How to Optimize Fertility in Males & Females

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。

Today we are discussing fertility.

今天我们讨论的是生育力。

We will discuss male fertility and female fertility.

我们将讨论男性生育力和女性生育力。

And I should mention that today's discussion is not just for people who are seeking to conceive children or who want to know how their children were conceived, but it's really for everybody.

我应该指出，今天的讨论不仅适合那些想要怀孕的人或想知道他们的孩子是如何怀孕的人，而是适合每个人。

And I say that because it is the story of all of us.

我这么说是因为这是我们所有人的故事。

All of us are here because a specialized set of cells called germ cells, that is the sperm and the egg, and I'll make it very clear why they're called germ cells a little bit later.

我们所有人都在这里，因为有一组称为生殖细胞的特殊细胞，即精子和卵子，稍后我会非常清楚地解释为什么它们被称为生殖细胞。

It has nothing to do with infection.

与感染无关。

But it's because a sperm cell and an egg cell arrived at one another, either in vivo, inside of our mother, or in vitro, so-called in vitro fertilization, and then were implanted into our mother and became us.

但这是因为一个精子细胞和一个卵细胞到达了彼此，要么在我们母亲的体内，要么在体外，即所谓的体外受精，然后被植入到我们的母亲体内，成为了我们。

And so understanding the process of how the egg cell and the sperm cell came to be is really the key to understanding how that fertilization process came to be.

因此，了解卵细胞和精子细胞的形成过程实际上是了解受精过程如何形成的关键。

I know everyone's thinking, I know how fertilization occurs.

我知道大家的想法，我知道受精是如何发生的。

It occurs through sexual intercourse, and so on.

它通过性交等发生。

And we'll talk a little bit about that, but I promise you that if you understand the menstrual cycle, and the menstrual cycle in today's conversation can best be thought of as a biological cycle that occurs in females that allows the potential for fertilization by the sperm, because that's really what it is.

我们会稍微讨论一下这个问题，但我向你保证，如果你了解月经周期，今天谈话中的月经周期最好被认为是女性中发生的一个生物周期，它允许精子受精，因为这确实是这样。

And it's a beautifully orchestrated process that I'll describe to you.

我将向您描述这是一个精心策划的过程。

And I should say all people, males and females, should really understand how the menstrual cycle works, how it impacts fertilization, but also how it impacts the brain and body behavior, psychology, et cetera.

我应该说，所有人，无论男性还是女性，都应该真正了解月经周期是如何运作的，它如何影响受精，以及它如何影响大脑和身体行为、心理等等。

And we will also talk about spermatogenesis, how sperm cells come to be and how they arrive, that is, how they swim to the egg, and the incredible interplay between the biology of the sperm and the biology of the egg leads to this incredible thing that we call embryogenesis and the birth of the child, and of course, the development of that child into an infant, a toddler, an adolescent, a teen, and an adult.

我们还将讨论精子发生、精子细胞如何形成以及它们如何到达，即它们如何游向卵子，以及精子生物学和卵子生物学之间令人难以置信的相互作用导致了我们称之为胚胎发生和孩子出生的令人难以置信的事情，当然还有孩子发育成婴儿、幼儿、青少年、青少年和成人。

Today's discussion, again, is not just for those of you that are seeking to have children.

再次强调，今天的讨论不仅仅适合那些想要孩子的人。

And I say that because when you look at the data, you look at the literature on longevity and vitality, two themes in biology that oftentimes people lump together but aren't always the same.

我这么说是因为当你查看数据时，你会看到有关长寿和活力的文献，这两个生物学主题经常被人们混为一谈，但并不总是相同的。

For instance, there are a lot of things that we can do to increase our vitality that actually can harm our longevity.

例如，我们可以做很多事情来增强活力，但实际上却会损害我们的寿命。

But there are a subset of biological rules and mechanisms that, when aligned, allow us to maximize both our vitality and our longevity.

但是，有一些生物规则和机制，当它们一致时，可以让我们最大限度地提高我们的活力和寿命。

And I think it's fair to say that all of those mechanisms and tools are housed in the discussion around maximizing fertility.

我认为可以公平地说，所有这些机制和工具都包含在围绕生育率最大化的讨论中。

And that's true whether or not you're male or female.

无论你是男性还是女性，这都是事实。

In other words, if you want children or if you don't, if you already have children or if you don't, understanding how fertility and fertilization occurs in the brain and body will allow you to maximize your vitality and longevity.

换句话说，无论您想要孩子还是不想要孩子，无论您已经有孩子还是没有孩子，了解生育力和受精在大脑和身体中如何发生将使您最大限度地提高活力和寿命。

And of course, today's discussion will provide an understanding of the biology and many actionable tools that will also help you conceive children if that's your wish.

当然，今天的讨论将提供对生物学的理解和许多可行的工具，如果您愿意的话，这些工具也将帮助您怀孕。

So of course, as is characteristic of this podcast, we will discuss science-based tools, including behavioral tools, both the do's and the don'ts, and we will discuss nutrition-based tools and supplementation-based tools and some other practices, including things like acupuncture, which have quite good data to support them in terms of improving fertility, and we will discuss why those certain practices can work.

当然，正如本播客的特点一样，我们将讨论基于科学的工具，包括行为工具，包括该做的和不该做的，我们将讨论基于营养的工具和基于补充剂的工具以及其他一些做法，包括针灸等，它们在提高生育能力方面有很好的数据支持它们，我们将讨论为什么这些某些做法可以发挥作用。

And we will discuss prescription drugs that your doctor can prescribe to you if, for instance, you have a deficit at the level of hormone production or neurotransmitter production at the level of the brain or the pituitary gland.

我们将讨论您的医生可以给您开的处方药，例如，如果您的大脑或垂体水平的激素产生或神经递质产生水平存在缺陷。

I'll explain what all of those things are soon.

我很快就会解释所有这些事情是什么。

Or the gonads, the ovary and the testes in females and males respectively.

或者分别是女性和男性的性腺、卵巢和睾丸。

Again, by the end of today's episode, you will have a lot of knowledge and actionable tools related to maximizing fertility, and you will have a lot of knowledge and actionable tools related to maximizing vitality and longevity.

同样，在今天的节目结束时，您将拥有大量与最大限度地提高生育能力相关的知识和可操作的工具，并且您将拥有大量与最大限度地提高活力和寿命相关的知识和可操作的工具。

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。

In keeping with that theme, I'd like to thank the sponsors of today's podcast.

为了与这个主题保持一致，我要感谢今天播客的赞助商。

Let's talk about fertility.

我们来谈谈生育能力。

And in doing so, let's take a step back from this word fertility and ask, what is fertility and fertilization really all about?

在这样做的过程中，让我们从“生育力”这个词退后一步，问一下，生育力和受精到底是什么？

Well, the obvious answer is that it's about producing offspring, but more importantly, it's about producing offspring that contain the genetic components of both parents and indeed contain half of the genes from one parent and half of the genes from another parent.

嗯，显而易见的答案是，它是关于产生后代，但更重要的是，它是关于产生包含父母双方遗传成分的后代，并且实际上包含来自父母一方的一半基因和另一方父母的一半基因。

Now, there are two general types of cells in the body.

现在，体内有两种一般类型的细胞。

The most common types of cells in the body are called somatic cells.

体内最常见的细胞类型称为体细胞。

So these would be all the cells in your body except the egg in females and the sperm in males.

所以这些将是你体内的所有细胞，除了女性的卵子和男性的精子。

The egg in females and the sperm in males are part of what's called the germline, and again, it has nothing to do with infection.

女性的卵子和男性的精子是所谓种系的一部分，同样，它与感染无关。

It's just that the cells of the germline have genes that cannot be modified by the behavior of the individual that houses those genes.

只是种系细胞中的基因无法通过拥有这些基因的个体的行为进行修改。

What do I mean by that?

我这么说是什么意思？

Well, if I were to tell you that by exercising you can improve mitochondrial function, you can change hormones, by reducing stress you can reduce cortisol, by hitting puberty, for instance, you will have the secretion of hormones that then change gene expression in other cells, leading to development of body hair, facial hair, deepening the voice, breast growth, et cetera.

好吧，如果我告诉你，通过锻炼，你可以改善线粒体功能，你可以改变激素，通过减轻压力，你可以减少皮质醇，例如，进入青春期，你会分泌激素，然后改变其他细胞的基因表达，导致体毛、面部毛发的发育，声音变得低沉，乳房生长等等。

You'd say, "Okay, great.

你会说：“好吧，太好了。

Yeah, that all makes perfect sense." But that's all occurring in the so-called somatic cells The germ cells or the germline cells, that is the egg and the sperm, are a very unique and protected set of cells that are generated in a particular way and whose genetic components are not modifiable by experience.

是的，这一切都很有道理。”但这一切都发生在所谓的体细胞中。生殖细胞或生殖系细胞，即卵子和精子，是一组非常独特且受保护的细胞，它们以特定方式生成，其遗传成分无法通过经验进行修改。

And when you take a step back and you think about it, you say, "Oh, that's right." There's no reason to think that exercising will make the children that you have not yet had stronger.

当你退后一步思考时，你会说：“哦，是的。”没有理由认为锻炼会让你还没有生的孩子变得更强壮。

And you say, "Of course not." Well, why is that?

你说：“当然不是。”嗯，这是为什么呢？

Well, that's because there is a barrier between the genes of the germline cells and behaviors.

嗯，那是因为生殖细胞的基因和行为之间存在障碍。

They cannot be modified by behaviors and the various things that you do in your lifetime.

它们不能通过你一生中的行为和所做的各种事情来改变。

Now, I suppose there's an exception in the negative direction, and what I'm referring to here is if you were to, say, be exposed to a chemical that could mutate the DNA of your egg or sperm, or if you were to fertilize an embryo in a certain way or at a certain stage of life that it got an extra chromosome, for instance.

现在，我想在消极的方向上有一个例外，我在这里指的是，如果你接触到一种可能使你的卵子或精子的 DNA 发生突变的化学物质，或者如果你以某种方式使胚胎受精，或者在生命的某个阶段使其获得了额外的染色体，例如。

We'll talk about this a little bit later.

我们稍后会讨论这个问题。

Well, then, of course, you could end up with offspring that have modified DNA that don't faithfully represent half of the genes from mom and half of the genes from dad, but that's not the same as specific behaviors modifying the genes of those cells, the sperm and the egg cells, in a way that improves the offspring.

那么，当然，你最终可能会得到DNA被修改的后代，这些DNA不能忠实地代表来自母亲的一半基因和来自父亲的一半基因，但这与修改这些细胞、精子和卵细胞的基因以改善后代的方式不同。

Okay?

好的？

So the key first thing to understand today is that there's a distinction between somatic cells, which is the vast majority of cells in your body, and the so-called germline cells, which are the egg and the sperm.

因此，今天要了解的第一件关键的事情是，体细胞（体内的绝大多数细胞）与所谓的生殖细胞（卵子和精子）之间存在区别。

The egg and the sperm are these highly protected populations of cells that in females actually come to be during embryogenesis.

卵子和精子是受到高度保护的细胞群，实际上是在女性胚胎发生过程中形成的。

Okay?

好的？

So for all females out there, you generate what today I'm going to refer to as a vault of cells.

因此，对于所有女性来说，你们会产生今天我所说的细胞库。

You have a vault of eggs that are your germline.

你有一个卵子库，它们是你的种系。

Those eggs all contain all the chromosomes of your DNA, so it's going to be, as most of you know, there are 23 chromosomes, and chromosomes exist in pairs.

这些卵子都含有你 DNA 的所有染色体，所以，正如你们大多数人所知，有 23 条染色体，并且染色体成对存在。

So the way to think about this is each pair is one strand, and you have 22 so-called autosomes, and then you have one sex chromosome.

因此，思考这个问题的方法是，每一对都是一条链，你有 22 条所谓的常染色体，然后你就有一条性染色体。

The sex chromosome will be either X or Y.

性染色体为 X 或 Y。

So in a female, they have two X chromosomes.

因此，女性有两条 X 染色体。

So in each one of the eggs that a woman has and that she's had since she was an embryo, and that's contained in this vault, those eggs are, of course, going to be very immature at birth, right?

因此，在女性从胚胎时期起就拥有的每一个卵子中，以及包含在这个保险库中的卵子中，这些卵子在出生时当然会非常不成熟，对吗？

She hasn't undergone puberty yet, and certainly as an embryo, she hasn't undergone puberty.

她还没有经历青春期，当然作为胚胎，她也没有经历青春期。

And those cells are going to contain 23 pairs of chromosomes.

这些细胞将包含 23 对染色体。

Okay, this is very important.

好的，这非常重要。

23 pairs of chromosomes.

23对染色体。

The chromosomes are essentially the wrapped up DNA that contains all the genetic information to create any cell type in the body and actually to create an entirely new individual.

染色体本质上是包裹的DNA，其中包含在体内创建任何细胞类型并实际上创建一个全新个体的所有遗传信息。

Now, there are 23 pairs of chromosomes, 22 of which are called autosomes.

现在，有23对染色体，其中22对称为常染色体。

Okay?

好的？

If that doesn't make sense to you, just remember autosome, okay, there's 22 of them, and then there's one so-called sex chromosome.

如果这对你来说没有意义，只要记住常染色体，好吧，有 22 条，还有一条所谓的性染色体。

The sex chromosomes are either X or Y, but this is a female, so she's going to have 23 pairs of chromosomes, and she's going to have two X chromosomes for the sex chromosomes.

性染色体要么是 X，要么是 Y，但这是一位女性，所以她将有 23 对染色体，并且她将有两条 X 染色体作为性染色体。

Okay?

好的？

If this is already confusing to you, don't worry.

如果这已经让您感到困惑，请不要担心。

I'll make it very clear how this all relates to fertility and how it relates to chromosomal segregation and a bunch of things that I think maybe you've heard of and that perhaps were opaque to you, but I promise to make them clear.

我将非常清楚地说明这一切与生育力的关系以及它与染色体分离的关系以及我认为您可能听说过并且可能对您来说不透明的一些事情，但我保证将它们说清楚。

But just understand that within each of those eggs, they have 23 pairs of chromosomes.

但只需了解，每个卵子中都有 23 对染色体。

And for those of you that like nomenclature, I'll tell you that those cells are considered diploid.

对于那些喜欢命名法的人，我会告诉您这些细胞被认为是二倍体。

They're called the diploid, and that means that they have 23 pairs of chromosomes.

它们被称为二倍体，这意味着它们有 23 对染色体。

As distinguished from cells that are haploid, where there's only one set of those 23 chromosomes.

与单倍体细胞不同，单倍体细胞只有一组 23 条染色体。

So instead of 23 pairs, there's only 23 chromosomes.

因此，染色体不是 23 对，而是只有 23 条。

We'll come back to haploid cells a little bit later.

稍后我们会回到单倍体细胞。

Okay, so when a female is born, she has all these eggs in the reserve, in this vault that she'll have for her entire life.

好吧，当雌性出生时，她会把所有这些卵子都储存在这个她一生都会拥有的保险库里。

She's not going to make any more.

她不会再赚更多了。

But they are very, very immature.

但他们非常非常不成熟。

So when a woman is in embryogenesis, she develops these very immature eggs.

因此，当女性处于胚胎发育阶段时，她会发育出这些非常不成熟的卵子。

Okay?

好的？

Today, we're also going to talk about follicles, and we will be careful to distinguish follicles from eggs.

今天我们还要讲一下卵泡，我们会仔细区分卵泡和卵子。

They're often talked about interchangeably online and elsewhere, and even by fertility docs and OBGYNs.

人们经常在网上和其他地方互换谈论它们，甚至生育医生和妇产科医生也经常谈论它们。

But right now, we're just talking about the egg cells.

但现在，我们只讨论卵细胞。

Okay?

好的？

The eggs themselves, which are cells.

卵子本身就是细胞。

Now, the goal of fertilization is to bring that egg cell into close enough proximity that it can be fertilized by a single sperm cell.

现在，受精的目标是使卵细胞足够接近，以便单个精子细胞可以使其受精。

And that sperm cell will bring 23 chromosomes as well that include, just as in the female egg, it'll have 22 autosomes and one sex chromosome, and in the male, that sex chromosome can either be an X chromosome, which then would give rise to female offspring, or a Y chromosome, which would give rise to male offspring.

该精子细胞也将带来 23 条染色体，其中包括，就像在女性卵子中一样，它将有 22 条常染色体和一条性染色体，而在男性中，该性染色体可以是 X 染色体，然后产生女性后代，也可以是 Y 染色体，这将产生男性后代。

And today, we're not talking about sexual differentiation.

今天，我们不是在谈论性别差异。

That's a topic of a previous and yet another future episode.

这是前一集和未来一集的主题。

But just to give you a sense of how X chromosomes and Y chromosomes can actually accomplish that sexual differentiation, both of body and brain, I'll just mention in two sentences that, for instance, if there's a Y chromosome as opposed to an X chromosome, that Y chromosome contains genes that suppress, for instance, the development of female genitalia, and thereby give rise to male genitalia.

但为了让您了解 X 染色体和 Y 染色体如何真正实现身体和大脑的性别分化，我将用两句话提到，例如，如果存在 Y 染色体而不是 X 染色体，则 Y 染色体包含抑制女性生殖器发育的基因，从而产生男性生殖器。

So rather than the formation of a clitoris, it's the formation of a penis.

因此，与其说是阴蒂的形成，不如说是阴茎的形成。

And rather than the formation of ovaries, the formation of a testes.

并且不是形成卵巢，而是形成睾丸。

Okay?

好的？

So that's more directed towards sexual differentiation.

所以这更针对性别分化。

We're not going to get into that right now.

我们现在不打算讨论这个问题。

We'll get into that in a future episode.

我们将在以后的剧集中讨论这个问题。

But even if you're only tracking about 10% of what I'm saying right now, I promise you're doing great.

但即使你现在只听懂了我所说内容的 10%，我保证你会做得很好。

If you're tracking more than 10%, well, then you're doing terrifically well.

如果您的跟踪率超过 10%，那么您就做得非常好。

Because the essence of fertility and fertilization is to bring together that haploid cell that is the sperm that only has 23 chromosomes, but not pairs of chromosomes, right, because that's the DNA from dad, together with the egg, which as I told you already, has 23 pairs of chromosomes.

因为生育和受精的本质是将单倍体细胞聚集在一起，即只有 23 条染色体的精子，而不是成对的染色体，对吧，因为那是来自父亲的 DNA，与卵子一起，正如我已经告诉过你的，卵子有 23 对染色体。

So part of the fertilization process has to be to get rid of one half of those 23 pairs in the female.

因此，受精过程的一部分必须是去除雌性体内这 23 对中的一半。

You got to get rid of it and You have to get the egg and the sperm in proximity so that the egg can potentially be fertilized by the sperm, bringing the DNA, the 23 single strands of chromosomes from dad into a cell that has 23 single strands from mom.

你必须摆脱它，你必须让卵子和精子靠近，这样卵子就有可能被精子受精，将DNA（来自父亲的23条单链染色体）带入含有来自母亲的23条单链染色体的细胞中。

Okay?

好的？

So I realize I'm probably being a little bit repetitive here, but I want everyone to understand this because it really frames up fertility and reproduction in the proper way.

所以我意识到我在这里可能有点重复，但我希望每个人都能理解这一点，因为它确实以正确的方式构建了生育和繁殖。

We've got a cell from mom, the egg, which has 23 pairs of chromosomes.

我们有一个来自母亲的细胞，即卵子，它有 23 对染色体。

We need to get rid of one set of those pairs so that there's only 23 chromosomes.

我们需要去掉其中的一组，这样就只剩下 23 条染色体了。

We need to get rid of half of those chromosomes.

我们需要去掉一半的染色体。

And then we need to bring that cell together physically with the sperm cell that contains the 23 chromosomal strands from dad, and we need to bring those together so that you get 23 chromosomal pairs from dad and 23 chromosomal pairs from mom.

然后我们需要将该细胞与含有来自父亲的 23 条染色体链的精子细胞物理结合在一起，我们需要将它们结合在一起，这样你就可以得到来自父亲的 23 对染色体和来自母亲的 23 对染色体。

And in doing so, you create a cell, which then becomes multiple cells, that's going to be the developing embryo that has half the genes from mom and half the genes from dad.

在这样做的过程中，你创造了一个细胞，然后它变成多个细胞，这将是发育中的胚胎，它有一半来自母亲的基因，一半来自父亲的基因。

So I hope that's clear.

所以我希望这是清楚的。

That is the biological logic, which I realize is a bit of a tongue twister, but forgive me, it is the most accurate way to describe this process.

这就是生物逻辑，我意识到这有点绕口令，但请原谅我，这是描述这个过程的最准确的方式。

We're trying to bring together the 23 single strands of chromosomes from dad and the 23 single strands of chromosomes from mom into the same cell.

我们试图将来自爸爸的 23 条单链染色体和来自妈妈的 23 条单链染色体整合到同一个细胞中。

Now, that requires a literal physical contact and pairing of the two cells.

现在，这需要两个电池的实际物理接触和配对。

But as I mentioned before, all these eggs in mom are sitting in a vault, and they're very, very immature.

但正如我之前提到的，妈妈体内的所有这些卵都存放在金库中，而且它们非常非常不成熟。

So the ovulatory cycle and the menstrual cycle are really about, first, eliminating half of the chromosomal pairs in that 23 sets of chromosomes, and not getting rid of, for instance, half just going one to 11 or 12 to 23.

因此，排卵周期和月经周期实际上是，首先，消除 23 组染色体中的一半染色体对，而不是消除，例如，一半只是从 1 到 11 或 12 到 23。

That's not the goal.

那不是目标。

The goal is to have chromosomes one, two, three, four, five, six, all the way up to 23, but only to have half of the chromosomes there.

目标是拥有一号、二号、三号、四号、五号、六号染色体，一直到 23 号染色体，但只拥有一半的染色体。

And to bring that cell together with the sperm cell physically, then allow them to fuse and allow the chromosomes from dad and the chromosomes from mom to fuse within a single cell and duplicate into cells that contain half the chromosomes from dad and half the chromosomes from mom.

将该细胞与精子细胞物理地结合在一起，然后让它们融合，让来自父亲的染色体和来自母亲的染色体融合在一个细胞内，并复制成包含一半来自父亲的染色体和一半来自母亲的染色体的细胞。

That's what the ovulatory and menstrual cycle are really all about.

这就是排卵和月经周期的真正含义。

So in thinking about it that way, I'd like to just initiate the discussion by focusing first on the female component or the egg component of fertility and fertilization.

因此，在这样思考的过程中，我想首先关注生育力和受精的女性成分或卵子成分来开始讨论。

As I mentioned before, a female has all the eggs, albeit very immature eggs, that she's going to have at the time that she's born.

正如我之前提到的，雌性拥有她出生时将拥有的所有卵子，尽管是非常不成熟的卵子。

Now, puberty will happen at some point and will allow the ovulatory and the menstrual cycle to commence.

现在，青春期将在某个时候发生，排卵和月经周期将开始。

Now, one question that you perhaps are asking is what controls the onset of puberty?

现在，您可能会问的一个问题是，是什么控制着青春期的开始？

And there, there are a number of different results, each of which could be an entire episode of a podcast on its own.

在那里，有许多不同的结果，每个结果都可能是播客的一整集。

But I'll just highlight a few things that we know about the onset of menses or menstruation, or it's sometimes also called menarche.

但我只想强调一些我们所知道的关于月经或月经（有时也称为月经初潮）的事情。

All right?

好的？

One thing that you'll notice about today's discussion is that if you were to take any number of your notes online and put them into a search function, that you would see a lot of different language used for the same thing.

关于今天的讨论，您会注意到的一件事是，如果您要在网上记下任意数量的笔记并将它们放入搜索功能中，您会看到许多不同的语言用于同一件事。

So for instance, some people will talk about the egg and the follicle as the same thing, even though they are not.

例如，有些人会将卵子和卵泡视为同一事物，尽管事实并非如此。

I'll explain the difference soon.

我很快就会解释其中的区别。

Some people will talk about menses or menstruation or menarche as the exact same thing.

有些人会将月经或月经或初潮视为完全相同的事情。

And in fact, they are not the exact same thing, but oftentimes these words are used interchangeably.

事实上，它们并不完全相同，但这些词通常可以互换使用。

I'll do my best today to not overload you with nomenclature, but rather to use the most commonly used terms for the different aspects of fertility and fertilization.

今天我将尽力不让您过多地使用术语，而是使用最常用的术语来描述生育和受精的不同方面。

But when it comes to the onset of puberty, first of all, most of you have probably heard that the onset of puberty is happening much earlier in females now than it was some years ago.

但说到青春期的开始，首先，你们大多数人可能都听说过，现在女性的青春期开始比几年前要早得多。

And in fact, that is the case.

事实上，情况正是如此。

And I'll talk about some statistics related to this, which are pretty striking, but don't necessarily point to anything detrimental.

我将讨论一些与此相关的统计数据，这些统计数据非常引人注目，但不一定表明有任何有害的东西。

It doesn't necessarily mean that something bad is happening.

这并不一定意味着发生了不好的事情。

What do we know for sure?

我们确定知道什么？

Well, we know that there are a number of signals that come both through the brain and through the body, and more likely both, in order to control the onset of puberty in females.

我们知道，为了控制女性青春期的开始，有许多信号通过大脑和身体（更有可能是两者）同时发出。

A couple of examples.

举几个例子。

The first is a mechanistic one.

第一个是机械性的。

We know, for instance, that the entire process of the ovulatory and menstrual cycle is initiated from the brain.

例如，我们知道排卵和月经周期的整个过程都是由大脑发起的。

We're going to get into this in a lot more detail in a few minutes.

我们将在几分钟内更详细地讨论这个问题。

But there's a certain number of hormones and neurotransmitters that are communicated from the brain, a structure called the hypothalamus, which roughly sits above the roof of your mouth, and that communicates with a gland, an endocrine or hormone-releasing gland called the pituitary gland.

但是，有一定数量的激素和神经递质是从大脑（一种称为下丘脑的结构，大致位于口腔顶部上方）传递的，它与一个腺体（一种称为垂体的内分泌腺或激素释放腺）进行交流。

The pituitary gland looks like a stalk that essentially extends out of the brain.

垂体看起来像一根从大脑中伸出的茎。

It's also located not far from the roof of your mouth.

它也位于离上颚不远的地方。

And that has two sort of small marble or grape-sized protrusions, the anterior pituitary and the posterior pituitary, and they release different hormones into the bloodstream.

它有两种小的大理石或葡萄大小的突起，垂体前叶和垂体后叶，它们向血液中释放不同的激素。

Puberty is in part controlled by the fact that up until puberty, there are neurons in the hypothalamus that release a neurotransmitter called GABA, which is inhibitory, and that prevents the neurons in the hypothalamus from releasing a very important hormone called gonadotropin-releasing hormone or GnRH.

青春期在一定程度上是由以下事实控制的：直到青春期，下丘脑中的神经元都会释放一种称为 GABA 的神经递质，这种神经递质具有抑制作用，并阻止下丘脑中的神经元释放一种非常重要的激素，称为促性腺激素释放激素或 GnRH。

So the first thing that I'd really like everyone to know and commit to memory today is very easy.

因此，今天我真正希望每个人都知道并记住的第一件事非常简单。

GnRH stands for gonadotropin-releasing hormone.

GnRH 代表促性腺激素释放激素。

This comes from the brain and will communicate to the pituitary to release certain hormones.

它来自大脑，会与垂体通讯以释放某些激素。

Prior to puberty, in both males and females, there are neurons in the brain that are actively suppressing the neurons that release GnRH.

在青春期之前，无论男性还是女性，大脑中的神经元都会主动抑制释放 GnRH 的神经元。

It's like no puberty, no puberty, no puberty.

就像没有青春期，没有青春期，没有青春期。

Can't have puberty.

不能进入青春期。

Can't have puberty.

不能进入青春期。

And in fact Those cells are releasing this neurotransmitter called GABA because its inhibitory prevents the firing of those neurons.

事实上，这些细胞正在释放一种名为 GABA 的神经递质，因为它的抑制作用会阻止这些神经元的放电。

Okay, so puberty is actively suppressed up until a certain point.

好吧，青春期在某个时刻之前会被积极抑制。

It's also actively suppressed, at least in some species, and we think at least partially in humans, by the tonic release.

它也被积极地抑制，至少在某些物种中，我们认为至少在人类中，通过补药的释放部分地被抑制。

That means the ongoing release around the clock of a hormone called melatonin.

这意味着一种叫做褪黑激素的激素全天候持续释放。

Later in life, in fact, after puberty, melatonin will be secreted only in the dark phase of each night and around the time that one goes to sleep.

事实上，在生命的后期，即青春期后，褪黑激素只会在每晚的黑暗阶段和入睡前后分泌。

But in children, and in particular in children prior to puberty, melatonin is released more or less constantly.

但对于儿童，尤其是青春期前的儿童，褪黑激素或多或少会持续释放。

Now, melatonin isn't the only source of suppression of puberty.

现在，褪黑激素并不是抑制青春期的唯一来源。

It's also these neural mechanisms involving GABA.

这也是涉及 GABA 的神经机制。

But it is certainly a great candidate for one of the reasons why puberty doesn't generally tend to happen at, say, age four or age five.

但它无疑是一个很好的候选者，因为这就是为什么青春期通常不会发生在四岁或五岁的时候的原因之一。

That would be very unusual.

那将是非常不寻常的。

Another component of suppression of puberty is that typically in children, they have relatively low body fat stores.

抑制青春期的另一个因素是，通常在儿童中，他们的体脂肪储存相对较低。

Why is this important?

为什么这很重要？

Well, we know that one of the things that can trigger the onset of puberty, in particular in females, is that when enough body fat accumulates, that body fat releases a hormone called leptin, and that hormone leptin travels in the bloodstream across the blood-brain barrier and goes to the hypothalamus and can trigger the onset of puberty by activating the neurons that release gonadotropin-releasing hormone.

嗯，我们知道，可以触发青春期开始的因素之一，特别是对于女性来说，是当足够的身体脂肪积累时，身体脂肪会释放一种叫做瘦素的激素，而瘦素激素在血液中穿过血脑屏障，到达下丘脑，并可以通过激活释放促性腺激素释放激素的神经元来触发青春期的开始。

So many people believe that one of the reasons that puberty is happening earlier and earlier in females is because of the accumulation of more body fat at younger ages than was observed 30 or 40, and certainly 100 years ago.

许多人认为，女性青春期越来越早发生的原因之一是，与 30 岁或 40 岁甚至 100 年前相比，年轻时体内积累的脂肪更多。

Now, I can already imagine a number of people are thinking, "Oh, this must relate to the obesity crisis." And indeed, there is a crisis of obesity.

现在，我已经可以想象很多人在想，“哦，这一定与肥胖危机有关。”事实上，存在肥胖危机。

Obesity is something that is causing all sorts of problems with people's health at various levels, brain and body, and that is far more frequent today than it was even 20 years ago.

肥胖会在大脑和身体等各个层面对人们的健康造成各种问题，而且今天的肥胖现象比 20 年前要频繁得多。

So it is indeed a crisis because it has enormous detrimental effects for so many aspects of brain and body health and longevity.

所以这确实是一场危机，因为它对大脑、身体健康和寿命的许多方面都有巨大的有害影响。

But this whole process of thinking about body fat signaling leptin to the hypothalamus and the onset of puberty doesn't necessarily have to do with the obesity crisis.

但是，关于身体脂肪向下丘脑发出瘦素信号以及青春期开始的整个思考过程并不一定与肥胖危机有关。

It might relate, but it could also relate to, for instance, improved nutrition, which is allowing body fat stores to accumulate, maybe not to the level of obesity, but to accumulate earlier and at younger ages in females, which is then causing earlier puberty in females.

这可能有关系，但也可能与营养的改善有关，营养的改善导致体内脂肪储存积累，也许不会达到肥胖的程度，但女性会更早、更年轻地积累脂肪，从而导致女性青春期提前。

To just highlight how that might be possible, I want to review some data that talk about the onset of menses, menstruation, that is puberty, in females according to country and according to age over the last 100 or more years.

为了强调这可能是如何实现的，我想回顾一下过去 100 年或更长时间里根据国家和年龄划分的一些关于女性月经（即青春期）开始的数据。

So what are the general trends in terms of the onset of puberty in females?

那么女性青春期开始的总体趋势是什么呢？

Well, that's an easy one to answer.

嗯，这是一个很容易回答的问题。

Over the last 100 years or so, the onset of puberty has been occurring much earlier with each passing decade.

在过去一百年左右的时间里，青春期的开始时间每过十年就提前得多。

It's really an incredible set of statistics.

这确实是一组令人难以置信的统计数据。

I will provide a link to these data since I know a number of you are listening and not just watching on YouTube.

我将提供这些数据的链接，因为我知道你们中的许多人正在聆听，而不仅仅是在 YouTube 上观看。

This is from a study in which the onset of puberty has been analyzed from as early as the 1850s, right, in certain countries there are data on that, out to the 1970s and in other countries starting at about 1900 extending out to about 1990.

这是来自一项研究，其中早在 1850 年代就对青春期的开始进行了分析，在某些国家，有相关数据，一直到 1970 年代，而在其他国家，则从 1900 年左右开始，一直延伸到 1990 年左右。

These are ongoing collections of data.

这些是持续的数据收集。

But just to give you a sense how the data are falling out in a couple of different countries, just to give you a flavor.

但只是为了让您了解几个不同国家的数据是如何变化的，只是为了让您了解一下。

But for those of you listening and for those of you watching, the essence of all of these findings is that puberty is happening much, much earlier with each passing decade.

但对于你们这些聆听和观看的人来说，所有这些发现的本质是，青春期在过去的十年中发生得越来越早。

So for instance, in the United States, around 1900 or 1903, the average age of menarche, the onset of puberty in females, was about 14 years old, whereas in 1990, the average age is 11.

例如，在美国，1900年或1903年左右，初潮（女性青春期开始）的平均年龄约为14岁，而在1990年，平均年龄为11岁。

So that's a pretty significant, we can say acceleration of the onset of puberty.

所以这是非常重要的，我们可以说青春期的加速。

Now, of course, these are averages, so there will be exceptions.

当然，现在这些都是平均值，所以会有例外。

There's a distribution of data.

有数据分布。

Today still, there will be young females who will undergo puberty at age 11 or 10, or maybe even nine, and others who will undergo puberty at age 13, 14, maybe even 16 or 17.

时至今日，仍然会有年轻女性在 11 岁或 10 岁，甚至可能是 9 岁进入青春期，而其他女性则在 13 岁、14 岁，甚至可能在 16 岁或 17 岁进入青春期。

However, if we look at, for instance, the data from Norway, which dates back quite far, they have excellent record keeping to 1850.

然而，例如，如果我们看一下挪威的数据，其历史可以追溯到很早以前，他们的记录一直保存到 1850 年。

What we see is that the average age of the onset of female puberty in 1850 in Norway was 17 years old, whereas in 1970 it's 13 years old.

我们看到，1850年挪威女性青春期开始的平均年龄是17岁，而1970年是13岁。

So this is a dramatic acceleration of the onset of puberty, and you see a similar trend in other countries as well.

所以这是青春期开始的急剧加速，你在其他国家也看到了类似的趋势。

So if we were to look in, for instance, in the UK, they have a smaller dataset, meaning it only extends back to about 1940, but the average age of the onset of puberty in the UK in 1940 was 13 and a half years old.

因此，如果我们以英国为例，他们的数据集较小，这意味着它只能追溯到 1940 年左右，但 1940 年英国青春期开始的平均年龄是 13 岁半。

Again, this is just for females, and in 1970 it was closer to 13 with a trend towards declining even further.

同样，这仅适用于女性，1970 年该数字接近 13，并且有进一步下降的趋势。

Unfortunately, they didn't continue to collect data out to 2022.

不幸的是，他们没有继续收集 2022 年的数据。

And as a final point, if we were to look at, for instance, in Germany and Finland, the average onset of puberty in 1870 was 16 and a half years old.

最后一点，如果我们以德国和芬兰为例，1870 年青春期的平均开始年龄是 16 岁半。

By 1940, it was down to 13 and a half years old.

到了1940年，年龄降到了13岁半。

So all of these data have borne out over and over again, regardless of location in the world, which is important because when you start to think about the obesity crisis, you could say, well, that's mainly in developed countries, believe it or not, or perhaps not surprisingly, and maybe it has to do with the obesity crisis, and yet I don't think we can conclude that at all.

因此，所有这些数据都一再得到证实，无论在世界哪个地方，这很重要，因为当你开始思考肥胖危机时，你可以说，不管你信不信，这主要发生在发达国家，或者也许并不奇怪，也许它与肥胖危机有关，但我认为我们根本不能得出这样的结论。

Something is happening, however.

然而，有些事情正在发生。

It could be increased body fat stores due to overeating and obesity.

由于暴饮暴食和肥胖，身体脂肪储存可能会增加。

However, it could also be unrelated to obesity.

然而，它也可能与肥胖无关。

It could be, for instance improve nutrition and the availability of quality nutrition, which can signal the maturation of the brain and body mechanisms that trigger the onset of puberty, ovulatory cycle, and menstruation.

例如，它可以改善营养和优质营养的供应，这可以标志着大脑和身体机制的成熟，从而触发青春期、排卵周期和月经的开始。

So we want to be very careful about leaping to conclusions about what these trends mean, but the trends themselves are very, very apparent.

因此，对于这些趋势的含义，我们要非常谨慎地妄下结论，但趋势本身是非常非常明显的。

And as a final point, I should also mention that there are a number of different behavioral and psychosocial, as they're called, interactions that can influence puberty as well.

作为最后一点，我还应该提到，有许多不同的行为和社会心理相互作用也会影响青春期。

This has been most strikingly observed in animals.

这在动物身上观察到最为明显。

And so I don't want anyone to be alarmed or to leap to any great conclusions about the onset of timing of puberty in humans, but I'd be remiss if I didn't tell you about a certain result which shows that if a young female is exposed to the odor, not necessarily the pheromones, right?

因此，我不希望任何人对人类青春期的开始时间感到震惊或仓促得出任何重大结论，但如果我不告诉你某个结果，那就是我的失职，该结果表明，如果年轻女性接触到这种气味，不一定是信息素，对吗？

There's a distinction between odors that we perceive and pheromones which are subconscious, right?

我们感知到的气味和潜意识的信息素之间有区别，对吗？

That we don't actively perceive, but that can impact our biology and pheromone effects in humans are very controversial.

我们不会主动感知，但这会影响我们的生物学和信息素对人类的影响，这是非常有争议的。

But we know, for instance, that if you take a female animal, and there's some evidence from humans that if you take a young pre-pubertal female and you expose her to the scent of a reproductively competent male for a series of days, but maybe even as short as a few hours, and she is also not regularly being exposed to the scent of her father, that she can undergo puberty earlier.

但我们知道，例如，如果你拿一只雌性动物，并且有一些来自人类的证据表明，如果你拿一只年轻的青春期前雌性动物，让她接触有生殖能力的雄性动物的气味几天，但甚至可能短至几个小时，而且她也不会经常接触她父亲的气味，她可以更早进入青春期。

That's right.

这是正确的。

There is something about the odor and/or pheromones or perhaps something else that occurs when a young pre-pubertal female has a father that she's in regular contact with.

当年轻的青春期前女性有一个经常接触的父亲时，会发生一些关于气味和/或信息素的事情，或者可能发生其他事情。

He wouldn't necessarily have to live at home, but that is around a lot, that his smell, excuse me, is registered by her biological systems that, I don't want to say protects because it kind of skews the valence of the conversation, but that offsets or buffers the otherwise observed effect, which is that the scent of a reproductively competent male, if it's present often enough or perhaps intensely enough, that it can trigger the onset of puberty in that female.

他不一定必须住在家里，但这在很多地方都是如此，对不起，他的气味被她的生物系统记录下来，我不想说保护，因为它有点扭曲谈话的效价，但它抵消或缓冲了其他观察到的效果，即具有生殖能力的男性的气味，如果它出现得足够频繁或可能足够强烈，它可以触发该女性青春期的开始。

In other words, the scent of a male that is not the father, and we think also that is not biologically related to her, can trigger earlier onset of puberty, and that effect can at least be partially buffered by her being in the presence of the scent from her biological father.

换句话说，非父亲的男性的气味，而且我们认为与她没有生物学上的关系，可以引发青春期提前到来，而这种影响至少可以通过她在生父的气味存在下得到部分缓冲。

Now, some of you are probably already leaping to conclusions about what this means.

现在，你们中的一些人可能已经对这意味着什么得出了结论。

Should you not allow your daughter to be exposed to any males who are of reproductive age, et cetera?

您是否应该不允许您的女儿接触任何育龄男性等？

That's certainly not what I'm saying.

我当然不是这个意思。

There's a huge number of considerations that go into that calculation for everybody and circumstances, et cetera.

在计算时需要考虑到每个人、每个人的具体情况等等。

But the point is that the odors of individuals, both related, in particular closely related, and non-related individuals, can shape the neural systems and the hormone systems that can trigger the onset of puberty or suppress the onset of puberty.

但关键是，个体的气味，无论是相关的，特别是密切相关的个体，还是非相关的个体，都可以塑造神经系统和激素系统，从而触发青春期的开始或抑制青春期的开始。

So whether or not we're talking about onset of puberty at this age or that age, and whether or not biologically related male or non-biologically related male scents around, et cetera, the thing I want everyone to know is that at some point during development, typically nowadays between the ages of 11 and 15 or so, again, there's variability there, the suppression of gonadotropin-releasing hormone released from the hypothalamus is removed, and then gonadotropin-releasing hormone can activate cells within the pituitary, and if you really want to know, it's the anterior pituitary in particular.

因此，无论我们是否在谈论这个年龄或那个年龄的青春期开始，也无论是否有生物学相关的男性或非生物学相关的男性气味，等等，我想让大家知道的是，在发育过程中的某个时刻，通常是现在的11岁到15岁左右，那里存在着变异，从下丘脑释放的促性腺激素释放激素的抑制被消除，然后促性腺激素释放激素可以激活垂体内的细胞，如果您真的想知道，尤其是垂体前叶。

And then the anterior pituitary gland, which sits at and kind of bridges the brain and the body because it allows the release of hormones into the bloodstream, that anterior pituitary is going to release two key hormones that everyone should know the name of and what they do.

然后是垂体前叶，它位于大脑和身体之间，因为它允许将激素释放到血液中，垂体前叶将释放两种关键激素，每个人都应该知道它们的名称和作用。

And when I say everyone, I mean males and females need to know about these hormones because they have an active role in both males and females, and of course, you should want to know and should know about the biology of everyone on the planet, in my opinion, because it tells you a lot more about humans than if you just focus on your own biology.

当我说每个人时，我的意思是男性和女性需要了解这些激素，因为它们在男性和女性中都发挥着积极的作用，当然，在我看来，你应该想知道并且应该了解地球上每个人的生物学，因为它比你只关注自己的生物学告诉你更多关于人类的信息。

But those two hormones are called luteinizing hormone, which is abbreviated LH, and follicle-stimulating hormone, which is abbreviated FSH, okay?

但这两种激素分别称为黄体生成素（缩写为 LH）和卵泡刺激素（缩写为 FSH），好吗？

So the simple picture that you need to have in your mind is gonadotropin-releasing hormone from the brain, from the hypothalamus in particular, is causing the release of luteinizing hormone and follicle-stimulating hormone.

因此，您需要记住的简单画面是，大脑（特别是下丘脑）的促性腺激素释放激素正在导致黄体生成素和卵泡刺激素的释放。

GnRH stimulates LH, luteinizing hormone, and follicle-stimulating hormone, FSH.

GnRH 刺激 LH、黄体生成素和卵泡刺激素 (FSH)。

LH and FSH travel in the blood and can access all the cells and tissues of the body.

LH 和 FSH 在血液中移动，可以进入身体的所有细胞和组织。

This is one of the incredible things about hormones, is that many hormones, and LH and FSH are included in this group, can travel into cells, and they can actually change the genetic expression of those cells.

这是关于激素的令人难以置信的事情之一，即许多激素（包括 LH 和 FSH）可以进入细胞，并且它们实际上可以改变这些细胞的基因表达。

They can change which genes are turned on and which genes are turned off, and they can also attach to the surface of those cells and make those cells take on different properties.

它们可以改变哪些基因被打开，哪些基因被关闭，它们还可以附着在这些细胞的表面，使这些细胞呈现出不同的特性。

So they can mature those cells.

这样它们就可以使这些细胞成熟。

So for instance, a good example of this outside of the context we've been talking about is the hormone testosterone can travel to the hair follicle and can stimulate changes in the genes of the cells of the hair follicle that can make hair grow.

例如，在我们一直讨论的背景之外，一个很好的例子是激素睾酮可以进入毛囊，并可以刺激毛囊细胞基因的变化，从而使头发生长。

A different hormone, estrogen, can travel to the cells of the breast tissue and activate genes that control enlargement of the cells of the breast tissue.

另一种激素，雌激素，可以进入乳腺组织的细胞并激活控制乳腺组织细胞增大的基因。

Prolactin, a different hormone, can travel to the mammary ducts and control the production and the secretion of milk.

催乳素是一种不同的激素，可以到达乳腺导管并控制乳汁的产生和分泌。

And in males, that can actually happen in certain cases, although it's rare.

对于男性来说，这种情况在某些情况下实际上可能会发生，尽管这种情况很少见。

But prolactin can also travel to areas of the brain that control libido, for instance.

但催乳素也可以到达控制性欲的大脑区域。

And just so you'll never forget it, males', elevated levels of prolactin are actually what set the refractory period after ejaculation and prevent erection for some period of time.

让您永远不会忘记的是，男性催乳素水平升高实际上是在射精后设定不应期并在一段时间内阻止勃起的原因。

So you'll never forget prolactin The point being that different hormones have different effects on different cells, depending on what cells those are, right?

所以你永远不会忘记催乳素 关键是不同的激素对不同的细胞有不同的影响，这取决于这些细胞是什么，对吧？

Estrogen or estradiol is going to have different effects on the breast tissue than it would on skin, although it has effects on both.

雌激素或雌二醇对乳房组织的影响与对皮肤的影响不同，尽管它们对两者都有影响。

Similarly, when LH and FSH, luteinizing hormone and follicle-stimulating hormone, travel in the blood to the gonad, and the gonad is an ovary, it will have a certain set of consequences.

同样，当 LH 和 FSH（黄体生成素和卵泡刺激素）通过血液到达性腺（而性腺是卵巢）时，就会产生一系列的后果。

And when luteinizing hormone and follicle-stimulating hormone travel in the blood to a gonad and that gonad happens to be a testi, then it will have a different set of biological implications.

当黄体生成素和卵泡刺激素在血液中到达性腺，而该性腺恰好是睾丸时，就会产生一系列不同的生物学影响。

So let's focus now on what happens when LH and FSH arrive at the ovary, and let's assume now that we're talking about a female who has already undergone puberty, or perhaps we could even frame this in the context of a female who is about to undergo puberty.

因此，现在让我们关注 LH 和 FSH 到达卵巢时会发生什么，并假设我们正在谈论已经经历青春期的女性，或者我们甚至可以将其置于即将经历青春期的女性的背景下。

FSH and LH are now able to be released because she's undergoing puberty, but the same set of processes essentially would occur for any point from puberty onward until menopause, which is the depletion of that vault, that ovarian reserve of all those immature eggs.

FSH 和 LH 现在能够释放，因为她正在经历青春期，但从青春期开始直到更年期的任何时间点，本质上都会发生同样的一组过程，即穹顶（所有未成熟卵子的卵巢储备）的耗尽。

Okay, so we're now going to talk about ovulation and menstruation, and let's just remember what this is all about.

好的，我们现在要讨论排卵和月经，让我们记住这是什么意思。

This is all about creating the potential for an egg to be fertilized, and that egg needs to have half of the chromosomal pair.

这一切都是为了创造卵子受精的潜力，而卵子需要拥有一半的染色体对。

So no pairs, but it's got to have 23 chromosomes just from mom, and we need to position that egg so that the egg can be met by the sperm, and that sperm can penetrate that egg and donate its 23 individual strands of chromosomes to that egg, so that you can bring together the DNA of dad and the DNA of mom.

所以不是成对的，但它必须有来自妈妈的 23 条染色体，我们需要定位卵子，以便精子能够遇到卵子，精子可以穿透卵子并将其 23 条染色体捐献给卵子，这样你就可以将爸爸的 DNA 和妈妈的 DNA 结合在一起。

So the ovulatory and menstrual cycle occurs when luteinizing hormone and follicle-stimulating hormone have been released.

因此，当黄体生成素和卵泡刺激素释放时，就会出现排卵和月经周期。

And the ovulatory/menstrual cycle, and here I have to kind of pick what I want to call it.

还有排卵/月经周期，在这里我必须选择我想要的名称。

I guess to be really accurate, we would just call it the female reproductive cycle, but that includes underneath it, but the menstrual cycle, as it's sometimes called, and the ovulatory cycle.

我想准确地说，我们只是将其称为女性生殖周期，但这包括它下面的月经周期（有时称为月经周期）和排卵周期。

So you decide.

所以你决定。

I'm going to interchangeably discuss the ovulatory cycle and the menstrual cycle.

我将交替讨论排卵周期和月经周期。

The problem is when you say menstruation, people often think about just the period, the shedding of the uterine lining when fertilization has not occurred.

问题是，当你说月经时，人们常常想到的只是月经期，即受精尚未发生时子宫内膜脱落的情况。

So if I start saying ovulatory cycle, just keep in mind I'm referring to the entire thing.

因此，如果我开始说排卵周期，请记住我指的是整个事情。

Now, this is probably also a good opportunity to say that if you heard that the ovulatory/menstrual cycle is 28 days long, that's true in some cases, but that's not always true.

现在，这可能也是一个很好的机会来说明，如果您听说排卵/月经周期是 28 天，那么在某些情况下确实如此，但并非总是如此。

It's on average 28 days long.

平均长达28天。

There are some females for which the ovulatory cycle will be shorter, it can be as short as 21 days, and other females for which it will be 35 days long.

有些女性的排卵周期较短，可能短至 21 天，而另一些女性则长达 35 天。

Shorter than 21 days and longer than 35 days is rare, although it does occur.

短于 21 天和长于 35 天的情况很少见，但确实会发生。

One of the key things when thinking about fertility is if you talk to OBGYNs who are focused on fertility, which I have in anticipation of this episode, they'll tell you that whether or not your cycle is 21 days long or 35 days long is not as much of an issue necessarily, unless it's happening to become much shorter or much longer in a kind of erratic way.

在考虑生育能力时，关键的事情之一是，如果你与关注生育能力的妇产科医生交谈，他们会告诉你，你的周期是 21 天还是 35 天，不一定是一个大问题，除非它以一种不稳定的方式变得更短或更长。

So if you're somebody who's consistently had 23-day long cycles and all of a sudden you're having 30-day long cycles, that's not necessarily an indication of anything bad.

因此，如果您一直有 23 天长的周期，突然之间却有 30 天长的周期，这并不一定是有什么不好的迹象。

But if it's 21 days one month and it's 30 days the next month and then it's 17 days the next month, or even if it's always falling within that 21 to 35-day long cycle, but it's very variable from each month or every other month or so, you probably want to talk to your OBGYN because that could indicate a number of different things.

但如果一个月是 21 天，下个月是 30 天，然后下个月是 17 天，或者即使它总是在 21 到 35 天的长周期内，但每个月或每隔一个月左右都有很大变化，您可能需要与您的妇产科医生交谈，因为这可能表明许多不同的事情。

Which things could it indicate?

它能表明哪些事情？

Well, that will become clear as I spell out the biology in a bit more detail.

好吧，当我更详细地阐述生物学原理时，这一点就会变得清楚。

Okay?

好的？

But this idea that the menstrual cycle, ovulatory cycle is always 28 days, that's just false.

但这种认为月经周期、排卵周期总是28天的想法，那是错误的。

That's just not true.

那不是真的。

I should also mention that there is a common misconception that because the average menstrual cycle is 28 days, indeed the average is 28 days, and the lunar cycle is 28 days, and of course, there is real biology to support the fact that the lunar cycle can in fact impact certain aspects of human behavior.

我还应该提到的是，有一个常见的误解，因为平均月经周期是 28 天，实际上平均值是 28 天，月球周期是 28 天，当然，有真正的生物学支持这一事实，即月球周期实际上可以影响人类行为的某些方面。

It does, and we'll talk about lunar cycles in a future episode.

确实如此，我们将在以后的剧集中讨论月球周期。

But there is zero data to support the idea that the menstrual cycle and the lunar cycle are linked in any kind of causal way.

但没有任何数据支持月经周期和月球周期以任何因果方式联系在一起的观点。

I'm sorry to break it to you, the lunar cycle and the tidal cycles at the ocean are definitely linked in ways that are super interesting, related to the tilt of the Earth and the pull of gravity of different planets, and it's an incredible story unto itself.

我很抱歉地告诉你，月球周期和海洋潮汐周期肯定以非常有趣的方式联系在一起，与地球的倾斜和不同行星的引力有关，这本身就是一个令人难以置信的故事。

But the lunar cycle and the menstrual cycle, despite having some weak correlation in terms of their duration or their so-called periodicity, no pun intended, well, there's no causal relationship whatsoever between the lunar cycle and the menstrual cycle.

但是月球周期和月经周期，尽管在持续时间或所谓的周期性方面有一些微弱的相关性，但没有双关语的意思，嗯，月球周期和月经周期之间没有任何因果关系。

If any of you are aware of any real data that conflict with what I just said, please put that in the comment section on YouTube.

如果你们知道任何与我刚才所说的内容相冲突的真实数据，请在 YouTube 的评论部分中提出。

But this is pretty well established as far as I know.

但据我所知，这是相当确定的。

Okay.

好的。

So we need to bring together the so-called haploid contents, the 23 individual strands of chromosomes from the egg, to a place in a position where it could potentially be fertilized by the male.

因此，我们需要将所谓的单倍体内容物（即来自卵子的 23 条染色体链）汇集到一个可能由雄性受精的位置。

So what happens?

那么会发生什么呢？

Luteinizing hormone and follicle-stimulating hormone travel to the ovary.

黄体生成素和卵泡刺激素进入卵巢。

These hormones are able to access the ovary.

这些激素能够进入卵巢。

There's a lot of blood supply to the ovary.

卵巢有大量的血液供应。

And FSH and LH arrive at the ovary.

FSH 和 LH 到达卵巢。

The ovary has this vault, this ovarian reserve of immature cells.

卵巢有这个穹窿，即卵巢储备的未成熟细胞。

They reside within what are called follicles.

它们存在于所谓的毛囊内。

The follicles are little spherical packages that can potentially provide a nice environment for those eggs to mature.

卵泡是小的球形包裹，可以为这些卵子的成熟提供良好的环境。

And when FSH in particular arrives at the ovary, a small number of those follicles will split off from the reserve They will exit the vault, and they will undergo maturation.

当 FSH 特别到达卵巢时，一小部分卵泡将从储备中分离出来，它们将离开保险库，并经历成熟。

And the key player here is follicle-stimulating hormone.

这里的关键角色是卵泡刺激激素。

And the first 14 days of the menstrual ovulatory cycle is referred to as the follicular phase because of this relationship between FSH triggering the maturation of a subset of follicles.

由于 FSH 触发卵泡子集成熟之间的这种关系，月经排卵周期的前 14 天被称为卵泡期。

Now, typically, in the context of a 28-day or so ovulatory menstrual cycle, day one is designated as the first day of the period of the shedding of the uterine lining from the previous ovulatory menstrual cycle in which fertilization did not occur.

现在，通常在 28 天左右的排卵月经周期中，第一天被指定为未发生受精的前一个排卵月经周期子宫内膜脱落时期的第一天。

Okay?

好的？

So day one is when the period initiates.

所以第一天是经期开始的时候。

It is days one through 14 approximately, right?

大约是第一天到第十四天，对吧？

Because here we're just considering the average of a 28-day cycle, but it could be longer, it could be shorter.

因为这里我们只考虑 28 天周期的平均值，但它可能更长，也可能更短。

But the first half of that cycle is the so-called follicular phase.

但该周期的前半部分是所谓的卵泡期。

FSH has triggered the departure of a subset of these follicles that contain immature eggs, and it is triggering the maturation of those eggs.

FSH 引发了这些含有未成熟卵子的卵泡子集的离开，并引发了这些卵子的成熟。

Luteinizing hormone is also present, but also at relatively low levels.

黄体生成素也存在，但水平相对较低。

And it's during the first half of this ovulatory menstrual cycle that the main goal is to get those follicles to mature.

在排卵月经周期的前半段，主要目标是让这些卵泡成熟。

So inside of those follicles, the egg is developing, it's growing, it's maturing.

因此，在这些卵泡内部，卵子正在发育、生长、成熟。

And in doing so, it's also making its own hormones.

在这样做的过程中，它也在制造自己的激素。

This, I think, is one of the most elegant aspects of the ovulatory menstrual cycle, that in a few minutes you'll learn about something which still to this day, even though I've known about this stuff for decades now because of my training, still just blows my mind that you have one hormone, follicle-stimulating hormone, triggering the maturation of some eggs inside of some follicles, and then those follicles themselves making another hormone that furthers the process, and then soon, as you'll learn, create a hormone to trigger the second half of the process.

我认为，这是排卵月经周期中最优雅的方面之一，几分钟后你就会了解到一些至今仍然存在的东西，尽管由于我的训练，我已经了解这些东西几十年了，但仍然让我震惊的是，你有一种激素，卵泡刺激激素，触发一些卵泡内的一些卵子的成熟，然后这些卵泡本身会产生另一种激素，进一步促进这一过程，然后很快，你就会明白学习，创造一种激素来触发该过程的后半部分。

Just a beautiful symphony of expression of different genes and different hormones to make everything work as optimally as possible.

这只是不同基因和不同激素表达的美妙交响曲，使一切尽可能最佳地运转。

So as these different follicles mature, somehow, and we still don't know exactly how, one of those follicles containing an egg gets selected.

因此，当这些不同的卵泡成熟时，我们仍然不知道到底是如何成熟的，其中一个含有卵子的卵泡就会被选中。

It's either because it matures the fastest or there's something about it that is still not completely understood that allows it to be selected and all the other follicles that are maturing degenerate and die.

要么是因为它成熟得最快，要么是因为它有一些尚未完全了解的东西，使得它能够被选择，而所有其他正在成熟的卵泡都会退化并死亡。

And they're gone.

他们走了。

They don't go back into the ovarian reserve.

它们不会回到卵巢储备。

They are now depleted from that bank account that is the ovarian reserve.

现在，她们的卵巢储备银行账户已经耗尽。

They die off, but that single egg that, keep in mind, contains 23 pairs of chromosomes, right?

它们会死去，但请记住，那个卵子包含 23 对染色体，对吧？

We haven't gotten rid of one half of those 23 sets of chromosomes yet.

我们还没有去掉这 23 组染色体中的一半。

But that one will continue to mature.

但那个人将继续成熟。

And then at some point, that egg will start to undergo a process in which those chromosomes are pulled apart by little components within the egg called spindles.

然后在某个时刻，卵子将开始经历一个过程，其中这些染色体被卵子内称为纺锤体的小成分拉开。

They literally have a physical pulling of the chromosomes apart.

它们实际上是通过物理方式将染色体拉开的。

So now those 23 pairs are no longer attached to one another at the middle like they were before, like two beads of strings, or I should say 23 short strands of beads that were at once connected to one another now are pulled apart so that you have 23 chromosomes on each side, but they're pulled apart from one another.

所以现在这 23 对不再像以前那样在中间相互连接，就像两串珠子一样，或者我应该说，23 条短串的珠子曾经相互连接，现在被拉开，这样每一侧都有 23 条染色体，但它们被彼此拉开。

Right?

正确的？

So that diploid cell is now starting to become a cell in which half of the chromosomes, half of those 23 pairs, are physically pulled away from the others.

因此，二倍体细胞现在开始变成其中一半染色体（这 23 对染色体中的一半）在物理上与其他染色体分离的细胞。

And then the egg actually starts to form its own, what we call an involution, a membrane around those 23 pairs, one set of them, and encapsulates them.

然后，鸡蛋实际上开始形成自己的，我们称之为内卷，即围绕着 23 对（其中一组）的膜，并将它们封装起来。

So you've sort of got an egg with two parts, where the two sets of chromosomes, two sets of 23 chromosomes, are now separate from one another inside of the egg.

所以你得到了一个由两部分组成的卵子，其中两组染色体，两组 23 条染色体，现在在卵子内部彼此分离。

And then one of those actually gets ejected from the egg.

然后其中一个实际上从鸡蛋中弹出。

And the name of that thing that gets ejected, it's sort of like the little Hubble pod is how I imagine it from Star Wars or from any kind of space odyssey movie where something is ready to happen, the little Hubble pod shoots out of the ship.

那个被弹出的东西的名字，有点像小哈勃吊舱，就像我从《星球大战》或任何类型的太空漫游电影中想象的那样，在某些事情即将发生时，小哈勃吊舱从飞船中射出。

Well, that 23 pairs is now ejected from the egg.

好吧，那 23 对现在已经从蛋中弹出了。

It's called the polar body, and that's going to degenerate.

它被称为极体，它会退化。

It's going to go away.

它会消失的。

And in doing so, take the egg cell, which was once diploid, it had 23 pairs of chromosomes, and making it haploid.

在此过程中，将曾经是二倍体、有 23 对染色体的卵细胞变成单倍体。

And now what you've got in ideal circumstances is a beautifully pristine egg that was selected for and has 23 single strands of chromosomes, 22 autosomes and one sex chromosome.

现在，在理想的情况下，您得到的是一颗经过精心挑选的美丽的原始卵子，它具有 23 条单链染色体、22 条常染色体和一条性染色体。

And that sex chromosome is going to be an X chromosome almost with certainty because female mother is creating that egg.

几乎可以肯定，该性染色体将是 X 染色体，因为女性母亲正在创造该卵子。

So then the egg that contains just the appropriate 23 single-stranded chromosomes is going to fuse with the wall of the ovary, and that egg will be released and will travel into the fallopian tube.

因此，含有适当 23 条单链染色体的卵子将与卵巢壁融合，卵子将被释放并进入输卵管。

Now, we'll get back to that egg in a few moments, but that process, which represents the first half of the ovulatory menstrual cycle, again, was triggered by FSH and to some extent luteinizing hormone.

现在，我们稍后会回到那个卵子，但是这个代表排卵月经周期前半段的过程再次是由 FSH 和某种程度上的黄体生成素触发的。

But it is the ongoing maturation of that egg which also causes the production of estrogen, which allows that whole process to occur.

但卵子的持续成熟也会导致雌激素的产生，从而使整个过程发生。

And you could say, why?

你可能会说，为什么？

Well, the answer to the why is a very important biological principle that we are going to return to in a number of different contexts today, both as reference to female and male fertility.

好吧，为什么这个问题的答案是一个非常重要的生物学原理，我们今天将在许多不同的背景下回到它，作为女性和男性生育力的参考。

And the principle is a so-called negative feedback.

而其原理就是所谓的负反馈。

So when estrogen is present at relatively low levels in females in the ovary as it is during the development of these eggs, some of that estrogen, of course, is going to exit the ovary, it's going to go into the bloodstream, and it's going to travel back to the pituitary.

因此，当女性卵巢中的雌激素水平相对较低时，就像在这些卵子的发育过程中一样，一些雌激素当然会离开卵巢，进入血液，然后返回垂体。

Now, the pituitary can release things like follicle-stimulating hormone and luteinizing hormone.

现在，垂体可以释放促卵泡激素和黄体生成素等物质。

But the way I'd like you to think about the pituitary for sake of feedback loops is that it's sort of like a thermometer that you would put into a pool, like a backyard pool, that is attached to the heater.

但我希望您为了反馈循环而考虑垂体，它有点像温度计，您可以将其放入连接到加热器的游泳池（例如后院游泳池）中。

And for instance, if you were to put a thermometer into a pool that you would like to keep at 70 degrees, and the temperature of that pool is 60 degrees, well, then that thermometer ought to trigger some sort of mechanism where the pool would heat up until the temperature of the pool hits 70 degrees, and then it should trigger that thermometer to turn off the heating system.

例如，如果你将一个温度计放入一个你想要保持在 70 度的水池中，而该水池的温度是 60 度，那么该温度计应该触发某种机制，使水池升温，直到水池的温度达到 70 度，然后它应该触发该温度计关闭加热系统。

Okay?

好的？

That's going to have a negative feedback system that would keep the temperature more or less correct.

这将有一个负反馈系统，可以或多或少地保持温度正确。

That's a lot of the way that the system's related to estrogen and also testosterone and these different things like luteinizing hormone and follicle-stimulating hormone work as well.

该系统与雌激素和睾酮以及黄体生成素和卵泡刺激素等不同物质的作用有很大关系。

Typically, when the level of a hormone is too high, then it shuts down the production of the hormones that would trigger further production of that hormone.

通常，当激素水平过高时，它就会停止产生会触发该激素进一步产生的激素。

I know that's a mouthful, it's a lot to think about, and some of you are probably thinking, "Whoa, I'm getting dizzy now with biology," but I promise you can understand this.

我知道这很拗口，需要考虑很多东西，你们中的一些人可能会想，“哇，我现在对生物学感到头晕了”，但我保证你们能理解这一点。

In females, when estrogen is relatively low, but not zero, but is relatively low during that first follicular half of the ovulatory cycle, it actually triggers negative feedback on LH and FSH so that not too much is produced.

在女性中，当雌激素相对较低但不是零时，而是在排卵周期的前半个卵泡期间相对较低，它实际上会触发 LH 和 FSH 的负反馈，从而不会产生太多。

But then just prior to ovulation, the levels of estrogen and the levels of some other hormones from those eggs, right, you have the eggs producing estrogen themselves, gets high enough that it actually triggers a positive feedback loop on the pituitary.

但就在排卵之前，这些卵子中的雌激素和其他一些激素的水平，对，卵子本身会产生雌激素，变得足够高，实际上会触发垂体的正反馈循环。

So the pituitary is essentially observing the amount of estrogen in the bloodstream produced by the ovary, and the amount of estrogen towards the end of the second half of the menstrual cycle has increased and triggers a positive feedback loop.

因此，垂体本质上是在观察卵巢产生的血液中雌激素的含量，并且在月经周期后半段结束时雌激素的含量增加并触发正反馈循环。

It triggers the pituitary to release more FSH and LH, and that helps trigger ovulation.

它会触发垂体释放更多 FSH 和 LH，从而有助于触发排卵。

Okay?

好的？

That deployment or the release of that one mature proper selected egg that's haploid with the 23 individual pairs of chromosomes into the fallopian tube.

将一个成熟的、正确选择的卵子部署或释放到输卵管中，该卵子是单倍体，具有 23 对单独的染色体。

So let's just back up really quickly and just kind of summarize what's happened.

因此，让我们快速备份并总结一下发生的事情。

Gonadotropin-releasing hormone from the hypothalamus triggers the release of follicle-stimulating hormone and luteinizing hormone.

下丘脑的促性腺激素释放激素触发促卵泡激素和黄体生成素的释放。

That travels to the ovary, triggers the release of a subset of immature follicles with immature eggs.

它传播到卵巢，触发释放含有未成熟卵子的未成熟卵泡子集。

Those immature follicles and immature eggs start to mature, start to grow because of the presence of follicle-stimulating hormone.

那些未成熟的卵泡和未成熟的卵子开始成熟，由于卵泡刺激激素的存在而开始生长。

The growth of those eggs themselves increases estrogen.

这些卵子本身的生长会增加雌激素。

As the estrogen starts to accumulate in the environment, some of that travels back to the pituitary, and when levels of estrogen arriving at the pituitary are relatively low, the pituitary says, "Oh, we don't need to release any more follicle-stimulating and luteinizing hormone."

当雌激素开始在环境中积聚时，其中一些会返回垂体，当到达垂体的雌激素水平相对较低时，垂体就会说：“哦，我们不需要释放更多的卵泡刺激素和黄体生成素。”

However, at some point, just prior to ovulation, enough estrogen has been produced by that one single selected mature egg and some of the other follicles around it that were maturing, but then since died off, that the estrogen triggers a positive feedback loop.

然而，在某个时刻，就在排卵之前，一个选定的成熟卵子及其周围正在成熟的其他一些卵泡已经产生了足够的雌激素，但随后死亡，雌激素触发了正反馈循环。

The pituitary says okay, and releases more follicle-stimulating hormone and luteinizing hormone, and bam, the egg, which has the proper genetic components, sets off out of the ovary and into the fallopian tube.

垂体说好，并释放更多的卵泡刺激素和黄体生成素，然后砰的一声，具有适当遗传成分的卵子从卵巢出发进入输卵管。

So-called ovulation has begun.

所谓的排卵已经开始。

Okay?

好的？

That itself, what I just described, constitutes the first half of the ovulatory menstrual cycle, which we call the follicular phase.

我刚才所描述的，它本身构成了排卵月经周期的前半部分，我们称之为卵泡期。

And it's marked by the presence of FSH and some other things, but we can really think about it as marked by FSH from the pituitary and by estrogen or estradiol made within the ovary.

它以 FSH 和其他一些物质的存在为标志，但我们实际上可以将其视为以来自垂体的 FSH 和卵巢内产生的雌激素或雌二醇为标志。

Okay, then comes the second half of the ovulatory menstrual cycle, which I personally think is one of the coolest mechanisms in all of biology.

好吧，接下来是排卵月经周期的后半段，我个人认为这是所有生物学中最酷的机制之一。

Which is that remember the follicle that housed that one egg that was the selected egg that became the mature egg?

还记得哪个卵泡中含有一个卵子，即成为成熟卵子的选定卵子吗？

And that follicle, which no longer contains the egg because the egg took off and ovulated, is called the corpus luteum.

由于卵子脱落并排卵，卵泡不再含有卵子，它被称为黄体。

And the corpus luteum starts making three hormones, which include estradiol, a thing called inhibin, but the most important hormone, the one that you really need to know about, is that it starts producing very high levels of progesterone.

黄体开始产生三种激素，其中包括雌二醇，一种称为抑制素的物质，但最重要的激素，也是您真正需要了解的激素，是它开始产生非常高水平的黄体酮。

Progesterone levels start to increase about the time of ovulation, although just prior to ovulation.

黄体酮水平在排卵时开始增加，尽管是在排卵之前。

And over the next second half of the ovulatory cycle, so about 14 days if it's a 28-day cycle, a little bit longer, a little bit shorter, depending on the length of the cycle, levels of progesterone in the second half of the ovulatory cycle are going to increase by 1,400 fold compared to what they were in the first half of the ovulatory cycle.

在排卵周期的后半段，如果是 28 天的周期，大约是 14 天，稍微长一点，短一点，具体取决于周期的长度，排卵周期后半段的黄体酮水平将比排卵周期前半段增加 1,400 倍。

So again, if we were to characterize the menstrual ovulatory cycle in broad strokes, what we would say is that FSH and estrogen mark the initial part, the first half, so-called follicular phase, and that the estrogen and FSH set in motion ovulation, and they prime the system for the production of a corpus luteum, which produces progesterone, and the second half of all of this is called the luteal phase.

因此，如果我们要大体上描述月经排卵周期，我们会说 FSH 和雌激素标志着初始部分，即前半部分，即所谓的卵泡期，雌激素和 FSH 启动排卵，它们为黄体的产生系统做好准备，黄体产生黄体酮，所有这一切的后半部分称为黄体期。

The second half of the ovulatory menstrual cycle is the luteal phase because of corpus luteum, this otherwise discarded tissue that produces progesterone.

排卵月经周期的后半段是黄体期，因为有黄体，这种原本被丢弃的组织会产生黄体酮。

What does progesterone do?

黄体酮有什么作用？

Well, progesterone impacts the uterine lining, the so-called endometrium, or the lining, the mucus lining of the uterus, where that egg that's ovulated is potentially going to implant if it's fertilized.

黄体酮会影响子宫内膜，即所谓的子宫内膜，或子宫内膜，即子宫的粘液内层，排卵的卵子如果受精，可能会植入子宫内膜。

And so in a kind of perfect way, or I should say in a seemingly perfect way, the egg is off on its way.

因此，以一种完美的方式，或者我应该说，以一种看似完美的方式，鸡蛋已经上路了。

It might get fertilized.

它可能会受精。

The remnants of the compartment that let go of that egg produce a hormone that then prepares the endometrial lining of the uterus for the potential implantation of that egg.

释放卵子的隔室残余物会产生一种激素，然后为子宫内膜为卵子的潜在植入做好准备。

It's basically making the bed for the fertilized egg to potentially embed in, to implant in, and then achieve all the nourishment that it needs to grow eventually into a healthy embryo and child.

它基本上是为受精卵植入、植入并获得最终成长为健康胚胎和儿童所需的所有营养奠定了基础。

Just an amazing set of biological mechanisms, if you ask me, because what you're observing here is an incredible economy of function, whereby the same cellular components that are producing the egg Well, some of them are being discarded, but they're not being discarded without purpose.

如果你问我的话，这只是一组令人惊奇的生物机制，因为你在这里观察到的是令人难以置信的功能经济，其中产生卵子的相同细胞成分嗯，其中一些被丢弃，但它们不会被无目的地丢弃。

They're being discarded in a way that triggers the onset of hormonal expression that then prepares the fertilized egg to be in an enriched environment in which it can thrive.

它们被丢弃的方式会触发荷尔蒙表达，然后让受精卵准备在一个可以茁壮成长的丰富环境中。

Now, I realize that was a lot of detail, but we have a couple of key themes.

现在，我意识到这涉及很多细节，但我们有几个关键主题。

We've got the hypothalamus, GnRH.

我们有下丘脑，GnRH。

We've got the pituitary with LH and FSH, and those hormones travel to the ovary.

我们的垂体含有 LH 和 FSH，这些激素会传送到卵巢。

The ovary has eggs in a vault, basically immature eggs in a vault.

卵巢的穹窿内有卵子，基本上是未成熟的卵子。

Some of those are activated by the presence of FSH and LH each month, and one of those eggs will be selected and will ovulate.

其中一些卵子每月会因 FSH 和 LH 的存在而被激活，其中一个卵子将被选择并排卵。

The remnants of the follicle and egg that are not selected, the chromosomes that you don't need disappear in the polar body, and the corpus luteum gives rise to progesterone and sets in motion the second half of the ovulatory menstrual cycle, which is the luteal phase, which is essentially the potential for that fertilized egg to embed in a nice nourishing environment.

未被选择的卵泡和卵子的残余物、不需要的染色体在极体中消失，黄体产生黄体酮并启动排卵月经周期的后半段，即黄体期，这本质上是受精卵嵌入良好滋养环境的潜力。

And of course, we should all be thinking if the egg is fertilized and then it lays down in the nice comfy uterine lining that's been prepared by progesterone in the corpus luteum, well then everything's fine and good.

当然，我们都应该考虑，如果卵子受精，然后它落在由黄体中的黄体酮准备的舒适的子宫内膜中，那么一切都会好起来的。

But what if fertilization doesn't occur?

但如果没有受精怎么办？

Well, we all know what happens if fertilization doesn't occur.

好吧，我们都知道如果不发生受精会发生什么。

If fertilization does not occur for whatever reason, that uterine lining is going to shed, and that's actually what's referred to as the period.

如果由于某种原因没有受精，子宫内膜就会脱落，这就是所谓的经期。

It's the actual removal or the departure rather of the thickened endometrium lining of the uterus when fertilization has not occurred.

这是在受精尚未发生时，子宫内膜的实际去除或离开，而不是增厚的子宫内膜。

And of course, if that happens, we need another ovulatory menstrual cycle.

当然，如果发生这种情况，我们需要另一个排卵月经周期。

So how does that happen?

那么这是怎么发生的呢？

Well, the hormone inhibin is also made by the corpus luteum and doesn't go quite as high as the hormone progesterone, but it kind of tracks that increase in progesterone that occurs in the second half of the ovulatory cycle.

嗯，激素抑制素也是由黄体产生的，并且不会像激素黄体酮那么高，但它在某种程度上跟踪排卵周期后半段发生的黄体酮的增加。

But then if fertilization does not occur, inhibin levels start to drop.

但如果不发生受精，抑制素水平就会开始下降。

And what I haven't told you is what inhibin does.

我没有告诉你的是抑制素的作用。

Inhibin, in concert with other hormones like estrogen, feed back to the hypothalamus and prevent the further release of follicle-stimulating hormone and luteinizing hormone.

抑制素与雌激素等其他激素协同作用，反馈至下丘脑并阻止卵泡刺激素和黄体生成素的进一步释放。

Right?

正确的？

If you have an egg that gets fertilized and can implant, well then you don't want more eggs to mature, right?

如果您有一个受精并可以着床的卵子，那么您不希望有更多的卵子成熟，对吧？

You want to hold on to the ones in the vault.

你想保留金库里的东西。

You don't want them to mature.

你不希望他们成熟。

And hormones like inhibin and again, working with other hormones, are going to prevent the secretion of things like FSH and LH.

抑制素等激素与其他激素一起作用，会阻止 FSH 和 LH 等物质的分泌。

Now, typically people are not getting pregnant every month.

现在，人们通常不会每个月都会怀孕。

In fact, that's not possible, and part of the reason it's not possible is that if the fertilized egg implants, there are a number of different hormone cascades that shut down the production of things like GnRH, FSH, and LH in ways that prevent further maturation of follicles in a follicular phase.

事实上，这是不可能的，部分原因是，如果受精卵着床，有许多不同的激素级联反应会关闭 GnRH、FSH 和 LH 等物质的产生，从而阻止卵泡在卵泡期进一步成熟。

But in the instance where fertilization does occur and menstruation occurs, and I should mention that the duration of menstruation, the actual bleeding, typically is anywhere from one to five days.

但在确实发生受精和月经的情况下，我应该提到月经的持续时间，即实际的出血，通常是一到五天。

The quote, unquote "heaviness," the lightness or heaviness of that bleeding will depend on, you guessed it, the amount of progesterone that is secreted from the corpus luteum.

引用，不引用“沉重”，出血的轻重将取决于，你猜对了，黄体分泌的黄体酮的量。

That's one of the key players there.

这是那里的关键人物之一。

And if menstruation occurs, well then inhibin levels also drop, progesterone levels also drop, and when that occurs, there's a positive feedback signal up at the level of the pituitary.

如果月经来了，那么抑制素水平也会下降，黄体酮水平也会下降，当这种情况发生时，垂体水平会出现一个正反馈信号。

The pituitary literally can register how much inhibin and progesterone and estrogen is present in the bloodstream, and if those levels are sufficiently low, well then GnRH gets secreted again, FSH gets secreted again, and LH gets secreted again, and the first half, the follicular phase of the menstrual cycle initiates all over again.

垂体确实可以记录血液中存在多少抑制素、黄体酮和雌激素，如果这些水平足够低，那么 GnRH 会再次分泌，FSH 会再次分泌，LH 会再次分泌，而月经周期的前半部分，即卵泡期会重新开始。

It's hard to overstate how beautifully orchestrated this entire system is, the number of feedback loops and feedforward loops.

很难夸大整个系统的精心编排、反馈循环和前馈循环的数量。

I think if you can just generally understand that the first half of the menstrual ovulatory cycle is marked by the maturation of the follicles in FSH, and that the second half is marked by the accumulation of progesterone and the thickening of the uterine lining should fertilization and implantation occur, I think that you will certainly understand the female reproductive cycle better than most people out there.

我想如果你能大致理解月经排卵周期的前半段以FSH中卵泡的成熟为标志，后半段以黄体酮的积累和子宫内膜增厚为标志（如果受精和着床发生），我想你肯定会比大多数人更了解女性生殖周期。

It will also help you understand a number of things that are sometimes associated with the female reproductive cycle.

它还将帮助您了解一些有时与女性生殖周期相关的事情。

For instance, there are data showing that in many, not all, but in many women, in the four to five days prior to ovulation, there is a dramatic increase in libido.

例如，有数据显示，在许多（不是全部）但在许多女性中，在排卵前的四到五天内，性欲急剧增加。

That dramatic increase in libido is triggered by a number of things, but some of those things include the spike in FSH that occurs, the spike in LH that occurs, and some associated increases in androgens.

性欲的急剧增加是由多种因素引发的，其中包括 FSH 的峰值、LH 的峰值以及相关的雄激素增加。

Things like DHEA and testosterone, which just as in males can be related to libido in females trigger libido.

脱氢表雄酮 (DHEA) 和睾丸激素等物质与男性的性欲有关，会触发女性的性欲。

You can imagine why this would be an effective mechanism to have in place in females if the goal, as it were, certainly of the egg perhaps not of the woman as a whole, but if the goal is to fertilize the egg.

你可以想象为什么这将是女性身上的一种有效机制，如果目标，可以说，当然是卵子，也许不是整个女性，但目标是让卵子受精。

So increases in libido just prior to the onset of ovulation.

因此，在排卵前，性欲会增加。

There's also been a lot of discussion and interest, and frankly, data exploring the malaise that can occur at certain portions of the menstrual cycle, and there's a lot of misconception about this.

还有很多讨论和兴趣，坦率地说，数据探索了月经周期某些部分可能发生的不适，对此存在很多误解。

A lot of people have focused on the malaise that can occur around the time of bleeding, but there are actually stronger data to support the fact that some, again, some not all women experience a kind of malaise sometimes associated with anxiety, sometimes not, that's associated with the mid to second half of the luteal phase of the ovulatory menstrual cycle.

很多人都关注出血期间可能出现的不适，但实际上有更有力的数据支持这样一个事实：有些女性会经历一种不适，有时与焦虑有关，有时则不然，这种不适与排卵月经周期黄体期的中后期有关。

And that, despite what people commonly think, is not associated with elevated levels of estrogen.

尽管人们普遍认为，这与雌激素水平升高无关。

It's actually associated with the depletion in estrogen levels that can occur during certain portions of that second half of the luteal phase of the menstrual cycle.

它实际上与月经周期黄体期后半段某些部分发生的雌激素水平下降有关。

So, again, this is highly variable.

因此，这也是高度可变的。

For some people, they might not experience any malaise at any point during their menstrual cycle Other individuals also, for instance, might not experience any variation in their libido at any point during their menstrual cycle.

对于某些人来说，他们可能在月经周期的任何时候都不会经历任何不适。例如，其他人也可能在月经周期的任何时候都不会经历性欲的任何变化。

Again, highly variable, and yet there are some statistically significant trends that have been observed that track to very specific hormonal components within the menstrual cycle.

同样，变化很大，但观察到一些统计上显着的趋势，可追踪月经周期内非常特定的激素成分。

Again, this will all be very contextual, and of course, this can play out in a number of different ways.

再说一次，这一切都将是非常相关的，当然，这可以通过多种不同的方式发挥作用。

So for instance, some women experience very heightened levels of sensitivity to caffeine at certain portions of their menstrual cycle.

例如，一些女性在月经周期的某些阶段对咖啡因的敏感性非常高。

Other women experience more cramping than others at different portions of their menstrual cycle.

其他女性在月经周期的不同阶段会比其他女性经历更多的痉挛。

Tremendous variation from individual to individual.

个体与个体之间存在巨大差异。

I view it as an advantage, but one of the things that many females can really do and experience because they have cycles that occur every month that are fairly dramatic in terms of their levels of hormones.

我认为这是一个优势，但这是许多女性真正可以做和经历的事情之一，因为她们每个月都会有一个周期，就她们的荷尔蒙水平而言，这是相当戏剧性的。

So for instance, a more than thousandfold increase in progesterone during the luteal phase of the menstrual cycle, and I should also mention a 200-fold increase in estrogen during the period just prior to ovulation.

例如，在月经周期的黄体期，黄体酮增加了千倍以上，我还应该提到在排卵前一段时间，雌激素增加了 200 倍。

That's why they always say estrogen primes progesterone.

这就是为什么他们总是说雌激素启动孕激素。

That's what you learn in kind of basic endocrinology when you're learning the menstrual cycle.

这就是您在学习月经周期时从基础内分泌学中学到的内容。

Estrogen in the first half of the menstrual cycle primes progesterone in the second half of the ovulatory menstrual cycle.

月经周期前半段的雌激素在排卵月经周期的后半段激发黄体酮。

Well, those estrogen increases just prior to ovulation are in part responsible for the increases in libido, but it's also the presence of increased androgen just prior to ovulation.

好吧，排卵前雌激素的增加部分是性欲增加的原因，但排卵前雄激素的增加也是原因之一。

So there's a lot of complex interplay.

所以有很多复杂的相互作用。

I think what we will do is we will reserve the discussion about libido per se, and some of the other aspects related to sexual differentiation that we were talking about earlier for a future episode.

我认为我们要做的是保留关于性欲本身的讨论，以及我们之前讨论过的与性别分化相关的其他一些方面，以供未来的剧集讨论。

But hopefully now you have in mind what the ovulatory menstrual cycle is.

但希望现在您已经了解排卵月经周期是什么。

It is a signal from the brain, from the hypothalamus, which then triggers a signal from the pituitary, an endocrine gland.

它是来自大脑、下丘脑的信号，然后触发来自垂体（内分泌腺）的信号。

Which then signals the release of hormones that travel to the ovary and that control two things, maturation of eggs and the identification of one egg in particular, and then preparation of the milieu, the environment in which that fertilized egg could potentially land and mature into a healthy embryo and child.

然后，这会发出释放激素的信号，这些激素会进入卵巢并控制两件事，即卵子的成熟和特别是一个卵子的识别，然后准备环境，即受精卵可能落地并成熟为健康胚胎和孩子的环境。

So if you have that framed up in your mind, and even if you just extracted maybe 10% to 15% of the hormones and different aspects that I described up until now, I would consider you far more knowledgeable about this entire process than 99% of people out there.

因此，如果你心里有这样的想法，即使你只是提取了我到目前为止所描述的 10% 到 15% 的激素和不同方面，我也会认为你比 99% 的人更了解这整个过程。

Certainly not the OBGYNs and urologists, but than 99% of individuals out there.

当然不是妇产科医生和泌尿科医生，而是 99% 的人。

It also frames up for us the second half of this whole story about fertility and fertilization, which is the generation of sperm and how the sperm eventually arrive at the egg, and how certain sperm are selected to potentially fertilize that egg, whereas others never really stand a chance.

它还为我们构建了关于生育和受精的整个故事的后半部分，即精子的产生以及精子最终如何到达卵子，以及如何选择某些精子使卵子受精，而其他精子则永远没有真正的机会。

So next, we're going to talk about sperm.

接下来，我们要谈谈精子。

We're going to talk about what sperm are, where they are generated and how they are generated, and how they need to travel both within the male and within the female in order to allow fertilization to potentially occur.

我们将讨论什么是精子、它们在哪里产生、如何产生，以及它们如何在男性和女性体内移动，以便可能发生受精。

So we've covered the ovulatory cycle in females, and I confess, it was a lot of information with a lot of biological nomenclature.

我们已经介绍了女性的排卵周期，我承认，这是大量的信息和大量的生物学术语。

But I promise you that many of those same themes, and indeed the same names and nomenclature, will show up in the discussion that we're going to have now, which is about the generation of sperm.

但我向你们保证，许多相同的主题，甚至相同的名称和术语，将出现在我们现在将要进行的关于精子生成的讨论中。

Now, sperm are similar to eggs in the sense that they are part of the germline.

现在，精子与卵子相似，因为它们都是种系的一部分。

They are these protected cells, protected in the sense that the activities of an individual are not going to change the genetic makeup of those cells.

它们是受保护的细胞，受保护的意思是个体的活动不会改变这些细胞的基因组成。

Now, again, there are instances in which mutagens, such as chemicals, could disrupt the genomes of the germ cells in males just as it could in females.

现在，在某些情况下，化学物质等诱变剂可能会破坏男性生殖细胞的基因组，就像破坏女性生殖细胞的基因组一样。

But in general, the activities, the things that we do, the experiences we have, doesn't tend to change the genome of those cells.

但总的来说，我们的活动、我们所做的事情、我们所拥有的经历，往往不会改变这些细胞的基因组。

However, there are a lot of lifestyle factors, dos and don'ts, nutrition and supplements, and prescription drugs, et cetera, that can indeed modify the quality of the sperm.

然而，有很多生活方式因素、注意事项、营养和补充剂以及处方药等等，确实可以改变精子的质量。

And we'll talk about what sperm quality means.

我们将讨论精子质量的含义。

But the point is that the sperm cell, much like the egg cell, are both germline cells.

但关键是，精子细胞和卵细胞一样，都是生殖细胞。

They're not like somatic cells.

它们不像体细胞。

They are unique populations.

他们是独特的人群。

And let's just remember what the job of the sperm cell is.

让我们记住精子细胞的工作是什么。

The job of the sperm cell is to deliver the genetic material from the father, and to do that in the form of a haploid cell.

精子细胞的工作是以单倍体细胞的形式传递来自父亲的遗传物质。

So that means 23 chromosomes, 22 autosomes, one so-called sex chromosome.

这意味着 23 条染色体、22 条常染色体、一条所谓的性染色体。

Again, not sex the verb, at least not in this case.

再说一遍，动词不是“性”，至少在这种情况下不是。

Sex the verb is a discussion we're going to have in a few minutes.

几分钟后我们将讨论“性”这个动词。

But sex the noun, the sex chromosome can either be an X chromosome or a Y chromosome.

但性是名词，性染色体可以是 X 染色体，也可以是 Y 染色体。

Okay, so 22 autosomes and then one sex chromosome is going to be contained within the sperm because it's a haploid cell, not a diploid cell.

好的，精子中将包含 22 条常染色体和一条性染色体，因为它是单倍体细胞，而不是二倍体细胞。

Remember, the egg was diploid, then it became haploid.

请记住，鸡蛋是二倍体，然后变成了单倍体。

The sperm cells are cells that are created through the division of other cells.

精子细胞是通过其他细胞分裂产生的细胞。

But after that division occurs, through a process called meiosis, the sperm cell is going to contain 23 chromosomes, consisting of 22 autosomes and one sex chromosome.

但在分裂发生后，通过称为减数分裂的过程，精子细胞将包含 23 条染色体，其中包括 22 条常染色体和一条性染色体。

And the sperm that manages to deposit its DNA contents into the egg to fertilize the egg will either have an X sex chromosome or a Y sex chromosome.

设法将其 DNA 内容物沉积到卵子中以使卵子受精的精子将具有 X 性染色体或 Y 性染色体。

And the Y sex chromosome has a number of different genes on that chromosome that will suppress, for instance, the development of the female reproductive axis.

Y 性染色体上有许多不同的基因，这些基因会抑制女性生殖轴的发育等。

One good example would be the Mullerian inhibiting hormone, or MIH.

苗勒管抑制激素（MIH）就是一个很好的例子。

The gene for Mullerian inhibiting hormone, which is a hormone that prevents the formation of the Mullerian ducts, which is part of the female reproductive structure.

苗勒管抑制激素的基因，这是一种阻止苗勒管形成的激素，苗勒管是女性生殖结构的一部分。

Well, that gene controls the prevention of the development of the female genitalia, and in doing so, promotes the development of the male genitalia.

那么，该基因控制着女性生殖器发育的预防，并以此促进男性生殖器的发育。

And there are other examples of genes that are on the Y chromosome that give you a what we call male phenotype, right?

Y 染色体上还有其他一些基因可以赋予我们所谓的男性表型，对吗？

You have genotype and phenotype.

你有基因型和表型。

By the way, in case you haven't heard this in a while from your high school biology, or if you never heard it, no big deal.

顺便说一句，如果你已经有一段时间没有在高中生物学中听到过这个，或者如果你从未听说过，也没什么大不了的。

Karyotype is the complement of chromosome XX or XY.

核型是 XX 或 XY 染色体的互补体。

And there are individuals out there that are XXY or XYY, a discussion for our episode on sex differentiation.

有些人是 XXY 或 XYY，这是我们关于性别分化的一集的讨论。

That's karyotype with a K.

这是带有 K 的核型。

Then there's genotype, which are the genes that you have.

然后是基因型，即你拥有的基因。

And then there's phenotype spelled P-H, phenotype, P-H-E-N-O-T-Y-P-E, phenotype.

然后是表型，拼写为 P-H，表型，P-H-E-N-O-T-Y-P-E，表型。

And the phenotype is how the genes, which then code for RNA, which code for protein, how those are expressed in terms of things like eye color.

表型是指基因如何编码RNA、编码蛋白质，以及这些基因如何以眼睛颜色等方式表达。

So eye color is a phenotype.

所以眼睛颜色是一种表型。

Height is a phenotype.

身高是一种表型。

Hair color is a phenotype.

头发颜色是一种表型。

Okay, so you have karyotype, genotype, and phenotype.

好的，现在你有了核型、基因型和表型。

Well, what we need to do is we need to bring together that sperm, which is haploid, contains those 23 chromosomal strands with either an X or a Y sex chromosome as the 23rd chromosome.

好吧，我们需要做的是，我们需要将单倍体精子汇集在一起​​，其中包含 23 条染色体链，其中 X 或 Y 性染色体作为第 23 条染色体。

We need to get that cell to the egg.

我们需要将该细胞转移到卵子中。

And so when we talk about spermatogenesis, of course, we're talking about the generation of sperm cells.

因此，当我们谈论精子发生时，当然，我们谈论的是精子细胞的产生。

But what we're really talking about is the generation of cells whose job is to deliver the genetic material from dad to the egg within the female in a way that increases the probability that not only will that egg be fertilized, but that it will progress in a healthy way with each set of chromosomes from mom and from dad, each set of 23 chromosomes that is, will progress in a healthy way, will implant in a healthy way, and will maintain and grow in a healthy way to a healthy embryo and child and eventually adult.

但我们真正谈论的是细胞的产生，其作用是将遗传物质从父亲传递到女性体内的卵子，这种方式不仅增加了卵子受精的可能性，而且增加了来自母亲和父亲的每组染色体，即每组 23 条染色体，将以健康的方式发展，以健康的方式植入，并以健康的方式维持和生长，形成健康的胚胎和儿童，最终成年。

That's the job of the sperm.

这就是精子的工作。

Okay?

好的？

So as we talk about spermatogenesis, let's just remember that and why they're there in the first place.

因此，当我们谈论精子发生时，我们首先要记住这一点以及它们存在的原因。

Now, a few things about sperm that are interesting, besides the fact that they're haploid, and besides the fact that as you all know, they swim.

现在，关于精子的一些有趣的事情，除了它们是单倍体的事实，以及众所周知的它们会游泳的事实之外。

They have a head and a tail.

它们有头和尾巴。

They actually have a head, a mid region, and a tail, and that mid region turns out to be very important.

它们实际上有一个头部、一个中部区域和一个尾部，而中部区域被证明是非常重要的。

It's something we'll come back to again and again.

我们会一次又一次地回顾这一点。

That mid region is really key for the ability for sperm to engage in forward progression, to swim forward.

中间区域对于精子向前推进、向前游动的能力确实至关重要。

It involves the activity of mitochondria, which are involved in generation of ATP, which is involved in all aspects of energy in all cells.

它涉及线粒体的活动，线粒体参与ATP的生成，ATP参与所有细胞能量的各个方面。

But let's just remember that the sperm are swimming cells, and in order to create a really good swimmer or set of swimmers, you need a couple of things.

但我们要记住，精子是游泳细胞，为了创造一个真正优秀的游泳者或一组游泳者，你需要做一些事情。

First of all, within the testes is where the sperm develop.

首先，睾丸内是精子发育的地方。

And unlike in females and unlike in the ovary, there's no vault of sperm.

与女性和卵巢不同的是，这里没有精子库。

The sperm are continually being generated.

精子不断地产生。

It takes about 60 days for sperm to be born from their parent cells, because cells actually give rise to other cells.

精子从其母细胞中诞生大约需要 60 天，因为细胞实际上会产生其他细胞。

That's the way it works.

这就是它的工作原理。

To be born from their parent cells and then mature to the point where they can be a really good swimmer.

从父母细胞中诞生，然后成熟到可以成为一名真正优秀的游泳运动员的程度。

Now, that doesn't mean that a bunch of sperm are made on day one, and then 60 days later, all those sperm are deployed in the form of ejaculate, and then the cycle starts over again.

现在，这并不意味着第一天就产生了一堆精子，然后 60 天后，所有这些精子都以射精的形式出现，然后又重新开始这个循环。

So it's a little different than the ovulatory menstrual cycle.

所以它与排卵月经周期有点不同。

Rather, at any given point in time, like right now, if you have testes, you have some sperm in your testes that are immature and cannot swim, cannot deliver those genetic contents rather to the female egg.

相反，在任何给定的时间点，比如现在，如果你有睾丸，你的睾丸中有一些不成熟的精子，不能游泳，不能将这些遗传内容传递给女性卵子。

And you have some sperm that are mature, and you very likely have some sperm that are so mature that they are dying off or that they're dead.

你有一些成熟的精子，而且你很可能有一些成熟到快要死掉或已经死亡的精子。

Almost certainly also, regardless of your age, you have some sperm that are healthier than others.

几乎可以肯定的是，无论您的年龄如何，您都有一些比其他精子更健康的精子。

They're better swimmers than others.

他们比其他人更擅长游泳。

This is just the way the system works.

这就是系统的工作方式。

Now, the process of spermatogenesis involves a couple of things, but a lot of the players are the same as the process of developing the so-called oocyte, the immature egg.

现在，精子发生的过程涉及到一些事情，但很多参与者都与所谓的卵母细胞（未成熟​​的卵子）发育的过程相同。

We've got GnRH from the hypothalamus.

我们从下丘脑获得 GnRH。

That's going to be a player.

那将是一名球员。

We have FSH, follicle-stimulating hormone, although the name's a little bit of a misnomer in the context of spermatogenesis because in the context of spermatogenesis, there is no follicle.

我们有 FSH，卵泡刺激激素，尽管这个名字在精子发生的背景下有点用词不当，因为在精子发生的背景下，不存在卵泡。

What we're really talking about is FSH for stimulating the maturation of the sperm cell, so not egg follicle, but sperm cell.

我们真正谈论的是刺激精子细胞成熟的FSH，所以不是卵泡，而是精子细胞。

But we still have GnRH, FSH, LH, and rather than the ovary being the target of those hormones, it's going to be the testes.

但我们仍然有 GnRH、FSH、LH，这些激素的目标不是卵巢，而是睾丸。

So most everybody should know that the testes and the ovaries are the so-called gonads.

所以大多数人都应该知道睾丸和卵巢是所谓的性腺。

The testes, of course, reside outside of the body.

当然，睾丸位于体外。

There are instances where the testes fail to descend during development.

在某些情况下，睾丸在发育过程中无法下降。

Certainly, if the testes don't descend on time, that's something that doctors need to be made aware of, the pediatrician to be made aware of, because that can prevent fertility.

当然，如果睾丸没有按时下降，医生和儿科医生都需要意识到这一点，因为这会妨碍生育。

Why would that be?

为什么会这样呢？

Well, turns out that the testes reside outside the body in the scrotum because the temperature conditions under which spermatogenesis can occur and under which healthy sperm can be maintained are very restricted and is approximately two degrees cooler than the rest of the body.

事实证明，睾丸位于体外的阴囊中，因为发生精子发生和维持健康精子的温度条件非常有限，并且比身体其他部位大约低两度。

This is very important.

这非常重要。

I think this is something that used to be discussed a lot more, but isn't discussed so much these days.

我认为这是一个曾经被讨论得很多的问题，但现在讨论得不多了。

But keeping the testes cool enough doesn't necessarily mean keeping them cold, although there is a place for using cold exposure, deliberate cold exposure, to improve sperm quality and number, and perhaps even testosterone levels.

但保持睾丸足够凉爽并不一定意味着让它们保持寒冷，尽管可以使用冷暴露、故意冷暴露来提高精子质量和数量，甚至可能提高睾酮水平。

We'll talk about that a little bit later.

我们稍后会讨论这个问题。

But keeping the testes about two degrees cooler than the rest of the body is absolutely key.

但保持睾丸比身体其他部位凉爽约两度绝对是关键。

If sperm get too hot, they die.

如果精子太热，它们就会死亡。

And if spermatocytes, the cells that give rise to sperm get too warm, well, then oftentimes the sperm that develop are not healthy.

如果精母细胞（产生精子的细胞）温度过高，那么发育出来的精子通常就不健康。

Not healthy in a number of ways.

在很多方面都不健康。

Either they can't engage in fast-forward progression, that is swimming, or they will lack the ability to deposit their DNA contents within the egg.

它们要么无法进行快速前进（即游泳），要么缺乏将 DNA 内容物沉积在卵内的能力。

So again, whatever is contained in the ejaculate is going to be a mixture of different sperm qualities, and sperm of different ages will impact the quality.

同样，精液中所含的物质都将是不同精子质量的混合物，不同年龄的精子会影响其质量。

But also the temperature under which Those sperm developed is going to impact their quality.

而且这些精子发育的温度也会影响它们的质量。

And so we're going to get into tools a little bit later, as I mentioned, but just to give you a simple takeaway, if you are hoping to conceive in the next 90 days, right?

因此，正如我提到的，我们稍后将介绍工具，但只是为了给您一个简单的启示，如果您希望在接下来的 90 天内怀孕，对吗？

The spermatogenesis cycle takes 60 days, but then the sperm actually have to migrate from the testicle into the so-called epididymis, which is a related structure, and then into the vas deferens, and then into the urethra, where it can be part of the ejaculate.

精子发生周期需要60天，但精子实际上必须从睾丸迁移到所谓的附睾（这是一个相关结构），然后进入输精管，然后进入尿道，在那里它可以成为射精的一部分。

In order for sperm to do all that properly, undergo that maturation, and then exit in ejaculate in a way that's healthy or that the sperm is healthy, if you plan to conceive children or to try and conceive children in the next 90 days, you definitely want to avoid exposing your testicles, that is your scrotum, to elevated temperatures.

为了让精子正确完成所有这些工作，经历成熟，然后以健康或精子健康的方式射精，如果您计划怀孕或在接下来的 90 天内尝试怀孕，您一定要避免将睾丸（即阴囊）暴露在高温下。

So that means definitely avoiding hot tubs, definitely avoiding hot baths.

所以这意味着绝对要避免洗热水澡，绝对要避免洗热水澡。

Now, a brief hot bath or hot tub or hot shower isn't going to be a problem, although if you're really interested in conceiving, I would avoid hot tubs and hot baths as much as possible.

现在，短暂的热水浴或热水浴缸或热水淋浴不会成为问题，但如果您真的对怀孕感兴趣，我会尽可能避免热水浴缸和热水浴。

Hot showers are probably fine.

热水淋浴可能没问题。

But if you're going to go into a sauna, for instance, you might want to rethink that decision, and if you do decide to, you almost certainly would want to bring a cold pack in that you could well hopefully put some material between the cold pack and the scrotum so you don't get a cold burn.

但是，例如，如果您要去桑拿房，您可能需要重新考虑这个决定，如果您确实决定这样做，那么您几乎肯定会想要带一个冷袋，这样您就可以在冷袋和阴囊之间放置一些材料，这样您就不会被冷烫伤。

But put something there, but keep the scrotal tissue cool.

但放一些东西在那里，但要保持阴囊组织凉爽。

Keep it cold to cool.

保持冷至冷却。

Because heat exposure can really mutate and disrupt the developing sperm, and it can kill sperm.

因为热暴露确实会使正在发育的精子发生突变和破坏，并且可以杀死精子。

And so again, that would be for an entire 90 days leading up to your attempts to conceive.

同样，这将是您尝试怀孕前的整整 90 天。

Again, we'll get into more tools later, but a number of people also have probably heard of the boxers versus briefs controversy, I guess it is.

同样，我们稍后会介绍更多工具，但很多人可能也听说过平角内裤与内裤的争议，我想是这样。

Or whether or not people call it going commando with no underwear of any kind, boxers, brief or briefs or otherwise, rather.

或者不管人们是否称其为不穿任何内衣的突击队，平角裤、三角裤或三角裤或其他。

Turns out that the data on that point to the fact that there isn't really a big difference in terms of sperm quality if people wear boxers or briefs or don't wear anything under their jeans or shorts at all.

事实证明，这方面的数据表明，如果人们穿平角内裤或三角裤，或者在牛仔裤或短裤内根本不穿任何东西，精子质量实际上并没有太大差异。

The scrotum has the ability to move the testicles far enough away from the body in order to achieve lower temperatures if it needs to.

阴囊有能力将睾丸移离身体足够远，以便在需要时达到较低的温度。

It achieves that through a muscle called the cremaster muscle, which is a really interesting muscle, believe it or not.

它通过一种叫做提睾肌的肌肉来实现这一点，无论你相信与否，这是一种非常有趣的肌肉。

I was reading up on the biology of the cremaster muscle, something I never thought I'd spend too much time on, but that I ended up spending far too much time reading up about.

我正在阅读有关提睾肌的生物学知识，我从没想过要花太多时间在这上面，但最终我花了太多时间阅读。

And it's really fascinating.

这真的很迷人。

What you have is a muscle that's a smooth muscle tissue, unlike skeletal muscle, which is striated muscle, that is temperature dependent.

你所拥有的是平滑肌组织的肌肉，与温度相关的横纹肌骨骼肌不同。

So it has certain nerve endings and it has certain receptors on it that allow it to respond to local temperature and then to relax in order to essentially let the testicles to descend further from the body or to contract and bring the testicles closer to the body in order to try and maintain the optimal temperature range.

因此，它具有某些神经末梢，并且上面有某些受体，使其能够对局部温度做出反应，然后放松，以便本质上让睾丸进一步下降，远离身体，或者收缩并使睾丸更接近身体，以尝试保持最佳温度范围。

And it turns out the cremaster muscle can achieve that whether or not people are wearing boxers or briefs.

事实证明，无论人们是否穿着平角内裤或三角裤，提睾肌都可以实现这一目标。

Although it stands to reason that any kind of, there's no other name for it, undergarments, I don't know why that word is, it just seems kind of antiquated, but undergarment that allows some movement of the scrotum and the testicles should be sufficient to allow these temperature variations to occur and keep things in range.

虽然按理说，任何一种，没有其他名称，内衣，我不知道为什么这个词，它似乎有点过时，但允许阴囊和睾丸进行一些运动的内衣应该足以允许这些温度变化发生并将温度保持在范围内。

That said, a little bit later, we'll go into some detail really, because it's important as to why, for instance, if you are somebody who has big thighs, believe it or not, that it actually can lower sperm count substantially.

也就是说，稍后我们会真正讨论一些细节，因为这很重要，例如，如果你是一个大腿粗的人，无论你相信与否，它实际上会大大降低精子数量。

Whether or not the big thighs occur because you're very muscular or the big thighs occur because you are overweight, it can increase the temperature.

无论是因为肌肉发达而出现大腿粗，还是因为体重过重而出现大腿粗，都会导致体温升高。

If you're sitting a lot, increases scrotal temperature for sure.

如果你久坐，阴囊温度肯定会升高。

And there are some other things that can increase scrotal temperature.

还有一些其他东西可以增加阴囊温度。

Seat heaters in cars, for instance.

例如，汽车座椅加热器。

Terrible idea, just terrible idea if you're hoping to conceive in the near future.

如果你希望在不久的将来怀孕，这真是个糟糕的主意。

And again, hot tub, things of that sort.

再说一遍，热水浴缸​​之类的东西。

Okay, so temperature modulation of spermatogenesis and sperm quality and function is key.

好吧，精子发生以及精子质量和功能的温度调节是关键。

That relates a little bit more to tools, but what happens?

这与工具有更多的关系，但是会发生什么呢？

How does the actual sperm develop?

实际的精子是如何发育的？

Well, contained within the testicle, you have the cells, the so-called spermatogonia, which differentiate into so-called spermatocytes.

好吧，睾丸内有细胞，即所谓的精原细胞，它们分化成所谓的精母细胞。

You don't have to remember all this.

你不必记住这一切。

And the spermatocytes undergo this process of meiosis.

精母细胞经历减数分裂过程。

Meiosis is a form of cell division, which reduces the chromosome number to those 23 individual strands as opposed to pairs, right?

减数分裂是细胞分裂的一种形式，它将染色体数量减少到 23 条单独的链，而不是成对的，对吗？

So it makes them haploid as opposed to diploid.

所以它使它们成为单倍体而不是二倍体。

Very important for reasons that we talked about earlier.

出于我们之前讨论过的原因，这非常重要。

And the meiosis process in these primordial sperm cells, these immature sperm cells, is similar to the meiosis process that occurs in eggs when the chromosomes segregate, in that it involves these spindle-like structures within the cell.

这些原始精子细胞（即未成熟精子细胞）的减数分裂过程与染色体分离时卵子中发生的减数分裂过程相似，因为它涉及细胞内的纺锤状结构。

Now, why do I keep bringing up the spindles?

现在，为什么我要不断地提起主轴？

Well, it turns out that the function of the spindle in the egg and the sperm is heavily dependent on mitochondrial function.

事实证明，卵子和精子中纺锤体的功能在很大程度上依赖于线粒体功能。

And later when we get into tools for improving egg and sperm quality, you're going to hear about a lot of tools for improving mitochondria.

稍后当我们讨论改善卵子和精子质量的工具时，您会听到很多改善线粒体的工具。

And it's not just because the mitochondria are involved in energy demanding aspects of cell biology, but it's also because the mitochondria in this context are very important for the removal of or the separation of one set of chromosomes to give you these two sets of haploid cells, the egg and the sperm.

这不仅是因为线粒体涉及细胞生物学的能量需求方面，还因为线粒体对于去除或分离一组染色体以产生这两组单倍体细胞（卵子和精子）非常重要。

And this is so important because many failures at fertilization, many failures at implantation, many miscarriages, and many birth defects that do survive after birth that are very detrimental, such as trisomies and things like that, occur because the spindles don't effectively pull apart the chromosomes in typically the egg, but it can also occur in the sperm.

这一点非常重要，因为许多受精失败、着床失败、流产以及出生后仍然存在的许多非常有害的先天缺陷（例如三体性和类似的情况）的发生是因为纺锤体不能有效地分离通常在卵子中的染色体，但它也可能发生在精子中。

Okay, so these spindles and the fact that mitochondria are rich on the spindle are very important for generating these haploid sperm.

好吧，这些纺锤体以及纺锤体上富含线粒体的事实对于产生这些单倍体精子非常重要。

Again, 23 individual strands of chromosomes That's occurring inside of the testes.

同样，23 条单独的染色体链出现在睾丸内部。

Okay?

好的？

So there's not as much long-distance migration of the spermatocytes and the sperm cells as there is the egg, just when you think about the overall architecture of the uterus and the fallopian tubes compared to the testicles, but there's still a lot of movement.

因此，当你考虑与睾丸相比的子宫和输卵管的整体结构时，精母细胞和精子细胞的长距离迁移并不像卵子那么多，但仍然有很多运动。

So within the testicle, if you were to look at the testicle in cross-section, and I prefer to call it that rather than cut the testicle in half.

因此，在睾丸内，如果你要观察睾丸的横截面，我更喜欢这样称呼它，而不是将睾丸切成两半。

Anytime you talk about anatomy, you actually talk about slicing things.

每当你谈论解剖学时，你实际上谈论的是切片。

That's what you would do with a cadaver, is what I teach and we do in my laboratory and frankly, in biological laboratories all over the place.

这就是你对尸体所做的事情，也是我所教的，也是我们在我的实验室中所做的，坦率地说，是在各地的生物实验室中所做的。

But when you talk about it, you have to talk about if you were to take a visual cross-section through the testicle, what you would find is that there are a lot of different little tubes, a lot of ducts, D-U-C-T-S, ducts.

但是当你谈论它时，你必须谈论如果你要通过睾丸进行视觉横截面，你会发现有很多不同的小管，很多导管，D-U-C-T-S，导管。

Those are pathways.

这些都是途径。

And the main ducts that are important for this discussion are called the seminiferous tubules.

对于本次讨论很重要的主要导管称为生精小管。

Okay?

好的？

So it's a mesh-like or network structure of tubes in the testicle, and the immature sperm sit on a little compartment along the edge of those tubes, and as they mature, they move towards the center of those tubes, and then when they are mature enough, those sperm cells actually drop into the hollow of the tube and then can travel through those tubes to a structure that's along the side of the testicle called the epididymis.

因此，它是睾丸中管子的网状或网络结构，未成熟的精子位于这些管子边缘的一个小隔间上，当它们成熟时，它们会向这些管子的中心移动，然后当它们足够成熟时，这些精子细胞实际上会落入管子的中空部分，然后可以穿过这些管子到达沿着睾丸侧面的称为附睾的结构。

The epididymis, again, is a series of ducts, and then the epididymis converges with something called the vas deferens.

附睾也是一系列导管，然后附睾与输精管汇合。

Okay?

好的？

I think in high school, we all remember this by thinking about it's the vast difference.

我想在高中时，我们都会通过思考这是巨大的差异来记住这一点。

I don't know who came up with that.

我不知道是谁想出这个主意的。

I think it was a young girl sitting to the left of me that was like, "Oh, it's like the vast difference." I never forgot that.

我想是坐在我左边的一个年轻女孩说，“哦，这就像巨大的差异。”我从未忘记过这一点。

I don't know.

我不知道。

Maybe it was the topic matter, maybe it was her, maybe it was some combination of the two.

也许是话题的问题，也许是她的问题，也许是两者的结合。

But in any case, the sperm go from the seminiferous tubules to the epididymis and then to the vas deferens, and then are contained in the ejaculate along with seminal fluid.

但无论如何，精子都是从生精小管进入附睾，然后进入输精管，然后与精液一起包含在精液中。

Now, the seminal fluid is the carrier fluid for the sperm themselves.

现在，精液是精子本身的载体液。

This is important because it turns out that a lot of the things that can both negatively or positively impact the quality of the sperm relates not just to the sperm cells themselves and the temperature of the environment that they were matured in, but also to the semen quality.

这很重要，因为事实证明，许多对精子质量产生负面或正面影响的因素不仅与精子细胞本身及其成熟环境的温度有关，还与精液质量有关。

For instance, if you are a heavy drinker, or if you are a smoker, or if you are a regular user of cannabis, especially if you smoke cannabis or vape cannabis, you create a lot of reactive oxygen species that disrupt the chemistry of the seminal fluid, which disrupts the sperm cells.

例如，如果您是酗酒者，或者您是吸烟者，或者您是大麻的经常使用者，特别是如果您吸食大麻或吸食大麻，您会产生大量活性氧，破坏精液的化学成分，从而破坏精子细胞。

So it's not a direct action always on the sperm cell itself, although it can be.

因此，尽管可以，但它并不总是对精子细胞本身产生直接作用。

So for instance, in the form of smoked tobacco or cannabis, there are a lot of carcinogens and mutagens that actually mutate the DNA, can cause DNA fragmentation and debilitate sperm.

例如，烟草或大麻中含有大量致癌物和诱变剂，它们实际上会导致 DNA 突变，导致 DNA 碎片并使精子衰弱。

But there are also a lot of things created by smoking in particular, regardless of what's being smoked, that can create elevated reactive oxygen species and disrupt the seminal fluid that the sperm are contained in, in the so-called ejaculate, the semen.

但吸烟也会产生很多东西，尤其是吸烟时产生的物质，无论吸什么，都会产生较高的活性氧，并破坏精子所含的精液，即所谓的射精液。

Now, this will also become a relevant conversation later when we briefly talk about vasectomies.

现在，当我们稍后简要谈​​论输精管切除术时，这也将成为一个相关的话题。

Vasectomies are literally a cutting of the vas deferens, which leads to a situation, provided the surgery was done correctly, where men can still achieve all the other aspects of intercourse.

输精管切除术实际上是对输精管的切割，这会导致一种情况，只要手术进行得正确，男性仍然可以实现性交的所有其他方面。

They can still achieve erection, they can still achieve orgasm, they can still ejaculate.

他们仍然可以勃起，仍然可以达到性高潮，仍然可以射精。

But when they ejaculate, the seminal fluid is released, but there are no sperm contained within the seminal fluid.

但是当他们射精时，精液被释放出来，但精液中不含精子。

And it turns out that vasectomies are a very effective form of birth control, and they always check to see if zero sperm and confirm that zero sperm are being released in the ejaculate.

事实证明，输精管切除术是一种非常有效的节育形式，他们总是检查是否有零精子，并确认精液中是否释放了零精子。

They are reversible.

它们是可逆的。

That is, vasectomies are reversible, but not always.

也就是说，输精管切除术是可逆的，但并非总是如此。

There are a subset of cases where it's not reversible, in which case, if people still want to have children, you have to go in and actually surgically extract sperm from the testicles.

有一部分情况是不可逆的，在这种情况下，如果人们仍然想生孩子，你就必须通过手术从睾丸中实际提取精子。

But it's a process in which the vas deferens is altered or severed in a way that the sperm can't actually exit the testicle.

但这是一个输精管被改变或切断的过程，导致精子实际上无法离开睾丸。

They can get into the epididymis usually, but not into the vas deferens, and so on and so forth.

它们通常可以进入附睾，但不能进入输精管等。

So if you've ever wondered what a vasectomy is, that's what a vasectomy is.

因此，如果您想知道什么是输精管结扎术，那就是输精管结扎术。

And I mention vasectomy now because it illustrates the difference between the seminal fluid, the semen, and the sperm that the semen contain.

我现在提到输精管结扎术，因为它说明了精液、精液和精液中含有的精子之间的区别。

Okay?

好的？

So 60 days to generate the sperm.

所以需要60天才能产生精子。

Another two weeks or so for the sperm to travel through the various ducts to the point where they can be contained in the ejaculate.

再过两周左右，精子就会穿过各个导管到达可以包含在精液中的位置。

Let's talk about the sperm cells themselves.

我们来谈谈精子细胞本身。

The sperm cells, again, have these 23 pairs of single-strand chromosomes.

同样，精子细胞也有 23 对单链染色体。

They're haploid.

它们是单倍体。

They have either an X or a Y sex chromosome as the 23rd so-called sex chromosome.

他们有 X 或 Y 性染色体，即第 23 条所谓的性染色体。

And as we all know, they have a head.

众所周知，他们有头脑。

The head tends to be oval in most cases.

在大多数情况下，头部往往是椭圆形的。

The head contains very important enzymes and proteins that are designed to fuse with the much larger egg and to actually take the membrane of the sperm cell and combine to actually mesh with the egg cell's membrane and then deliver the genetic contents to the egg cell.

头部含有非常重要的酶和蛋白质，这些酶和蛋白质旨在与更大的卵子融合，并实际获取精子细胞的膜并结合，与卵细胞的膜实际啮合，然后将遗传内容传递到卵细胞。

In other words, to fertilize the egg cell.

换句话说，就是让卵细胞受精。

Now, just behind the head is a region called the mid region.

现在，头部后面有一个区域称为中部区域。

That mid region is a slightly thickened region.

该中间区域是稍微加厚的区域。

And here, of course, I'm talking about healthy sperm cell morphology.

当然，我在这里谈论的是健康的精子细胞形态。

Morphology simply means shape.

形态学简单地说就是形状。

A mid region.

中部地区。

That mid region has a bunch of things related to cell motility and to the forward progression of the cells.

中间区域有很多与细胞运动和细胞前进相关的东西。

First of all, it is chock-a-block full of mitochondria.

首先，它充满了线粒体。

In fact, if you were to look just behind the head of the sperm, what you'd see is that it is completely surrounded by mitochondria.

事实上，如果你观察精子头部的后面，你会看到它完全被线粒体包围。

There are mitochondria elsewhere in the cell, but most of them are contained in this mid region compartment just behind the head of the sperm.

细胞中的其他地方也有线粒体，但大多数都包含在精子头部后面的中间区域隔室中。

And that thick region is where the tail movement of the sperm, the flagellation back and forth, is actually generated from.

那个厚的区域实际上是精子尾部运动（来回鞭毛）产生的地方。

Much like if you were to hold a rope, like a battle rope in the gym, and you were to whip the battle rope.

就像你拿着一根绳子，就像健身房里的战绳一样，你要鞭打战绳。

The whip at the one end of the rope is what allows for the-- Let's just call it what it is, the curves in the rope, the oscillations, the rising and falling of the rope all the way out to the end.

绳索一端的鞭子允许——我们就这么称呼它吧，绳索的弯曲、振动、绳索的上升和下降，一直到末端。

Right?

正确的？

It is the force of the whip right at that end, with the battle rope you're doing with your hand, and then with the sperm that it's occurring just behind the head of the sperm, that is actually going to dictate how fast and how well that sperm can swim.

正是在那一端的鞭子的力量，以及你用手拉的战绳，然后是发生在精子头部后面的精子，这实际上决定了精子游动的速度和能力。

And indeed, the sperm has to swim very far.

事实上，精子必须游很远的距离。

How far?

多远?

Well, on a relative scale, and again, these are estimations because there are going to be, how should we say?

好吧，在相对规模上，这些都是估计，因为将会有，我们该怎么说？

There will be differences in the distance from the head of the penis and where the ejaculation occurs to the cervix, depending on the relative size of the vaginal canal and the penis that delivers the ejaculate to the vaginal canal.

阴茎头和射精位置到子宫颈的距离会有所不同，具体取决于阴道管和将射精输送到阴道管的阴茎的相对大小。

But once the sperm arrive at the cervix, which is at the back of the vaginal canal, just at the opening to the uterus.

但是一旦精子到达子宫颈，子宫颈位于阴道管的后部，就在子宫的开口处。

Once the sperm arrive there, the distance from the cervix to the egg, of course, will vary depending on where that egg is in its ovulatory trajectory, its pathway.

当然，一旦精子到达那里，从子宫颈到卵子的距离将根据卵子在其排卵轨迹（其路径）中的位置而变化。

But it is akin, if you scale for size, to the distance between Los Angeles and San Francisco, which is many hundreds of miles.

但如果按规模计算，它类似于洛杉矶和旧金山之间数百英里的距离。

So those sperm have to swim very far.

所以那些精子必须游很远的距离。

Now, of course, if the sperm are delivered in the vaginal canal somewhat further away, they will have further to go.

当然，如果精子被输送到距离阴道稍远的地方，它们就会走得更远。

If they're delivered right at the cervical opening, they will have less far to go.

如果它们在宫颈口直接分娩，那么分娩的距离就会更短。

The very effective swimming sperm swim very fast, so they are able to accomplish that distance in just a few days.

游动效率极高的精子游得非常快，因此它们能够在短短几天内完成这一距离。

And this relates to a discussion that we will get into in a lot more detail later as to how often couples should have intercourse if they're trying to conceive.

这与我们稍后将更详细地讨论的一个讨论有关，即如果夫妇试图怀孕，他们应该多久进行一次性行为。

Many people might think, well, it's every day.

很多人可能会想，好吧，每天都是如此。

However, the more frequent the ejaculation, the lower the concentration of sperm in each ejaculate.

然而，射精越频繁，每次射精中精子的浓度就越低。

So this is not a discussion about how often to have intercourse, depending on your preferences for pleasure or bonding or whatever reason.

因此，这不是讨论性交频率，这取决于您对快乐或亲密关系或任何原因的偏好。

This is a discussion about how often to have intercourse in order to optimize the probability of fertilization of the egg.

这是关于性交频率以优化卵子受精概率的讨论。

There's some general rules that, of course, come to mind, which is ejaculations close to ovulation, both before, during, or sometimes after, are obviously advantageous.

当然，我想到了一些一般规则，即接近排卵时射精，无论是在排卵前、排卵期间或有时在排卵后，显然都是有利的。

But you will also hear OBGYNs and urologists suggesting intercourse every other day leading up to the day of ovulation, starting about three to four days out from the day of ovulation.

但您也会听到妇产科医生和泌尿科医生建议在排卵日之前每隔一天进行一次性交，从排卵日起大约三到四天开始。

So we got a little bit sidetracked, albeit, I think appropriately so, in focusing on fertilization.

因此，在关注受精方面，我们有点偏离了方向，尽管我认为这是适当的。

But what we were talking about right up until the point of that is the anatomy of the sperm itself, which is the head, the mid region that contains all those mitochondria, and then the tail.

但到目前为止我们所讨论的是精子本身的解剖结构，即头部、包含所有线粒体的中间区域，然后是尾部。

Now, what we haven't discussed is the actual generation of the sperm.

现在，我们还没有讨论精子的实际产生。

So if you're a male or if you're a female, I think it's really important to understand how spermatogenesis works.

因此，无论您是男性还是女性，我认为了解精子发生的原理非常重要。

Spermatogenesis works in much in the same way that the generation and maturation of eggs work.

精子发生的原理与卵子的产生和成熟的原理大致相同。

Although, as I mentioned before, it's going to occur ongoing throughout the cycle of the male's life after puberty.

尽管如此，正如我之前提到的，它将在青春期后男性的整个生命周期中持续发生。

We already talked about puberty, and I'll just cover this in two or three sentences as it relates to males, and it's essentially the same thing.

我们已经讨论过青春期，我将用两到三句话来介绍这一点，因为它与男性有关，本质上是同一件事。

The hypothalamus, up until the point of puberty, is providing suppression of the release of gonadotropin-releasing hormone.

直到青春期，下丘脑都会抑制促性腺激素释放激素的释放。

Then some biological clock, which is still not clearly understood.

然后是一些生物钟，目前还不清楚。

It's probably not leptin coming from body fat.

它可能不是来自身体脂肪的瘦素。

Again, unlike in the female, it's probably not leptin coming from body fat, but some other signal arrives to the hypothalamus, removes that inhibition, and GnRH, gonadotropin-releasing hormone, is now released onto the pituitary.

同样，与女性不同的是，它可能不是来自身体脂肪的瘦素，而是一些其他信号到达下丘脑，消除了这种抑制，并且 GnRH（促性腺激素释放激素）现在被释放到垂体上。

A bunch of hormones are deployed from the pituitary as a consequence.

结果，垂体释放出大量激素。

The two most important ones for the context of this discussion are follicle-stimulating hormone and luteinizing hormone.

本次讨论中最重要的两个激素是卵泡刺激素和黄体生成素。

Follicle-stimulating hormone and luteinizing hormone travel to the testes, and they're going to do two main things.

卵泡刺激素和黄体生成素到达睾丸，它们将做两个主要的事情。

One, they're going to trigger the production of testosterone, and they're going to trigger the production of the sperm themselves.

第一，它们将触发睾酮的产生，并且它们将触发精子本身的产生。

They're going to set in motion for essentially the rest of the life of the male, the production of sperm.

它们将在男性的余生中启动精子的产生。

They're going to initiate the spermatogenesis cycle, and that cycle is going to be ongoing at various stages for different sperm for the rest of the man's life.

他们将启动精子发生周期，并且该周期将在人的余生中针对不同的精子在不同阶段持续进行。

This is very different than the triggering of development of oocytes in eggs in females, where there's an existing vault.

这与触发雌性卵子中卵母细胞的发育非常不同，雌性卵子中存在一个穹窿。

That vault can be depleted to the point of zero where it can't occur again.

该金库可以耗尽到零，这样就不会再发生了。

Men can generate sperm their entire lifetime.

男性一生都可以产生精子。

Of course, there's a diminishment of sperm production in very late age, say 80s and 90s or 100s, but believe it or not, there's still sperm being produced.

当然，在很晚的年龄，比如80多岁、90多岁或100多岁，精子的产生会减少，但不管你信不信，精子仍然在产生。

The quality of those sperm is another question.

这些精子的质量是另一个问题。

So everything we're going to talk about now is essentially puberty onward.

所以我们现在要讨论的一切基本上都是青春期以后的事情。

Okay?

好的？

Prior to that, testicles are present, but they're not generating sperm.

在此之前，睾丸已经存在，但它们不产生精子。

Ejaculation is impossible, or if it is possible, it's very unlikely and unusual, and it's not going to contain sperm.

射精是不可能的，或者即使有可能，也是极不可能且不寻常的，而且它不会含有精子。

Everything we're going to talk about now is puberty forward.

我们现在要谈论的一切都是青春期前的事情。

Okay?

好的？

So puberty onward to the rest of life.

就这样从青春期一直到余生。

And luteinizing hormone secreted from the pituitary acts on the testes and on a very specific cell type in the testes called the Leydig cells or Leydig cells, L-E-Y-D-I-G.

垂体分泌的黄体生成素作用于睾丸和睾丸中一种非常特殊的细胞类型，称为 Leydig 细胞或 Leydig 细胞，L-E-Y-D-I-G。

The Leydig cells.

间质细胞。

The Leydig cells of the testes are what produce testosterone Testosterone is going to have two major effects, and here I mean really major because it has many hundreds of effects on different tissues of the body.

睾丸的间质细胞产生睾酮。睾酮将产生两个主要影响，这里我的意思是非常重要，因为它对身体的不同组织有数百种影响。

In fact, that's the definition of a hormone really.

事实上，这就是激素的定义。

It's a substance that acts in an endocrine fashion.

它是一种以内分泌方式起作用的物质。

It can act on the very tissue that generated it.

它可以作用于产生它的组织。

So for instance, testosterone made by the Leydig cells within the testes will act on the testes, as we'll talk about in a moment, but it can also act on other tissues.

例如，睾丸内的间质细胞产生的睾酮会作用于睾丸，我们稍后会讨论，但它也可以作用于其他组织。

It can act on the pharynx and larynx and deepen the voice as it does during puberty.

它可以作用于咽部和喉部，使声音像青春期时一样加深。

It can act on the hair follicles and generate facial hair.

它可以作用于毛囊，产生面部毛发。

It can act on the musculature and generate protein synthesis and development of muscle, bone, et cetera.

它可以作用于肌肉组织并产生蛋白质合成和肌肉、骨骼等的发育。

Okay, all the things we associate with puberty and with testosterone typically.

好吧，所有我们通常与青春期和睾丸激素联系在一起的事情。

Restricting the conversation to the effects of testosterone on the testicle itself and on spermatogenesis, the Leydig cells make testosterone, and keep in mind that some of that testosterone will travel elsewhere in the body and do its thing for gene expression and the more acute effects of testosterone on the brain included.

将讨论限制在睾酮对睾丸本身和精子生成的影响上，间质细胞会产生睾酮，请记住，其中一些睾酮会进入身体的其他部位，对基因表达以及睾酮对大脑的更严重的影响发挥作用。

But the testosterone within the testes is at extremely high concentration.

但睾丸内的睾酮浓度极高。

In fact, the concentration of intratesticular testosterone is at least 100 times higher than the concentration of testosterone anywhere else in the body, even though it's being secreted into the rest of the body.

事实上，睾丸内睾酮的浓度至少比体内其他部位的睾酮浓度高 100 倍，即使它被分泌到身体的其他部位。

And that's because there are a number of different so-called binding proteins and enzymes that sequester the testosterone within the testes.

这是因为有许多不同的所谓结合蛋白和酶可以将睾酮隔离在睾丸内。

So the Leydig cells are making testosterone.

所以间质细胞正在产生睾酮。

A lot of that testosterone is acting on and is restricted to the testes.

许多睾丸激素作用于睾丸，并且仅限于睾丸。

And that turns out to be very important because testosterone within the testes acts in concert with a different biological program that starts with FSH, follicle-stimulating hormone, that also travels to the testes and acts on a very specific set of cells that are called supporting cells or more specifically, the Sertoli cells.

事实证明，这非常重要，因为睾丸内的睾酮与不同的生物程序协同作用，该程序从 FSH（卵泡刺激素）开始，也进入睾丸并作用于一组非常特定的细胞，这些细胞被称为支持细胞，或更具体地说是支持细胞。

The Sertoli cells are the cells that generate something called ABP or androgen-binding protein.

支持细胞是产生 ABP 或雄激素结合蛋白的细胞。

And it is the combination of testosterone from the Leydig cells and ABP from the Sertoli cells that is necessary for spermatogenesis.

来自 Leydig 细胞的睾酮和来自 Sertoli 细胞的 ABP 的结合是精子发生所必需的。

It's necessary for those spermatocytes to become what will eventually be healthy, mature sperm that have really nice shaped oval heads, have a mid region chock-a-block through mitochondria, and can generate a fast whipping motion of the tail to swim from the cervix or up the vagina to the cervix and from the cervix to the egg to fertilize the egg.

这些精母细胞有必要成为最终健康、成熟的精子，它们有非常漂亮的椭圆形头部，中间区域被线粒体堵塞，并且可以产生尾巴的快速鞭打运动，从子宫颈或上阴道游到子宫颈，再从子宫颈游到卵子，使卵子受精。

So it's really a basic set of chemical players that are involved here, and so basic, in fact, that if you were to disrupt any one of these chemical players, either the luteinizing hormone, the FSH, the testosterone from the Leydig cells, or androgen-binding protein, you would observe pretty marked disruption in spermatogenesis or the elimination of sperm entirely.

因此，这里涉及的实际上是一组基本的化学参与者，而且非常基本，事实上，如果你要破坏这些化学参与者中的任何一个，无论是黄体生成素、FSH、来自睾丸间质细胞的睾酮，还是雄激素结合蛋白，你都会观察到精子发生的明显破坏或完全消除精子。

We'll get into a few deficits in sperm development and sperm number and sperm function a little bit later, but just keep in mind, or I should say, maybe sit back and just appreciate that the exact same players, GnRH from the hypothalamus, which causes luteinizing hormone and follicle-stimulating hormone release from the pituitary, which travels to the gonad, which in this case is the testicle, which triggers the release of testosterone from Leydig cells, which triggers the action of the supporting cells, the Sertoli cells, which make androgen-binding protein.

稍后我们将讨论精子发育、精子数量和精子功能方面的一些缺陷，但请记住，或者我应该说，也许坐下来欣赏一下完全相同的参与者，来自下丘脑的 GnRH，它导致黄体生成素和卵泡刺激素从垂体释放，然后转移到性腺，在这种情况下是睾丸，它触发 Leydig 细胞释放睾酮，从而触发该作用支持细胞，支持细胞，产生雄激素结合蛋白。

Testosterone and androgen-binding protein combine and create a chemical and actually a structural milieu in which those little spermatocytes can go from the walls, from literally the walls of the tubes of the seminiferous tubules, can mature into healthy, well-developed sperm, and can hop into those ducts, those little tubes, and then head off to the epididymis, where they will reside.

睾酮和雄激素结合蛋白结合并产生一种化学物质，实际上是一种结构环境，在这种环境中，那些小精母细胞可以从壁上，从字面上的曲细精管壁上，成熟为健康、发育良好的精子，并可以跳入这些管道、那些小管中，然后前往附睾，它们将在那里居住。

The epididymis is the tissue nearby the testicle or surrounding one portion of the testicle, and then eventually fuse with the vas deferens, can combine with or be contained with, rather, the seminal fluid, and then can be ejaculated via the urethra into the female, where then they can swim very quickly, effectively the distance for them anyway, from Los Angeles to San Francisco over the course of a very short period of time and fertilize the egg.

附睾是睾丸附近或睾丸一部分周围的组织，最终与输精管融合，可以与精液结合或包含在精液中，然后可以通过尿道射精到女性体内，然后它们可以在很短的时间内从洛杉矶游到旧金山，并在很短的时间内从洛杉矶游到旧金山并使卵子受精。

So that's the process of spermatogenesis, the maturation of sperm, which is ongoing throughout the lifespan from puberty onward.

这就是精子发生的过程，即精子的成熟过程，从青春期开始贯穿整个生命周期。

And in doing so, we talked about some of the hormonal elements coming from the hypothalamus and coming from the pituitary, and within the testes themselves, the Leydig cells, which produce testosterone, the Sertoli cells, which are the support cells that allow spermatogenesis to occur.

在此过程中，我们讨论了一些来自下丘脑和垂体的激素元素，以及睾丸本身的睾丸间质细胞（产生睾酮）和支持细胞（支持精子发生的支持细胞）。

With that in mind, next I'd like to think about what's actually contained in the ejaculate in terms of numbers of sperm and what's really being selected for in terms of the sperm that actually successfully fertilizes the egg, and what sorts of elements come into play in dictating whether or not fertilization will or won't occur.

考虑到这一点，接下来我想思考一下精液中实际含有的精子数量以及实际上成功使卵子受精的精子的真正选择是什么，以及哪些因素在决定受精是否会发生方面发挥作用。

And the major themes that we're going to discuss are frequency of ejaculation, but really that's just kind of a proxy for talking about maximizing sperm concentration and quality of sperm arriving at the egg, right?

我们要讨论的主要主题是射精频率，但这实际上只是谈论最大化精子浓度和到达卵子的精子质量的代表，对吗？

Because remember, ovulation and the menstrual cycle are really about creating the opportunity for fertilization, okay?

因为请记住，排卵和月经周期实际上是为了创造受精机会，好吗？

And we are also going to talk about how the vaginal duct, the vagina, and the milieu around the cervix, and some other elements within the female herself contribute to and support the sperm in their journey to the egg and in the likelihood that they will fertilize the egg.

我们还将讨论阴道导管、阴道和子宫颈周围的环境，以及女性体内的一些其他元素如何促进和支持精子在到达卵子的过程中以及它们使卵子受精的可能性。

So really what we need to talk about first is sperm quality.

所以我们首先需要讨论的是精子质量。

And we should also probably talk about ejaculate quality, because as odd as that theme might seem, really the ejaculate quality, which has a number of different parameters, including the number of Mature sperm that are not so mature that they're swimming slow or are dead, but also quality sperm that have, for instance, one tail.

我们或许还应该谈谈射精质量，因为尽管这个主题看起来很奇怪，但射精质量确实如此，它有许多不同的参数，包括成熟精子的数量，这些精子还没有成熟到游动缓慢或死亡的程度，但也包括有质量的精子，例如，有一条尾巴。

It's not entirely uncommon to see sperm with two tails, because they just didn't form properly, or sperm that are not moving very much.

看到带有两条尾巴的精子并不完全罕见，因为它们只是没有正常形成，或者精子移动得不太频繁。

In fact, sperm motility is scored along a scale of zero, one, two, or three, three being the best for fast forward progressing.

事实上，精子活力的评分标准为 0、1、2 或 3，其中 3 是快速前进的最佳评分。

A zero is not moving at all.

零根本没有动。

One, they're actually called twitchers.

一，他们实际上被称为抽搐者。

Twitchers are sperm that sort of just twitch in place but don't undergo forward progression.

抽动者是一种只是在原地抽动但不会向前推进的精子。

Two is somewhere in between one and three, not surprisingly.

二介于一和三之间，这并不奇怪。

Different clinics, different OBGYNs, different urologists will throw out different numbers, but in general, it is hoped that more than 50% of the sperm should be motile in some way or another.

不同的诊所、不同的妇产科医生、不同的泌尿科医生会给出不同的数字，但总的来说，希望超过 50% 的精子以某种方式具有活动能力。

So not scoring a zero, but a one, a two, or ideally a three.

因此，得分不是零，而是一、二，或者最好是三。

The concentration of sperm, of course, if it's higher within the ejaculate, the total number of sperm per milliliter of ejaculate, if that's higher, then there's a higher probability that one of those sperm will fertilize the egg.

当然，如果精液中的精子浓度较高，即每毫升精液中的精子总数，如果较高，那么其中一个精子使卵子受精的可能性就较高。

One thing I didn't mention before when discussing the production of eggs and ovulation, and I probably should have, so I will now, is that most often, only one ovary gives rise to an ovulating egg.

我之前在讨论卵子的产生和排卵时没有提到的一件事是，大多数情况下，只有一个卵巢会产生排卵的卵子，而我可能应该提及，所以我现在会提及。

It happens, but it's somewhat rare for two mature eggs, one from each ovary, to be deployed during a single ovulation.

这种情况确实发生过，但在一次排卵期间排出两个成熟卵子（每个卵巢各一个）的情况有点罕见。

There's a name for that when it occurs and both are fertilized.

当它发生并且两者都受精时，就会有一个名字。

It's called fraternal twins.

这就是所谓的异卵双胞胎。

If a single egg, that of course comes from a single ovary, is fertilized and the egg splits, and that's something that happens further along the process of fertilization and differentiation of the embryo, well, then what you get are identical twins.

如果一个卵子，当然来自一个卵巢，受精并且卵子分裂，这是在受精和胚胎分化过程中进一步发生的事情，那么你得到的就是同卵双胞胎。

There are other instances that are quite uncommon in which you can get fraternal twins through other circumstances, but in general, that's the way it works.

还有其他一些非常罕见的情况，在这些情况下，您可以通过其他情况获得异卵双胞胎，但总的来说，这就是它的运作方式。

But essentially what happens is one egg from one ovary, that's the most common occurrence.

但本质上发生的情况是一个卵巢产下一个卵子，这是最常见的情况。

The sperm, once ejaculated into the vaginal duct, are going to pass through the cervix and then are going to swim toward the egg.

精子一旦射入阴道管，就会穿过子宫颈，然后游向卵子。

The egg could be at varying locations along the female reproductive axis.

卵子可能位于雌性生殖轴上的不同位置。

Now, this is actually a very important thing and actually gets right down to the safety of both the potentially developing embryo and the mother.

现在，这实际上是一件非常重要的事情，实际上关系到潜在发育的胚胎和母亲的安全。

There is something referred to as ectopic pregnancy, and that's when the pregnancy actually occurs within the fallopian tubes.

有一种情况被称为宫外孕，即怀孕实际上发生在输卵管内。

So the precise location in which fertilization between the sperm and the egg occurs can vary somewhat, but ideally, the fertilized egg implants into the endometrium or the endometrial lining of the uterus and develops there as opposed to within the fallopian tubes, which is so-called ectopic pregnancy.

因此，精子和卵子之间发生受精的精确位置可能会有所不同，但理想情况下，受精卵会植入子宫内膜或子宫内膜并在那里发育，而不是在输卵管内发育，这就是所谓的宫外孕。

Now, where the sperm and the egg meet exactly can vary, as I mentioned before, but in general, the faster swimming sperm and the more far along the ovulatory trajectory the egg are, the higher the probability of a successful fertilization because of the proximity to the implantation zone of the uterus.

现在，正如我之前提到的，精子和卵子的确切相遇位置可能会有所不同，但总的来说，精子游动速度越快，卵子沿排卵轨迹越远，成功受精的可能性就越高，因为靠近子宫的着床区。

So basically it's all a probabilities game.

所以基本上这都是一个概率游戏。

It's a probabilities game related to the number of sperm cells that encounter the egg and where the egg is in terms of its ovulatory cycle, and also its position where it is in the ovulatory cycle.

这是一个概率游戏，与遇到卵子的精子细胞数量、卵子在排卵周期中的位置以及卵子在排卵周期中的位置有关。

The sperm parameters, I should say the semen parameters and ejaculate parameters that most clinicians want to see if you were to give a sperm sample, would be somewhere in excess of 15 million sperm per milliliter of ejaculate.

如果您要提供精子样本，精子参数，我应该说大多数临床医生想要查看的精液参数和射精参数，将超过每毫升精液 1500 万个精子。

Now, there's a lot of discussion nowadays.

现在，现在有很多讨论。

It seems to be a very popular news theme to talk about diminishing sperm counts.

谈论精子数量减少似乎是一个非常流行的新闻主题。

The idea that 100 years ago or maybe even 35 years ago, the typical male ejaculate contained 100 million sperm per milliliter, and nowadays it's down to 15 to 20 or 50.

100 年前，甚至 35 年前，典型的男性精液每毫升含有 1 亿个精子，而现在这一数字已降至 15 至 20 或 50 个。

And indeed, sperm counts do seem to be declining, and the exact reasons for that are not clear.

事实上，精子数量似乎确实在下降，其确切原因尚不清楚。

Now, I confess I'm a little bit reluctant to talk about this because there have been a lot of back-and-forth discussions about the safety of EMFs, of electromagnetic fields.

现在，我承认我有点不愿意谈论这个，因为关于 EMF 和电磁场的安全性已经有很多反复的讨论。

That's not exactly what we're talking about here, but there are some excellent data contained in meta-analysis and reviews that I will provide links to and that we'll talk about in more detail in a minute, that correlate the advent of smartphones, and in particular, carrying of smartphones in the pocket with diminishing sperm counts.

这并不完全是我们在这里讨论的内容，但是荟萃分析和评论中包含一些出色的数据，我将提供这些数据的链接，我们将在一分钟内更详细地讨论这些数据，这些数据将智能手机的出现，特别是口袋里携带的智能手机与精子数量的减少联系起来。

Although there are certain to be other factors that can explain diminishing sperm counts as well.

尽管肯定还有其他因素可以解释精子数量减少的原因。

Dr. Shanna Swan, for instance, has done beautiful work describing how the phthalates, and the BPAs, and so-called endocrine disruptors might be disrupting some of the milieu of the seminiferous tubules.

例如，莎娜·斯旺 (Shanna Swan) 博士做了出色的工作，描述了邻苯二甲酸盐、双酚 A 和所谓的内分泌干扰物可能如何扰乱生精小管的某些环境。

So this would be reductions in testosterone and/or disruptions to the Sertoli cells and androgen-binding protein brought about by endocrine disruptors such as phthalates contained in pesticides and contained on printed receipts and things of that sort.

因此，这将是睾丸激素的减少和/或对支持细胞和雄激素结合蛋白的破坏，这是由内分泌干扰物（例如杀虫剂中所含的邻苯二甲酸盐、印刷收据等中所含的邻苯二甲酸盐）引起的。

There are some data that that is negatively impacting sperm counts.

有一些数据表明这会对精子数量产生负面影响。

How much so is still debatable.

究竟是多少，目前仍有争议。

There are also quite good data pointing to the fact that both the heat-related and the non-heat-related impact of smartphones and laptops contained on the lap are impacting sperm counts and in a negative way.

还有相当好的数据表明，放在膝盖上的智能手机和笔记本电脑与热相关和与热无关的影响都会对精子数量产生负面影响。

Again, there's going to be tremendous variation in the concentration of sperm from one individual to the next.

同样，一个人的精子浓度与另一个人的精子浓度存在巨大差异。

It will vary according to age and a number of other factors that we'll talk about a little bit later.

它会根据年龄和我们稍后讨论的许多其他因素而变化。

But in general, if somebody is wishing to conceive, then clinicians like to see an ejaculate volume of more than two milliliters.

但一般来说，如果有人希望怀孕，那么临床医生希望看到射精量超过两毫升。

So ejaculate volume can be anywhere from 1.5 to 5 milliliters, and that will strongly be determined by how frequent ejaculation is occurring.

因此，射精量可以在 1.5 到 5 毫升之间，这很大程度上取决于射精发生的频率。

There's a lot that goes into evaluating the quality of ejaculate and sperm, but basically These huge variations that are observed of anywhere from 15 million sperm per milliliter, or in some males who are not producing sperm for whatever reason, we'll talk about those reasons in a little bit, as low as five million sperm per milliliter, all the way up to 100 or maybe even 200 million sperm per milliliter.

评估精液和精子的质量需要做很多工作，但基本上，这些巨大的变化可以观察到，从每毫升 1500 万个精子，或者在一些出于某种原因不产生精子的男性中，我们将稍微讨论一下这些原因，低至每毫升 500 万个精子，一直到每毫升 100 个甚至 2 亿个精子。

Huge variation.

巨大的变化。

The cause of which is not always clear, but is certainly determined in part by the frequency of ejaculation.

其原因并不总是很清楚，但肯定部分取决于射精的频率。

So because there are so many variables impacting why one male versus another male, or even the same male across the lifespan might have variations in his concentration of sperm within the ejaculate, let's talk for a second about frequency of ejaculation as it relates to the goal of fertility per se, because that's really what today's episode is all about.

因此，由于有很多变量会影响为什么一个男性与另一个男性，甚至同一个男性在整个生命周期中的射精中精子浓度可能会有所不同，所以让我们谈谈射精频率，因为它与生育目标本身相关，因为这就是今天这一集的重点。

So what I'd like to talk about next is how people can increase the probability of a successful fertilization, focusing both on the components from the male side and from the female side.

那么我接下来要讲的是人们如何提高受精成功的概率，重点关注男性和女性方面的组成部分。

And I'm mainly going to couch this discussion in the context of the so-called natural method of sexual intercourse and ejaculation in vivo, within the female.

我主要是在女性体内所谓的自然性交和射精方法的背景下进行这个讨论。

But I will also touch on some parallel themes as it relates to in vitro fertilization and intrauterine insemination.

但我也会谈到一些与体外受精和宫内授精相关的平行主题。

Okay, so the idea here is that we want the maximum number of high-quality sperm, that is rapidly forward motile sperm that are of the correct morphology, that is shape.

好的，这里的想法是，我们想要最大数量的高质量精子，即具有正确形态（即形状）的快速向前运动的精子。

That's going to require a lot of mitochondria in the mid region, a well-shaped head, so it's going to be an oval-shaped head.

这将需要中间区域有大量线粒体，一个形状良好的头部，所以它将是一个椭圆形的头部。

The tail is going to be a single tail, not multiple tails.

尾巴将是单尾巴，而不是多尾巴。

These aren't going to be the twitcher type or immotile type of sperm that are either twitching in place or aren't moving forward.

这些精子不会是抽动型或不动型精子，它们要么原地抽动，要么不向前移动。

All of those components are going to be essential for increasing the probability of fertilization.

所有这些成分对于增加受精概率都至关重要。

But of course, there's the female side of it too, which is that ovulation occurs on just one day during the menstrual ovulatory cycle, and that egg will be available for fertilization for approximately 24 hours.

当然，也有女性的一面，即排卵只发生在月经排卵周期的某一天，卵子在大约 24 小时内可供受精。

Now, keep in mind that the sperm can survive within the vaginal duct and within the area around the cervix and within the uterus and along the female reproductive tract for anywhere from three to five, or it's even been described as up to seven days.

现在，请记住，精子可以在阴道导管内、子宫颈周围区域内、子宫内以及女性生殖道内存活三到五天，甚至被描述为长达 7 天。

But generally, it's going to be about three to five days.

但一般来说，三到五天左右。

Now, most women can figure out the day of their ovulation by counting the total number of days of their typical cycle.

现在，大多数女性可以通过计算典型周期的总天数来计算出排卵日。

And this is where it's really useful to have a cycle that's of more or less regular duration, or rather of more or less regular length.

这就是拥有一个或多或少有规律的持续时间，或者或多或少有规律的长度的周期真正有用的地方。

So as we talked about earlier, if somebody's cycle is 21 days or 25 days, and it's 21 or 25 days consistently, or even 30 days consistently, that's going to be a far better scenario to favor fertilization than if it's 20 days one month and then 21 days the next month, but then suddenly 30 days and then suddenly 35 days.

因此，正如我们之前谈到的，如果某人的周期是 21 天或 25 天，并且持续 21 天或 25 天，甚至持续 30 天，那么这将是一个比一个月 20 天，下个月 21 天，然后突然 30 天，然后突然 35 天更好的受精方案。

Those varying durations of the ovulatory cycle make it very hard, obviously, to time and understand when ovulation is going to occur.

显然，排卵周期持续时间的不同使得很难计算和了解排卵何时发生。

So regular duration ovulatory cycles are the ideal circumstance, and they're the ideal circumstance because even though the egg is only available for fertilization for a few days, those sperm can survive for some period of time, which leads to the issue of how often should couples be having intercourse, and here I'm referring specifically to intercourse with ejaculation.

所以排卵周期规律是理想的情况，之所以是理想的情况，是因为尽管卵子只能受精几天，但那些精子可以存活一段时间，这就产生了夫妻应该多久同房一次的问题，这里我特指的是射精同房。

How often should couples be having intercourse around the time of ovulation if the specific goal is successful fertilization of the egg and the creation of a baby?

如果具体目标是成功使卵子受精并生下婴儿，夫妻在排卵期间应该多久进行一次性交？

Okay, this is leaving aside all issues, which of course are interesting issues related to how often people are having intercourse, whether or not there's ejaculation every time they have intercourse or not, for sake of pleasure, or for sake of pair bonding and pleasure, or for sake of any number of other potential goals of intercourse.

好吧，这一切都放在一边，当然，这些有趣的问题与人们性交的频率有关，无论每次性交时是否射精，为了快乐，或者为了夫妻关系和快乐，或者为了任何其他潜在的性交目标。

Here I'm only referring to intercourse as it relates to the goal of fertilization of the egg, okay?

这里我仅指性交，因为它与卵子受精的目标有关，好吗？

So knowing what we know about spermatogenesis and the fact that ejaculate is going to contain a certain concentration of sperm, but that within that ejaculate, some of the sperm will be older and less healthy, and some will be optimally mature, and some might even be a little bit immature, although there's a tendency for the immature sperm to not have yet exited the seminiferous tubules, gone into the epididymis and vas deferens.

因此，了解我们对精子发生的了解以及射精将含有一定浓度的精子这一事实，但在射精中，一些精子会较老且不太健康，有些精子会处于最佳成熟状态，有些甚至可能有点不成熟，尽管不成熟的精子往往尚未离开生精小管，进入附睾和输精管。

But given that the ejaculate contains sperm of varying ages and therefore varying quality, and given that with each successive ejaculation in a short period of time, there's going to be a decrease in the concentration of sperm per milliliter of semen, of ejaculate.

但考虑到精液中含有不同年龄的精子，因此质量也不同，并且考虑到在短时间内连续射精，每毫升精液中的精子浓度将会下降。

We can make some good arguments as to how often couples should have intercourse with ejaculation around the time of ovulation if the goal is to fertilize.

如果目标是受精，我们可以提出一些很好的论据，说明夫妻在排卵期间应该多久进行一次射精。

If ovulation occurs on, for instance, day 14 of a cycle, and here we're using the kind of standard average of 28 days of the cycle, but for some people with a 30-day cycle, that could be day 15, or with a shorter cycle, it could be day 12, for instance.

例如，如果排卵发生在周期的第 14 天，这里我们使用周期 28 天的标准平均值，但对于某些周期为 30 天的人来说，排卵可能是第 15 天，或者周期较短的人可能是第 12 天。

But given a 28-day average cycle, let's say ovulation occurs on day 13 or on day 14, and typically would occur on day 14 of a 28-day cycle.

但考虑到平均周期为 28 天，假设排卵发生在第 13 天或第 14 天，并且通常会发生在 28 天周期的第 14 天。

Well, then, given how long sperm can survive inside of the woman, you might think that the optimal strategy would be to have as much intercourse with ejaculation in the three or four days leading up to ovulation, hope that those sperm swim as far as they possibly can and will encounter the egg just as soon as possible after it ovulates.

那么，考虑到精子在女性体内可以存活的时间，你可能会认为最佳策略是在排卵前的三四天内尽可能多地进行性交并射精，希望这些精子尽可能游得更远，并在排卵后尽快遇到卵子。

It turns out that's not the optimal strategy.

事实证明这不是最佳策略。

The optimal strategy is really to maximize the concentration of healthy sperm within each ejaculate and to really center that around the day of ovulation.

最佳策略实际上是最大限度地提高每次射精中健康精子的浓度，并将其集中在排卵当天。

So what this involves generally, and what the typical recommendation is, is to abstain from intercourse with ejaculation about two or three days out from ovulation, and then on the day prior to ovulation and on the day of ovulation, to essentially introduce as much semen and ejaculate into the reproductive pathway of the female as possible.

因此，这通常涉及的内容以及典型的建议是，在排卵后两三天左右避免射精性交，然后在排卵前一天和排卵当天，将尽可能多的精液和射精引入女性的生殖途径。

Okay?

好的？

Now, that's the general recommendation that the OBGYNs and the urologists that I spoke to gave.

这是我采访过的妇产科医生和泌尿科医生给出的一般建议。

But you will also hear a different strategy.

但您也会听到不同的策略。

It's only slightly different, but the different strategy involves trying to maximize the concentration of healthy sperm within each ejaculate, with the understanding that with each subsequent ejaculation over about a 24-hour period, that there's going to be a dramatic reduction in the concentration of sperm.

只是略有不同，但不同的策略包括尝试最大限度地提高每次射精中健康精子的浓度，并了解在大约 24 小时内的每次射精，精子浓度都会急剧降低。

What that means is that if a couple, for instance, were to have intercourse with ejaculation many times on the day prior to ovulation, yes, that will introduce a lot of sperm into the reproductive pathway of the female.

这意味着，例如，如果一对夫妇在排卵前一天多次性交并射精，是的，这会将大量精子引入女性的生殖途径。

But what it means is that on the day of ovulation, if they were to have intercourse, the number of high-quality sperm that will be available to the egg will be greatly diminished.

但这意味着，在排卵当天，如果他们发生性行为，可供卵子使用的优质精子的数量将大大减少。

And if none of the sperm that were introduced on the day prior managed to fertilize that egg, well then, essentially chances are off that there will be fertilization, or they're greatly diminished.

如果前一天引入的精子都无法使卵子受精，那么受精的机会基本上就消失了，或者大大减少了。

Rather, if they're having intercourse with ejaculation once or twice on the day prior to ovulation, and then a maximal number of times with ejaculation on the day of ovulation, that itself can maximize the probability of fertilization.

相反，如果他们在排卵前一天进行一次或两次射精性交，然后在排卵当天进行最大次数的射精，这本身就可以最大限度地提高受精的可能性。

So which strategy is optimal?

那么哪种策略是最优的呢？

Should couples have as much intercourse with ejaculation on the day prior to ovulation and on the day of ovulation?

夫妻在排卵前一天和排卵当天射精的性交次数应该一样多吗？

Or should they have intercourse on the day prior to ovulation, but not so frequently that it diminishes the concentration of sperm and then allows for intercourse with the maximum number of ejaculations on the day of ovulation?

或者应该在排卵前一天进行性交，但不要太频繁，以免降低精子浓度，然后在排卵日以最大射精次数进行性交？

You really hear it both ways.

你确实听到了两种说法。

And what this really boils down to is, frankly, that nobody knows.

坦率地说，这真正归结为什么，没人知道。

And the reason nobody knows is that there's tremendous variation among males in terms of the absolute concentration of sperm per milliliter of ejaculate, and the amount of sperm per milliliter of ejaculate within a given timeframe.

没有人知道的原因是，男性之间每毫升精液中精子的绝对浓度以及给定时间内每毫升精液中精子的数量存在巨大差异。

But what everyone agrees on is that a period of abstinence ranging from 48 to 72 hours prior to an ejaculation increases the concentration of high-quality sperm within that first ejaculation to occur after the abstinence period.

但大家都同意，射精前 48 至 72 小时的禁欲期会增加禁欲期后第一次射精时高质量精子的浓度。

Okay?

好的？

So again, to reiterate, if one's goal is to fertilize the egg, you want to take into consideration that most often there's going to be a dramatic decline in the concentration of sperm per ejaculate anytime those ejaculations are occurring within a short period of time, say, within 12 to 24 hours of one another.

因此，再次重申，如果一个人的目标是使卵子受精，您需要考虑到，每次射精在短时间内（例如，在 12 至 24 小时内）发生时，每次射精的精子浓度通常都会急剧下降。

Now, all of this, of course, also relates to female biology and the extent to which the woman can precisely identify the day and timing of her ovulation.

当然，所有这一切也与女性生物学以及女性能够精确识别排卵日期和时间的程度有关。

Some women feel as if, and indeed are very accurate at estimating their time of ovulation to within a couple of hours, or some women even report being able to feel their actual ovulation.

有些女性感觉好像并且确实非常准确地估计自己的排卵时间在几个小时内，或者有些女性甚至报告能够感觉到自己的实际排卵。

Whether or not they are feeling the ovulation itself, the deployment of the egg or not, isn't clear.

目前还不清楚他们是否感觉到排卵本身、卵子的部署。

I certainly wouldn't know.

我当然不知道。

I've never produced eggs, nor have I ovulated.

我从来没有产生过卵子，也没有排卵。

And I'm certainly not going to contest the idea that women can do that.

我当然不会质疑女性可以做到这一点的想法。

It makes sense that some people have a very keen so-called interoceptive awareness, an awareness of the sensory events within their body.

有些人有一种非常敏锐的所谓内感受意识，即对体内感官事件的意识，这是有道理的。

And while, of course, the ovaries are not thought of as an organ that we want to be able to sense what's going on in there in terms of feel, there are sensory endings within the ovary.

当然，虽然卵巢不被认为是我们希望能够通过感觉来感知其中发生的事情的器官，但卵巢内有感觉末梢。

And so the notion that one could literally sense changes within their ovary, including the deployment of the egg, is not outside the bounds of reason, and in fact, could likely be the case.

因此，人们可以从字面上感觉到卵巢内的变化，包括卵子的部署，这一概念并非超出了理性的范围，事实上，情况很可能如此。

Now, that said, there are a number of different ways that women will track their ovulation.

也就是说，女性可以通过多种不同的方式来追踪排卵。

One is the temperature method.

一是温度法。

So they'll actually measure intravaginal temperature.

所以他们实际上会测量阴道内温度。

They're looking for changes in temperature that are consistent around the time of ovulation.

他们正在寻找在排卵期间一致的温度变化。

We're going to have an expert guest on, an OBGYN, who can tell us a lot more about the details and nuances of the temperature method.

我们将邀请一位妇产科专家来宾，他可以告诉我们更多有关温度方法的细节和细微差别的信息。

You'll see a lot of information about this online, but there's a lot of misunderstanding about it as well.

你会在网上看到很多关于这方面的信息，但也存在很多误解。

Other women will use apps that take into account either the temperature information, if they're acquiring temperature information.

其他女性如果要获取温度信息，会使用考虑温度信息的应用程序。

That'll be entered into the app, as well as marking the onset of menstruation, the onset of bleeding, therefore the start of the ovulatory cycle, because, of course, as we mentioned earlier, that marks day one of their cycle.

这将被输入到应用程序中，并标记月经的开始、出血的开始，因此排卵周期的开始，因为，当然，正如我们之前提到的，这标志着月经周期的第一天。

And then again and again, you can see how regularity of cycle duration or relative regularity of cycle duration really favors this whole process of being able to predict when one ovulates.

然后一次又一次，您可以看到周期持续时间的规律性或周期持续时间的相对规律性如何真正有利于能够预测排卵时间的整个过程。

And fortunately, if the goal is fertilization, there are some margins for error that are introduced by the fact that the sperm can survive within the female reproductive tract for some period of days, thereby reducing the need for absolute certainty about the time of ovulation and so on.

幸运的是，如果目标是受精，由于精子可以在女性生殖道内存活一段时间，因此存在一些误差范围，从而减少了对排卵时间等的绝对确定性的需要。

In fact, it's pretty well known that around the time of ovulation, a couple of things happen.

事实上，众所周知，在排卵期间会发生一些事情。

Earlier, we talked about one thing, which is there's an increase in libido just prior to ovulation.

早些时候，我们讨论过一件事，那就是排卵前性欲增加。

This relates to, in part, an increase in some of the androgens, things like DHEA, but also testosterone and some related androgens that can increase libido both in males and females.

这在一定程度上与某些雄激素的增加有关，例如 DHEA，还有睾酮和一些相关的雄激素，它们可以增加男性和女性的性欲。

And changes to the reproductive pathway of the female, in particular, a change in the pH, that is the relative acidity versus basic nature of the mucosal lining near the cervix and also vaginal secretions, such that around the time of ovulation, the entire milieu of the vagina and the cervix and the locations in which fertilization can occur and certainly in which the sperm are swimming towards the opportunity for fertilization, is shifted to support sperm motility and health.

女性生殖途径的变化，特别是pH值的变化，即子宫颈附近粘膜和阴道分泌物的相对酸度与碱性，这样在排卵期间，阴道和子宫颈的整个环境以及受精发生的位置，当然还有精子游向受精机会的位置，都会发生变化，以支持精子的活力和健康。

In other words, one of the best environments for sperm to survive is going to be within the female reproductive pathway itself.

换句话说，精子生存的最佳环境之一就是女性生殖途径本身。

And as long as we're talking about vaginal secretions and mucus, it's important to point out that a number of commercially available lubricants can actually be detrimental for sperm health, even if they don't contain spermicide.

只要我们谈论阴道分泌物和粘液，就必须指出，许多市售润滑剂实际上可能对精子健康有害，即使它们不含杀精剂。

So this is something that you'll want to discuss with your OBGYN or Certainly if you're male, you could also discuss this with your urologist and your partner's OB-GYN.

因此，您需要与您的妇产科医生讨论这个问题，或者当然，如果您是男性，您也可以与您的泌尿科医生和伴侣的妇产科医生讨论这个问题。

A lot of the commercially available lubricants contain chemicals that while they may favorably change the consistency or the viscosity of the vaginal pathway for purposes of intercourse, certainly may not be the most favorable for maintaining the health of the sperm and the motility of the sperm.

许多市售润滑剂含有化学物质，虽然它们可能有利于改变阴道通道的稠度或粘度以达到性交目的，但当然可能不是最有利于维持精子的健康和精子活力。

So again, here we're talking about intercourse only in the context of trying to maximize fertilization.

再说一次，我们在这里讨论性交只是为了最大限度地受精。

And I should mention that there are certain lubricants that are more conducive to the sperm environment, but it's something that you'll really want to talk to your OB-GYN about, or at least read up about if your interest is in trying to fertilize and develop an embryo.

我应该提到，有些润滑剂更有利于精子环境，但您确实想与您的妇产科医生讨论这一点，或者至少阅读一下您是否对尝试受精和发育胚胎感兴趣。

So we covered the optimal strategies for how often couples should have intercourse with ejaculation around the time of ovulation in order to maximize the probability that successful fertilization and ultimately pregnancy will occur.

因此，我们介绍了夫妻在排卵期间应多久进行一次射精的最佳策略，以最大限度地提高成功受精和最终怀孕的可能性。

What we haven't covered yet, however, is how long couples should apply that method over time in order to achieve successful fertilization and pregnancy.

然而，我们还没有讨论的是，夫妻应该应用这种方法多长时间才能成功受精和怀孕。

Now, of course, if a couple decides that they want to conceive and they apply that method or any other method, for instance, and they achieve fertilization and a successful pregnancy the very first month that they try, well, then there's no other work to do, at least until that child is born, and if and only if they decide they want to have more children.

当然，现在，如果一对夫妇决定他们想要怀孕，并应用该方法或任何其他方法，例如，他们在尝试的第一个月就实现了受精并成功怀孕，那么，至少在孩子出生之前，并且当且仅当他们决定想要更多的孩子时，就没有其他工作要做。

However, many couples find that they do not conceive in the first month of trying, even when they apply the optimal methods and even if their age and every other factor related to egg quality and sperm quality is optimized.

然而，许多夫妇发现他们在尝试的第一个月就没有怀孕，即使他们采用了最佳方法，即使他们的年龄以及与卵子质量和精子质量相关的所有其他因素都得到了优化。

Now, I think it's the rare instance in which egg quality and sperm quality are optimized.

现在，我认为这是卵子质量和精子质量得到优化的罕见实例。

In fact, the word optimal and optimization and optimized is a little bit misleading in general because no one really knows what that is.

事实上，“最佳”、“优化”和“优化”这个词一般来说有点误导，因为没有人真正知道那是什么。

But of course, there is an ideal, there's a perfect standard to which everyone would like to achieve.

但当然，有一个理想，有一个每个人都想达到的完美标准。

But of course, we all enter the picture with genetic variables, environmental variables, and so forth, many of which we'll talk about because you can in fact adjust them in the direction that you would like to improve sperm and egg quality.

当然，我们都会涉及遗传变量、环境变量等，我们将讨论其中的许多变量，因为实际上您可以按照您想要提高精子和卵子质量的方向调整它们。

But most people simply will not succeed in achieving a successful fertilization the first month that they try.

但大多数人在尝试的第一个月根本无法成功受精。

Now, there is a truth that governs how many tries it ought to take in order to achieve successful fertilization and ultimately pregnancy.

现在，有一个事实决定了应该进行多少次尝试才能成功受精并最终怀孕。

And it's very age dependent, and in particular, it's dependent on the age of the mother because the age and quality of the egg, while it's not the only factor, is certainly one of the most determining factors in whether or not successful fertilization occurs.

它非常依赖于年龄，特别是依赖于母亲的年龄，因为卵子的年龄和质量虽然不是唯一的因素，但肯定是成功受精的最决定因素之一。

And as women age, the quality of the eggs tends to diminish over time, largely due to changes in the mitochondrial function and the spindle that pulls the chromosomes apart, although there could be other factors involved as well.

随着女性年龄的增长，卵子的质量往往会随着时间的推移而下降，这主要是由于线粒体功能和将染色体拉开的纺锤体发生变化，尽管也可能涉及其他因素。

Now, before continuing any further, I just want to acknowledge that this whole language around egg quality and sperm quality is not the greatest language because it's entirely subjective.

现在，在继续之前，我只想承认，关于卵子质量和精子质量的整个语言并不是最好的语言，因为它完全是主观的。

And yet the word quality in these instances is really there to explain a broad variety of factors that can in fact be measured.

然而，在这些情况下，“质量”一词确实可以解释实际上可以测量的各种因素。

Things like the number of follicles that are deployed each month in a woman's ovulation, or the number of motile sperm, or the number of morphologically, that is correctly shaped sperm in the male and so forth.

比如女性排卵期间每个月部署的卵泡数量，或者活动精子的数量，或者男性形态正确的精子数量等等。

So when we talk about egg quality or sperm quality, we're really referring to an amalgam of different features related to the different aspects of ovulation leading to successful fertilization, or the different aspects of sperm related to whether or not they can arrive and deliver their DNA contents and so forth.

因此，当我们谈论卵子质量或精子质量时，我们实际上指的是与导致成功受精的排卵的不同方面相关的不同特征的混合体，或者与精子是否能够到达并输送其 DNA 内容等相关的精子的不同方面。

So I will use the words egg quality and sperm quality just as general themes, because that's what a lot of the clinicians use.

因此，我将使用卵子质量和精子质量这两个词作为一般主题，因为这是许多临床医生使用的术语。

But I do understand that it's a little bit of a loaded term in both instances, and it doesn't relate to any one specific parameter per se.

但我确实明白，在这两种情况下，这都是一个有点负载的术语，并且它本身与任何一个特定参数无关。

So getting back to this issue of how long couples should try according to the age of the female and perhaps also the age of the male.

那么回到这个问题，夫妻应该根据女性的年龄，也许还有男性的年龄，尝试多长时间。

Well, most of the data that have been collected relate to the age of the female, as I mentioned before.

嗯，正如我之前提到的，收集到的大部分数据都与女性的年龄有关。

And what we're about to discuss is within the scientific literature described as what's called fecundability, which is the amount of time over which a given couple needs to attempt to conceive, of course, by having intercourse with ejaculation around the time of ovulation.

我们要讨论的是科学文献中所谓的生育能力，即一对夫妇需要尝试怀孕的时间，当然，是在排卵期间进行性交和射精。

Okay.

好的。

It assumes that all the other things are being done correctly.

它假设所有其他事情都已正确完成。

And what we know is that there's a strong age dependent effect that largely rests on the age of the egg, that is of the female.

我们知道，存在很强的年龄依赖性效应，很大程度上取决于卵子（即雌性）的年龄。

And what we know is that for females 30 years old or younger, if they have intercourse with ejaculation around the time of ovulation, say on the day before and on the day of ovulation, and there could be other intercourse with ejaculation around that time as well, on average, that will result in a successful fertilization and pregnancy about 20% of the time on the first month of attempting, the first ovulation cycle.

我们知道，对于 30 岁或以下的女性来说，如果她们在排卵时间（即排卵前一天和排卵当天）进行性交并射精，并且在该时间附近可能还有其他性交并射精，那么平均而言，在尝试的第一个月（即第一个排卵周期）中，大约有 20% 的时间会成功受精和怀孕。

Now, if fertilization and pregnancy occurs, great.

现在，如果受精和怀孕发生，那就太好了。

Right?

正确的？

There'll be at least a nine-month lag until they decide whether or not they want to try and conceive again.

在他们决定是否要再次尝试怀孕之前，至少会有九个月的延迟。

However, most couples, even if the woman is 30 years old or younger, will not successfully conceive on that first attempt, and that's because the probability is not 100%, it's 20%.

然而，大多数夫妇，即使女性年龄在 30 岁或更小，第一次尝试也不会成功受孕，因为概率不是 100%，而是 20%。

So 80% of the time, they simply will not conceive, which means that they hopefully will try again the very next month.

因此，80% 的情况下，她们根本不会怀孕，这意味着她们希望在下个月再次尝试。

And if they successfully conceive, great, and if they don't, then they ought to try again the next month, the next month, and so forth.

如果他们成功受孕，那就太好了，如果没有，那么他们应该在下个月、下个月再次尝试，依此类推。

Now, the typical advice that an OB-GYN would give you is that for a woman 30 years or younger, and leaving aside the age of the father, but still assuming that egg quality and sperm quality are sufficiently high to achieve fertilization, that the couple should, or if the woman's trying to have kids alone, the woman should attempt to conceive over the period of six months.

现在，妇产科医生会给您的典型建议是，对于 30 岁或以下的女性，不考虑父亲的年龄，但仍然假设卵子质量和精子质量足够高，可以实现受精，这对夫妇应该，或者如果该女性试图独自生孩子，则该女性应该在六个月内尝试怀孕。

Why?

为什么？

Well, if you think about it, if there's a 20% chance in the first month and it's unsuccessful, well then on the second month, there'll also be a 20% chance.

嗯，你想一想，如果第一个月有20%的机会不成功，那么第二个月也有20%的机会。

On the third month, also a 20% chance.

第三个月，同样有20%的机会。

What I'm describing here is what obviously is independent probabilities.

我在这里描述的显然是独立概率。

That is, if you were to flip a coin and the probability of getting heads is 50%, the probability of getting tails is 50%, of course.

也就是说，如果你抛一枚硬币，正面朝上的概率是 50%，那么反面朝上的概率当然也是 50%。

You don't expect that the previous flip had anything to do with the result that you'll get on the subsequent flip.

您不会期望上一次翻转与下一次翻转的结果有任何关系。

That's what independent probabilities are.

这就是独立概率。

However, when it comes to fecundability, we're really talking about something which is called cumulative pregnancy rate, which is not really independent probabilities.

然而，当谈到生育能力时，我们真正谈论的是所谓的累积妊娠率，这并不是真正的独立概率。

Now why would that be?

为什么会这样呢？

Why would it be that if you did not successfully conceive in the first month of trying, that by simply trying again and again and again, the probability of conceiving would increase?

为什么第一个月没有成功受孕，只要一再尝试，受孕的几率就会增加呢？

Well, the reason for that is that this whole business of fertilization is not just about what's happening with the egg, it's also about what's happening with the sperm.

原因是整个受精过程不仅与卵子发生的情况有关，还与精子发生的情况有关。

So there are a number of different events related to the biology of the egg and the biology of the sperm, which you are now very familiar with from everything I've talked about up until now.

因此，有许多与卵子生物学和精子生物学相关的不同事件，从我到目前为止所讨论的所有内容中，您现在已经非常熟悉了。

And there are a bunch of chance events, for instance, that the sperm won't actually arrive at the egg in time, or that the egg won't arrive at the sperm in time, because of course it's a bi-directional migration of those two cell types.

还有很多偶然事件，例如，精子实际上不会及时到达卵子，或者卵子不会及时到达精子，因为这当然是这两种细胞类型的双向迁移。

Or that for whatever reason, fertilization won't occur.

或者无论出于何种原因，受精都不会发生。

So what we're really talking about when we talk about the cumulative pregnancy rate over time is the fact that there are multiple probabilities at work, and yes, those are somewhat independent in the sense that the biology of the sperm doesn't really strictly depend on the biology of the egg, at least not until they meet and fertilize.

因此，当我们谈论一段时间内的累积怀孕率时，我们真正谈论的是存在多种概率的事实，是的，这些概率在某种程度上是独立的，因为精子的生物学并不真正严格依赖于卵子的生物学，至少在它们相遇并受精之前不会。

But the likelihood of pregnancy depends on those independent probabilities, which makes this a cumulative pregnancy rate.

但怀孕的可能性取决于这些独立的概率，这使得它成为累积怀孕率。

Now, if any of that is confusing, what it basically means is that for the egg and the sperm to meet and to fertilize a number of different events that carry some intentionality, right?

现在，如果其中有任何令人困惑的地方，它基本上意味着卵子和精子相遇并受精的许多不同事件带有某种意向性，对吗？

The sperm swims towards the egg and so forth.

精子游向卵子，依此类推。

The egg doesn't have a personality in there, at least not yet, but it "wants to be fertilized," right?

卵子里面没有个性，至少现在还没有，但它“想要受精”，对吗？

It is in principle receptive to fertilization.

原则上它是易于受精的。

Well, in order for that to happen, there are going to be some events related to chance that could limit the ability for that to happen, and there'll be other events dictated by the biology of those two cell types that are driving that event to happen, that are biasing the event to yes happen.

好吧，为了让这种情况发生，将会有一些与机会相关的事件可能会限制这种情况发生的能力，并且还会有由这两种细胞类型的生物学决定的其他事件驱动该事件发生，从而使该事件发生偏向。

And so what we're talking about when we talk about cumulative pregnancy rate is how much of the biology of the woman is skewed towards fertilization to be likely to occur.

因此，当我们谈论累积怀孕率时，我们谈论的是女性的生物学有多少偏向于可能发生的受精。

Okay, so to make this very simple, all we need to know is that for women 30 years old or younger, because the probability of getting pregnant on any one attempt to conceive is 20%, well then if that doesn't occur the first time, then she should simply repeat that at least five and probably six times before deciding to go to an OBGYN and conclude that there's something going on either with the egg or of course it could be with the sperm.

好吧，简单来说，我们需要知道的是，对于 30 岁或以下的女性来说，因为任何一次尝试怀孕的概率都是 20%，那么如果第一次没有发生这种情况，那么她应该简单地重复这一点至少五次甚至可能六次，然后再决定去妇产科，并得出结论，要么是卵子出了问题，当然也可能是精子出了问题。

But in general, that's why OBGYNs will tell their female patients, "Look, if you're setting out to conceive, try for about five or six months, and if you're not successful, come back and see me." Now, for women who are age 31 to 33, the probability of conceiving in that first month drops to about 18%.

但总的来说，这就是为什么妇产科医生会告诉她们的女性患者，“听着，如果你打算怀孕，尝试大约五六个月，如果不成功，就回来见我。”现在，对于 31 岁至 33 岁的女性来说，第一个月受孕的概率下降至 18% 左右。

So women in that age range and their partners should certainly try and conceive naturally over a period of six or seven months.

因此，这个年龄段的女性及其伴侣当然应该在六七个月的时间内尝试自然受孕。

And then for women who are age 34 to 37, the probability of conceiving in that first month of trying, and certainly every month thereafter is about 11%.

而对于 34 至 37 岁的女性来说，在尝试的第一个月以及之后的每个月受孕的概率约为 11%。

So when the age of the woman starts extending out to about 34 or 35 years old, then the typical advice of the OBGYN is going to be to attempt to conceive over a period of about nine months to a year before deciding to take some sort of medical intervention.

因此，当女性的年龄开始延长至 34 或 35 岁左右时，妇产科医生的典型建议是在决定采取某种医疗干预之前，在大约九个月到一年的时间内尝试怀孕。

And then of course, as the age of the woman increases, so too does the quality of the eggs go down.

当然，随着女性年龄的增长，卵子的质量也会下降。

Now, that's not true for every woman.

但并不是每个女人都这样。

There are many women who in their late 30s and 40s and even early 50s, have successfully conceived healthy children.

许多30多岁、40多岁甚至50岁出头的女性都成功怀上了健康的孩子。

Although the probability of that, the likelihood of it drops substantially.

虽然这种可能性很大，但发生的可能性却大幅下降。

So for instance, for women who are age 38 to 39, the probability of a successful conception by natural conception, intercourse with ejaculation, is going to be about 5%, right?

比如说，对于38岁到39岁的女性来说，通过自然受孕、射精同房成功受孕的概率大约是5%，对吧？

So it's really dropped to a quarter of what it was when that woman was 30.

所以它真的下降到了那个女人 30 岁时的四分之一。

Again, these are averages only.

再次强调，这些只是平均值。

What does that mean?

这意味着什么？

Well, it means that if you are age 38 or older, chances are that you should probably go to your OBGYN right at the outset of your desire to conceive and ask what you can do to improve egg quality.

嗯，这意味着，如果您年满 38 岁或以上，您很可能应该在您一开始想要怀孕时就去妇产科，询问可以采取哪些措施来提高卵子质量。

Otherwise, if you were to extend the math out, right, we know that if you're age 30 or younger, 20% chance in any one given month, that means about four to six months of trying.

否则，如果你把数学延伸出去，对吧，我们知道，如果你年龄在 30 岁或更小，在任何一个月里有 20% 的机会，这意味着大约四到六个月的尝试。

Well, you can simply multiply that times four or five for someone in their late 30s or early 40s.

对于 30 岁末或 40 岁出头的人来说，你可以简单地将这个数字乘以四或五。

And so what you're really talking about is several years of trying, and of course, what's happening during those several years, the woman is getting older, and as a consequence, the quality of the eggs is declining even further.

所以你真正谈论的是几年的尝试，当然，这几年发生的事情，女人越来越老，结果，卵子的质量进一步下降。

So if you are 35, 36 years old, it might not be entirely unreasonable to talk to your OBGYN right at the outset of desiring to conceive.

因此，如果您是 35 岁、36 岁，在想要怀孕之初就与您的妇产科医生交谈可能并非完全没有道理。

But you could also just take the approach of trying to conceive naturally for about a year or a year and a half before deciding to do that.

但您也可以采取尝试自然受孕大约一年或一年半的方法，然后再决定这样做。

Keeping in mind that all the while you can't stop time, so biological time and aging is going to occur in the backdrop.

请记住，您始终无法停止时间，因此生物时间和衰老将在背景中发生。

But hopefully, this description of cumulative pregnancy rate makes sense.

但希望这种对累积怀孕率的描述是有意义的。

Again, the idea is that while it's true that every single month there's an independent chance of the woman getting pregnant, and that chance is dropping from about 20% at age 30 over time to about really one to 3% for women 40 or older.

同样，这个想法是，虽然女性每个月都有独立的怀孕机会，但随着时间的推移，这个机会从 30 岁左右的 20% 下降到 40 岁或以上女性的 1% 到 3% 左右。

There's also this notion of cumulative probability, which involves multiple biological events in both the egg and the sperm that have to converge in time and space in order for successful fertilization to occur.

还有累积概率的概念，它涉及卵子和精子中的多个生物事件，这些事件必须在时间和空间上聚合才能成功受精。

Now, as long as we're on this topic, I think it's only fair to address the issue of miscarriage.

现在，只要我们讨论这个话题，我认为解决流产问题才是公平的。

And miscarriages can arise from a variety of sources.

流产可能有多种原因。

They can arise from genetic defects.

它们可能是由遗传缺陷引起的。

They can arise from issues in the milieu of the uterus.

它们可能是由子宫环境的问题引起的。

They can arise from issues with the sperm, for that matter.

就此而言，它们可能是由精子问题引起的。

We really don't want to put all the weight and all the responsibility on the egg.

我们真的不想把所有的重量和责任都放在鸡蛋上。

This is always an egg-sperm dynamic.

这始终是卵子-精子的动态变化。

And when I say egg-sperm dynamic, now hopefully that calls to mind the huge library of information that we've been covering up until now about chromosomal segregation and the coming together of these different cell types and their genetic information.

当我说卵子-精子动态时，希望这能让人想起我们迄今为止一直在掩盖的关于染色体分离以及这些不同细胞类型及其遗传信息的汇集的庞大信息库。

Any number of different steps within the process of fertilization leading up to pregnancy can lead to miscarriage.

受精过程中导致怀孕的任何不同步骤都可能导致流产。

However, the probability of miscarriage greatly increases as a function of the age of the egg.

然而，流产的可能性随着卵子年龄的增加而大大增加。

And the basic numbers on this are that for women who are 35 years or older, about 25% of successful fertilizations lead to miscarriages.

基本数据是，对于 35 岁或以上的女性，大约 25% 的成功受精会导致流产。

Now, when those miscarriages occur during pregnancy can be highly variable.

现在，怀孕期间发生流产的时间可能存在很大差异。

Sometimes it's within the first trimester, sometimes it could be later, but the probability is about 25%.

有时是在孕早期，有时可能会晚一些，但概率约为 25%。

That probability increases greatly over time, such that by the time women are in their early 40s, so 40 or older, the probability of miscarriage after a successful fertilization is going to be about 50%.

随着时间的推移，这种可能性会大大增加，因此，到女性 40 岁出头时，即 40 岁或以上，成功受精后流产的可能性将达到 50% 左右。

And this could be due to a number of factors, as I mentioned before, but one common reason is that there can be chromosomal abnormalities, and that could be related typically to the segregation of the egg when half of the chromosomes in that egg are removed, taking it from diploid to haploid.

正如我之前提到的，这可能是由于多种因素造成的，但一个常见的原因是可能存在染色体异常，这通常与卵子的分离有关，当卵子中的一半染色体被去除时，将其从二倍体变为单倍体。

If you recall, there's that little polar body, which is the removal of the chromosomes that's ejected from the egg that will eventually ovulate.

如果你还记得的话，有一个小极体，它是从最终排卵的卵子中排出的染色体的去除。

And sometimes not all the chromosomes that were supposed to be ejected in that polar body are ejected, and as a consequence, there are multiple chromosomes or duplications of chromosomes, things like trisomies.

有时，并不是所有应该在极体中排出的染色体都被排出，因此，存在多条染色体或染色体重复，例如三体性。

Sometimes too many chromosomes move away, and they're actually removal of entire chromosomes, meaning both strands, so that you have chromosomal deletions.

有时太多的染色体会移走，它们实际上是去除了整个染色体，即两条链，因此出现了染色体缺失。

And in that case, typically fertilization won't occur, but there are instances in which fertilization will occur.

在这种情况下，通常不会发生受精，但在某些情况下会发生受精。

So a woman will get a positive pregnancy test, her periods will stop, and the couple will think that they're advancing along the steps to a successful pregnancy, and then there will be, sadly, a miscarriage.

因此，一名女性的妊娠测试呈阳性，她的月经会停止，夫妻俩会认为他们正在朝着成功怀孕的方向前进，然后不幸的是，会流产。

Many, many times those miscarriages are the consequence of the fact that when there are extra chromosomes there, or there are too few chromosomes present, that embryogenesis can simply not progress in a healthy way.

很多时候，这些流产是由于以下事实造成的：当存在额外的染色体或染色体太少时，胚胎发生根本无法以健康的方式进行。

There are some instances in which all of the chromosomes and all the chromosomal arrangements are perfectly normal and miscarriages can still occur.

在某些情况下，所有染色体和所有染色体排列都完全正常，但仍然可能发生流产。

I'm going to do a future episode about pregnancy and embryonic development, where we will get into this more deeply.

我将制作关于怀孕和胚胎发育的下一集，我们将更深入地讨论这一点。

But just understand that the frequency of miscarriages increases dramatically after about age 34, and then continues to increase dramatically, extending well out into the 40s.

但要明白的是，流产的频率在 34 岁左右之后急剧增加，然后继续急剧增加，一直延伸到 40 多岁。

Now, a very important consideration in terms of understanding and predicting fertility and fecundability, this word that describes the probability of getting pregnant on a given try and over time, is trying to address how quote unquote fertile a woman is, and importantly, how quote unquote fertile a male is.

现在，在理解和预测生育力和生育能力方面一个非常重要的考虑因素，这个词描述了在给定的尝试和一段时间内怀孕的概率，试图解决女性的生育能力如何，更重要的是，男性的生育能力如何。

And we'll talk about the male side in a moment.

我们稍后会讨论男性方面。

But when trying to address how fertile a woman is, of course, age is going to be one of the major factors.

但是，当试图解决女性的生育能力时，年龄当然将成为主要因素之一。

But just one factor.

但这只是一个因素。

We already talked about how age determines the likelihood of a successful pregnancy if the intercourse and ejaculation is being carried out at the correct times and with viable sperm capable of fertilizing eggs.

我们已经讨论过，如果在正确的时间进行性交和射精并且精子能够使卵子受精，那么年龄如何决定成功怀孕的可能性。

And then, of course, there's the issue of egg quality.

当然，还有鸡蛋质量的问题。

But in general, most women would like to know how fertile they are as a function of their age.

但总的来说，大多数女性都想知道她们的生育能力与年龄的关系。

And I actually think this is one of the most important topics in this whole space around fertility that isn't often discussed, or at least isn't often discussed until women are in their late 30s or 40s, when oftentimes they will look back and wish that either they had frozen their eggs or they had frozen fertilized embryos, which is a whole thing unto itself.

事实上，我认为这是整个生育领域最重要的话题之一，但很少有人讨论这个话题，或者至少在女性 30 多岁或 40 多岁之前不会经常讨论，那时她们常常会回顾过去并希望要么冷冻卵子，要么冷冻受精胚胎，这本身就是一回事。

And we talk about that when we have an episode on in vitro fertilization in more depth.

当我们更深入地了解体外受精的一集时，我们会讨论这一点。

But there is a fairly straightforward way or set of ways that women can determine their basic level of fertility.

但是，女性可以通过一种或一组相当简单的方法来确定其基本生育水平。

Leaving aside a lot of the detailed issues about the quality of eggs and so forth, one thing that you already learned is that there's this vault, there's this reserve that we call the ovarian reserve, and that each month, a certain number of follicles leave that reserve, and there's the opportunity, based on the ovulation of a single egg, to fertilize that egg and for the woman to get pregnant.

抛开许多有关卵子质量等的详细问题，您已经了解到的一件事是，有一个穹顶，有一个储备，我们称之为卵巢储备，每个月都有一定数量的卵泡离开该储备，并且根据单个卵子的排卵，有机会使该卵子受精并使女性怀孕。

Now, one thing that we know for sure is that the size of the population that's released from that vault each month has a very strong positive correlation with the size of the reserve in the vault itself.

现在，我们确定的一件事是，每个月从该金库释放的人口规模与金库本身的储备规模具有非常强的正相关关系。

So the way to think about this perhaps is that the vault is like a bank account, has a certain amount of money, or in this case, eggs in it.

因此，思考这个问题的方法可能是，金库就像一个银行账户，里面有一定数量的钱，或者在这种情况下，里面有鸡蛋。

And you could imagine if someone's reasonably logical, that if they have more money in their bank account, then they're going to withdraw a larger amount each month than if they have a small amount each month, if the idea is to make that vault, that bank of eggs, available to them over the longest period of time.

你可以想象，如果一个人的逻辑合理，如果他们的银行账户里有更多的钱，那么他们每个月会提取比每月少量的更多的金额，如果这个想法是让那个金库，那个鸡蛋银行，在最长的时间内可供他们使用。

And indeed, biology is pretty smart.

事实上，生物学非常聪明。

It doesn't deploy or release half the follicles in one month and then just slowly trickle out the remainder of follicles.

它不会在一个月内部署或释放一半的卵泡，然后慢慢地排出剩余的卵泡。

No, that's not how it works.

不，事情不是这样的。

What you find is that, of course, in younger women, so say in their late teens, 20s, and 30s, the ovarian reserve in the vault is going to have more eggs in it, and the number of follicles and eggs that leave that vault each month is going to be quite high.

当然，你会发现，对于年轻女性，比如十几岁、二十几岁和三十多岁的女性，卵巢储备库中的卵子会更多，并且每个月离开卵巢库的卵泡和卵子数量会相当高。

So one way to evaluate How "fertile" you are, again, just one way is to go to your OBGYN and say that you would like to know how many follicles you have in a given month.

因此，评估您的“生育力”程度的一种方法，再次强调，一种方法就是去妇产科，并说您想知道您在给定月份内有多少个卵泡。

And of course, they'll look at them on both sides in both ovaries.

当然，他们会观察两侧卵巢的情况。

And for instance, if a woman has just two or three follicles that are out each month, well, then the assumption, again, it's just an assumption, but the assumption that's pretty good because there's this positive correlation that generally occurs is that that ovarian reserve, that the number of eggs in the vault is fairly low compared to someone who, say, has 20 follicles or 30 follicles each month.

举个例子，如果一个女人每个月只有两到三个卵泡，那么这个假设，同样，这只是一个假设，但是这个假设是相当好的，因为通常存在这种正相关性，即卵巢储备，即与每月有 20 个或 30 个卵泡的人相比，卵巢储备库中的卵子数量相当低。

Okay?

好的？

And that's the typical trend.

这就是典型的趋势。

Again, these are averages, and it's very important to not get attached to any one number here.

再次强调，这些都是平均值，不要执着于任何一个数字，这一点非常重要。

Again, these are averages.

再次强调，这些是平均值。

So for instance, there are women who only deploy five follicles and eggs each month out of their ovarian vault, but who find themselves to be very fertile, right?

举例来说，有些女性每个月只从卵巢穹窿中排出五个卵泡和卵子，但她们发现自己的生育能力很强，对吗？

And there could be a number of different factors to explain that.

可能有许多不同的因素可以解释这一点。

Other women will have 20 or 30 eggs and follicles that leave that vault, the ovarian reserve, each month, and they will have a harder time getting pregnant for any number of different reasons.

其他女性每月会有 20 或 30 个卵子和卵泡离开卵巢储备库，并且由于各种不同的原因，她们怀孕会更加困难。

But in general, the more eggs and follicles that leave the vault each month, the higher number of eggs that are still in reserve, meaning the greater amount of time over which a given woman could still attempt to have successful fertilizations.

但总的来说，每月离开卵泡的卵子和卵泡越多，仍然保留的卵子数量就越多，这意味着特定女性仍然可以尝试成功受精的时间就越长。

Now, this small collection of follicles and eggs that are released each month actually has a name.

现在，每个月释放的这一小部分卵泡和卵子实际上有了一个名字。

They're called antral follicles.

它们被称为窦卵泡。

These are small follicles.

这些是小毛囊。

They tend to be about 2 to 9 millimeters across.

它们的宽度通常约为 2 至 9 毫米。

The way these are analyzed or measured is woman will go into the OBGYN office and by ultrasound, typically, there's some local anesthesia, but it's not often a general anesthesia, but by local anesthesia or sometimes no anesthesia.

这些分析或测量的方式是女性进入妇产科办公室并通过超声波检查，通常会有一些局部麻醉，但通常不是全身麻醉，而是局部麻醉或有时不麻醉。

They will essentially count the number of follicles that are present in each side, on the ovary on the left and the ovary on the right, and give a woman some sense of how many follicles she has.

他们基本上会计算两侧卵巢（左侧卵巢和右侧卵巢）的卵泡数量，并让女性了解自己有多少个卵泡。

And typically, this is done over a series of months to determine how many eggs are leaving the ovarian reserve each month, and therefore, how many eggs she is likely to still have in the ovarian reserve.

通常，这是在几个月的时间内完成的，以确定每个月有多少卵子离开卵巢储备，因此，她的卵巢储备中可能还有多少卵子。

Now, there's a non-invasive way to do this as well, although typically an OBGYN will do both what I just described with ultrasound and measure something called AMH, which is anti-Müllerian hormone, which is a hormone that is released by that antral follicle population, the population of follicles and eggs that leave the ovarian reserve each month.

现在，也有一种非侵入性的方法可以做到这一点，尽管妇产科医生通常会做我刚才描述的超声检查，并测量一种叫做 AMH 的东西，AMH 是抗苗勒氏管激素，这是一种由窦卵泡群（每月离开卵巢储备的卵泡和卵子群）释放的激素。

So one is a blood draw measure of a hormone, AMH.

其中之一是通过抽血测量 AMH 激素。

The other is a structural imaging measure of the antral follicles directly.

另一种是直接对窦卵泡进行结构成像测量。

Again, the typical trend is for the number of antral follicles to decline over time.

同样，典型的趋势是窦卵泡的数量随着时间的推移而减少。

So one might expect, for instance, that a woman in her 20s or 30s might have 20, 30, maybe even 40 antral follicles that are exiting the reserve each month.

例如，人们可能会预期，一名 20 多岁或 30 多岁的女性每月可能有 20、30、甚至 40 个窦卵泡离开储备区。

And again, that's the total across both ovaries.

再说一遍，这是两个卵巢的总数。

Again, these are just averages.

再次强调，这些只是平均值。

These are going to be distributions.

这些将是发行版。

There will be people with far fewer, there will be people with far more.

有些人的财富要少得多，有些人的财富要多得多。

But that over time, regardless of where a woman starts out, from one decade to the next half decade and decade and so on, that the number of antral follicles will decline and the amount of or the levels of AMH will also decline.

但随着时间的推移，无论女性从哪里开始，从十年到下一个五年、十年等等，窦卵泡的数量都会减少，AMH 的数量或水平也会下降。

So what does this all mean?

那么这一切意味着什么呢？

What this means is that if you are a woman who is in her 20s or 30s or 40s, whatever your age, if you are interested in conceiving in the future, it's very likely a good idea to go to your OBGYN and get either your AMH levels measured or your follicle count measured.

这意味着，如果您是 20 多岁、30 多岁或 40 多岁的女性，无论您的年龄如何，如果您有兴趣在未来怀孕，那么去妇产科测量您的 AMH 水平或测量您的卵泡计数很可能是个好主意。

And to do that several times in a given period, and I don't mean a menstrual period, I mean a given period of time across several months to determine what is the average number of follicles, what's your average AMH level, thereby giving you some window into how many eggs you are likely to still have in your ovarian reserve.

在给定的时期内多次这样做，我指的不是月经期，而是几个月的给定时间段，以确定卵泡的平均数量是多少，您的平均 AMH 水平是多少，从而为您提供一些窗口，了解您的卵巢储备中可能还有多少卵子。

I cannot tell you how many women that I've spoken to and how many OBGYNs, more importantly, because they speak to many more women about this than I ever have or ever will, wish that they had done this earlier.

我无法告诉你我曾与多少女性和多少妇产科医生交谈过，更重要的是，因为她们与比我曾经或将来更多的女性谈论过这个问题，希望她们早点这样做。

Right?

正确的？

They think, "Oh, well, I'm in my 20s, so I'm likely to have a ton of follicles." Or they got pregnant once before, and so they're not so concerned about the number of follicles or their AMH levels.

他们想，“哦，好吧，我已经 20 多岁了，所以我可能有很多卵泡。”或者她们以前怀孕过一次，所以她们不太关心卵泡的数量或 AMH 水平。

But over and over again, I was told in researching for this episode that the earlier and more frequent that women do this procedure of measuring AMH and measuring their follicle count, the higher the probability that they will eventually have a successful fertilization and pregnancy when they seek to do so.

但在研究这一事件时，我一次又一次被告知，女性越早、越频繁地进行 AMH 测量和卵泡计数测量，当她们寻求这样做时，她们最终成功受精和怀孕的可能性就越高。

Now, the mirror image of all this, of course, is the sperm.

当然，这一切的镜像就是精子。

And there's a kind of common misconception out there that the sperm, you only need one, and indeed, you only need one.

人们普遍存在一种误解，认为精子，你只需要一个，事实上，你只需要一个。

But actually, you need many, and it's only one that's able to successfully fertilize the egg.

但实际上，你需要很多，而且只有一个能够成功使卵子受精。

So this whole concept of you only need one is both dismissive of the sperm, but more importantly, dismissive of the biology of the sperm and the egg.

因此，“你只需要一个”的整个概念既是对精子的不屑一顾，但更重要的是，对精子和卵子的生物学特性的不屑一顾。

Okay?

好的？

It only takes one successful sperm and one successful egg, but that's sort of like telling a woman, "Hey, you only need one egg." Right?

它只需要一个成功的精子和一个成功的卵子，但这有点像告诉一个女人，“嘿，你只需要一个卵子。”正确的？

You need one egg of sufficient quality in the right time and place, and you need one sperm of sufficient quality in the right time and place in order to get successful fertilization and hopefully pregnancy.

您需要在正确的时间和地点获得一颗足够质量的卵子，并且需要在正确的时间和地点获得一颗足够质量的精子，才能成功受精并希望怀孕。

But you need a lot of sperm in order to get a high probability that that one sperm will be able to successfully fertilize the egg.

但是您需要大量精子才能使一个精子成功使卵子受精的可能性很高。

So we have this image of sperm as kind of these dumb operators that just sort of swim mindlessly towards anything, and if they bump into an egg, then they fertilize the egg, and that's really not the way it works.

所以我们把精子想象成这些愚蠢的操作员，他们只是盲目地游向任何东西，如果它们撞到卵子，那么它们就会使卵子受精，而这实际上不是它的工作方式。

As I talked about earlier, the sperm with its head, its midregion, and its tail, chock-a-block with mitochondria in the midregion, is really an active motile cell that indeed will just swim forward if it's a healthy forward progressing sperm.

正如我之前谈到的，精子及其头部、中部区域和尾部，中部区域充满线粒体，实际上是一个活跃的运动细胞，如果它是一个健康的向前推进的精子，它确实会向前游动。

But many males out there just simply do not have any knowledge of how many quality sperm that they happen to have.

但许多男性根本不知道自己有多少优质精子。

Now, given the fact that sperm analysis is relatively inexpensive and also the fact that freezing sperm is relatively inexpensive, I think it stands to reason that most men should at least get some window into the number and quality of their sperm.

现在，考虑到精子分析相对便宜以及冷冻精子相对便宜的事实，我认为大多数男性至少应该了解他们精子的数量和质量，这是理所当然的。

Now, it's a fair assumption to say that if someone is in their late teens or early 20s or 30s, that they probably have high-quality sperm.

现在，可以合理地假设，如果一个人十几岁、二十岁出头或三十岁出头，他们可能拥有高质量的精子。

But again, as with the egg and the importance of measuring AMH and follicle count across time, men should really evaluate the quality and number of their sperm.

但同样，正如卵子以及随时间测量 AMH 和卵泡计数的重要性一样，男性应该真正评估其精子的质量和数量。

And we talked a little bit earlier about some of the parameters that urologists and OBGYNs like to see when evaluating sperm.

我们之前讨论过泌尿科医生和妇产科医生在评估精子时喜欢看到的一些参数。

There's a minimum number or concentration of sperm that they like to see if a couple is going to use IVF, in vitro fertilization, and typically that's going to be about 15 to 20 million per ml of sperm or semen.

如果一对夫妇打算使用 IVF（体外受精），他们希望看到精子的最低数量或浓度，通常为每毫升精子或精液约 15 至 2000 万个。

And typically, they want to see somewhere between two and five milliliters of semen overall in a given ejaculate after a 72 to 48-hour abstinence period, because of course, the more ejaculations, the smaller the volume of the ejaculate in a short period of time.

通常，他们希望在 72 至 48 小时禁欲期后，在一次射精中看到总精液量在 2 至 5 毫升之间，因为射精次数越多，短时间内射精量就越小。

But after 48 to 72 hours, you more or less maximize the volume of ejaculate.

但 48 至 72 小时后，您的射精量或多或少会达到最大。

And then, of course, they want to see 50%, but typically 60% or more of motile sperm in order to get IVF, but more is better.

当然，他们希望看到 50%（通常是 60% 或更多）的活动精子才能进行 IVF，但越多越好。

And of course, there is an enormous range, as I mentioned before.

当然，正如我之前提到的，范围很大。

Some males will have anywhere from 10 to 20 million sperm per milliliter of ejaculate, and some men will have 100 to 200 million.

有些男性每毫升精液中含有 10 至 2000 万个精子，而有些男性则有 100 至 2 亿个。

Okay?

好的？

But just because they have 100 to 200 million doesn't mean that all of those sperm are of high quality and can fertilize eggs.

但仅仅因为它们有 100 到 2 亿个，并不意味着所有这些精子都是高质量的并且可以使卵子受精。

Sometimes more than half will be twitchers and some will be immotile, and so on and so forth.

有时超过一半的人会抽搐，有些人会不动，等等。

So it's very straightforward what I believe most people should do and what the urologist I spoke to in advance of this episode said to do, which is to simply do a sperm analysis.

因此，我认为大多数人应该做的事情以及我在本集之前采访过的泌尿科医生所说的事情都是非常简单的，那就是简单地进行精子分析。

Refrain from ejaculation for 48 to 72 hours, give a sperm sample, have that sperm sample analyzed.

48 至 72 小时内不要射精，提供精子样本，并分析该精子样本。

The cost of the sperm analysis is not typically that much, okay?

精子分析的费用通常不会那么高，好吗？

And considering that conception and healthy conception and fertilization is an expensive process if you have to go the in vitro fertilization route, it stands to reason that the cost is pretty well justified.

考虑到如果您必须走体外受精路线，受孕、健康受孕和受精是一个昂贵的过程，按理说，成本是相当合理的。

You also have the option to freeze sperm over time.

您还可以选择随着时间的推移冷冻精子。

There is evidence that the age of the father, and therefore the age of the sperm, can dictate whether or not there's a higher instance of problematic pregnancy or developmental outcomes, including autism.

有证据表明，父亲的年龄以及精子的年龄可以决定怀孕或发育结果（包括自闭症）问题的发生率是否较高。

That is true.

确实如此。

You probably heard that if the father is 40 years or older, the incidence of autism is increased significantly.

您可能听说过，如果父亲超过 40 岁，自闭症的发病率会显着增加。

That is true, although the overall probability of having an autistic offspring, if the father is 40 years or older, is still quite a bit lower than you would imagine.

确实如此，尽管如果父亲年龄在 40 岁或以上，生出患有自闭症后代的总体概率仍然比您想象的要低很多。

It's not as if the probability suddenly skyrockets.

并不是说概率突然飙升。

Okay?

好的？

So we'll have an episode on autism and genetic and non-genetic influences on autism and other aspects of the autism spectrum.

因此，我们将有一集关于自闭症以及自闭症和自闭症谱系其他方面的遗传和非遗传影响。

But the point is this, I believe, and the urologists I spoke to who are interested in fertility and male health and sexual health, suggest that men get their sperm analyzed at least once every five years.

但我认为，重点是这一点，我采访过的对生育力、男性健康和性健康感兴趣的泌尿科医生建议，男性至少每五年进行一次精子分析。

And certainly, if they're going to want to conceive children in the distant future, that they consider freezing their sperm, because that too is fairly nominal cost in order to freeze sperm at a younger age.

当然，如果他们想在遥远的将来怀孕，他们会考虑冷冻精子，因为这对于在更年轻的时候冷冻精子来说也是相当名义上的成本。

And of course, if you can freeze and use sperm from the time in which you were younger, why wouldn't you, right?

当然，如果你可以冷冻并使用你年轻时的精子，为什么不呢，对吧？

You can still opt to go for natural pregnancy later if that's what you want to do, but having that in reserve is generally a good idea.

如果您愿意的话，您仍然可以选择稍后进行自然怀孕，但保留它通常是一个好主意。

And I discussed some of the parameters that are looked for.

我讨论了一些要寻找的参数。

And perhaps most importantly, there is the possibility of an underlying issue whereby, for instance, there is very little sperm in an ejaculate.

也许最重要的是，可能存在潜在的问题，例如，射精中的精子很少。

As I mentioned earlier, the seminal fluid in the ejaculate could have zero sperm in it, but the volume of ejaculate could appear completely normal.

正如我之前提到的，射精中的精液中可能含有零个精子，但射精量可能看起来完全正常。

So just because your ejaculate volume is normal to you or is in that range of two to five milliliters, well, then that doesn't necessarily mean that there are any sperm there or that there are very few sperm there, and the few sperm that are there, or the many sperm that are there, are functionally motile.

因此，仅仅因为您的射精量对您来说是正常的，或者在两到五毫升的范围内，那么这并不一定意味着那里有任何精子，或者那里的精子很少，并且那里的少数精子或那里的许多精子具有功能性活动能力。

So get this analyzed.

那么对此进行分析。

It's really worth doing.

这确实值得一做。

And again, it's not something you have to do every year.

再说一次，这不是你每年都必须做的事情。

It's something that you want to do probably every five years, at least until the point where you've conceived as many children as you ever want to conceive.

这是你可能每五年想做一次的事情，至少直到你怀上了你想要怀的孩子为止。

So the basic takeaway here is that if you're a woman, to get your egg count, your antral follicle count, that is, and therefore your reserve of eggs indirectly measured, and of course, also get your AMH levels measured.

因此，这里的基本要点是，如果您是女性，要获取您的卵子计数、窦卵泡计数，即间接测量您的卵子储备，当然还要测量您的 AMH 水平。

And if you're a male, to have a sperm analysis and to do that relatively early.

如果您是男性，请尽早进行精子分析。

In fact, another incentive for doing that early is that you have a comparison point so that, for instance, if you are in your early 20s and you're not thinking about having kids at all, or you're thinking that you might someday have kids, but it's a really someday, someday far off in the future, well, it's wonderful to have a reference point from which to compare your biology in your early 20s to your biology in your mid or late 30s or 40s when you might happen to be interested in conceiving.

事实上，早做这件事的另一个动机是你有一个比较点，例如，如果你20岁出头，你根本没有考虑要孩子，或者你认为有一天你可能会有孩子，但这确实是某一天，遥远的未来的某一天，那么，有一个参考点来比较你20岁出头的生物学与30岁中后期或40岁的生物学，这是很棒的。可能碰巧对怀孕感兴趣。

And if that doesn't provide incentive enough, I should mention, and this is important to point out and that I think both males and females are not aware of, is that one in five couples that have issues with fertility, the issue ends up falling on the biology, that is the quality of the sperm or a lack of number of sperm.

如果这还不能提供足够的激励，我应该指出，这一点很重要，我认为男性和女性都没有意识到，五分之一的夫妇有生育问题，问题最终落在生物学上，即精子的质量或精子数量的缺乏。

So I think there's a misconception that when fertility is an issue, it's always an issue with the eggs, and this age-dependent decline in egg quality, again, it's the best language we have available to us at the moment.

因此，我认为存在一种误解，即当生育成为问题时，总是卵子的问题，而这种与年龄相关的卵子质量下降，再次强调，这是我们目前可以使用的最好的语言。

This age-dependent decline in egg quality is often to blame, but not always.

这种与年龄相关的卵子质量下降通常是罪魁祸首，但并非总是如此。

One in five couples that have challenges conceiving, turns out that it's going to be an issue with the sperm.

五分之一的夫妇在受孕方面遇到困难，结果证明这将是精子的问题。

And of course, there are a number of different sperm analyses that should all the other parameters of sperm appear normal.

当然，还有许多不同的精子分析，精子的所有其他参数都应该显示正常。

Now, for instance, you can get a DNA fragmentation analysis.

例如，现在您可以获得 DNA 碎片分析。

You can see whether or not the DNA of the sperm are somehow disrupted.

您可以查看精子的 DNA 是否受到某种程度的破坏。

Urologists these days are excellent at figuring out, for instance, if a male has lots and lots of sperm, everything looks great, but the shape of the head of the sperm isn't quite right.

如今，泌尿科医生非常擅长弄清楚，例如，如果男性有很多很多精子，一切看起来都很好，但精子头部的形状不太正确。

If it's not oval enough and it's too rounded, that could be a genetic defect under Which conditions there is zero probability of the male ever naturally conceiving, right?

如果它不够椭圆并且太圆，那可能是遗传缺陷。在哪种条件下，男性自然受孕的可能性为零，对吗？

Regardless of who the female partner is.

不管女配是谁。

Believe it or not, males can have a ton of sperm, but if they carry a certain genetic defect, those sperm will be incapable of depositing those 23 chromosomes into the egg.

不管你相信与否，男性可以拥有大量精子，但如果他们携带某种遗传缺陷，这些精子将无法将这 23 条染色体沉积到卵子中。

However, there are ways in which that sperm can be coaxed or forced to fertilize the egg and deposit its genetic contents by in vitro fertilization and then implantation into the female.

然而，有一些方法可以诱导或强迫精子与卵子受精，并通过体外受精然后植入女性体内来沉积其遗传内容。

So again, lots of reasons to have an egg reserve analysis by ultrasound and AMH for females, and lots of reasons for males to have a sperm analysis.

因此，对于女性来说，有很多理由通过超声波和 AMH 进行卵子储备分析，而男性也有很多理由进行精子分析。

And of course, typically with a sperm analysis and an ovarian reserve analysis will be a hormone analysis.

当然，通常在精子分析和卵巢储备分析中还会进行激素分析。

And I'm a very strong believer in people getting an insight that is a window into their hormonal composition, not just when they encounter problems, but starting at a pretty early age.

我非常相信人们能够洞察自己的荷尔蒙成分，不仅是在遇到问题时，而且是从很小的时候就开始。

Even if it's only done once every five years or so, having a reference point to your 20s and to your 30s and mid-30s for when you felt a certain way.

即使每五年左右才进行一次，也要以 20 多岁、30 多岁和 30 多岁中期为参考点，以了解您何时有某种感觉。

Maybe, as in the case for many people I know, they actually feel better in their 40s than they did in their 20s because they're doing a lot of things to support their health.

也许，正如我认识的许多人的情况一样，他们在 40 多岁时实际上比 20 多岁时感觉更好，因为他们做了很多事情来支持自己的健康。

That is possible.

这是可能的。

But in many cases, people start feeling not as well, or their fertility seems to be dropping off, or any number of different parameters that we've discussed today or related to vitality and longevity seem to be dropping off over time, and they want to get an insight into what could be the issue.

但在许多情况下，人们开始感觉不太好，或者他们的生育能力似乎正在下降，或者我们今天讨论的或与活力和寿命相关的许多不同参数似乎随着时间的推移而下降，他们想深入了解可能出现的问题。

And hormones are sometimes, not always, but sometimes involved in those underlying issues.

荷尔蒙有时（并非总是）但有时与这些潜在问题有关。

And there's nothing as valuable as having a reference point from a time in which things were going well to evaluate the, for instance, the levels of hormones.

没有什么比在事情进展顺利时获得一个参考点来评估荷尔蒙水平等更有价值的了。

Not just testosterone, but also estrogen and progesterone and so forth.

不仅仅是睾酮，还有雌激素和黄体酮等等。

So you need a comparison point in order to determine what really needs to be changed.

所以你需要一个比较点来确定真正需要改变的地方。

So all of this is a strong push for people to use your insurance if you're able to put it on insurance.

因此，如果您能够购买保险，所有这些都将有力地推动人们使用您的保险。

Oftentimes, people are.

很多时候，人们都是如此。

And if not, to try and find a reasonable or reasonably priced way to do a sperm and egg analysis and to ideally do a hormone analysis as well.

如果没有，尝试找到一种合理或价格合理的方法来进行精子和卵子分析，最好还进行激素分析。

It's really going to set you up for the maximum probability of being able to conceive children when you want to, and also to avoid a bunch of other health-related issues that involve hormones and reproductive health.

它确实可以让您在想要的时候最大程度地怀孕，并避免一系列涉及激素和生殖健康的其他健康相关问题。

And in general, to support your mental health and physical health.

一般来说，支持您的心理健康和身体健康。

So I've been talking about a bunch of things to do.

所以我一直在谈论很多要做的事情。

There are a couple of things to be mindful of to actively avoid if your goal is to be and remain fertile, and that's regardless of whether or not you want to conceive children in the future or not.

如果您的目标是保持生育能力，并且无论您将来是否想怀孕，有几件事需要注意并积极避免。

Now, in the context of this discussion, the same things that we've heard to be true for other aspects of our health turn out to also be true.

现在，在这次讨论的背景下，我们所听到的对我们健康的其他方面同样适用的事情也被证明是正确的。

So let's just start with the basics.

那么让我们从基础开始吧。

Everybody should be getting approximately six to eight hours of sleep every night.

每个人每晚都应该有大约六到八个小时的睡眠。

That should be quality sleep.

这应该是高质量的睡眠。

Optimizing your sleep is fundamental to balancing your hormones.

优化睡眠对于平衡荷尔蒙至关重要。

Now, balancing your hormones is kind of a catchphrase for all things related to proper hormone regulation.

现在，平衡荷尔蒙已成为所有与适当荷尔蒙调节相关的事物的流行语。

Sleep is the fundamental layer of mental health, physical health, and performance of all kinds, and believe it or not, fertility.

睡眠是心理健康、身体健康以及各种表现（不管你信不信）的生育能力的基础。

When people are not sleeping well or enough, stress hormones, in particular cortisol, shift to peaking later in the day, and those elevated cortisol levels later in the day cause a bunch of different problems in both males and females, many of which impact fertility.

当人们睡眠质量不好或睡眠不足时，压力荷尔蒙，特别是皮质醇，会在当天晚些时候达到峰值，而当天晚些时候皮质醇水平升高会给男性和女性带来一系列不同的问题，其中许多会影响生育能力。

So controlling cortisol starts with controlling your sleep.

因此，控制皮质醇首先要从控制睡眠开始。

It also impacts testosterone and estrogen levels.

它还会影响睾酮和雌激素水平。

So of course, the proper ratios of testosterone and estrogen will vary from males to females, but in order to get those right or as right as they can be without other interventions, you want to make sure you're getting enough quality sleep.

当然，睾酮和雌激素的适当比例因男性和女性而异，但为了在不采取其他干预措施的情况下获得正确的比例或尽可能正确的比例，您需要确保自己获得足够的优质睡眠。

How much sleep?

睡多少时间？

Most people need about six to eight hours of sleep per night.

大多数人每晚需要大约六到八小时的睡眠。

Waking up once, maybe twice per night in the middle of the night and going back to sleep is not such a big deal, but six to eight hours of solid sleep would be ideal.

每晚半夜醒来一次，也许两次，然后再入睡并不是什么大不了的事，但六到八小时的稳定睡眠是理想的。

Some people need a little bit less in order to function, five hours.

有些人需要稍微少一点的时间才能正常工作，即五个小时。

Some people need a little bit more.

有些人需要多一点。

Developing teenagers and babies and kids need a lot more.

正在发育的青少年、婴儿和儿童需要更多。

People who are sick or recovering from injury need a lot more.

生病或从伤病中恢复的人需要更多。

We've done multiple episodes on sleep.

我们已经做了多集关于睡眠的内容。

We have a toolkit for sleep available free at hubermanlab.com.

我们在 hubermanlab.com 上免费提供睡眠工具包。

You go there.

你去那里。

You don't even have to sign up for the newsletter, although you can if you want.

您甚至不必注册时事通讯，但如果您愿意，也可以注册。

Just go to Toolkit for Sleep under the menu, and you'll be able to download that, or you can even just view it on the screen if you don't want to download it.

只需转到菜单下的 Toolkit for Sleep，您就可以下载它，如果您不想下载，您甚至可以在屏幕上查看它。

It has lots of tools.

它有很多工具。

We've done an episode called Perfect Your Sleep that has a lot of tools.

我们制作了一集名为“完美你的睡眠”的节目，其中包含很多工具。

They're all timestamped for you.

它们都为您打上了时间戳。

We've done a Master Your Sleep episode, so lots of tools to get your sleep right.

我们制作了“掌握你的睡眠”一集，提供了很多帮助你保持良好睡眠的工具。

Get your sleep right if you are wishing to conceive and/or to simply have healthy biology to be fertile or otherwise.

如果您希望怀孕和/或只是希望拥有健康的生理功能以保持生育能力或其他原因，请保持良好的睡眠。

That's just fundamental.

这只是基本的。

Now, there are other things to not do, and those, again, fall into the somewhat obvious categories.

现在，还有其他一些事情不能做，而这些又属于有些明显的类别。

But I think a lot of people aren't aware of just how striking an effect these certain behaviors that you want to avoid can have in diminishing your fertility for both males and females.

但我认为很多人并没有意识到这些你想要避免的某些行为会对降低男性和女性的生育能力产生多么显着的影响。

So let's talk about those.

那么让我们来谈谈这些吧。

So the first one is smoking.

所以第一个就是抽烟。

And when we talk about smoking here, we're talking about smoking nicotine, and we're talking about smoking cannabis.

当我们在这里谈论吸烟时，我们谈论的是吸尼古丁，我们谈论的是吸大麻。

And indeed, there are strong data, and I will put a reference to one of the better, larger analyses of these data.

事实上，有强有力的数据，我将引用对这些数据进行的更好、更大规模的分析之一。

There are strong data showing that cannabis reduces fertility.

有强有力的数据表明大麻会降低生育能力。

Now, I can already hear the screams from the back, although they're probably fairly drawled out screams from the back of people saying they smoke cannabis and they had no trouble conceiving.

现在，我已经能听到背后传来的尖叫声，尽管他们可能是那些说自己吸大麻并且怀孕没有困难的人背后发出的相当拖长的尖叫声。

Certainly, there will be exceptions, but whether or not you're male or female, smoking cannabis is a bad idea if you want to conceive a healthy child.

当然，也会有例外，但无论你是男性还是女性，如果你想生一个健康的孩子，吸食大麻都是一个坏主意。

Can you still conceive a healthy child while smoking cannabis?

吸食大麻还能怀上健康的孩子吗？

Probably certain people can.

也许某些人可以。

Many people will greatly decrease the probability of a healthy fertilization and pregnancy by smoking cannabis.

许多人吸食大麻会大大降低健康受精和怀孕的可能性。

There are excellent data to support that.

有很好的数据可以支持这一点。

As well, nicotine, both smoked or vaped, is going to disrupt the process of fertilization and can disrupt pregnancy dramatically, okay?

此外，尼古丁，无论是吸烟还是吸电子烟，都会扰乱受精过程，并可能严重扰乱怀孕，好吗？

So just avoid it altogether.

所以完全避免它。

How does this happen?

这是怎么发生的？

Well, it turns out that smoking increases what are called reactive oxygen species.

事实证明，吸烟会增加活性氧的含量。

This Greatly disrupts the quality of the egg at the level of the spindle and mitochondria and a number of other features.

这极大地破坏了卵子的纺锤体和线粒体水平以及许多其他特征的质量。

And in the sperm, turns out that smoking doesn't necessarily disrupt the sperm directly, although it can cause DNA fragmentation, which can cause all sorts of abnormalities, can prevent fertilization, can lead to birth defects in the offspring.

而在精子中，事实证明，吸烟并不一定会直接破坏精子，尽管它会导致DNA断裂，从而导致各种异常，可以阻止受精，可以导致后代出生缺陷。

But more importantly, it increases what are called reactive oxygen species in the seminal fluid, in the semen that contain the sperm.

但更重要的是，它增加了精液（含有精子的精液）中所谓的活性氧。

This very, under normal circumstances, under healthy circumstances, beautifully orchestrated chemistry of fluid that allows the sperm to thrive in their trajectory and attempt to fertilize the egg and lead to a healthy pregnancy.

在正常情况下，在健康的情况下，这种精心策划的液体化学反应使精子能够在其轨迹中茁壮成长，并尝试使卵子受精并导致健康怀孕。

So if you are a smoker and you want to conceive, the best advice I can give you is to quit smoking.

因此，如果您是吸烟者并且想怀孕，我能给您的最好建议就是戒烟。

And yes, that includes cannabis as well.

是的，这也包括大麻。

Now, I am not somebody who believes that cannabis across the board is not useful.

现在，我并不是一个认为大麻全面无用的人。

There are medical applications and other applications.

有医疗应用和其他应用。

I talk about that in an episode all about cannabis for health and disease, and notice health was in there too.

我在一集中谈论大麻对健康和疾病的影响，并注意到健康也在那里。

So you cannabis smokers, don't come after me with, I guess, whatever it is, with bongs and pipes or whatever it is that you want, or with vapes.

所以你们这些吸大麻的人，我想，不要用任何东西来追我，不管是什么，烟枪和烟斗，或者任何你想要的东西，或者电子烟。

The point is that while it can be beneficial for certain populations, it's certainly bad for others.

关键是，虽然它可能对某些人群有益，但对其他人肯定有害。

And if you're trying to conceive, it is bad for fertility and for a healthy pregnancy.

如果您想怀孕，这对生育能力和健康怀孕都是不利的。

Okay?

好的？

Now, that's smoking, and vaping by the way, okay?

现在，顺便说一句，那就是吸烟，好吗？

Vaping is included there.

那里包括电子烟​​。

Now, the next category of don'ts relates to alcohol.

现在，下一类不该做的事情与酒精有关。

Now, everyone has heard that drinking during pregnancy is a bad idea.

现在，每个人都听说怀孕期间喝酒是个坏主意。

You may have heard, and some people have talked about the fact that there are cultures in which they allow, if you will, or even condone, sadly, one or two drinks while pregnant, provided it's just champagne or something of that sort.

您可能听说过，有些人谈论过这样一个事实，即在某些文化中，如果您愿意的话，他们允许甚至宽恕怀孕期间喝一两杯酒，只要是香槟或类似的东西即可。

That is a terrible idea.

这是一个糟糕的主意。

I did an episode all about alcohol, both its potential health effects, of which there turned out to be zero, and yes, that includes red wine.

我做了一集关于酒精的节目，包括它对健康的潜在影响，结果为零，是的，其中包括红酒。

It is far better to not drink at all.

最好根本不喝酒。

And if you're going to drink, the limit if you're a healthy adult who's not trying to conceive, not pregnant, and you don't have issues with alcoholism, is probably two drinks per week total.

如果你要喝酒，如果你是一个健康的成年人，没有试图怀孕，没有怀孕，而且你没有酗酒的问题，那么每周的饮酒总量可能是两杯。

That's right, two drinks per week total.

没错，每周总共喝两杯。

And that's the level that you really should consider if you're a drinker, if you're somebody who's trying to conceive.

如果您是一个饮酒者，如果您是一个想要怀孕的人，那么这就是您真正应该考虑的水平。

However, for a woman who becomes pregnant, the total number of drinks that you should allow yourself per week while pregnant and breastfeeding is indeed zero.

然而，对于怀孕的女性来说，怀孕和哺乳期间每周应允许的饮酒总量实际上为零。

There is absolutely no evidence that one can, quote, unquote, "get away with drinking during pregnancy." And people say, "Well, I had a perfectly healthy child," but of course you don't know what the health of that child would have been had you not drank at all.

绝对没有证据表明人们可以引用或取消引用“怀孕期间饮酒”。人们会说，“嗯，我有一个非常健康的孩子”，但你当然不知道如果你根本不喝酒的话，那个孩子的健康状况会如何。

Now, I'm not here with any generally strong stance against alcohol.

现在，我在这里并没有任何强烈的反对酒精的立场。

I myself am somebody who has a drink every once in a while, although I don't consider myself somebody who has a strong proclivity for alcohol.

我自己也是一个偶尔喝酒的人，虽然我不认为自己是一个酗酒的人。

And of course, at this moment, I'm not trying to conceive children, and I'm certainly not pregnant.

当然，此时此刻，我并不想怀孕，我当然也没有怀孕。

So that's safe for me, but frankly, I haven't had a drink in a very long time.

所以这对我来说是安全的，但坦白说，我已经很长时间没有喝酒了。

And so I don't miss it, and that's me.

所以我不会错过它，那就是我。

But I do realize that a lot of people enjoy alcohol, and so it's that two drinks per week limit that really sets the upper limit and threshold beyond which you start running into issues with cellular mutation.

但我确实意识到很多人都喜欢喝酒，所以每周喝两杯酒的限制真正设定了上限和阈值，超过这个上限和阈值，你就会开始遇到细胞突变的问题。

You start running into issues of oxidative stress, greatly increased cancer risk, in particular breast cancer risk.

您开始遇到氧化应激问题，大大增加癌症风险，特别是乳腺癌风险。

All that's covered in the alcohol episode that we did.

所有这些都在我们所做的酒精事件中涵盖了。

You can find it at hubermanlab.com, and timestamped if you want to navigate to specific topics and so forth, find out all about the data supporting the statements that I'm making, so on and so forth.

您可以在 hubermanlab.com 上找到它，如果您想导航到特定主题等，则可以找到它并带有时间戳，找出支持我所做陈述的所有数据，等等。

Now, if you're somebody who's seeking to conceive or you fall into this category that some couples describe themselves as, "We're not trying, but we're not not trying," meaning they're not using birth control, they're kind of letting chance run its course, well then you should definitely be aware of the data showing that even just one bout, one bout of so-called binge drinking, which is five to six drinks in a given night or half day in a 12-hour period, one bout of five to six drinks, if you're a woman or you're a man, greatly increases both the likelihood of mutations in the embryo that would result from a fertilization and at the same time, for reasons that should be obvious to you based on all the biology we've talked about, a greatly reduced probability of fertilization.

现在，如果你是一个正在寻求怀孕的人，或者你属于某些夫妇描述自己的类别，“我们没有尝试，但我们也不是没有尝试”，这意味着他们没有使用节育措施，他们有点让机会自然发生，那么你绝对应该意识到数据显示，即使只是一次，一次所谓的酗酒，即在 12 小时内的一个晚上或半天喝 5 到 6 杯酒，如果你是女性或男性，喝五到六杯酒会大大增加受精引起的胚胎突变的可能性，同时，基于我们所讨论的所有生物学，原因对你来说应该是显而易见的，受精的可能性也会大大降低。

Now, that absolutely does not mean that you should use the ingestion of five or six drinks as a method of birth control.

现在，这绝对并不意味着您应该使用喝五六杯饮料作为避孕方法。

That is not what I'm saying here.

我不是在这里说的。

What I'm saying is, is that if you go out on a given night and you have five or six drinks and you happen to become pregnant, the probability that that pregnancy will be disrupted in some way is greatly increased.

我的意思是，如果你在某个晚上出去喝了五六杯酒，而你碰巧怀孕了，那么怀孕以某种方式中断的可能性就会大大增加。

What the exact consequences are, no one can tell you.

具体后果是什么，没有人能告诉你。

But also, if you're somebody who is interested in conceiving a child, well then you absolutely should abstain from ingesting drinks more than one or two during the time in which you're trying to conceive, and ideally it would be zero.

而且，如果您有兴趣怀孕，那么您绝对应该在尝试怀孕期间避免摄入超过一两杯的饮料，理想情况下饮酒量为零。

And you certainly would want to avoid drinking multiple drinks per night.

您当然希望避免每晚喝多杯饮料。

And so this idea of going out and having three or four drinks or four or five drinks in a given night at a time in which you're also trying to conceive children, the biology tells us, the epidemiology tells us that this is just a terrible idea.

因此，生物学告诉我们，流行病学告诉我们，在某个特定的晚上，在你还想怀孕的时候出去喝三四杯或四五杯的想法是一个糟糕的想法。

It's going to reduce the likelihood of fertility and successful pregnancy.

这会降低生育和成功怀孕的可能性。

And if there is a successful pregnancy, the word success needs to be in quotes, right?

如果成功怀孕，成功这个词需要加引号，对吧？

I think every parent, every species for that matter, wants to increase the probability of having healthy offspring.

我认为每个父母、每个物种都希望增加拥有健康后代的可能性。

And so, to my mind anyway, and to the OBGYNs and the urologists that are focused on fertility that I spoke to, everyone will say, "Try as hard as you can to avoid these so-called binge drinking episodes." And again, these episodes are one night of consuming five to six drinks.

因此，无论如何，在我看来，以及与我交谈过的关注生育问题的妇产科医生和泌尿科医生，每个人都会说：“尽最大努力避免这些所谓的酗酒事件。”再说一次，这些情节是一晚上喝五到六杯酒。

Now, another important thing to remember in this context is that the negative effects of consuming five or six drinks in a given night extend over many weeks following the ingestion of that alcohol.

现在，在这方面需要记住的另一件重要事情是，在特定晚上喝五六杯酒的负面影响会在摄入酒精后持续数周。

If you're a male, what that means is that's going to impact the quality of your sperm and greatly decrease the likelihood of successful fertilization and/or healthy pregnancy over the period of that entire spermatogenesis window, which is, as we talked about before, 60 to 90 days.

如果您是男性，这意味着这将影响您精子的质量，并大大降低在整个精子生成窗口（即我们之前讨论过的 60 至 90 天）期间成功受精和/或健康怀孕的可能性。

60 to generate the sperm, and then some additional time for the sperm to be transported to the point where they could be ejaculated.

60 来产生精子，然后再花费一些时间将精子运送到可以射精的地方。

If you're a woman and you have five or six drinks on a given night, well then you are going to disrupt the quality not of just the egg that eventually ovulates, but indeed the entire pool of follicles that leaves the ovarian vault in reserve and from which the one egg will be selected.

如果你是一名女性，并且在某个晚上喝了五六杯酒，那么你不仅会破坏最终排卵的卵子的质量，而且会破坏整个卵泡池的质量，这些卵泡池保留了卵巢穹窿，并从中选择了一个卵子。

In other words, you are reducing the quality of all of the eggs that you happen to deploy that month.

换句话说，您正在降低当月部署的所有鸡蛋的质量。

Now, some of you who were really following the biology earlier might say, "Well, what if I have those five or six drinks during the time in which I'm menstruating, in which there's bleeding present, and therefore I haven't yet ovulated?" Ah, but if you remember the biology we talked about earlier, specifically, there is a subset of follicles and eggs that leave that ovarian reserve quite a bit before that one egg is selected for and ovulates.

现在，你们中一些真正关注生物学的人可能会说，“好吧，如果我在月经期间喝了五六杯酒，期间出现出血，因此我还没有排卵怎么办？”啊，但是如果你还记得我们之前讨论过的生物学，具体来说，有一个卵泡和卵子的子集，在选择一个卵子并排卵之前，会留下相当多的卵巢储备。

And of course, there are all the different hormonal cascades in the general milieu of the ovary, which are important and are being regulated by different hormones.

当然，卵巢的一般环境中存在各种不同的激素级联，这些级联很重要并且受到不同激素的调节。

And yes, indeed, the regulation of those hormones is strongly impacted by alcohol through a number of different pathways, through the regulation of the neurotransmitter GABA up in the brain.

是的，确实，这些激素的调节受到酒精通过许多不同途径的强烈影响，即通过调节大脑中的神经递质 GABA。

It's actually a lot of GABA and GABA receptors in the hypothalamus, the very region from which gonadotropin-releasing hormone, our old friend from a couple of hours ago in this discussion.

实际上，下丘脑中有很多 GABA 和 GABA 受体，下丘脑正是促性腺激素释放激素的区域，我们几小时前讨论过的老朋友。

You're going to disrupt GnRH secretion.

你会破坏 GnRH 的分泌。

You can disrupt pituitary function with alcohol.

酒精会破坏垂体功能。

Again and again, what we're seeing is that consuming more than one or two drinks per week of alcohol is really detrimental to the entire process of fertility and the entire process of healthy pregnancy.

我们一次又一次地看到，每周饮酒超过一到两杯酒精确实不利于整个生育过程和整个健康怀孕过程。

And that's true from both the male side and the sperm, and it's true from the female side and the egg.

从男性方面和精子来看都是如此，从女性方面和卵子方面来看也是如此。

So my simple advice on this is if you are wishing to have a healthy fertilization and pregnancy, the best thing to do would be avoid alcohol altogether.

因此，我对此的简单建议是，如果您希望健康受精和怀孕，最好的办法就是完全避免饮酒。

And if you're going to drink, to really limit that drinking to one or two drinks per week maximum.

如果您要喝酒，请确实将饮酒量限制在每周最多喝一到两杯。

So those are the major don'ts.

所以这些是主要不要做的事情。

Really avoid excessive stress.

真正避免压力过大。

And I should mention, excessive stress is not just best avoided by getting enough quality sleep at night, although that is the primary way.

我应该提到，避免过度压力的最佳方法不仅仅是晚上获得充足的优质睡眠，尽管这是主要方法。

There are other ways to avoid stress.

还有其他方法可以避免压力。

We've done entire episodes about this, and we have a toolkit related to reducing stress with very simple zero-cost tools.

我们已经完成了这方面的全部内容，并且我们有一个与通过非常简单的零成本工具减轻压力相关的工具包。

Again, you can find all that at hubermanlab.com.

同样，您可以在 hubermanlab.com 上找到所有这些内容。

And I should mention, if you want to find any episode or topic or timestamp, that website is keyword search available, so you can just go to hubermanlab.com, put into the search function "stress tools" and a bunch of different links will pop up related to those topics.

我应该提一下，如果你想找到任何剧集、主题或时间戳，该网站可以进行关键字搜索，所以你只需访问 hubermanlab.com，输入搜索功能“压力工具”，就会弹出一堆与这些主题相关的不同链接。

Likewise with sleep, likewise with any number of different topics you might be interested in.

睡眠也是如此，您可能感兴趣的许多不同主题也是如此。

So get enough quality sleep and thereby reduce stress, and also directly buffer stress with real-time tools to buffer stress that I've talked about in the episodes that you can access.

因此，获得足够的优质睡眠，从而减轻压力，并且还可以使用我在您可以访问的剧集中讨论过的实时工具来直接缓冲压力，以缓冲压力。

And there are ways to greatly reduce your overall level of stress, to limit any cortisol that's released to early in the day, which is when you want cortisol released and not have it late in the day, and so on and so forth.

有一些方法可以大大降低您的整体压力水平，限制皮质醇在一天早些时候的释放，也就是您希望皮质醇释放而不是在一天的晚些时候释放的时间，等等。

So reduce your stress.

所以减轻你的压力。

And as I just told you, by all means, do not drink more than two drinks per week, and zero is better than two.

正如我刚才告诉你的，无论如何，每周喝的酒不要超过两杯，零总比两杯好。

If anyone tells you, "Oh, well, there's all this resveratrol in red wine, and that's good for us," the data simply tell us that there's not enough resveratrol in red wine to really have any positive health benefit.

如果有人告诉你，“哦，红酒中含有这么多白藜芦醇，这对我们有好处”，那么数据只是告诉我们，红酒中的白藜芦醇含量不足以真正对健康产生任何积极的益处。

The data around resveratrol and health benefits itself is under question nowadays.

如今，有关白藜芦醇和健康益处本身的数据受到质疑。

Zero alcohol is better than any alcohol.

零酒精比任何酒精都要好。

Two drinks per week is the limit.

每周喝两杯是限制。

Also, limit or eliminate or avoid nicotine and ideally cannabis smoking and vaping at the time in which you are trying to get pregnant.

此外，在您试图怀孕时，限制或消除或避免尼古丁，最好是大麻吸烟和电子烟。

And certainly, if you are pregnant, avoid all of the things as best you can that I just described a moment ago.

当然，如果您怀孕了，请尽可能避免我刚才描述的所有事情。

Now, there are a couple other don'ts that are really important.

现在，还有其他一些非常重要的禁忌。

One of the most important don'ts relates to STIs or sexually transmitted infections.

最重要的禁忌之一与性传播感染或性传播感染有关。

Everyone who's sexually active should get an STI check.

每个性活跃的人都应该接受性传播感染检查。

In fact, if you go to a fertility clinic or you go for sperm analysis or you go for egg analysis, almost always they will do an STI check even if you happen to be in a monogamous relationship, even if you happen to be not sexually active and you're somebody who's seeking to use IVF with a sperm donor or something of that sort.

事实上，如果你去生育诊所，或者去做精子分析，或者去做卵子分析，他们几乎总是会做性传播感染检查，即使你碰巧处于一夫一妻制关系中，即使你碰巧没有性行为，并且你正在寻求与精子捐赠者或类似的人一起进行体外受精。

Why would they do that?

他们为什么要这么做？

Why is there so much concern about that?

为什么对此有如此多的担忧？

Is it about avoiding giving birth to a child that has something like a herpes infection or HIV?

是为了避免生出患有疱疹感染或艾滋病毒等疾病的孩子吗？

Well, certainly that's one reason, but that's a down the line reason, because at the time when someone goes into the clinic for one of these sperm or egg analyses, that's well in advance of any pregnancy, right?

嗯，当然这是一个原因，但这是一个根本原因，因为当有人进入诊所进行精子或卵子分析之一时，这远远早于任何怀孕，对吧？

The reason is there are a number of STIs, in particular chlamydia, for which it greatly increases the probability of miscarriage.

原因是有许多性传播感染，特别是衣原体，它大大增加了流产的可能性。

So chlamydia is one of those very insidious and cryptic STIs because a lot of people, both males and females, don't even realize that they have chlamydia, and then they can carry chlamydia at the time in which they conceive, and then that can lead to ectopic pregnancies and/or miscarriages.

因此，衣原体是一种非常阴险和神秘的性传播感染，因为很多人，无论男性还是女性，甚至没有意识到自己患有衣原体，然后他们在怀孕时携带衣原体，然后可能导致宫外孕和/或流产。

So by all means, get an STI check if you are somebody who's seeking to conceive children or evaluating your fertility generally.

因此，如果您正在寻求怀孕或总体评估您的生育能力，请务必进行性传播感染检查。

Chlamydia can also have damaging effects on the epididymis and on the various other aspects of male reproductive health.

衣原体还会对附睾和男性生殖健康的各个其他方面产生破坏性影响。

In the future, we will do an episode all about sexual health.

将来我们会做一集关于性健康的节目。

This is not the time for that.

现在不是这样做的时候。

But get an STI check if your goal is to conceive a healthy child.

但如果您的目标是生一个健康的孩子，请进行性传播感染检查。

Now, the other thing that can have a very negative impact on fertility and healthy pregnancy is a viral infection.

现在，另一件可能对生育和健康怀孕产生非常负面影响的事情是病毒感染。

For instance, if a male has had a severe viral illness, and this could be any number of different viral illnesses, from flu to cold or any number of different viruses, pick your favorite virus, in the previous 70 to 90 days, that can greatly diminish the number and/or quality of sperm.

例如，如果一名男性患有严重的病毒性疾病，并且这可能是多种不同的病毒性疾病，从流感到感冒或多种不同的病毒，请在过去 70 至 90 天内选择您最喜欢的病毒，这会大大减少精子的数量和/或质量。

So that's really important.

所以这非常重要。

This is also important if you're going to go in and do a sperm analysis and you had a viral infection in the previous 70 to 90 days.

如果您打算进行精子分析并且您在过去 70 至 90 天内感染过病毒，这一点也很重要。

Well then you need to be aware of that because it could greatly impact the parameters of that sperm analysis.

那么您需要意识到这一点，因为它可能会极大地影响精子分析的参数。

Likewise, for women, if you've had a serious viral infection in the previous 30 days, does that mean you should not try and conceive?

同样，对于女性来说，如果您在过去 30 天内患有严重的病毒感染，是否意味着您不应该尝试怀孕？

Not necessarily, but you should talk to your OBGYN about that.

不一定，但您应该与您的妇产科医生讨论此事。

There are data showing that viral infection, in particular of influenza in the mother in the first trimester of pregnancy has some correlation, it's not 100%, but some correlation with negative mental health outcomes of the offspring sometime later, including schizophrenia.

有数据显示，病毒感染，特别是母亲在怀孕前三个月感染流感，有一定的相关性，虽然不是100%，但与后代的负面心理健康结果有一定的相关性，包括精神分裂症。

This is some of the work that was done at Caltech a number of years ago, and other laboratories as well.

这是加州理工学院以及其他实验室几年前所做的一些工作。

Those data are still being built up over time.

这些数据仍在随着时间的推移而积累。

Again, it's not one for one, it's not causal.

再说一次，这不是一对一的，也不是因果关系。

So if you did get an influenza or a cold or other kind of viral infection during the first trimester or any trimester of pregnancy, I don't want to cause alarm, but you should talk to your OBGYN about this.

因此，如果您在怀孕的前三个月或怀孕的任何三个月期间确实感染了流感、感冒或其他类型的病毒感染，我不想引起恐慌，但您应该与您的妇产科医生讨论此事。

The goal, of course, is to avoid viral illness at any time when you're trying to conceive or have a healthy pregnancy.

当然，我们的目标是在您尝试怀孕或健康怀孕时随时避免病毒性疾病。

But of course, sometimes people will get ill, and the children can turn out to be perfectly normal and fine.

但当然，有时人们会生病，而孩子们可能会变得完全正常、很好。

But it is something that you want to avoid, and it will impact your egg analysis and it will impact sperm analysis.

但这是您想要避免的事情，它会影响您的卵子分析，也会影响精子分析。

Now, one thing I found really surprising in researching this episode was that 1 in 25 men carry a copy of a mutation for cystic fibrosis.

现在，我在研究这一事件时发现真正令人惊讶的一件事是，每 25 名男性中就有 1 人携带囊性纤维化突变的副本。

Now, some of you are probably familiar with cystic fibrosis as a condition that can cause issues with the lungs, the accumulation of fluid in the lungs or other tissues.

现在，你们中的一些人可能熟悉囊性纤维化，它是一种可能导致肺部问题、肺部或其他组织积液的疾病。

Cystic fibrosis, in order to express that way of accumulation of fluid in the lungs, you really need two copies.

囊性纤维化，为了表达肺部积液的方式，你确实需要两个副本。

You need two mutant copies, or you need two copies of the cystic fibrosis gene.

您需要两个突变副本，或者您需要两个囊性纤维化基因副本。

One in 25 men will carry just one copy and therefore will not have any symptoms of cystic fibrosis.

二十五名男性中就有一人只携带一份拷贝，因此不会出现任何囊性纤维化症状。

But those 1 in 25 men will have defects in the architecture of the vas deferens, the duct through which the ejaculate needs to pass in order to eventually be ejaculated out of the urethra.

但是，每 25 名男性中就有 1 人的输精管结构存在缺陷，输精管是射精最终从尿道射出的管道。

And so what that means is that these men can have what appears to be normal semen volume, but that they won't have normal numbers of sperm, and that's not because of a deficit in making the sperm.

因此，这意味着这些男性可以拥有看似正常的精液量，但他们不会拥有正常数量的精子，而这并不是因为制造精子的缺陷。

The testes can function just fine.

睾丸可以正常运作。

The brain and the pituitary are communicating with the testes just fine.

大脑和垂体与睾丸的通讯良好。

But that literally the passageway by which those sperm arrive within the seminal fluid and are eventually ejaculated is disrupted by the cystic fibrosis gene.

但实际上，这些精子到达精液并最终射精的通道被囊性纤维化基因破坏了。

Luckily, if somebody has just one copy of the cystic fibrosis gene and they're male and this is the issue, the vas deferens either can be repaired by a urologist who's expert in the surgical repair of vas deferens, or sperm can be extracted from the testicle directly.

幸运的是，如果某人只有一份囊性纤维化基因，并且是男性，而这就是问题所在，那么输精管要么可以由擅长输精管修复手术的泌尿科医生修复，要么可以直接从睾丸中提取精子。

Which might sound like a painful procedure, but I believe nowadays, in talking with various experts on this, turns out that it can be done with a minimum of discomfort, and certainly if the goal is to have a healthy child, you're going to need those sperm, so you're going to want to get them one way or the other, regardless of the discomfort.

这听起来可能是一个痛苦的过程，但我相信，现在，在与各个专家讨论这个问题时，事实证明，这可以在最小化不适的情况下完成，当然，如果目标是生一个健康的孩子，你将需要这些精子，所以无论有什么不适，你都会想以某种方式获取它们。

Now, before getting into some of the things that you can do in the positive sense to increase your fertility, we do need to touch on just a few other things that you want to avoid in order to avoid diminishing your fertility.

现在，在讨论您可以采取积极的措施来提高生育能力之前，我们确实需要谈谈您想要避免的其他一些事情，以避免降低您的生育能力。

And this mainly relates to males, but it will also be relevant to females.

这主要与男性有关，但也与女性有关。

And of course, when I say also relevant to females, I'm referring to the fact that if it's a woman and a man who are trying to conceive, then she, of course, is going to be interested in her egg quality, but also the sperm quality.

当然，当我说也与女性相关时，我指的是这样一个事实：如果是一个女人和一个男人想要怀孕，那么她当然会对她的卵子质量感兴趣，但也会对精子质量感兴趣。

And of course, there are women who are conceiving by way of sperm donor through IVF or IUI or otherwise.

当然，有些女性通过体外受精（IVF）、宫腔内人工授精（IUI）或其他方式通过精子捐赠者受孕。

But in any case, the need to understand and maximize the quality of both the egg and the sperm is paramount.

但无论如何，了解并最大限度地提高卵子和精子的质量是至关重要的。

So in order for men to maximize the quality of their sperm, as I mentioned earlier, does not seem to be a big difference whether or not they use boxers or briefs or whether or not they, quote, unquote, "go commando," they don't wear any boxers or briefs of any kind.

因此，正如我之前提到的，为了使男性最大限度地提高精子质量，无论他们是否使用平角内裤或内裤，或者无论他们是否引用或取消引用“突击队”，他们是否不穿任何类型的平角内裤或内裤，似乎都没有太大区别。

However, it is important to keep the testicles cool enough.

然而，保持睾丸足够凉爽很重要。

They need to be about two degrees cooler than the rest of the body, and there are a number of different ways to do that.

它们需要比身体其他部分的温度大约低两度，并且有许多不同的方法可以做到这一点。

As I mentioned before, avoid going in hot tubs during the period in which you're trying to conceive children.

正如我之前提到的，在怀孕期间避免泡热水浴缸。

You should also avoid going in saunas during the period in which you are trying to conceive children.

在备孕期间，您还应该避免去桑拿浴室。

And if you do go in the sauna, you can bring an ice pack there and you can put it on the testicles in order to offset the heat of the sauna and keep the testicles cool while in the sauna.

如果你去桑拿，你可以带一个冰袋，放在睾丸上，以抵消桑拿的热量，使睾丸在桑拿时保持凉爽。

The other thing that you'll definitely want to do is avoid putting a laptop or any other hot device directly onto your lap.

您肯定想要做的另一件事是避免将笔记本电脑或任何其他热设备直接放在腿上。

There are a number of different devices that you can put on your lap.

您可以将多种不同的设备放在腿上。

You could put books or a box, or there are these devices that are designed to dispel the heat from the laptop.

您可以放置​​书籍或盒子，或者放置一些旨在散发笔记本电脑热量的设备。

I would say if you're trying to conceive, just keep the laptop off of your lap.

我想说，如果您想怀孕，请将笔记本电脑放在腿上。

Just put it on a table or standing desk or whatever.

只需将其放在桌子或立式办公桌或其他任何地方即可。

Just keep it off of your lap.

只要将其远离你的腿即可。

Also, there are some really interesting data showing that the amount of time that men spent sitting, regardless of whether or not they sit with their ankle on their opposite knee or with knees spread, the classic man spread stance or any other kind of seated stance, is going to increase the temperature of the scrotum.

此外，有一些非常有趣的数据表明，男性坐着的时间长短，无论他们是否将脚踝放在对侧膝盖上或膝盖张开，经典的男性张开姿势或任何其他坐姿，都会增加阴囊的温度。

For reasons that are somewhat obvious, if you think about the architecture of all this, I think both men and women, if you put enough thought to it, you go, "Oh, yeah, that would increase the temperature." Obviously, avoid seat heaters in cars or otherwise.

出于一些显而易见的原因，如果你考虑所有这一切的架构，我认为无论男性还是女性，如果你对此进行足够的思考，你会说，“哦，是的，这会增加温度。”显然，避免在汽车或其他地方使用座椅加热器。

But reducing the total amount of time that you spend seated is really important if you want to keep the temperature milieu of the scrotum optimal for sperm quality and fertilization.

但是，如果您想保持阴囊的温度环境有利于精子质量和受精，那么减少坐着的总时间非常重要。

And as I mentioned earlier, it's going to be important to make sure that your legs are not really big to the point where they are creating a hotter than is healthy environment for the scrotum and testicles.

正如我之前提到的，重要的是要确保您的腿不会太大，以免为阴囊和睾丸创造比健康环境更热的温度。

So a hotter than normal environment for the testicles can be caused by legs that are very large, upper thighs that are very large due to obesity or due to those upper thighs being too muscular.

因此，睾丸的环境比正常温度高可能是由于腿部过大、大腿上部因肥胖或肌肉过于发达而导致的。

So by all means, don't skip leg day, but be aware that if you're somebody who's trying to conceive, you want to do whatever you can to reduce the temperature of the scrotum, or at least not let it get too hot for too long.

因此，无论如何，不​​要跳过腿部日，但要注意，如果您正在尝试怀孕，您需要尽一切努力降低阴囊的温度，或者至少不要让它太热太久。

So, I can think of all sorts of reasons now that men are going to come up with to do the man spread stance of their knees really far apart, even further if they have large legs.

所以，我现在可以想到各种各样的原因，男人们会想出将膝盖分开很远的姿势，如果他们有大腿，甚至会更远。

That's not a discussion we want to have here, and that's not really what today's discussion is about.

这不是我们想在这里进行的讨论，也不是今天讨论的真正内容。

Really, the principle is what's most important, which is to keep the temperature of the scrotum and testicles lower than the rest of your body.

其实，原则是最重要的，就是保持阴囊和睾丸的温度低于身体其他部位的温度。

There's a direct blood flow from the body to the testicle that provides blood flow.

血液从身体直接流向睾丸，提供血液流动。

It's designed in a way that that blood pathway should be outside the body and as far away from the body as possible in order to get the temperature milieu of the scrotum and testicle correct for healthy sperm quality.

它的设计方式是，血液通路应该在体外，并尽可能远离身体，以使阴囊和睾丸的温度环境适合健康的精子质量。

Now, a topic that is sure to be a bit controversial, but it really shouldn't be because the data, at least to me, are very clear, is this issue of phone use and sperm quality.

现在，这个话题肯定会有点争议，但这确实不应该，因为至少对我来说，数据非常清楚，那就是手机使用和精子质量的问题。

Now, this can open up a whole array of issues related to things like EMFs, and you've got people out there that have ideas about 5G and all of this stuff.

现在，这可能会引发一系列与 EMF 等相关的问题，并且有人对 5G 和所有这些东西有想法。

That is not what this discussion is about.

这不是本次讨论的目的。

The discussion I'm about to have with you relates to the fact that the electromagnetic fields and the heat-related effects of smartphones can indeed have a detrimental effect on sperm quality, and yes, indeed, on testosterone levels as well.

我即将与您讨论的事实是，智能手机的电磁场和与热相关的影响确实会对精子质量产生有害影响，是的，确实也会对睾丸激素水平产生有害影响。

I'm going to refer you to a paper.

我将向您推荐一篇论文。

We will link it in the show note captions.

我们将在节目注释标题中链接它。

The title of this paper is "Effects of Mobile Phone Usage on Sperm Quality: No Time-Dependent Relationship on Usage, a Systematic Review and Updated Meta-Analysis."

这篇论文的标题是“手机使用对精子质量的影响：对使用没有时间依赖关系，系统回顾和更新的荟萃分析”。

This is a paper that came out in 2021 and talks about the fact that phones emit a radio frequency electromagnetic waves, which are called RF, radio frequency, EMWs, electromagnetic waves, at a low level between 80 and 2,200 MHz that can be absorbed by the human body.

这是 2021 年发表的一篇论文，讨论了手机会发射射频电磁波，称为 RF、射频、EMW、电磁波，其频率较低，介于 80 至 2,200 MHz 之间，可被人体吸收。

We know this, okay?

我们知道这一点，好吗？

This is not controversial and have potential adverse effects on brain, heart, endocrine system, and reproductive function.

这没有争议，并且对大脑、心脏、内分泌系统和生殖功能有潜在的不利影响。

That has been established.

这已经成立了。

Keep in mind, there is basically no controversy that radio frequency waves and EMFs can have a negative impact on biological tissues.

请记住，射频波和电磁场会对生物组织产生负面影响，这一点基本上没有争议。

The question is, how intense are those radio frequency waves and EMFs, and how detrimental are those on those biological tissues, okay?

问题是，这些射频波和电磁场有多强烈，它们对生物组织的危害有多大，好吗？

It's a matter of degrees.

这是一个程度的问题。

But there is very little controversy as to whether or not they have an effect on biological tissues, and I'm aware of absolutely zero data showing that they can have a positive effect on biological tissues.

但关于它们是否对生物组织有影响几乎没有争议，而且我知道绝对零数据表明它们可以对生物组织产生积极影响。

Since what we're mainly talking about now are smartphones, we want to separate out the heat effects of smartphones from the EMFs related to the fact that they are Wi-Fi smartphones, or they're using cellular towers and Wi-Fi.

由于我们现在主要讨论的是智能手机，因此我们希望将智能手机的热效应与电磁场分开，因为它们是 Wi-Fi 智能手机，或者它们正在使用蜂窝塔和 Wi-Fi。

One or the other, or a combination.

其一或二，或两者的组合。

Okay, so there are a number of different things in the phone that could be detrimental.

好吧，手机中有很多不同的东西可能是有害的。

We need to separate those out.

我们需要将它们分开。

Why?

为什么？

Well, because you might have heard that carrying your phone in your pocket can reduce your testosterone levels and sperm count.

嗯，因为您可能听说过将手机放在口袋里会降低您的睾丸激素水平和精子数量。

And guess what?

你猜怎么着？

That is true.

确实如此。

The data contained within this meta-analysis and other meta-analysis clearly point out that it can reduce sperm count and maybe testosterone levels significantly, but certainly sperm count and motility significantly.

这项荟萃分析和其他荟萃分析中包含的数据清楚地指出，它可以显着减少精子数量，可能还可以显着减少睾酮水平，但肯定会显着减少精子数量和活力。

It reduces sperm quality.

它会降低精子质量。

So should you avoid putting your phone in your pocket?

那么你应该避免把手机放在口袋里吗？

Certainly your front pocket, I would suggest yes, if you are somebody who is seeking to conceive.

当然是你的前口袋，如果你正在寻求怀孕，我建议你可以。

I'm not somebody who is going to stop using my smartphone.

我不会停止使用智能手机。

I don't expect anyone's going to stop using their smartphone.

我不认为有人会停止使用智能手机。

The question is, should you carry it in your front pocket if you're a male?

问题是，如果你是男性，你应该把它放在前面的口袋里吗？

I think to be on the safe side, the answer is probably avoid doing that too much of the time.

我认为为了安全起见，答案可能是避免太多时间这样做。

Ideally, don't do it at all.

理想情况下，根本不要这样做。

Then people will say, "Well, what if I turn off the Wi-Fi or I turn off the cellular access, then is it still a problem?" Well, it's a problem due to the heat-related effects.

然后人们会说，“好吧，如果我关闭 Wi-Fi 或关闭蜂窝接入怎么办，那还有问题吗？”嗯，这是由于与热相关的影响而产生的问题。

And then people say, "Well, I don't actually feel the heat of the phone.

然后人们会说：“好吧，我实际上感觉不到手机的热量。

It doesn't get that warm." But the temperature effects of the phone, it turns out, are enough, even under conditions in which people don't report it to be uncomfortably warm, that it can change the temperature milieu of the testicle in ways that can diminish sperm quality.

天气没那么热了。”但事实证明，手机的温度影响足以改变睾丸的温度环境，从而降低精子质量，即使人们没有报告它温度过高。

How much and how that relates to fertility and healthy pregnancy?

这与生育和健康怀孕有多大关系以及如何相关？

Not clear.

不清楚。

But since we're talking about things to avoid if your goal is to have a healthy fertilization and pregnancy, well then, by all means, just don't carry it in your front pocket.

但是，既然我们讨论的是如果您的目标是健康受精和怀孕，则需要避免的事情，那么无论如何，不​​要将其放在前面的口袋里。

Then people say, "Well, what about back pocket?" Or, "What about backpack?" Look, it's very clear that avoiding being too close to the phone is probably better for your sperm quality than putting the phone very close to your testicles or anywhere else on your body.

然后人们会说：“那么，后口袋呢？”或者，“背包怎么样？”看，很明显，避免离手机太近可能比将手机靠近睾丸或身体其他任何地方更有利于精子质量。

But it's also the reality that most people are going to carry a phone nowadays.

但这也是当今大多数人都会携带手机的现实。

All right?

好的？

It's just the reality.

这就是现实。

I think the current estimates, and it's discussed in this paper, that 90% of the human population has a smartphone.

我认为目前的估计以及本文中所讨论的，90% 的人口拥有智能手机。

90%, which is incredible.

90%，这太不可思议了。

The adult population, of course, although a lot of kids have them as well.

当然，成年人也有，尽管很多孩子也有。

So this paper goes on to detail a number of different studies and outcomes from studies.

因此，本文继续详细介绍了许多不同的研究和研究结果。

But basically what they find, and here I'm paraphrasing, is that the data indicate that sperm quality declines when people start using a mobile phone.

但基本上他们发现的（我在这里解释一下）是，数据表明，当人们开始使用手机时，精子质量会下降。

So from the point they start using a mobile phone, regardless of the usage time, this is important.

所以从他们开始使用手机的那一刻起，无论使用时间长短，这一点都很重要。

It used to be thought that it was four hours a day or more of holding your phone or having that phone close to your body was going to diminish sperm quality.

过去人们认为，每天拿着手机四个小时或更长时间或将手机靠近身体会降低精子质量。

It turns out that it's not related to usage time.

事实证明，这与使用时间无关。

That's even the title of the paper.

这甚至是论文的标题。

It's just the fact that people are using mobile phones is reducing sperm count and quality.

事实上，人们使用手机正在减少精子数量和质量。

That's the reality.

这就是现实。

Is it entirely responsible for all the reductions in sperm quality and maybe even the reductions in testosterone levels that we're observing from decade to decade going forward?

它是否完全是我们在未来十年中观察到的所有精子质量下降甚至睾酮水平下降的原因？

I doubt that's the case.

我怀疑情况确实如此。

Is it likely to be one of the major players?

它有可能成为主要参与者之一吗？

I've got my bet on the fact that it is based on the data that I've observed.

我敢打赌，它是基于我观察到的数据。

And so if any of you would like to peruse the data in this meta-analysis, they're quite good.

因此，如果你们中的任何人想仔细阅读此荟萃分析中的数据，它们都非常好。

This study looked at 18 studies that include 4,280 samples.

这项研究考察了 18 项研究，包括 4,280 个样本。

They were able to separate out the radio frequency versus the heat effects, and they were able to eliminate this time of usage variable that previously we thought if you were exposed to a lot of cellphone contact, that it was far worse than if you were exposed to a little bit.

他们能够将射频与热效应分开，并且能够消除这个使用时间变量，我们之前认为，如果你经常接触手机，情况会比接触一点点要糟糕得多。

Turns out if you're exposed to any at all, you're going to diminish sperm quality.

事实证明，如果您接触到任何一种物质，就会降低精子质量。

What does that mean?

这意味着什么？

Does that mean that no matter what you do, if you own a smartphone, that you're going to diminish sperm quality?

这是否意味着无论你做什么，如果你拥有智能手机，你的精子质量都会下降吗？

I think the short answer is yes, but that you can mitigate it What might you do?

我认为简短的答案是肯定的，但你可以减轻它你可以做什么？

Well, keeping your phone away from your groin or as far from your groin as possible if you're a male who's wishing to conceive, and maybe even a male who's wishing to maximize his testosterone levels, because it does appear that radio frequency waves and the heat from the phone, so both of those factors independently and together, of course, can disrupt the Leydig cells of the testes and the production of testosterone.

那么，如果您是一位想要怀孕的男性，甚至可能是一位希望最大限度地提高睾酮水平的男性，请将手机远离腹股沟，或者尽可能远离腹股沟，因为射频波和手机发出的热量，所以这两个因素单独或共同作用，当然会扰乱睾丸的间质细胞和睾酮的产生。

And intratesticular testosterone is important for sperm production.

睾丸内睾酮对于精子的产生很重要。

The exact biological variables leading to all these changes isn't exactly clear, but if you're like me, you say, "Okay, probably not a problem for most males to carry their phone," but probably best to not carry it in the front pocket, maybe even avoid carrying in the back pocket as well.

导致所有这些变化的确切生物变量尚不清楚，但如果你像我一样，你会说，“好吧，对于大多数男性来说携带手机可能不是问题”，但最好不要将手机放在前面的口袋里，甚至也不要放在后面的口袋里。

Again, in the future, we will have an episode all about Bluetooth.

同样，将来我们将有一集关于蓝牙的内容。

We'll talk about various aspects of EMFs.

我们将讨论 EMF 的各个方面。

It's a super interesting data set, and it's a data set which there's a ton of controversy.

这是一个超级有趣的数据集，也是一个存在很多争议的数据集。

It's really interesting, however, and there are more and more quality data coming out all the time, and I think going forward, we are going to see that indeed, there are some negative effects of smartphones related to both their radio frequency transmission and the fact that they generate heat.

然而，这确实很有趣，而且一直有越来越多的高质量数据出现，我认为展望未来，我们确实会看到智能手机确实存在一些与其射频传输和产生热量相关的负面影响。

And in general, heat is not good for biological tissues.

一般来说，热量对生物组织不利。

So any discussion about heat and sperm and how heat is detrimental to sperm has to raise this issue of whether or not cold is good for the testicle.

因此，任何关于热和精子以及热如何对精子有害的讨论都必须提出冷是否对睾丸有益的问题。

Okay, well, now there's a lot of data starting to come out about the positive effects, the positive biological effects of deliberate cold exposure on different aspects of brain biology, such as the release of dopamine and norepinephrine, and on the biology of the body, to some extent, metabolism, but more so the impact on brown fat stores, which are good for us, so-called brown fat thermogenesis.

好吧，现在有很多关于积极影响的数据开始出现，刻意的寒冷暴露对大脑生物学不同方面的积极生物学影响，例如多巴胺和去甲肾上腺素的释放，以及对身体生物学的积极影响，在某种程度上，新陈代谢，但更重要的是对棕色脂肪储存的影响，这对我们有好处，即所谓的棕色脂肪生热作用。

There's a lot related to deliberate cold exposure, and we've done entire episodes on deliberate cold exposure.

有很多与故意寒冷暴露有关的内容，我们已经完成了关于故意寒冷暴露的整集。

Again, you can find that at hubermanlab.com.

同样，您可以在 hubermanlab.com 上找到它。

We did a guest episode with an expert on the use of cold for health and performance with my colleague Craig Heller from Stanford Department of Biology.

我们与一位来自斯坦福大学生物系的同事克雷格·海勒（Craig Heller）一起客串了一位关于如何利用寒冷来促进健康和提高表现的专家。

We also have a toolkit on how to apply deliberate cold exposure for health for both females and for males, for sports performance, cognitive performance, mood, sleep, et cetera.

我们还有一个工具包，介绍如何有意地进行寒冷暴露，以促进女性和男性的健康，包括运动表现、认知表现、情绪、睡眠等。

You can find all that, again, hubermanlab.com, totally zero cost.

您可以再次在 hubermanlab.com 上找到所有这些，完全零成本。

Just go into the menu, go to Newsletter, and scroll down, and you'll find those.

只需进入菜单，转到新闻通讯，然后向下滚动，您就会找到这些内容。

When thinking about sperm quality, we want to remember that excessive heat is bad.

在考虑精子质量时，我们要记住，过热是不好的。

Now, does that mean that deliberate cold is good?

那么，这是否意味着故意冷是好的呢？

Well, it turns out that one of the major causes of lowered sperm count and overall reduced sperm quality that's quite common is the presence of what's called a varicocele.

事实证明，精子数量减少和精子质量总体下降的主要原因之一是精索静脉曲张的存在，这种情况很常见。

A varicocele has kind of like varicose veins of the veins that innervate the testicle.

精索静脉曲张有点像支配睾丸的静脉曲张。

And what it essentially does is it means that blood will pool in the testicular region.

它本质上的作用是意味着血液会聚集在睾丸区域。

It can't circulate back to the body quickly enough, and therefore, the temperature of that environment increases.

它无法足够快地循环回体内，因此环境温度会升高。

There are some other things that varicoceles do which can be obstructive at the physical level, so they're not just temperature related.

精索静脉曲张还会造成其他一些可能在身体层面上造成阻碍的事情，因此它们不仅仅与温度有关。

It's pretty clear that using deliberate cold exposure can be healthy for the sperm because of the ways not that cold directly supports testosterone or sperm quality, but rather because cold reduces heat.

很明显，故意暴露在寒冷环境下对精子有益，因为寒冷不是直接支持睾酮或精子质量，而是因为寒冷会减少热量。

Okay, so you will find available online, I think they're actually called, forgive me, but that's what they're called, I didn't name them, called Snowballs.

好吧，所以你会在网上找到，我想他们实际上被称为，请原谅我，但这就是他们的名字，我没有给他们命名，叫雪球。

They're sort of like gel pack cold briefs that you can buy and men will wear for some period of time.

它们有点像凝胶包冷内裤，你可以购买，男士会穿着一段时间。

I don't think you wear them all day.

我不认为你整天都戴着它们。

You wear them for some period of time.

您佩戴它们一段时间。

A lot of people are now using cold showers and ice baths and circulating cold baths or going into a cold ocean or lake for any number of different reasons I talked about earlier.

由于我之前提到的各种不同原因，现在很多人都在使用冷水淋浴、冰浴和循环冷水浴，或者进入寒冷的海洋或湖泊。

I myself start every day with either a one- to three-minute cold shower or one to three-minute immersion up to my neck in a cold bath, cold water, circulating water, or a cold shower.

我自己每天开始时要么洗一到三分钟的冷水澡，要么在冷水浴、冷水、循环水或冷水淋浴中浸泡一到三分钟，直至颈部。

I do that mainly for the psychological effects related to the long-lasting increases in dopamine and epinephrine.

我这样做主要是为了与多巴胺和肾上腺素的长期增加相关的心理影响。

But there are other data starting to come out showing that that sort of approach or similar approaches can increase testosterone levels and maybe even sperm counts, can reduce cortisol late in the evening if the cold exposure is done early in the day, so on and so forth.

但也有其他数据开始出现，表明这种方法或类似的方法可以增加睾酮水平，甚至可能增加精子数量，如果在白天早些时候进行寒冷暴露，可以减少晚上的皮质醇，等等。

So a lot of interesting data coming out in really good journals that are peer-reviewed and so on in humans.

因此，许多有趣的数据出现在经过同行评审的非常好的期刊上，等等。

I should mention those studies are done in humans to support the use of deliberate cold exposure.

我应该提到的是，这些研究是在人类身上进行的，以支持故意冷暴露的使用。

But again, if you're going to use deliberate cold exposure to improve sperm quality, can it work?

但话又说回来，如果你打算通过刻意的冷暴露来提高精子质量，这有效吗？

Yes, indeed, it can work, either indirectly by increasing testosterone or directly by improving sperm quality.

是的，它确实可以发挥作用，可以通过间接增加睾丸激素或直接通过提高精子质量来发挥作用。

But both of those effects are likely to be indirect by virtue of reducing the temperature of the testicle overall, not because there's any sort of magic effect of cold on the testicle.

但这两种影响很可能是间接的，因为总体上降低了睾丸的温度，而不是因为寒冷对睾丸有任何神奇的影响。

Now, I have to imagine that a number of you, in particular the females listening to this, are going to say, "Is deliberate cold exposure, and for that matter, is deliberate heat exposure, like sauna or hot tub, good or bad for the ovary, for eggs, and for fertility?" Now, there, there are fewer data to look to, unfortunately.

现在，我可以想象，你们中的许多人，特别是听到这个消息的女性，会说，“故意冷暴露，就此而言，故意热暴露，比如桑拿或热水浴缸，对卵巢、卵子和生育能力是好是坏？”不幸的是，现在可供参考的数据越来越少。

But what we do know is that deliberate cold exposure done in the way that I just described, one to three minutes a day, ideally early in the day through cold shower or immersion up to the neck, doesn't have to be an ice bath, could be cold circulating water or even non-circulating cold water.

但我们所知道的是，按照我刚才描述的方式进行刻意的冷暴露，每天一到三分钟，最好是在一天的早些时候通过冷水淋浴或浸泡到颈部，不一定是冰浴，可以是冷循环水，甚至是非循环冷水。

And people will say, "Well, how cold?" I should have mentioned that before.

人们会说：“嗯，有多冷？”我之前就应该提到这一点。

How cold?

有多冷？

There is no way I can tell you exactly how cold the water should be, because for some people, 60 degrees Fahrenheit will be exceedingly cold.

我无法准确告诉你水应该有多冷，因为对于某些人来说，60 华氏度会非常冷。

For other people, 40 degrees is going to be more appropriate.

对于其他人来说，40 度会更合适。

How cold should you make it?

你应该把它调到多冷？

If you're going to embrace these practices, according to the literature, what you want to do is make it uncomfortably cold, such that you really want to get out, but safe, right?

根据文献，如果你打算接受这些做法，你想做的就是让它变得不舒服的寒冷，这样你真的很想出去，但又安全，对吗？

You don't want to go into 30-degree water immediately.

你不想立即进入30度的水中。

You can actually have a heart attack and die if you do that.

如果你这样做，你实际上可能会心脏病发作并死亡。

So you want to progress gradually into the cold.

所以你要逐渐进入寒冷状态。

So you don't want to shock your system too much, although it is the adrenaline evoked by that quickening or shortening or elimination of the breath for a short period of time when you get into uncomfortably cold water that correlates with, or is actually the reflection of, would be more accurate to say, the release of adrenaline and then dopamine and so forth, which has been very well documented.

所以你不想让你的系统受到太大的冲击，尽管当你进入令人不舒服的冷水时，短时间内加速、缩短或消除呼吸会引起肾上腺素，这与肾上腺素和多巴胺等的释放相关，或者实际上反映了，更准确地说，肾上腺素的释放，然后是多巴胺等，这已经有很好的记录。

So Uncomfortably cold but safe to stay in, and I cannot tell you an exact number that is uncomfortably cold but safe for you.

寒冷得令人不舒服，但呆在里面很安全，我无法告诉你寒冷得不舒服但对你来说安全的确切数字。

It's going to differ person by person.

这会因人而异。

You want to figure that out.

你想弄清楚这一点。

Just like I can't tell you how much weight that you should squat in order to achieve some effective resistance training for the legs.

就像我无法告诉你应该深蹲多少重量才能对腿部进行有效的阻力训练。

It's going to differ depending on your strength and your prior experience and so forth.

根据您的实力和之前的经验等，它会有所不同。

So ease into it, be safe.

所以放松一点，注意安全。

But it does appear that both for men, for reasons I talked about a few minutes ago, and for women, that deliberate cold exposure can be beneficial for fertility and for hormone production, but in particular for females in terms of regulating cortisol and for hormone production.

但出于我几分钟前谈到的原因，对于男性和女性来说，刻意的寒冷暴露确实有利于生育和激素的产生，特别是对于女性来说，在调节皮质醇和激素的产生方面。

Now, you might say, "Okay, getting into cold is stressful.

现在，你可能会说：“好吧，感冒是有压力的。

How can that be helpful for regulating stress?" Well, it turns out when you get into the cold, you get a big surge in adrenaline and then dopamine, which is very long-lasting, provided that's done in the early part of the day.

这对调节压力有何帮助？”事实证明，当你感到寒冷时，你的肾上腺素和多巴胺会大量激增，如果是在一天的早些时候完成的话，这种作用是非常持久的。

So I would say not too close to sleep.

所以我想说不要睡得太近。

Then what you do is you restrict your maximum cortisol release to a period earlier in the day that buffers, reduces, that is, the likelihood that you would have excessive amounts of cortisol later in the day, which not only can disrupt sleep but is correlated with a number of other hormonal effects that are not good for us and therefore not good for fertility.

然后你要做的就是将皮质醇的最大释放量限制在当天早些时候的一段时间内，以缓冲、减少当天晚些时候皮质醇过量的可能性，这不仅会扰乱睡眠，而且与许多其他激素效应相关，这些效应对我们不利，因此不利于生育。

So here what I'm describing are positive yet indirect effects of the cold on hormone levels, both in males and in females.

因此，我在这里描述的是寒冷对男性和女性激素水平的积极但间接的影响。

So for men, we talked about increased testosterone, improved sperm quality.

因此，对于男性来说，我们谈论的是增加睾酮水平，提高精子质量。

That was indirect, right?

那是间接的，对吧？

You're reducing the temperature of the testicle, but it's not that cold itself is positively impacting those things.

你正在降低睾丸的温度，但寒冷本身并不会对这些事情产生积极影响。

Does that make sense?

这有道理吗？

Heat is bad, therefore reducing temperature is good.

热是不好的，因此降低温度是好的。

Likewise with females, deliberate cold exposure can be good for the overall fertility process, not because cold is good for the ovary or being cold is good for the ovary, or for luteinizing hormone, or for follicle-stimulating hormone, or anything else like that, but rather that using deliberate cold exposure as a way to restrict stress in a deliberate way to a particular time of day increases the release of cortisol then and indirectly reduces the amount of cortisol that's released at other times along the 24-hour cycle.

同样，对于女性来说，刻意的寒冷暴露可能有利于整个生育过程，不是因为寒冷对卵巢有好处，或者寒冷对卵巢、黄体生成素、卵泡刺激素或其他类似的东西有好处，而是因为使用刻意的寒冷暴露作为一种故意将压力限制在一天中特定时间的方法，会增加皮质醇的释放，然后间接减少在整个过程中其他时间释放的皮质醇的量。 24小时循环。

Okay, so these are positive yet indirect effects.

好的，这些都是积极但间接的影响。

So if you're a woman who really is interested in exploring deliberate cold exposure or who enjoys it or is already doing it and you're wishing to conceive, great.

因此，如果您是一位真正有兴趣探索故意寒冷暴露的女性，或者喜欢它或已经这样做并且您希望怀孕，那就太好了。

Explore it.

探索它。

Do it safely, of course, but explore it and continue to do it.

当然，要安全地进行，但要探索并继续这样做。

However, if you're somebody who just hates the cold and doesn't want to go anywhere near it, there's no reason to think that you absolutely need it, provided that your stress, your sleep, and other factors are all being carried out properly.

然而，如果你只是讨厌寒冷，不想去任何靠近寒冷的地方，那么没有理由认为你绝对需要它，只要你的压力、睡眠和其他因素都得到妥善处理。

The next things that we'll talk about in terms of positive things or things that we can do in order to maximize fertility for both females and males are the things that you also generally hear about elsewhere.

接下来我们将讨论积极的事情或我们可以做的事情，以最大限度地提高女性和男性的生育能力，这些事情也是您在其他地方通常听到的。

Right along with sleep and avoiding alcohol and avoiding nicotine and avoiding cannabis, avoiding excessive heat for the testicle, avoiding excessive stress, is that you want to try to get enough exercise, right?

除了睡眠、避免饮酒、避免尼古丁、避免大麻、避免睾丸过热、避免过度压力之外，您还想尝试进行足够的锻炼，对吧？

Why would exercise have anything to do with any of this?

为什么运动与这些有关系呢？

Well, exercise, and that is both a combination of resistance training and cardiovascular exercise, is going to improve the health of the mitochondria, in particular cardiovascular exercise.

嗯，运动，即阻力训练和心血管运动的结合，将改善线粒体的健康，特别是心血管运动。

And I realize that for you fitness experts out there, anytime someone says cardio, people kind of roll their eyes, like, "What is that?" There's endurance training, there's interval training, there's HIIT training, there's sprints, there's all sorts of different things.

我意识到，对于健身专家来说，每当有人提到有氧运动时，人们都会翻白眼，比如“那是什么？”有耐力训练，有间歇训练，有HIIT训练，有冲刺训练，有各种各样不同的训练。

Some of those overlap, some of them are separate.

其中有些是重叠的，有些是分开的。

Indeed, that's the case.

确实如此。

But we can use a general rule of thumb here, which is that for most people, getting anywhere from 30 and ideally 45 to 60 minutes of exercise per day for six days per week, maybe even seven, but most people like to take a day off or need to take a complete day off each week, six to seven days per week is going to be good for mitochondrial health and function.

但我们可以在这里使用一个一般的经验法则，即对于大多数人来说，每周锻炼六天，甚至七天，每天锻炼 30 分钟，最好是 45 到 60 分钟，但大多数人喜欢休息一天或需要每周休息一整天，每周锻炼 6 到 7 天将有利于线粒体的健康和功能。

It's also going to impact all the other things like quality sleep, mood, reducing stress, and so on and so forth.

它还会影响所有其他方面，例如睡眠质量、情绪、减轻压力等等。

So exercise we can handle pretty quickly by just saying everyone should be doing it.

因此，只要说每个人都应该这样做，我们就能很快地处理好锻炼。

Now, when people are pregnant, they might have to, of course, change the amount of exercise or the type of exercise that they're doing.

现在，当人们怀孕时，他们当然可能必须改变运动量或运动类型。

There are varying opinions on that, but certainly the type of exercise and the amount can vary when people are pregnant.

对此有不同的看法，但怀孕期间的运动类型和运动量肯定会有所不同。

But if you're seeking to conceive, getting enough exercise is good because it's good for the mitochondria.

但如果您想怀孕，进行足够的锻炼是有好处的，因为这对线粒体有好处。

The mitochondria are present in that mid-region of the sperm, and mitochondria are critical for chromosomal segregation and the spindle and other aspects of the formation of a healthy egg, ovulation, and fertilization in the female.

线粒体存在于精子的中部区域，线粒体对于染色体分离、纺锤体以及女性健康卵子形成、排卵和受精的其他方面至关重要。

One thing that I know a lot of people are interested in nowadays is so-called intermittent fasting or time-restricted feeding.

我知道现在很多人感兴趣的一件事是所谓的间歇性禁食或限时进食。

I mean, let's be fair.

我的意思是，让我们公平一点。

Everybody is restricting their feeding time because hopefully everybody is sleeping at some point in the 24-hour cycle and nobody's eating while they are sleeping.

每个人都在限制进食时间，因为希望每个人都在 24 小时周期的某个时刻睡觉，并且没有人在睡觉时进食。

That said, many people are employing a so-called eight-hour feeding window or a 10-hour feeding window or a 12-hour feeding window, and indeed, there are some data to support the idea that that can be a good thing for a number of different biological and health parameters.

也就是说，许多人正在采用所谓的 8 小时喂养窗口、10 小时喂养窗口或 12 小时喂养窗口，事实上，有一些数据支持这样的观点，即这对于许多不同的生物和健康参数来说可能是一件好事。

However, also a lot of data, especially recently, pointing to the fact that your overall number of calories and the quality of your food sources is going to be the most important variable, and some people simply find that time-restricted feeding, intermittent fasting as it's also called, is just a convenient way to ensure that your total intake of calories is not excessive for what you need.

然而，也有很多数据，尤其是最近的数据，指出你的卡路里总量和食物来源的质量将是最重要的变量，有些人只是发现限时进食，也称为间歇性禁食，只是确保你摄入的总卡路里不会超出你的需要的一种便捷方法。

Now, with all that said, there is evidence that I've covered in a solo episode and will soon have an expert guest on showing that time-restricted feeding can have certain positive outcomes for various aspects of organ, cellar, and tissue health.

话虽如此，有证据表明我已经在一个单独的节目中进行了报道，并且很快就会有一位专家嘉宾来证明限时喂养可以对器官、地窖和组织健康的各个方面产生某些积极的结果。

Okay, this is somewhat controversial, but there is growing evidence that by restricting your feeding window to, say, eight hours or 10 hours or 12 hours, that it is better than if you were to eat over a longer period of each 24-hour cycle.

好吧，这有些争议，但越来越多的证据表明，将进食时间限制为 8 小时、10 小时或 12 小时，这比在每个 24 小时周期中延长进食时间要好。

But again, the data are still incoming.

但同样，数据仍在传入。

The reason we want to talk about time-restricted feeding, intermittent fasting, is that a lot of people do use it because they find it easier to not eat at certain periods of their 24-hour cycle than to restrict calories.

我们之所以要谈论限时进食（间歇性禁食），是因为很多人确实使用它，因为他们发现在 24 小时周期的某些时段不吃东西比限制卡路里更容易。

But again, keep in mind that you have to restrict calories if your goal is to maintain or lose weight.

但再次请记住，如果您的目标是保持或减肥，则必须限制卡路里。

All right?

好的？

A discussion that we've covered in that episode on intermittent fasting and in the episode with Dr. Layne Norton, and that we will cover in other episodes in the future.

我们在关于间歇性禁食的那一集中以及与莱恩·诺顿博士的那一集中讨论了这个讨论，并且我们将在未来的其他集中讨论。

So refer to those episodes at hubermanlab.com if you would like to learn more about intermittent fasting per se.

因此，如果您想了解有关间歇性禁食本身的更多信息，请参阅 hubermanlab.com 上的这些剧集。

For sake of this conversation, a number of people are probably asking, "If I restrict my feeding to a certain window each 24 hours because that's what's convenient or because I'm excited about the potential positive effects of intermittent fasting, is that going to disrupt the likelihood of fertility and thereby a healthy pregnancy?" And the short answer to that is if you are a female and you are having regular menstrual cycles, that is a fairly consistent duration.

为了进行这次对话，许多人可能会问，“如果我将喂食限制在每 24 小时的某个时段，因为这样比较方便，或者因为我对间歇性禁食的潜在积极影响感到兴奋，那么这是否会破坏生育的可能性，从而破坏健康怀孕的可能性？”简短的回答是，如果您是女性并且月经周期规律，那么月经的持续时间相当稳定。

So maybe it's 21 days, maybe it's 35, or anywhere in between, but it's fairly consistent from month to month and you are following intermittent fasting time-restricted feeding, well, then chances are pretty good that it's not disrupting your fertility and likelihood of fertilization and a healthy pregnancy.

所以也许是 21 天，也许是 35 天，或者介于两者之间，但每个月的情况相当一致，而且您正在遵循间歇性禁食限时喂养，那么很有可能它不会破坏您的生育能力以及受精和健康怀孕的可能性。

Of course, during pregnancy, you need to talk to your doctor and make sure that you're eating in a way that's supportive both of you and of the developing fetus.

当然，在怀孕期间，您需要咨询您的医生，并确保您的饮食方式有利于您和正在发育的胎儿。

That's extremely important.

这非常重要。

I am not aware of data exploring in a regimented way time-restricted feeding during pregnancy, okay?

我不知道有数据探索怀孕期间有规律的限时喂养，好吗？

So please if you're pregnant, do not jump on a time-restricted feeding, so-called intermittent fasting diet.

因此，如果您怀孕了，请不要急于进行限时喂养，即所谓的间歇性禁食。

Talk to your OBGYN, talk to your doctor, talk to multiple doctors for that matter, before doing anything like that because, of course, you're now eating for two, or if you have twins in there, you're eating for three.

在做类似的事情之前，先咨询您的妇产科医生，咨询您的医生，咨询多位医生，因为当然，因为您现在正在吃两个人的饭，或者如果您有双胞胎，那么您正在吃三个人的饭。

Very important.

非常重要。

If, however, you're not yet pregnant and you want to be fertile, get pregnant, or simply maintain a fertile potential and biology and you're following intermittent fasting, it's going to be the regularity of those periods and regularity of cycle length that will tell you whether or not that's a good idea or not.

然而，如果您尚未怀孕，并且想要生育、怀孕或只是保持生育潜力和生物学特性，并且您正在进行间歇性禁食，那么这些时期的规律性和周期长度的规律性将告诉您这是否是一个好主意。

Keeping in mind, of course, that if your total number of calories is too low, your periods will cease.

当然，请记住，如果您的卡路里总量太低，您的月经就会停止。

That's a well-known effect.

这是众所周知的效果。

But of course, stress can also induce cessation of menstruation, and there are other factors that can induce cessation of menstruation as well.

当然，压力也会导致月经停止，还有其他因素也会导致月经停止。

Some of them start with changes in the brain, literally in the hypothalamus.

其中一些始于大脑的变化，实际上是下丘脑的变化。

Some occur in the pituitary.

有些发生在垂体中。

Many lifestyle factors can do that, but most typically it's going to be excessive caloric restriction or it's going to be a caloric deficit brought on by excess physical activity.

许多生活方式因素都可以造成这种情况，但最常见的是过度限制热量，或者是过度体力活动导致的热量不足。

So even if someone's eating a lot, if they're not eating enough to offset their physical activity or they're not eating enough of in particular fats, the essential fatty acids and protein, but also carbohydrates, well, then menstruation can cease.

因此，即使某人吃得很多，但如果他们吃的东西不足以抵消他们的体力活动，或者他们没有吃足够的特定脂肪、必需脂肪酸和蛋白质，还有碳水化合物，那么月经就会停止。

And of course, if menstruation is ceasing, chances are almost with certainty that you're not getting regular ovulations.

当然，如果月经停止，几乎可以肯定您没有正常排卵。

Now in terms of males and whether or not intermittent fasting is going to disrupt spermatogenesis and testosterone production, there's essentially no data we can look to, but we can look to the general logic around the relationship between body fat, testosterone, and spermatogenesis.

现在，就男性而言，间歇性禁食是否会扰乱精子发生和睾酮生成，我们基本上没有可以参考的数据，但我们可以看看身体脂肪、睾酮和精子发生之间关系的一般逻辑。

And this was something that was covered in a discussion I had on optimization of hormone health for males that I had with Dr. Kyle Gillett who's a medical doctor and an obesity specialist.

这是我与凯尔·吉列博士（Kyle Gillett）进行的关于优化男性荷尔蒙健康的讨论中所涉及的内容，他是一名医生和肥胖专家。

Again, you can find that episode at hubermanlab.com if you want to learn all about hormone optimization in males.

同样，如果您想了解有关男性激素优化的所有信息，您可以在 hubermanlab.com 上找到该剧集。

And essentially the story is as follows.

故事的本质如下。

If a male is excessively overweight, he's carrying too much body fat in particular, not too much muscle, although that can be an issue too, but too much body fat is typically the issue.

如果男性过度超重，那么他的身体脂肪尤其过多，而不是肌肉过多，尽管这也可能是一个问题，但过多的身体脂肪通常是问题所在。

So more than, say, 20% body fat, well, then losing body fat is going to be the primary goal for maximizing testosterone, sperm health, and spermatogenesis.

因此，如果体脂超过 20%，那么减少体脂将成为最大化睾酮、精子健康和精子发生的主要目标。

If, however, a male is already lean, well, then actually increasing calories will increase testosterone.

然而，如果男性已经很瘦，那么实际上增加卡路里会增加睾丸激素。

So it's a bit of a complicated story, although not so complicated that none of us can understand it.

所以这是一个有点复杂的故事，虽然还没有复杂到我们谁都无法理解的程度。

Basically, if you're overweight, you should focus on losing weight in order to maximize sperm quality and health.

基本上，如果您超重，您应该专注于减肥，以最大限度地提高精子质量和健康。

If you are very lean, well, then restricting your calories to the point where you are starting to lose weight or you're dropping even more body fat is unlikely to increase your testosterone further.

如果你很瘦，那么限制你的卡路里到你开始减肥或减少更多身体脂肪的程度就不太可能进一步增加你的睾丸激素。

Right?

正确的？

It doesn't necessarily mean it's bad or that you shouldn't try and go, for instance, from 15% to 10% body fat.

例如，这并不一定意味着它不好，或者您不应该尝试将体脂从 15% 降至 10%。

I'm not saying that that's bad and that will reduce your testosterone, but in general, if you're already very lean, so 10% body fat, 5% body fat, and you start restricting calories further, your testosterone levels will drop.

我并不是说这不好，这会降低你的睾酮水平，但一般来说，如果你已经很瘦了，那么 10% 的体脂、5% 的体脂，然后你开始进一步限制卡路里，你的睾酮水平就会下降。

So in the context of intermittent fasting, it's really not an issue of whether or not your feeding window is eight hours or 12 hours.

因此，在间歇性禁食的情况下，进食窗口是 8 小时还是 12 小时实际上并不是问题。

It's really an issue of whether or not you're getting enough calories to offset the physical demands and activities of your life, whether or not you're on a maintenance diet to maintain your weight, and of course, you have to put all that in the context of whether or not you're overweight or lean to begin with.

这实际上是一个问题，你是否获得了足够的卡路里来抵消生活中的身体需求和活动，你是否正在通过维持饮食来维持体重，当然，你必须首先考虑你是否超重或瘦。

The simple thing to take away from this is if you're a male who's using because you like it, intermittent fasting, so-called time-restricted feeding, and you're following an eight-hour or maybe even a one meal per day type approach, although I don't really recommend that for a number of reasons we could talk about separately.

简单的一点是，如果你是一名男性，因为你喜欢间歇性禁食，即所谓的限时喂养，并且你正在遵循八小时甚至每天一顿饭的方法，尽管我并不真正建议这样做，原因有很多，我们可以单独讨论。

If you're eating over the course of eight or 10 or 12 hours per day because that's what works for you and you are ingesting enough calories to maintain your weight if you're already lean or you are ingesting fewer calories than you are burning in order to lose weight because you are already overweight and you want to lose body fat, you're probably optimizing for all the things that you need to do in order to improve sperm quality and testosterone levels.

如果您每天的进食时间超过 8、10 或 12 小时，因为这对您有效，并且您摄入了足够的卡路里来维持体重，如果您已经很瘦，或者您摄入的卡路里少于为了减肥而燃烧的卡路里，因为您已经超重并且想要减掉体内脂肪，那么您可能正在优化所有需要做的事情，以提高精子质量和睾酮水平。

Now, also in that episode that I did with Dr. Kyle Gillett on optimizing hormones for males, we talked about testosterone replacement therapy.

现在，在我与凯尔吉列博士一起优化男性荷尔蒙的那一集中，我们讨论了睾酮替代疗法。

It's not a topic I want to get into in any detail right now, but I will say this.

这不是我现在想详细讨论的话题，但我会这么说。

Remember earlier when we were talking about spermatogenesis and the fact that in order for sperm to be generated consistently every month ongoing from the time of puberty until essentially the time that a man dies, you need two things.

还记得之前我们谈论精子发生时的事实吗？为了让精子从青春期到男性死亡期间每个月都能持续产生，你需要做两件事。

You need testosterone production from the Leydig cells of the testes, and you need spermatogenesis to be supported by that androgen binding protein coming from the support cells from the Sertoli cells.

您需要睾丸间质细胞产生睾酮，并且需要来自支持细胞支持细胞的雄激素结合蛋白支持精子发生。

So you need testosterone and you need androgen binding protein, and you need the Leydig cells and the Sertoli cells active.

所以你需要睾酮，你需要雄激素结合蛋白，你需要间质细胞和支持细胞活跃。

When men take exogenous, meaning from outside the body, testosterone either by cream or by patch or by pellets, or more typically by injection, the most typical TRT approach nowadays is testosterone cypionate, which is biologically identical to the kind of testosterone you would make.

当男性通过霜剂、贴片或丸剂，或者更常见的是注射方式服用外源性（即从体外）睾酮时，当今最典型的 TRT 方法是环戊丙酸睾酮，它在生物学上与您将产生的睾酮类型相同。

Well, because of negative feedback loops, which you also learned about earlier, the testicles themselves shut down their own testosterone production.

好吧，由于负反馈循环（您之前也了解到这一点），睾丸本身会关闭自己的睾丸激素生产。

Why would that be?

为什么会这样呢？

Okay, so you're taking testosterone in by syringe or by patch or any other method.

好的，所以你可以通过注射器、贴剂或任何其他方法服用睾酮。

So the circulating testosterone and the amount that arrives at the testicle is going to be hopefully clinically appropriate, not super physiological, but it'll be somewhere in the healthy reference range, maybe a little bit higher.

因此，循环睾酮和到达睾丸的量将有望在临床上适当，而不是超生理，但它将在健康参考范围内，也许更高一点。

Nowadays, some people are going a little bit higher.

如今，有些人的追求更高了。

So we're not talking about full-blown, quote, unquote, "anabolic steroid use," keeping in mind, of course, that estrogen is a steroid, testosterone is a steroid, but when we think about steroids, we mean like performance-enhancing drugs, so super physiological doses.

因此，我们并不是在谈论成熟的“合成代谢类固醇的使用”，当然，请记住，雌激素是类固醇，睾酮也是类固醇，但当我们想到类固醇时，我们指的是像增强表现的药物，所以超生理剂量。

We're talking about within physiological or near physiological ranges.

我们谈论的是生理范围内或接近生理范围。

So if someone's taking their testosterone in from an outside exogenous source, the levels of circulating testosterone will be sufficiently high that the pituitary will register that and will stop making luteinizing hormone and generally follicle-stimulating hormone as well.

因此，如果某人从外部来源摄入睾酮，则循环睾酮的水平将足够高，垂体会记录下来，并停止产生黄体生成激素和通常的卵泡刺激激素。

And as a consequence, spermatogenesis is vastly reduced or eliminated.

结果，精子发生大大减少或消除。

In other words, for men who are on TRT or who are taking testosterone from an external source, the number of sperm that they're going to make is going to be dramatically reduced.

换句话说，对于接受 TRT 或从外部来源服用睾酮的男性来说，他们产生的精子数量将急剧减少。

There are things that they can do to offset that, like taking hCG, human chorionic gonadotropin, which is just kind of a mimic for luteinizing hormone to stimulate the testes to continue to make testosterone.

他们可以采取一些措施来抵消这一影响，例如服用 hCG（人绒毛膜促性腺激素），它是黄体生成素的模拟物，可以刺激睾丸继续产生睾酮。

And some men will also or instead take FSH to stimulate the Sertoli cells to support spermatogenesis, excuse me, or both, or some combination.

有些男性也会服用 FSH 来刺激支持细胞以支持精子发生，对不起，或者两者兼而有之，或者某种组合。

Some people take clomiphene Citrate.

有些人服用克罗米芬柠檬酸盐。

There are any number of different ways to bypass or offset the sperm-reducing effects of taking exogenous testosterone.

有许多不同的方法可以绕过或抵消服用外源睾酮造成的精子减少效应。

This is a conversation that was covered in a fair amount of detail in that episode with Dr. Gillette.

这段对话在与吉列医生的那一集中有相当多的细节。

But just keep in mind that if you are taking testosterone from an exogenous source, your sperm counts will dramatically be reduced unless you do something to offset it.

但请记住，如果您从外源获取睾酮，您的精子数量将急剧减少，除非您采取措施来抵消它。

So if you are wishing to conceive, you need to think about whether or not you're going to offset the testosterone replacement therapy or whether or not you're going to come off it entirely.

因此，如果您希望怀孕，您需要考虑是否要抵消睾酮替代疗法，或者是否要完全停止睾酮替代疗法。

So you'll need to talk to a urologist and endocrinologist about that.

因此，您需要与泌尿科医生和内分泌科医生讨论此事。

And again, a number of these different themes and ways to go about tapering off TRT were covered in that episode with Dr. Kyle Gillette.

凯尔·吉列博士在那一集节目中再次讨论了许多不同的主题和逐渐减少 TRT 的方法。

So if you're on TRT or you're considering taking it and you're interested in having children, not just now, but at any point, you really want to take these things into consideration.

因此，如果您正在接受 TRT 或您正在考虑接受该治疗，并且您对生孩子感兴趣，那么不仅仅是现在，而是在任何时候，您都确实需要考虑这些事情。

Now, I do want to point out that for the number of you out there who are taking supplements, some of which we've talked about on this podcast and I've talked about on other podcasts, such as tongkat ali, turns out that there are a lot of men and women taking tongkat ali to reduce sex hormone binding globulin levels, to increase testosterone and estrogen in some cases, libido, and so forth.

现在，我确实想指出，对于那些正在服用补充剂的人来说，其中一些我们在这个播客上讨论过，我也在其他播客上讨论过，例如东革阿里，事实证明，有很多男性和女性服用东革阿里来降低性激素结合球蛋白水平，在某些情况下增加睾酮和雌激素，性欲等等。

Those approaches, meaning supplement-based approaches to increase testosterone or free testosterone or some related hormones, are not going to shut down your own endogenous testosterone production and reduce the number of sperm that you make, or at least as far as we know, disrupt ovulation in any kind of way, provided that the dosages are within normal ranges.

这些方法，意味着以补充剂为基础的方法来增加睾酮或游离睾酮或一些相关激素，不会关闭您自己的内源性睾酮生成并减少您产生的精子数量，或者至少据我们所知，只要剂量在正常范围内，就不会以任何方式扰乱排卵。

Again, supplementation to support your hormones should not disrupt ovulation or spermatogenesis or testosterone production.

再次强调，支持荷尔蒙的补充剂不应干扰排卵、精子发生或睾酮生成。

Quite the opposite.

恰恰相反。

It should enhance it.

应该加强它。

What I just described around TRT is taking exogenous testosterone, and that itself is an entirely different beast.

我刚才描述的 TRT 是服用外源性睾酮，而这本身就是一个完全不同的野兽。

Now, with all of that said, there are some supplements out there that include testosterone as a ingredient that's been snuck in to various formulas that include blends and things of that sort.

话虽如此，现在有一些补充剂含有睾酮作为一种成分，它被偷偷地添加到各种配方中，包括混合物和类似的东西。

You want to be aware of that, and we did an episode about how to develop a rational guide to supplementation.

你想知道这一点，我们做了一集关于如何制定合理的补充指南的节目。

I highly recommend listening to that episode.

我强烈推荐听那一集。

Again, it's timestamped, available free at hubermanlab.com in all formats, because it talks about which supplements are likely to be clean, quote, unquote, "to contain the things that you expect them to contain." There's more and more evidence coming out that a lot of supplements, including some, for instance, supplements that contain testicle or the extracts of testicles can contain testosterone.

同样，它带有时间戳，可以在 hubermanlab.com 上以各种格式免费获得，因为它讨论了哪些补充剂可能是干净的、引用的、不引用的，“包含您期望它们包含的内容”。越来越多的证据表明，许多补充剂，包括一些含有睾丸或睾丸提取物的补充剂，都可能含有睾酮。

Whether or not that can shut down your own endogenous testosterone production isn't clear.

目前还不清楚这是否会阻止你自己的内源性睾酮产生。

No one's really explored that in detail.

没有人真正详细地探讨过这一点。

But based on everything we just talked about with TRT, it stands to reason that it might either reduce it or shut it down.

但根据我们刚刚与 TRT 谈论的一切，理所当然地，它可能会减少它或关闭它。

It's just never been explored yet.

只是还没有被探索过。

So by all means, make sure that you know what you're taking if you're taking supplements.

因此，如果您正在服用补充剂，请务必确保您知道自己正在服用什么。

But again, the major point here is that for both females and males, taking supplements to support healthy hormone production, including things like tongkat ali, is not the same as taking hormones or bioidentical hormones, which indeed can shut down your own endogenous production of hormones and thereby reduce both egg quality and the chance of fertilization and healthy pregnancy, and sperm quality and the chance of fertilization and healthy pregnancy.

但这里的重点是，对于女性和男性来说，服用补充剂来支持健康的激素产生，包括东革阿里之类的东西，与服用激素或生物同质激素不同，后者确实可以关闭您自身内源性激素的产生，从而降低卵子质量和受精和健康怀孕的机会，以及精子质量和受精和健康怀孕的机会。

Anytime there's a discussion about fertility and pregnancy, there seems to also be a parallel discussion about sex determination.

每当讨论生育和怀孕时，似乎也会同时讨论性别决定。

That is, what factors can influence whether or not the child that's born is male or female.

也就是说，哪些因素会影响所生的孩子是男性还是女性。

That is, whether or not it has double X chromosomes, so one X chromosome from mom, one X chromosome from dad, because the egg was fertilized by a sperm that had an X sex chromosome, that 23rd chromosome, or whether or not the offspring is male, whether or not it has the X chromosome from mom because it's always going to be the X chromosome in that egg, and a Y chromosome from the sperm that fertilized that particular egg.

也就是说，无论它是否有双X染色体，一条来自母亲的X染色体，一条来自父亲的X染色体，因为卵子是由具有X性染色体的精子（即第23条染色体）受精的，或者无论后代是否是男性，无论它是否具有来自母亲的X染色体，因为它总是该卵子中的X染色体，以及来自使该特定卵子受精的精子的Y染色体。

Now, of course, there are instances out there of people that have XXY chromosomes or XYY chromosomes.

当然，现在有些人拥有 XXY 染色体或 XYY 染色体。

But the vast majority of people out there are going to have either an XX chromosome, so we call that a female karyotype.

但绝大多数人都会有 XX 染色体，所以我们称之为女性核型。

This is different than genotype and phenotype, but I Female karyotype would be XX or a male karyotype, which would be XY.

这与基因型和表型不同，但女性核型为 XX，男性核型为 XY。

Okay?

好的？

Now, despite the fact that it is the egg and the sperm and the chromosomes that they carry that are going to determine the chromosomes, there's a lot of lore and discussion about the factors that can bias which sperm will fertilize the egg, and thereby whether or not you're going to get an XX female or an XY male chromosome, and therefore offspring.

现在，尽管事实是卵子、精子以及它们携带的染色体将决定染色体，但对于哪些因素会影响哪些精子使卵子受精，从而决定您是否会得到 XX 女性染色体或 XY 男性染色体，以及后代，有很多知识和讨论。

Now, not only is the lore around this whole issue of sex determination rather prominent, but it is also somewhat unusual and perhaps even interesting.

现在，围绕性别决定整个问题的传说不仅相当突出，而且还有些不寻常，甚至可能很有趣。

So for instance, Aristotle himself proposed that if a man is thinking about himself and his own pleasure more than his partner and her pleasure at the point of ejaculation, then the offspring will be male.

例如，亚里士多德本人提出，如果一个男人在射精时更多地考虑自己和自己的快乐，而不是他的伴侣和她的快乐，那么后代将是男性。

Aristotle also asserted that if a man is thinking more about his partner and her pleasure at the point in which he ejaculates, well, then the offspring would be female.

亚里士多德还断言，如果一个男人在射精时更多地考虑他的伴侣和她的快乐，那么他的后代将是女性。

Of course, we have zero reason to believe that there's any truth to Aristotle's theory.

当然，我们没有零理由相信亚里士多德的理论是正确的。

There are no data to support that.

没有数据支持这一点。

In fact, I'm not even sure how you would run that experiment because you can't really look at people's thoughts.

事实上，我什至不确定你将如何进行这个实验，因为你无法真正了解人们的想法。

You'd have to rely on honest self-report and even if people were to faithfully report what they were thinking about at the moment of ejaculation, this would involve, of course, bringing people into the laboratory and somehow measuring or analyzing their thoughts or gathering their thoughts during the sexual intercourse at the point of ejaculation, then figuring out which biological sex was the offspring, et cetera.

你必须依靠诚实的自我报告，即使人们要如实地报告他们在射精那一刻所想的事情，这当然也需要将人们带入实验室，并以某种方式测量或分析他们的想法，或者在射精时的性交过程中收集他们的想法，然后弄清楚哪种生物性别是后代，等等。

Just near impossible and probably not the most important experiment to invest our time doing.

这几乎是不可能的，而且可能不是值得我们花时间去做的最重要的实验。

Nonetheless, there continues to be a lot of lore about what determines the sex of the offspring.

尽管如此，关于什么决定了后代的性别，仍然有很多传说。

Most notably, there's a lot of lore and discussion and rumor about the idea that particular sexual positions at the point of ejaculation during intercourse can somehow bias the likelihood that a pregnancy will be either resulting in male or female offspring.

最值得注意的是，有很多传说、讨论和谣言，认为性交时射精时的特定性姿势会在某种程度上影响怀孕产生男性或女性后代的可能性。

Now again, there are zero data to support this, and yet this whole notion of sex determination is a really interesting one that people seem to be somewhat obsessed by.

现在，支持这一点的数据为零，然而性别决定的整个概念是一个非常有趣的概念，人们似乎有些着迷。

So much so that, again, if you go online or if you were to talk to people in the sort of let's call it holistic or peripheral health spaces related to fertility, there is discussion about, okay, well, you take this sexual position at the point of ejaculation to get a boy, and you take that sexual position at the point of ejaculation to get a girl, or you do this in the early part of the day or the later part of the day.

以至于，再次，如果你上网，或者如果你在与生育相关的整体或外围健康空间中与人们交谈，就会有讨论，好吧，好吧，你在射精时采取这种性姿势会生男孩，你在射精时采取这种性姿势会生女孩，或者你在一天的早些时候或一天的晚些时候这样做。

Again, all for which there is zero data to support any kind of systematic relationship between what I just discussed and the biological sex of the offspring.

同样，所有这些都没有零数据来支持我刚才讨论的内容与后代的生物性别之间的任何系统关系。

That said, there are now emerging methods that people are using in order to separate out the sperm that will indeed give rise to a male offspring versus a female offspring.

也就是说，人们现在正在使用新兴的方法来区分确实会产生男性后代和女性后代的精子。

Now, this of course is done in the context of in vitro fertilization.

现在，这当然是在体外受精的背景下完成的。

We haven't talked too much about in vitro fertilization, but in vitro fertilization involves, as the name suggests, taking an egg and taking a sperm, pairing them in a dish.

我们没有过多谈论体外受精，但体外受精，顾名思义，就是取一个卵子和一个精子，将它们在培养皿中配对。

This can be done a number of different ways, but just to briefly describe the IVF procedure, IVF involves administering supra, meaning greater than normal, supraphysiological levels of follicle-stimulating hormone and luteinizing hormone during the follicular phase of a woman's cycle.

这可以通过多种不同的方式来完成，但为了简要描述 IVF 程序，IVF 涉及在女性周期的卵泡期施用高于正常、超生理水平的卵泡刺激素和黄体生成素。

What that causes is the maturation of not just one egg that would be ovulated, but multiple follicles and eggs, and then ovulation itself is suppressed also through the administration of exogenous hormones.

其原因不仅是一个要排卵的卵子成熟，而且是多个卵泡和卵子的成熟，然后排卵本身也通过外源激素的施用而受到抑制。

And then under ultrasound guidance, an OBGYN goes in and collects the mature eggs and follicles, puts them in a dish, and then sperm are delivered to that dish, and those could either be sperm that were frozen previously or more typically, or ideally, it would be live sperm collected that day that are washed through a very straightforward procedure.

然后在超声波引导下，妇产科医生进入并收集成熟的卵子和卵泡，将它们放入培养皿中，然后将精子输送到该培养皿中，这些精子可以是之前冷冻的精子或更典型的，或者理想情况下，是当天收集的活精子，并通过非常简单的程序进行清洗。

And then those sperm either are allowed to compete for those eggs and fertilize those eggs and allow them to advance to very early embryo stage before those embryos are frozen and eventually implanted into a woman in order to have them be carried to full term ideally.

然后，这些精子要么被允许竞争这些卵子，并使这些卵子受精，并允许它们进入非常早期的胚胎阶段，然后这些胚胎被冷冻并最终植入女性体内，以便让它们理想地足月。

Or there's a procedure in which specific sperm are selected because they have the best morphology, motility, and so forth, and in a process called ICSI, I-C-S-I, in which the sperm themselves are literally forced to fertilize that particular egg.

或者有一种程序，其中选择特定的精子，因为它们具有最佳的形态、活力等，并且在称为 ICSI、I-C-S-I 的过程中，精子本身实际上被迫与特定的卵子受精。

Now, under those conditions, typically a couple or a woman, if she's doing this on her own with a sperm donor, will get multiple fertilized embryos, okay, that are carried to a multicellular stage so that it's clear that they could grow into a child if they were implanted into a viable host.

现在，在这种情况下，通常一对夫妇或一个女人，如果她自己与精子捐赠者一起做这件事，就会得到多个受精胚胎，好吧，这些胚胎被带到多细胞阶段，这样很明显，如果它们被植入到一个可行的宿主体内，它们就可以成长为一个孩子。

Sometimes the surrogate, sometimes the woman who wants the child herself.

有时是代孕妈妈，有时是自己想要孩子的女人。

And under those conditions, it is possible to look at the genetic makeup, including the karyotype of those early nascent embryos.

在这些条件下，可以观察基因组成，包括那些早期新生胚胎的核型。

In which case, people really can select the sex of their offspring.

在这种情况下，人们真的可以选择后代的性别。

That is, they will have some embryos that are XX, some embryos that are XY.

也就是说，他们将有一些胚胎是 XX，一些胚胎是 XY。

It's very likely also that they will have some embryos that have karyotypes or genotypes which are not ideal, in that they would potentially lead to a miscarriage or some other genetic defect.

他们也很可能拥有一些核型或基因型不理想的胚胎，因为它们可能会导致流产或其他一些遗传缺陷。

And so typically, people do not select to implant those embryos if they have the option to implant embryos that are of either XX or XY karyotype and the normal chromosomal arrangements for obvious reasons.

因此，通常情况下，如果人们可以选择植入 XX 或 XY 核型以及正常染色体排列的胚胎，那么出于明显的原因，他们不会选择植入这些胚胎。

So the whole point here is that sex selection is possible But only using in vitro fertilization.

所以这里的重点是性别选择是可能的，但只能使用体外受精。

The other thing that is becoming clear to us in more recent years is that sex selection is actually possible at the level of the sperm, even prior to fertilization.

近年来我们逐渐清楚的另一件事是，性别选择实际上可以在精子水平上进行，甚至在受精之前也是如此。

This is an emerging data set, and this is largely happening in clinics outside of the United States, but there are some clinics that have figured out methods in which they can take a sperm sample, and they can spin that sperm sample in a centrifuge at a rate that separates out the sperm into what are called different fractions.

这是一个新兴的数据集，这主要发生在美国以外的诊所，但有些诊所已经找到了提取精子样本的方法，他们可以在离心机中以一定的速度旋转精子样本，将精子分离成所谓的不同部分。

So for those of you who've done a little bit of biology with centrifuges, when you spin any kind of substance that includes multiple things in it of different weights, when you spin them, the things of different weights segregate out into different fractions along the depth of the tube.

因此，对于那些用离心机进行过一些生物学研究的人来说，当您旋转任何一种包含多种不同重量的物质的物质时，当您旋转它们时，不同重量的物质沿着管的深度分离成不同的部分。

And then you can take out one fraction or the next.

然后你可以取出一小部分或下一部分。

Simply with a little pipette, you take out the top fraction, the middle fraction, and so forth.

只需用一根小移液器，即可取出顶部部分、中间部分等。

And what these clinics have figured out is that if they spin the sperm sample at the correct spin rate, that the sperm that will give rise to male offspring and the sperm that will give rise to female offspring segregate out into different fractions, allowing them to take each of those fractions separately and to apply them to eggs if it's in vitro fertilization and give rise very reliably, certainly much more than chance, to either male or female embryos.

这些诊所发现，如果他们以正确的旋转速度旋转精子样本，将产生雄性后代的精子和将产生雌性后代的精子会分离成不同的部分，从而使他们能够分别取出这些部分并将其应用于卵子（如果是体外受精），并且非常可靠地（当然不仅仅是偶然）产生男性或女性胚胎。

They also, of course, can choose to do this outside the context of in vitro fertilization.

当然，他们也可以选择在体外受精之外进行此操作。

So some people are now opting to have their sperm samples spun out in this way, separate out the sperm that give rise to male or female offspring, and then to only use the fraction that they are interested in.

因此，现在有些人选择以这种方式分离精子样本，分离出产生男性或女性后代的精子，然后只使用他们感兴趣的部分。

So if they want a boy, they'll use one fraction.

所以如果他们想要一个男孩，他们会用一小部分。

If they want a girl, they'll use a different fraction.

如果他们想要一个女孩，他们会使用不同的分数。

And then to use those fractions in the context of what's called IUI or intrauterine insemination, which is, as the name suggests, rather than having the man deliver the ejaculate with his penis and the sperm with his penis, they have a device.

然后，为了在所谓的 IUI 或宫内授精的背景下使用这些分数，顾名思义，他们不是让男人用阴茎输送精液，用阴茎输送精子，而是用一种装置。

The devices are now commercially sold.

这些设备现已投入商业销售。

Believe it or not, they're sold over the counter and on the internet, so people will even do this at home.

不管你相信与否，它们在柜台和互联网上都有销售，所以人们甚至会在家里这样做。

And so what they're doing is they'll take the sperm, and they'll do IUI in order to bias the probability that they're going to get a male or a female offspring.

所以他们所做的就是采集精子，进行宫内人工受精（IUI），以偏向他们获得男性或女性后代的概率。

Again, this is something that's now emerging.

同样，这是现在正在出现的事情。

It's not commonplace.

这并不常见。

Most of the time, people simply roll the dice, as it were, by having either intercourse and just hoping for or not caring if they get a male or a female offspring.

大多数时候，人们只是通过性交来掷骰子，只是希望或不关心他们是否会得到一个男性或女性的后代。

Or in the instance of IVF, selecting male or female offspring, sometimes largely on the basis of the chromosomal arrangements.

或者在体外受精的例子中，选择男性或女性后代，有时主要是根据染色体排列。

So of course, some people might prefer to have one or the other biological sex as their offspring.

因此，当然，有些人可能更喜欢以一种或另一种生物性别作为他们的后代。

But of course, the healthy chromosomal arrangements are going to be paramount for getting a healthy child.

但当然，健康的染色体排列对于获得健康的孩子至关重要。

And, as I mentioned before, unhealthy chromosomal arrangements or abnormal chromosomal arrangements often lead to miscarriage and/or birth defects.

而且，正如我之前提到的，不健康的染色体排列或异常的染色体排列通常会导致流产和/或出生缺陷。

So selecting for healthy chromosomal arrangements is always paramount, but some people are selecting for biological sex.

因此，选择健康的染色体排列始终是最重要的，但有些人正在选择生物性别。

And indeed, some couples who can conceive naturally are opting for IUI in order to be able to select biological sex because of this ability to spin out the sperm samples to different fractions and select the male or female sperm.

事实上，一些能够自然受孕的夫妇选择宫腔内人工受精（IUI），以便能够选择生物性别，因为这种技术能够将精子样本分离成不同的部分，并选择男性或女性精子。

That is the sperm that would give rise to a male or female offspring.

这是产生男性或女性后代的精子。

So this is a rapidly emerging theme, believe it or not.

所以，不管你信不信，这是一个迅速出现的主题。

Who knew?

谁知道？

And of course, it has nothing to do with Aristotle's assertions about what people are thinking about at the point of ejaculation, nor does it have anything to do with body position at the point of ejaculation.

当然，这与亚里士多德关于人们在射精时所想的东西的断言无关，也与射精时的身体姿势无关。

But I do find it rather interesting that even in this day and age, people seem to be continually pursuing new and different ways to understand why one sperm or another sperm happens to fertilize the egg.

但我确实发现相当有趣的是，即使在当今时代，人们似乎仍在不断寻求新的、不同的方法来理解为什么一个精子或另一个精子恰好使卵子受精。

And when that information is not available, because frankly it's not available yet, we don't know why a sperm containing a Y chromosome or a sperm containing an X chromosome is more likely to fertilize an egg.

当这些信息无法获得时，因为坦率地说还无法获得，我们不知道为什么含有 Y 染色体的精子或含有 X 染色体的精子更有可能使卵子受精。

There are some ideas, for instance, that older fathers tend to have more daughters as opposed to sons.

例如，有一些观点认为，年长的父亲往往会生更多的女儿，而不是儿子。

But when you really look at the data, it's pretty mixed.

但当你真正查看数据时，你会发现情况相当复杂。

So if you've heard that before, it has a particular nickname that I'm not going to describe on the podcast.

因此，如果您以前听说过它，它有一个特殊的昵称，我不会在播客中描述该昵称。

You can look it up online.

你可以上网查一下。

But if any of you are aware of any other kind of ideas or lore, no matter how ridiculous or crazy, please put them in the comments section on YouTube.

但如果你们中的任何人知道任何其他类型的想法或传说，无论多么荒谬或疯狂，请将它们放在 YouTube 的评论部分。

I'd be very curious to learn about those, mostly out of interest and curiosity.

我非常想了解这些，主要是出于兴趣和好奇心。

But look, sometimes these outrageous stories, such as notions of body position and how they influence biological sex, even though they turn out not to be true, turn out to be interesting for other reasons.

但你看，有时这些离谱的故事，比如身体姿势的概念以及它们如何影响生物性别，即使事实证明它们不是真的，但由于其他原因却变得有趣。

And in fact, next, we're going to talk about how body position during sexual intercourse can, in fact, influence fertility and pregnancy.

事实上，接下来我们将讨论性交时的身体姿势实际上如何影响生育和怀孕。

So another common theme around fertility and pregnancy that you'll hear about is that for couples that are trying to get pregnant, that during intercourse, they should do whatever it is that works for them.

因此，您会听到的关于生育和怀孕的另一个常见主题是，对于试图怀孕的夫妇来说，在性交期间，他们应该做任何对他们有效的事情。

But then after the man ejaculates, that the woman should try and position her ankles above her head or somehow otherwise tilt her pelvis back in order to increase the rate and/or probability that the sperm swim toward the egg as opposed to the other direction.

但在男人射精后，女人应该尝试将脚踝放在头顶上方，或者以其他方式将骨盆向后倾斜，以增加精子向卵子游动的速度和/或概率，而不是向另一个方向游动。

Now, I talked to a couple of different OBGYNs and urologists that are focused on fertility about this topic.

现在，我与几位专注于生育力的不同妇产科医生和泌尿科医生讨论了这个话题。

And it turns out you get pretty mixed answers as to whether or not there's any validity to this idea that the woman's body position after the man ejaculates inside of her can somehow influence the probability of pregnancy.

事实证明，对于这个想法是否有效，你得到的答案非常复杂，即男人在女人体内射精后女人的身体姿势会以某种方式影响怀孕的可能性。

One group of experts told me that there is no reason for a woman to need to continue to lie down, elevate the ankles, or in any way tilt her pelvis back in order to increase the probability of successful fertilization.

一组专家告诉我，女性没有理由需要继续躺下、抬高脚踝或以任何方式向后倾斜骨盆，以增加成功受精的可能性。

The other group suggested that indeed there is a strong reason to believe that tilting the pelvis back, maybe even keeping the ankles elevated and having a woman lie on her back for about 15 minutes with the pelvis positioned at about 20 degrees back is ideal for optimizing fertilization.

另一组则表示，确实有充分的理由相信，骨盆向后倾斜，甚至可能保持脚踝抬高，让女性仰卧约 15 分钟，骨盆向后倾斜约 20 度，是优化受精的理想选择。

They were really specific about the recommendation.

他们的建议非常具体。

So I find this interesting that within the cohort of extremely well-trained MDs, OB-GYNs, and urology fertility docs and OB-GYNs, you see a split.

所以我发现这很有趣，在训练有素的医学博士、妇产科医生、泌尿科生育医生和妇产科医生的队列中，你看到了分裂。

It has nothing to do with whether or not the physician was male or female, or their training, or their institution.

这与医生是男性还是女性、他们的培训或他们的机构无关。

None of that.

都不是。

There just seemed to be a sort of even split between the two.

两者之间似乎存在某种平分秋色。

Now, granted, it wasn't the largest sample size that I could've obtained, and yet I do find it interesting that there's this split in the opinion about this.

现在，诚然，这不是我可以获得的最大样本量，但我确实发现对此的看法存在分歧，这很有趣。

One group, the group that said, "No, pelvic position doesn't really matter.

一组人说：“不，骨盆位置并不重要。

Don't worry about it.

别担心。

It's not going to influence the rates of fertilization," argued that the sperm swim very quickly, and that if they are released near the cervix, they're going to swim very quickly toward the egg in order to fertilize it, regardless of pelvic position.

这不会影响受精率。”他认为，精子游动得非常快，如果它们在子宫颈附近释放，它们就会非常快地游向卵子，以便使其受精，无论骨盆位置如何。

The other group said, well, yes, sperm swim quickly, and even if they're released right at the entry to the cervix, that the sperm still have a long distance to go.

另一组说，嗯，是的，精子游得很快，即使它们在子宫颈入口处被释放，精子仍然有很长的距离。

Again, if you were to scale this according to the size of the sperm versus the size of a human body, an entire human body, what you'd scale it to is the distance between Los Angeles and San Francisco, and it needs to undergo that basically within 24 hours or so.

再说一次，如果你要根据精子的大小与人体、整个人体的大小来缩放，你会缩放到洛杉矶和旧金山之间的距离，并且基本上需要在 24 小时左右的时间内完成。

Although, as we mentioned earlier, sperm can survive quite a while inside of the woman's body, maybe three or five days at least.

不过，正如我们之前提到的，精子可以在女性体内存活很长一段时间，至少可能三五天。

So in both cases, they acknowledge it's a long distance, but on the one hand, you have a group of experts that are saying the sperm more or less know what to do and are going to do it regardless of the position of the woman after ejaculation inside her.

因此，在这两种情况下，他们都承认这是一个很长的距离，但一方面，一群专家说，精子或多或少知道要做什么，并且无论女性在射精后在她体内的位置如何，精子都会这样做。

And the other group saying, "No, we want to do everything we can to bias the likelihood that the sperm will fertilize the egg." Okay.

另一组则说：“不，我们想尽一切努力来偏向精子使卵子受精的可能性。”好的。

Well, setting aside the basic argument that tilting back of the pelvis and lying stationary or so for about 15 minutes after sexual intercourse and ejaculation is not an expensive endeavor, although it requires a little bit of time, and it forces people to remain motionless or close to motionless, and they're not up and around and moving about.

好吧，抛开基本论点，即性交和射精后骨盆向后倾斜并保持静止大约 15 分钟并不是一项昂贵的努力，尽管它需要一点时间，并且它迫使人们保持静止或接近静止，并且他们不能起身走动。

Aside from that, it's a relatively low investment, so one argument is, well, if it could bias the likelihood of fertilization at all and people want to get pregnant, why wouldn't they do that?

除此之外，这是一项相对较低的投资，所以一个论点是，如果它会影响受精的可能性，而人们想要怀孕，他们为什么不这样做呢？

Okay, so that's a reasonable argument, but it doesn't really point to the mechanism.

好吧，这是一个合理的论点，但它并没有真正指出机制。

The arguments that point to a potential mechanism are that if you recall what we were talking about when we talked about sperm quality, sperm quality involves a bunch of different measures like concentration of sperm per milliliter semen, morphology of those sperm, how many are forward motile.

指向潜在机制的论点是，如果你还记得我们在谈论精子质量时所谈论的内容，精子质量涉及一系列不同的指标，例如每毫升精液中的精子浓度、这些精子的形态、有多少精子向前运动。

It turns out that in any one ejaculate sample, the total number of forward motile and yet fast forward motile sperm that are also of the highest quality morphology is actually quite low.

事实证明，在任何一份射精样本中，具有最高形态质量的向前运动和快速向前运动的精子总数实际上相当低。

And so the idea here is that you want to get as many sperm of the highest quality swimming toward the egg because those sperm stand the highest probability of fertilizing that egg.

所以这里的想法是，你希望有尽可能多的最高质量的精子游向卵子，因为这些精子使卵子受精的可能性最高。

And in fact, this relates to some of the discussion we were having earlier about behavioral dos and don'ts for sake of increasing the probability of fertilization.

事实上，这与我们之前为了增加受精概率而进行的关于行为该做和不该做的一些讨论有关。

And the one that is most important here is cannabis.

这里最重要的是大麻。

It turns out that the data on cannabis really do support the idea that some of you may have heard from parents and teachers, I don't know, I did hear this from parents and teachers, that cannabis can disrupt the swimming styles of sperm in ways that are not supportive of fertilization, that it can turn more of the sperm into twitchers.

事实证明，有关大麻的数据确实支持这样的观点，你们中的一些人可能从父母和老师那里听说过，我不知道，我确实从父母和老师那里听说过，大麻可以以不支持受精的方式扰乱精子的游动方式，它可以将更多的精子变成抽动者。

Although, when I learned about this, I was not informed of the word twitchers.

虽然，当我了解到这一点时，我并不知道 twitchers 这个词。

What I was told is that if you use cannabis, that the sperm don't know which direction to go, that they're confused.

有人告诉我，如果你使用大麻，精子就不知道该往哪个方向走，他们会感到困惑。

Almost implying that the sperm themselves are high on cannabis.

几乎意味着精子本身含有大量大麻。

Well, that's certainly not the argument that I'm making here, but it does seem to be the case that people who use cannabis, even once, the sperm that are generated during that particular month or two months during which or after which they use cannabis, have less forward motility and possibly altered morphology as well.

嗯，这当然不是我在这里提出的论点，但情况似乎确实如此，使用大麻的人，即使是一次，在他们使用大麻期间或之后的特定月份或两个月内产生的精子，向前运动较少，并且可能也改变了形态。

Okay, I want to be very clear.

好吧，我想说得非常清楚。

I did not say that if you use cannabis once, you are forever disrupting the motility and morphology of your sperm.

我并没有说如果你使用大麻一次，你就会永远破坏精子的活力和形态。

I did not say that.

我没有这么说。

What I said is that if you use cannabis once, then the sperm that are generated in the 60 days after that cannabis use are going to have a higher incidence of disrupted motility and perhaps morphology as well.

我所说的是，如果您使用过一次大麻，那么在使用大麻后 60 天内产生的精子的活力和形态可能会出现更高的紊乱。

Okay?

好的？

Remember, sperma continually generated every 60 days or so.

请记住，精子每 60 天左右就会持续产生一次。

And so if you use cannabis once, you are not forever disrupting your sperm.

因此，如果您使用大麻一次，您不会永远破坏您的精子。

But if you are using cannabis and then you are looking to conceive in the next 60 days, you are going to be reducing, we think significantly so, the number of quality forwardly motile sperm.

但如果您正在使用大麻，并且您希望在接下来的 60 天内怀孕，我们认为，您的优质前向活动精子的数量将会显着减少。

So the simple takeaway from this is avoid cannabis use, although if you are going to use cannabis, and again, there are medical uses of cannabis and beneficial uses of cannabis for certain populations.

因此，简单的结论是避免使用大麻，尽管如果您要使用大麻，而且大麻有医疗用途，并且大麻对某些人群有益。

It can be bad for other populations.

这可能对其他人群不利。

We talked about that in the Huberman Lab podcast, all about cannabis.

我们在休伯曼实验室播客中讨论了这一点，都是关于大麻的。

But if you're going to use cannabis, you should try and abstain from cannabis in the two months prior to the attempt to fertilize and get pregnant.

但如果您打算使用大麻，您应该在尝试受精和怀孕之前的两个月内尝试戒除大麻。

Now, I'm not aware of any data on how cannabis use by the woman can influence the likelihood of fertilization and pregnancy.

现在，我不知道有关女性使用大麻如何影响受精和怀孕可能性的任何数据。

And I want to couch this whole discussion around cannabis under the umbrella of something that came up in the episode that I did on cannabis, which is that for about half of people out there, male and female, okay, so here we're not distinguishing by biological sex.

我想将整个围绕大麻的讨论放在我关于大麻的那一集中出现的东西的保护伞下，大约一半的人，男性和女性，好吧，所以在这里我们不按生物性别来区分。

About half of people that use cannabis report it as an aphrodisiac.

大约一半使用大麻的人称其为壮阳药。

It makes them want to have sexual intercourse more than if they don't use cannabis.

与不使用大麻相比，这使他们更想进行性交。

And for the other half, it actually has the opposite effect by way of an influence on a hormone called prolactin, which suppresses the dopamine system, the testosterone, and the estrogenic system And so this whole idea that cannabis is an aphrodisiac seems to be true for about half of the human population and not for the other half of the human population.

对于另一半来说，它实际上通过影响一种叫做催乳素的激素而产生相反的效果，催乳素会抑制多巴胺系统、睾酮和雌激素系统。因此，大麻是一种春药的整个想法似乎对大约一半的人口来说是正确的，而对另一半人口来说则不然。

So I mention that because I know a number of people use cannabis as an aphrodisiac.

所以我提到这一点是因为我知道很多人使用大麻作为春药。

They like to use cannabis before intercourse.

他们喜欢在性交前吸食大麻。

It was actually very surprising to me to discover when I researched that cannabis episode, that approximately 15, 1-5%, of women who are pregnant continue to use cannabis during pregnancy, and that's a very alarming statistic.

事实上，当我研究大麻事件时，我非常惊讶地发现，大约 15%（即 1-5%）的孕妇在怀孕期间继续使用大麻，这是一个非常令人震惊的统计数据。

And everything we know is that the use of cannabis during pregnancy is detrimental to the health, in particular, the brain development of the fetus.

我们所知道的是，怀孕期间使用大麻不利于健康，特别是胎儿的大脑发育。

So that's a real concern.

所以这是一个真正令人担忧的问题。

I highly recommend women abstain from cannabis use during pregnancy.

我强烈建议女性在怀孕期间不要使用大麻。

Talk to your OBGYN about it if you're using at all or considering using at all.

如果您正在使用或正在考虑使用，请与您的妇产科医生讨论。

So based on what I told you earlier about the fact that cannabis use is not good for egg quality, and the fact that cannabis use can disrupt the motility of sperm and therefore is not good for sperm quality, and it can disrupt the patterns of swimming in sperm in ways that reduce the likelihood of fertility, I think the take-home message is clear, which is that whether or not you want to be a cannabis user or not, if you are going to try and conceive, and certainly while you're pregnant, you're going to want to avoid the use of cannabis, and that is smoked cannabis and vaped cannabis.

因此，根据我之前告诉过您的事实，大麻的使用对卵子质量不利，并且大麻的使用会破坏精子的活力，因此对精子的质量不利，而且它会破坏精子的游动模式，从而降低生育的可能性，我认为要传达的信息很明确，那就是，无论您是否想成为大麻使用者，如果您打算尝试怀孕，当然在怀孕期间，您将希望避免使用大麻，即熏制大麻和电子烟大麻。

And during pregnancy, the consumption of cannabis, even in edible form or in tincture form, is also going to be detrimental to the developing fetus.

在怀孕期间，食用大麻，即使是食用形式或酊剂形式，也会对发育中的胎儿有害。

But of course, we started this conversation in the context of body position, in particular at the point of ejaculation, in determining the sex of the offspring and/or the likelihood of getting a successful fertilization and pregnancy.

当然，我们是在身体姿势的背景下开始这场对话的，特别是在射精时，以确定后代的性别和/或成功受精和怀孕的可能性。

And I think that given that the tilting back of the pelvis, so again, this is elevating the pelvis by about 20 degrees.

我认为考虑到骨盆向后倾斜，这又将骨盆抬高了大约 20 度。

I don't think it has to be exact, but about 20 degrees for about 15 minutes post-ejaculation inside of the woman, or I suppose if people are using IUI, intrauterine insemination.

我不认为它必须是准确的，但射精后在女性体内大约 15 分钟，大约 20 度，或者我想如果人们使用 IUI，宫内授精。

Since that seems to be the consensus among those experts that believe that pelvic tilt backward can be beneficial for increasing the probability of fertilization, and given that it involves no cost but a little bit of time, seems to me that if you want to get pregnant, that that would be the right thing to do.

因为这似乎是那些专家的共识，他们认为骨盆向后倾斜有利于增加受精的可能性，而且考虑到它不需要任何成本，只需要一点时间，在我看来，如果你想怀孕，那将是正确的做法。

And as far as I know, there's no information, nor was I able to obtain any recommendations from experts about what the ideal body position of the male is after ejaculation if the goal is to increase the probability of fertilization and pregnancy.

据我所知，如果目标是增加受精和怀孕的可能性，没有任何信息，也无法从专家那里获得关于男性射精后的理想身体姿势的任何建议。

So we've been talking about behavioral interventions, some dos and some don'ts that people can do to increase their fertility, and the likelihood that any fertilized egg will be carried to term successfully.

因此，我们一直在讨论行为干预，人们可以采取哪些措施来提高生育能力，以及任何受精卵成功足月的可能性。

And soon we'll also talk about things that people can take to improve their fertility.

很快我们还将讨论人们可以采取哪些措施来提高生育能力。

Now, keep in mind that this entire discussion is about fertility, but also remember, as we discussed at the beginning of the episode, trying to increase your fertility is one of the best ways to think about trying to create and maintain optimal physical health.

现在，请记住，整个讨论都是关于生育能力的，但也请记住，正如我们在本集开头所讨论的那样，尝试提高生育能力是考虑尝试创造和保持最佳身体健康的最佳方法之一。

So for people that are trying to conceive and for people who are not trying to conceive, optimizing your fertility status, whether or not you're male or female, it's one of the best ways to target those approaches.

因此，对于想要怀孕的人和不想要怀孕的人来说，优化您的生育状态，无论您是男性还是女性，都是针对这些方法的最佳方法之一。

And there are now a lot of data supporting the idea that acupuncture, of all things, can be very beneficial for improving both female and male fertility and should a woman get pregnant, for improving the quality of outcomes, that is, the likelihood that there will be a successful pregnancy that is carried to term, not premature, and so on and so forth.

现在有大量数据支持这一观点，即针灸对于提高女性和男性的生育能力非常有益，并且如果女性怀孕，则可以提高结果质量，即成功怀孕到足月而不是早产的可能性，等等。

Now, for some of you out there, you might think, oh, of course, acupuncture.

现在，对于你们中的一些人来说，您可能会想，哦，当然是针灸。

Acupuncture has been known to work for thousands of years, and it's not surprising that it would assist with fertility and pregnancy.

针灸的功效已有数千年历史，它有助于生育和怀孕也就不足为奇了。

For many of you out there, however, you're probably thinking, acupuncture?

然而，对于很多人来说，您可能会想，针灸？

That seems kind of like fringe science.

这看起来有点像边缘科学。

But what I can assure you is that there are now quite a few clinical trials funded by government agencies like the National Institutes of Health, showing that acupuncture is a very effective treatment for a number of different things, including fertility and pregnancy, but for hormone status, for stress relief, but even for chronic illnesses of different kinds, including autoimmune illnesses.

但我可以向你保证的是，现在有相当多的由美国国立卫生研究院等政府机构资助的临床试验表明，针灸对于许多不同的事情都是一种非常有效的治疗方法，包括生育和怀孕，但对于激素状态、缓解压力，甚至对于包括自身免疫性疾病在内的各种慢性疾病也是如此。

So this is no longer considered fringe science.

所以这不再被认为是边缘科学。

In fact, one of the best laboratories in the world working on this is a laboratory out of Harvard Medical School run by a guy named Qiufu Ma.

事实上，世界上从事这方面工作的最好的实验室之一是哈佛医学院的一个实验室，由一个名叫马秋福的人管理。

And Qiufu's lab has really been exploring in a mechanistic way how the different stimulation sites that are used in acupuncture, so where the needles are inserted, tap into neural pathways that link the different organs of the body.

求福的实验室一直在以机械的方式探索针灸中使用的不同刺激部位，即针插入的位置，如何进入连接身体不同器官的神经通路。

So for instance, they've found that stimulation of a particular site on the lower limb can reduce inflammation dramatically throughout the body by way of neural pathways that originate in the lower limb and extend to areas such as the kidney and the pancreas.

例如，他们发现刺激下肢的特定部位可以通过起源于下肢并延伸到肾脏和胰腺等区域的神经通路来显着减少全身炎症。

So all these "ancient maps" of the human body as they relate to acupuncture are now being parsed at the level of mechanism, which I think is wonderful because it not only is showing us that so much of what has been purported and reported in the landscape of acupuncture actually has an underlying mechanistic basis, and with additional mechanistic understanding, of course, always arrive new and better practices.

因此，所有这些与针灸相关的人体“古老地图”现在都在机制层面上进行解析，我认为这很棒，因为它不仅向我们展示了针灸领域中声称和报道的许多内容实际上具有潜在的机械基础，而且随着额外的机械理解，当然总是会带来新的、更好的实践。

That's the idea, to evolve these fields of acupuncture, to evolve the fields of mechanistic understanding of our biology and health.

这就是我们的想法，要发展针灸的这些领域，发展对我们的生物学和健康的机械理解领域。

And so the issue of whether or not acupuncture can assist in getting pregnant and in carrying a child to term and for that child to be healthy are really starting to emerge in a major way.

因此，针灸是否可以帮助怀孕、足月分娩以及孩子健康的问题确实开始在很大程度上浮出水面。

And rather than go into all those data in detail, what I can tell you is that there are clinical trials and data supporting the fact that female fertility itself can be supported by acupuncture through several mechanisms.

我可以告诉你的是，有临床试验和数据支持这样一个事实：针灸本身可以通过多种机制支持女性生育能力，而不是详细讨论所有这些数据。

One of which is the balancing, and I realize that's a somewhat tricky term, and I'll define it better in a moment.

其中之一是平衡，我意识到这是一个有点棘手的术语，我稍后会更好地定义它。

The balancing of hormones across the ovulatory/menstrual cycle Including regulating levels of FSH so that they're not too high nor too low, and restricting the FSH to the follicular phase of the menstrual cycle.

整个排卵/月经周期的激素平衡包括调节 FSH 水平，使其不会太高或太低，并将 FSH 限制在月经周期的卵泡期。

As well as using acupuncture to improve things like blood flow and the health of the ovary itself, and other aspects of the female reproductive axis.

以及使用针灸来改善血液流动和卵巢本身的健康以及女性生殖轴的其他方面。

So acupuncture can operate at the chemical level, impacting hormones.

因此，针灸可以在化学水平上发挥作用，影响荷尔蒙。

It can act at the mechanical level, impacting the different tissues through which the egg has to pass and so on and so forth.

它可以在机械层面发挥作用，影响卵子必须通过的不同组织等等。

Likewise, on the male side, acupuncture has been shown to improve semen volume, quality of sperm, sperm motility, et cetera, and in large part through changes in the neural pathways that innervate the very tissues and vascular input to the scrotum and testicles, because as we learned earlier, temperature regulation of the scrotum and testicles is so vital for getting healthy sperm and increasing sperm quality.

同样，在男性方面，针灸已被证明可以改善精液量、精子质量、精子活力等，并且在很大程度上是通过改变支配阴囊和睾丸的组织和血管输入的神经通路，因为正如我们之前了解到的，阴囊和睾丸的温度调节对于获得健康的精子和提高精子质量至关重要。

In addition, there are good data to support the idea that acupuncture can increase levels of testosterone, free testosterone, and the sorts of hormones that are going to support healthy hormone production and sperm production in males.

此外，有充分的数据支持这一观点，即针灸可以提高睾酮、游离睾酮以及支持男性健康激素产生和精子产生的各种激素的水平。

And this is distinct from applying testosterone from an exogenous source.

这与使用外源睾酮不同。

So when we're talking about acupuncture and increasing levels of testosterone, we're talking about increasing levels of endogenous testosterone, so those Leydig cells can support the Sertoli cells, and the Sertoli cells can make that androgen binding protein, and you get enhanced spermatogenesis.

因此，当我们谈论针灸和提高睾酮水平时，我们谈论的是提高内源性睾酮水平，因此这些间质细胞可以支持支持细胞，支持细胞可以产生雄激素结合蛋白，从而增强精子发生。

You can find evidence for all of these different features, both changes to the chemical milieu, that is the hormones, and changes to the mechanical milieu, including, for instance, improvement of the pathways leading from the seminiferous tubules to the epididymis to the vas deferens, basically clearing out the plumbing so that more quality ejaculate can be delivered, which of course is going to increase the probability of fertilization.

你可以找到所有这些不同特征的证据，既包括化学环境（即激素）的变化，也包括机械环境的变化，包括，例如，从生精小管到附睾再到输精管的路径的改善，基本上清理了管道，以便可以输送更多优质的射精，这当然会增加受精的可能性。

So when you hear that acupuncture can improve the likelihood of pregnancy, that's an accurate statement for which there are now increasing amounts of mechanistic data.

因此，当您听说针灸可以提高怀孕的可能性时，这是一个准确的说法，现在有越来越多的机械数据证明这一点。

If you want to learn more about how acupuncture can be used to contribute to improved fertilization and pregnancy, there are a number of different excellent reviews on this, both as it relates to females and as it relates to males.

如果您想更多地了解针灸如何用于改善受精和怀孕，有许多不同的精彩评论，无论是与女性还是男性相关。

One of the best papers that I happen to like is one that we'll provide a link to in the references entitled Acupuncture and Herbal Medicine for Female Fertility: An Overview of Systematic Reviews.

我碰巧喜欢的最好的论文之一是我们将在题为《针灸和草药治疗女性生育力：系统评价概述》的参考文献中提供的链接。

So a review of reviews.

所以评论评论。

This was published recently in 2021.

这是 2021 年最近发布的。

We'll provide a link to that.

我们将提供一个链接。

And there's also going to be a link to a review that relates to acupuncture for male fertility and hormone augmentation.

而且还会有一个与针灸治疗男性生育能力和激素增强相关的评论的链接。

I should just mention briefly that if you're going to look at scientific papers, one thing that you'll want to consider is also looking at the references that they reference.

我应该简单提一下，如果您要查看科学论文，您需要考虑的一件事就是查看它们引用的参考文献。

Now, of course, papers tend to reference a ton of references, and particularly in reviews.

当然，现在论文往往引用大量参考文献，尤其是评论。

So what you'll want to do is look for the references that are showing up most often in the introduction.

因此，您要做的就是查找简介中最常出现的参考文献。

Those references often are going to be the most prominent recent reviews or the most important findings in recent years.

这些参考文献通常是最近几年最突出的评论或最重要的发现。

That's not always the case, but that's often the case.

情况并非总是如此，但情况经常如此。

So if you read the first couple of paragraphs of these papers, and these are openly available as full text, by the way, online, if you go to these links.

因此，如果您阅读了这些论文的前几段，顺便说一下，如果您访问这些链接，它们可以作为全文公开获取。

You'll be able to access the best papers, the most relevant papers in the context of acupuncture supporting female and acupuncture supporting male fertility and hormone status.

您将能够获得关于针灸支持女性和针灸支持男性生育能力和激素状态的最佳论文、最相关的论文。

Now I'd like to discuss things that both men and women can take in order to maximize their fertility.

现在我想讨论一下男性和女性都可以采取哪些措施来最大限度地提高生育能力。

And again, when we're talking about fertility, we're talking about people who want to conceive and have children, but also we're talking about a basic measure of overall health status.

再说一遍，当我们谈论生育能力时，我们谈论的是想要怀孕和生孩子的人，但我们也在谈论总体健康状况的基本衡量标准。

So if you're somebody who does not want to conceive children, I still encourage you to think about whether or not you would want to do certain things or not do certain things in order to maximize your fertility as a means to maximize your vitality and longevity, because that's really what maximizing fertility is about for a lot of people.

因此，如果您不想怀孕，我仍然鼓励您考虑是否愿意做某些事情或不做某些事情，以最大限度地提高您的生育能力，以此作为最大限度地提高您的活力和寿命的手段，因为这对很多人来说确实是最大限度地提高生育能力的意义所在。

That said, I know a lot of people would like to conceive children, perhaps not right away, but in the future.

也就是说，我知道很多人都想怀孕，也许不是现在，而是将来。

And what I'm about to describe are some tools and interventions, that is things that one can take in order to improve their hormone status, but also in particular, the quality of their eggs and the quality of their sperm in the short and long term.

我要描述的是一些工具和干预措施，人们可以采取这些措施来改善荷尔蒙状态，特别是短期和长期的卵子质量和精子质量。

The first on the list of things that people can take in order to improve egg quality or sperm quality is L-carnitine.

人们可以服用以提高卵子质量或精子质量的第一个药物是左旋肉碱。

L-carnitine is present in various foods, in particular in red meats.

左旋肉碱存在于各种食物中，特别是红肉中。

But again, it's going to be very hard to get sufficient levels of L-carnitine to improve egg quality and sperm quality, unless you're going to take it in supplement form.

但同样，除非您以补充剂形式服用，否则很难获得足够水平的左旋肉碱来提高卵子质量和精子质量。

The typical recommendation, based on peer-reviewed studies, that have shown significant improvements in egg quality, that is chromosomal arrangements, that is the likelihood of fertility or pregnancy rather, the likelihood of sperm being forward-fast swimmers as opposed to twitchers or immotile and having proper morphology.

基于同行评审研究的典型建议显示卵子质量显着改善，即染色体排列，即生育或怀孕的可能性，而不是精子向前快速游泳的可能性，而不是抽搐或不动并具有适当的形态。

All those measures has been demonstrated to be significantly improved by the ingestion of L-carnitine.

事实证明，摄入左旋肉碱可以显着改善所有这些措施。

How much L-carnitine?

左旋肉碱含量是多少？

Well, that depends on how you're obtaining the L-carnitine.

嗯，这取决于您如何获得左旋肉碱。

If you're obtaining it in capsule form, one to three grams per day of capsule form L-carnitine is what's been suggested to improve egg quality and sperm quality.

如果您购买胶囊形式的左旋肉碱，建议每天服用一到三克胶囊形式的左旋肉碱，以提高卵子质量和精子质量。

Now, one to three grams per day can be taken all at once or spread out throughout the 24-hour cycle.

现在，每天可以一次性服用一到三克，也可以在整个 24 小时周期内分散服用。

It can be taken with or without food.

它可以与食物一起服用或单独服用。

Does not seem to matter.

似乎并不重要。

And when taken for a period of 30 to 60 days, does seem to significantly improve all the parameters that have been discussed for egg quality and sperm quality.

当服用 30 至 60 天时，似乎确实显着改善了所讨论的卵子质量和精子质量的所有参数。

Now the mechanism for that effect is pretty clear.

现在这种效果的机制已经非常清楚了。

L-carnitine is involved in the processing of lipids, fats, in terms of mitochondrial function.

就线粒体功能而言，左旋肉碱参与脂质、脂肪的加工。

And as we talked about before, mitochondria are vital for the organization and action of the spindle that pulls apart the chromosomes, taking that cell within the female from diploid to haploid, which is essential.

正如我们之前谈到的，线粒体对于纺锤体的组织和作用至关重要，纺锤体将染色体拉开，将女性体内的细胞从二倍体转变为单倍体，这是至关重要的。

You really want just the 23 individual chromosomal strands.

您实际上只需要 23 条染色体链。

You don't want chromosomal repeats.

你不想要染色体重复。

It's also involved in the actual fusion of the egg as it exits the ovary and enters the ovulation cycle.

当卵子离开卵巢并进入排卵周期时，它还参与卵子的实际融合。

Mitochondria are also important, as we talked about before, for the forward motility of sperm because of the enrichment of mitochondria in that mid region just behind the head that cause the whipping flagellation of the tail allowing for forward movement, as well as other aspects of cellular morphology.

正如我们之前谈到的，线粒体对于精子的向前运动也很重要，因为头部后面的中部区域线粒体富集，导致尾巴鞭打，允许向前运动，以及细胞形态的其他方面。

So it makes a lot of sense as to why L-carnitine supplementation would be beneficial.

因此，为什么补充左旋肉碱是有益的，这是很有意义的。

Again, it's one to three grams per day over a period of about 30 to 60 months.

同样，在大约 30 到 60 个月的时间内每天摄入 1 到 3 克。

If you're hoping to conceive in the upcoming months, recommend taking it for at least 30 days prior to that.

如果您希望在接下来的几个月内怀孕，建议在此之前至少服用 30 天。

Of course, based on the data we talked about before, the cumulative probability, fecundability, et cetera, there's no reason to not continue to try for pregnancy before taking L-carnitine.

当然，根据我们之前讲的数据，累积概率、生育力等等，在服用左旋肉碱之前，没有理由不继续尝试怀孕。

But L-carnitine is going to improve egg and sperm quality, and so you might actually take the stance that even if you don't have any problem getting pregnant, wouldn't you want to maximize the quality of the egg that gets fertilized and the quality of the sperm that fertilizes that egg?

但左旋肉碱会改善卵子和精子的质量，所以你实际上可能会采取这样的立场：即使你怀孕没有任何问题，你难道不想最大限度地提高受精卵子的质量和使卵子受精的精子的质量吗？

So that's additional rationale for taking L-carnitine.

这是服用左旋肉碱的额外理由。

One important note, if you are going to take L-carnitine in oral form, in capsule form, it can increase something called TMAO.

一个重要的注意事项是，如果您要服用口服左旋肉碱胶囊形式的左旋肉碱，它会增加一种叫做TMAO的物质。

TMAO can cause stiffening of the arteries.

TMAO 可导致动脉硬化。

You don't want TMAO levels to go too high.

您不希望 TMAO 水平过高。

One way to offset the increases in TMAO caused by oral L-carnitine is to take 600 milligrams of garlic per day.

抵消口服左旋肉碱引起的 TMAO 增加的一种方法是每天服用 600 毫克大蒜。

I suppose you could eat cloves of garlic.

我想你可以吃几瓣大蒜。

That would work just as well because garlic contains something called allicin, which can offset the increase in TMAO.

这也同样有效，因为大蒜含有一种叫做大蒜素的物质，它可以抵消TMAO的增加。

But 600 milligram capsules of garlic are going to be, or garlic extract rather, is going to be the most probably cost-effective and simplest way to do this.

但 600 毫克大蒜胶囊，或者更确切地说，大蒜提取物，将是最有成本效益且最简单的方法。

And also they are going to create that garlic smell.

他们还将创造大蒜味。

Some people like the smell of garlic, some people don't.

有些人喜欢大蒜的味道，有些人不喜欢。

So if you're going to take oral L-carnitine, I suggest also taking 600 milligrams a day of garlic extract, and you can do that at any time throughout the day.

因此，如果您打算口服左旋肉碱，我建议您每天还服用 600 毫克大蒜提取物，而且您可以在一天中的任何时间服用。

It doesn't have to be with the L-carnitine.

它不一定与左旋肉碱一起使用。

The next item on the list of compounds that have been shown to improve egg quality and sperm quality, and quite robustly so, is coenzyme Q10.

已证明可以显着提高卵子质量和精子质量的化合物列表中的下一项是辅酶 Q10。

Coenzyme Q10 is something that you can actually measure levels of in your blood.

辅酶 Q10 是一种可以实际测量血液中含量的物质。

Most physicians will say that they want to see your levels of coenzyme Q10 to be somewhere between 0.5 and 2.5.

大多数医生会说他们希望您的辅酶 Q10 水平在 0.5 到 2.5 之间。

It's going to depend on the units.

这将取决于单位。

Most people I realize they're not going to run off and get their CoQ10 measured.

我意识到大多数人都不会跑去测量辅酶 Q10。

It's not included in most standard blood tests, but if you were to measure your CoQ10, that's the range that you want to look for.

大多数标准血液测试中不包含它，但如果您要测量 CoQ10，这就是您想要寻找的范围。

That said, many people opt to supplement with CoQ10, and you'll find that many fertility docs, OBGYNs, and urologists that are trying to assist their male patients with fertility will suggest CoQ10 because again, it supports the health of mitochondria.

也就是说，许多人选择补充 CoQ10，您会发现许多试图帮助男性患者生育的生育医生、妇产科医生和泌尿科医生会建议补充 CoQ10，因为它再次支持线粒体的健康。

Mitochondria are so vital to so many aspects of the formation and fertilization of the egg and sperm that, of course, fertilizes the egg.

线粒体对于卵子和精子的形成和受精的许多方面都至关重要，当然，线粒体也会使卵子受精。

The coenzyme Q10 dosages that are most often suggested and that you'll observe in the peer-reviewed research literature on humans, I should add, is 100 to 400 milligrams per day.

我应该补充一点，最常建议的辅酶 Q10 剂量是每天 100 至 400 毫克，您将在同行评审的人类研究文献中观察到。

And the coenzyme Q10 is taken generally with a meal, and ideally a meal that contains fat.

辅酶 Q10 通常与膳食一起服用，最好是与含有脂肪的膳食一起服用。

And there's even some idea that taking coenzyme Q10 with your dinner, assuming that dinner includes some fat, you don't have to add additional fat, is going to be more advantageous than taking coenzyme Q10 early in the day.

甚至有人认为，晚餐时服用辅酶 Q10，假设晚餐中含有一些脂肪，则不必添加额外的脂肪，这将比早上服用辅酶 Q10 更有利。

Although that's probably a detail that's getting a little too far down in the weed.

尽管这个细节可能有点太过了。

So again, 100 to 400 milligrams of coenzyme Q10 per day, whether or not you're a man or a woman, for improving the likelihood of fertility by way of improving egg and sperm quality.

同样，无论您是男性还是女性，每天服用 100 至 400 毫克辅酶 Q10，可以通过改善卵子和精子的质量来提高生育的可能性。

And again, if you're somebody who just doesn't have any problem getting pregnant, or if you're already producing many sperm of quality morphology, this is another case in which you could take a step back and just say, "Well, why wouldn't I want to further optimize the quality of the egg and the sperm?" Because the quality of the egg and the sperm ultimately are going to determine not just whether or not you have a successful pregnancy, but are going to determine, admittedly in ways that will forever remain cryptic to you, but nonetheless are going to be important in determining the qualities of the brain tissue and body tissue of your offspring.

再说一次，如果你怀孕时没有任何问题，或者你已经产生了许多形态良好的精子，那么在这种情况下，你可以退一步说：“好吧，我为什么不想进一步优化卵子和精子的质量呢？”因为卵子和精子的质量最终不仅会决定你是否能成功怀孕，而且会以一种对你来说永远神秘的方式来决定，但尽管如此，它对于决定你后代的脑组织和身体组织的质量也很重要。

The third item on the list of compounds which are commonly suggested or prescribed by fertility docs nowadays for men and women wishing to conceive and/or optimize their fertility as a basis for general vitality and health is inositol.

如今，生育医生通常为希望怀孕和/或优化其生育能力的男性和女性建议或规定的化合物清单中的第三项是肌醇，作为一般活力和健康的基础。

Now, inositol has many uses.

现在，肌醇有很多用途。

So you'll hear about the use of inositol for reducing anxiety or improving mood, or even for the treatment of depression.

因此，您会听说肌醇可用于减轻焦虑或改善情绪，甚至用于治疗抑郁症。

We talked about inositol in previous episodes of this podcast.

我们在本播客的前几集中讨论了肌醇。

For instance, I talked about inositol and in particular taking 900 milligrams of myo-inositol prior to sleep, which is something that I do along with the other supplements that I take and recommend for sleep, such as magnesium threonate, apigenin, and theanine.

例如，我谈到了肌醇，特别是在睡前服用 900 毫克肌醇，这是我与我服用并推荐的其他睡眠补充剂（例如苏糖酸镁、芹菜素和茶氨酸）一起做的事情。

If you're curious about those, you can see our newsletter on sleep or our Perfect Your Sleep episode or the Master Your Sleep episode.

如果您对此感到好奇，您可以查看我们关于睡眠的时事通讯或我们的“完美您的睡眠”剧集或“掌握您的睡眠”剧集。

It talks about behavioral and supplementation-based tools for improving sleep.

它讨论了基于行为和补充的改善睡眠的工具。

But myo-inositol is not just suggested for or prescribed for people that are wishing to get pregnant and for general health.

但肌醇不仅仅建议或处方给希望怀孕的人和一般健康的人。

But myo-inositol is often recommended for people that want to improve egg and sperm quality because of the way that it can positively impact insulin sensitivity.

但肌醇通常被推荐给想要改善卵子和精子质量的人，因为它可以积极影响胰岛素敏感性。

Insulin sensitivity might sound like a bad thing to people out there, but it turns out that you want to be insulin sensitive.

对于人们来说，胰岛素敏感性可能听起来是一件坏事，但事实证明你想要胰岛素敏感。

The last thing you want is to be insulin insensitive.

您最不想看到的就是胰岛素不敏感。

Insulin insensitivity is associated with type 2 diabetes, with obesity, and even for people who are not challenged with obesity, you want your cells to be insulin sensitive.

胰岛素不敏感与 2 型糖尿病和肥胖有关，即使对于没有肥胖问题的人来说，您也希望自己的细胞对胰岛素敏感。

You don't want a lot of insulin floating around in your system with your cells unable to use that insulin.

您不希望大量胰岛素在您的系统中漂浮，而您的细胞无法使用该胰岛素。

That's really what insulin insensitivity is about.

这就是胰岛素不敏感的真正含义。

Myo-inositol at dosages of one to five grams per day, it's pretty high, one to five grams per day, keeping in mind that 1,000 milligrams is one gram, has been suggested to improve egg quality and sperm quality.

肌醇的剂量每天一到五克，相当高，每天一到五克，请记住，1,000 毫克是一克，建议改善卵子质量和精子质量。

Now, one point of, I wouldn't say caution, but of note is that myo-inositol can reduce anxiety and it can be a slight sedative, which is why some folks, including myself, take almost a gram, 900 milligrams prior to sleep If you're going to take five grams of myo-inositol, you would want to restrict that to the late evening or second half of your day.

现在，我不想说要小心，但值得注意的是，肌醇可以减轻焦虑，并且可以起到轻微的镇静作用，这就是为什么有些人，包括我自己，在睡觉前服用近 1 克（900 毫克）的原因。如果您打算服用 5 克肌醇，您可能会希望将其限制在傍晚或一天的后半段。

And I don't suggest starting that high.

我不建议起点那么高。

I would start with one or two grams, and then working your way up, seeing what you can tolerate in terms of the level of anti-anxiety and drowsiness that it produces.

我会从一两克开始，然后逐渐增加，看看你能忍受它产生的抗焦虑和睡意水平。

One to five grams per day of myo-inositol is what's suggested for both men and women wishing to improve egg health and sperm health.

对于希望改善卵子健康和精子健康的男性和女性，建议每天摄入一到五克肌醇。

But for women, it's also often suggested to include also, okay, so to take myo-inositol, but to also take D-chiro inositol.

但对于女性来说，通常还建议服用肌醇，但也服用 D-手性肌醇。

D-chiro inositol has elements in it that can be both pro and anti-androgenic.

D-手性肌醇中含有既可以促雄激素也可以抗雄激素的元素。

Androgens are things like testosterone and related molecules.

雄激素是睾酮和相关分子之类的东西。

There are a number of different causes of infertility and disruption to egg quality, age being the most significant factor, but another significant and very common factor, even among young women who are of fertile age, is having too many androgens and as it relates to something called polycystic ovarian syndrome.

不孕和卵子质量受损的原因有很多，其中年龄是最重要的因素，但另一个重要且非常常见的因素，即使是在育龄的年轻女性中，也是雄激素过多，因为它与多囊卵巢综合症有关。

And we'll do an entire episode about menopause and PCOS and a number of other things that relate to fertility because it's an entire and very interesting other discussion that we need to have.

我们将制作一整集关于更年期和多囊卵巢综合症以及许多其他与生育有关的事情，因为这是我们需要进行的完整且非常有趣的其他讨论。

But the recommendation is that women take one to five grams of myo-inositol, but also D-chiro inositol because of the ways that it can balance androgens and offset some of the negative effects of polycystic ovarian syndrome, or even for women who do not have polycystic ovarian syndrome because of the ways that D-chiro inositol can balance androgens in ways that are beneficial.

但建议女性服用 1 到 5 克肌醇，但也可服用 D-手性肌醇，因为它可以平衡雄激素并抵消多囊卵巢综合症的一些负面影响，甚至对于没有多囊卵巢综合症的女性也可以服用，因为 D-手性肌醇可以以有益的方式平衡雄激素。

The dosages of D-chiro inositol that are recommended tend to be 1/25 to 1/40 of the myo-inositol dose.

推荐的 D-手性肌醇剂量往往是肌醇剂量的 1/25 至 1/40。

So you have to get out your calculator.

所以你必须拿出你的计算器。

Remember, 1,000 milligrams equals one gram.

请记住，1,000 毫克等于 1 克。

So figure out if you're taking one gram of myo-inositol per day or two grams, you're going to want to convert that to milligrams.

因此，请弄清楚您每天服用一克肌醇还是两克，您需要将其转换为毫克。

So let's say you're taking two grams of myo-inositol per day, that's 2,000 milligrams, then you'd want to divide that by 25, and that's how many milligrams of D-chiro inositol you would want to take as well.

假设您每天服用 2 克肌醇，即 2,000 毫克，那么您需要将其除以 25，这就是您想要服用的 D-手性肌醇的数量。

Or you could go with the lower end dose and divide it by 40 and take that number of milligrams of D-chiro inositol along with the inositol.

或者，您可以选择较低的最终剂量，将其除以 40，然后与肌醇一起服用该毫克数的 D-手性肌醇。

Again, probably taking it later in the day is going to be good, and it's not clear at all that taking it with food or without food makes any difference whatsoever.

再说一次，可能在当天晚些时候服用会很好，而且目前还不清楚与食物一起服用或不与食物一起服用有什么区别。

So I would suggest you do either.

所以我建议你要么这样做。

Keep in mind as I'm discussing these recommendations, I may call them prescriptions, but none of these are prescription drugs.

请记住，当我讨论这些建议时，我可能会将它们称为处方药，但这些都不是处方药。

And of course, you should always discuss any supplements that you're planning to take or stop taking, for that matter, with your physician.

当然，您应该始终与您的医生讨论您计划服用或停止服用的任何补充剂。

I don't say that to protect me.

我这么说并不是为了保护我。

I say that to protect you.

我这么说是为了保护你。

Anytime you're going to add or change something in your overall health regimen, you want to discuss that with your trusted healthcare professional.

每当您要在整体健康养生方案中添加或更改某些内容时，您都需要与值得信赖的医疗保健专业人士讨论。

Typically, I would hope a board-certified MD.

通常情况下，我希望有一个经过董事会认证的医学博士。

The fourth item in the list of commonly suggested supplements for men and women wishing to optimize egg and sperm quality, respectively, is omega-3 fatty acids.

对于希望分别优化卵子和精子质量的男性和女性来说，常见建议补充剂列表中的第四项是 omega-3 脂肪酸。

And now here we're talking about something that could be obtained from food and can be obtained from food.

现在我们在这里谈论的是可以从食物中获得并且可以从食物中获得的东西。

So if you're consuming fatty ocean fish, things like sardines, anchovies, salmon with the skin, chances are you're going to get some quality omega-3s.

因此，如果您食用富含脂肪的海洋鱼类，例如沙丁鱼、凤尾鱼、带皮鲑鱼，您很可能会获得一些优质的 omega-3。

Omega-3s are also available in plant-based sources.

Omega-3 也有植物来源的形式。

It's also available in krill, for that matter.

就此而言，磷虾中也有这种成分。

But most people find it difficult to reach the threshold required for optimizing mental health and physical health, that is the threshold of the EPA essential fatty acids.

但大多数人发现很难达到优化心理健康和身体健康所需的阈值，即EPA必需脂肪酸的阈值。

And so for that matter, I've suggested before on this podcast, and many fertility docs will suggest, that their patients take omega-3 fatty acids in supplement form.

因此，就这一点而言，我之前在这个播客上建议过，许多生育医生也会建议他们的患者服用 Omega-3 脂肪酸补充剂。

It could be taken in liquid form or in capsule form.

它可以以液体形式或胶囊形式服用。

But enough of those so that you're getting at least one gram per day of the EPA form of omega-3s, okay?

但摄入足够的量，以便您每天至少摄入 1 克 EPA 形式的 omega-3，好吗？

So at least one gram per day and as high as two or even three grams per day of the EPA form.

因此，每天至少摄入 1 克 EPA，最高可达 2 克甚至 3 克。

So you'll need to look at the packaging because oftentimes it'll say high potency omega-3s, and it'll say 1,500 milligrams of omega-3s, but that's not 1,500 milligrams of the EPA form.

因此，您需要查看包装，因为它通常会说高效 omega-3，并且会说 1,500 毫克 omega-3，但这不是 1,500 毫克 EPA 形式。

You look on the back of the label, and it'll say each serving contains 750 milligrams of EPA.

您查看标签背面，您会发现每份含有 750 毫克 EPA。

You want to get above that one gram dosage per day and as high as three grams per day of the EPAs.

您希望每天摄入的 EPA 剂量高于 1 克，最高可达 3 克。

The most cost-effective way to do that is going to be liquid form omegas, but that's a little bit inconvenient for many people, and some people don't like the taste.

最经济有效的方法是使用液体形式的欧米茄，但这对很多人来说有点不方便，而且有些人不喜欢这种味道。

That's why they rely on the capsule form omegas.

这就是为什么他们依赖欧米茄胶囊。

And of course, there are compounds that can impact fertility status, quality of eggs, quality of sperm, not by adjusting mitochondria or insulin sensitivity or creating a general milieu of support for the egg and the sperm production and function, such as the compounds that I just listed off do, but rather compounds that influence the hormones involved in the generation of sperm and the generation of the eggs involved in the ovulatory cycle and the spermatogenesis cycle, that is.

当然，有些化合物可以影响生育状态、卵子质量、精子质量，不是通过调整线粒体或胰岛素敏感性或为卵子和精子的产生和功能创造一个支持的一般环境，例如我刚才列出的化合物，而是影响参与排卵周期和精子发生周期的精子生成和卵子生成的激素的化合物。

Now, these are going to come in different forms, and I want to just emphasize that the supplements that do this, that adjust hormones in these ways that can be beneficial, are distinct from hormone therapy or bioidentical hormones, okay?

现在，这些将以不同的形式出现，我想强调的是，能够做到这一点的补充剂，以这些有益的方式调整激素，与激素疗法或生物同质激素不同，好吗？

Distinct from hormone therapy or bioidentical hormones, because as we discussed earlier, when you take a hormone like testosterone or even estrogen, for that matter, from an exogenous and outside source, you're going to disrupt the feedback pathways inside of your body, and you're going to shut down your own endogenous production.

与激素疗法或生物同质激素不同，因为正如我们之前讨论的，当您从外源性和外部来源服用睾酮甚至雌激素等激素时，您将破坏体内的反馈途径，并且您将关闭自己的内源性生产。

The supplements I'm about to describe do not do that and yet can adjust levels of hormones in more subtle ways that could be beneficial for the process of maximizing fertility for males and for females.

我将要描述的补充剂不会这样做，但可以以更微妙的方式调整激素水平，这可能有利于男性和女性生育能力最大化的过程。

The first of which on this list that I'd like to discuss has been discussed in previous podcasts as well, which is a substance called tongkat ali.

我想讨论的第一个在之前的播客中也已经讨论过，这是一种称为东革阿里的物质。

Tongkat ali also goes by other names, but when taken at 400 milligrams per day, sometimes separated into two dosages, but typically taken as once a day, early in the day because it can be a little bit stimulating Although not anxiety-provoking, I've never heard of that.

东革阿里还有其他名称，但每天服用 400 毫克时，有时会分成两次剂量，但通常每天服用一次，在当天早些时候服用，因为它可能会有点刺激，虽然不会引起焦虑，但我从未听说过。

It can be a little bit stimulating, but 400 milligrams a day of tongkat ali has been shown to increase free testosterone by way of reducing something called sex hormone binding globulin.

它可能有点刺激，但每天 400 毫克东革阿里已被证明可以通过减少性激素结合球蛋白来增加游离睾酮。

It's also been shown to increase luteinizing hormone, the net effect of which has been described as a subtle but significant increase in libido and some of the other parameters associated with increased androgens, like free testosterone in males and females.

它还被证明可以增加黄体生成激素，其净效应被描述为性欲和与雄激素增加相关的一些其他参数的微妙但显着的增加，例如男性和女性的游离睾酮。

So a number of people out there are taking tongkat ali in this way, 400 milligrams per day, restricted to the early part of the day, with or without food.

因此，很多人都以这种方式服用东革阿里，每天 400 毫克，仅限于一天的早些时候，无论是否与食物一起服用。

People always ask, do you need to cycle tongkat ali?

人们总是问，你需要骑车东革阿里吗？

I'm not aware of any need to cycle tongkat ali.

我不知道有什么需要骑自行车东革阿里。

In fact, it tends to work better, meaning the effects on libido and some other hormone profiles tends to increase over time.

事实上，它往往效果更好，这意味着对性欲和其他一些激素特征的影响往往会随着时间的推移而增加。

Again, tongkat ali is an option, as certainly none of these things are requirements.

同样，东革阿里是一种选择，因为当然这些都不是必需的。

We're simply listing off options.

我们只是列出选项。

But many people, both males and females, seem to benefit from and like tongkat ali, even if they're not seeking to conceive.

但许多人，无论男性还是女性，似乎都受益于并喜欢东革阿里，即使他们并不打算怀孕。

There's no reason to think that tongkat ali directly improves egg or sperm quality, except in males, the increase in androgen created by tongkat ali supplementation can indeed lead to improved spermatogenesis.

没有理由认为东革阿里会直接改善卵子或精子的质量，除了男性之外，补充东革阿里产生的雄激素增加确实可以改善精子发生。

So there's a growing amount of data in this research literature on tongkat ali.

因此，有关东革阿里的研究文献中的数据越来越多。

Many people find it beneficial, and so it's something that both men and women wishing to conceive and/or optimize their fertility, just as a general health parameter, might want to explore.

许多人发现它有益，因此希望怀孕和/或优化生育能力的男性和女性都可能想要探索它，就像一般健康参数一样。

The other supplement that's been shown to improve both egg quality and sperm quality, and there I'm referring to a number of different parameters related to egg quality and sperm quality, as well as to increase libido fairly substantially, is a substance called shilajit.

另一种被证明可以提高卵子质量和精子质量的补充剂，我指的是与卵子质量和精子质量相关的许多不同参数，以及相当大地提高性欲的物质，它是一种叫做喜来芝的物质。

Shilajit, spelled S-H-I-L-A-G-I-T.

Shilajit，拼写为 S-H-I-L-A-G-I-T。

Shilajit is actually a compound that's used in Ayurvedic medicine, but there are some really good research studies exploring the supplementation with shilajit at about 250 milligrams twice per day.

喜来芝实际上是一种用于阿育吠陀医学的化合物，但有一些非常好的研究探索每天两次补充约 250 毫克喜来芝。

And this has been looked at in males and in females.

这已经在男性和女性身上进行了研究。

And it does seem to significantly increase two hormones.

它似乎确实显着增加了两种激素。

One is testosterone, and the other is follicle-stimulating hormone.

一种是睾酮，另一种是卵泡刺激素。

And for that reason, shilajit is often considered a tonic that people use both as an aphrodisiac to increase libido as well as to increase fertility.

出于这个原因，喜来芝通常被认为是一种补品，人们既可以用它作为壮阳药来增加性欲，也可以提高生育能力。

Now, one note of caution, if you're a woman and you're considering taking shilajit in order to increase testosterone and follicle-stimulating hormone, keep in mind that the ovulatory cycle is this very tightly regulated cycle in which you want low but elevated levels of follicle-stimulating hormone early in the follicular phase, then it peaks right before ovulation, and then low levels of follicle-stimulating hormone in the second half of your cycle.

现在，需要注意的是，如果您是一名女性，并且正在考虑服用喜来芝来增加睾酮和卵泡刺激素，请记住，排卵周期是一个受到严格调控的周期，您希望在卵泡期早期卵泡刺激素水平较低但较高，然后在排卵前达到峰值，然后在周期后半段卵泡刺激素水平较低。

For that reason, using shilajit chronically around the entire course of your ovulatory cycle could be a little bit risky, and I'd recommend that you talk to your OBGYN prior to doing that, or if doing that at all.

因此，在整个排卵周期中长期使用喜来芝可能会有点风险，我建议您在这样做之前或如果确实这样做的话，先咨询您的妇产科医生。

For males, it's a little bit less of an issue because, as I mentioned earlier, sperm are constantly being generated and the presence of FSH is going to increase spermatogenesis.

对于男性来说，这不是一个问题，因为正如我之前提到的，精子不断产生，FSH 的存在会增加精子发生。

Now, shilajit is not FSH itself.

现在，喜来芝并不是 FSH 本身。

Shilajit stimulates the release of FSH, and it stimulates the release of testosterone.

喜来芝刺激 FSH 的释放，并刺激睾酮的释放。

So again, there's no reason to think that it would shut down your endogenous testosterone or FSH production.

再次强调，没有理由认为它会关闭内源性睾酮或 FSH 的产生。

Although there are a limited amount of data that really explore that in detail, many people use shilajit in order to increase their testosterone, FSH, their libido, and various aspects of sperm health.

尽管真正详细探索这一点的数据有限，但许多人使用喜来芝来增加睾酮、FSH、性欲和精子健康的各个方面。

Again, the dosages of shilajit are about 250 milligrams two times per day.

同样，喜来芝的剂量约为 250 毫克，每天两次。

One issue with shilajit is it often comes as a tar.

喜来芝的一个问题是它通常以焦油的形式出现。

It's a little hard to measure out the dosages.

测量剂量有点困难。

Yes, a tar.

是的，焦油。

It's this kind of thick, gummy substance that you're supposed to dissolve in water, and the recommendations are you take a little bead and dissolve it in water.

这种粘稠的胶状物质应该溶解在水中，建议您取一点珠子并将其溶解在水中。

It is available in capsule form, where the ability to control the dosage is made a little bit easier.

它有胶囊形式，可以更容易地控制剂量。

But of course, as with any supplement, I recommend starting with the lowest possible dosage.

当然，与任何补充剂一样，我建议从尽可能低的剂量开始。

So you might just want to start with a very small bead of shilajit dissolved in water, taken once per day, and then increase the dosage as needed in order to obtain the effects that you want.

因此，您可能只想先将一小颗喜来芝溶解在水中，每天服用一次，然后根据需要增加剂量，以获得您想要的效果。

Things like shilajit start to bring us into the realm of what can only be described as a little bit unwieldy, right?

像喜来芝这样的东西开始把我们带入只能被形容为有点笨拙的境界，对吧？

Here we're saying you can't really control the dosage.

在这里我们说你无法真正控制剂量。

Now you're talking about hormones that need to be tightly regulated, at least for females, across the ovarian cycle.

现在您谈论的是在整个卵巢周期中需要严格调节的激素，至少对于女性而言。

For males, yes, it has been shown to increase testosterone and FSH, improve sperm motility and sperm count pretty significantly.

对于男性来说，是的，它已被证明可以显着增加睾酮和 FSH，提高精子活力和精子数量。

No reason to think that you couldn't do that chronically with shilajit.

没有理由认为你不能长期服用喜来芝来做到这一点。

And yet, I do want to acknowledge that shilajit, as this black tar substance, contains a lot of different things.

然而，我确实想承认喜来芝这种黑色焦油物质含有很多不同的物质。

In fact, it comes from a mineral pitch.

事实上，它来自矿物沥青。

What is that?

那是什么？

It comes from literally the dirt and plants that have been compressed by rocks in the Himalayas.

它实际上来自喜马拉雅山被岩石压缩的泥土和植物。

So it's pretty esoteric stuff when it really comes down to it.

所以当它真正归结为它时，这是非常深奥的东西。

But the biological effects of shilajit in both males and females seem to be related to the fact that it is highly enriched in something called fulvic acid.

但喜来芝对男性和女性的生物效应似乎与其富含黄腐酸有关。

And fulvic acid is involved in a lot of different cellular processes, not the least of which, at least in this context, is the transport of molecules across cell membranes.

黄腐酸参与许多不同的细胞过程，其中最重要的是，至少在这种情况下，分子跨细胞膜的运输。

And for hormones to have their effect, they need to cross cell membranes on the outside and the inside of the cell.

为了让激素发挥作用，它们需要穿过细胞内外的细胞膜。

So maybe that's how it's having its effect.

所以也许这就是它产生效果的方式。

Again, the mechanisms of exactly how shilajit increases testosterone and FSH, and thereby libido, egg quality, and sperm quality, aren't entirely clear.

同样，喜来芝究竟如何增加睾酮和 FSH，从而提高性欲、卵子质量和精子质量的机制尚不完全清楚。

But for the more adventurous of you out there who want to experiment with shilajit, whether or not you're trying to conceive or not, it might be something to consider.

但对于那些想要尝试喜来芝的更具冒险精神的人来说，无论您是否想要怀孕，这都可能是值得考虑的事情。

But of course, do talk to your physician.

但当然，请咨询您的医生。

The next compound that I want to discuss is zinc.

我想讨论的下一个化合物是锌。

And this discussion mainly pertains to males, although I, of course, should point out that females should get the recommended daily allowance of zinc each day.

这个讨论主要针对男性，尽管我当然应该指出女性应该每天摄入建议的每日锌摄入量。

Males, on the other hand, seem to benefit from having additionally high levels of zinc intake.

另一方面，男性似乎受益于额外高水平的锌摄入量。

Now, that can be obtained through foods.

现在，这可以通过食物获得。

You often hear, oh, oysters are enriched in zinc and And oysters are an aphrodisiac.

你经常会听到，哦，牡蛎富含锌，而且牡蛎还有壮阳药。

I don't know who's doing the marketing for oysters, but it's really terrific.

我不知道谁在为牡蛎做营销，但这确实很棒。

I think that seems to have persisted, and maybe it's true.

我认为这种情况似乎一直持续存在，也许这是真的。

Oysters are enriched in zinc.

牡蛎富含锌。

What does zinc do for fertility?

锌对生育有什么作用？

Well, in males, we know based on a really nice set of studies, that zinc dosages that are pretty high of about 120 milligrams taken twice per day, that's quite a lot, with meals, can significantly increase testosterone and dihydrotestosterone.

嗯，根据一组非常好的研究，我们知道男性的锌剂量相当高，每天服用两次，约为 120 毫克，这是相当多的，随餐服用，可以显着增加睾酮和二氢睾酮。

And this probably shouldn't come as a surprise to us.

这对我们来说可能并不奇怪。

It turns out that zinc is highly enriched in human testes and in the testes of other animals, including fish and other mammals.

事实证明，人类睾丸和其他动物（包括鱼类和其他哺乳动物）的睾丸中锌含量很高。

And it was actually in 1921 that it was observed in fish that zinc levels skyrocket in the testes of fish during their breeding season.

事实上，早在 1921 年，人们就在鱼类中观察到，在繁殖季节，鱼类睾丸中的锌含量会急剧上升。

So zinc is correlated with increases in breeding, but you never know which direction that correlation is running.

因此，锌与繁殖率的增加相关，但你永远不知道这种相关性朝哪个方向发展。

Turns out that zinc in both animals, including fish, other mammals, and in humans, strongly impacts the enzymatic functions in the testes, including the function of androgen binding protein.

事实证明，包括鱼类、其他哺乳动物和人类在内的两种动物中的锌都会强烈影响睾丸中的酶功能，包括雄激素结合蛋白的功能。

So it seems that high levels of zinc can increase spermatogenesis and testosterone levels very significantly.

因此，高水平的锌似乎可以非常显着地增加精子发生和睾酮水平。

This was explored in a really nice study that I'll provide a reference to.

这是在一项非常好的研究中进行了探讨，我将提供参考。

It's an older study, but I really like it.

这是一项较旧的研究，但我真的很喜欢它。

It's called "Effect of Zinc Administration on Plasma Testosterone, Dihydrotestosterone, and Sperm Count." This is but just one study among many now.

它被称为“锌管理对血浆睾酮、二氢睾酮和精子数量的影响”。这只是目前众多研究中的一项。

This dates back to 1981, but there have been studies subsequently that point to the fact that supplementation with zinc at those high levels can really be helpful in terms of increasing sperm count, testosterone, and even testicular size of all things.

这可以追溯到 1981 年，但随后的研究表明，补充高水平的锌确实有助于增加精子数量、睾丸激素，甚至睾丸大小等。

So one important point about taking zinc, this 120 milligrams of zinc two times daily, definitely needs to be done with meals.

因此，关于服用锌的一个要点是，每天两次，每次 120 毫克，一定要随餐服用。

If you've ever taken zinc on an empty stomach, even if you just take 15 or 30 milligrams of zinc, you can feel very nauseous, not well for a few hours.

如果你曾经空腹服用过锌，即使你只服用15或30毫克的锌，你也会感到非常恶心，几个小时内都不舒服。

So make sure that you're taking zinc with full meals.

因此，请确保在正餐时补充锌。

So this would mean that you're taking in at least two full meals per day.

所以这意味着您每天至少吃两顿正餐。

I should also mention that zinc supplementation did not appear to impact gonadotropin-releasing hormone or prolactin, so it seems to be a fairly targeted effect on the testosterone and related pathways in males.

我还应该提到，补充锌似乎不会影响促性腺激素释放激素或催乳素，因此它似乎对男性睾酮和相关途径具有相当有针对性的影响。

As far as I know, there have not been systematic explorations of the effects of high levels of zinc administration on females.

据我所知，目前还没有系统地探讨高水平锌摄入对女性的影响。

I would hope that those studies would soon be done.

我希望这些研究能够很快完成。

But meanwhile, if you're a male and you're interested in improving sperm quality and your testosterone levels overall for whatever reason, zinc likely is a good candidate.

但与此同时，如果您是一名男性，并且无论出于何种原因，您有兴趣提高精子质量和整体睾酮水平，那么锌可能是一个不错的选择。

And that pretty much summarizes the compounds that men and women should take in order to maximize egg quality, sperm quality, and fertility.

这几乎概括了男性和女性应该服用的化合物，以最大限度地提高卵子质量、精子质量和生育能力。

And then, of course, we start to enter the landscape of other things that men and women can take in order to improve fertility, and those other things generally are prescription drugs.

当然，然后我们开始了解男性和女性可以服用的其他药物来提高生育能力，而这些其他药物通常是处方药。

And so I just want to mention what a few of those are, but of course, these are things that you would absolutely have to obtain prescriptions for from your MD, and your MD would, without question, would want to take blood tests prior to prescribing these things.

所以我只想提一下其中的一些内容，但是当然，这些是您绝对必须从您的医生那里获得处方的东西，毫无疑问，您的医生会在开这些东西之前进行血液检查。

So for instance, if men have been taking exogenous testosterone through the use of anabolic steroids like performance-enhancing drugs or even testosterone replacement therapy, their endogenous testosterone levels are going to be very low, and their sperm counts are going to be very low, unless, for instance, they are prescribed and taking something like hCG, human chorionic gonadotropin, which mimics LH and would stimulate the testes to produce testosterone and through some indirect pathways, rescue spermatogenesis, although not to the same degree as if people are not taking exogenous sources of testosterone.

因此，举例来说，如果男性通过使用合成代谢类固醇（如性能增强药物，甚至睾酮替代疗法）服用外源性睾酮，那么他们的内源性睾酮水平将非常低，精子数量也会非常低，除非他们按照处方服用 hCG（人绒毛膜促性腺激素）之类的药物，它模仿 LH，刺激睾丸产生睾酮，并通过一些间接途径，拯救精子发生，尽管程度与不服用外源睾酮的人不同。

Some men, even if they've never touched TRT or exogenous testosterone of any kind, will be prescribed to take hCG because of its ability to stimulate the testes to produce more testosterone and sperm.

有些男性，即使他们从未接触过 TRT 或任何类型的外源性睾酮，也会被要求服用 hCG，因为它能够刺激睾丸产生更多的睾酮和精子。

So they're just taking hCG alone.

所以他们只是单独服用 hCG。

Other men will take or will be prescribed rather FSH in order to stimulate spermatogenesis, or hCG and FSH, or clomiphene, which can regulate all sorts of things in both testosterone and estrogen-related pathways at the level of brain and pituitary and gonad, testes.

其他男性会服用或服用 FSH 来刺激精子发生，或者使用 hCG 和 FSH，或者克罗米芬，它们可以在大脑、垂体和性腺、睾丸水平调节睾酮和雌激素相关途径中的各种物质。

Likewise, for women, if they're low in FSH, they might be prescribed FSH.

同样，对于女性来说，如果她们的 FSH 含量较低，可能会服用 FSH。

If they are low in luteinizing hormone, they might be prescribed hCG.

如果他们的黄体生成激素水平较低，可能会服用 hCG。

If they're low in testosterone, they might even be prescribed testosterone.

如果他们的睾酮水平较低，甚至可能会服用睾酮。

And if their testosterone is too high and they're dealing with PCOS, they might be prescribed anti-androgens and androgen blockers, and on and on and on.

如果他们的睾丸激素过高并且患有多囊卵巢综合症，他们可能会服用抗雄激素和雄激素阻滞剂，等等。

There are so many different hormones that can impact the different aspects of the ovulatory and the spermatogenesis cycle that the OBGYNs and the urologists focused on male fertility nowadays really have an excellent handle on which levers and buttons and threads to pull and push and so forth in order to set in motion a proper ovulatory cycle and a proper spermatogenesis cycle.

有许多不同的激素可以影响排卵和精子发生周期的不同方面，以至于当今专注于男性生育能力的妇产科医生和泌尿科医生确实拥有出色的手柄，可以拉动和推动杠杆、按钮和螺纹等，以便启动适当的排卵周期和适当的精子发生周期。

Everything we talked about up until now and in the early phase of this episode, especially about how the brain commands the pituitary and the pituitary commands the gonads, and then the gonads, the ovary, or the testes send feedback signals to the pituitary to then influence the pituitary.

到目前为止以及本集前期我们所讨论的一切，特别是大脑如何命令垂体，垂体如何命令性腺，然后性腺、卵巢或睾丸向垂体发送反馈信号，然后影响垂体。

All of that incredible orchestra, that dance, is so tightly regulated in a way that really provides the OBGYNs and the fertility docs concerned with male fertility, exceptional tools to, for instance, figure out if a man is not producing any sperm, but his testosterone levels are well within normal range.

所有这些令人难以置信的管弦乐队，那种舞蹈，都受到如此严格的监管，真正为妇产科医生和与男性生育力有关的生育医生提供了特殊的工具，例如，可以确定一个男人是否没有产生任何精子，但他的睾酮水平是否在正常范围内。

Well, then there's some very clear sets of explorations and potential treatments, some of which are mechanical, making sure the epididymis and vas deferens are clear, allowing the sperm to enter the ejaculate, and the ejaculate to enter the urethra, and obviously, to enter the female.

嗯，然后有一些非常明确的探索和潜在的治疗方法，其中一些是机械的，确保附睾和输精管畅通，允许精子进入射精，射精进入尿道，显然，进入女性。

As well as for a woman who's not ovulating to adjust her levels of FSH or maybe even to apply acupuncture in conjunction with supplementation and various prescription hormone therapies to adjust fertility and ovulation and the probability of successful pregnancy.

对于不排卵的女性来说，可以调整 FSH 水平，甚至可以应用针灸结合补充剂和各种处方激素疗法来调整生育力和排卵以及成功怀孕的可能性。

So there's a vast landscape of prescription drugs and surgical interventions of varying degrees of invasiveness, and some are, for instance, outpatient procedures, some require general anesthesia, et cetera, in order to maximize male and female fertility.

因此，处方药和不同程度侵入性的外科手术干预措施种类繁多，有些是门诊手术，有些需要全身麻醉等，以最大限度地提高男性和女性的生育能力。

What I've tried to do today is to provide you with a deep dive understanding of the ovulatory and menstrual cycle.

我今天试图做的是让您深入了解排卵和月经周期。

We talked about the brain, the pituitary, the ovary, the fallopian tubes, and in fact, the whole female reproductive axis as it relates to fertility and reproduction.

我们讨论了大脑、垂体、卵巢、输卵管，事实上，还讨论了与生育和生殖相关的整个女性生殖轴。

I also described the male reproductive axis as it relates to the brain, the pituitary, the gonad, the testes, and the various ducts, the pathways out of the testes that allow the sperm to be enriched within the semen, and then the semen and the ejaculate to exit through the urethra.

我还描述了男性生殖轴，因为它与大脑、垂体、性腺、睾丸和各种导管有关，睾丸的出路允许精子在精液中富集，然后精液和射精通过尿道排出。

I did all that as a way to frame the various tools and interventions that can really assist in increasing fertility, egg quality, and sperm quality.

我所做的一切都是为了构建各种工具和干预措施，真正有助于提高生育能力、卵子质量和精子质量。

So when we discuss mitochondria in the context of the development of an egg or the development of sperm and its ability to swim quickly forward, now it should make sense as to why a given intervention, whether or not it's L-carnitine or whether or not it's exercise or whether or not it's getting enough sleep and limiting stress, why all that should matter and why, in fact, mechanistically those interventions can work.

因此，当我们在卵子发育或精子发育及其快速向前游动的能力的背景下讨论线粒体时，现在应该明白为什么要进行某种特定的干预措施，无论是左旋肉碱还是运动，或者是否获得充足的睡眠和限制压力，为什么所有这些都重要，以及为什么实际上这些干预措施可以发挥作用。

Because indeed, there are many interventions that we can all do and use to support our fertility.

因为事实上，我们都可以采取许多干预措施来支持我们的生育能力。

And again, as a more general theme today, I really wanted to, A, teach you about the human reproductive axis.

再说一次，作为今天一个更普遍的主题，我真的很想，A，教你有关人类生殖轴的知识。

I do find the biology of the ovulatory and menstrual cycle and spermatogenesis to be absolutely fascinating to me.

我确实发现排卵和月经周期以及精子发生的生物学对我来说绝对令人着迷。

And again, if you're somebody who's interested in conceiving or if you've already conceived children, and even if you don't want more children, this is really the aspect of our biology that allowed us to be here.

再说一次，如果你对怀孕感兴趣，或者你已经怀孕了，即使你不想要更多的孩子，这确实是我们生物学的一个方面，让我们能够来到这里。

It's the aspect of our biology that determined whether or not we are male or female.

我们的生物学特征决定了我们是男性还是女性。

It's the aspect of our biology that determines so, so much, and yet I think that most of us generally are not taught this in school, or at least not at the depth that we discussed it today.

这是我们生物学的一个方面决定了这么多，但我认为我们大多数人通常在学校里没有学到这一点，或者至少没有达到我们今天讨论的深度。

So hopefully that information was in and of itself interesting and perhaps useful as well.

所以希望这些信息本身是有趣的，也许也是有用的。

And I do think that even if people are not wishing to conceive more children, that the information related to fertility and optimizing egg and sperm health is of value in the sense that optimizing egg and sperm health can be used as a proxy for optimizing our body and brain health generally.

我确实认为，即使人们不希望怀孕更多的孩子，与生育和优化卵子和精子健康相关的信息也是有价值的，因为优化卵子和精子健康可以作为优化我们身体和大脑健康的指标。

In other words, and here I'm admittedly taking words out of the mouths of the various wonderful doctors, the OBGYNs, and urologists that helped inform me in anticipation of this episode, what is good for the woman is good for the egg and for fertility and for her pregnancy.

换句话说，在这里，我承认，我是从各个出色的医生、妇产科医生和泌尿科医生的口中摘取的话，他们在预期这一事件时帮助告诉我，对女性有益的就是对卵子、生育力和怀孕都有好处。

And what's good for the man is good for the quality and production of sperm and for fertility and pregnancy.

对男性有益的是精子的质量和产生以及生育和怀孕。

Put differently, whether or not we are male or female, the things that we can do to optimize our fertility are the exact same things that we should all be doing to optimize our vitality and our longevity.

换句话说，无论我们是男性还是女性，我们为优化生育能力而可以做的事情与我们都应该为优化我们的活力和寿命而做的事情完全相同。

Now, I realize today's episode was so much the deep dive and fairly broad as well that it ended up being fairly long and extensive, and yet we still have not touched on any of the important themes that I know a number of people want to know about.

现在，我意识到今天的这一集是如此深入和相当广泛，以至于它最终变得相当长和广泛，但我们仍然没有触及我知道很多人想了解的任何重要主题。

So for instance, menopause, andropause, PCOS, and other themes related to hormones and reproductive function and biology.

例如，更年期、男性更年期、多囊卵巢综合症以及其他与激素、生殖功能和生物学相关的主题。

And I promise that we will have episodes, both solo episodes and episodes with expert guests in the future to cover all of those topics in detail.

我保证我们将来会制作剧集，包括个人剧集和专家嘉宾的剧集，详细涵盖所有这些主题。

Meanwhile, the information discussed in today's episode should serve as a basic foundation for those discussions going forward, and hopefully were of interest to you in their own right.

同时，今天这一集中讨论的信息应该作为后续讨论的基础，并且希望您本身也会感兴趣。

If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.

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 Spotify and Apple.

此外，请订阅 Spotify 和 Apple 上的播客。

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。

If you have questions or comments about the podcast or guests that you'd like me to bring on the Huberman Lab podcast, please put those questions and suggestions in the comment section on YouTube.

如果您对播客或希望我在 Huberman Lab 播客上邀请的嘉宾有任何疑问或意见，请在 YouTube 的评论部分提出这些问题和建议。

I do read all the comments.

我确实阅读了所有评论。

In addition, please check out the sponsors mentioned at the beginning and throughout today's episode.

此外，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。

During today's episode and on many previous episodes of the Huberman Lab podcast, we discuss supplements.

在今天的节目以及 Huberman 实验室播客的许多以前的节目中，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 sleep, hormone augmentation, focus, and much more.

虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的益处，例如睡眠、增强荷尔蒙、注意力等等。

The Huberman Lab podcast is now partnered with Momentous Supplements because, as mentioned at the beginning of today's episode, Momentous Supplements are of the very highest quality, they ship internationally, and they have single-ingredient formulations that allow you to develop the most biologically effective and cost-effective supplement regimen for you.

Huberman Lab 播客现在与 Momentous Supplements 合作，因为正如今天节目开头提到的，Momentous Supplements 具有最高的质量，它们在全球范围内发货，并且它们具有单一成分配方，可让您为您开发最具生物有效性和成本效益的补充方案。

If you'd like to see the supplements discussed on today's and other Huberman Lab podcasts, please go to livemomentous, spelled O-U-S, so livemomentous.com/huberman.

如果您想查看今天和其他 Huberman Lab 播客中讨论的补充内容，请访问 livemomentous，拼写为 O-U-S，即 livemomentous.com/huberman。

If you're not already following us on social media, please do so.

如果您还没有在社交媒体上关注我们，请这样做。

We are hubermanlab on Instagram, Twitter, Facebook, and LinkedIn.

我们在 Instagram、Twitter、Facebook 和 LinkedIn 上是 hubermanlab。

And at all of those places, I discuss science and science-related tools, some of which overlap with the contents of the Huberman Lab podcast, but much of which is distinct from the content of 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 hubermanlab on all social media platforms.

再说一遍，所有社交媒体平台上都是 hubermanlab。

And if you haven't already subscribed to our newsletter, we have a zero-cost newsletter.

如果您还没有订阅我们的时事通讯，我们有一份零成本的时事通讯。

It is called the Neural Network Newsletter, and each month it includes things like podcast summaries and toolkits for things like sleep focus, dopamine optimization, fitness, and so on.

它被称为神经网络通讯，每个月都包含播客摘要和睡眠焦点、多巴胺优化、健身等工具包等内容。

You can sign up for the newsletter, again, completely zero cost, by going to hubermanlab.com.

您可以访问 hubermanlab.com，以完全零成本的方式订阅时事通讯。

Go to the menu, go to Newsletter.

转到菜单，转到时事通讯。

You provide your email, and we do not share your email.

您提供您的电子邮件，我们不会共享您的电子邮件。

And again, the newsletter is completely zero cost.

再说一遍，时事通讯完全是零成本。

Thank you once again for joining me for today's discussion all about the biology surrounding this incredible thing that we call fertility, including the ovulatory cycle, spermatogenesis, fertilization itself, and all the events leading up to pregnancy.

再次感谢您参加今天的讨论，讨论围绕着我们称之为生育力的这一令人难以置信的事物的生物学，包括排卵周期、精子发生、受精本身以及导致怀孕的所有事件。

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。