要担心这个吗？

So we're starting to see sperm banks finally start to reel back and put limitations on how many families.

因此，我们开始看到精子库最终开始倒退，并限制了家庭的数量。

Total children's tough, right, because one family might have a child, and you want them to be able to have sibling children, but at least for how many families that donor can contribute to.

孩子总数是很难的，对吧，因为一个家庭可能有一个孩子，你希望他们能够有兄弟姐妹，但至少捐赠者可以为多少个家庭做出贡献。

And we're seeing sperm donors deal with the fact that now there's no anonymous donation.

我们看到精子捐献者正在面对这样一个事实：现在没有匿名捐献。

We can act like anonymous donation exists, meaning it is not identified at the time that somebody's utilizing the sperm, but with direct-to-consumer testing for genetics like 23andMe and Ancestry, people are being connected with their sperm donors, with their egg donors, with their sibling pods, and we have to believe that technology's only going to improve over time.

So what people do for money, especially when they're young, I think without understanding the potential ramifications, and I don't want to act like sperm donation or egg donation are bad, they give people the opportunity to become parents that otherwise might not be able to, and that is a lovely and a beautiful gift.

所以人们为了钱所做的事情，特别是当他们年轻的时候，我认为在不了解潜在后果的情况下，我不想表现得好像捐精或捐卵是坏事，它们给了人们机会成为父母，否则他们可能无法成为父母，这是一份可爱而美丽的礼物。

But you need to understand what that might mean and how that might impact your own potential children later, too, to know that they have genetic half siblings out there.

Egg donation, people do get compensated much better than sperm donation.

捐献卵子，人们确实比捐献精子获得了更好的补偿。

There are certain characteristics that are hard to find that get compensated even more so, and certain ethnicities, doctorate degrees, and things like that where somebody can really pay for their education by donating their eggs.

It's a dilemma because what you'd love to say is, "Freeze some eggs for you, too, if you're going to do that.

这是一个两难的选择，因为你想说的是，“如果你要这样做的话，也为你冷冻一些鸡蛋。

You're at the perfect age to freeze your own eggs." And there's been strategies to try to mitigate this, and I don't want to get off too much on a tangent, but it's a really fine line that you walk with what people understand.

你正处于冷冻自己卵子的最佳年龄。” And there's been strategies to try to mitigate this, and I don't want to get off too much on a tangent, but it's a really fine line that you walk with what people understand.

So there is a company, and I won't name them, but they are promoting that young women donate their eggs, and they will freeze half of them for you, and half of them will go and become donor eggs.

所以有一个公司，我就不提他们的名字了，但是他们在提倡年轻女性捐卵，他们会给你冷冻一半，一半去成为捐赠卵子。

Andrew Huberman:

安德鲁·休伯曼：

Interesting business model.

有趣的商业模式。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay.

好的。

Andrew Huberman:

安德鲁·休伯曼：

But I could see the potential ethical concerns.

但我可以看到潜在的道德问题。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So I think ethically, this sounds good because you get to freeze some eggs, but I think more people will donate eggs than otherwise would have for some of the reasons we previously stated.

And I also think you would get more money by simply donating your eggs and then turning around and paying for a round of freezing your own eggs.

我还认为，只要捐出你的卵子，然后再支付一轮冷冻你自己的卵子的费用，你就会得到更多的钱。

You would get paid more, and you'd have more eggs.

你会得到更多的报酬，你也会有更多的鸡蛋。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Because one of the issues is do you now falsely believe that you have enough eggs in the bank because you did this split but you don't really have enough?

因为问题之一是，你现在是否错误地认为你在银行里有足够的鸡蛋，因为你做了这个分割，但你实际上没有足够的鸡蛋？

Because we already walked through the math at 20 eggs doesn't really result in such a high probability of having a multi-child family.

因为我们已经计算过 20 个鸡蛋并不能真正导致多孩子家庭的概率如此之高。

So, there's a lot of ethical debate in gamete and embryo donation.

因此，配子和胚胎捐赠存在很多伦理争议。

It definitely is the Wild West, and there's uncharted territory.

这绝对是狂野的西部，还有未知的领域。

Even in embryo donation, there's places who are very unethical about it, who will only allow people to have embryos if they are heterosexual, been married for three years, make a certain income, submit to a home study, yet they let the people have no say over the embryos that are transferred, be it how many, what stage, what quality.

即使在胚胎捐献方面，也有一些地方非常不道德，只允许异性恋、结婚三年、有一定收入、接受家庭研究的人才能拥有胚胎，但对于移植的胚胎，无论是多少、什么阶段、什么质量，他们却让老百姓没有发言权。

And they are taking people's money and putting terrible embryos inside of them and really wasting their resources, which could've been used in another way.

他们拿了人们的钱，把可怕的胚胎放进他们体内，真的浪费了他们的资源，这些资源本来可以用其他方式使用。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, the dangers of profitization of biology.

是的，生物学利润化的危险。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

And tech entering spaces is amazing, but also technology starts to advance before studies, right?

技术进入太空是令人惊奇的，但技术在研究之前就开始进步，对吗？

Tech has more finance backing than we see scientific studies get.

科技获得的资金支持比我们看到的科学研究更多。

Andrew Huberman:

安德鲁·休伯曼：

I feel like One of the major questions out there is whether or not IVF babies, let's just call them that-

我觉得主要问题之一是是否体外受精婴儿，我们就这样称呼它们吧——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

have a higher incidence of things like spectrum conditions or other developmental trajectories, let's call them.

诸如频谱条件或其他发展轨迹之类的事情发生率较高，我们可以这样称呼它们。

And I'm not trying to be politically correct here, but I think nowadays that the word disorder has to be really carefully examined when considering any neurologic and psychiatric situation.

我并不是想在政治上正确，但我认为现在在考虑任何神经和精神疾病时，必须仔细检查“障碍”这个词。

We've had discussions about this on this podcast before.

我们之前已经在这个播客上讨论过这个问题。

But a lot of people are wondering, just to be direct-

但很多人都想知道，直接说——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

a lot of people are wondering, do more IVF babies have autism than non-IVF babies?

很多人想知道，试管婴儿中患有自闭症的婴儿是否比非试管婴儿中的婴儿更多？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

This is a good question, and it's changed over time in a couple different ways, and I think this is important to understand.

这是一个很好的问题，随着时间的推移，它以几种不同的方式发生了变化，我认为理解这一点很重要。

So if we just think about the hormonal environment with natural conception, and you have a peak estrogen, let's say of 200 something, you have progesterone being made, the placenta is implanting.

因此，如果我们只考虑自然受孕的荷尔蒙环境，雌激素达到峰值，比如说 200 左右，黄体酮正在生成，胎盘正在植入。

And what is the main difference with IVF babies?

与IVF婴儿的主要区别是什么？

And a lot of it has been tied back to the uterine environment, especially in what we call fresh embryo transfers, which is really not a common practice anymore.

其中很多都与子宫环境有关，特别是在我们所说的新鲜胚胎移植中，这实际上已经不再是常见的做法。

So in a fresh embryo transfer, I'm going to take the eggs out of your body, fertilize them in the lab, and grow out embryos, and then I'm going to put the best embryo back in your body five days later at the natural time of implantation.

因此，在新鲜胚胎移植中，我将从您的体内取出卵子，在实验室中使它们受精，并培育出胚胎，然后在五天后的自然植入时间将最好的胚胎放回您的体内。

And if we rewind the clock, that's how IVF was done, right?

如果我们倒转时钟，试管受精就是这样进行的，对吗？

When you couldn't freeze embryos very well, and they didn't survive.

当你不能很好地冷冻胚胎时，它们就无法存活。

And you'd put lots of embryos inside because they wouldn't survive, and that's the early days of IVF when you saw a lot of multiples, a lot of high order multiples, and of course, multiples have their own distinct issues that put them at higher risk for developmental disorders and issues with development and birth risks-

你会把很多胚胎放进去，因为它们无法存活，那是体外受精的早期，你看到了很多多胞胎，很多高阶多胞胎，当然，多胞胎有自己独特的问题，使它们面临更高的发育障碍风险以及发育和出生风险问题-

Andrew Huberman:

安德鲁·休伯曼：

Sure

当然可以

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

in general, right?

一般来说，对吗？

Andrew Huberman:

安德鲁·休伯曼：

To be fair, they're commonly referred to as disorders.

公平地说，它们通常被称为疾病。

I just think around autism in particular, there's a growing camp out there that want it referred to differently.

我只是想，特别是在自闭症方面，越来越多的人希望以不同的方式来称呼它。

We've covered this.

我们已经介绍过这一点。

Anytime this comes up, I bring up both just to highlight the fact that, yes, we are aware and sensitive to that emerging issue.

每当出现这种情况时，我都会提出这两个问题，只是为了强调这样一个事实：是的，我们对这个新出现的问题已经意识到并且很敏感。

Right now, unfortunately, for sake of conversation, there's no new nomenclature, so we could easily get-

不幸的是，现在为了方便讨论，没有新的术语，所以我们可以很容易地得到——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Bogged down in

深陷其中

Andrew Huberman:

安德鲁·休伯曼：

...

caught down in the attempt to try and smooth over everything with everybody, and as a consequence, confuse everybody.

试图与每个人圆滑地解决所有问题，结果却让每个人都感到困惑。

So I think we'll go for clarity forward with the understanding that the nomenclature is changing.

因此，我认为我们将在理解术语正在发生变化的情况下继续澄清。

Can't even say alcoholism anymore.

甚至不能再说酗酒了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I know.

我知道。

Andrew Huberman:

安德鲁·休伯曼：

Because it's alcohol use disorder.

因为这是酒精使用障碍。

And I don't have a problem with that, but a lot of people wonder if those are two different things.

我对此没有意见，但很多人想知道这是不是两个不同的事情。

And-

还有——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Which is confusing-

这令人困惑-

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Yeah

是啊

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

and we want to simplify science for people.

我们希望为人们简化科学。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Exactly.

确切地。

So feel free.

所以随意吧。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay.

好的。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So when we first were doing IVF, we're putting embryos back in an extremely unnatural environment.

因此，当我们第一次进行体外受精时，我们将胚胎放回一个极其不自然的环境中。

If you have 20 eggs growing and each egg makes 200 picograms of estrogen, suddenly now you have these extremely high supraphysiologic estrogen levels, higher progesterone levels because there's more corpus luteums, and this environment is not the normal for how the placenta would invade into that maternal blood circulature.

如果你有 20 个卵子在生长，每个卵子产生 200 皮克的雌激素，突然之间你就会拥有极高的超生理雌激素水平，由于黄体增多，黄体酮水平也会更高，而且这种环境不适合胎盘侵入母体血液循环的正常环境。

And a lot of these issues that are commonly associated became so because of placental issues.

许多通常相关的问题都是由于胎盘问题而变得如此。

So a lot of things like growth restriction, small for gestational age, preterm birth, which further puts you at risk for other developmental disorders, were associated with these fresh transfers.

因此，许多事情，例如生长受限、小于胎龄、早产，这进一步使您面临其他发育障碍的风险，都与这些新鲜移植有关。

The field has changed.

领域已经改变。

We do a lot of frozen embryo transfers, and a lot of it for this reason.

我们进行了大量的冷冻胚胎移植，而且很多都是出于这个原因。

We see huge improvement in neonatal outcomes when you bleed off that high hormonal uterine environment and then regrow the lining of the uterus in a hormonal level that's more natural and then transfer the embryo, and we see completely different fetal outcomes.

当您排出高激素子宫环境，然后以更自然的激素水平重新生长子宫内膜，然后移植胚胎时，我们看到新生儿结局的巨大改善，我们看到完全不同的胎儿结局。

So that's fantastic as far as looking at the change over the field.

所以从现场的变化来看，这真是太棒了。

But of course, if you take all IVF babies over all time, it's a little murky because you have modern practice and old practice.

但当然，如果你把所有的体外受精婴儿都放在一起，那就有点模糊了，因为你有现代的做法和旧的做法。

We also know that infertility people, if you get diagnosed with infertility, so you're under age 35 and you try to get pregnant with regular periods for one year and have not had success, or you're 35 and older and you've tried for six months and you've not had success, you meet the medical definition for infertility.

我们还知道，不孕症患者，如果您被诊断为不孕症，那么您年龄在 35 岁以下，您尝试在一年内定期月经怀孕但没有成功，或者您年龄在 35 岁以上，并且您已经尝试了六个月但没有成功，那么您就符合不孕症的医学定义。

When that happens, you now statistically, regardless if you get pregnant naturally in the next month or you do IVF, you have a 1% higher chance of birth defects, and you have a slightly higher chance of developmental disorders.

当这种情况发生时，你现在从统计上看，无论你是在下个月自然怀孕还是进行试管受精，你出现出生缺陷的几率都会增加 1%，而且你出现发育障碍的几率也会稍高一些。

So is it more population-based versus procedure-based?

那么它是更多地基于人群还是基于程序呢？

And there's probably something to that to underline a lot of potentially what goes in or what can cause infertility when it comes to quality of eggs or sperm or uterine environment or things that we're still learning about.

当涉及到卵子或精子的质量或子宫环境或我们仍在了解的事情时，这可能强调了许多潜在的因素或可能导致不孕的因素。

When it comes to autism specifically, the number one strongest association we have is advanced paternal age.

具体到自闭症，我们最强烈的关联是高龄父亲。

So when you look at the people and the male sperm comes from an ejaculation after age 50, that one does have the highest significance associated with autism, and also with some other very interesting autosomal dominant disorders.

因此，当你观察人们时，会发现男性精子来自 50 岁以后的射精，这确实与自闭症以及其他一些非常有趣的常染色体显性遗传疾病相关。

So we don't want to take advanced paternal age lightly, although it does get so much less attention than what we call advanced maternal age, or being over age 35 in a woman, and that is purely because of the differences in the sperm and the egg environment and how their quality is impactful.

因此，我们不想轻视父亲高龄，尽管它确实比我们所说的高龄母亲（或女性超过 35 岁）受到的关注要少得多，而这纯粹是因为精子和卵子环境的差异及其质量的影响。

Andrew Huberman:

安德鲁·休伯曼：

Thank you for that answer.

谢谢你的回答。

I think it's really important for people to hear that, because the lore out there is that higher incidence of autism in IVF babies, but it sounds like a good percentage of those could be because of age-related factors as well as technology-related factors, and that the technology is getting better all the time, if I understood correctly.

我认为人们听到这个消息真的很重要，因为有传言说体外受精婴儿自闭症的发病率较高，但听起来其中很大一部分可能是由于与年龄相关的因素以及与技术相关的因素，而且如果我理解正确的话，技术一直在变得更好。

We didn't complete the discussion of IVF, and I want to do that.

我们还没有完成关于体外受精的讨论，我想这样做。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Talk about ICSI and a few other things.

谈论 ICSI 和其他一些事情。

I know that's definitely your wheelhouse.

我知道那绝对是你的驾驶室。

Before we do that, can we inject a little sub-conversation around this?

在此之前，我们可以围绕此插入一些子对话吗？

Because I neglected to bring this up earlier, and I know there's a lot of curiosity about this, and then we'll finish off IVF.

因为我之前忘记提出这个问题，而且我知道大家对此很好奇，然后我们就会结束 IVF。

Can we do that?

我们可以这样做吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Let's do it.

让我们开始吧。

Andrew Huberman:

安德鲁·休伯曼：

Sort of a pause in the IVF.

有点像试管受精过程中的暂停。

So the eggs are out, they're frozen.

所以鸡蛋就出来了，它们被冷冻了。

Sperm's out, it's frozen.

精子出来了，被冷冻了。

Or maybe they're going to put non-frozen sperm directly onto those unfrozen eggs.

或者也许他们会将未冷冻的精子直接放入那些未冷冻的卵子上。

We'll pause there, intermission for those potential embryos, and talk about something that you've been very open about, and a lot of people are not, frankly, in your profession, so I really appreciate this, which is nutrition and supplementation to optimize the health of egg quality, and not just for people who want to get pregnant, but for people who believe that fertility is a proxy for overall health.

我们将在此暂停，为那些潜在的胚胎进行中场休息，并谈论一些您一直非常开放的事情，坦率地说，很多人并不从事您的职业，所以我真的很欣赏这一点，即营养和补充剂，以优化卵子质量的健康，不仅适用于那些想要怀孕的人，而且适用于那些相信生育能力代表整体健康的人。

So, are there things that people should eat and not eat, things that people should supplement and not supplement, in order to optimize their fertility?

那么，为了优化生育能力，人们是否应该吃什么和不应该吃什么，应该补充什么和不应该补充什么？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

This is definitely an interest of mine, right?

这绝对是我的兴趣，对吧？

All my fellowship research cycles around fecundability and natural fertility, and I think we really do a disservice by how medicine really is categorized by organ systems, because we act like things in one place don't impact the other.

我所有的奖学金研究都围绕着生育力和自然生育力展开，我认为我们对医学如何按器官系统进行分类确实造成了伤害，因为我们的行为就像一个地方的事物不会影响另一个地方。

Andrew Huberman:

安德鲁·休伯曼：

As if.

仿佛。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right?

对吗？

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But you have a body, and your body, and especially your hormones, change and fluctuate, and they're meant to.

但你有一个身体，你的身体，尤其是你的荷尔蒙，会发生变化和波动，这是注定的。

They are meant to be a dynamic system.

它们应该是一个动态系统。

But the world and the environment of which you are subjecting your body to has proven changes on both hormonal function and also when it comes to egg and sperm quality.

但事实证明，您的身体所处的世界和环境已经改变了荷尔蒙功能以及卵子和精子的质量。

And so if you are somebody who just wants to live your healthiest life and have your most regular periods and have your hormones as well-balanced as they can be, for lack of a better word, we'll just say that that means that they're functioning normally, then paying attention to the things that you do are really important.

因此，如果您只是想过上最健康的生活，拥有最规律的月经，并让荷尔蒙尽可能保持平衡，那么，没有更好的词来形容，我们只能说，这意味着它们功能正常，那么关注您所做的事情就非常重要。

And so I know this is a big one for you.

所以我知道这对你来说是一件大事。

Sleep is probably the number one thing that people don't do that does impact their reproductive hormone system, and therefore can impact egg and sperm quality because sleep is when you have cellular repair and when you can drop your inflammation levels.

睡眠可能是人们不做的第一件事，它会影响他们的生殖激素系统，因此会影响卵子和精子的质量，因为睡眠是细胞修复和降低炎症水平的时候。

We know that inflammation is just toxic to eggs and sperm.

我们知道炎症只是对卵子和精子有毒。

It is.

这是。

The inflammatory environment is not ideal for conception.

炎症环境不适合受孕。

And then for a female, you have to deal with the fact that you have your egg quality, but you also have how inflammation or what you're exposed to impacts your uterine environment.

对于女性来说，你必须面对这样一个事实：你有卵子质量，但你也有炎症或你所接触的东西如何影响你的子宫环境。

So you have a twofold situation here.

所以这里有双重情况。

So none of this should be shocking news when it comes to nutrition, but it is not talked about enough.

因此，就营养而言，这些都不应该是令人震惊的消息，但人们对此的讨论还不够。

You're right.

你说得对。

Decreasing inflammation by the foods that we put in our body is consistently shown with an improvement in fecundability, an improvement in ovulation, and an improvement in success with IVF, and a decrease in miscarriage.

我们摄入体内的食物可以减少炎症，从而提高受孕能力、改善排卵、提高体外受精成功率以及减少流产。

Right?

正确的？

Huge studies have looked at these.

大量研究已经研究过这些。

Now, the big caveat is that nutrition studies are super hard because people who consume flax, for example, tend to have other good health behaviors that sometimes make it hard to identify what flax did, versus their general health, versus somebody who eats fast food every day.

现在，需要注意的是，营养研究非常困难，因为食用亚麻的人往往有其他良好的健康行为，有时很难确定亚麻的作用，与他们的总体健康状况相比，与每天吃快餐的人相比。

So nutrition studies tend to be observational, and fertility studies are really hard, too, because what endpoint are you using?

因此，营养研究往往是观察性的，而生育力研究也确实很困难，因为你使用的终点是什么？

Is it getting pregnant?

难道是怀孕了？

Is it live birth?

是活产吗？

Are you looking at IVF?

你在看IVF吗？

Are you looking at natural fertility?

您在寻找自然生育能力吗？

And we have a lot of different overlap that makes both of these a little bit difficult.

我们有很多不同的重叠，这使得这两者都有点困难。

And so they're all cohort-based or population-based studies where you analyze how people perform when it comes to fertility treatments or getting pregnant naturally based on their exposures to certain things.

因此，它们都是基于队列或基于人群的研究，您可以根据人们接触某些事物的情况来分析人们在生育治疗或自然怀孕方面的表现。

Diets high in fruits and vegetables are good for you.

富含水果和蔬菜的饮食对您有好处。

Right?

正确的？

Fiber, antioxidants.

纤维、抗氧化剂。

Fruit is not bad.

水果还不错。

Fruit got this really bad reputation.

水果的名声非常不好。

Andrew Huberman:

安德鲁·休伯曼：

Really?

真的吗？

I love fruit.

我喜欢水果。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I love fruit, too, but people think that it has sugar and that it's bad for you.

我也喜欢水果，但人们认为它含有糖，对身体不好。

Andrew Huberman:

安德鲁·休伯曼：

It has fructose, but you know.

它含有果糖，但你知道。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

No, that type of sugar is not bad for you, if we can just agree on the fact that fruit has a lot of nutritional benefit, especially when it comes to vitamins and antioxidants that can be extremely beneficial in decreasing inflammation.

不，如果我们都同意水果具有很多营养价值这一事实，尤其是维生素和抗氧化剂对减少炎症非常有益，那么这种糖对你来说并没有坏处。

Grains.

谷物。

So whole grains, especially that your body provide a lot of great fiber.

所以全谷物，尤其是你的身体可以提供大量优质纤维。

So of course, if you have celiac or you're gluten intolerant, you're a different category.

当然，如果您患有乳糜泻或麸质不耐症，那么您就属于不同的类别。

But there was so much focus on keto and people eliminating grains as a food group overall.

但人们对酮类和人们将谷物作为一个整体食物类别的消除给予了如此多的关注。

And even though that might be utilized in a dietary strategy to lose weight, and losing weight can improve fertility, likely because of inflammation being the primary driver, because we know that even in studies where I take donor eggs and I transfer that embryo into somebody who's overweight, they have lower odds of success than if they were a normal BMI.

即使这可能被用于减肥的饮食策略中，而减肥可以提高生育能力，可能是因为炎症是主要驱动因素，因为我们知道，即使在研究中，我使用捐赠的卵子并将胚胎移植到超重的人身上，他们的成功几率也比体重指数正常的人低。

So we can't act like that causation is just on egg quality from obesity.

因此，我们不能认为肥胖只是导致卵子质量下降的原因。

Right?

正确的？

There's also some inflammation, some inflammatory changes that impact the body's ability or desire to allow an embryo to implant.

还有一些炎症，一些炎症变化会影响身体允许胚胎植入的能力或愿望。

So fruits, veggies, whole grains are all good.

所以水果、蔬菜、全谷物都是好的。

Interestingly, dairy tends to be okay in most studies, but what we do see is that if you're going to have dairy, have the real thing.

有趣的是，在大多数研究中，乳制品往往没问题，但我们确实看到，如果你要吃乳制品，就吃真正的东西。

The processed dairy, the skim milk, that actually decreases your fertility, and likely because the processing to make it still look like milk when you take out the fat is adding in things that are unnatural, potentially impacting your fertility.

经过加工的乳制品，即脱脂牛奶，实际上会降低您的生育能力，很可能是因为在去除脂肪后使其看起来仍然像牛奶的加工过程中添加了不自然的物质，可能会影响您的生育能力。

Andrew Huberman:

安德鲁·休伯曼：

I don't drink milk anymore, but when I was a teenager, I drank half-and-half.

我现在不喝牛奶了，但十几岁的时候，我喝了一半。

I'm not recommending anyone do that.

我不建议任何人这样做。

Remember, I was a skinny teenager.

请记住，我是一个骨瘦如柴的青少年。

I was like-

我当时就像——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

You were trying to bulk up.

你正试图增肥。

Andrew Huberman:

安德鲁·休伯曼：

Well, no, I just could afford to.

好吧，不，我只是负担得起。

At that age, I wasn't trying to at all, but it was just delicious.

在那个年纪，我根本没有尝试，但它真的很美味。

But so Cheeses, full-fat milk-

但是奶酪、全脂牛奶-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yogurt

酸奶

Andrew Huberman:

安德鲁·休伯曼：

...

half-and-half-

一半一半——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

yogurt.

酸奶。

Okay.

好的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, but don't choose the skim one.

是的，但不要选择脱脂的。

Choose the actual one that comes with some of the milk fat.

选择带有一些乳脂的实际产品。

Fat is not bad for you.

脂肪对你来说并不坏。

There's also this, hopefully we're getting away from it, but there's been such a low-fat craze, or this real attention that fat is so bad, but fat comes in so many important forms.

还有一点，希望我们能够远离它，但是存在着如此低脂肪的热潮，或者人们真正关注脂肪是如此糟糕，但脂肪有很多重要的形式。

Avocados and oils and nuts, dairy, meat.

鳄梨、油、坚果、奶制品、肉类。

Fat and cholesterol are the backbone for all hormones.

脂肪和胆固醇是所有激素的支柱。

So you need that in order for your body to make the estrogen and progesterone that it needs to allow this whole process to happen.

因此，您需要它才能使您的身体产生使整个过程发生所需的雌激素和黄体酮。

And so there's this idea that those are bad for you, that's just really not.

所以有人认为这些对你有害，但事实并非如此。

So healthy fats, whole grains, fruits, veggies.

所以健康的脂肪、全谷物、水果、蔬菜。

Andrew Huberman:

安德鲁·休伯曼：

And what about proteins and meats?

那么蛋白质和肉类呢？

Because I think within those categories, I'm a big fan of sustainably raised meats if possible.

因为我认为在这些类别中，如果可能的话，我非常喜欢可持续饲养的肉类。

Some people choose not to eat meat, but fish, eggs.

有些人选择不吃肉，而是吃鱼、鸡蛋。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Love it all.

喜欢这一切。

Okay, so let's just go through the meats and the myth and the facts.

好吧，让我们来看看肉类、神话和事实。

So we'll do tofu.

那我们就来做豆腐吧。

So there's this big issue that tofu has soy and that too much soy can be bad because soy can be a phytoestrogen.

所以有一个大问题，豆腐含有大豆，过多的大豆可能不好，因为大豆可能是一种植物雌激素。

Tofu does not negatively impact fertility, even in men.

豆腐不会对生育能力产生负面影响，即使对于男性也是如此。

In fact, it can improve it because it does have some antioxidant-like properties, lots of iron.

事实上，它可以改善它，因为它确实具有一些类似抗氧化剂的特性，大量的铁。

When it comes to fish, fish are fantastic sources of healthy fats and omega-3 fatty acids, which are very crucial in the reproductive process.

说到鱼，鱼是健康脂肪和 omega-3 脂肪酸的绝佳来源，它们在生殖过程中非常重要。

We do worry about if you're pregnant, having too much fish and overexposure to mercury, and how that can impact fetal brain development.

我们确实担心您是否怀孕、吃太多鱼和过度接触汞，以及这会如何影响胎儿的大脑发育。

So the general recommendation is three servings per week.

所以一般建议是每周三份。

That doesn't-

那不-

Andrew Huberman:

安德鲁·休伯曼：

And let me guess, a serving is like four to six ounces-

让我猜猜，一份大约是四到六盎司——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right

右

Andrew Huberman:

安德鲁·休伯曼：

...

as opposed to like a real human that eats-

而不是像一个真正的人类那样吃——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Well

嗯

Andrew Huberman:

安德鲁·休伯曼：

...

you know.

你知道。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

A real human.

一个真正的人。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

That eats six to eight ounces of fish.

它可以吃六到八盎司的鱼。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And I think it's important to say, even though people will tell you that when you're trying to get pregnant with the idea of we don't know when you're going to be pregnant, if you're going through things like egg freezing or IVF, and you know when you're going to be pregnant, I wouldn't feel like you have to restrict yourself on the consumption of seafood during those time periods when you know you're not pregnant yet.

我认为重要的是，即使人们会告诉你，当你试图怀孕时，我们不知道你什么时候会怀孕，如果你正在经历卵子冷冻或试管受精之类的事情，而且你知道你什么时候会怀孕，我不认为你必须在你知道自己还没有怀孕的那段时间限制自己吃海鲜。

Because really the concern is about that mercury and what it could potentially do to a fetal brain.

因为真正令人担忧的是汞及其对胎儿大脑的潜在影响。

Andrew Huberman:

安德鲁·休伯曼：

And raw seafood, correct?

还有生海鲜，对吗？

No sushi, no sashimi.

没有寿司，没有生鱼片。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Well, when you're pregnant, correct.

好吧，当你怀孕时，正确的。

And that's mostly because of the risk of infectious disease that can cause severe brain development and other issues.

这主要是因为传染病的风险可能导致严重的大脑发育和其他问题。

Andrew Huberman:

安德鲁·休伯曼：

What do they do in Japan?

他们在日本做什么？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I don't know.

我不知道。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I don't live there.

我不住在那里。

Andrew Huberman:

安德鲁·休伯曼：

They probably laugh at this.

他们可能会嘲笑这一点。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They probably do laugh at us.

他们可能确实嘲笑我们。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They probably do laugh at us a lot.

他们可能确实经常嘲笑我们。

Andrew Huberman:

安德鲁·休伯曼：

Someone who's been pregnant in Japan-

在日本怀孕过的人-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, reach out, tell us

是的，联系我们，告诉我们

Andrew Huberman:

安德鲁·休伯曼：

...

yeah, or conceived in Japan, tell us.

是的，或者在日本受孕，请告诉我们。

Don't tell us the story of the conception, but tell us, did you have sashimi?

不要告诉我们受孕的故事，但告诉我们，你有生鱼片吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Overall, meat is a really broad category, and studies study it differently.

总的来说，肉类是一个非常广泛的类别，并且研究对其进行了不同的研究。

Like is it all meat?

好像全都是肉？

Are you distinguishing out red meat and chicken?

你能区分红肉和鸡肉吗？

Are you putting it all together?

你把它们放在一起吗？

Obviously, I think we can all come to the agreement that processed meats are not good for a variety of different reasons.

显然，我认为我们都可以达成共识，由于各种不同的原因，加工肉类不好。

In addition to being carcinogenic, those toxins do negatively impact fertility.

这些毒素除了致癌之外，还会对生育能力产生负面影响。

Now-

现在——

Andrew Huberman:

安德鲁·休伯曼：

So deli meat, no bueno.

所以熟食肉，没有布埃诺。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So yeah, but in specifically those things like the bacon and the things that are really highly processed, hot dogs.

是的，但特别是那些像培根和真正经过高度加工的东西，热狗。

Sorry, the Fourth of July hot dog picnic.

抱歉，七月四日热狗野餐。

But those things really do not provide nutritional advantages and only harm.

但这些东西确实没有营养优势，反而有害。

Especially then when we have red meat.

尤其是当我们吃红肉时。

For the most part, red meat, when isolated individually, in most circumstances, in moderation tends to be fine.

在大多数情况下，在大多数情况下，单独食用红肉时，适量食用往往没问题。

I usually tell my patients, I want them to eat a plant-forward diet.

我通常告诉我的病人，我希望他们吃植物性饮食。

But that doesn't mean no meat.

但这并不意味着没有肉。

But I say, "Look at your meat servings.

但我说，“看看你的肉类份量。

I don't want it red meat every single day." Because there was a study looking at IVF and looking at embryos, and the more servings, a lot of nutritional studies base things on quartiles, so who eats the lowest, then the second most, and the third most, and the top most.

我不想每天都吃红肉。”因为有一项研究着眼于体外受精和胚胎，以及更多的份量，所以很多营养研究都以四分位数为基础，所以谁吃得最少，然后是第二多，第三多，最后是最多。

And people who ate in that top quartile of red meat had lower progression of embryos through the culture, so less embryos that developed, less normal embryos, and lower success rates.

吃前四分之一红肉的人在培养过程中的胚胎进展速度较低，因此发育的胚胎较少，正常胚胎也较少，成功率也较低。

Andrew Huberman:

安德鲁·休伯曼：

And do we know anything about how that meat was arriving?

我们知道这些肉是如何到达的吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

No.

不。

Andrew Huberman:

安德鲁·休伯曼：

Are we talking about-

我们正在谈论-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Unfortunately, we don't

不幸的是，我们不

Andrew Huberman:

安德鲁·休伯曼：

...

like hoagie sandwiches?

喜欢三明治？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

We don't know.

我们不知道。

Andrew Huberman:

安德鲁·休伯曼：

Or are we talking about like grass-fed steaks?

或者我们谈论的是草饲牛排？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

These studies are not wonderful, but that doesn't mean that they don't hold merit in helping us guide counseling.

这些研究并不精彩，但这并不意味着它们在帮助我们指导咨询方面没有价值。

But no, that one was how many servings of red meat do you eat in a week, right?

但不，那个是你一周吃多少份红肉，对吧？

So we don't really know, does the really ethically sourced, the grass-fed, this environment which we feel like is much less toxic than potentially, let's say, like a cattle factory where the cows are injected with all sorts of things.

所以我们真的不知道，我们认为真正符合道德来源的、草饲的环境是否比潜在的毒性要小得多，比如说，就像一个养牛场，奶牛被注射了各种各样的东西。

Is there a difference in how those impact your reproduction?

这些对您的繁殖有何影响？

Probably, right?

也许吧？

If this cow's getting injected with a lot-

如果这头牛被注射了很多——

Andrew Huberman:

安德鲁·休伯曼：

Sure

当然可以

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

of hormones, why are we thinking that it's not impacting the meat that you're then ingesting into your body?

激素，为什么我们认为它不会影响您摄入体内的肉类？

Andrew Huberman:

安德鲁·休伯曼：

Oh, I think our audience will certainly subscribe to that idea.

哦，我想我们的观众肯定会同意这个想法。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Hmm.

嗯。

Andrew Huberman:

安德鲁·休伯曼：

I think most of them will.

我想他们中的大多数都会。

The notion that the pollutants you breathe in the air somehow are not the air that you breathe into your lungs is just completely naive.

认为你呼吸的空气中的污染物在某种程度上不是你吸入肺部的空气的想法是完全天真的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Wild.

狂野。

Andrew Huberman:

安德鲁·休伯曼：

And the idea-

还有这个想法——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But people feel that way, and they hold strongly to this idea that it can't be this thing that I love that is causing this problem, right?

但人们有这样的感觉，他们强烈地认为，不可能是我喜欢的东西造成了这个问题，对吗？

The denial of the association between what we put in and on our body and how it impacts our body's function is really strong in some people, and I think it's really just lack of education and awareness because the medical community for so long did not address these factors.

有些人非常强烈地否认我们摄入体内和体内的物质与它如何影响我们身体的功能之间的联系，我认为这实际上只是缺乏教育和意识，因为医学界长期以来没有解决这些因素。

Your doctor never talked to you about nutrition, and so it just became this idea that it must not matter, otherwise your doctor would talk to you about it.

你的医生从来没有和你谈论过营养问题，所以它就变成了这样的想法：这一定不重要，否则你的医生会和你谈论它。

I think sugar is the last thing I just didn't mention, but added sugar and artificial sugars- are bad for you.

我认为糖是我最后没有提到的，但添加糖和人造糖对你有害。

Andrew Huberman:

安德鲁·休伯曼：

Artificial sugars.

人造糖。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Artificial sugars too.

还有人造糖。

So e-

所以电子

Andrew Huberman:

安德鲁·休伯曼：

Including stevia, sort of plant-based, low-calorie sweeteners?

包括甜叶菊，一种植物性低热量甜味剂？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Stevia itself hasn't been studied as much as the other ones, things like Sweet'N Low-

甜叶菊本身并没有像其他甜菊糖那样被研究得那么多，比如 Sweet'N Low-

Andrew Huberman:

安德鲁·休伯曼：

Saccharin

糖精

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

and all of those.

以及所有这些。

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But what we do know is that they cause inflammation inside the body, and then they also can cause a stress reaction, and they can cause higher rates of miscarriage when you intake more sugar and artificial sugar.

但我们所知道的是，它们会引起体内炎症，然后还会引起应激反应，并且当您摄入更多糖和人造糖时，它们会导致更高的流产率。

So that's a lot to wrap your head around, and I say the same thing to every patient.

所以，有很多事情需要你思考，我对每个病人都说同样的话。

One cake, one this, one hot dog, I mean, those things individually are not going to make a difference, right?

一个蛋糕，一个这个，一个热狗，我的意思是，这些东西单独来说不会有什么不同，对吧？

It's the choices that you make every single day that are going to set you up to be your healthy self or not.

您每天所做的选择将决定您能否成为健康的自己。

And so you should make choices in line with how you want to treat yourself.

因此，您应该根据自己想要如何对待自己来做出选择。

You want to be in your best health.

您希望保持最佳健康状态。

You want your hormones functioning the best.

您希望您的荷尔蒙发挥最佳作用。

And if that added helps you get pregnant when you want to, helps you have a better chance of success with IVF, oh my gosh, what a fantastic benefit.

如果添加的这些可以帮助您在想要怀孕时怀孕，帮助您获得更好的试管受精成功机会，天哪，这真是太棒了。

But that doesn't mean you can't enjoy some of these bad things here and there, as long as you've set yourself up on the day to day, where you're giving your body lots of nutritious food that it needs to make hormones.

但这并不意味着你不能到处享受这些不好的事情，只要你每天都做好准备，为你的身体提供大量产生激素所需的营养食物。

Similarly, being very underweight and calorie restricting, we all know is really terrible for your reproductive system and can cause the brain to totally shut down ovulation because it senses that you can't have a pregnancy.

同样，我们都知道，体重过轻和热量限制对您的生殖系统来说非常糟糕，并且可能导致大脑完全停止排卵，因为它感觉到您无法怀孕。

So-

所以——

Andrew Huberman:

安德鲁·休伯曼：

Do people miscarry, excuse me, by virtue of being underweight?

请问，人们会因为体重过轻而流产吗？

I learned some years ago, I think this is still true, that one of the signals for the onset of puberty in females is that leptin, a hormone, is secreted from body fat-

几年前我了解到，我认为这仍然是正确的，女性青春期开始的信号之一是瘦素，一种激素，是从体内脂肪分泌的——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

that then signals to the brain, to the hypothalamus like, okay, there's enough reserves to create environment...

然后向大脑、下丘脑发出信号，比如，好吧，有足够的储备来创造环境......

It's a signal about environmental-

这是一个关于环境的信号——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, there's enough extra fat-

是的，有足够的多余脂肪-

Andrew Huberman:

安德鲁·休伯曼：

Yeah

是啊

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

to have a baby.

生孩子。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, and there's presumably enough food around to sustain that baby.

是的，而且周围大概有足够的食物来养活那个婴儿。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Both.

两者皆有。

Andrew Huberman:

安德鲁·休伯曼：

Right.

对。

Are miscarriages and lack of body fat correlated?

流产和体内脂肪缺乏有相关性吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

On both ends of the spectrum, yes.

在光谱的两端，是的。

Right?

正确的？

So lack of body fat and being overweight, we see decrease in getting pregnant per month, and we see increase in losing pregnancies.

因此，由于身体脂肪不足和体重超重，我们发现每月怀孕的人数减少，而流产的人数增加。

So certainly, there is a healthy medium where your body has what it needs.

因此，当然，有一种健康的媒介可以让您的身体获得所需的东西。

And that makes sense because if you have, I like to even say hypothalamic dysfunction, so maybe your brain's not totally shut off, where it's sending out no hormones and you're not ovulating, because you're not getting pregnant in that circumstance.

这是有道理的，因为如果你有，我什至喜欢说下丘脑功能障碍，所以也许你的大脑没有完全关闭，它不发出任何激素，你也不会排卵，因为在这种情况下你不会怀孕。

But certainly, ovulation disorders are on a spectrum where you go from a perfectly synchronized cycle to one that prolongs it, gets shorter together, then prolongs, and then you have nothing.

但可以肯定的是，排卵障碍是一个范围，从一个完全同步的周期到一个延长周期，一起变短，然后延长，然后就什么也没有了。

There's this spectrum of dysfunction which is representing your hormones not being necessarily perfect, and that can have impacts on the placenta trying to grow into that uterus.

有一系列的功能障碍，代表您的激素不一定是完美的，并且可能会对试图生长到子宫的胎盘产生影响。

I mean, the placenta's fascinating, right?

我的意思是，胎盘很迷人，对吧？

An entire talk just on the placenta.

整个谈话都是关于胎盘的。

But it does this incredible job where your body has to not reject it, yet allow it to eat away at the side of your uterus and grow into your blood vessels.

但它完成了这项令人难以置信的工作，您的身体必须不排斥它，但要允许它侵蚀您的子宫侧面并生长到您的血管中。

But that requires a very specific hormonal environment for it to be done and to be done right.

但这需要非常特定的荷尔蒙环境才能完成并且正确完成。

I think in the same breath of all this, what you're also asking is, yeah, okay, so that's eating healthy.

我认为，与此同时，你还想问的是，是的，好吧，这就是健康饮食。

None of that's really new news for most people.

对于大多数人来说，这些都不是真正的新消息。

A lot of those things I just said-

刚才说了很多话——

Andrew Huberman:

安德鲁·休伯曼：

Well, I think so, but I do want to thank you because I think rarely, if ever, do we hear a physician be really direct about like, "Hey, listen, some red meat, yes, not excessive amounts of red meat, ideally from sustainable sources, whole fat milk products, grains, fruits, vegetables." I mean, those kind of what, to you seem like straightforward directives are actually pretty rare in the landscape of public health discussion because, more often than not, people talk about nutrition and these kind of elimination diet type things.

嗯，我想是这样，但我确实想感谢你，因为我认为我们很少（如果有的话）听到医生真正直接地说，“嘿，听着，一些红肉，是的，不要过量的红肉，最好来自可持续来源，全脂奶制品，谷物，水果，蔬菜。”我的意思是，这些对你来说看似简单的指令实际上在公共卫生讨论领域非常罕见，因为人们通常会谈论营养和此类消除饮食类型的事情。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Like eliminate all the grains or eliminate all the meat or eliminate all the milk fats when, in reality, I think people forget that most people out there are omnivores.

就像消除所有谷物或消除所有肉类或消除所有乳脂一样，实际上，我认为人们忘记了大多数人都是杂食动物。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

Andrew Huberman:

安德鲁·休伯曼：

And they can make better choices-

他们可以做出更好的选择——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Eat everything

什么都吃

Andrew Huberman:

安德鲁·休伯曼：

...

about not deli meat.

大约不是熟食肉。

Less bacon if any bacon, right?

如果有培根，就少吃培根吧？

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Have some veggies with your lunch, right?

午餐时吃一些蔬菜，对吗？

You can make better choices on the day to day.

您可以每天做出更好的选择。

I think that is a great point.

我认为这是一个很好的观点。

I think there's a place for supplements.

我觉得还是有一个补充的地方。

I think the big disclaimer that everybody's going to say with supplements is that they are not regulated like the way medications are, right?

我认为每个人都会对补充剂说的最大免责声明是，它们不像药物那样受到监管，对吗？

And I will say supplements and herbs are different things, right?

我会说补充剂和草药是不同的东西，对吗？

A supplement, but many companies are adding herbs to their supplements, and that can get into really murky territory, especially when it comes to how some of these herbs do have estrogen and progestin-like properties and can impact reproduction and hormones.

一种补充剂，但许多公司都在他们的补充剂中添加草药，这可能会进入一个非常模糊的领域，特别是当谈到其中一些草药确实具有雌激素和孕激素样特性并可能影响生殖和激素时。

Andrew Huberman:

安德鲁·休伯曼：

And perhaps even androgenic properties too.

也许甚至还有雄激素特性。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes, yes.

是的，是的。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So we can't act like everything's created equal.

所以我们不能表现得一切生而平等。

So I always tell people if I recommend you take a supplement or your doctor does, your due diligence is to look at what is also included and make sure it doesn't have these extra added things that they're unaware of.

因此，我总是告诉人们，如果我建议您服用补充剂或您的医生服用补充剂，您的尽职调查是查看其中还包含哪些内容，并确保其中没有这些他们不知道的额外添加的东西。

Because sometimes they can have negative impact at one stage of your life or another, depending on where you are.

因为有时它们可能会对您人生的某个阶段或另一个阶段产生负面影响，具体取决于您所处的位置。

Certainly, a prenatal vitamin which has folic acid, we all know that folic acid is really important to prevent neural tube defects, but it's also important in cell division and how the ovary is growing follicles and growing eggs.

当然，含有叶酸的产前维生素，我们都知道叶酸对于预防神经管缺陷非常重要，但它对于细胞分裂以及卵巢如何生长卵泡和卵子也很重要。

Andrew Huberman:

安德鲁·休伯曼：

So should people, women, but also men, be taking a vitamin with folic acid even when they're not trying to conceive?

那么，人们，无论是女性还是男性，即使在不打算怀孕的时候也应该服用含有叶酸的维生素吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

There's no harm in having it, but very often pregnancies occur when you're not trying to conceive, and that is a store that needs to be built up three months ahead of time.

拥有它并没有什么坏处，但怀孕通常是在您不打算怀孕时发生的，而这是一个需要提前三个月建立的商店。

So we really need you to be taking that ahead of getting pregnant, so not just, "Let's get pregnant right now.

因此，我们确实需要您在怀孕前采取这一措施，而不仅仅是“我们现在就怀孕吧。

I'm going to start this prenatal vitamin."

我要开始服用这种产前维生素。”

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So I recommend anybody who's in their reproductive years take a prenatal vitamin.

因此，我建议任何处于育龄期的人服用产前维生素。

We also know that many, many people are vitamin D deficient, and vitamin D does impact reproduction.

我们还知道，很多人都缺乏维生素 D，而维生素 D 确实会影响生殖。

And so I usually say 1,000 international units of vitamin D is not going to be harmful in anybody.

所以我通常说 1,000 国际单位的维生素 D 对任何人都不会有害。

It's going to be helpful for most people.

这对大多数人都会有帮助。

Some people definitely need higher levels So we screen everybody with a vitamin D to see who needs to have extra.

有些人肯定需要更高的维生素 D 水平，因此我们会对每个人进行维生素 D 筛查，看看谁需要额外补充。

But a blanket statement that extra vitamin D is going to be helpful.

但总而言之，额外的维生素 D 会有帮助。

Omega-3 fatty acids, also extremely important in, one, being anti-inflammatory, but two, brain development of a fetus.

Omega-3 脂肪酸的作用也极其重要，一是抗炎，二是胎儿大脑发育。

So most prenatals now actually do have those omega-3 fatty acids in them.

所以现在大多数产前婴儿体内确实含有 omega-3 脂肪酸。

But if they don't, I recommend a patient take those.

但如果他们不这样做，我建议病人服用这些。

Andrew Huberman:

安德鲁·休伯曼：

Just a brief-

只是一个简短的介绍——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

a question/insertion there.

那里有一个问题/插入。

There's a laboratory up at the University of California, Santa Barbara, that's published some really interesting data showing that essentially brain weight, which is just but one indirect measure of brain health, but brain weight at birth seems to be correlated, at least in some positive way, with the amount of essential fatty acids that mom consumed during pregnancy.

加州大学圣塔芭芭拉分校有一个实验室，发表了一些非常有趣的数据，表明大脑重量本质上只是大脑健康的一种间接衡量标准，但出生时的大脑重量似乎与妈妈在怀孕期间消耗的必需脂肪酸量相关，至少以某种积极的方式相关。

Does that sound-- Does that hold?

听起来是这样吗——这成立吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

I mean, that does hold, and there's mice studies about that mice are smarter when they have diets with omega-3 fatty acids when they are in utero, right?

我的意思是，这确实成立，并且有小鼠研究表明，当小鼠在子宫内食用含有 omega-3 脂肪酸的饮食时，它们会更聪明，对吗？

So the exposure and the time period is really important.

所以曝光和时间段非常重要。

And omega-3s have a lot of health benefits when it comes to their antioxidant properties, especially in endometriosis, diseases that are very highly inflammatory, they can be very beneficial.

omega-3 的抗氧化特性对健康有很多好处，特别是对于子宫内膜异位症这种高度炎症的疾病，它们非常有益。

Andrew Huberman:

安德鲁·休伯曼：

We're definitely going to talk about your work about after baby has arrived and impact of essential fatty acids, but what would you say is the dosage cutoff?

我们肯定会谈论您关于婴儿出生后的工作以及必需脂肪酸的影响，但您认为剂量截止值是多少？

On this podcast before, I've sort of thrown out numbers like one to two grams per day of the EPA form of essential fatty acid.

之前在这个播客中，我抛出了每天一到两克 EPA 形式的必需脂肪酸的数字。

And then we could have a whole discussion about omega-3, omega-6 ratios.

然后我们可以对 omega-3、omega-6 比例进行全面讨论。

But do you think there's an upper limit?

但你认为有上限吗？

Is it truly that, let's say up to four grams per day of EPA, would that be advantageous?

假设每天摄入 4 克 EPA，真的会有好处吗？

Is it better than one gram?

比一克好吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I tell people a gram.

我告诉人们一克。

Andrew Huberman:

安德鲁·休伯曼：

A gram.

一克。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So-

所以——

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

That's in alignment with pretty much what we've talked about before

这与我们之前讨论过的内容几乎一致

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

so that's what I recommend.

这就是我的建议。

When I give my handout to my patients and they're trying to get pregnant, it's going to have a prenatal, 1,000 IUs of vitamin D, a gram of omega-3s, and then CoQ10.

当我向想要怀孕的患者发放讲义时，他们会接受产前检查、1,000 国际单位的维生素 D、一克 omega-3，然后是辅酶 Q10。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So CoQ10, which essentially, in general, is trying to help the mitochondria.

因此，CoQ10 本质上是在试图帮助线粒体。

That's the whole idea here, that it is helping provide support across the body in a lot of different ways, right?

这就是这里的整个想法，它以多种不同的方式帮助为整个身体提供支持，对吗？

Like CoQ10 is used in a lot of different areas of the body.

像 CoQ10 一样，它被用于身体的许多不同部位。

But when it comes to reproduction, when it comes to meiosis and cell division and ovulation and egg quality, and even sperm quality, there's a place for CoQ10 showing benefit without harm, right?

但在生殖方面，在减数分裂、细胞分裂、排卵、卵子质量，甚至精子质量方面，CoQ10 都发挥着百利而无一害的作用，对吗？

And so note, as I said earlier, nothing's without any harm or any risk-

所以请注意，正如我之前所说，没有什么是没有任何伤害或任何风险的——

Andrew Huberman:

安德鲁·休伯曼：

Sure

当然可以

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

of harm, but very, very little.

伤害，但非常非常小。

So I usually recommend if you're trying to get pregnant and you take CoQ10, a dose of 200 milligrams three times a day.

因此，如果您想要怀孕，我通常建议您服用 CoQ10，剂量为 200 毫克，每天 3 次。

So that's kind of a higher dose than sometimes people are on.

所以这比人们有时服用的剂量要高。

Often prenatals now have just like 200 total in it.

通常产前检查现在总共只有大约 200 个。

And so we-

所以我们——

Andrew Huberman:

安德鲁·休伯曼：

The expensive ingredients are usually the lower concentrations in blends.

昂贵的成分通常是混合物中浓度较低的成分。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

They're giving you just enough so they can-

他们给你的只是足够的，这样他们就可以-

Andrew Huberman:

安德鲁·休伯曼：

Right

右

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

put it on the label.

把它放在标签上。

Andrew Huberman:

安德鲁·休伯曼：

Right, includes CoQ10.

对，包括 CoQ10。

Does the form of CoQ10 matter?

CoQ10 的形式重要吗？

Because you'll find them in gel capsules, you'll also find them in powdered capsules.

因为您会在凝胶胶囊中找到它们，所以您也会在粉状胶囊中找到它们。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I always say, there might be for the individual person, absorption of medication is really dependent a lot on gut health and other factors.

我总是说，对于个人而言，药物的吸收实际上很大程度上取决于肠道健康和其他因素。

But the number one issue with supplementation is that people don't stick to it.

但补充的首要问题是人们不坚持服用。

So I always say, whichever one you're going to consistently take is going to be the better form.

所以我总是说，无论你坚持采取哪种形式，都会是更好的形式。

Andrew Huberman:

安德鲁·休伯曼：

Great.

太棒了。

A question about L-carnitine.

关于左旋肉碱的问题。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yep.

是的。

Andrew Huberman:

安德鲁·休伯曼：

In researching a little bit for this episode and others, oral L-carnitine has been associated with some improvements in forward motility in sperm-

在对这一事件和其他事件的一些研究中，口服左旋肉碱与精子向前运动的一些改善有关。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm

嗯嗯

Andrew Huberman:

安德鲁·休伯曼：

...

maybe egg quality.

也许是卵子质量。

But we know that a very small percentage of the oral L-carnitine that one ingests is actually utilized, so some people actually purchase and use injectable L-carnitine, which is kind of painful because it's in an alcohol-based suspension, so not comfortable.

但我们知道，一个人摄入的口服左旋肉碱只有很小一部分被实际利用，所以有些人实际上购买并使用注射左旋肉碱，这有点痛苦，因为它是酒精悬浮液，所以不舒服。

It's got to be done intramuscularly.

必须通过肌肉注射来完成。

But my read of the data is kind of impressive.

但我读到的数据令人印象深刻。

I wouldn't say super impressive.

我不会说超级令人印象深刻。

Are you ever injecting patients or having them inject themselves with L-carnitine?

您是否曾经给病人注射左旋肉碱或让他们自己注射左旋肉碱？

This would be both female or male patients or both, or using oral L-carnitine, or do the data just not impress you enough to motivate that?

这可能是女性或男性患者，或者两者兼而有之，或者使用口服左旋肉碱，或者这些数据是否不足以让您印象深刻，不足以激发您的兴趣？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

We use a gram of L-carnitine with a gram of vitamin C for our male patients who have any abnormal sperm parameter.

对于精子参数异常的男性患者，我们使用一克左旋肉碱和一克维生素 C。

And so that is kind of what we consider the sperm enhancement protocol.

这就是我们所认为的精子增强方案。

And so-

所以——

Andrew Huberman:

安德鲁·休伯曼：

And just that.

仅此而已。

That's your-

那是你的——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

That with a multivitamin.

与多种维生素一起服用。

Andrew Huberman:

安德鲁·休伯曼：

Got it.

明白了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So those two with a multivitamin and CoQ10.

所以这两个人都服用了多种维生素和 CoQ10。

So that's kind of like the male protocol.

这有点像男性协议。

Of course, there's different specifics for one individual person.

当然，具体情况因人而异。

I don't tend to recommend it for most females.

我不倾向于向大多数女性推荐它。

That being said, those who have endometriosis fall into a unique category where inflammation is so high that usually it's a different environment where we recommend L-carnitine, N-acetylcysteine, vitamin C and E.

话虽这么说，患有子宫内膜异位症的人属于一个独特的类别，他们的炎症非常严重，因此通常是在不同的环境中，我们建议使用左旋肉碱、N-乙酰半胱氨酸、维生素 C 和 E。

They kind of fall into a different category-

他们属于不同的类别 -

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm

嗯嗯

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

because they have a known inflammatory disease.

因为他们患有已知的炎症性疾病。

But if we're just talking about the person at whole who maybe wants to take some supplements for their reproductive health that have very little side effects and for the most part can potentially be helpful, it's going to be CoQ10, L-carnitine, vitamin C can be helpful, especially for the male.

但如果我们只是谈论那些可能想服用一些补充剂来促进生殖健康的人，这些补充剂副作用很小，而且在大多数情况下可能会有帮助，那么辅酶 Q10、左旋肉碱、维生素 C 可能会有所帮助，尤其是对于男性。

For the female partner, we're going to be looking at that extra vitamin D in addition to the prenatal with folic acid.

对于女性伴侣，除了产前叶酸外，我们还将考虑额外的维生素 D。

Andrew Huberman:

安德鲁·休伯曼：

And what about women with PCOS?

那么患有多囊卵巢综合症的女性呢？

I get so many questions-

我有很多问题——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Inositol

肌醇

Andrew Huberman:

安德鲁·休伯曼：

...

about PCOS.

关于多囊卵巢综合症。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Inositol.

肌醇。

And there, are we talking myo-inositol or the, what is it, the D-chiro?

我们谈论的是肌醇还是 D-chiro？

Do I have that right?

我有这个权利吗？

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

You do have that right.

你确实有这个权利。

Myo-inositol is the main driver of inositol and how it can be helpful.

肌醇是肌醇的主要驱动力，以及它如何发挥作用。

Most blends are going to have a combination of both of them, but a much higher ratio of myo-inositol to D-chiro.

大多数混合物将两者结合，但肌醇与 D-手性的比例要高得多。

And so myo-inositol is probably the one that really is doing the work in PCOS.

因此，肌醇可能是真正在多囊卵巢综合症中发挥作用的物质。

What is it doing?

它在做什么？

It is definitely helping the body when it comes to insulin and sugar, helping the body be more sensitive to insulin or less resistant to it, essentially helping you respond to what you eat in a better way, and it also looks like it does potentially decrease some of that inflammation pathway in PCOS.

当涉及到胰岛素和糖时，它肯定对身体有帮助，帮助身体对胰岛素更敏感或减少抵抗力，从本质上帮助你以更好的方式对你所吃的东西做出反应，而且看起来它确实有可能减少多囊卵巢综合症的一些炎症途径。

In PCOS- This insulin resistance correlates with this testosterone production from the ovary, meaning even metformin alone can decrease testosterone levels based on some of the change that it has in the ovary.

在 PCOS 中，这种胰岛素抵抗与卵巢产生的睾酮相关，这意味着即使单独使用二甲双胍也可以根据卵巢中的一些变化来降低睾酮水平。

Andrew Huberman:

安德鲁·休伯曼：

Take note, men.

请注意，男士们。

So many of you guys taking metformin or berberine thinking, "Oh, this is great.

很多服用二甲双胍或小檗碱的人都在想，“哦，这太棒了。

I'm going to lower my blood sugar, mimic fasting, and live longer." And then these are also the same people who are writing to me going, "How come when I take metformin, I either have headaches because I'm essentially hypoglycemic?"

我要降低血糖，模仿禁食，并活得更长。”然后这些人也写信给我，“为什么当我服用二甲双胍时，我要么会头痛，因为我本质上是低血糖的？”

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, your sugar's low, too.

是的，你的糖分也很低。

Andrew Huberman:

安德鲁·休伯曼：

But also, their testosterone levels are getting crushed.

而且，他们的睾丸激素水平正在被压垮。

Not in every case, but it happens.

并非在所有情况下，但它都会发生。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And I think those are things people just don't think about.

我认为这些是人们没有想到的事情。

They read that a supplement might be beneficial for this one thing that doesn't apply to them, and they start taking it.

他们了解到补充剂可能对这不适用于他们的事情有益，于是他们开始服用它。

So-

所以——

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Also, the evidence on metformin extending life, we had Peter Attia on here to talk about this.

另外，关于二甲双胍延长寿命的证据，我们邀请了 Peter Attia 来讨论这个问题。

The evidence for that is so poor.

这方面的证据太少了。

It's just not really that convincing.

只是这并没有那么令人信服。

It may change, but then now all the excitement's about rapamycin.

它可能会改变，但现在所有的兴奋都是关于雷帕霉素的。

And so, extending your life while plummeting your testosterone, you know what I mean?

所以，在延长你的生命的同时，你的睾丸激素会大幅下降，你明白我的意思吗？

Actually, that strategy's been tried in the longevity community.

事实上，这一策略已经在长寿界尝试过。

There was this whole castration idea.

这就是整个阉割的想法。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, I remember this.

哦，我记得这个。

Andrew Huberman:

安德鲁·休伯曼：

Right?

对吗？

Oh, yeah.

哦，是的。

This was like the Heaven's Gate cult where they castrated themselves in order-

这就像天堂之门邪教，他们按顺序阉割自己——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Did they live longer?

他们活得更长吗？

Andrew Huberman:

安德鲁·休伯曼：

Well, they ended up committing mass suicide.

好吧，他们最终集体自杀了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, no.

哦，不。

Andrew Huberman:

安德鲁·休伯曼：

So, they ended the experiment early.

于是，他们提前结束了实验。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Rightfully.

理所当然。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

So, in any event, going back to supplements, sorry, I couldn't help myself.

所以，无论如何，回到补充剂，抱歉，我无法控制自己。

Supplements that women can potentially take just to increase their fertility, even if they don't want to get pregnant, as just kind of creating a milieu of health.

女性可以服用补充剂来提高生育能力，即使她们不想怀孕，也只是为了创造一个健康的环境。

You talked about the nutrition, you talked about CoQ10, maybe L-carnitine, vitamin C, the essential fatty acids, getting at least one gram of EPA.

你谈到了营养，你谈到了辅酶Q10，也许是左旋肉碱，维生素C，必需脂肪酸，至少获得一克EPA。

So that might require taking two grams of fish oil-

所以这可能需要服用两克鱼油-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Combined, yeah

结合起来，是啊

Andrew Huberman:

安德鲁·休伯曼：

...

to get the EPA.

获得 EPA。

Myo-inositol.

肌醇。

So how much are you talking about?

那么你说的是多少？

I've seen some pretty high dosages thrown out there.

我见过一些相当高剂量的药物被扔在那里。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

For myo-inositol?

对于肌醇？

Andrew Huberman:

安德鲁·休伯曼：

Yeah, for what-

是啊，为了什么——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

2,000 milligrams.

2,000 毫克。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Taken before sleep, or does it matter?

睡前服用，有关系吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

That one doesn't matter.

那个没关系。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

That one doesn't matter.

那个没关系。

Andrew Huberman:

安德鲁·休伯曼：

Thank you for covering the topic of supplements and supplementation.

感谢您涵盖补充剂和补充剂的主题。

This is probably a good point to return back to those harvested eggs.

这可能是回到那些收获的鸡蛋的好时机。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

So eggs are out, and there's a collection of them frozen.

所以鸡蛋已经出来了，并且有一批冷冻的鸡蛋。

Maybe, just maybe, live...

也许，只是也许，活着……

They're always alive, sorry.

他们永远活着，对不起。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I mean, they're not-

我的意思是，他们不是——

Andrew Huberman:

安德鲁·休伯曼：

Fresh sperm.

新鲜的精子。

They call them-

他们称他们为——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They're not always alive

他们并不总是活着

Andrew Huberman:

安德鲁·休伯曼：

...

fresh sperm.

新鲜的精子。

They're fresh sperm.

它们是新鲜的精子。

They're not always live.

他们并不总是活着。

Some portion of the ejaculate is going to be dead sperm, right?

精液的某些部分将是死精子，对吧？

Some live, some forward motile, some non-forward motile.

有些是活的，有些是向前运动的，有些是不能向前运动的。

The twitchers, I read is the name that we're-

我读到的抽搐者是我们的名字——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I hate those twitchers.

我讨厌那些抽搐的人。

Andrew Huberman:

安德鲁·休伯曼：

Right?

对吗？

And so okay, they're going to wash the sperm.

好吧，他们要清洗精子。

Why?

为什么？

Because yeah, most of what people see as ejaculate, or know, excuse me, as ejaculate is not actually the sperm, right?

因为是的，大多数人看到的都是射精，或者知道，对不起，射精实际上并不是精子，对吧？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

Okay.

好的。

But sperm are washed.

但精子被洗掉了。

They're in one compartment.

他们在一个隔间里。

You get the eggs out.

你把鸡蛋拿出来。

You or your embryologist at your clinic is then going to, at some point, decide to combine them.

然后，您或您诊所的胚胎学家将在某个时候决定将它们结合起来。

So is it a sperm race, or are you...

这是一场精子竞赛，还是你...

Maybe you could explain ICSI.

也许你可以解释一下 ICSI。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

And why would one opt for ICSI, and are there any risks with ICSI?

为什么人们会选择 ICSI？ICSI 是否有任何风险？

Because there, you're really, at some level, this is the only place where I kind of sit back and go, "Okay, as somebody who studied neural development," at some level you're saying, "Hey, that sperm looks good." Whereas when you run a sperm race, nature is saying, "Hey, this sperm really did beat all the other sperm."

因为在那里，在某种程度上，这是我唯一可以坐下来的地方，“好吧，作为研究神经发育的人”，在某种程度上，你会说，“嘿，精子看起来不错。”然而，当你进行精子竞赛时，大自然会说：“嘿，这个精子确实击败了所有其他精子。”

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So let's segue first, because I think this is nice, because a question I get asked all the time when we talk about nutrition and supplements and all of that is too, now you're doing IVF or you're freezing your eggs, and what behaviors are good or bad?

所以让我们先继续，因为我认为这很好，因为当我们谈论营养和补充剂以及所有这些时，我总是被问到一个问题，现在你正在进行体外受精或冷冻卵子，哪些行为是好还是坏？

Of course, all of those same ones are.

当然，所有这些都是相同的。

But about how long do you need to do them?

但你需要做多久呢？

And this is why if you live healthy most of the days, it doesn't really matter because that's how you're living.

这就是为什么如果你大部分时间都生活得健康，那并不重要，因为这就是你的生活方式。

But we already know the sperm cycle is about 90 days, and the eggs, I like to say, even though they're in the vault, they start lining up, getting ready to exit the vault, and become more susceptible to the things you're doing in that 90-day window.

但我们已经知道精子周期约为 90 天，而卵子，我想说，即使它们在保险库中，它们也会开始排队，准备退出保险库，并且变得更容易受到您在 90 天窗口期所做的事情的影响。

And we know that to be true as well.

我们也知道这是真的。

So they start to be pre-selected for who's coming out the next month.

因此，他们开始被预选为下个月上映的演员。

They start to line up.

他们开始排队。

And so making these changes as you start thinking about getting pregnant, doing fertility treatments, is still extremely beneficial.

因此，当您开始考虑怀孕、进行生育治疗时，做出这些改变仍然非常有益。

People will often say, "Well, I haven't been doing that, so why start now?

人们经常会说：“好吧，我还没有这样做过，那为什么现在开始呢？

It's not going to make a difference." But truly, it can.

这不会有什么不同。”但确实可以。

Andrew Huberman:

安德鲁·休伯曼：

Or "I'll drink up until the week that-"

或者“我会一直喝到那一周——”

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Until the day of, right?

直到那一天，对吗？

Andrew Huberman:

安德鲁·休伯曼：

Until the day of.

直到那一天。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Like, "I'll just get it in the entire time."

就像，“我会一直得到它。”

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

No, I know a number of people like, "I'm going to have my two glasses of wine," which actually equates to about six glasses of wine when you measure out by-

不，我知道很多人喜欢，“我要喝两杯酒”，当你通过以下方式测量时，这实际上相当于大约六杯酒——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

How much it actually is

实际是多少

Andrew Huberman:

安德鲁·休伯曼：

...

by the volume, right, right up until the week before getting pregnant or something like that.

按音量，对，直到怀孕前一周或类似的事情。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Not-

不-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But no. So people always ask, "What should I be doing?" It's these healthy behaviors, and you should be doing them this whole time.

但没有。所以人们总是会问：“我应该做什么？”这些都是健康的行为，你应该一直这样做。

When we do IVF, and I'm going to get to all the things you just asked, but earlier you said, "Well, how tolerable is it?" The truth is, you're taking shots.

当我们进行试管受精时，我将讨论您刚才问的所有问题，但之前您说过，“那么，它的耐受性如何？”事实是，你正在拍摄。

These are subcutaneous shots during the egg growth process.

这些是卵子生长过程中的皮下注射。

So-

所以——

Andrew Huberman:

安德鲁·休伯曼：

So next to the belly button?

那么肚脐旁边呢？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, next to the belly button, like how a diabetic gives insulin.

是的，在肚脐旁边，就像糖尿病患者注射胰岛素一样。

A very small needle.

一根非常小的针。

Nobody loves shots, but they're not a big intramuscular shot.

没有人喜欢注射，但它们不是大肌肉注射。

It's not like a flu shot or something like that.

这不像流感疫苗或类似的东西。

Andrew Huberman:

安德鲁·休伯曼：

Listen, I've been to Austin.

听着，我去过奥斯汀。

The Texan mosquitoes hurt-

德克萨斯州的蚊子很伤人——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They're way worse

他们更糟糕

Andrew Huberman:

安德鲁·休伯曼：

They hurt way worse-

他们伤得更严重——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They're way worse

他们更糟糕

Andrew Huberman:

安德鲁·休伯曼：

...

than one of these needles.

比这些针中的一根。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Exactly.

正是如此。

Andrew Huberman:

安德鲁·休伯曼：

You know?

你知道吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So you're going to use those medications for about 12 to 14 days.

因此，您将使用这些药物大约 12 到 14 天。

You're going to have your follicles grow.

你的卵泡将会生长。

You're going to feel that.

你会感觉到的。

So you're going to have pelvic pressure.

所以你会有骨盆压力。

As your estrogen rises, you're also going to third space your fluid, which means your fluid, your water component of your blood, is going to start to just eke out a little bit, and you're going to get more bloated.

当你的雌激素上升时，你的液体也会进入第三个空间，这意味着你的液体，你血液中的水成分，将开始稍微勉强维持，你会变得更加浮肿。

You're going to have more water weight.

你将会有更多的水重量。

You're going to feel puffier, and that is very common just because of getting the eggs to grow.

你会感觉更浮肿，这很常见，因为卵子长大了。

You're going to mentally be fine because the female brain loves high estrogen.

你的精神状态会很好，因为女性大脑喜欢高雌激素。

So you're doing fine.

所以你做得很好。

And that's one of the main concerns is, "How emotional will I be?" And during this phase of the process- People do great.

主要关心的问题之一是“我的情绪有多激动？”在这个过程的这个阶段——人们做得很好。

When we take the eggs out of the body, it's about a 20-minute procedure.

当我们将卵子从体内取出时，整个过程大约需要 20 分钟。

It is usually done under IV sedation, like propofol and fentanyl, and we are watching while we drain those follicles and get test tubes full of the eggs.

这通常是在静脉注射镇静剂（如异丙酚和芬太尼）的情况下完成的，我们一边观察一边排干卵泡并取出装满卵子的试管。

Andrew Huberman:

安德鲁·休伯曼：

Do some people opt to not use any-- I hear the word fentanyl, and I'm sure a lot of people are like-

是否有些人选择不使用任何药物——我听到芬太尼这个词，我确信很多人都会这样——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So, okay

那么，好吧

Andrew Huberman:

安德鲁·休伯曼：

...

wait, fentanyl crisis.

等等，芬太尼危机。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I mean.

我的意思是。

Andrew Huberman:

安德鲁·休伯曼：

And obviously, fentanyl is a drug that has its valid uses in the medical community.

显然，芬太尼是一种在医学界有其有效用途的药物。

Does anyone just opt for just-

有谁只是选择-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

We have an anesthesiologist who is really talking to the patients.

我们有一位麻醉师，他真正与患者交谈。

Propofol is the base of it.

异丙酚是它的基础。

Certainly, there's some patients who may want to avoid narcotic usage, and they use different strategies.

当然，有些患者可能想避免使用麻醉品，他们会采取不同的策略。

There was this huge-- The Retrievals podcast came out from the "New York Times" doing a deep dive into a fertility clinic, Yale, where a nurse was siphoning off fentanyl and-

有一个巨大的——《纽约时报》的检索播客深入探讨了耶鲁大学的一家生育诊所，那里的一名护士正在吸走芬太尼，然后——

Andrew Huberman:

安德鲁·休伯曼：

For herself

为了她自己

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

for herself, and replacing it with saline and giving patients saline.

为她自己，用生理盐水代替，并给病人注射生理盐水。

This clinic did not do anesthesia-based propofol.

本诊所不做异丙酚麻醉。

So they were supposed to just get fentanyl and have kind of a less pain environment, not a no pain environment.

所以他们应该只服用芬太尼并有一种较少疼痛的环境，而不是无疼痛的环境。

Andrew Huberman:

安德鲁·休伯曼：

Whoa.

哇哦。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And not just a few, hundreds of women reported extreme pain through the procedure.

不仅仅是少数，数百名女性在手术过程中报告了极度疼痛。

Really speaks largely to pain not being taken seriously when they went and found this out.

确实很大程度上是因为当他们发现这一点时没有认真对待痛苦。

Andrew Huberman:

安德鲁·休伯曼：

Whoa.

哇哦。

I can't help but ask, what happened to this technician?

我不禁要问，这位技术人员怎么了？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Well, I mean.

嗯，我的意思是。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

They're-

他们是——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It-

它——

Andrew Huberman:

安德鲁·休伯曼：

...

trying to find fentanyl behind bars.

试图在监狱里找到芬太尼。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But it's huge as far as too-

但它也太大了——

Andrew Huberman:

安德鲁·休伯曼：

Wow

哇

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

I can't imagine-

我无法想象-

Andrew Huberman:

安德鲁·休伯曼：

Terrible

太糟糕了

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

doing-- I do this procedure all the time.

我一直在做这个程序。

I've done thousands and thousands in my career, and I can't imagine having people be in pain during it.

在我的职业生涯中，我已经完成了成千上万的工作，我无法想象人们在其中会感到痛苦。

But it's important to know that some clinics don't use IV sedation, or they don't use propofol.

但重要的是要知道一些诊所不使用静脉注射镇静剂，或者不使用异丙酚。

They don't put you to sleep.

他们不会让你入睡。

Understanding what your clinic is using is really, really important to set the expectations or to know, am I going to be awake, or am I going to be asleep?

了解您的诊所正在使用什么对于设定期望或知道我是清醒的还是睡着的非常非常重要？

All of-

所有的-

Andrew Huberman:

安德鲁·休伯曼：

Can a patient ask you to what specific drugs are you going to give me to kill pain?

病人能问一下你要给我什么具体的药物来止痛吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

For sure.

当然。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And some clinics only do one.

有些诊所只做一项。

I am not going to do a retrieval under no sedation.

我不会在没有镇静剂的情况下进行检索。

Now, some clinics would allow that.

现在，一些诊所允许这样做。

Some clinics, that's all that they do.

有些诊所，这就是他们所做的一切。

But that's a huge piece of the puzzle that you need to know if you're a patient.

但这是您作为患者需要了解的一大难题。

Are you going to be feeling pain, not feeling pain?

你会感到疼痛，还是感觉不到疼痛？

What's it going to be like?

会是什么样子？

I'll say most clinics use propofol and put patients to sleep.

我想说大多数诊所都使用异丙酚并让患者入睡。

And so you take a nice little nap for 15 to 20 minutes.

所以你可以小睡 15 到 20 分钟。

The eggs are retrieved from the follicles under direct visualization.

在直接观察下从卵泡中取出卵子。

They're in test tubes.

它们在试管中。

You wake up, and you're going to feel crampy, and you'll get a period 10-ish days later.

你醒来后会感到痉挛，十天左右你就会来月经。

But this is when you'll feel your worst, and this is just the one thing I want to say about tolerability of it.

但这是你感觉最糟糕的时候，这只是我想说的关于容忍度的一件事。

Andrew Huberman:

安德鲁·休伯曼：

Can you get pregnant in that time?

到时候可以怀孕吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

There's a case report of an egg donor who was donating her eggs, and she had sex with her boyfriend.

有一个案例报告称，一名卵子捐赠者在捐赠卵子时与男友发生了性关系。

And because not every egg is always retrieved from the follicles, or some small ones could ovulate, too, and she got pregnant with quintuplets.

因为并不是每个卵子都能从卵泡中取出，或者一些小卵子也可以排卵，所以她怀上了五胞胎。

Andrew Huberman:

安德鲁·休伯曼：

Whoa.

哇哦。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay?

好吧？

So you have to really tell people not to have intercourse, one, from an infectious standpoint, because we really are poking a pretty large gauge needle through the vaginal mucosa into the peritoneal cavity, so we don't want to introduce infection, but also for pregnancy in that time period.

所以你必须真正告诉人们不要性交，第一，从感染的角度来看，因为我们确实是用一根相当大规格的针穿过阴道粘膜刺入腹膜腔，所以我们不想引入感染，也是为了那个时期的怀孕。

And if you got pregnant, your risk of what we call ovarian hyperstimulation syndrome, or OHSS, is very profound.

如果您怀孕了，患卵巢过度刺激综合征（OHSS）的风险就非常大。

So what is normally happening is after the retrieval, your estrogen and progesterone are going to drop.

因此，通常发生的情况是，在取出后，您的雌激素和黄体酮会下降。

You're going to feel a severe PMS, for lack of a better word.

你会感受到严重的经前综合症，找不到更好的词来形容。

It's when you'll be more emotional.

这个时候你会更加情绪化。

You're still pretty bloated until this all heals.

在这一切痊愈之前，你仍然很浮肿。

If you get OHSS, which is very uncommon in modern practice, but when you did fresh embryo transfers, or people who don't utilize some of the modern protocols, this means that hCG continues to encourage all those follicles to make estrogen and progesterone.

如果您患有 OHSS（这在现代实践中非常罕见），但当您进行新鲜胚胎移植时，或者不使用某些现代方案的人，这意味着 hCG 会继续鼓励所有这些卵泡产生雌激素和黄体酮。

And if you are pregnant, you're just going to have a constant yet exponential increase in hCG, and so this is going to get worse and worse.

如果你怀孕了，你的 hCG 就会持续呈指数增长，所以情况会变得越来越糟。

So we really don't want people to get pregnant in that time period.

所以我们真的不希望人们在那个时间段怀孕。

Andrew Huberman:

安德鲁·休伯曼：

So when during that time period should they avoid sex?

那么在这段时间内他们什么时候应该避免性行为呢？

So is it in the few days before-

前几天也是如此——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's a lot

很多

Andrew Huberman:

安德鲁·休伯曼：

...

the extraction?

提取？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

So typically, I usually say it's from day five of your stimulation.

通常，我通常会说是从刺激的第五天开始。

Okay?

好的？

So usually, the earliest egg retrievals are around cycle day 9 or 10, if somebody goes fast, until your next period comes.

因此，通常情况下，最早的取卵时间是在月经周期的第 9 或 10 天左右（如果有人取卵速度快的话），直到您的下一个月经周期到来。

So that's usually about a three-week time period where we want you to abstain from intercourse.

因此，我们通常希望您在三周左右的时间段内避免性交。

So for the most part, though, the more eggs you have, the more you're going to feel both this hormonal and physical shift than the fewer eggs that you have.

所以在大多数情况下，你拥有的卵子越多，你就越能感受到这种荷尔蒙和身体的变化，而不是你拥有的卵子越少。

So if you have a low egg count and you need to do IVF or freeze your eggs, and you might do multiple cycles or rounds, you're going to tolerate it actually pretty fine because you're not going to have these huge shifts.

因此，如果您的卵子数量较低，并且需要进行体外受精或冷冻卵子，并且您可能会进行多个周期或轮次，那么您实际上可以很好地忍受它，因为您不会有这些巨大的转变。

Physically, you're going to feel fine, and that's always a big concern.

从身体上来说，你会感觉良好，这始终是一个大问题。

When you mentioned earlier about different stimulation types, people have this idea that things that are more natural are better.

当您之前提到不同的刺激类型时，人们有这样的想法：越自然的东西越好。

It's just this human thought that natural is good and synthetic is bad.

这只是人类的想法，天然的就是好的，合成的就是坏的。

Naturally, you ovulate one egg a month.

当然，您每月排卵一个卵子。

When we're trying to get eggs out of your body, the success is determined by how many eggs I can get and how young you are.

当我们尝试从您体内取出卵子时，成功与否取决于我能取出多少卵子以及您的年龄。

So it doesn't make sense, in most circumstances, to do a minimal stimulation protocol, meaning purposefully under-stimulating somebody by saving them money in medication cost in order to purposely get fewer eggs.

因此，在大多数情况下，进行最小刺激方案是没有意义的，即通过节省药物费用来故意减少某人的刺激，从而故意获得更少的卵子。

Because their odds of getting the ultimate success of what they want is going to be so much lower.

因为他们获得自己想要的最终成功的几率会低得多。

Andrew Huberman:

安德鲁·休伯曼：

I don't want to put you in the position of having to demonize your colleagues in your profession, but I could see how there's a pretty significant financial incentive for people who are really desperate to have children or who just simply might want to have children down the road.

我不想让你不得不在你的职业中妖魔化你的同事，但我可以看到，对于那些真正渴望生孩子或只是想生孩子的人来说，有相当大的经济激励。

They hear low stim is better.

他们听说低刺激更好。

We're talking multiple low stim cycles.

我们正在谈论多个低刺激周期。

They might be even a fraction of the cost of a full stim cycle, but then there are many, many more-

它们甚至可能只是整个刺激周期成本的一小部分，但还有很多很多——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

You got it

你明白了

Andrew Huberman:

安德鲁·休伯曼：

...

low stim cycles.

低刺激周期。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

You got it.

你明白了。

You can make a lot more money.

你可以赚更多的钱。

By doing things that are not in the best interest of the patient.

做一些不符合患者最佳利益的事情。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And that's not uncommon in my field, which is very sad, but it does mean that because reproduction and IVF are so foreign and unknown, so many people walk in blind, not knowing if what they're being told really makes sense for their situation.

这在我的领域并不少见，这是非常悲伤的，但这确实意味着，因为生殖和体外受精是如此陌生和未知，所以很多人盲目行走，不知道他们被告知的内容是否真的适合他们的情况。

There are a couple situations where minimal stimulation makes sense.

在某些情况下，最小的刺激是有意义的。

If you're only going to make three eggs, you're only going to make three eggs.

如果你只想做三个鸡蛋，那么你就只能做三个鸡蛋。

I don't need all the drugs in the world to tell your body to make three eggs, because there's only three.

我不需要世界上所有的药物来告诉你的身体产生三个鸡蛋，因为只有三个。

And so, that is a scenario where minimal stimulation does make sense.

因此，在这种情况下，最小的刺激确实有意义。

And then there's the scenario where there's something called InVoCell.

还有一种情况是，有一种叫做 InVoCell 的东西。

Has your research exposed you to this?

您的研究让您了解了这一点吗？

Andrew Huberman:

安德鲁·休伯曼：

No.

不。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

InVoCell is a way to try to take IVF into making it more financially accessible for certain patient populations, mainly people who don't ovulate, like your very refractory PCOS patient who doesn't respond to medication, or who have tubal factor infertility.

InVoCell 是一种尝试将 IVF 应用于某些患者群体（主要是不排卵的患者）的经济上的方法，例如对药物没有反应的难治性 PCOS 患者或患有输卵管因素不孕症的患者。

So your fallopian tubes are blocked because of chlamydia or endometriosis, and we just have a problem here that egg and sperm can't get together, because you're not ovulating or your tubes are blocked.

因此，您的输卵管由于衣原体或子宫内膜异位症而被堵塞，而我们遇到的问题是卵子和精子无法结合在一起，因为您不排卵或输卵管被堵塞。

An InVoCell, it's a device that is plastic, and you can fit up to 10 eggs in it, and there's a little middle chamber where the sperm can go.

InVoCell 是一种塑料装置，最多可容纳 10 个卵子，中间有一个小室供精子进入。

And so you go through this IVF process with the goal to only get eight to 10 eggs, because that's what fits in the device, and then you put the sperm in the middle of it.

因此，您通过 IVF 过程的目标是只获得 8 到 10 个卵子，因为这正是设备所适合的，然后您将精子放入其中。

And then you put it inside your vagina, and you hold it in place with a diaphragm.

然后将其放入阴道内，并用隔膜将其固定到位。

And the vagina is the right temperature to incubate.

而且阴道的温度正好适合孵化。

And so you incubate your embryos in this little InVoCell container inside your vagina.

因此，您可以在阴道内的这个 InVoCell 小容器中孵化胚胎。

And then five days later, you come in and we take it out, and we take the best embryo and we transfer it.

五天后，你进来，我们把它取出来，我们取出最好的胚胎并进行移植。

And you can do a fresh transfer because you didn't make so many eggs, so your hormones weren't so high.

而且你可以进行新鲜移植，因为你没有制造那么多鸡蛋，所以你的激素没有那么高。

Andrew Huberman:

安德鲁·休伯曼：

Do people like this procedure?

人们喜欢这个程序吗？

There's something that seems like, staying in proximity to the sperm and egg, like you're taking it home and then you're like-

有一种东西看起来就像是靠近精子和卵子，就像你把它带回家然后你就像——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Okay, so I love this procedure in some circumstances, and I see it applied often in the wrong case, and that can be frustrating, because it's still not cheap.

好吧，在某些情况下我喜欢这个程序，而且我发现它经常应用在错误的情况下，这可能会令人沮丧，因为它仍然不便宜。

Even if it's cheaper than IVF, it is still not inexpensive in any means.

即使它比体外受精便宜，但无论如何它仍然不便宜。

And so patient selection, like most things in this field, are so important.

因此，与该领域的大多数事情一样，患者的选择非常重要。

So let's just say if the sperm's the problem, then it's probably not smart to just presume that the sperm and egg will be fine in there.

因此，如果精子是问题所在，那么仅仅假设精子和卵子在那里都没有问题可能并不明智。

That might be a case where you really do need help with assisted fertilization.

这可能是您确实需要辅助受精帮助的情况。

Or if you have unexplained infertility.

或者如果您有不明原因的不孕症。

If we don't know why you haven't been able to get pregnant because everything looks good on paper, what if fertilization is the issue?

如果我们不知道为什么您无法怀孕，因为纸面上一切看起来都很好，那么如果受精是问题呢？

And these are circumstances where you pull out an InVoCell and there's no embryos, and you don't really know where it went wrong.

在这些情况下，你取出 InVoCell 但没有胚胎，你真的不知道哪里出了问题。

Was it the fertilization step?

这是受精步骤吗？

Was it the growth step of the embryos in culture?

这是胚胎在培养物中的生长步骤吗？

So you do have less data.

所以你的数据确实较少。

Notably, I like data.

值得注意的是，我喜欢数据。

You can't do genetic testing, and this isn't really a strategy that allows you to freeze embryos for future family growth.

你无法进行基因测试，这实际上并不是一种可以冷冻胚胎以供未来家庭成长的策略。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

That being said, the young patient who's got great egg quality, who might have really bad PCOS or tubal disease, it can certainly allow them the opportunity for a child at a lower price point when they still have many reproductive years to finalize their family.

话虽这么说，对于那些卵子质量很好的年轻患者来说，他们可能患有严重的多囊卵巢综合症或输卵管疾病，当他们还有很多生育年限来完成他们的家庭时，这肯定可以让他们有机会以较低的价格生孩子。

It also is a lovely option for people who need donor sperm to conceive because the success rates with this are so much higher than an IUI, which is what a lot of people use, an intrauterine insemination or putting the sperm in the uterus.

对于需要捐献精子来受孕的人来说，这也是一个不错的选择，因为这种方法的成功率比很多人使用的宫内人工授精（IUI）高得多，即宫内授精或将精子放入子宫。

So now we're able to improve this outcome.

所以现在我们能够改善这个结果。

So like our same sex couples or our single parents by choice, if it's a single woman who's trying to become a parent, then they need to buy donor sperm and go through the process anyway.

因此，就像我们的同性伴侣或我们选择的单亲父母一样，如果单身女性想成为父母，那么她们无论如何都需要购买捐赠精子并完成整个过程。

This often can improve that efficacy through the process, pending their age and other factors.

这通常可以提高整个过程的功效，具体取决于他们的年龄和其他因素。

There was a study that was just really neat.

有一项研究非常巧妙。

There was a lesbian couple and one of them, the eggs came out of, and the other one incubated the embryos, and then the other one had the embryo transfer.

有一对女同性恋夫妇，其中一个，卵子出来了，另一个孵化了胚胎，然后另一个进行了胚胎移植。

But it gave both partners a way to feel a little more involved in the process, which I just think is always a really cool way when you have these different options with reproduction.

但它给了双方一种更多地参与这个过程的方式，我认为当你有这些不同的繁殖选择时，这总是一种非常酷的方式。

Andrew Huberman:

安德鲁·休伯曼：

It seems also that it's a more of a three-dimensional environment.

看起来它更像是一个三维环境。

I always imagine that the Petri dish approach is so two-dimensional compared to the body, and all these things, having done cell culture before and cultured neurons and things of that sort, there's all these concerns about the concentration of CO2 and the thing.

我总是想象，与身体相比，培养皿方法是二维的，所有这些东西，以前做过细胞培养，培养神经元和类似的东西，所有这些都是关于二氧化碳浓度和东西的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, yeah.

哦，是的。

Andrew Huberman:

安德鲁·休伯曼：

Or God forbid, if there's a fluctuation in...

或者上帝保佑，如果有波动......

You have backup generators and things, but in the electrical flow to the incubators, that's disruptive.

你有备用发电机和其他东西，但在流向孵化器的电流中，这是破坏性的。

Whereas the natural environment of the body, even though it fluctuates in temperature, this has evolved over tens of thousands if not hundreds of thousands of years to be the process by which embryos are created.

而身体的自然环境，即使温度波动，也已经进化了数万年甚至数十万年，成为胚胎形成的过程。

So here's where I sort of default in my mind anyway, to the kind of like, "Oh, it seems more natural." You're incubating in the more quote-unquote more natural environment.

所以无论如何，这就是我心里默认的地方，就像“哦，这看起来更自然”。你正在更加自然的环境中孵化。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

But at the same breath, why are you having infertility if you're an infertility patient, right?

但与此同时，如果你是不孕症患者，为什么会不孕呢？

So if you need donor sperm, you maybe don't have infertility.

因此，如果您需要捐赠精子，您可能没有不孕症。

Or if you have tubal disease, you have a very defined reason why we don't think that there's this huge inflammatory issue in your body or something unknown.

或者，如果您患有输卵管疾病，那么您有一个非常明确的理由，为什么我们不认为您的身体存在巨大的炎症问题或未知的问题。

So again, I'll see it applied to people who really are bad candidates for it based on their age or based on their diagnosis.

所以，我会再次看到它适用于那些根据年龄或诊断而确实不适合的人。

And so it's not always better, but for the right patient, I've had patients have babies that way who otherwise may not be able to.

因此，这并不总是更好，但对于合适的患者，我曾让患者以这种方式生下孩子，否则他们可能无法生下孩子。

Andrew Huberman:

安德鲁·休伯曼：

Interesting.

有趣。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

So it can really open up the door.

所以它确实可以打开大门。

So that's the most minimal of the minimal stimulation.

所以这是最小刺激中的最小刺激。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Then we have minimal stimulation because you don't have many eggs, so we don't really need that.

然后我们受到的刺激很小，因为你没有很多鸡蛋，所以我们并不真正需要它。

But for the vast majority of people who go through egg freezing or IVF, we are really trying to get as many eggs as you potentially have Everybody has a different number, but whatever you have, whatever that antral follicle count is for you, is what we're trying to get, and that's what this combination of medications is trying to do.

但对于绝大多数经历卵子冷冻或试管受精的人来说，我们确实在努力获得尽可能多的卵子。每个人的卵子数量都不同，但无论您拥有什么，无论窦卵泡数量对您来说是什么，都是我们想要获得的，这就是这种药物组合想要做到的。

When the eggs come into the lab, if you have egg freezing, very important to know is before we get into the ICSI discussion, the eggs are stripped of their outer cells, which is called the cumulus.

当卵子进入实验室时，如果进行卵子冷冻，在我们开始讨论 ICSI 之前，需要知道的非常重要的一点是，卵子的外层细胞（称为卵丘）会被剥离。

That's what the sperm has to attach to in order to fertilize.

这就是精子必须附着才能受精的地方。

In order to freeze the eggs, those cumulus cells are stripped off.

为了冷冻卵子，这些卵丘细胞被剥离。

The eggs are frozen.

鸡蛋被冷冻。

You have to do ICSI.

你必须做ICSI。

So if we're going to lead into this ICSI conversation, if you're freezing your eggs, you're having ICSI when you fertilize them.

因此，如果我们要进行 ICSI 对话，如果您冷冻卵子，那么当您使卵子受精时，您就进行了 ICSI。

So I don't want somebody to ever not know that, if that is what they are choosing.

所以我不希望有人不知道这一点，如果这是他们的选择的话。

Andrew Huberman:

安德鲁·休伯曼：

And ICSI is, you can tell us.

您可以告诉我们，ICSI 是这样的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yes.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

ICSI stands for, it's ICSI or intracytoplasmic sperm injection.

ICSI是ICSI的缩写，即卵胞浆内单精子注射。

It is taking a sperm that under the microscope looks normal in shape and moves well, and you're pulling it up into a little needle, and you're essentially using a little laser on the side of the egg or the zona pellucida of the egg, and you're injecting that one sperm into that egg cytoplasm.

它需要一个在显微镜下看起来形状正常并且运动良好的精子，然后将其拉入一根小针中，并且实质上是在卵子的侧面或卵子的透明带上使用一个小激光，然后将这个精子注射到卵子细胞质中。

Andrew Huberman:

安德鲁·休伯曼：

And you're picking that sperm on the basis of shape, motility.

你是根据形状和活力来挑选精子的。

You're picking what you think is the best sperm in the batch, obviously.

显然，你正在挑选你认为这批精子中最好的精子。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

There's going to be one sperm per egg, so there's multiple sperm that are chosen.

每个卵子都会有一个精子，因此会选择多个精子。

But you're picking sperm that look like they have the highest potential.

但你挑选的精子看起来潜力最大。

Andrew Huberman:

安德鲁·休伯曼：

My understanding is that there's a range from very low to potentially high, but hopefully not high, of DNA fragmentation in pretty much every cell of the body.

我的理解是，身体几乎每个细胞中的 DNA 碎片程度从非常低到可能很高，但希望不是很高。

Like, the cell's always-

就像，细胞总是——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah

是啊

Andrew Huberman:

安德鲁·休伯曼：

...

repairing its DNA.

修复其DNA。

So when visually selecting a sperm, for ICSI, it's based on morphology, shape, and motility, right?

因此，在目视选择精子进行 ICSI 时，它是基于形态、形状和活力，对吗？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right.

对。

You can't see the DNA damage inside-

你看不到里面的DNA损伤-

Andrew Huberman:

安德鲁·休伯曼：

Right

右

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

...

the head of the sperm or the DNA itself, but-

精子的头部或 DNA 本身，但是——

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

Are we soon to have a technology where you could actually get a dye that could label DNA fragmentation and select...

我们是否很快就会拥有一种技术，让您能够真正获得一种染料，可以标记 DNA 片段并选择……

Because I feel like when we talk about embryology, not to get too far down in the weeds, but the methods of selecting eggs and selecting sperm, these are the same methods that have been used in embryology since the 1930s.

因为我觉得当我们谈论胚胎学时，不要太深究，而是选择卵子和选择精子的方法，这些方法与20世纪30年代以来胚胎学中使用的方法相同。

Like, "Oh, this one looks good.

就像，“哦，这个看起来不错。

That one looks good." And the skilled embryologist can really develop a real talent over time of knowing what correlated with healthy pregnancy and offspring.

那个看起来不错。”随着时间的推移，熟练的胚胎学家确实可以培养出真正的才能，了解什么与健康怀孕和后代相关。

But I do like technology.

但我确实喜欢科技。

You would think that by now, 2023, that someone would have some dye that you could drop on the sperm and go, "Well, that one has a lot of DNA fragmentation, and that one doesn't."

你可能会认为，到了 2023 年，有人会拥有一些染料，你可以将其滴在精子上，然后说：“嗯，那个有很多 DNA 碎片，而那个则没有。”

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

I know, right?

我知道，对吧？

There should be better ways to choose which sperm.

应该有更好的方法来选择精子。

People are trying things.

人们正在尝试一些事情。

Nothing has proven to be helpful so far.

到目前为止，没有什么被证明是有帮助的。

There's definitely some interest in this because we're starting to get more insight as we have become better at embryo culture, getting embryos to grow, doing genetic testing on embryos to understand that that male genome kicks in at day three, and there's a subset of people who have beautiful fertilization and embryo growth day zero to three, and that's all on the egg.

人们对此肯定有一些兴趣，因为随着我们在胚胎培养、让胚胎生长、对胚胎进行基因测试以了解男性基因组在第三天开始发挥作用，我们开始获得更多的见解，并且有一部分人在零到第三天拥有美丽的受精和胚胎生长，而这一切都在鸡蛋上。

And then as soon as that male genome kicks in, you have this huge drop-off in your embryo number, and even some of this is in the context of normal sperm parameters, right?

一旦男性基因组启动，胚胎数量就会大幅下降，甚至其中一些是在正常精子参数的情况下，对吧？

So things aren't really normal, though.

不过，事情并不正常。

Or there's something underlying it, and-

或者它背后有什么东西，而且-

Andrew Huberman:

安德鲁·休伯曼：

Does that mean that every embryo failure on day three post-fertilization is sperm-based?

这是否意味着受精后第三天的每一次胚胎失败都是基于精子的？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

No, of course not, but it definitely means that none of the ones before that can be blamed on the sperm, and ones after that, there's definitely still maternal and sperm contributions.

不，当然不是，但这绝对意味着之前的一切都不能归咎于精子，而之后的一切，肯定仍然有母体和精子的贡献。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, we don't want to create any couple disputes around this.

是的，我们不想因此引起任何夫妻纠纷。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

But it can be an insight when you're trying to look through somebody's IVF cycle about potentially modifiable factors, right?

但当您试图了解某人的试管受精周期中潜在可改变的因素时，这可能是一种洞察，对吗？

Can you improve sperm quality by some of these lifestyle measures?

您可以通过这些生活方式措施来提高精子质量吗？

The debatable thing about a DNA sperm fragmentation, so what is that?

关于精子 DNA 碎片的争议性问题，那么到底是什么？

It is not a normal semen analysis.

这不是正常的精液分析。

But it is like that as far as it's a sperm sample that is then sent off to be evaluated how much fragmentation or abnormal DNA is in the heads of those sperm.

但只要是精子样本，然后将其送去评估这些精子头部有多少碎片或异常 DNA，情况就是这样。

The studies have shown that people who have abnormal DNA sperm fragmentation should do ICSI.

研究表明，DNA 精子碎片异常的人应该进行 ICSI。

Okay?

好的？

That's the point of the study.

这就是本研究的重点。

Now, ICSI's become very commonplace.

现在，ICSI 已经变得非常普遍。

So ICSI, choosing the sperm to put into the egg originally didn't exist, right?

那么ICSI，选择精子放入卵子本来就不存在，对吗？

So what's the alternative?

那么还有什么选择呢？

Conventional fertilization.

常规施肥。

This is having your petri dish.

这是你的培养皿。

Your eggs are on it.

你的鸡蛋就在上面。

You squirt your sperm.

你喷出你的精子。

You cover it up.

你把它掩盖起来。

You put it in the incubator.

你把它放在培养箱里。

Andrew Huberman:

安德鲁·休伯曼：

Guys, she didn't mean you squirt your sperm.

伙计们，她的意思不是让你喷出精子。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, no, not you.

哦，不，不是你。

Andrew Huberman:

安德鲁·休伯曼：

She meant it's like the embryologist.

她的意思是就像胚胎学家一样。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

The embryologist squirts the sperm on top.

胚胎学家将精子喷在上面。

Andrew Huberman:

安德鲁·休伯曼：

Just to be clear, just to be clear.

只是为了说清楚，只是为了说清楚。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And then pulls it out, and the next day sees by which eggs and sperm fertilized.

然后把它拔出来，第二天就可以看到哪个卵子和哪个精子受精了。

Well, it's really devastating to pull out the dish and have no fertilization, and it definitely is a cause of infertility, and it can be very hard to know that because fertilization is not challenged on a cellular level until you challenge it.

好吧，拔出培养皿而没有受精确实是毁灭性的，而且它肯定是不孕的一个原因，而且很难知道这一点，因为在你挑战受精之前，受精不会在细胞水平上受到挑战。

So ICSI used to be an add-on cost.

因此，ICSI 曾经是一项附加成本。

It used to be this separate thing because it was harder to find embryologists who could do it.

它曾经是一个单独的事情，因为很难找到能够做到这一点的胚胎学家。

It's so standard that a lot of clinics do it the majority of the time purely because you often don't know all the variables that are impacting fertilization, and you're trying to give somebody as many opportunities as possible.

这是如此标准，以至于很多诊所在大多数情况下都会这样做，纯粹是因为您通常不知道影响受精的所有变量，并且您试图为某人提供尽可能多的机会。

ICSI has, in a lot of those original IVF studies, got some of the bad reputation of being the problem with why you might see that 1% rise of birth defects.

在许多最初的 IVF 研究中，ICSI 已经获得了一些不好的名声，因为它是导致出生缺陷增加 1% 的原因。

Andrew Huberman:

安德鲁·休伯曼：

Mm.

嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And so ICSI took the brunt from a lot of that.

因此，ICSI 首当其冲。

We really don't see that when we're growing out, and we're doing freezing the embryos, doing frozen transfers, and I do ICSI on almost every patient.

当我们长大时，我们确实没有看到这一点，我们正在冷冻胚胎，进行冷冻移植，我对几乎每个患者都进行了 ICSI。

I'm not going to say on every one, but-

我不会对每一个都说，但是——

Andrew Huberman:

安德鲁·休伯曼：

A higher probability of success, right?

成功的概率更高吧？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Higher probability of success, and when you get to this point, and so few people have insurance coverage, so they're spending their money.

成功的可能性更高，当你达到这一点时，很少有人有保险，所以他们会花钱。

They're getting second mortgages.

他们正在获得第二抵押贷款。

They're taking out loans.

他们正在贷款。

If there's one decision that you say, "Well, I don't know.

如果有一个决定你说：“好吧，我不知道。

You could have zero eggs fertilized, or I could have the embryologist pick the best sperm and put them inside the egg, and we expect a 75% chance of fertilization." That makes sense for the majority of people.

你可以让零个卵子受精，或者我可以让胚胎学家挑选最好的精子并将它们放入卵子内，我们预计受精的几率为 75%。”这对大多数人来说都是有道理的。

Andrew Huberman:

安德鲁·休伯曼：

Yeah.

是的。

That makes sense to me, because I'm obsessed with data and do blood work fairly regularly.

这对我来说很有意义，因为我痴迷于数据并且相当定期地进行血液检查。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Not obsessively, but twice a year or so now.

不是痴迷，但现在每年两次左右。

I didn't always do that.

我并不总是这样做。

I actually did one of these DNA fragmentation tests.

我实际上做了其中一项 DNA 碎片测试。

They're pretty expensive.

它们相当昂贵。

They're in the-

他们在——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

They're far more than a semen analysis, yeah.

是的，它们不仅仅是精液分析。

Andrew Huberman:

安德鲁·休伯曼：

Yeah, they're in the low $1,200, $1,500 or so, at least the one that I did.

是的，它们的价格低至 1,200 美元、1,500 美元左右，至少我做的就是这样。

It was very informative.

这是非常有用的。

I was relieved to see not abnormal levels of DNA fragmentation.

看到 DNA 碎片水平没有异常，我松了口气。

But I will say that based on everything you just said, it seems like it might be the lower cost option because the alternative is to go through repeated cycles of IVF, and it's failing, and that's certainly much more expensive.

但我想说的是，根据你刚才所说的一切，这似乎可能是成本较低的选择，因为替代方案是经历重复的体外受精周期，但它失败了，而且肯定要贵得多。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It is.

是的。

And I will say that there is some current thought by my urology colleagues.

我想说的是，我的泌尿科同事目前有一些想法。

So I am not a urologist, but definitely when I have a male who needs a sperm extraction, maybe he's had a prior vasectomy, maybe he's got very low sperm count, and we're going in, we're doing a sperm extraction procedure, that potentially if you have a patient who has an abnormal DNA sperm fragmentation, and even with ICSI, has this drop-off in embryo growth after day three because the sperm are still being made the same way.

所以我不是泌尿科医生，但肯定的是，当我有一个男性需要提取精子时，也许他之前接受过输精管切除术，也许他的精子数量非常低，我们正在进行精子提取程序，如果你的病人有异常的 DNA 精子碎片，即使进行了 ICSI，第三天后胚胎生长可能会下降，因为精子仍然以相同的方式制造。

Are they still fragmented?

他们仍然支离破碎吗？

That potentially the ejaculatory process could cause some of that fragmentation in certain men, and that by going in and doing a sperm extraction and not subjecting those sperm to the rigors of ejaculation, for lack of a better word, could potentially lessen the fragmentation and improve outcomes.

射精过程可能会导致某些男性出现碎片，通过进行精子提取，而不是让这些精子经受射精的严格考验，可能会减少碎片并改善结果。

And I have some patients who we've gone down that road, and that has helped them.

我有一些病人，我们已经走上了这条路，这对他们有帮助。

Clear to say, there's not a study.

明确地说，没有研究。

That's not the point of DNA sperm frag.

这不是DNA精子碎片的重点。

It's to try to distinguish if potentially ICSI could be a helpful technology.

这是为了尝试区分 ICSI 是否可能是一种有用的技术。

But a lot of doctors are offering or doing ICSI because we want you to fertilize your eggs.

但许多医生提供或进行 ICSI 是因为我们希望您的卵子受精。

When they grow it in culture, as we talked about IVF changing, the metabolic needs of the embryo change throughout the process.

当他们在培养物中培养胚胎时，正如我们谈到的 IVF 变化一样，胚胎的代谢需求在整个过程中都会发生变化。

And so embryo culture has become so much more successful, but even in those best case scenarios, we're looking at 50% progression.

因此胚胎培养变得更加成功，但即使在最好的情况下，我们也看到了 50% 的进展。

So you're going to have loss throughout that culture process no matter what.

因此，无论如何，你都会在整个文化过程中遭受损失。

Andrew Huberman:

安德鲁·休伯曼：

And you said 50% progression, so half of the fertilized embryos that make it past, let's say day seven, then they're screened for chromosomal abnormalities.

你说的是 50% 的进展，所以一半的受精胚胎过了，比如说第七天，然后对它们进行染色体异常筛查。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Mm-hmm.

嗯嗯。

Andrew Huberman:

安德鲁·休伯曼：

So then okay, then you've got, let's say two or three of those, maybe four, depending on how many eggs were harvested.

那么好吧，那么你就得到了，比方说其中两个或三个，也许四个，这取决于收获的鸡蛋数量。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

And your age.

还有你的年龄。

Andrew Huberman:

安德鲁·休伯曼：

And age.

还有年龄。

Yes, thank you.

是的，谢谢。

And then you said of those that are implanted into, let's say, a woman 45 or younger, you're looking at about anywhere from 30% to 65% successful implantation and pregnancy, like healthy baby.

然后你说，对于那些被植入到 45 岁或更年轻女性体内的植入物，你看到大约 30% 到 65% 的成功植入和怀孕，就像健康的婴儿一样。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

It's usually a 65% chance of live birth if it's a genetically tested embryo.

如果是经过基因测试的胚胎，活产的几率通常为 65%。

Andrew Huberman:

安德鲁·休伯曼：

Mm-hmm.

嗯嗯。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

That asterisk is the if, and that's why you're going to see such varying IVF success rates.

那个星号是“如果”，这就是为什么您会看到如此不同的试管受精成功率。

Because if you don't do genetic testing of embryos, let's use the 40-year-old who makes four embryos, and I send them off for genetic testing.

因为如果不对胚胎进行基因检测，我们就用40岁的人制造四个胚胎，然后我将它们送去进行基因检测。

I anticipate she has one normal embryo.

我预计她有一个正常的胚胎。

If I do genetic testing, which takes-- It's called PGT, pre-implantation genetic testing.

如果我做基因测试，这需要——这被称为PGT，植入前基因测试。

I am testing for aneuploidy as the traditional testing, meaning does it have the right number of chromosomes?

我正在像传统测试一样测试非整倍性，这意味着它是否具有正确的染色体数量？

You can also importantly test for single gene disorders like cystic fibrosis or Huntington's.

您还可以重要地测试单基因疾病，如囊性纤维化或亨廷顿舞蹈症。

But if we're just doing PGT for aneuploidy, I expect an age-related proportion of your eggs to be normal or abnormal.

但如果我们只是针对非整倍体进行 PGT，我预计您的卵子中与年龄相关的比例将是正常或异常的。

So at age 40, I expect 20% to 25% normal.

所以在 40 岁时，我预计 20% 到 25% 是正常的。

So I can choose that one and put it in you, and have a 65% chance that you have a baby.

所以我可以选择那个并将其放入你体内，你有 65% 的机会生下孩子。

I could not do it.

我做不到。

I still have the same four.

我还有同样的四个。

That one is in there, but if I go and transfer them each independently, I'm now going to have closer to a 20% to 30% chance of success.

那个就在那里，但如果我单独去转移它们，我现在成功的机会将接近 20% 到 30%。

Andrew Huberman:

安德鲁·休伯曼：

Got it.

明白了。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Right?

对吗？

So it is not that I'm changing the embryo by testing it, but I'm allowing myself to have higher utility of success, higher efficiency, putting somebody through less failed transfers, which is extremely important, and less miscarriages, because those also take time.

所以我并不是通过测试来改变胚胎，而是让自己获得更高的成功效用、更高的效率，让某人经历更少的失败移植（这是极其重要的），以及更少的流产，因为这些也需要时间。

And one of the most important things is that you have the opportunity to understand how many potential normal embryos you have in batch cycles.

最重要的事情之一是您有机会了解在批次周期中有多少潜在的正常胚胎。

So you could go and do another cycle because I'm 40, I just met my person, I really want to have two kids because my sibling is really important in my life.

所以你可以去再做一个周期，因为我已经 40 岁了，我刚刚遇到了我的人，我真的很想要两个孩子，因为我的兄弟姐妹在我的生活中非常重要。

Yet naturally, by the age I would be for that second child, it's going to be very hard to conceive.

当然，到了我生第二个孩子的年龄，怀孕会变得非常困难。

I can go through IVF and batch some embryos.

我可以进行试管受精并批量生产一些胚胎。

So I could save two or three for that second baby that I'm not going to transfer for a few years, and that's called embryo banking.

因此，我可以为几年内不会移植的第二个孩子存两到三个，这就是所谓的胚胎银行。

And that is changing the ways that people can potentially grow their family at later ages.

这正在改变人们晚年发展家庭的方式。

But you don't know that unless you know what's normal or not.

但除非你知道什么是正常的，什么是不正常的，否则你不会知道这一点。

And it also gives you the chance to go and intervene right now.

它还让您有机会立即进行干预。

Because right now, especially if you're older, I'm going to have a higher chance of success than if I am four transfers down the road, and maybe there was one miscarriage in there, too.

因为现在，尤其是如果你年纪大了，我成功的机会比我接下来四次转会的机会要高，而且也许还有一次流产。

We're suddenly now eight months down the road before I can go do another cycle and get more eggs.

突然之间，我们距离我可以再做一个周期并获得更多卵子还有八个月的时间了。

Versus if I found out that none of those were genetically normal.

反之，如果我发现这些基因都不正常。

The average 40-year-old might have zero to one if they have average ovarian reserve per cycle.

如果 40 岁的人每个周期的卵巢储备量平均为 0 到 1，那么他们的平均水平可能为 0 到 1。

So they're going to need multiple cycles.

所以他们将需要多个周期。

It's not that it's impossible, but it's just setting that road of expectation for them.

并不是说不可能，只是给他们设定了那条期待之路。

But if I don't get any normal embryos, I can turn right around and go get more.

但如果我没有得到任何正常的胚胎，我可以转身去获取更多。

So I am using what's left in that ovarian vault each month to try to get to that opportunity of a pregnancy for you in a much more efficient way by utilizing genetic testing of these embryos.

因此，我每个月都会利用卵巢穹窿中剩下的东西，通过对这些胚胎进行基因检测，以更有效的方式为您争取怀孕的机会。

Andrew Huberman:

安德鲁·休伯曼：

This is where we can put an ellipse in and sort of like dot, dot, dot, healthy baby.

我们可以在这里放置一个椭圆，有点像点，点，点，健康的宝宝。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

Andrew Huberman:

安德鲁·休伯曼：

Right?

对吗？

And maybe in the future, if we're lucky, you'll come back and talk to us about healthy pregnancy-

也许将来，如果我们幸运的话，你会回来和我们谈论健康怀孕——

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Love to

喜欢

Andrew Huberman:

安德鲁·休伯曼：

...

and healthy baby onward.

和健康的宝宝。

That would be a fun and important set of discussions.

这将是一系列有趣且重要的讨论。

I would like to touch on the I don't want to call it the issue, but the topic of menopause, which I assume is defined as the cessation of menses.

我想谈谈我不想称之为问题，而是更年期的话题，我认为更年期的定义是月经停止。

But there I'm guessing.

但我猜测。

And I'm guessing it's a constellation of things that happen.

我猜这是一系列正在发生的事情。

And I have a very straightforward question, which is: Is there an acceleration of the onset of menopause?

我有一个非常直接的问题，那就是：更年期的到来是否会加速？

Are we seeing that nowadays?

如今我们看到了吗？

Are there good data on that?

有这方面好的数据吗？

Should people try to delay menopause?

人们应该尝试推迟更年期吗？

What are some of the things that you talk to patients about in terms of their considerations of ways to ease that transition or maybe even offset that transition with hormone replacement therapy or other approaches?

您与患者谈论了哪些事情，以考虑如何缓解这种转变，甚至可能通过激素替代疗法或其他方法抵消这种转变？

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

These are great questions, and I do think this is going to be a huge interest in upcoming years as we have learned more about the menopausal transition and the health risks really associated with being hypoestrogenic or having low estrogen.

这些都是很好的问题，我确实认为这将在未来几年引起人们的巨大兴趣，因为我们对更年期过渡以及与低雌激素或低雌激素真正相关的健康风险有了更多的了解。

Menopause, if we define it, is ovarian failure.

如果我们定义更年期的话，那就是卵巢衰竭。

So your ovaries now have no eggs or so few eggs that they are refractory to the brain sending out FSH.

因此，您的卵巢现在没有卵子或卵子太少，以至于大脑难以释放 FSH。

So your brain is sending out all the FSH and LH that it can.

因此，您的大脑正在尽可能地发出所有 FSH 和 LH。

Your ovary is done and not making any estradiol or progesterone anymore.

您的卵巢已经成熟，不再产生任何雌二醇或黄体酮。

In this time period, what we know is, one, are we seeing a population-based increase in earlier menopause?

在这个时期，我们所知道的是，第一，我们是否看到更年期提前的人口数量有所增加？

There's not been a study to say that.

还没有研究表明这一点。

Observationally and clinically, I would say yes, because I see so many younger women having low ovarian reserve or having premature ovarian failure or premature ovarian insufficiency, which is the more politically correct way of saying it.

从观察和临床角度来看，我会说是的，因为我看到很多年轻女性的卵巢储备能力较低或患有卵巢早衰或卵巢早衰，这是政治上更正确的说法。

But when we think about what this is, there are modifiable factors, right?

但当我们思考这是什么时，有一些可以改变的因素，对吧？

If running out of eggs is a variable, and we already said certain things like smoking cigarettes and exposure to toxins and likely chronic inflammation and untreated disease, we know that having diabetes, those things increase your risk of going into menopause earlier.

如果鸡蛋耗尽是一个变量，并且我们已经说过某些事情，例如吸烟、接触毒素以及可能的慢性炎症和未经治疗的疾病，那么我们知道患有糖尿病，这些事情会增加您提前进入更年期的风险。

So paying attention to the lifestyle that you have when you're not concerned about your fertility.

因此，当您不关心自己的生育能力时，请注意您的生活方式。

When you're in your younger years and maybe you're not worried about getting pregnant yet, or you're not worried about menopause, but those choices that you're making in those time periods, at least for women, your eggs are going to hold on to them.

当你年轻的时候，也许你还不担心怀孕，或者你不担心更年期，但你在这些时期所做的选择，至少对于女性来说，你的卵子会保留下来。

So they have an influence later.

所以他们对后来有影响。

Similarly, trying to live a lower inflammatory life and getting sleep and avoiding toxins of which you can is some of the best that you can do to try to naturally prolong when you'll go through menopause with the huge caveat that everybody is truly born with a different number, and you do not control that.

同样，尝试过一种低炎症的生活、保证睡眠、避免毒素，是你能做的最好的事情，可以自然地延长更年期的时间，但要注意的是，每个人出生时的数字确实不同，而且你无法控制这一点。

You don't.

你不知道。

And so you might have been born with a lower number, and you can't change that trajectory.

所以你出生时的数字可能较低，而且你无法改变这个轨迹。

And you might have cancer and be exposed to chemotherapy, which also will deplete your ovarian reserve.

您可能患有癌症并接受化疗，这也会耗尽您的卵巢储备。

But so do things like endometriosis, especially if it's not being treated in any fashion.

但像子宫内膜异位症这样的疾病也是如此，尤其是如果没有以任何方式治疗的话。

So that's where we think the birth control pill or progestin exposure or surgery, ways to go and decrease the inflammation.

因此，我们认为避孕药或孕激素暴露或手术是减少炎症的方法。

It's that inflammation associated with endometriosis that's really causing these women to have low ovarian reserve and go into menopause early.

真正导致这些女性卵巢储备功能低下并提前进入更年期的是与子宫内膜异位症相关的炎症。

So not only is that impacting fertility and how many eggs you get and how long you have to grow your family, but when you go into menopause earlier, you have a lower life expectancy than people who go into menopause later.

因此，这不仅会影响生育能力、获得多少卵子以及养家糊口的时间，而且当您较早进入更年期时，您的预期寿命会比较晚进入更年期的人要低。

And that's why you even said it earlier, fertility is this variable kind of reflecting longevity and health overall.

这就是为什么你之前说过，生育率是反映整体寿命和健康状况的变量。

So what we do know about menopause is that having that low estrogen, whether that happens at the average age of menopause at 51, 52, or at an earlier time period, it's not good for the brain.

因此，我们对更年期的了解是，雌激素水平较低，无论是在 51 岁、52 岁的平均绝经年龄，还是更早的时期，对大脑都不利。

Higher risks of dementia, increased risks of osteoporosis, increased risk of heart disease and stroke, and essentially higher risks of death.

痴呆症的风险增加，骨质疏松症的风险增加，心脏病和中风的风险增加，死亡的风险也增加。

And that's not even to talk about the impact on your life, what it can be like to have hot flashes, heat and cold insensitivity, to have profound vulvar and vaginal atrophy to the point that you no longer want to have intercourse, and the changes that it can even have on your gut and your immune system.

这甚至还不是谈论对您生活的影响，潮热、热和冷不敏感、外阴和阴道严重萎缩到您不再想要性交的程度，以及它甚至可能对您的肠道和免疫系统产生的变化。

So we, as a community of doctors, especially OBGYNs, really recommend hormone replacement therapy in women who are going through menopause, and the key here is to initiate it right at the beginning.

因此，作为一个医生群体，尤其是妇产科医生，我们强烈建议对正在经历更年期的女性进行激素替代疗法，而关键是从一开始就开始进行。

That big women's health initiative study, which came out forever ago and showed all this harm with hormone replacement therapy, the big issue there was that these people were hypoestrogenic for 10-plus years in one group and then started back on the hormones.

那项大型女性健康倡议研究很久以前就发表了，它显示了激素替代疗法的所有这些危害，其中的一个大问题是，这些人在一组中雌激素水平低10多年，然后又开始重新使用激素。

And in that circumstance, they'd already been put into this higher risk category, and their body had adjusted to not having the hormones.

在那种情况下，他们已经被归入了这个较高风险的类别，并且他们的身体已经适应了没有激素的情况。

And when re-exposed, they had more adverse events.

当再次暴露时，他们出现了更多的不良事件。

But if you are starting on estrogen replacement, and it can be various, but honestly, the estrogen that we try to replace in this time period much more mimics estradiol.

但如果你开始服用雌激素替代品，它可以是多种多样的，但老实说，我们在这个时期尝试替代的雌激素更像是雌二醇。

We have estradiol pills.

我们有雌二醇药片。

You can have vaginal inserts.

您可以使用阴道插入物。

You can have patches.

你可以有补丁。

So it depends on what's going to work for your life.

所以这取决于什么对你的生活有用。

But it is not the birth control pill most often.

但最常见的并不是避孕药。

In some people, it might be that's what they choose, but we really are trying to pick an estrogen that is estradiol, more mimics that natural structure, and you can't have unopposed estrogen without reaching the risk of endometrial cancer, and so that's why we need to have some progestin.

对于某些人来说，这可能是他们的选择，但我们确实在尝试选择一种雌激素，即雌二醇，更模仿自然结构，并且在没有达到子宫内膜癌风险的情况下不可能拥有不受对抗的雌激素，因此这就是为什么我们需要一些孕激素。

So some people will choose a daily progestin.

所以有些人会选择每日服用孕激素。

Some will choose a cyclic progestin and still have periods.

有些人会选择环状孕激素，但仍然会来月经。

Some will put in an IUD at this time period and then take their daily estrogen.

有些人会在这个时间段放置宫内节育器，然后每天服用雌激素。

There's a lot of different options.

有很多不同的选择。

We're trying to find the lowest dose of hormones that relieves your symptoms to provide you relief from some of these lifestyle issues, but also helps you not just live longer, right?

我们正在努力寻找最低剂量的激素来缓解您的症状，帮助您缓解一些生活方式问题，同时还能帮助您延长寿命，对吗？

We're not just trying to live longer.

我们不只是想活得更久。

We want to be healthy longer.

我们希望健康得更长久。

We want to have a better quality of life, and certainly Women's health has for long stopped at this menopausal period, and then it's been, "You're on your own, kid." And this is when we're really starting to see that intervening at that place, especially for women who go into ovarian failure early.

我们希望拥有更好的生活质量，当然，女性的健康早已停止在更年期，然后就是“你要靠自己了，孩子。”这是我们真正开始看到对那个地方进行干预的时候，特别是对于早期卵巢衰竭的女性。

So those people who have low ovarian reserve who I diagnose, I tell all of them, "Hey, if you don't freeze your eggs or I never see you again, you're going to go through menopause early.

因此，对于那些我诊断出的卵巢储备功能低下的人，我告诉他们所有人：“嘿，如果你不冷冻卵子，或者我再也见不到你，你就会提前进入更年期。

And when you do, I want you to go see somebody.

当你这样做时，我希望你去见某人。

I don't want you to just ignore it and suffer with these symptoms," which is something that does commonly happen.

我不希望你忽视它并遭受这些症状的折磨，”这是经常发生的事情。

So just making sure that women are empowered to know that these symptoms are what happens, it's what happens naturally.

因此，只要确保女性有权知道这些症状是如何发生的，这是自然发生的。

But by giving their bodies more estrogen, and not crazy high doses, but just these physiologic levels, can really improve both the quality and the longevity of their life.

但是，通过给他们的身体提供更多的雌激素，而不是疯狂的高剂量，而只是这些生理水平，可以真正提高他们的生活质量和寿命。

Andrew Huberman:

安德鲁·休伯曼：

Is it just the presence of these symptoms that signals the onset of menopause, or are there additional cues?

仅仅是这些症状的出现就标志着更年期的开始，还是还有其他线索？

Like for instance, if their cycle is getting shorter or longer.

例如，他们的周期是否变短或变长。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah.

是的。

You certainly will have cycle changes, and we consider that the perimenopausal period, where you're starting to really start seeing a spacing out of your period.

您肯定会经历周期变化，我们认为在围绝经期，您开始真正开始看到月经间隔。

So they're no longer coming at that perfect ovulatory pattern.

所以他们不再处于完美的排卵模式。

When you get into the low ovarian reserve but you're still ovulating regularly, they first shorten, as we said earlier.

当您的卵巢储备能力较低但仍定期排卵时，它们首先会缩短，正如我们之前所说的。

But then when they start lengthening or you start skipping months, that's a real big clue that things are not going in the right direction.

但当它们开始延长或者你开始跳过几个月时，这就是一个真正的大线索，表明事情没有朝着正确的方向发展。

And if you find out you have very, very low ovarian reserve or you're approaching that perimenopause period, you're going to start to have more prolonged periods of low estrogen, and you'll feel mentally cloudy, fatigued, more headaches, more hot flashes, lack of libido, those vulvar vaginal symptoms.

如果你发现自己的卵巢储备功能非常非常低，或者你正接近更年期，你就会开始出现更长时间的低雌激素水平，你会感到精神恍惚、疲劳、头痛、潮热、性欲缺乏以及外阴阴道症状。

Overall, more likelihood to have depressed mood, and that's a lot.

总的来说，情绪低落的可能性更大，而且很多。

Andrew Huberman:

安德鲁·休伯曼：

It is a lot.

这是很多。

Well, Natalie, Dr. Crawford, I want to extend a huge thank you on behalf of myself.

娜塔莉、克劳福德博士，我谨代表我自己向你们表示衷心的感谢。

I've learned so much from you today about fertility, about hormone health for women, and you've also touched on a number of important issues about hormone health and fertility for men along the way.

今天，我从您那里学到了很多有关生育力、女性荷尔蒙健康的知识，您还谈到了有关男性荷尔蒙健康和生育力的许多重要问题。

So it's truly been a master class in fertility and hormones and really touched on topics that are so essential to everybody, even if people aren't seeking to conceive or maybe think they don't want to.

因此，这确实是生育力和荷尔蒙方面的大师班，并且真正触及了对每个人都至关重要的主题，即使人们并不寻求怀孕或可能认为自己不想怀孕。

There's so many considerations that really extend back to one's teens, and if one is beyond their teens, whatever age people are, essentially, they need to think about these issues and make important decisions.

有很多考虑因素实际上可以追溯到一个人的十几岁，如果一个人已经过了十几岁，无论什么年龄的人，本质上都需要考虑这些问题并做出重要的决定。

And you've really also clarified a lot of the, what I think are quite destructive myths that are prominent out there about, for instance, egg harvest and what that does to one's fertility.

而且您确实还澄清了很多我认为具有相当破坏性的神话，这些神话非常突出，例如，关于卵子收获及其对生育能力的影响。

So first of all, thank you for joining us today.

首先，感谢您今天加入我们。

I know you're extremely busy.

我知道你非常忙。

You run a clinic, you manage a family as well, co-manage a family, I believe.

我相信，你经营一家诊所，你也管理一个家庭，共同管理一个家庭。

But this is the sort of knowledge that is so challenging to find in one place, and yet you also have a number of really spectacular avenues that you deliver information, Instagram, podcasts, books, and things of that sort.

但这种知识很难在一个地方找到，但你也有许多非常壮观的途径来传递信息，Instagram、播客、书籍和类似的东西。

We will refer everyone to those links.

我们将向大家推荐这些链接。

I've learned so much from you over the years really, in following your content, and today you've just far exceeded already high expectations.

多年来，在关注您的内容时，我确实从您那里学到了很多东西，今天您远远超出了本来就很高的期望。

So thank you ever so much.

所以非常感谢你。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Oh, thank you for having me, and just thank you for giving a space to talk about women's health and fertility and reproductive medicine.

哦，谢谢你邀请我，也谢谢你给我一个空间来谈论女性健康、生育和生殖医学。

It means a lot to me, and it means a lot to the people who really are trying to do their best every day, so we appreciate it.

这对我来说意义重大，对那些每天都努力做到最好的人来说意义重大，所以我们很感激。

Andrew Huberman:

安德鲁·休伯曼：

We appreciate you, and with some luck, we'll convince you to come back and talk to us about-

我们感谢您，如果运气好的话，我们会说服您回来和我们谈谈-

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Yeah, let's do it

是的，我们开始吧

Andrew Huberman:

安德鲁·休伯曼：

...

pregnancy and a bit more on some of the topics that we moved through quickly.

怀孕以及我们快速讨论的一些话题的更多内容。

Thank you.

谢谢。

Dr. Natalie Crawford:

娜塔莉·克劳福德博士：

Thank you.

谢谢你。

Andrew Huberman:

安德鲁·休伯曼：

Thank you for joining me for today's discussion about female hormones and fertility with Dr. Natalie Crawford.

感谢您今天与 Natalie Crawford 博士一起讨论女性荷尔蒙和生育能力。

You can find links to her clinical practice, as well as to her social media handles, in the show note captions.

您可以在节目注释标题中找到她的临床实践以及她的社交媒体账号的链接。

Please also check out the link to her excellent podcast entitled, "As a Woman." If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.

另请查看她题为“作为女人”的优秀播客的链接。如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。

That's a terrific zero-cost way to support us.

这是支持我们的绝佳零成本方式。

In addition, please subscribe to the podcast on both Spotify and Apple.

此外，请在 Spotify 和 Apple 上订阅该播客。

And on both Spotify and Apple, you can leave us up to a five-star review.

在 Spotify 和 Apple 上，您都可以给我们五星级的评价。

Please also check out the sponsors mentioned at the beginning and throughout today's episode.

另请查看今天节目开头和整个节目中提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

If you have questions for me or comments about the podcast or guests that you'd like me to consider hosting on the Huberman Lab podcast, please put those in the comment section on YouTube.

如果您对我有疑问或对您希望我考虑在 Huberman Lab 播客上主持的播客或嘉宾有意见，请将这些意见放在 YouTube 的评论部分。

I do read all the comments.

我确实阅读了所有评论。

Not during today's episode, but on many previous episodes of the Huberman Lab podcast, we discuss supplements.

不是在今天的节目中，而是在 Huberman Lab 播客的许多之前的节目中，我们讨论了补充剂。

While supplements aren't necessary for everybody, many people derive tremendous benefit from them, for things like enhancing sleep, hormone support, and improving focus.

虽然补充剂并不是每个人都需要的，但许多人都从它们中获得了巨大的好处，例如增强睡眠、激素支持和提高注意力。

If you'd like to learn more about the supplements discussed on the Huberman Lab podcast, you can go to Live Momentous, spelled O-U-S, so livemomentous.com/huberman.

如果您想了解有关 Huberman Lab 播客上讨论的补充剂的更多信息，您可以访问 Live Momentous，拼写为 O-U-S，即 livemomentous.com/huberman。

If you're not already following me on social media, it's Huberman Lab on all social media platforms.

如果您还没有在社交媒体上关注我，那么所有社交媒体平台上都有 Huberman Lab。

So that's Instagram, Twitter, now called X, Threads, Facebook, LinkedIn.

这就是 Instagram、Twitter（现在称为 X）、Threads、Facebook、LinkedIn。

And on all those places, I discuss science and science-related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the content on the Huberman Lab podcast.

在所有这些地方，我讨论了科学和与科学相关的工具，其中一些与胡伯曼实验室播客的内容重叠，但其中大部分与胡伯曼实验室播客的内容不同。

So again, it's Huberman Lab on all social media platforms.

再说一遍，所有社交媒体平台上都是 Huberman Lab。

If you haven't already subscribed to our monthly Neural Network Newsletter, the Neural Network Newsletter is a completely zero-cost newsletter that gives you podcast summaries as well as toolkits in the form of brief PDFs.

如果您还没有订阅我们的每月神经网络通讯，神经网络通讯是完全零成本的通讯，它为您提供播客摘要以及简短 PDF 形式的工具包。

We've had toolkits related to optimizing sleep, to regulating dopamine, deliberate cold exposure, fitness, mental health, learning and neuroplasticity, and much more.

我们拥有与优化睡眠、调节多巴胺、刻意寒冷暴露、健身、心理健康、学习和神经可塑性等相关的工具包。

Again, it's completely zero cost to sign up.

再次强调，注册成本完全为零。

You simply go to hubermanlab.com, go over to the Menu tab, scroll down to Newsletter, and supply your email.

您只需访问 hubermanlab.com，转到“菜单”选项卡，向下滚动到“时事通讯”，然后提供您的电子邮件即可。

I should emphasize that we do not share your email with anybody.

我要强调的是，我们不会与任何人分享您的电子邮件。

Thank you once again for joining me for today's discussion with Dr. Natalie Crawford.

再次感谢您参加今天与 Natalie Crawford 博士的讨论。

And last but certainly not least, thank you for your interest in science.

最后但并非最不重要的一点是，感谢您对科学的兴趣。