How Women Can Improve Their Fertility & Hormone Health | Dr. Natalie Crawford
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Everybody should get an AMH test.
每个人都应该接受 AMH 测试。
I think it's a very important marker.
我认为这是一个非常重要的标记。
If you are listening to this and you want kids one day, ask your doctor for this test.
如果您正在听此内容并且您有一天想要孩子，请向您的医生询问这项测试。
It is not a test of egg quality.
这不是卵子质量的测试。
And we talked about what egg quality is, right?
我们讨论了卵子质量是什么，对吗？
Genetics and egg competency.
遗传学和卵子能力。
But it is a check of how many eggs you have, and that knowledge can be really impactful for how you view your future and your plan.
但这是对您有多少鸡蛋的检查，而这些知识对于您如何看待自己的未来和计划确实会产生影响。
Andrew Huberman:
安德鲁·休伯曼：
Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.
欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。
My guest today is Dr. Natalie Crawford.
今天我的客人是娜塔莉·克劳福德博士。
Dr. Natalie Crawford is a double board-certified physician specializing in obstetrics and gynecology, fertility, and reproductive health.
娜塔莉·克劳福德 (Natalie Crawford) 医生是一位获得双重委员会认证的医生，专长于妇产科、生育力和生殖健康。
Today, we discuss the actionable steps that all women can take to improve their reproductive and hormone health, both to enhance probability of successful pregnancy, but also because fertility and hormone health are strong correlates of general health and longevity.
今天，我们讨论所有女性可以采取的改善生殖和激素健康的可行步骤，这不仅是为了提高成功怀孕的可能性，而且还因为生育力和激素健康与总体健康和长寿密切相关。
Dr. Crawford shares what all women, regardless of age or reproductive goals, can do to enhance their health using lifestyle, nutrition, supplementation, and prescription medical tools that she indeed uses in her practice.
克劳福德博士分享了所有女性，无论年龄或生育目标如何，都可以通过她在实践中实际使用的生活方式、营养、补充剂和处方医疗工具来增强她们的健康。
We also have a very honest discussion about biological versus chronological age and fertility, why age is not just a number, but also why it is that many women do successfully conceive in their 40s.
我们还就生理年龄与实际年龄以及生育能力进行了非常诚实的讨论，为什么年龄不仅仅是一个数字，而且还解释了为什么许多女性在 40 多岁时成功怀孕。
Of course, there's a lot of information online nowadays about women's hormones, fertility, and health.
当然，现在网上有很多关于女性荷尔蒙、生育能力和健康的信息。
Today, thanks to Dr. Crawford, you'll learn what is known and documented and what she has herself consistently observed clinically in her practice about women's health and fertility.
今天，感谢克劳福德博士，您将了解已知和记录的内容，以及她本人在女性健康和生育实践中临床上一贯观察到的内容。
Few, if any, people have Dr. Crawford's training, clinical acumen, understanding of the new research, and incredible ability to communicate the well- and lesser-known actionable steps for improving female health.
很少有人拥有克劳福德博士的训练、临床敏锐性、对新研究的理解，以及传达众所周知和鲜为人知的改善女性健康的可行步骤的令人难以置信的能力。
Dr. Crawford also has a new book out entitled The Fertility Formula: Take Control of Your Reproductive Future, which, again, focuses on reproductive health, but also hormone health and how both of those things impact female health in the short and long term.
克劳福德博士还出版了一本新书，题为《生育公式：掌控你的生殖未来》，该书再次关注生殖健康，但也关注激素健康以及这两者如何影响女性健康的短期和长期。
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, today's episode does include sponsors.
为了与这个主题保持一致，今天的节目确实有赞助商。
And now for my discussion with Dr. Natalie Crawford.
现在我与娜塔莉·克劳福德博士进行讨论。
Dr. Natalie Crawford, welcome back.
娜塔莉·克劳福德博士，欢迎回来。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Thank you so much for having me.
非常感谢你邀请我。
I'm thrilled to be here.
我很高兴来到这里。
Andrew Huberman:
安德鲁·休伯曼：
And congratulations on your new book-
祝贺你的新书出版——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Thank you
谢谢你
Andrew Huberman:
安德鲁·休伯曼：
...
...
The Fertility Formula.
生育力公式。
It's no small feat to complete a book, and it's especially a big feat to complete a book that offers people so much advice, not just people who want to get pregnant, but also looking at things through the lens of fertility as an important health metric.
完成一本书并不是一件小事，尤其是完成一本为人们提供如此多建议的书，这不仅是那些想要怀孕的人，而且还通过生育能力作为一个重要的健康指标来看待事物，这尤其是一项伟大的壮举。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So, yeah.
所以，是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Thank you so much.
非常感谢。
You know what goes into writing a book, and it's always been this aspirational goal of mine.
你知道写一本书需要什么，这一直是我的愿望目标。
And after educating and talking about fertility with patients and people online, it's been something I've wanted to do.
在网上与患者和人们进行有关生育的教育和讨论之后，这是我一直想做的事情。
But I will say it is a much bigger feat to go through it-
但我想说，经历它是一项更大的壮举——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
to work with editors, to try to refine within your word count, I was 20,000 words over and try to bring it back in.
与编辑合作，尝试在字数范围内进行优化，我超过了 20,000 字，并尝试将其恢复。
So thank you for having me and for holding it up and reading it early and sharing your endorsement for it, too.
因此，感谢您邀请我阅读并尽早阅读它，并分享您对它的认可。
That means so much.
这意味着很多。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I am insisting as much as one can insist that various people in my life read this book, including family members and other people, because again, it's not just about people who want to have children or who already have children, but fertility as a way of kind of knowing where one is in their health arc, in their life arc.
我尽可能地坚持让我生活中的不同人阅读这本书，包括家庭成员和其他人，因为这不仅仅是关于那些想要孩子或已经有孩子的人，而是关于生育力作为一种了解一个人在他们的健康弧和生命弧中的位置的一种方式。
So if you don't mind, how should people think about fertility purely as a readout of health?
那么，如果您不介意的话，人们应该如何将生育率纯粹视为健康指标呢？
Just how do you frame this for-- If somebody comes to you and says, listen, they have kids, or they don't want kids-
你如何看待这个——如果有人来找你说，听着，他们有孩子，或者他们不想要孩子——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm
毫米
Andrew Huberman:
安德鲁·休伯曼：
...
...
or they're not sure if they want kids, but why use fertility as a lens on general health?
或者他们不确定自己是否想要孩子，但为什么要用生育能力作为总体健康的指标呢？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Fertility is a health marker, and I love that you bring that up the top of the episode here, because so often patients, women specifically, think fertility is only the ability to get pregnant.
生育力是一个健康标志，我喜欢你把它放在这一集的顶部，因为很多患者，特别是女性，认为生育力只是怀孕的能力。
We really simplify it into this one phase of life.
我们确实将其简化为人生的这一阶段。
But if we want to zoom out, your fertility is a sign that you have good hormonal health, good cellular, good metabolic health, because it takes so many different moving parts to ovulate, for an egg to allow a sperm to fertilize, to implant, to get pregnant.
但如果我们想缩小范围，你的生育能力是一个标志，表明你有良好的荷尔蒙健康、良好的细胞、良好的代谢健康，因为排卵、卵子让精子受精、着床和怀孕需要许多不同的活动部件。
But also your hormonal health and the ovarian function is really going to impact your entire life, how you feel on a day-to-day as a woman.
而且您的荷尔蒙健康和卵巢功能确实会影响您的整个生活，以及您作为女性的日常生活感受。
But if we want to be really specific, if you have infertility, you have increased rates of metabolic syndrome, cancer, heart attack, stroke, and dying early.
但如果我们想真正具体一点的话，如果你患有不孕症，那么你患代谢综合征、癌症、心脏病、中风和早逝的几率就会增加。
Those are extremely scary statistics, and you know I had my own infertility journey, so I fall into this category.
这些都是极其可怕的统计数据，你知道我也有过不孕不育的经历，所以我属于这一类。
But the reason why is not that infertility causes any of those things directly.
但原因并不是不孕不育直接导致这些事情。
It's that for most people, it's one of the first warning signs that something is not right in their body and that there's higher levels of chronic inflammation or insulin resistance that we know can impact long-term health outcomes.
对于大多数人来说，这是第一个警告信号，表明他们的身体出现了问题，并且慢性炎症或胰岛素抵抗水平较高，我们知道这些会影响长期的健康结果。
Andrew Huberman:
安德鲁·休伯曼：
For women who are still of reproductive age-
对于仍处于育龄期的女性来说——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and I realize there's no strict cutoff, we can and certainly will talk about what are the measures, direct and indirect, of fertility that can give them a window into their kind of health span risk factors, lifespan risk factors.
我意识到没有严格的界限，我们可以而且肯定会讨论哪些直接和间接的生育措施可以让他们了解自己的健康风险因素、寿命风险因素。
For women that have already reached menopause or in perimenopause, how should they think about fertility as a health marker?
对于已经进入更年期或围绝经期的女性，应该如何看待生育能力作为健康指标？
Meaning, if somebody is past the point where they can safely get pregnant-
意思是，如果有人超过了可以安全怀孕的时间-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
does that mean that their periods are no longer informative?
这是否意味着他们的经期不再提供信息？
I imagine their periods, features about their menstrual cycle are still very informative about their general health.
我想他们的经期、月经周期的特征对于他们的整体健康状况仍然非常有帮助。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
As long as you're having a menstrual cycle, it is a sign that you're ovulating and you theoretically could get pregnant.
只要您有月经周期，就表明您正在排卵，理论上您可能会怀孕。
So I think it's really important to say that even in perimenopause, which is the transitional time between having regular, appropriate hormonal function, that reliable Characteristic of the ovary responding to the brain.
因此，我认为重要的是，即使在围绝经期，即具有正常、适当的荷尔蒙功能与卵巢对大脑做出反应的可靠特征之间的过渡时间。
This is the transition time as you're starting to get to a lower egg count, that you will eventually start to see some cycle changes, but you also have a lot of hormone dysfunction.
这是过渡时间，因为您的卵子数量开始减少，您最终会开始看到一些周期变化，但您也会出现很多激素功能障碍。
But you can still get pregnant.
但您仍然可以怀孕。
And in fact, I see a fair amount of patients who said, "I thought I was past that stage of my life based on my age." But if you're still having periods, it's a really important window into your hormonal health.
事实上，我看到很多患者说：“根据我的年龄，我认为我已经过了人生的那个阶段。”但如果您仍有月经，那么这是了解荷尔蒙健康状况的一个非常重要的窗口。
It can tell you a lot about your body, especially if you know when you ovulate, and we can look at the distinct phases of the cycle, the follicular phase and the luteal phase.
它可以告诉您很多有关您身体的信息，特别是如果您知道自己何时排卵，我们可以查看周期的不同阶段：卵泡期和黄体期。
When we're a little bit past this, menopause by definition, which I hate, is 12 months without a period.
当我们过了这个阶段后，更年期的定义是 12 个月没有月经，这是我讨厌的。
So menopause is one single day in time.
所以更年期是一天的时间。
Really, it means you've been in ovarian failure for 12 months before you'll magically get this diagnosis.
实际上，这意味着您已经患有卵巢功能衰竭 12 个月，然后您才会神奇地得到这一诊断。
But menopause at its purest is ovarian failure.
但更年期最纯粹的表现是卵巢衰竭。
The ovaries no longer have the capability to respond to the brain signals.
卵巢不再有能力对大脑信号做出反应。
You're not going to make estrogen or progesterone anymore.
你不会再产生雌激素或黄体酮。
At that time, a woman's metabolic health completely changes, but the age of which you went through menopause really can impact your reproductive health outcomes long term.
那时，女性的代谢健康状况会完全改变，但您经历更年期的年龄确实会长期影响您的生殖健康结果。
And some of the characteristics you might have had in your cycle when we look backwards can inform us some about your cellular health now.
当我们回顾过去时，您在周期中可能具有的一些特征可以告诉我们一些有关您现在细胞健康状况的信息。
So it's still really important to think back and move forward.
因此，回顾并继续前进仍然非常重要。
And then on a bigger scale, we're seeing the tide turn on hormone replacement therapy, and I know that's not what this entire episode's about, but as a reproductive endocrinologist, I love estrogen.
然后在更大的范围内，我们看到激素替代疗法的潮流转变，我知道这不是整个事件的主题，但作为一名生殖内分泌学家，我喜欢雌激素。
I love hormones.
我喜欢荷尔蒙。
And I think it's really important for women to know that you can start hormone replacement therapy at any time.
我认为对于女性来说，知道可以随时开始激素替代疗法非常重要。
So even though a long time ago we felt really comfortable starting it right at the time of menopause, we're starting to see benefits starting it in the perimenopausal period.
因此，尽管很久以前我们在更年期时开始服用它感到非常舒服，但我们开始看到在围绝经期开始服用它的好处。
We see a benefit starting it once you have menopause.
我们发现，一旦您进入更年期，开始服用它就会有好处。
But I think it's a disservice to women to make them have no period, ovarian failure for 12 months, no estrogen, feel terrible, before we'll allow them to have hormone replacement therapy.
但我认为，在我们允许她们接受激素替代疗法之前，让她们没有月经、卵巢功能衰竭12个月、没有雌激素、感觉很糟糕，对她们来说是一种伤害。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, this is such an important theme and if I may, I realize I have to be very careful- ...
是的，这是一个如此重要的主题，如果可以的话，我意识到我必须非常小心 - ...
to not draw parallels to men's hormonal health when talking about women's hormonal health, because it's not a one-for-one.
在谈论女性荷尔蒙健康时，不要将其与男性荷尔蒙健康相提并论，因为这不是一对一的。
They're very distinct processes.
它们是非常不同的过程。
On the other hand, I think thematically what I'm about to say, I believe holds, so hopefully it won't upset too many people.
另一方面，我认为我要说的主题是成立的，所以希望它不会让太多人感到不安。
Which is, for many years now, for reasons that are unfair, hormone replacement therapy sort of became widely available for men before it became-
多年来，由于不公平的原因，激素替代疗法在男性中广泛使用之前，
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
widely available for women.
广泛供女性使用。
There are reasons for this.
这是有原因的。
We don't have to go into it, but they're the kind of obvious ones, that things were pushed to market more quickly and so forth.
我们不必深究，但它们是那种显而易见的问题，比如产品被更快地推向市场等等。
But there's been this idea, there it's usually testosterone replacement therapy, right?
但有这样的想法，通常是睾酮替代疗法，对吗？
And there was this idea that unless somebody fell below 300 nanograms per deciliter-
有人认为除非某人的浓度低于每分升 300 纳克——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
for a male, that they shouldn't get testosterone replacement therapy.
对于男性来说，他们不应该接受睾酮替代疗法。
Now it's kind of understood that if somebody chooses, they can usually find a doctor that if they're at the low end of normal, they can push to the high end of normal or to the middle of the range, so that they can get their symptoms away-
现在人们明白，如果有人选择，他们通常可以找到一位医生，如果他们处于正常的低端，他们可以将其推至正常的高端或范围的中间，这样他们就可以摆脱症状——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Optimize
优化
Andrew Huberman:
安德鲁·休伯曼：
...
...
and just feel-- Right, to optimize within the normal range.
只是感觉——对，在正常范围内优化。
And so I'm relieved to hear that you're saying the same is true for women.
因此，听到您说女性也是如此，我感到很欣慰。
And I'm relieved to hear it because I think that having these strict cutoffs of no periods for a year, well, I mean, it could take a long time to reach that.
听到这个消息我感到很欣慰，因为我认为严格限制一年内没有月经，我的意思是，可能需要很长时间才能达到这一目标。
I mean, what if it's two periods per year, right?
我的意思是，如果每年有两个时期怎么办，对吧？
Does that mean that that person-
这是否意味着那个人——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Exactly
正是如此
Andrew Huberman:
安德鲁·休伯曼：
...
...
doesn't deserve the therapy?
不值得治疗？
Which is essentially what-
这本质上就是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
I think you're saying.
我想你是说。
So the R in hormone replacement is the dangerous letter, in my opinion, because there is this notion of augmenting hormones.
因此，在我看来，激素替代中的 R 是一个危险的字母，因为存在增强激素的概念。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
Okay, so forgive me for going long, but I think the two situations, it would be great if both women and men could augment their hormones to be at the high end of normal or wherever puts them in a place where they're not experiencing symptoms.
好吧，请原谅我说得太长了，但我认为这两种情况，如果女性和男性都能将荷尔蒙增加到正常水平的高端，或者让他们处于没有出现症状的地方，那就太好了。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Absolutely.
绝对的。
We know that as humans, we now have longer lifespans, we outlive our reproductive hormones, yet they are essential for our day-to-day function and to feel our best, and we should at least be given the opportunity to have our symptoms evaluated, to be offered hormone therapy if we want it, and to not have to have these harsh cutoffs, especially for something that can be so protective long term.
我们知道，作为人类，我们现在的寿命更长，我们的生殖激素比生殖激素更长寿，但它们对于我们的日常功能和感觉最好是至关重要的，我们至少应该有机会评估我们的症状，如果我们愿意的话可以接受激素治疗，并且不必有这些严格的限制，特别是对于可以长期提供保护的东西。
I mean, for women, we see it be cardio protective.
我的意思是，对于女性来说，我们认为它具有心脏保护作用。
It can help lower the risk of Alzheimer's disease.
它可以帮助降低患阿尔茨海默病的风险。
Of course, it can be protective for your bones.
当然，它可以保护您的骨骼。
So I love this greater discussion, and it really stems from learning about your body, knowing what's normal so you can advocate for what's not normal, and really feeling like you have your own agency over your health and your own future.
所以我喜欢这个更大的讨论，它真的源于了解你的身体，知道什么是正常的，这样你就可以倡导什么是不正常的，并且真正感觉你对你的健康和你自己的未来有自己的代理权。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to take a quick break to acknowledge one of our sponsors, David.
我想稍微休息一下，向我们的赞助商之一大卫表示感谢。
David makes protein bars unlike any other.
大卫制作的蛋白质棒与众不同。
Their newest bar, the Bronze Bar, has 20 grams of protein, only 150 calories, and zero grams of sugar.
他们最新的 Bronze Bar 含有 20 克蛋白质，仅 150 卡路里，零克糖。
I have to say, these are the best-tasting protein bars I've ever had, and I've tried a lot of protein bars over the years.
我不得不说，这些是我吃过的味道最好的蛋白质棒，这些年来我尝试过很多蛋白质棒。
These new David bars have a marshmallow base, and they're covered in chocolate coating, and they're absolutely incredible.
这些新的大卫巧克力棒有一个棉花糖底座，上面覆盖着巧克力涂层，它们绝对令人难以置信。
I, of course, eat regular whole foods.
当然，我经常吃天然食品。
I eat meat, chicken, fish, eggs, fruits, vegetables, et cetera.
我吃肉、鸡肉、鱼、鸡蛋、水果、蔬菜等等。
But I also make it a point to eat one or two David bars per day as a snack, which makes it easy to hit my protein goal of one gram of protein per pound of body weight.
但我也强调每天吃一两块大卫棒作为零食，这样很容易达到我每磅体重一克蛋白质的蛋白质目标。
And that allows me to take in the protein I need without consuming excess calories.
这使我能够摄入所需的蛋白质，而不会消耗过多的热量。
I love all the David Bronze Bar flavors, including Cookie Dough, Caramel Chocolate, Double Chocolate, Peanut Butter Chocolate.
我喜欢大卫青铜棒的所有口味，包括饼干面团、焦糖巧克力、双重巧克力、花生酱巧克力。
They all actually taste like candy bars.
它们实际上尝起来都像棒棒糖。
Again, they're amazing.
再说一次，他们太棒了。
But again, they have no sugar, and they have 20 grams of protein with just 150 calories.
但同样，它们不含糖，并且含有 20 克蛋白质，只有 150 卡路里热量。
If you'd like to try David, you can go to davidprotein.com/huberman.
如果您想尝试 David，可以访问 david Protein.com/huberman。
Right now, David is offering a deal where if you buy four cartons, you get the fifth carton for free.
现在，大卫正在提供一项优惠，如果您购买四箱，您可以免费获得第五箱。
You can also find David on Amazon or in stores such as Target, Walmart, and Kroger.
您还可以在亚马逊或 Target、沃尔玛和克罗格等商店找到 David。
Again, to get the fifth carton for free, go to davidprotein.com/huberman.
同样，要免费获得第五箱，请访问 david Protein.com/huberman。
Today's episode is also brought to us by BetterHelp.
今天的节目也是由 BetterHelp 为我们带来的。
BetterHelp offers professional therapy with a licensed therapist carried out entirely online.
BetterHelp 提供由持证治疗师完全在线进行的专业治疗。
Now, I've been doing therapy for a long time, and I can tell you that it's a lot like physical workouts.
现在，我已经做了很长时间的治疗，我可以告诉你，这很像体育锻炼。
There are days when I want to do it, and there are days when I don't want to do it.
有想做的日子，也有不想做的日子。
But when I finish a therapy session, every single time, I come away feeling better, knowing the time was well spent, and that's because typically, I come away with a valuable insight or new perspective that I hadn't considered before, something perhaps that I'm working through with regards to work or relationships, or simply my relationship to myself.
但是，当我每次完成治疗时，我都会感觉更好，知道时间花得很值，这是因为通常情况下，我会得到以前没有考虑过的宝贵见解或新观点，也许是我正在解决工作或人际关系方面的问题，或者只是我与自己的关系方面的问题。
With BetterHelp, they make it very easy to find an expert therapist who can help provide the benefits that come from effective therapy.
通过 BetterHelp，他们可以很容易地找到可以帮助提供有效治疗带来的好处的专家治疗师。
They have a short questionnaire to help match you to a therapist.
他们有一份简短的调查问卷来帮助您与治疗师匹配。
And while BetterHelp has an industry-leading match rate, if you aren't happy with your match, you can switch to a different therapist at any time.
虽然 BetterHelp 拥有行业领先的匹配率，但如果您对匹配不满意，您可以随时更换为其他治疗师。
And it works.
它有效。
BetterHelp has an average rating of 4.9 out of five for its live sessions based on over 1.7 million client reviews.
根据超过 170 万条客户评论，BetterHelp 的现场会议平均评分为 4.9 分（满分 5 分）。
Also, because BetterHelp is done entirely online, it's very time efficient.
此外，由于 BetterHelp 完全在线完成，因此非常省时。
There's no driving to a therapist's office, looking for parking, et cetera.
无需开车去治疗师办公室、寻找停车位等。
If you'd like to try BetterHelp, go to betterhelp.com/huberman to get 10% off your first month.
如果您想尝试 BetterHelp，请访问 betterhelp.com/huberman，第一个月可享受 10% 的折扣。
Again, that's betterhelp.com/huberman.
再说一次，这是 betterhelp.com/huberman。
I wish that the medical profession could agree on nomenclature that included hormone replacement, the R-
我希望医学界能够就包括激素替代疗法、R-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
replacement therapy for people that are out of range, that are too low, out of the normal reference range.
针对超出范围、过低、超出正常参考范围的人的替代疗法。
Hormone augmentation therapy for people that want to push within the normal range.
针对想要将体重推至正常范围内的人的激素增强疗法。
And then, of course, there's super physiological stuff, and that's kind of how all of this got here was there were a bunch of mainly guys taking tons of anabolic steroids.
当然，还有超级生理学的东西，这就是所有这一切的发生方式，因为有一群主要的人服用了大量的合成代谢类固醇。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And then estrogen's a steroid, testosterone's a steroid, and then it just became a long road to get to this point where people like you are able to even talk about this, right?
然后雌激素是一种类固醇，睾酮是一种类固醇，然后它就变成了一条漫长的道路才能达到像你这样的人甚至能够谈论这个的地步，对吗？
I think 10 years ago, I think the medical profession was not open to the idea that a 40-year-old woman, for instance-
我认为 10 年前，我认为医学界还没有接受这样的想法：例如，一个 40 岁的女性——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
who had not yet undergone menopause by the strict definition, would take estrogen.
按照严格的定义，尚未经历更年期的人会服用雌激素。
It was seen as a risk as opposed to a benefit.
这被视为一种风险，而不是一种好处。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Isn't it interesting?
是不是很有趣？
And by professional organizations, they would even call it menopausal hormone therapy, MHT-
专业组织甚至将其称为更年期激素疗法，MHT-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
not even just hormone replacement therapy.
甚至不仅仅是激素替代疗法。
And I talk about this a lot with my patients, the difference in replacing a hormone, we'll use in an embryo transfer cycle.
我和我的病人经常谈论这个问题，我们将在胚胎移植周期中使用替代激素的区别。
If I'm going to give you estrogen, you haven't ovulated, I now have to replace your progesterone, or I have to give it in a certain format that it can get to high enough levels, versus supplementing.
如果我要给你雌激素，你还没有排卵，我现在必须更换你的黄体酮，或者我必须以某种形式给予它，使其达到足够高的水平，而不是补充。
Your body's making some, and we're supplementing that or augmenting it, like you said, to get it to the appropriate level or to make sure we have enough.
你的身体正在制造一些，我们正在补充或增强它，就像你说的，以使其达到适当的水平或确保我们有足够的。
I've given hormone therapy for a long time.
我已经接受激素治疗很长时间了。
I've been out of practice for over 10 years.
我已经十多年没有练习了。
And what's so interesting is that we'll use premature ovarian failure.
有趣的是我们将使用卵巢早衰。
So going into ovarian failure before age 40, well accepted that these women need hormone replacement, even when they still have the low end of hormonal function.
因此，在 40 岁之前出现卵巢功能衰竭的女性，即使荷尔蒙功能仍处于低水平，也需要补充荷尔蒙，这是公认的事实。
So in this population, we've been doing it for a really long time.
所以在这个人群中，我们已经这样做了很长时间。
But for menopause, it's been so frowned upon because of the WHI and fear-based tactics about what would happen with hormone replacement.
但对于更年期，由于 WHI 和对激素替代疗法会发生什么的恐惧策略，人们对此非常不赞成。
So it's interesting, and I'm really glad to see the tide is turning, and we're really allowing people to stand up for themselves, to also know what's normal within their body, which sounds so common.
所以这很有趣，我真的很高兴看到潮流正在转变，我们真的允许人们为自己挺身而出，也知道他们身体内的正常情况，这听起来很常见。
But if we think about it, many women have been dismissed and gaslit for so long.
但如果我们仔细想想，很多女性已经被解雇并被煤气灯点燃了这么久。
And if you go to your doctor and you talk about your painful periods or your irregular cycles or your bloating that you have with your period and some of these red flag warning signs, the spotting, the this, and it gets pushed to the side.
如果你去看医生，谈论你的经期疼痛、周期不规律或经期腹胀，以及一些危险信号，如点滴出血等，这些问题就会被抛到一边。
When you start to go through actual hormonal change later, it's really hard to then believe yourself.
当您后来开始经历真正的荷尔蒙变化时，真的很难相信自己。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And so I think it's really important.
所以我认为这非常重要。
I have a whole chapter in the book about how to learn to track your cycle and your ovulation and really learn to see the red flags your body gives you, not just if you want to get pregnant now, but to know that your hormones are really functioning as they should.
我在书中有一整章关于如何学习跟踪您的周期和排卵，并真正学会看到您的身体给您的危险信号，不仅仅是您现在是否想怀孕，而是了解您的荷尔蒙是否真正发挥了应有的作用。
And that's going to help you stand up for yourself later when you're in this transitional period, because perimenopause or diminished ovarian reserve, like we call it in the fertility world, that can last five to 10 years.
这将帮助您在以后的过渡期中坚持自己的立场，因为围绝经期或卵巢储备功能下降（就像我们在生育领域所说的那样）可能会持续五到十年。
That can be a really long transitional period that women are going through, and they deserve support if they're not feeling their best.
这可能是女性正在经历的一个非常漫长的过渡期，如果她们感觉不好，她们应该得到支持。
Andrew Huberman:
安德鲁·休伯曼：
Now I want to call it hormone augmentation.
现在我想称之为激素增强。
Let's just call it hormone replacement for sake of simplicity.
为了简单起见，我们将其称为激素替代品。
Hormone therapies for women, do they always start with estrogen when it comes to trying to encourage fertility or push fertility or wellbeing out into more years?
针对女性的激素疗法，在尝试鼓励生育或将生育或健康延长几年时，是否总是从雌激素开始？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
That's an interesting question.
这是一个有趣的问题。
I think when it comes to hormone replacement therapy in general, we've got estrogen, progesterone, testosterone.
我认为一般来说，当谈到激素替代疗法时，我们有雌激素、黄体酮、睾酮。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Most women, when they start not reliably making estrogen, that's when they really start to feel bad.
大多数女性，当她们开始无法可靠地产生雌激素时，她们就真正开始感觉糟糕了。
And so typically, some type of estrogen replacement, and there's many different ways.
通常，某种类型的雌激素替代品，有很多不同的方法。
There's patches, there's pills, there's vaginal inserts, there's vaginal cream, often helps some of the symptoms they're having.
有贴剂、有药丸、有阴道插入物、有阴道霜，通常可以帮助缓解他们所出现的一些症状。
But progesterone alone or in combination can be a big player.
但黄体酮单独或联合使用可以发挥重要作用。
Progesterone also is not made if you're not ovulating well, so there's this tandem where often you need both of them.
如果您排卵不佳，也不会产生黄体酮，因此您通常需要同时使用这两种黄体酮。
But I have some perimenopausal patients who feel great on just progesterone.
但我有一些围绝经期患者只服用黄体酮就感觉很好。
To me, testosterone's the last one we add to the mix, and it will always depend on clinical scenario.
对我来说，睾酮是我们添加到混合物中的最后一种，它始终取决于临床情况。
There's nuance.
有细微差别。
Estrogen and testosterone can convert back and forth.
雌激素和睾酮可以来回转换。
So for most women, if they are adequately being replaced on estrogen and they still have functioning ovaries, so in this transitional period, they tend to not need testosterone.
因此，对于大多数女性来说，如果她们补充了足够的雌激素，并且卵巢仍然有功能，那么在这个过渡时期，她们往往不需要睾酮。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
But that's never 100% of the time.
但这永远不是 100% 的情况。
I think greater to your question about is there a way for us to extend the ovarian lifespan is a really good one We know that women who go into ovarian failure early, so when we look at that, we call it POI, the premature ovarian insufficiency group, their ovaries have more inflammatory markers.
我认为，对于你的问题，有没有一种方法可以延长卵巢寿命，这确实是一种很好的方法。我们知道，卵巢早衰的女性，所以当我们观察时，我们称之为 POI，即卵巢早衰群体，她们的卵巢有更多的炎症标志物。
They have more chronic inflammation and fibrosis inside the ovary.
她们的卵巢内有更多的慢性炎症和纤维化。
There's a higher prevalence with autoimmune disease or chronic inflammatory disorders.
自身免疫性疾病或慢性炎症性疾病的患病率较高。
So I think there's also something to be said, despite not having the perfect paper to sit here and say that we know a variety of different things that increase chronic inflammation, cause you to have a lower egg count, and are associated with earlier menopause or earlier ovarian failure, that paying attention to these factors earlier in your life, whether it's controlling an autoimmune disease, earlier diagnosis of Hashimoto's, whether it's treating your endometriosis or cultivating a lifestyle that's decreasing inflammation, right?
因此，我认为还有一些话要说，尽管没有完美的论文可以坐在这里说我们知道有多种不同的因素会增加慢性炎症，导致卵子数量减少，并与更年期提前或卵巢衰竭提前相关，但请在生命早期关注这些因素，无论是控制自身免疫性疾病，还是桥本氏病的早期诊断，无论是治疗子宫内膜异位症还是培养减少炎症的生活方式，对吗？
Avoiding certain toxins, eating anti-inflammatory foods, the type of exercise, and how we deal with those lifestyle tenets, that that likely has the capability to extend our ovarian lifespan to the degree that it can.
避免某些毒素、吃抗炎食物、运动类型以及我们如何处理这些生活方式原则，这些都可能有能力延长我们的卵巢寿命。
Andrew Huberman:
安德鲁·休伯曼：
I know these days people are very concerned about plastics.
我知道现在人们非常关心塑料。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And you mentioned toxins, so I was going to get to this later, but I'll just ask now.
你提到了毒素，所以我本来打算稍后再谈这个，但我现在就问一下。
How concerned are you about plastic water bottles and-- We can't avoid exposure to plastics, and I think one thing that Dr. Rhonda Patrick has done nicely is to highlight the fact that the really small, hence microplastics, are really the ones that we worry about the most because they can get into so many tissues.
您对塑料水瓶有多担心——我们无法避免接触塑料，我认为朗达·帕特里克博士做得很好的一件事是强调了这样一个事实：非常小的塑料，因此微塑料，确实是我们最担心的，因为它们可以进入如此多的组织。
But we're constantly ingesting plastic.
但我们不断地摄入塑料。
Some of them are just excreted because they're big, but some of them get into our cells.
其中一些因为体积较大而被排出体外，但其中一些会进入我们的细胞。
Are there any data that have you, or observational data that have you genuinely concerned that plastics are becoming more of an issue vis-à-vis fertility?
是否有任何数据或观察数据让您真正担心塑料对生育能力的影响越来越大？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
There definitely is concern.
肯定有担忧。
I always want to frame this, and you did a nice job of it, so I'll double down.
我一直想把这个框起来，而你做得很好，所以我会加倍努力。
The goal when we talk about toxin avoidance is you can't avoid everything.
当我们谈论避免毒素时，我们的目标是你无法避免一切。
You cannot avoid every toxin in this world, nor should we try to have this all-or-nothing mentality, which is what so many people do.
你无法避免这个世界上的每一种毒素，我们也不应该试图抱有这种要么全有要么全无的心态，这正是很多人所做的。
"Oh, if I can't avoid it, I just will totally ignore it then in general." When we want to think about toxins, there's many different mechanisms why plastics can be harmful.
“哦，如果我无法避免它，那么我一般都会完全忽略它。”当我们思考毒素时，塑料有害的原因有很多不同的机制。
When it comes to microplastics, as you mentioned, we know they can accumulate in the ovary.
当谈到微塑料时，正如您提到的，我们知道它们可以在卵巢中积聚。
So if we want to be really transparent and simple, your ovaries must function in order for you to make estrogen and progesterone, in order for you to ovulate, in order for you to get pregnant.
因此，如果我们想要真正透明和简单，您的卵巢必须发挥作用，以便您产生雌激素和黄体酮，以便您排卵，以便您怀孕。
So if microplastics can accumulate inside the ovary, that's obviously detrimental towards fertility or ovarian function.
因此，如果微塑料在卵巢内积聚，这显然不利于生育或卵巢功能。
On a greater scale, we know that some of the endocrine-disrupting chemicals that are in plastics have been associated with worse IVF outcomes, lower live birth rates, longer time to pregnancy.
从更大范围来看，我们知道塑料中的一些内分泌干扰化学物质与较差的体外受精结果、较低的活产率和较长的怀孕时间有关。
And these are population-based cohort studies, so there's no randomized control trial.
这些是基于人群的队列研究，因此没有随机对照试验。
So we have to limit it.
所以我们必须限制它。
And there's some truth to the fact that people who might be more exposed to plastics may have other lifestyle factors, such as we know plastics can also be in food wrappers, right?
事实上，更多接触塑料的人可能有其他生活方式因素，例如我们知道塑料也可以出现在食品包装纸中，对吗？
So maybe they have more of an ultra-processed food diet.
所以也许他们的饮食更多是超加工食品。
So it's never one specific thing, but I look at all of these lifestyle factors, and I include toxins as one of them.
所以这从来都不是一件具体的事情，但我会考虑所有这些生活方式因素，并将毒素列为其中之一。
These are all either contributing to your inflammatory burden or they're helping you.
这些要么会加重您的炎症负担，要么会帮助您。
And when we start thinking about optimal hormonal health and fertility, it is your decision every single day.
当我们开始考虑最佳的荷尔蒙健康和生育能力时，这就是您每天的决定。
Am I drinking water out of this cup or out of a plastic bottle?
我喝的是这个杯子里的水还是塑料瓶里的水？
Am I going to lift weights, do nothing?
我要举重，什么也不做吗？
Am I going to run?
我要跑吗？
How much sleep am I going to get?
我要睡多少觉？
What foods am I going to eat?
我要吃什么食物？
How do I deal with stress?
我该如何应对压力？
And these choices, even though one single one's not going to make it or break it, together they can add up to that inflammatory burden, or they can help decrease it.
这些选择，即使单个选择不会成功或破坏它，但它们一起可以增加炎症负担，或者可以帮助减轻炎症负担。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And that chronic inflammation does in fact matter to your fertility and does worry me.
事实上，慢性炎症确实对你的生育能力很重要，并且让我很担心。
Andrew Huberman:
安德鲁·休伯曼：
I realize I'm jumping around here a bit-
我意识到我在这里有点跳来跳去-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm
毫米
Andrew Huberman:
安德鲁·休伯曼：
...
...
but in just thinking about what seems to be on a lot of people's mind, I took an informal poll of some people heading into this because obviously I only know my own experience as a male.
但在思考很多人的想法时，我对一些人进行了非正式民意调查，因为显然我只知道自己作为男性的经历。
So to a number of women, I asked the question, "What are you wondering about?" And a common question was, it seems that for some women, if they've been pregnant once before, they have it in mind that it's going to be easy for them to get pregnant again later.
因此，我向一些女性提出了这样的问题：“你们想知道什么？”一个常见的问题是，似乎对于一些女性来说，如果她们以前怀孕过一次，她们就会认为以后很容易再次怀孕。
Or easier.
或者更容易。
And of course, they understand the logic that they were younger before, by definition, even if it's a year, right?
当然，他们理解这样的逻辑：根据定义，他们以前更年轻，即使是一年，对吧？
And that fertility drops off with time.
而且生育能力会随着时间的推移而下降。
But there seems to be this kind of belief that if one was pregnant before, that it's going to be possible to get pregnant again within the normal windows of biological windows for getting pregnant.
但似乎有这样一种信念，即如果一个人以前怀孕过，那么在正常的怀孕生物学窗口内就有可能再次怀孕。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Is there any evidence that having been pregnant before makes it easier to get pregnant again that's separate from the fact that obviously they were pregnant before?
是否有任何证据表明，以前怀孕过可以更容易再次怀孕，这与显然他们以前怀孕过的事实不同？
I realize that it's a convoluted question, but it's not a perfect experiment, right?
我意识到这是一个令人费解的问题，但这不是一个完美的实验，对吗？
Because if they've been pregnant before, obviously they can get pregnant.
因为如果她们以前怀孕过，显然她们可以怀孕。
If they haven't, the control group is not a very-
如果他们没有，对照组就不是一个非常-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
it's not a good control group for an experiment.
这不是一个好的实验对照组。
But within the person, if they've been pregnant before, can they exhale a little bit that, yes, they can get pregnant?
但在人体内，如果他们以前怀孕过，他们可以呼出一点，是的，他们可以怀孕吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I did fellowship research with the primary investigator on a large cohort study, one of the biggest ones we have on natural fertility, and this study was called Time to Conceive.
我与主要研究者一起进行了一项大型队列研究，这是我们关于自然生育力的最大研究之一，这项研究被称为“受孕时间”。
And it was looking at women who did not have a history of infertility, who were trying to get pregnant, who were 30 and older, and then we looked at different variables of them.
我们研究的是那些没有不孕史、正在尝试怀孕、年龄在 30 岁及以上的女性，然后我们研究了她们的不同变量。
And one of the most startling pieces of data is that there's a huge age-related impact of fertility, right?
最令人震惊的数据之一是生育力对年龄有巨大的影响，对吧？
This data set set the standards for the numbers that we quote, meaning if I will sit here and say, "If you're trying to get pregnant with your first child and you're 30, you'll have a 20% chance per month," right?
这个数据集为我们引用的数字设定了标准，这意味着如果我坐在这里说：“如果你已经 30 岁了，想要怀上第一个孩子，那么你每个月的几率是 20%，”对吧？
The finest point we look at in natural fertility studies is called fecundability, the probability of pregnancy per month.
我们在自然生育研究中关注的最重要的一点称为生育力，即每月怀孕的概率。
But as you age, when you're 35 to 36, that number will be 11% to 12% per month.
但随着年龄的增长，当你在 35 岁到 36 岁之间时，这个数字将是每月 11% 到 12%。
At age 38, it'll be 5% per month, and at 40 and beyond, it'll be 3% per month.
38岁，每月5%，40岁以上，每月3%。
Importantly, for the person hearing this, none of those numbers are zero.
重要的是，对于听到这个消息的人来说，这些数字都不为零。
And so by no means do we mean you can't get pregnant but in the group who had a child before and were trying to conceive with the same partner that number stayed between 18 to 20% up till age 37-
因此，我们绝不意味着你不能怀孕，但在之前有过孩子并试图与同一伴侣怀孕的群体中，这个数字一直保持在 18% 到 20% 之间，直到 37 岁——
Andrew Huberman:
安德鲁·休伯曼：
Wow
哇
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
and then it dropped.
然后它就掉下来了。
So we do see that there is this protective benefit for a multitude of reasons, right?
所以我们确实看到这种保护性好处有多种原因，对吗？
You conceived with that person, so they had sperm, right?
你和那个人一起怀孕了，所以他们有精子，对吗？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Sometimes I find out some patients the male partner has no sperm, and we didn't know all that time they were trying.
有时我发现一些患者的男性伴侣没有精子，而我们一直不知道他们在尝试。
Andrew Huberman:
安德鲁·休伯曼：
Oh, my goodness.
哦，天哪。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Right?
对吗？
Oh, I've had patients try for years, be dismissed by their doctor.
哦，我已经让病人尝试了很多年，但被他们的医生解雇了。
Andrew Huberman:
安德鲁·休伯曼：
Because men and women mistakenly think that because there's semen, there's sperm.
因为男人和女人错误地认为，因为有精液，所以就有精子。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Exactly.
正是如此。
There's ejaculate, so there must be sperm-
有精液，所以一定有精子——
Andrew Huberman:
安德鲁·休伯曼：
Mm
毫米
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
inside of it.
在它里面。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And then when we find out there's none, it's heartbreaking.
然后当我们发现没有的时候，我们感到心碎。
It's a big reason why we can segue and say one of the things I really hate the most right now about my field is that by definition, infertility is a failure, and we don't even recommend testing or screening or talk about a preventive approach at all until you have failed.
这是我们可以继续说我现在最讨厌的关于我的领域的一件事的一个重要原因是，根据定义，不孕不育是一种失败，我们甚至不建议进行测试或筛查，或者根本不谈论预防方法，直到你失败为止。
Yet, if we look at the population, say, okay, the definition of infertility is trying to get pregnant for 12 months, and then once you've reached that point, well, now we'll check a semen analysis.
然而，如果我们看看人口，好吧，不孕症的定义是尝试怀孕 12 个月，然后一旦达到这一点，那么现在我们将检查精液分析。
Now we'll do an anatomical investigation.
现在我们要做一个解剖学调查。
Now we'll check your ovarian reserve.
现在我们将检查您的卵巢储备功能。
Now we will discuss if you're ovulating.
现在我们将讨论您是否排卵。
So we're making you go through this period of time where you're trying, and yes, maybe the majority of people will get pregnant, but most people who do will get pregnant in the first six months.
所以我们让你经历这段你正在尝试的时期，是的，也许大多数人都会怀孕，但大多数人会在前六个月内怀孕。
So 72% of people will get pregnant in that first six months of trying, and only 13% will get pregnant in the next six months of trying.
因此，72% 的人会在尝试的前六个月内怀孕，而只有 13% 的人会在接下来的六个月内怀孕。
That's why if you're 35 and older, we will shorten that testing interval down to six months.
这就是为什么如果您年满 35 岁，我们会将测试间隔缩短至六个月。
But sitting across from so many people who've tried and tried, went to their doctor, their doctor said, "Oh, you're fine.
但坐在这么多尝试过的人对面，去看他们的医生，他们的医生说：“哦，你很好。
You're young.
你还年轻。
You're this, you're that," forced them to try longer and fail, and then to find out fallopian tubes are blocked.
你就是这个，你就是那个，”迫使他们尝试更长时间但失败，然后发现输卵管被堵塞。
They had a birth defect of the uterus.
他们的子宫有先天缺陷。
He had no sperm.
他没有精子。
She had low ovarian reserve.
她的卵巢储备能力较低。
And they would've intervened differently back at time period A had they had that data, really makes me feel like we have to switch how we approach infertility in the world where infertility rates are rising, women are waiting later to get pregnant.
如果他们有这些数据，他们会在 A 时期采取不同的干预措施，这真的让我觉得我们必须改变我们处理不孕不育问题的方式，因为世界上不孕率正在上升，女性正在等待较晚的时间才怀孕。
It doesn't really make sense to make people fail first before we'll even do an investigation.
在我们进行调查之前就让人们先失败确实没有意义。
We should test things, and if it's all normal, maybe you do just go try your six or 12 months.
我们应该测试一下，如果一切正常，也许你就去尝试 6 或 12 个月。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We would capture people who don't get pregnant and be able to help them at a sooner time period, which is so valuable.
我们会捕获那些没有怀孕的人，并能够在更早的时间内帮助他们，这是非常有价值的。
So to your origin question, there is data that having a child previously puts you statistically at a higher chance of getting pregnant again.
因此，对于您的起源问题，有数据表明，从统计数据来看，以前生过孩子会使您再次怀孕的机会更高。
But secondary infertility is real.
但继发性不孕是真实存在的。
This is where you've gotten pregnant before, and now you're having a hard time conceiving your second child.
这就是您以前怀孕过的地方，而现在您很难怀上第二个孩子。
I want to acknowledge that it's really hard for people who walk it because they weren't expecting it.
我想承认，对于那些走这条路的人来说，这真的很难，因为他们没有预料到会发生这样的事。
They're a little underprepared for it because they said, "Oh, I got pregnant so fast before." They come into it just assuming it will be as easy.
他们对此有点准备不足，因为他们说：“哦，我以前怀孕得这么快。”他们只是假设这会很容易。
They watch their children have a longer age gap, a bigger age gap than they wanted.
他们看着自己的孩子的年龄差距越来越大，比他们想要的还要大。
But also, they don't really fit into the community, meaning there's a really robust infertility community, and they support each other.
而且，他们并不真正融入这个社区，这意味着有一个非常强大的不孕不育社区，而且他们互相支持。
And so many patients who have secondary infertility say they feel caught in between feeling guilty that their child's not enough for wanting more.
许多患有继发性不孕症的患者表示，他们感到自己的孩子不够好，无法想要更多，因此他们感到内疚。
Of course, they're thankful for their child, but not really fitting into that category, yet also simultaneously feeling left behind their friend group or their family group or watching their family start to look differently.
当然，他们感谢自己的孩子，但并不真正属于这一类别，但同时也感觉自己被落在了朋友群体或家庭群体后面，或者看着他们的家人开始变得不同。
And so even in women who've had a prior child, age does become impactful.
因此，即使对于已经生过孩子的女性来说，年龄也确实会产生影响。
It's not the only variable.
这不是唯一的变量。
We also see that sperm counts change with age, so your partner's sperm count will change with age.
我们还发现精子数量会随着年龄而变化，因此您伴侣的精子数量也会随着年龄而变化。
We see egg quality starts to change with age, largely because metabolic health changes with age as well.
我们看到卵子质量开始随着年龄的增长而变化，很大程度上是因为代谢健康也随着年龄的增长而变化。
And then we see things like endometriosis and adenomyosis, which are tincture of time diseases.
然后我们看到子宫内膜异位症和子宫腺肌病，它们是时间疾病的酊剂。
It's simply you've had more time, so there's a higher probability that these diseases could be present.
只是你有更多的时间，所以这些疾病出现的可能性更高。
So I think it's important to say, yes, you can probably take a sigh of relief that most likely you won't have trouble again.
所以我认为重要的是，是的，你可以松一口气，很可能你不会再遇到麻烦了。
But if you've been trying those six months after and you're not pregnant, I would say kind of at the longest, go and get an evaluation.
但是，如果您在六个月后一直在尝试并且没有怀孕，我会说，最多可以去接受评估。
And if you're a little bit older or maybe started your journey a little bit later, it's never too early to get an evaluation for anybody at any time because you can't make decisions on data you don't know.
如果您年龄稍大一些，或者可能晚一些开始您的旅程，那么随时对任何人进行评估都不会太早，因为您无法根据您不知道的数据做出决策。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I'm a big fan of knowing the data and then making the choice that's right for you and your circumstance versus taking population-based data and just applying it to every single person.
我非常喜欢了解数据，然后做出适合您和您的情况的选择，而不是获取基于人口的数据并将其应用于每个人。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, all excellent points.
是的，所有的优点都很棒。
And with respect to the sperm testing, since clearly there are men who think they're making sperm, and they're not, there are at-home tests of that as well.
至于精子测试，因为显然有些男性认为他们正在制造精子，但他们没有，所以也有家庭测试。
So once again, men have it a little bit easier.
所以，再一次，男人的处境变得更容易一些。
They can do it at home.
他们可以在家做。
Although, I don't know how high quality the at-home tests are.
不过，我不知道在家测试的质量有多高。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
There are some that are just telling you almost like a pregnancy test, plus, minus, are sperm present, are sperm not.
有些只是告诉您几乎就像怀孕测试一样，加号、减号、是否存在精子、是否不存在。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Of course, that's not really telling you the full picture.
当然，这并不能真正告诉您全部情况。
There are, though, some mail-in tests that go to a true lab that we would even take as valid.
不过，有些邮寄测试会送到真正的实验室，我们甚至会认为它们是有效的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So it's called a CLIA certified lab, C-L-I-A, for somebody listening, and you can find some of these online mail-in sperm tests and collect a sample.
所以它被称为 CLIA 认证实验室，C-L-I-A，供大家聆听，您可以找到一些在线邮寄精子测试并收集样本。
They send you the whole kit.
他们会向您发送整个套件。
You mail it off.
你把它邮寄出去。
It's very valid.
这是非常有效的。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And you get all the sperm parameters that we would then look for.
然后您就可以获得我们要寻找的所有精子参数。
So that's a great way to get data yourself and not have to have your doctor tell you no or go to a fertility clinic.
因此，这是您自己获取数据的好方法，而不必让您的医生告诉您“不”或去生育诊所。
I mean, we'll do a semen analysis for anybody who calls, and most clinics will.
我的意思是，我们将为任何打电话的人进行精液分析，大多数诊所都会这样做。
It's usually earlier that patients are getting roadblocked, whether it's their PCP or their regular OBGYN.
患者通常会更早地遇到障碍，无论是他们的 PCP 还是常规的 OBGYN。
They're getting dismissed and just, "Oh, just try first.
他们被解雇了，只是说：“哦，先试试吧。
It's probably fine."
大概没问题吧。”
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
You mentioned that if a woman has had a successful pregnancy that the probability of getting pregnant again is significantly higher-
您提到，如果女性曾经成功怀孕，那么再次怀孕的概率会明显更高——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm
毫米
Andrew Huberman:
安德鲁·休伯曼：
...
...
although with the caveats you mentioned.
尽管有你提到的警告。
Is there any data about if someone has been pregnant and either terminated or lost the pregnancy, whether or not that's related to ability to get pregnant again later?
是否有任何数据表明某人是否怀孕并终止或流产，这是否与以后再次怀孕的能力有关？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
That's a good question.
这是个好问题。
Most of the data that exists is looking at prior live birth.
现有的大部分数据都是针对之前的活产情况。
So I think there's a couple things.
所以我认为有几件事。
If you've gotten pregnant, regardless of the outcome of that pregnancy If it's with the same partner, we can feel confident that they had sperm present, so that's already one leg up over never getting pregnant.
如果你已经怀孕了，无论怀孕的结果如何，如果是与同一个伴侣，我们可以确信他们有精子，所以这已经比从未怀孕有了优势。
If it was an intrauterine pregnancy, we know at least one fallopian tube was functioning, so that's also in the camp of we're checking some mental boxes of some of the things that we think about.
如果是宫内妊娠，我们知道至少有一个输卵管正在发挥作用，所以这也属于我们正在检查一些我们所思考的一些事情的心理盒子的范围。
And we know your body could accept an embryo implanting, at least to some degree.
我们知道您的身体至少在某种程度上可以接受胚胎植入。
The top cause of pregnancy loss is going to be random genetic abnormality.
流产的首要原因是随机基因异常。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
This wasn't the right embryo, or the embryo didn't have the right capacity or capability to truly implant.
这不是正确的胚胎，或者胚胎不具备真正植入的正确能力。
So I think that should give you some sigh of relief-
所以我想这应该会让你松一口气——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
that it's probably going to be a little bit easier because certain boxes are checked.
这可能会更容易一些，因为某些方框已被选中。
I think it's also really important to say, I had four pregnancy losses myself.
我认为也很重要的是，我自己也有过四次流产。
I don't know if you know this.
我不知道你是否知道这一点。
So I had four pregnancy losses.
所以我有四次流产。
Andrew Huberman:
安德鲁·休伯曼：
From your book.
来自你的书。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
And by the way, I really appreciate the personal story sharing in the book because it really clearly was in service to your patients and to the reader.
顺便说一句，我真的很欣赏书中分享的个人故事，因为它确实明显是为您的患者和读者服务的。
And even as a male who-
甚至作为一个男性——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
can't relate certainly to certain aspects of all this, it was not only very moving, but it was really a testament to just how that sort of thing lands, and then the process of trying to sort out what's real.
无法肯定地与所有这一切的某些方面联系起来，这不仅非常感人，而且确实证明了这类事情是如何发生的，以及试图理清真实情况的过程。
And it just made me even more grateful for the other information.
这让我对其他信息更加感激。
Because otherwise, it would sort of be like if I'm talking about ovarian health.
因为否则的话，就像我在谈论卵巢健康一样。
Right?
正确的？
Which I've talked about on podcasts, but-
我在播客上谈到过，但是-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Which we're talking about.
我们正在谈论的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, right.
是的，对。
With all the caveats, but of course, how could I possibly know?
尽管有这么多警告，但当然，我怎么可能知道呢？
So your personal experience, while the reader in I feel and felt for you in reading it, it is super impactful because there's a level of trust that just comes from somebody who's been through that whole jungle.
因此，你的个人经历，虽然《我》中的读者在阅读它时感受到了你的感受，但它是非常有影响力的，因为有一定程度的信任来自于经历过整个丛林的人。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Thank you.
谢谢你。
I'll try not to cry on this show about it, which is funny because it's so long ago, right?
我会尽量不要在这个节目中为此哭泣，这很有趣，因为那是很久以前的事了，对吧？
I have two children now, had them after this journey, and it was terrible for so many different reasons.
我现在有两个孩子，在这次旅行之后生下了他们，由于很多不同的原因，这很糟糕。
Of course, going through pregnancy loss is an emotional rollercoaster.
当然，经历流产是一种情绪上的过山车。
I started to have a lot of self-blame against myself, felt like it was my own body, something was wrong.
我开始对自己产生很多自责，感觉是我自己的身体出了问题。
And professionally, what I was unprepared for is this was the end of OBGYN and then the beginning of my reproductive endocrinology fellowship.
从专业角度来说，令我始料未及的是，这是妇产科的结束，然后是我的生殖内分泌学研究金的开始。
So I felt like, how am I going to be a fertility doctor, Andrew, if I can't even get myself pregnant?
所以我想，如果我连自己都怀孕不了，我怎么能成为一名生育医生呢，安德鲁？
Right?
正确的？
The professional impact of how it made me view myself and my space, I was so unprepared for, right?
它让我如何看待自己和我的空间，这对我的专业影响是我措手不及的，对吧？
Especially in an era where you separate your personal and professional life, which is what was 100% accepted back then.
尤其是在个人生活和职业生活分开的时代，这在当时是100%被接受的。
My last pregnancy loss was an ectopic pregnancy.
我上次流产是宫外孕。
My fertility nurse had to give me my methotrexate shot.
我的生育护士不得不给我注射甲氨蝶呤。
Everybody knew about it, and I felt like a really big failure.
每个人都知道这件事，我感觉自己是一个很大的失败。
And when I sought help to say, "It'll happen, just relax, there's nothing you can do," or even, "Just do IVF," felt so dismissive of what I felt like was true as the patient experience.
当我寻求帮助说“这会发生的，放松点，你无能为力”，甚至“做试管受精”时，我对我所认为的患者经历的真实情况感到非常不屑一顾。
Say, "Well, what about this symptom?" or, "What about this question?" And just really, really pushed aside.
说：“那么，这个症状怎么办？”或者，“这个问题怎么样？”真的，真的被推到一边了。
And I'll be honest, my whole career is different because of it, which, isn't that interesting how sometimes things happen to us that are not ideal and that can be really terrible.
老实说，我的整个职业生涯因此而不同，这不是很有趣，有时我们会遇到不理想的事情，而且可能非常糟糕。
I have the two kids I'm meant to have, but also I have forever viewed fertility differently.
我有两个本应有的孩子，但我对生育的看法也永远不同。
In fact, all my fellowship research was on natural fertility because of it.
事实上，因此我所有的奖学金研究都是关于自然生育力的。
Because I said at the core, I want to know why some people get pregnant naturally and why other people don't.
因为我说的核心是，我想知道为什么有些人会自然怀孕，而其他人却不能。
I really want to know that.
我真的很想知道这一点。
I want to do epidemiologic research.
我想做流行病学研究。
I got a master's in clinical research because that research is very complicated to understand, and most fellows do an IVF lab project, which is great, but it's a lot more of a controlled environment.
我获得了临床研究硕士学位，因为这项研究非常难以理解，而且大多数研究员都会进行体外受精实验室项目，这很棒，但它更多的是一个受控环境。
And then I've been so passionate about talking about it since then.
从那时起我就一直热衷于谈论它。
And so I think to walk back what I wanted to say, though, is if you've gone through pregnancy loss, I don't want to ever dismiss how terrible that experience is, and sometimes it can feel that way by me sitting here as a professional and saying, "Oh, you had a pregnancy loss, so that could be a good sign for the future."
所以我想回到我想说的，如果你经历过流产，我不想忽视这种经历是多么可怕，有时我作为一个专业人士坐在这里说，“哦，你流产了，所以这可能是未来的一个好兆头。”
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And I don't want anybody to ever feel that hearing it, but it does tell us that certain systems are intact.
我不希望任何人听到它时有这种感觉，但它确实告诉我们某些系统完好无损。
On the other hand, after two pregnancy losses, you need an evaluation.
另一方面，在两次流产后，您需要进行评估。
The evaluation is for certain blood tests, a semen analysis, a sperm fragmentation, and a uterine and tubal evaluation.
该评估针对某些血液测试、精液分析、精子碎片以及子宫和输卵管评估。
That can be moved up to one if you had heavy blood loss, needed a D&C procedure, if your periods have changed afterward.
如果您失血过多、需要 D&C 手术、或者之后您的月经发生变化，则可以将其提高到 1。
If anything was really off, you can always get tested.
如果确实有什么问题，您随时可以接受测试。
And we never want to be in the world where we used to make women go through three pregnancy losses before they would get an evaluation.
我们永远不想回到过去让女性经历三次流产才能得到评估的世界。
And I fell into that camp.
我就落入了这个阵营。
After two, I said, "Shouldn't we do tests?
两点后，我说：“我们不应该做测试吗？
I'm starting to fall off the curve here.
我在这里开始掉下曲线。
Is something wrong?" And I was told, "You need to have another pregnancy loss before we'll do those tests." And that's the worst thing, the worst feeling, that I had to fail again to a certain degree and lose a pregnancy before they would even investigate why.
有什么事吗？”我被告知，“在我们进行这些测试之前，您需要再次流产。”这是最糟糕的事情，最糟糕的感觉，在他们调查原因之前，我不得不再次失败到一定程度并失去怀孕。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, this theme, it seems, of it's only menopause when you haven't had a period for a year.
是的，这个主题似乎只是当你一年没有来月经时才算更年期。
You have to have two pregnancy losses, and then we can put you into this category of amenable for treatment.
您必须经历过两次流产，然后我们才能将您归入适合接受治疗的类别。
It's something really backwards about all of that.
这一切确实是一种倒退。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It is.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I imagine with your book and you being public facing with health information, and hopefully others with you in your field, that eventually this will change.
我想象通过你的书和你公开面对健康信息，并希望其他人与你一起在你的领域，最终这种情况将会改变。
If I were to draw the parallel to psychiatry, which isn't a fair one, should someone really have to be waking up at 3:00 in the morning for an entire year and have no hope for the future and be near suicidal before they get whatever the adequate treatment is?
如果我将其与精神病学进行类比（这并不公平），那么是否有人真的必须在整整一年的时间里凌晨 3:00 起床，对未来没有希望并接近自杀，然后才能得到适当的治疗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Right.
对。
Before we'll treat them for depression or whatever's going on.
在我们治疗他们的抑郁症或其他疾病之前。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It doesn't make sense.
这没有道理。
I don't think it serves us.
我认为这对我们没有好处。
And I will say this, too.
我也会这么说。
We're starting to see a change.
我们开始看到变化。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
My big lofty hope for the book is that it changes the entire field of fertility.
我对这本书的远大希望是它能改变整个生育领域。
I understand why OBGYN used to take care of this.
我明白为什么 OBGYN 过去要处理这个问题。
And then at some point, they said, "Some people have infertility.
然后在某个时候，他们说：“有些人患有不孕症。
Let's draw a line in the sand and have some people specialize in this." Right?
让我们划清界限，并让一些人专门从事这方面的工作。”正确的？
And I did three years of training in that after OBGYN.
妇产科结束后我接受了三年的培训。
But at the same point, it doesn't make sense to practice that way.
但同时，这样修行也是没有意义的。
It doesn't make sense to force people to fail.
强迫人们失败是没有意义的。
And I might tell you, "Hey, the greatest likelihood is all the tests will come back normal," but we should do them because sometimes it doesn't.
我可能会告诉你，“嘿，最有可能的是所有测试都会恢复正常”，但我们应该这样做，因为有时情况并非如此。
Right?
正确的？
If I look across somebody who has recurrent pregnancy loss and I say, "80% of the time, every test will come back normal." But 20% is a big number.
如果我遇到反复流产的人，我会说：“80% 的情况下，每次测试都会恢复正常。”但20%是一个很大的数字。
That's a lot of people who maybe it's a simple medication, maybe it's a procedure.
对于很多人来说，这可能是一种简单的药物，也可能是一种手术。
Something can markedly change what they're going through.
有些事情可以显着改变他们正在经历的事情。
And in the same breath, the 80% really need specialized care because what's really going on if we don't have an easy test for it?
与此同时，80% 的人确实需要专门的护理，因为如果我们没有一个简单的测试，到底会发生什么？
So I agree with you.
所以我同意你的观点。
I think the whole field needs to change.
我认为整个领域都需要改变。
I think we need to change how we define terms, how we address women, how we approach reproductive health and hormones and fertility, and really in a more proactive, patient-centric approach.
我认为我们需要改变我们定义术语的方式，我们如何对待女性，我们如何对待生殖健康、激素和生育力，并且真正以一种更积极主动、以患者为中心的方法。
And women and men are driving this really by talking about it.
女性和男性实际上是通过谈论来推动这一趋势的。
Ten years ago, when I started on social media, nobody talked about fertility, and patients who did had nameless, faceless accounts.
十年前，当我开始使用社交媒体时，没有人谈论生育能力，而谈论的患者也有匿名、不露面的账户。
And now you see celebrities talking about IVF, talking about endometriosis, talking about their termination for genetic reasons or whatever happened.
现在你会看到名人谈论试管受精，谈论子宫内膜异位症，谈论因遗传原因终止妊娠或发生的任何事情。
And those stories are so powerful to drop the stigma, but also highlight how wrong it is that we force women to fail before we'll even evaluate what's going on, let alone treat.
这些故事是如此有力，足以消除耻辱，但也凸显了我们在评估正在发生的事情之前就强迫女性失败是多么错误，更不用说治疗了。
Andrew Huberman:
安德鲁·休伯曼：
As many of you know, I've been taking AG1 for nearly 15 years now.
你们很多人都知道，我服用 AG1 已有近 15 年了。
I discovered it way back in 2012, long before I ever had a podcast, and I've been taking it every day since.
我早在 2012 年就发现了它，那时我还没有播客，从那时起我就每天都在听它。
The reason I started taking it, and the reason I still take it, is because AG1 is, to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market.
我开始服用它的原因，以及我仍然服用它的原因，是因为据我所知，AG1是市场上质量最高、最全面的基础营养补充剂。
It combines vitamins, minerals, prebiotics, probiotics, and adaptogens into a single scoop that's easy to drink, and it tastes great.
它将维生素、矿物质、益生元、益生菌和适应原结合到一勺中，易于饮用，味道极佳。
It's designed to support things like gut health, immune health, and overall energy, and it does so by helping to fill any gaps you might have in your daily nutrition.
它旨在支持肠道健康、免疫健康和整体能量等，并通过帮助填补您日常营养中可能存在的任何缺口来实现这一目标。
Now, of course, everyone should strive to eat nutritious whole foods.
当然，现在每个人都应该努力吃有营养的天然食品。
I certainly do that every day.
我当然每天都这样做。
But I'm often asked, if you could take just one supplement, what would that supplement be?
但我经常被问到，如果您只能服用一种补充剂，那么该补充剂会是什么？
And my answer is always AG1, because it has just been oh-so critical to supporting all aspects of my physical health, mental health, and performance.
我的答案始终是 AG1，因为它对于支持我的身体健康、心理健康和表现的各个方面都非常重要。
I know this from my own experience with AG1, and I continually hear this from other people who use AG1 daily.
我从自己使用 AG1 的经验中了解到这一点，并且我不断从其他每天使用 AG1 的人那里听到这一点。
If you would like to try AG1, you can go to drinkag1.com/huberman to get a special offer.
如果您想尝试 AG1，可以访问 Drinkag1.com/huberman 以获得特别优惠。
For a limited time, AG1 is giving away six free travel packs of AG1 and a bottle of vitamin D3 K2 with your subscription.
限时订阅后，AG1 将赠送 6 个免费 AG1 旅行包和一瓶维生素 D3 K2。
Again, that's drinkag1, with the numeral one, .com/huberman to get six free travel packs and a bottle of vitamin D3 K2 with your subscription.
同样，这是 Drinkag1，通过数字 1 .com/huberman 订阅即可获得六个免费旅行包和一瓶维生素 D3 K2。
One theme that I heard over and over again was women would say, okay, they thought that they might have been pregnant before, or they knew they had been pregnant once before.
我一遍又一遍听到的一个主题是，女性会说，好吧，她们认为自己以前可能怀孕过，或者她们知道自己以前怀孕过一次。
Circumstances varied, but they sort of had it in mind that they could get pregnant at one point.
情况各不相同，但他们都知道自己可能会在某一时刻怀孕。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And that their mom had either them or a sibling let's say at age 42 or 43, and they're in good health themselves.
他们的妈妈在 42 或 43 岁时生下了他们或有一个兄弟姐妹，而且他们自己身体状况良好。
And so they have in mind that there's time.
所以他们认为还有时间。
I think this is not uncommon.
我认为这种情况并不少见。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And given that life is very expensive, most people in the world seem to be underpaid nowadays.
鉴于生活非常昂贵，当今世界上大多数人的工资似乎都过低。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And people are waiting longer to get married and have children.
人们等待结婚生子的时间更长。
And the other common narrative that I was hearing was that there are people that want kids, but it's under the, "Well, if I found the right person, I would do it, but otherwise I wouldn't do it on my own."
我听到的另一个常见的说法是，有人想要孩子，但这是在“好吧，如果我找到合适的人，我会这样做，但否则我不会自己这样做。”
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
That's not always the case, but it's pretty-
情况并非总是如此，但它很漂亮-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It's a true statement
这是一个真实的陈述
Andrew Huberman:
安德鲁·休伯曼：
It's a common theme, right?
这是一个共同的主题，对吧？
So for those women, which I think is quite a few, whether or not they're in their 20s or their 30s or their 40s, what sorts of things do you recommend they would add to that rather just kind of real-life analysis?
因此，对于那些我认为相当多的女性，无论她们是 20 多岁、30 多岁还是 40 多岁，您建议她们在这种现实生活分析中添加哪些内容？
Those are not meaningless metrics, like how one's mother had a child-
这些不是毫无意义的指标，就像一个人的母亲如何生孩子一样——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
for instance.
例如。
But things have changed.
但事情已经改变了。
Microplastics, maybe certain things have gotten better, right?
微塑料，也许某些事情已经变得更好了，对吧？
We're no longer eating margarine.
我们不再吃人造黄油了。
I'm not trying to be facetious here.
我并不是想在这里开玩笑。
I think that-
我认为——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
No, I know
不，我知道
Andrew Huberman:
安德鲁·休伯曼：
...
...
there's so many variables.
有很多变数。
People are living longer, yet there are more environmental toxins, perhaps.
人们的寿命越来越长，但环境毒素或许也越来越多。
People are smoking less.
人们吸烟越来越少。
So it, the-
所以它，那个——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Are they, though?
但他们是吗？
Andrew Huberman:
安德鲁·休伯曼：
Are they?
他们是吗？
We'll talk about nicotine for sure.
我们肯定会谈论尼古丁。
So for those women in their, let's say 20s, 30s, and early 40s-
所以对于那些20多岁、30多岁和40岁出头的女性来说——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
what's the level of urgency that they get certain things checked out, and what should they get checked out?
他们检查某些事情的紧急程度是什么？他们应该检查什么？
Oh, and I should say that they'll say that they're having regular periods.
哦，我应该说他们会说他们的月经很规律。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I'd love to answer it, and I'm going to, but for the person who's maybe coming to this discussion, let's explain egg quality really quickly-
我很想回答这个问题，而且我会回答这个问题，但对于可能参加这次讨论的人来说，让我们快速解释一下卵子质量——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
because it really is going to tie into what we can test and what we cannot.
因为它确实会与我们可以测试什么和不能测试什么联系起来。
As you know well, women are born with all the eggs they're ever going to have.
众所周知，女性生来就拥有她们将拥有的所有卵子。
The eggs are kept, I like to think about it, as in a vault inside your ovary, and so they're stored there.
我喜欢这样想，卵子被保存在卵巢内的一个金库中，所以它们被储存在那里。
You have the most eggs when you're five months old inside your mom.
当你五个月大的时候，你在妈妈体内拥有最多的卵子。
You have six to seven million eggs.
你有六到七百万个鸡蛋。
By the time that you're born, you have one to two million.
当你出生时，你已经有一到两百万了。
By the time you start your first period, you have half a million.
当你开始第一个月经周期时，你已经有五十万了。
So you lose eggs over time.
所以随着时间的推移，你会失去卵子。
A lot of the determination of that starting number will be influenced some by genetics and some from your mom's health while she's pregnant with you, things she's exposed to, her current disease state.
起始数字的确定很大程度上会受到遗传因素的影响，还有一些因素会影响您母亲在怀您时的健康状况、她接触过的事物以及她目前的疾病状况。
What I want people to think about is every single month, you are losing eggs.
我想让人们想到的是，每个月，你都在失去卵子。
So I like to imagine and describe to my patients a group of eggs is coming out of the vault.
所以我喜欢想象并向我的病人描述一群鸡蛋正从金库中出来。
Each egg grows inside a small fluid-filled structure called a follicle.
每个卵子都生长在一个称为卵泡的充满液体的小结构内。
The brain sends out follicle-stimulating hormone, or FSH, well-named, gets a follicle to grow.
大脑会发出促卵泡激素（FSH，顾名思义），促进卵泡生长。
As the follicle grows, it makes estrogen.
随着卵泡的生长，它会产生雌激素。
This is called the follicular phase.
这称为卵泡期。
Estrogen levels talk back to the brain.
雌激素水平会向大脑反馈。
Remember that the brain does not see what's happening anywhere in the body.
请记住，大脑看不到身体任何地方正在发生的事情。
It is simply waiting for the hormone signal.
它只是在等待激素信号。
That's what hormones are.
这就是荷尔蒙。
They're communication signals.
它们是通讯信号。
I like to think about it like text messages between friends.
我喜欢把它想象成朋友之间的短信。
When estrogen is high enough for long enough, 200 picograms for 50 hours And that's the level it'll tell the brain it's time to ovulate.
当雌激素水平足够高且持续时间足够长时，即 200 皮克持续 50 小时，这就是它会告诉大脑排卵时间的水平。
The brain will send out a surge of LH, a follicle within rupture, egg will be released.
大脑会发出激增的LH，卵泡内破裂，卵子就会被释放出来。
It only has 24 hours to be fertilized, but that follicle will actually reform and become the corpus luteum.
它只有 24 小时的时间受精，但卵泡实际上会重组并成为黄体。
Now we're entering to the back half of the cycle called the luteal phase.
现在我们正在进入称为黄体期的周期后半部分。
The corpus luteum makes progesterone stimulated from LH pulses from the brain.
黄体在大脑发出的 LH 脉冲的刺激下产生黄体酮。
So then it makes progesterone pulses throughout the luteal phase, can only live for about two weeks unless a pregnancy occurs.
因此，它会在整个黄体期产生黄体酮脉冲，除非怀孕，否则只能存活约两周。
When you have an embryo come in an implant, it makes HCG the pregnancy hormone we check in a pregnancy test.
当胚胎植入植入物时，HCG 就会成为我们在妊娠测试中检查的妊娠激素。
Fun nerdy fact, HCG and LH share a receptor.
有趣的是，HCG 和 LH 共享一个受体。
So HCG comes into the corpus luteum and now stimulates a constant production of progesterone.
因此，HCG 进入黄体并刺激黄体酮的持续产生。
But if that doesn't happen, corpus luteum will die, progesterone will drop, and you'll get a period.
但如果这种情况没有发生，黄体就会死亡，黄体酮就会下降，你就会来月经。
Okay.
好的。
Also back to the vault, you have a different number of eggs that come out every month that is proportional to how many remain.
同样回到金库，每个月产生的鸡蛋数量不同，与剩余数量成正比。
So when you are younger, when you have more eggs, more eggs come out of the vault every month.
所以当你年轻的时候，当你有更多的鸡蛋时，每个月都会有更多的鸡蛋从金库里出来。
As you get older and you have fewer eggs, fewer come out every month.
随着年龄的增长，卵子越来越少，每个月排出的卵子也会越来越少。
That explains why you go from six to seven million to one to two million, and why you go from one to two million to half a million.
这解释了为什么你从六到七百万到一到两百万，以及为什么你从一到两百万到五十万。
Because you had more, you're losing more.
因为你拥有的更多，所以你失去的也更多。
At some point, everybody will be out of eggs, right?
到了某个时候，每个人都会没有鸡蛋，对吧？
We're going to call that ovarian failure and not menopause for the sake of our discussion.
为了便于讨论，我们将其称为卵巢衰竭而不是更年期。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
But so everybody will go into ovarian failure.
但因此每个人都会出现卵巢衰竭。
Now, the timeline once you have, your clock is now up because at that point, there's no more eggs.
现在，一旦你有了时间线，你的时钟就到了，因为到那时，就没有更多的鸡蛋了。
You cannot get pregnant with your own genetic child.
你不可能怀上你自己的遗传孩子。
You still have a functioning uterus.
您仍然有一个功能正常的子宫。
It's just not being stimulated.
只是没有受到刺激而已。
So importantly, those women can get pregnant with donor eggs or donor embryos.
重要的是，这些女性可以通过捐赠的卵子或捐赠的胚胎怀孕。
They can still carry a pregnancy.
他们仍然可以怀孕。
That's sometime a myth that people think about.
这有时是人们思考的一个神话。
But once you're out of eggs, that's kind of the end of your clock.
但一旦鸡蛋用完，你的时间就结束了。
Now, two things are happening with time that are really important because your eggs are inside that vault inside your ovary, is that they absorb the wear and tear of your life.
现在，随着时间的推移，发生了两件非常重要的事情，因为您的卵子位于卵巢的穹窿内，它们会吸收您生活中的磨损。
And your egg has many different functions.
你的鸡蛋有许多不同的功能。
It has to respond to hormone signals and make estrogen, make progesterone, and ovulate.
它必须对激素信号做出反应并产生雌激素、黄体酮和排卵。
The mitochondria inside the egg, which everybody knows the mitochondria, the powerhouse of the cell, gets exclusively passed on to the embryo.
卵子内的线粒体，众所周知，线粒体是细胞的动力源，它专门传递给胚胎。
It completely controls embryo growth and development.
它完全控制胚胎的生长和发育。
In fact, the male genome doesn't even kick in until day three after fertilization.
事实上，男性基因组直到受精后第三天才开始发挥作用。
Andrew Huberman:
安德鲁·休伯曼：
Oh.
哦。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Those first few days are 100% maternal.
最初的几天是 100% 的母性。
The egg also has to hold the chromosomes in correct position.
卵子还必须将染色体保持在正确的位置。
So an interesting fact is that inside the egg, it is frozen in metaphase of meiosis II for whatever reason.
一个有趣的事实是，在卵子内部，无论出于何种原因，它都被冻结在减数分裂 II 的中期。
And so the chromosomes have met in the middle and they're held apart by those meiotic spindles, and they do not separate until you ovulate.
因此，染色体在中间相遇，它们被减数分裂纺锤体分开，直到排卵时它们才会分开。
And so then you get your egg that has what we think about as your 23Ls.
这样你就得到了我们认为是 23L 的鸡蛋。
The other part goes into a polar body.
另一部分进入极体。
Okay, this means that when you're 25, your eggs have only been held in metaphase for 25 years.
好吧，这意味着当你 25 岁时，你的卵子只在中期保存了 25 年。
Your chromosomes are, for the most part, still in the right position.
您的染色体在很大程度上仍然处于正确的位置。
Your proteins are strong that are holding them apart.
你的蛋白质很强大，可以将它们分开。
Most people have better generalized metabolic health.
大多数人的代谢健康状况较好。
Their mitochondria are stronger.
他们的线粒体更强。
When you are 40, 40 years have passed.
当你40岁的时候，40年过去了。
We've asked those chromosomes to hold there longer.
我们要求这些染色体在那里停留更长时间。
I always say if I have a line of kindergartners and I ask them to stand for 40 years, somebody's going to get out of line.
我总是说，如果我让幼儿园的孩子们排队 40 年，就会有人不守规矩。
So tincture of time adds up.
所以时间的酊剂会累积起来。
But the other thing that happens as we get older is as a population, we get more metabolically unhealthy.
但随着年龄的增长，发生的另一件事是，作为一个群体，我们的新陈代谢变得更加不健康。
So we see more chronic inflammation, more insulin resistance, more obesity, and all of those factors influence oxidative stress, mitochondrial health, DNA damage.
因此，我们看到更多的慢性炎症、更多的胰岛素抵抗、更多的肥胖，所有这些因素都会影响氧化应激、线粒体健康和 DNA 损伤。
They can damage the meiotic spindles holding those chromosomes apart.
它们会损坏将这些染色体分开的减数分裂纺锤体。
So we also see more genetic abnormalities as we age, but that is worsening as metabolic health worsens, too.
因此，随着年龄的增长，我们也会看到更多的遗传异常，但随着代谢健康状况的恶化，这种情况也会恶化。
Okay.
好的。
We don't have a direct test for egg quality.
我们没有对卵子质量的直接测试。
That's what we call egg quality, genetic normalcy and egg competency.
这就是我们所说的卵子质量、遗传正常性和卵子能力。
How good are the mitochondria?
线粒体有多好？
Can it do its job?
它能完成它的工作吗？
We approximate it to age, which has some faults because not all 40-year-olds are created equal.
我们将其近似为年龄，但这有一些缺陷，因为并非所有 40 岁的人都是平等的。
When we think about ovarian reserve, this is how many eggs you have remaining.
当我们考虑卵巢储备时，这就是您剩余的卵子数量。
So this is how many eggs are inside the vault, and we can approximate it with a blood test called AMH.
这就是金库内的卵子数量，我们可以通过称为 AMH 的血液测试来估算它。
AMH stands for anti-Müllerian hormone.
AMH 代表抗苗勒氏管激素。
It's made from the granulosa cells that surround each follicle.
它由每个卵泡周围的颗粒细胞组成。
So in its purest form, more eggs inside the vault, more come out, more AMH.
因此，以最纯粹的形式，金库内的卵子越多，出来的卵子就越多，AMH 就越多。
Fewer eggs in the vault, fewer come out, lower AMH.
库里的卵子越少，出来的卵子就越少，AMH 就越低。
Not a perfect test.
不是一个完美的测试。
The vault also is not perfect, so there's some month-to-month variability in how many exactly get sent out.
该金库也并不完美，因此确切发出的数量存在一定的月度变化。
And in prolonged periods of not ovulating, AMH can be suppressed, whether it's from birth control pills, pregnancy, postpartum, whatever the reason is.
在长时间不排卵的情况下，AMH 会受到抑制，无论是由于避孕药、怀孕、产后，无论是什么原因。
So AMH is imperfect, but it is something, and it's a very simple blood test.
因此，AMH 并不完美，但它确实有用，而且是一项非常简单的血液测试。
It's not telling us if you can get pregnant or not, but it is telling us how many eggs do we have outside the vault.
它不是告诉我们是否可以怀孕，而是告诉我们在保险库之外还有多少卵子。
And the way I like to frame this is that every woman who wants to have children or understand her own reproductive timeline should get an AMH checked.
我喜欢这样描述这一点：每个想要孩子或了解自己生育时间表的女性都应该接受 AMH 检查。
That is against medical advice, meaning the American College of OBGYN says that women should not get an AMH checked unless they have infertility.
这违背了医学建议，这意味着美国妇产科学院表示，女性不应该接受 AMH 检查，除非她们患有不孕症。
Okay, this is wild to me, right?
好吧，这对我来说太疯狂了，对吧？
Andrew Huberman:
安德鲁·休伯曼：
I mean, to me as well.
我的意思是，对我来说也是如此。
I mean, it just seems like this failure criteria-
我的意思是，这似乎就是这个失败标准——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Again
再次
Andrew Huberman:
安德鲁·休伯曼：
...
...
it just seems just very extreme and unnecessary.
这似乎非常极端并且没有必要。
Unless there's some hidden agenda to try and prevent people from maintaining fertility or-
除非有一些隐藏的议程试图阻止人们维持生育能力，否则——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Which doesn't even make sense
这甚至没有意义
Andrew Huberman:
安德鲁·休伯曼：
...
...
or having children because-- And that doesn't square with at least my assumptions.
或者生孩子，因为——这至少不符合我的假设。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
The idea here is that it can be really stressful.
这里的想法是，它可能真的很有压力。
This is what they say in their document, American College of OBGYN, that it can be very stressful for a woman to find out she has a low AMH and that it doesn't predict fertility.
他们在美国妇产科学会的文件中表示，女性发现自己的 AMH 值较低且不能预测生育能力时，可能会感到非常有压力。
And there's some truth to that.
这有一定道理。
So let's think about I have two 30-year-olds.
让我们想想我有两个 30 岁的孩子。
One has 20 eggs outside the vault, which would be age-related norm, and one has five eggs outside the vault.
其中一个在避难所外有 20 个鸡蛋，这将是与年龄相关的正常情况，而一个在避难所外有 5 个鸡蛋。
Well, if every single other factor is the same and they each are ovulating one egg They have the same chance of getting pregnant.
好吧，如果其他因素都相同，并且她们各自排卵一个卵子，那么她们怀孕的机会是相同的。
So that's not a faulty statement.
所以这并不是一个错误的说法。
However, the person who has five eggs will not have as long to grow her family.
然而，拥有五个鸡蛋的人将没有那么长的时间来发展她的家庭。
She will not get as many eggs if we're doing advanced treatment like egg freezing or IVF because I can only get the eggs outside the vault to grow.
如果我们进行卵子冷冻或试管受精等高级治疗，她将不会获得那么多卵子，因为我只能让卵子在保险库外生长。
So it's hugely impactful for what your journey may look like in treatment.
因此，它对您的治疗历程影响巨大。
But more so than that, Andrew, so many of the causes of a low AMH directly contribute to infertility.
但更重要的是，安德鲁，AMH 低的许多原因都直接导致不孕。
Things like autoimmune disease, insulin resistance, endometriosis, smoking cigarettes.
诸如自身免疫性疾病、胰岛素抵抗、子宫内膜异位症、吸烟等。
So if there are factors, some of which you can control, some of which you can treat, if I have a woman who has a low AMH, I'm not going to sit here and say, "Okay, well, you can still get pregnant, no worries." I'm going to say, "I don't know that you'll have infertility, but some of the reasons your AMH is low can cause infertility.
因此，如果有一些因素是你可以控制的，有些是你可以治疗的，如果我有一个 AMH 值较低的女性，我不会坐在这里说：“好吧，你仍然可以怀孕，不用担心。”我会说：“我不知道您是否会不孕，但 AMH 较低的某些原因可能会导致不孕。
You will get fewer eggs if we're freezing your eggs or doing IVF.
如果我们冷冻您的卵子或进行体外受精，您获得的卵子将会减少。
You will go into menopause earlier." So we need not wait.
你会更早进入更年期。”所以我们不需要等待。
To your point, the woman who's 20, 30, 40, thinking about this, she might make a very different decision when she knows she's really faced with a timeline that is less than ideal.
就你的观点而言，20、30、40 岁的女性，想想这个，当她知道自己确实面临着不太理想的时间表时，她可能会做出非常不同的决定。
And why should we allow time to be making that decision for us instead of at least playing an active role?
为什么我们应该留出时间来为我们做出决定而不是至少发挥积极作用？
I sit across from women every day who find out they have a low AMH, and I say this, "Let's do the investigation and see if we can find out why." Probably 50% of the time, we find an autoimmune disease.
我每天都会遇到发现自己 AMH 水平较低的女性，我会说：“让我们进行调查，看看是否能找出原因。”大概 50% 的情况下，我们会发现自身免疫性疾病。
I can't reverse the clock, but I can slow down the rate of inflammation.
我无法逆转时钟，但我可以减慢炎症的速度。
Speaker 3:
演讲者3：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Say if it's Hashimoto's, suddenly we can do thyroid replacement, we can work on decreasing inflammation.
比如说，如果是桥本氏症，我们突然可以进行甲状腺替代治疗，我们可以致力于减少炎症。
If inflammation harms our ovary, maybe we can slow down that rate of egg loss.
如果炎症损害了我们的卵巢，也许我们可以减缓卵子流失的速度。
At least she's being treated and probably feeling better and will have improved fertility outcomes because her Hashimoto's is treated.
至少她正在接受治疗，并且可能感觉好多了，并且由于她的桥本氏症得到了治疗，生育结果也会得到改善。
So we should look at why.
所以我们应该看看为什么。
Why is it low?
为什么低？
And treating that why very well may impact fertility.
很好地治疗这个原因可能会影响生育能力。
We also might say, what should we do about this?
我们也可能会说，这该怎么办？
I have a lot of couples who are partnered who are just waiting for the right time to get pregnant.
我有很多伴侣，他们只是在等待合适的怀孕时间。
So sometimes we say, "Well, we could get pregnant, but I'm in medical training.
所以有时我们会说，“好吧，我们可能会怀孕，但我正在接受医学培训。
I'm going to law school.
我要去法学院。
I'm doing XYZ.
我正在做XYZ。
It's not a good time." Well, when faced with their perfect time, they may not have eggs anymore.
现在不是好时机。”好吧，当他们面临完美的时机时，他们可能不再有鸡蛋了。
Suddenly, we reevaluate where we are, and there's no one right answer.
突然，我们重新评估自己所处的位置，但没有一个正确的答案。
We might choose to try to get pregnant now.
我们可能会选择现在就尝试怀孕。
If we don't have a partner, we might buy donor sperm and try to get pregnant.
如果我们没有伴侣，我们可能会购买捐赠精子并尝试怀孕。
Maybe we freeze eggs.
也许我们冷冻卵子。
Maybe we freeze embryos.
也许我们冷冻胚胎。
Maybe we do none of those things.
也许我们什么都不做。
But we made the active choice.
但我们做出了积极的选择。
Sitting here saying, "I chose not to pursue treatment, knowing my AMH was low and that I might be in ovarian failure at the point when I was planning to have a family, and I know that," makes the journey so much easier to walk because you made that active choice from a place of knowledge.
坐在这里说，“我选择不寻求治疗，因为我知道我的 AMH 很低，而且在我计划组建家庭时我可能患有卵巢功能衰竭，我知道这一点”，这会让这段旅程变得更加容易，因为你从知识的角度做出了积极的选择。
That was your autonomous decision versus saying, "I asked my doctor for an AMH test five years ago.
这是你的自主决定，而不是说：“五年前我要求我的医生进行 AMH 测试。
They told me it wasn't medically recommended because I don't have infertility.
他们告诉我，医学上不建议这样做，因为我没有不孕症。
And had I known that information, then I might have done something different." That was the longest discussion to say everybody should get an AMH.
如果我知道这些信息，那么我可能会做一些不同的事情。”这是关于每个人都应该接受 AMH 的最长的讨论。
I think it's a very important marker.
我认为这是一个非常重要的标记。
It's a newer-ish test.
这是一个较新的测试。
We've only been checking it for about the past 10 years.
我们只是在过去 10 年里才对此进行检查。
It's not a perfect test.
这不是一个完美的测试。
I don't have the nomogram for exactly how it should drop over time, and I like to think about it as categories.
我没有列线图来说明它应该如何随着时间的推移而下降，我喜欢将其视为类别。
Normal, above average, below average, critically low.
正常、高于平均水平、低于平均水平、极低。
And based on your category, we should probably talk and do different things.
根据您的类别，我们可能应该谈论并做不同的事情。
If you are listening to this and you want kids one day, ask your doctor for this test.
如果您正在听此内容并且您有一天想要孩子，请向您的医生询问这项测试。
If they say no, you can order it yourself at a LabCorp quest.
如果他们拒绝，您可以在 LabCorp 任务中自行订购。
Many of the online platforms like Function Health, you can have an AMH check through them.
很多在线平台，比如Function Health，都可以通过它们进行AMH检查。
You can ask your doctor for it and say, "Well, if it's low, I know I'll talk to a fertility doctor to find out more information." Or call a fertility clinic and just say you want fertility testing, the end.
您可以向您的医生询问并说：“好吧，如果它很低，我知道我会与生育医生交谈以了解更多信息。”或者打电话给生育诊所，只是说你想要生育测试，结束。
Okay?
好的？
I think it's such-
我想是这样的——
Speaker 3:
演讲者3：
Mm
毫米
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
an important marker.
一个重要的标志。
It is not a test of egg quality.
这不是卵子质量的测试。
And we talked about what egg quality is.
我们讨论了鸡蛋质量是什么。
Genetics and egg competency.
遗传学和卵子能力。
But it is a check of how many eggs you have, and that knowledge can be really impactful for how you view your future and your plan.
但这是对您有多少鸡蛋的检查，而这些知识对于您如何看待自己的未来和计划确实会产生影响。
So I think everybody should get an AMH.
所以我认为每个人都应该接受 AMH 检测。
I think we've got to learn to track our cycle, and I know you said in the vignette that these women have regular cycles.
我认为我们必须学会跟踪我们的周期，我知道你在小插图中说过这些女性有规律的周期。
Having a regular period is really good.
月经规律确实很好。
It's much better than having an irregular period.
这比月经不调要好得多。
But knowing when you ovulate and tracking ovulation is a much more sensitive health marker than simply when you bleed or when you have a period.
但是，了解排卵时间并跟踪排卵是一个比简单的出血时间或月经时间更敏感的健康指标。
Because tracking ovulation is going to allow us to know how long is your luteal phase and how long is your follicular phase.
因为跟踪排卵可以让我们知道您的黄体期有多长以及卵泡期有多长。
And ovulation disorders progress through a very predictable pattern, and we know this well.
排卵障碍的进展是非常可预测的，我们对此很清楚。
The first stage of an ovulation disorder is a luteal phase defect, meaning a shortening of your luteal phase.
排卵障碍的第一阶段是黄体期缺陷，这意味着黄体期缩短。
So you're ovulating, but the brain and ovary have a miscommunication, and we don't make progesterone long enough to sustain the luteal phase.
所以你正在排卵，但大脑和卵巢沟通不畅，我们无法产生足够长的黄体酮来维持黄体期。
Less than 11 days is a short luteal phase.
少于11天为短黄体期。
But you'll still have regular cycles.
但你仍然会有规律的周期。
So if I sit across from somebody and I just say, "Are your cycles regular?" And they say yes, and we carry on, I've missed the fact that they actually have a shortened luteal phase, and that warrants further investigation.
因此，如果我坐在某人对面，我只是说：“你的周期规律吗？”他们说是的，我们继续，我错过了一个事实，即他们的黄体期实际上缩短了，这值得进一步调查。
Prolactin, thyroid, AMH, PCOS, looking at different causes.
催乳素、甲状腺、AMH、PCOS，寻找不同的原因。
The second stage of ovulation disorder is a long luteal phase.
排卵障碍的第二阶段是黄体期较长。
Takes the ovary longer to actually respond to the FSH stimulus from the brain.
卵巢需要更长的时间才能真正对大脑的 FSH 刺激做出反应。
And then from there, we'll progress into irregularity and true amenorrhea or absence of periods.
然后从那里开始，我们将进展为不规则和真正的闭经或没有月经。
But those first stages, you might miss the little red flag warning sign that something's wrong inside your body because you are just tracking when your bleed is, and it's every 34 days, so you think it's normal.
但在最初的阶段，您可能会错过表明您体内出现问题的小红旗警告信号，因为您只是追踪出血时间，并且每 34 天出血一次，因此您认为这是正常的。
But if we were looking at when you actually ovulated, we have more data.
但如果我们查看您实际排卵的时间，我们就会获得更多数据。
So learning to track ovulation as opposed to just cycle tracking, I think is one of the most important skills a woman can have for Learning to listen to her own hormonal cues.
因此，我认为学习跟踪排卵而不仅仅是跟踪周期是女性可以拥有的最重要的技能之一，可以学习倾听自己的荷尔蒙暗示。
Andrew Huberman:
安德鲁·休伯曼：
Amazing.
太棒了。
And I don't say that lightly.
我不会轻易这么说。
You just explained egg quality, the biology of the ovulation cycle, and how it links to the actionables, and I'm just struck.
您刚刚解释了卵子质量、排卵周期的生物学原理，以及它如何与可操作的措施联系起来，我很震惊。
It's awesome.
太棒了。
And it has me asking a couple of practical questions.
这让我问了几个实际问题。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Some people will have insurance, some won't.
有些人会有保险，有些人则没有。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
What's the cost of an AMH test?
AMH 测试的费用是多少？
Let's assume insurance doesn't cover it-
假设保险不承保——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and they just have to go completely out of pocket.
他们必须完全自掏腰包。
And before you answer, I will say, whatever it is, I think it should probably be compared against what it would be to try and, I don't want to say rescue, but to not take the test and then three years later you're trying to harvest eggs.
在你回答之前，我会说，无论是什么，我认为它可能应该与尝试进行比较，我不想说救援，但不参加测试，然后三年后你试图收获鸡蛋。
It could be-
可能是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
multiple cycles-
多次循环-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Exactly
正是如此
Andrew Huberman:
安德鲁·休伯曼：
...
...
because you realized it was only five eggs per month as opposed to-
因为你意识到每月只有五个鸡蛋，而不是-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And what could have been three years ago
三年前可能会发生什么
Andrew Huberman:
安德鲁·休伯曼：
...
...
age matched, right?
年龄相符吧？
15, right, exactly.
15，对，没错。
So, are we talking hundreds of dollars, thousands?
那么，我们谈论的是数百美元还是数千美元？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
79.
79.
Andrew Huberman:
安德鲁·休伯曼：
$79.
79 美元。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
We're withholding a $79 test, and I feel really strongly about this.
我们取消了 79 美元的测试，对此我的感受非常强烈。
I do not view myself as the gatekeeper of information about your body.
我不认为自己是有关您身体信息的看门人。
Do you want hormone levels checked?
您想要检查激素水平吗？
Do you want an AMH?
您想要 AMH 吗？
I do not think that is the role of a physician.
我认为这不是医生的职责。
And now I can say your insurance doesn't cover it.
现在我可以说你的保险不承保它。
You can make the decision if $79 is worth it to you.
如果 79 美元对您来说值得的话，您可以做出决定。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
But in the age of information, where that's an easy test to do, every lab runs it, and it's relatively inexpensive compared to freezing your eggs or IVF.
但在信息时代，这是一项很容易进行的测试，每个实验室都会进行它，而且与冷冻卵子或体外受精相比，它相对便宜。
I mean, right, multitudes.
我的意思是，对，很多。
$79.
79 美元。
We're throwing a fit over a $79 test.
我们对 79 美元的测试大发雷霆。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
I'm going to make sure that message goes far and wide- ...
我要确保这个信息传播得更远、更广——……
because I thought you were going to say maybe in the high hundreds-
因为我以为你会说也许在几百个-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
or thousands, which for some people is going to be-
或数千，对于某些人来说这将是-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Would be cost-prohibitive
成本高昂
Andrew Huberman:
安德鲁·休伯曼：
...
...
prohibitively expensive.
昂贵得令人望而却步。
Yes.
是的。
So get AMH checked.
所以要检查AMH。
I think I'll avoid going into too much editorializing here because I'm really just interested in how you view this.
我想我会避免在这里进行太多的社论，因为我真的只是对你如何看待这个问题感兴趣。
But how you describe the way your field has originated and where it's headed reminds me a little bit of, I remember in the '80s, genetic testing was starting to become possible, and a lot of it was happening at Stanford.
但是你如何描述你的领域的起源方式以及它的发展方向让我想起了一点，我记得在 80 年代，基因测试开始成为可能，而且很多都是在斯坦福大学发生的。
I happened to grow up near campus, and I remember hearing you could get tested for Huntington's disease-
我碰巧在校园附近长大，我记得听说你可以接受亨廷顿氏舞蹈症检测——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
which can be a devastating disease.
这可能是一种毁灭性的疾病。
And the idea was people don't want to know.
这个想法是人们不想知道。
I think everything I've observed, I can't speak for everyone, but everything I've observed about people's interests in their own health and genetics and what genetics does and doesn't-
我认为我所观察到的一切，我不能代表所有人，但我所观察到的关于人们对自己的健康和遗传学的兴趣以及遗传学的作用和不作用的一切-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
mean tells me that people are actually much more interested, and they're much smarter than, let's just call it the traditional medical field, certainly medical genetic testing gave them credit for.
平均值告诉我，人们实际上比传统医学领域更感兴趣，而且他们更聪明，当然医学基因测试给了他们信任。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
100%.
100%。
Andrew Huberman:
安德鲁·休伯曼：
It's like people aren't idiots.
就好像人们不是白痴一样。
You can sit someone down and say, "Hey, listen, you have this gene.
你可以让某人坐下来说：“嘿，听着，你有这个基因。
There's an X probability.
有 X 的可能性。
Here are the things you can do to protect yourself." But there was this assumption like people don't want to know because now they're going to live in dread, and their life is going to be destroyed if they know they're going to get full-blown Huntington's or something like that.
您可以采取以下措施来保护自己。”但有这样的假设，人们不想知道，因为现在他们将生活在恐惧中，如果他们知道自己将患上全面的亨廷顿舞蹈症或类似疾病，他们的生活就会被摧毁。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
It's so paternalistic.
这太家长式了。
Andrew Huberman:
安德鲁·休伯曼：
It borders on unethical.
这近乎不道德。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
People are smart.
人们很聪明。
People can take in information, and they can make decisions that don't necessarily crater them on the basis of just knowledge.
人们可以获取信息，并且可以根据知识做出不一定会让他们陷入困境的决定。
It feels like we sort of treat people like little children.
感觉就像我们对待别人就像对待小孩子一样。
Even little children would probably want to know certain things, although you don't want to give them genetic information, but certain things like, "Hey, you have a challenge with X, Y, and Z-
即使是小孩子也可能想知道某些事情，尽管你不想给他们遗传信息，但某些事情比如，“嘿，你在 X、Y 和 Z 方面面临挑战——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and you can overcome it in the following ways."
你可以通过以下方式克服它。”
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Look, technology's advanced.
瞧，科技发达了。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It has.
确实如此。
How we counsel and how we approach healthcare needs to advance also, meaning we don't live in a universal healthcare system.
我们的咨询方式和医疗保健方式也需要进步，这意味着我们并不生活在全民医疗保健系统中。
We don't have only X dollars to spend on every single patient.
我们不仅仅只有 X 美元可以花在每个病人身上。
And in certain circumstances, when that's the case or a patient has limited money, we do have to make very judicious decisions about the best use of those dollars.
在某些情况下，当这种情况或患者的资金有限时，我们确实必须就如何最好地利用这些资金做出非常明智的决定。
But for the majority of people who will be listening to this, they are willing to spend money on their health, and it shouldn't be a society or a physician or somebody standing in the way of getting data that can dramatically impact your life.
但对于大多数愿意听这个的人来说，他们愿意为自己的健康花钱，并且不应该是社会、医生或其他人阻碍获取可以极大影响你的生活的数据。
And because you mentioned Huntington's, I should say, autosomal dominant disorder, people have very strong feelings on if they want to know they have it or not, and I've had patients, because we can test for this with IVF.
因为你提到了亨廷顿舞蹈症，我应该说，常染色体显性遗传疾病，人们对于是否想知道自己是否患有亨廷顿舞蹈症有非常强烈的感觉，而且我有病人，因为我们可以通过体外受精来测试这一点。
So we do genetic testing of embryos, and we often do screening to see if the chromosomes are in the right position, which we talked about for age.
所以我们对胚胎进行基因检测，我们经常进行筛查，看看染色体是否处于正确的位置，这就是我们谈到年龄的时候。
That can be really beneficial.
这确实非常有益。
But we can do single gene testing as well, PGT-M for monogenetic diseases, and Huntington's is one of them.
但我们也可以做单基因检测，针对单基因疾病的PGT-M，亨廷顿舞蹈症就是其中之一。
And I've had some patients say, "My mom had Huntington's.
我有一些病人说：“我妈妈患有亨廷顿舞蹈症。
It was the worst experience to watch her go through that.
看着她经历这一切是最糟糕的经历。
I would love to test my embryos, but I've committed to myself that I don't want to know if I have it or not." Okay?
我很想测试我的胚胎，但我已经向自己保证，我不想知道我是否拥有它。”好的？
And I think it's really important just to mention that disease to say, "We can blind test you.
我认为提及这种疾病并说“我们可以对你进行盲测”是非常重要的。
You can make a probe to see if you carry it or not.
你可以做一个探针，看看你是否携带它。
You don't have to know, and we can still test the embryos." And I've had a few patients who then themselves did not want to know, but we went through the steps to make a probe in case they did.
你不必知道，我们仍然可以测试胚胎。”我有一些病人，他们自己不想知道，但我们按照步骤进行了调查，以防他们知道。
In both cases, the patient did carry it, didn't find out that they did, but they could assuredly transfer an embryo that did not have it.
在这两种情况下，患者确实携带了它，但他们没有发现自己携带了它，但他们肯定可以移植没有它的胚胎。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Because often, these people have felt so strongly watching a family member die from a terrible progressive disease.
因为通常情况下，这些人看到家庭成员死于可怕的进行性疾病时会有如此强烈的感受。
They've said, "Children are not in the cards for me," or, "I'm not going to have genetic kids." Or sometimes they'll come to me saying, "We have to use an egg donor or sperm donor because I might carry this and don't want to know." So again, it's the idea that that should be your own individual choice whether you want to know or not, but it shouldn't be the society or somebody else putting this roadblock up.
他们说，“我不可能生孩子”，或者“我不会生孩子。”有时他们会来找我说：“我们必须使用卵子捐赠者或精子捐赠者，因为我可能携带着这个，但我不想知道。”再说一次，无论你想知道与否，这都应该是你自己的个人选择，但不应该是社会或其他人设置这个障碍。
And it's such an antiquated approach in the era of technology and access, where you really can get so many data points.
在技术和访问时代，这是一种过时的方法，你确实可以获得如此多的数据点。
Why should somebody be making the decision on if that information's valuable to you?
为什么要有人来决定该信息对您是否有价值？
Andrew Huberman:
安德鲁·休伯曼：
And I think with blood testing, the price coming down, it seems to me maybe it's just the circles I run in that people want more information as opposed to less.
我认为，随着血液检测的价格下降，在我看来，也许这只是我所处的圈子，人们想要更多的信息，而不是更少的信息。
But I'm glad that you raised these cases where people don't want to know certain amounts of information.
但我很高兴您提出了人们不想了解某些信息的情况。
One thing that, well, I'll just pose this as a question.
有一件事，好吧，我只是将其作为一个问题提出。
How many women out there do you think know if-- I have to be careful how I word this, if doing an egg harvest cycle decreases their ovarian reserve or not?
你认为有多少女性知道——我必须小心我的措辞，卵子采集周期是否会降低她们的卵巢储备？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
The majority of patients that I sit across from will tell me, "I'm afraid to freeze my eggs or do IVF because I don't want to go into menopause earlier." So the myth that doing that is going to tap into the vault and pull out eggs is inaccurate and a fear that really does need to be busted, because it doesn't.
我对面的大多数患者都会告诉我，“我害怕冷冻卵子或进行试管受精，因为我不想提前进入更年期。”因此，那种认为这样做会进入金库并取出鸡蛋的神话是不准确的，这种恐惧确实需要打破，因为事实并非如此。
It's a limitation of the science that I can only get the eggs outside the vault to grow.
由于科学的限制，我只能让卵子在避难所外生长。
If I could tap into the vault, it would change the game.
如果我能进入金库，就会改变游戏规则。
But right now, I am limited by the eggs you give me, the number of them controlled by whatever's outside the vault.
但现在，我受到了你给我的蛋的限制，蛋的数量由金库外的任何东西控制。
We in IVF, we just give FSH, the same hormone your brain makes, trying to stimulate more than one egg to grow.
在体外受精中，我们只给予 FSH（与大脑产生的激素相同），试图刺激多个卵子生长。
Your body doesn't want to have five kids or 12 kids or 20 kids, so it has checks and balances to prevent that from happening.
您的身体不想生 5 个孩子、12 个孩子或 20 个孩子，因此它会通过制衡来防止这种情况发生。
I, however, would like every egg outside the vault to grow, because in nature, you will ovulate one and everything else will die.
然而，我希望避难所外的每一个卵子都能生长，因为在自然界中，你会排卵，而其他一切都会死亡。
You are constantly losing eggs no matter what.
无论如何，你都会不断失去卵子。
When you're pregnant, when you're breastfeeding, when you're on birth control, before you start your first period.
当您怀孕时、当您母乳喂养时、当您采取节育措施时、当您第一次月经来潮之前。
Constantly losing them.
不断失去他们。
I cannot change that right now.
我现在无法改变这一点。
So doing IVF or egg freezing is not going to decrease your ovarian reserve.
因此，进行试管受精或卵子冷冻不会减少您的卵巢储备。
It is simply going to influence one month in time trying to not have all those eggs die.
它只会影响一个月的时间，试图不让所有这些鸡蛋都死掉。
Andrew Huberman:
安德鲁·休伯曼：
And I think the myth is that by doing a cycle of egg freezing, that you're taking more eggs from-
我认为神话是，通过进行卵子冷冻循环，您可以从以下位置获取更多卵子：
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
your reserve.
你的储备。
But as you pointed out, women are losing the same number of eggs each month, or follicles each month, regardless.
但正如您所指出的，无论如何，女性每个月都会失去相同数量的卵子或卵泡。
You're maximizing on that process by just maturing more and taking them-
你可以通过让自己更加成熟并接受它们来最大化这个过程——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Exactly
正是如此
Andrew Huberman:
安德鲁·休伯曼：
...
...
as opposed to letting them die.
而不是让他们死去。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We are not running out of eggs early.
我们的鸡蛋不会很快用完。
I think it's just based on, again, nobody understands basic biology, so we think in our brain, "I'm just losing that one egg since I'm ovulating." We're not thinking about all the ones that were sent out of the vault who weren't chosen.
我认为这只是基于，再次，没有人了解基本生物学，所以我们在大脑中认为，“自从我排卵以来，我只是失去了一个卵子。”我们并没有考虑那些被送出保险库但未被选中的人。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, and I think people will also assume because they haven't been told that if you do an egg-
是的，我认为人们也会假设，因为他们没有被告知如果你做了一个鸡蛋-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
if you stimulate for more to mature-
如果你刺激更多人成熟-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
that you're somehow taking away from eggs that you would've had stuck-
你以某种方式从你本来会卡住的鸡蛋中拿走-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
around somehow.
以某种方式周围。
So we're saying the same thing three different ways.
所以我们用三种不同的方式说同一件事。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
So you're giving-
所以你给-
Andrew Huberman:
安德鲁·休伯曼：
Right
右
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
It's fascinating to me if you think about it, because we are allowing the possibility for you to have children in your family that likely you would not.
如果你仔细想想，这对我来说很有趣，因为我们允许你在家里生孩子，而你可能不会。
Because if you were to get pregnant naturally that month, the greatest probability is it would just be one that you would ovulate.
因为如果你在那个月自然怀孕，最大的可能性就是你会排卵。
Yet for IVF, we can sometimes take one month's group of eggs in time and have a couple different embryos, and those become a couple children for you that you have from this one exact cohort.
然而，对于体外受精，我们有时可以及时取出一个月的一组卵子，并培育出几个不同的胚胎，这些胚胎就成为您从同一队列中获得的一对孩子。
I think it's so fascinating.
我觉得这太迷人了。
Early IVF days, IVF's not that old.
早期试管受精时代，试管受精并没有那么古老。
It's only been around 46 years, I think, the oldest IVF babies.
我想，最大的 IVF 婴儿只有 46 岁左右。
We didn't have gonadotropins.
我们没有促性腺激素。
We didn't have FSH that was synthetic or purified, and so we couldn't get multiple eggs to grow.
我们没有合成或纯化的 FSH，因此无法让多个卵子生长。
So original IVF patients had to go live at their IVF clinic, and they had urinary-based hormone measurements done every day so they could try to gauge, as estradiol was rising, when they were getting closer to ovulation.
因此，最初的试管受精患者必须前往试管婴儿诊所，他们每天都会进行基于尿液的激素测量，这样他们就可以在雌二醇上升的情况下尝试衡量，当他们接近排卵时。
And in those days, this is just science, they went and they did abdominal surgery to aspirate the egg.
在那些日子里，这只是科学，他们做了腹部手术来吸出卵子。
Now we do a vaginal egg retrieval where we take a needle attached to a vaginal ultrasound.
现在我们进行阴道取卵，用一根连接到阴道超声波的针。
It's a minimally invasive procedure.
这是一种微创手术。
But back in the origin IVF studies, they had to go and do an abdominal incision to put a needle into one single follicle to get the follicular fluid and the egg out.
但回到最初的体外受精研究，他们必须做一个腹部切口，将一根针插入一个卵泡，取出卵泡液和卵子。
So it was very low odds of working.
所以工作的可能性非常低。
It was crazy to even think of.
连想起来都觉得很疯狂。
But the advent of gonadotropins, the ability to first start it by purifying FSH and LH and be able to give that to people to stimulate more than one egg, understanding this concept that there's so many more eggs that you have outside the vault every month, that has changed the game, and it's such an amazing advancement in science that we can leverage that physiology for egg freezing or IVF.
但促性腺激素的出现，能够首先通过纯化 FSH 和 LH 来启动它，并能够让人们刺激多个卵子，理解每个月在储存库外有更多卵子的概念，这改变了游戏规则，这是科学上的一个惊人进步，我们可以利用这种生理学来冷冻卵子或 IVF。
Andrew Huberman:
安德鲁·休伯曼：
A very practical question.
一个非常实际的问题。
It's clear that the younger that a woman is, the more eggs-
很明显，女人越年轻，卵子就越多——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
that could be frozen in a given cycle.
可以在给定的周期内冻结。
But I think it's fair to say that many people, either because of finances or life circumstances, that could be not having a partner and wanting a partner before having kids, this sort of thing, are waiting.
但我认为可以公平地说，很多人，无论是因为经济状况还是生活环境，可能没有伴侣并且在生孩子之前想要一个伴侣，诸如此类的事情，都在等待。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
They're just waiting.
他们只是在等待。
What stands between us now in the United States and egg freezing being covered by insurance 100%?
现在在美国，我们与保险 100% 承保卵子冷冻之间存在什么障碍？
I don't hold any superpowers, but there are pretty powerful ways to lobby all the administrations, regardless of who happens-
我没有任何超能力，但有相当强大的方法可以游说所有政府，无论发生谁——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
to be in office when that actually happens.
当这一切真正发生时就在办公室。
It is possible, right?
有可能，对吧？
The phone is a powerful tool.
电话是一个强大的工具。
Advocacy is a powerful tool.
宣传是一个强大的工具。
I do think that things can happen if there's a lot of advocacy.
我确实认为，如果有大量倡导，事情就会发生。
So first question is, what would that require?
所以第一个问题是，这需要什么？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And is that a good idea?
这是个好主意吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I am a fan of knowledge and options, and egg freezing is not a guarantee.
我喜欢知识和选择，冷冻卵子并不能保证。
So how I pose it to patients is we are going to keep the door of opportunity open longer for you, and that is our goal.
因此，我向患者提出的建议是，我们将为您提供更长久的机会之门，这就是我们的目标。
If we want to compartmentalize it, as some people will falsely sit across from me and say, "Oh, egg freezing's an insurance policy for my fertility," and it's not, because an insurance policy always pays off, but it's an investment in my fertility.
如果我们想对其进行划分，就像有些人会错误地坐在我对面说：“哦，卵子冷冻是我生育能力的一项保险”，但事实并非如此，因为保险总是有回报的，但它是对我生育能力的投资。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Like investing in the stock market probably will pay off.
就像投资股票市场可能会有回报一样。
But depends on external factors that we don't have yet.
但这取决于我们还没有的外部因素。
So the ROI is yet to be determined, but in general considered to be a good thing.
因此投资回报率尚未确定，但总的来说被认为是一件好事。
I think it would be absolutely incredible to be in a place where egg freezing could be covered, and there's definitely countries where it is, that they have said, "Well, the birth rate is dropping.
我认为在一个可以覆盖卵子冷冻的地方绝对是令人难以置信的，而且肯定有这样的国家，他们说，“嗯，出生率正在下降。
We want to keep the reproductive lifespan open for some patients.
我们希望为一些患者保留生殖寿命。
We want to offer this." I think to be honest and transparent, the number one restriction against that that we see as a field right now is the camp of people who are ethically or morally opposed to IVF for reasons of embryo disposition.
我们想提供这个。”我认为，诚实和透明地讲，目前我们所看到的这个领域的第一个限制是那些在伦理上或道德上因胚胎处置原因而反对体外受精的人的阵营。
Andrew Huberman:
安德鲁·休伯曼：
Embryo disposition?
胚胎性格？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah, like the personhood of an embryo.
是的，就像胚胎的人格一样。
Is an embryo a person?
胚胎是人吗？
Andrew Huberman:
安德鲁·休伯曼：
I see, because embryos that are not used are going to be either kept frozen or discarded, and to those people, that's seen as essentially killing a baby.
我明白了，因为不使用的胚胎要么被冷冻，要么被丢弃，对那些人来说，这基本上被视为杀死婴儿。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Correct.
正确。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
That's their view.
这是他们的观点。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
And we should acknowledge that I have many patients right now who are donating embryos when they are done with their family, which is an amazing way to kind of pass forward the opportunity and for other couples to have a family.
我们应该承认，我现在有很多患者在与家人结束后捐赠胚胎，这是一种传递机会并让其他夫妇拥有家庭的奇妙方式。
And I also just want to say at the top of this is that IVF's incredible.
我还想说最重要的是体外受精是令人难以置信的。
Seventeen million babies have been born in this world because of IVF.
世界上已有一千七百万婴儿因试管受精而诞生。
So I think this technology's great.
所以我认为这项技术很棒。
Does that mean everybody has to do IVF?
这是否意味着每个人都必须进行试管受精？
No. You are allowed to have your own feelings and decisions about anything that you do, IVF included.
不。您可以对自己所做的任何事情有自己的感受和决定，包括体外受精。
And there's often things we can do within the procedure for patients who might have religious or ethical concerns to limit the number of embryos that we make or only transfer embryos that are created, and that's important to know to bring that up if that's your line in the sand, is that we can often do things differently based on your beliefs.
对于可能有宗教或道德问题的患者，我们通常可以在手术过程中做一些事情，以限制我们制造的胚胎数量或仅移植所产生的胚胎，如果这是您的底线，那么重要的是要知道提出这一点，我们通常可以根据您的信仰采取不同的做法。
It might be less efficient, it might cost more money, it might have a lower rate of success.
它可能效率较低，可能花费更多资金，成功率可能较低。
But I've had patients walk that road, and that's the way it felt comfortable to them.
但我曾让病人走过那条路，他们觉得这样很舒服。
In this country, there's a camp, not to get too political, and they're really pushing something called restorative reproductive medicine, and they're opposing a lot of the American Society for Reproductive Medicine's attempt to get fertility treatment and fertility preservation covered.
在这个国家，有一个阵营，不要太政治化，他们确实在推动一种叫做恢复性生殖医学的东西，他们反对美国生殖医学会的许多尝试，以覆盖生育治疗和生育力保存。
And their rationale, even though a lot of RRM I'm a huge fan of, it's about teaching women cycle tracking and getting to the root cause and really supporting understanding your fertility.
他们的基本原理是，尽管我是很多 RRM 的忠实粉丝，但它是关于教导女性进行周期跟踪并找到根本原因并真正支持了解您的生育能力。
Like bullet point 10 on their list is that IVF is unethical.
就像他们清单上的第 10 点一样，体外受精是不道德的。
Andrew Huberman:
安德鲁·休伯曼：
But these people are ostensibly pro-child, so that-
但这些人表面上是支持儿童的，所以——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I agree with you
我同意你的观点
Andrew Huberman:
安德鲁·休伯曼：
...
...
my political stance-
我的政治立场——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
people often speculate.
人们经常猜测。
I'll be really honest, I don't like politics.
说实话，我不喜欢政治。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And I'm very disappointed in the current state of politics, on both sides.
我对双方目前的政治状况都非常失望。
And I try and go issue by issue, and I realize that itself is a controversial statement.
我试着逐个问题地讨论，我意识到这本身就是一个有争议的声明。
You're supposed to take a hard stance for or against.
你应该采取强硬立场支持或反对。
But I think that as a biologist- ...
但我认为作为一名生物学家......
I look at certain things and I go, "All right." And I look at other things, I go, "Oh, my goodness.
我看着某些东西然后说：“好吧。”当我看其他东西时，我会说：“哦，天哪。
Like what Stone Age are we living in?" And so I think that to argue whatever it is that one believes about-- It seems to me that IVF, at least to me, maybe I just am too through my own lens, but the whole notion of freezing eggs and creating embryos seems very pro-child to me.
就像我们生活在什么样的石器时代？”所以我认为，无论人们相信什么，在我看来，体外受精，至少对我来说，也许我只是通过自己的视角来看，但冷冻卵子和创造胚胎的整个概念对我来说似乎非常支持孩子。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I-
我-
Andrew Huberman:
安德鲁·休伯曼：
So it doesn't square with-
所以它不符合-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It doesn't square with points-
它与点不相符-
Andrew Huberman:
安德鲁·休伯曼：
...
...
with number 10 on this list.
在此列表中排名第 10。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I agree with you.
我同意你的看法。
I agree with you, and I think a lot of the people who are a fan of RRM might actually agree with you and I, but there are definitely people who are very adamantly opposed to IVF who put number 10 in there because they have a different agenda.
我同意你的观点，而且我认为很多 RRM 粉丝实际上可能会同意你和我的观点，但肯定有一些人非常坚决反对 IVF，他们把数字 10 放在那里，因为他们有不同的议程。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I'm a fertility doctor, right?
我是一名生育医生，对吗？
I want as many people to have a family as they desire.
我希望尽可能多的人拥有自己想要的家庭。
I want you to fulfill your life's dreams.
我希望你能实现你一生的梦想。
If having a child is a part of it, I want to do everything I can to help you have that.
如果生孩子是其中的一部分，我想尽我所能来帮助你实现这一点。
I am not here to sell IVF or force IVF.
我不是来推销试管婴儿或强制试管婴儿的。
At the end of the day, it impacts me zero what you individually choose to do.
归根结底，你个人选择做的事情对我的影响为零。
But I believe that across the board, people deserve the tools in the toolbox.
但我相信，总的来说，人们应该拥有工具箱中的工具。
They deserve to be presented with all the choices.
他们应该拥有所有的选择。
We could try Clomid.
我们可以试试克罗米芬。
We could try IUI.
我们可以尝试宫腔内人工授精（IUI）。
We could try surgery.
我们可以尝试手术。
We could try IVF.
我们可以尝试试管受精。
Oh, you're getting older.
哦，你年纪越来越大了。
We could freeze your eggs.
我们可以冷冻你的卵子。
There are just more tools.
只是有更多的工具。
There's more opportunities.
还有更多的机会。
And then based on your circumstance, your financial, your beliefs, you should be allowed to choose.
然后根据你的情况、你的财务状况、你的信仰，你应该被允许选择。
I feel very adamantly that one's own beliefs that cause you to want to put it at number 10 on the list should not be the beliefs that we enforce on everybody, especially when we know that IVF can be so powerful to help so many people have a family.
我非常坚定地认为，导致你想将其排在清单上第 10 位的个人信念不应该是我们强加给每个人的信念，尤其是当我们知道体外受精可以如此强大地帮助这么多人拥有家庭时。
It should be something that is offered to you if indicated, and you get the choice.
如果有指示，它应该是提供给您的东西，并且您可以选择。
And so back to the origin, it would be incredible to live in a world or a country where egg freezing was offered to women as we do see people are waiting longer to start their families.
回到最初，生活在一个向女性提供卵子冷冻的世界或国家是令人难以置信的，因为我们确实看到人们等待更长的时间来组建家庭。
It would allow more people to feel less pressure, less pressure with a partnership and on their relationship, not to feel like, "Oh, this better work out because my clock is ticking," and be able to really feel like they could chase one dream and not at the expense of another.
这将使更多的人感受到更少的压力，更少的伙伴关系和他们的关系上的压力，而不是感觉，“哦，这更好，因为我的时钟在滴答作响”，并且能够真正感觉到他们可以追逐一个梦想，而不是以牺牲另一个梦想为代价。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I think we're further in this country than we want to admit from that.
我认为我们在这个国家的发展比我们愿意承认的还要进一步。
We can't even get fertility treatments covered for patients with cancer when we know that chemotherapy is going to deplete their ovarian reserve.
当我们知道化疗会耗尽癌症患者的卵巢储备时，我们甚至无法为癌症患者提供生育治疗。
We have some states that we can't even get egg freezing covered for them.
我们有一些州甚至无法为他们提供卵子冷冻服务。
Andrew Huberman:
安德鲁·休伯曼：
So this is state by state.
所以这是逐个州的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
This is state by state right now.
目前这是一个州一个州的情况。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We would love federal protection for everybody.
我们希望联邦为每个人提供保护。
We would love to be able to see-- I don't know.
我们很希望能够看到——我不知道。
To me, that's my litmus, what your state or your country would do for patients who have cancer or are in this position.
对我来说，这是我的试金石，你的州或你的国家将为癌症患者或处于这种情况的患者做些什么。
And if we're not even willing to move to help them, the idea that we could cover it for everybody, we're still ages away from that, I think.
我认为，如果我们甚至不愿意采取行动来帮助他们，甚至不愿意为每个人提供服务，那么我们距离这一目标还有很长的路要走。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, because none of what we're talking about is forcing anyone to do anything.
是的，因为我们所谈论的一切都不会强迫任何人做任何事情。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
No.
不。
Andrew Huberman:
安德鲁·休伯曼：
Nor is it necessarily the destruction of an embryo.
也不一定是破坏胚胎。
I mean, there is a world where the embryos are created and kept frozen, right?
我的意思是，有一个胚胎被创造并保持冷冻的世界，对吗？
There is no-
没有-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
No.
不。
Andrew Huberman:
安德鲁·休伯曼：
Like-
就像-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We call that embryo banking.
我们称之为胚胎银行。
I mean, to specify-
我的意思是，要指定-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Yeah
是啊
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
maybe for somebody who doesn't understand, right?
也许对于不理解的人来说，对吧？
Egg freezing, getting those eggs outside the vault to grow, taking them out of your body, and we freeze them right there at the egg state.
卵子冷冻，让这些卵子在保险库之外生长，将它们带出你的身体，然后我们将它们冷冻在卵子状态。
Making an embryo is going to be thawing that egg, fertilizing it with sperm, letting it grow out to the implantation stage, which is day five or six.
制造胚胎需要解冻卵子，用精子使其受精，让它生长到植入阶段，即第五天或第六天。
Not every egg will survive, fertilize, grow.
并非每个卵子都能存活、受精、生长。
There's a ton of attrition in culture.
文化中有大量的消耗。
So 90% of eggs survive the freeze thaw.
所以 90% 的鸡蛋能在冻融后存活下来。
75% will fertilize, 50% will make it to the implantation stage, and then not everyone will be genetically normal based on your age and other factors.
75% 的人会受精，50% 的人会进入着床阶段，然后根据您的年龄和其他因素，并非每个人的基因都会正常。
And then even a genetically normal embryo only has a 65% chance of live birth.
即使是基因正常的胚胎也只有 65% 的活产机会。
The science has come far, but we're not there all the way.
科学已经取得了很大的进步，但我们还没有完全实现。
With that being said, they do morally really feel like an embryo could be a potential life, and they do struggle with what to do if they have leftover embryos.
话虽如此，他们在道德上确实觉得胚胎可能是一个潜在的生命，而且他们确实在为如果有剩余胚胎该怎么办而苦苦挣扎。
And I have some patients who've told me, "Every embryo we make, we're going to transfer." Okay, well, we want to be really mindful what we do in that circumstance.
我有一些患者告诉我，“我们制造的每一个胚胎，我们都会进行移植。”好吧，我们要非常注意我们在这种情况下所做的事情。
And even though it's unlikely, I have a patient right now with four children and one embryo in the freezer because we froze five knowing that everyone shouldn't implant based on that 65% number, but we've gone four for four.
尽管这不太可能，但我现在有一个病人，他有四个孩子，冰箱里有一个胚胎，因为我们知道每个人都不应该根据 65% 的数字进行植入，所以冷冻了五个，但我们已经四个换四个了。
Okay?
好的？
So, we have to know that if that's what we're doing, we're prepared for-
所以，我们必须知道，如果这就是我们正在做的事情，我们就做好了准备——
Andrew Huberman:
安德鲁·休伯曼：
Mm
毫米
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
how the data may fall, because data just helps us guide decisions.
数据可能会如何下降，因为数据只是帮助我们指导决策。
Right?
正确的？
Especially when it comes to live birth.
尤其是当涉及到活产时。
It's zero or 100.
它是零或 100。
It happens or doesn't.
它发生或不发生。
Now, if I freeze them as eggs, for some patients who have really strong beliefs and they are afraid of that number five, we might take more time or more money, but we might say, "Let's thaw them and only fertilize two."
现在，如果我把它们冷冻成卵子，对于一些有非常强烈信念并且害怕数字五的患者来说，我们可能会花费更多的时间或更多的钱，但我们可能会说，“让我们解冻它们，只使两个受精。”
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
"Let's leave everything else frozen, and then whatever makes its embryo, we can transfer." And yes, that's not a cost-effective way to go through the process because we might be having to pay for thawing and the fertilization and the transfer more times because there may be nothing to transfer based on that attrition.
“让我们把其他所有东西都冷冻起来，然后无论什么东西形成胚胎，我们都可以移植。”是的，这不是一种具有成本效益的方式来完成这个过程，因为我们可能不得不支付更多次解冻、受精和转移的费用，因为基于这种消耗，可能没有任何东西可以转移。
It can let some patients say, "Okay, I feel better with that process." So just freezing eggs, to your point, is not making embryos.
它可以让一些患者说：“好吧，这个过程让我感觉好多了。”因此，就您而言，仅仅冷冻卵子并不能制造胚胎。
Right?
正确的？
And there's different things we can choose along the way to make an individual person feel comfortable, but we shouldn't be dictating how the field has to function.
在此过程中，我们可以选择不同的东西来让个人感到舒服，但我们不应该规定这个领域必须如何运作。
I think it would be incredible if we could encourage egg freezing earlier.
我认为如果我们能够更早地鼓励卵子冷冻，那就太不可思议了。
I think it would open the door of opportunity.
我认为这会打开机会之门。
And not everybody who freezes eggs will need them, but the peace of mind knowing that there's a chance is really impactful on the human mind.
并不是每个冷冻卵子的人都需要它们，但知道有机会的安心对人类的心灵确实有影响。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to take a quick break and acknowledge our sponsor, Eight Sleep.
我想稍微休息一下，并向我们的赞助商“八睡”表示感谢。
Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity.
August Sleep 生产具有冷却、加热和睡眠跟踪功能的智能床垫套。
One of the best ways to ensure you get a great night's sleep is to make sure that the temperature of your sleeping environment is correct, and that's because in order to fall asleep and stay deeply asleep, your body temperature actually has to drop by about one to three degrees.
确保您睡个好觉的最佳方法之一是确保睡眠环境的温度正确，这是因为为了入睡并保持深度睡眠，您的体温实际上必须下降约一到三度。
And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees.
为了醒来时感觉神清气爽、精力充沛，您的体温实际上必须升高约一到三度。
Eight Sleep automatically regulates the temperature of your bed throughout the night according to your unique needs.
八睡眠会根据您的独特需求自动调节整个晚上的床温。
I've been sleeping on an Eight Sleep mattress cover for nearly five years now, and it has completely transformed and improved the quality of my sleep.
我已经睡在八睡眠床垫罩上近五年了，它彻底改变并改善了我的睡眠质量。
The latest Eight Sleep model is the Pod 5.
最新的八睡眠型号是 Pod 5。
This is what I'm now sleeping on, and I absolutely love it.
这就是我现在睡觉的地方，我非常喜欢它。
It has so many incredible features.
它有很多令人难以置信的功能。
For instance, the Pod 5 has a feature called Autopilot, which is an AI engine that learns your sleep patterns and then adjusts the temperature of your sleeping environment across different sleep stages.
例如，Pod 5有一个名为Autopilot的功能，这是一个人工智能引擎，可以学习你的睡眠模式，然后在不同的睡眠阶段调整你的睡眠环境温度。
It'll even elevate your head if you're snoring, and it makes other shifts to optimize your sleep.
如果您打鼾，它甚至会抬高您的头部，并进行其他转换以优化您的睡眠。
If you'd like to try Eight Sleep, go to eightsleep.com/huberman to get up to $350 off the new Pod 5.
如果您想尝试八睡眠，请访问八睡眠.com/huberman，新款 Pod 5 最高可享受 350 美元优惠。
Eight Sleep ships to many countries worldwide, including Mexico and the UAE.
八号睡眠船运往世界各地的许多国家，包括墨西哥和阿联酋。
Again, that's eightsleep.com/huberman to save up to $350.
同样，访问八睡眠.com/huberman 最多可节省 350 美元。
So insurance, I would think, would want to do this because covering all the other stuff is expensive, too.
因此，我认为保险会愿意这样做，因为涵盖所有其他内容也很昂贵。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Most insurance doesn't cover IVF.
大多数保险不承保体外受精。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
You're not wrong, right?
你没有看错吧？
In principle, if I freeze a 25-year-old's eggs, I will have three times as many eggs to work with than I would if she's going through IVF when she's 37.
原则上，如果我冷冻一个 25 岁的卵子，我可以使用的卵子数量是她 37 岁时接受体外受精的卵子数量的三倍。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So if I'm going to pay for her to do IVF at 37, it'll take so many more cycles.
因此，如果我要在 37 岁时付钱让她做试管受精，则需要更多的周期。
I'll spend so much more money.
我会花更多的钱。
That one cycle of egg freezing is much more cost-effective if I'm covering them both.
如果我同时涵盖这两个项目，那么一个周期的卵子冷冻会更具成本效益。
But we don't even cover the latter, so many times patients, this is such a hard stretch for everybody.
但我们甚至不涵盖后者，很多时候患者，这对每个人来说都是一个艰难的时期。
And look, the technology is incredible.
看，这项技术令人难以置信。
As somebody who has an IVF lab, as somebody who keeps embryos on site, it's outrageously expensive.
作为拥有试管婴儿实验室的人，作为在现场保存胚胎的人，它的费用非常昂贵。
Our generator alone is a million dollars.
仅我们的发电机就价值一百万美元。
Right?
正确的？
Because if the power goes out-
因为如果停电的话——
Andrew Huberman:
安德鲁·休伯曼：
Mm
毫米
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
what do we have to keep going?
我们要继续做什么？
We always say, "If there's zombies coming, come to the clinic." The technology to keep up with all the advancements, to have trained embryologists, their micromanipulation skills, it's impressive.
我们总是说，“如果有僵尸来，就来诊所。”技术跟上所有的进步，训练有素的胚胎学家，他们的显微操作技能，令人印象深刻。
So it costs money to run a lab like that that will provide results.
因此，运行这样一个能够提供结果的实验室需要花钱。
So the process and the technology is really, really expensive.
所以这个过程和技术真的非常非常昂贵。
That being said, I shouldn't be the one sitting here making assumptions again on what you're going to do with your money.
话虽这么说，我不应该是那个坐在这里再次假设你将如何使用你的钱的人。
And if somebody's in a position where they know their egg count's low and they should freeze their eggs because they're not partnered or they're not ready to get pregnant and they don't have the financial resources, we can sometimes find more money, right?
如果有人知道自己的卵子数量很低，并且应该冷冻卵子，因为他们没有伴侣，或者他们还没有准备好怀孕，而且他们没有经济资源，我们有时可以找到更多的钱，对吗？
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We make decisions every day when it comes to money.
我们每天都会在金钱方面做出决定。
We can't find more time, we can't find more eggs or more ovary.
我们找不到更多的时间，我们找不到更多的卵子或更多的卵巢。
So again, this idea that, well, what are they going to do about it if they find out they have a low AMH, or, oh, they can't afford to freeze their eggs anyway, or, oh, it's too expensive.
再说一次，这个想法是，如果他们发现自己的 AMH 值较低，或者，哦，他们无论如何也买不起冷冻卵子，或者，哦，冷冻卵子太贵，他们会怎么做。
We all make individual choices on how we leverage our different resources-
我们都对如何利用不同的资源做出个人选择 -
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
which I consider to be your time, your money, your physical energy, and your emotional energy.
我认为这是你的时间、你的金钱、你的体力和你的情感能量。
And every day you're leveraging them.
你每天都在利用它们。
But when it comes to reproductive health, having a family, I feel strongly, you feel strongly, which I love, that we should be giving more access and more options to people so that they can pursue this.
但当谈到生殖健康、拥有一个家庭时，我强烈地感觉到，你强烈地感觉到，我喜欢这一点，我们应该为人们提供更多的机会和更多的选择，以便他们能够追求这一目标。
And so the arguments across the board, too, like why not check an AMH in somebody who's younger?
因此，也存在广泛的争论，比如为什么不检查更年轻的人的 AMH？
Well, they can't afford egg freezing anyway, so what are they going to do about it?
好吧，他们无论如何也买不起卵子冷冻费用，那么他们该怎么办呢？
Again, we shouldn't be making the assumptions of what somebody will or will not do with their resources or with their data.
再次强调，我们不应该假设某人会或不会用他们的资源或数据做什么。
We should be ones helping them get the data and interpret the data, understand what resources or options exist, and then the individual has what they need to make the decision.
我们应该帮助他们获取数据并解释数据，了解存在哪些资源或选项，然后个人就有了做出决定所需的信息。
Andrew Huberman:
安德鲁·休伯曼：
In the Bay Area, where there are a lot of tech companies-
在科技公司云集的湾区——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm
毫米
Andrew Huberman:
安德鲁·休伯曼：
...
...
my understanding is there's an opportunity at many of these companies for female employees to freeze their eggs.
我的理解是，许多这样的公司为女性员工提供冷冻卵子的机会。
That landed much more controversial than I thought it would.
这引起的争议比我想象的要大得多。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Isn't it crazy?
是不是很疯狂？
Andrew Huberman:
安德鲁·休伯曼：
Because to some people, the tacit message there is, "Don't have kids now."
因为对于某些人来说，默认的信息就是“现在不要孩子”。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Don't have kids now.
现在还没有孩子。
Work for us.
为我们工作。
Andrew Huberman:
安德鲁·休伯曼：
"Work like crazy, and then have them later," right?
“疯狂地工作，然后再拥有它们”，对吧？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But having known some people that worked there and froze their eggs in their late 20s or early 30s, the ones I know would say, "Yeah, I'm really grateful that I did that, and that the company I worked for paid for it." And they got to keep their eggs, even though they don't work for the company anymore.
但我认识一些在那里工作并在 20 岁末或 30 岁出头冷冻卵子的人，我认识的人会说：“是的，我真的很感激我这么做了，而且我工作的公司为此支付了费用。”即使他们不再为公司工作，他们也必须保留自己的鸡蛋。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So there's that.
所以就是这样。
But it was kind of interesting.
但这很有趣。
So anyway-
所以无论如何——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
I mean-
我的意思是——
Andrew Huberman:
安德鲁·休伯曼：
...
...
we're getting kind of-
我们有点-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We are
我们是
Andrew Huberman:
安德鲁·休伯曼：
...
...
sociological here-
这里的社会学——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
But what we can say is-
但我们可以说的是——
Andrew Huberman:
安德鲁·休伯曼：
...
...
but I think it's important
但我认为这很重要
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
yeah, what data supports is that when companies do leverage a fertility package in their benefits, they retain employees longer, employees are happier, and more people utilize the service than would without it, meaning people freeze their eggs when it's offered to them through their company, and that gives them that peace of mind.
是的，数据支持的是，当公司确实在福利中利用生育计划时，他们保留员工的时间更长，员工更快乐，并且使用该服务的人比没有该服务的人更多，这意味着当通过公司向他们提供卵子时，人们会冷冻卵子，这让他们安心。
Understanding it's not everything, but they feel more comfortable exploring bigger opportunities, and they are grateful to the company.
理解这并不是一切，但他们更愿意探索更大的机会，并且对公司心怀感激。
They stay with the company longer because that is an investment in your employees.
他们在公司工作的时间更长，因为这是对员工的投资。
I think it's incredible.
我认为这太不可思议了。
In Austin, a lot of these tech companies have second homes, so we see a lot of these patients also.
在奥斯汀，很多科技公司都有第二套住房，所以我们也看到很多这样的病人。
And I do think that has changed the game for so many people to be able to have access.
我确实认为这改变了游戏规则，让很多人能够访问。
Because for many, it's not ethical or moral, it's financial.
因为对许多人来说，这不是伦理或道德，而是财务。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Often, the time when you would freeze your eggs, when it would give you the highest rate of return, you don't have the resources to do so.
通常，当您冷冻卵子会给您带来最高回报率时，您却没有资源这样做。
So having a company that's able to come in and do that is really, I think, impactful.
因此，我认为，拥有一家能够参与并做到这一点的公司确实具有影响力。
I wish more companies would do that.
我希望更多的公司能够这样做。
Maybe we can change their minds.
也许我们可以改变他们的想法。
Andrew Huberman:
安德鲁·休伯曼：
I tend to get pretty loud and pretty consistently loud about the things that I believe in, once I understand the landscape.
一旦我了解了情况，我就会非常大声地、持续地大声谈论我所相信的事情。
So I plan to be vocal about it, for what it's worth.
所以我打算大声疾呼，无论它的价值如何。
You mentioned that birth control can reduce AMH levels-
您提到节育可以降低 AMH 水平 -
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
on a month-to-month basis.
按月计算。
And we should define birth control-
我们应该定义节育——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
because it's such a broad category.
因为它是一个如此广泛的类别。
But is there any evidence that taking hormonal birth control can lower chances of pregnancy when somebody comes off birth control?
但是否有任何证据表明，当某人停止节育时，服用激素节育可以降低怀孕的机会？
In my friendships and knowledge space, and this isn't I have a friend, I know a number of people who have kids now-
在我的友谊和知识空间中，这不是我的朋友，我认识很多现在有孩子的人-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
who were on birth control, came off birth control, and got pregnant right away.
那些正在采取节育措施、取消节育措施并立即怀孕的人。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
So I think a lot of people assume that's how it works.
所以我认为很多人都认为这就是它的运作方式。
But are there any good examples of how certain forms of birth control can actually suppress fertility in women long after women come off birth control?
但是，有没有什么好的例子可以说明某些形式的节育措施如何在女性停止节育后很长时间内实际上抑制女性的生育能力呢？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Excellent question.
很好的问题。
Okay, let's break the data down from big to little.
好吧，让我们把数据从大到小分解一下。
Number one, big studies looking at all different types of contraception, no higher rate of infertility, again, defined as failure to get pregnant at 12 months.
第一，针对所有不同类型避孕方法的大型研究，不孕率没有升高，再次定义为 12 个月未能怀孕。
So you come off your contraception, at 12 months later when we look, there's no higher rate of infertility than we would have on the population base level.
因此，当您停止避孕后，12 个月后，当我们观察时，不孕率并不高于人口基数水平。
So that data leads us to comfortably say birth control is not causing infertility.
因此，这些数据让我们可以放心地说节育不会导致不孕。
Now, if we go and we look more nuanced at different types of contraception, if you look at the birth control pill, what most people are talking about, the birth control pill is a combination of synthetic estrogen, ethinyl estradiol, and a type of progesterone or a progestin.
现在，如果我们更细致地研究不同类型的避孕方法，如果你看看大多数人谈论的避孕药，避孕药是合成雌激素、乙炔雌二醇和一种黄体酮或黄体酮的组合。
These work by telling the brain, essentially tricking it, so the brain doesn't send out FSH or LH.
它们的工作原理是告诉大脑，本质上是欺骗它，这样大脑就不会发出 FSH 或 LH。
And as we described earlier, those are important in getting you to ovulate.
正如我们之前所描述的，这些对于让您排卵很重要。
So you don't ovulate when you have taken the birth control pill, and that's why it's a very effective contraceptive choice.
因此，服用避孕药后您不会排卵，这就是为什么它是一种非常有效的避孕选择。
However, the half-life of the birth control pill is only 28 hours, so it's actually quite short.
然而，避孕药的半衰期只有28小时，所以实际上很短。
So you can miss even just one pill, and you could ovulate.
因此，即使您漏服一粒药，您也可能会排卵。
So when you stop the birth control pill, your period should come back that next month.
因此，当您停止服用避孕药时，您的月经应该会在下个月恢复。
So immediately you should have resumption of ovulation.
因此，您应该立即恢复排卵。
A couple of problems with this one is that the birth control pill has some valid medical uses, has some non-valid ones, but very often, especially in the generation of women that we see right now, they were given the pill, potentially for a valid medical reason, without any investigation of what it was.
这方面的两个问题是，避孕药有一些有效的医疗用途，也有一些无效的医疗用途，但很多时候，尤其是我们现在看到的这一代女性，她们可能是出于有效的医疗原因而服用避孕药，而没有对其是什么进行任何调查。
So maybe a woman had irregular cycles or some acne, and her doctor said, "Well, here, take the birth control pill.
所以也许一个女人有月经周期不规律或有一些痤疮，她的医生说：“好吧，在这里，服用避孕药。
It will help." And it did help.
这会有帮助的。”它确实有帮助。
But just based on that history, I would sit here and say, I bet she has PCOS.
但根据这段历史，我会坐在这里说，我打赌她患有多囊卵巢综合症。
And the woman, though, never was told, "I think you have PCOS.
然而，这位女士从未被告知，“我认为你患有多囊卵巢综合症。
Here's what it is.
这就是它是什么。
You probably will not ovulate when you stop the birth control, and your acne will come back, and you should talk to a fertility doctor, and here's lifestyle things we can do to decrease insulin resistance." Never had that discussion.
当你停止节育时，你可能不会排卵，你的痤疮也会复发，你应该咨询生育医生，我们可以采取以下生活方式来降低胰岛素抵抗。”从来没有过这样的讨论。
So in her mind, had some symptoms, started the pill, those symptoms resolved.
所以在她看来，有一些症状，开始服药后，这些症状就消失了。
Now we stop the pill, and we're not getting pregnant, and we have irregular cycles.
现在我们停药了，我们没有怀孕，而且月经周期不规律。
And we start to blame the pill as the reason why, instead of understanding that the pill was maybe masking it or treating certain aspects of it.
我们开始将原因归咎于药丸，而不是理解药丸可能掩盖它或治疗它的某些方面。
So we do see failure to get to a diagnosis in women who were prescribed the birth control pill young, and then with the idea, I'm going to stop the pill and get pregnant right away.
因此，我们确实看到年轻时服用避孕药的女性未能得到诊断，然后有了这个想法，我将停止服用避孕药并立即怀孕。
What I like to say is, you're not ovulating on the pill.
我想说的是，服用避孕药后你不会排卵。
If ovulation and knowing when you ovulate is one of your most sensitive health markers and really essential information in trying to get pregnant.
排卵和了解排卵时间是您最敏感的健康指标之一，也是尝试怀孕的真正重要信息。
If you are trying to get pregnant, the egg only lives for 24 hours.
如果您想怀孕，卵子只能存活 24 小时。
The fertile window is the five days before and the day of ovulation, meaning sperm can live in the reproductive tract for up to five days.
受孕窗口是排卵前五天和排卵当天，这意味着精子可以在生殖道中存活长达五天。
Most will stay around for two days.
大多数人会停留两天。
That's why the two days before and the day of ovulation have a 20% to 30% chance of getting pregnant compared to a zero day the day after ovulation, 0%.
这就是为什么排卵前两天和排卵日当天有 20% 至 30% 的怀孕机会，而排卵后第二天的零日怀孕机会为 0%。
So very defined fertile window.
所以非常明确的肥沃窗口。
So if you know when you're ovulating and you target intercourse, you're going to have a higher odds and get pregnant faster.
因此，如果您知道自己的排卵时间并以性交为目标，那么您的怀孕几率就会更高，怀孕的速度也会更快。
Data supports that very much so.
数据非常支持这一点。
But you don't know how to track your ovulation because you've been on the pill, so you don't know how to do that.
但您不知道如何追踪排卵，因为您一直在服用避孕药，所以您不知道该怎么做。
So I recommend that you stop the pill three to six months before you're really wanting to start your family so you can track your cycle, learn to detect ovulation, and if you do have an abnormality, you're not now six months of trying or one year of trying before it's evaluated.
因此，我建议您在真正想要组建家庭之前三到六个月停止服用避孕药，这样您就可以跟踪您的周期，学会检测排卵，如果您确实出现异常，那么您现在不需要六个月或一年的尝试才能进行评估。
You can say, "Oh, I can't detect ovulation," or "My cycles are irregular.
您可以说，“哦，我检测不到排卵”，或者“我的周期不规律。
Let me go get that investigated now so we're not kind of behind in our own timeline." The progesterone IUD is another one that we talk about a lot.
现在让我去调查一下，这样我们就不会落后于我们自己的时间表。”黄体酮宫内节育器是我们经常谈论的另一种宫内节育器。
The progesterone IUD is local progesterone that is placed inside the uterus There's different types that can release progesterone in different amounts.
黄体酮宫内节育器是放置在子宫内的局部黄体酮。有不同的类型可以释放不同量的黄体酮。
It typically suppresses ovulation in the first two years, but then progesterone levels drop, and it tends not to suppress ovulation.
它通常会在头两年抑制排卵，但随后黄体酮水平下降，并且往往不会抑制排卵。
But that chronic progesterone exposure thins the endometrial lining to the degree that many women do not have periods anymore.
但长期接触黄体酮会使子宫内膜变薄，导致许多女性不再来月经。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
That can be great if you don't like having a period.
如果您不喜欢经期，这会很棒。
That can decrease the chance of anemia or menstrual cramping.
这可以减少贫血或月经痉挛的机会。
So it can be very lifestyle positive during those years.
因此，在那些年里，生活方式可能非常积极。
But when you stop the IUD, we do see a change in endometrial receptivity, at least for six months after it's been removed, and it can take time to build that lining back up.
但是，当您停止使用宫内节育器时，我们确实会看到子宫内膜容受性发生变化，至少在取出宫内节育器后的六个月内，并且可能需要时间来恢复子宫内膜。
So I always recommend that a progesterone IUD is removed at least six months before you want to get pregnant.
因此，我始终建议您在怀孕前至少六个月取出黄体酮宫内节育器。
Give the endometrium time to rebuild and regrow, and then you'll have better odds at conceiving.
给子宫内膜足够的时间重建和再生，然后您的受孕几率就会更高。
We do see a little bit of lower pregnancy rates in those first six months of conceiving in women coming off of the IUD.
我们确实发现停用宫内节育器的女性在怀孕的前六个月内怀孕率略有下降。
More of them are getting pregnant in the back six months.
更多的人在后六个月内怀孕。
So kind of shift your own timeline.
所以改变你自己的时间表。
And the birth control, I think it's always important to mention in this conversation, is one that's not as common, but it's the Depo-Provera shot.
我认为在这次谈话中值得提及的节育措施并不常见，但它是 Depo-Provera 注射剂。
So this is a high-dose intramuscular progesterone shot that can prevent ovulation for three months.
所以这是一种大剂量肌肉注射黄体酮注射剂，可以阻止排卵三个月。
On population-based levels, to use it as an effective contraceptive must get every three months.
在以人群为基础的水平上，要将其作为有效的避孕方法，必须每三个月进行一次。
But one single dose can prevent ovulation for 18 months.
但一剂即可阻止排卵 18 个月。
So this is that one exception where if you want to get pregnant potentially in the next two years, please don't get Depo-Provera.
因此，这是一个例外，如果您想在未来两年内怀孕，请不要服用 Depo-Provera。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Incredibly thorough and clear.
令人难以置信的彻底和清晰。
Is there any evidence one way or the other that intentional termination of a pregnancy can disrupt chances of getting pregnant again later?
是否有任何证据表明故意终止妊娠会破坏以后再次怀孕的机会？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
No study supports that having a termination is going to negatively impact your fertility later.
没有研究表明终止妊娠会对您以后的生育能力产生负面影响。
One caveat I just want to mention is that any intrauterine procedure has the potential to damage the endometrium and result in scar tissue.
我想提一下的一个警告是，任何宫内手术都有可能损伤子宫内膜并导致疤痕组织。
So that could be having an IUD, could be having a fibroid removed, it could be a prior C-section, it can be a prior DNC because you had a pregnancy loss, it could be from a termination.
因此，这可能是使用宫内节育器，可能是切除肌瘤，可能是之前的剖腹产，也可能是之前的 DNC，因为您流产了，也可能是由于终止妊娠。
Where we see the greatest risk in all of these circumstances is from heavy bleeding or from an infection associated with it.
我们发现在所有这些情况下最大的风险是大量出血或与之相关的感染。
So in general, most terminations are done early, very routine.
所以一般来说，大多数终止都是提前完成的，非常常规。
Where we are fearful is when they are accessed in non-safe environments.
我们担心的是在不安全的环境中访问它们。
We're seeing more infection or heavy bleeding, or even when women are having to travel statewide to access care, and they're getting the procedure done later with a higher risk of complication.
我们看到更多的感染或大量出血，甚至当女性不得不前往全州范围内获得护理时，她们会在晚些时候完成手术，并发症的风险更高。
In Texas, where I practice, there's obviously an abortion ban, and so women who need an elective termination for a medical reason.
在我执业的德克萨斯州，显然有堕胎禁令，因此女性因医疗原因需要选择性终止妊娠。
I had one patient who's been very open about her story.
我有一位病人，她对自己的故事非常坦率。
Her baby had anencephaly.
她的孩子患有无脑畸形。
So she went through IVF and had a baby that had no brain develop.
于是她进行了试管受精，生下了一个没有大脑发育的婴儿。
And they made the decision that they wanted to terminate that pregnancy since that's not compatible with life.
他们决定终止妊娠，因为这与生活不相容。
They didn't want to have to carry the entire pregnancy.
他们不想承担整个怀孕过程。
They had to travel out of state to access care.
他们必须出国才能获得护理。
Their first appointment was canceled, so they had to make another one in a different state.
他们的第一个预约被取消了，所以他们不得不在不同的州进行另一个预约。
Took them much longer than they wanted.
他们花费的时间比他们想要的要长得多。
Had the procedure much later.
手术的时间晚了很多。
And then she had residual scar tissue inside her uterus that was because it was done at a later term that we then had to fix before she could get pregnant again.
然后她的子宫内有残留的疤痕组织，因为这是在后期完成的，然后我们必须在她再次怀孕之前修复它。
So I think it's just important to say that across the board, any intrauterine procedure poses a little bit of a risk.
所以我认为重要的是要说，总的来说，任何宫内手术都会带来一点风险。
No matter what it is, if your periods are different afterward, the hallmark sign is going to be a lighter cycle.
不管是什么，如果您之后的经期有所不同，那么标志性的迹象就是周期会变得更轻。
So no matter what thing on that list you had done, if your cycle is now lighter afterward, I am worried there could be scarring inside the uterus.
因此，无论您做了清单上的哪件事，如果您的周期现在变得更轻，我担心子宫内可能会留下疤痕。
And we'd rather evaluate that in the clinic.
我们宁愿在诊所进行评估。
We can do a saline sonogram to just check and make sure there's no scar tissue because that will impact your fertility.
我们可以做盐水超声检查来检查并确保没有疤痕组织，因为这会影响您的生育能力。
Andrew Huberman:
安德鲁·休伯曼：
Thank you.
谢谢你。
Some practical questions-
一些实际问题——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
about metabolic health, mitochondrial health, and egg quality.
关于代谢健康、线粒体健康和卵子质量。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Let's do it.
让我们开始吧。
Andrew Huberman:
安德鲁·休伯曼：
In your book, you go into this in some degree of detail, but when you think about the things that can really help support egg quality aside from age-
在您的书中，您对此进行了一定程度的详细介绍，但是当您考虑除年龄之外真正有助于支持卵子质量的因素时-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
in fact, I should say at any age, what are the sort of top contour of those?
事实上，我应该说在任何年龄，那些顶部轮廓是什么样的？
You mentioned inflammation is the enemy.
你提到炎症是敌人。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
But inflammation happens all the time-
但炎症却时常发生——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and we can't avoid it.
我们无法避免它。
But we can certainly avoid exacerbating it.
但我们当然可以避免加剧这种情况。
So what are the things that people can do, not do, and take?
那么人们可以做、不能做、可以采取的事情有哪些呢？
We can do-
我们可以做——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Okay.
好的。
I love it
我喜欢它
Andrew Huberman:
安德鲁·休伯曼：
...
...
those three.
那三个。
Do, not do, and take.
做、不做、拿。
Yeah.
是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Okay.
好的。
So yes, inflammation is prevalent in our world, and the goal is not to avoid all of it.
所以，是的，炎症在我们的世界中很普遍，我们的目标不是避免所有炎症。
In fact, acute inflammation is required for conception, right?
事实上，受孕需要急性炎症，对吧？
We need acute inflammation with ovulation.
我们需要排卵时出现急性炎症。
If we just think real physiology, a follicle is rupturing, allowing the egg to be released and then reforming.
如果我们只考虑真正的生理学，卵泡就会破裂，让卵子被释放出来，然后重新形成。
Like, we need our acute inflammatory response to allow that to happen to the degree that if women take NSAIDs around the time of ovulation, Advil, ibuprofen, Aleve, they'll prevent the follicle from rupturing.
就像，我们需要我们的急性炎症反应来允许这种情况发生，如果女性在排卵期间服用非甾体抗炎药、Advil、布洛芬、Aleve，它们就会防止卵泡破裂。
Andrew Huberman:
安德鲁·休伯曼：
Really?
真的吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yes.
是的。
So they will go through the hormonal changes of ovulation, but the egg will not be released.
所以他们会经历排卵时荷尔蒙的变化，但卵子不会被释放。
So that's why we recommend, and fun fact or important to know, if you're trying to get pregnant, you can take those medications only when you're on your period.
因此，这就是我们建议的原因（有趣的事实或重要的是要知道），如果您想怀孕，则只能在经期时服用这些药物。
So period cramping, fine, but we don't want you taking them for the rest of the cycle because you can prevent ovulation from occurring.
因此，经期痉挛没问题，但我们不希望您在整个周期的剩余时间内服用它们，因为这样会阻止排卵。
Andrew Huberman:
安德鲁·休伯曼：
How many people, in your experience, do you think know that?
根据您的经验，您认为有多少人知道这一点？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I don't think very many-
我认为不多——
Andrew Huberman:
安德鲁·休伯曼：
Okay
好的
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
honestly, right?
老实说，对吧？
Which is why-
这就是为什么——
Andrew Huberman:
安德鲁·休伯曼：
I mean, I feel like it's sort of like banner across the sky.
我的意思是，我觉得它有点像天空中的旗帜。
Like you said, you're not going to lose eggs by doing a freeze cycle, a collect and freeze cycle.
就像你说的，通过冷冻周期、收集和冷冻周期，你不会失去卵子。
I mean-
我的意思是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Basic facts about our biology that we are never taught.
我们从未被教导过有关我们生物学的基本事实。
Andrew Huberman:
安德鲁·休伯曼：
So if somebody's trying to get pregnant, NSAIDs can be problematic.
因此，如果有人试图怀孕，非甾体抗炎药可能会产生问题。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
They can be problematic.
它们可能会带来问题。
They can prevent the egg from being released with ovulation.
它们可以阻止卵子在排卵时释放。
So I think that this is important because I will sometimes have patients say, "Well, if inflammation's bad, can't I just take medicine for it?" Right?
所以我认为这很重要，因为有时我会让病人说，“好吧，如果炎症很严重，我不能只吃药吗？”正确的？
Like that in our brain might make sense.
就像我们大脑中的那样可能是有道理的。
And I always want to say your immune system is essential for ovulation and also for implantation.
我总是想说，您的免疫系统对于排卵和着床至关重要。
So like, I don't want to turn off your immune system.
就像，我不想关闭你的免疫系统。
What I want to do, though, is not have it be so burdened with what we call chronic inflammation, that constant activation where it can't even do the job that we need it to do.
不过，我想做的并不是让它承受我们所谓的慢性炎症的负担，这种持续的激活甚至无法完成我们需要它完成的工作。
So I like to think about this as that inflammatory burden, and so we're all exposed to some, but how do we, to your degree, make it better?
因此，我喜欢将其视为炎症负担，因此我们都接触到一些炎症负担，但就您而言，我们如何使其变得更好？
How do we add to it and make it worse?
我们如何增加它并使其变得更糟？
And really framing ourselves so that we can cultivate, and I like to think about it as resilience within your body.
真正塑造我们自己，以便我们能够修炼，我喜欢将其视为你身体内的弹性。
You're going to be exposed to inflammation.
你将会受到炎症的影响。
Life is going to throw things at you.
生活会向你扔东西。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
But you want to cultivate these best practices of your life so that you are reducing inflammation to the degree that you had, and this goes hand in hand with insulin resistance, which we'll get into.
但你想要培养生活中的这些最佳实践，以便将炎症减少到你所拥有的程度，这与我们将要讨论的胰岛素抵抗密切相关。
And I usually divide it into what I call my five non-negotiables of sleep, stress, muscle, food, and toxins, and thinking about how we leverage these to our benefit by giving people the knowledge that if they understand their bodies, they can then be empowered to make choices that are in line with their goals.
我通常将其分为我所说的睡眠、压力、肌肉、食物和毒素这五个不容忽视的因素，并思考如何利用这些因素为我们带来好处，让人们知道，如果他们了解自己的身体，他们就可以做出符合自己目标的选择。
And so I really also just want to say, really importantly, I hate the narrative that there's nothing you can do for your fertility or that it's all luck.
所以我真的也想说，非常重要的是，我讨厌这样的说法：你对自己的生育能力无能为力，或者这全都是运气。
Because the truth is, even if we can't control everything, we have a huge control over our metabolic and cellular health, which, as we just said, plays a huge role in our ability to get pregnant for both men and women.
因为事实是，即使我们无法控制一切，我们也可以极大地控制我们的新陈代谢和细胞健康，正如我们刚才所说，这对我们男性和女性的怀孕能力发挥着巨大作用。
So taking control of what we can, I think, is really important information, and one person can take with that and make the choices they want to make.
因此，我认为，控制我们能做的事情是非常重要的信息，一个人可以利用这一信息并做出他们想要做出的选择。
But the worst thing that I hear every single day is people sitting across from me saying, "Gosh, I wish I'd known that information.
但我每天听到的最糟糕的事情是坐在我对面的人说：“天哪，我希望我知道这些信息。
I would've made a different decision." Why do we make people go through a failed IVF cycle, they have no embryos form, and only then do they make lifestyle changes when we know the lifespan of a sperm is 90 days, and sperm are so sensitive?
我会做出不同的决定。”为什么我们要让人们经历失败的试管婴儿周期，他们没有胚胎形成，当我们知道精子的寿命是90天，而且精子如此敏感时，他们才改变生活方式？
And then we know that even though eggs are in your body your whole life, the 60 days before you get pregnant is when the egg is most susceptible to the world around you.
然后我们知道，尽管卵子一生都在您的体内，但怀孕前的 60 天是卵子最容易受到周围世界影响的时期。
So this is this time period that I like to call trimester zero, the time before you're getting pregnant, where the choices you make can influence your egg and sperm quality the most, and to what you said earlier, if we're making them even earlier in life, can we influence ovarian function longer?
所以我喜欢将这段时期称为“零三个月”，即怀孕前的一段时间，此时您所做的选择对卵子和精子的质量影响最大，正如您之前所说，如果我们在生命的早期进行这些选择，我们可以更长时间地影响卵巢功能吗？
I think there is good thought to that.
我认为这是一个很好的想法。
But how do we leverage these choices and diving into them?
但我们如何利用这些选择并深入研究它们呢？
Number one for me is sleep, and I think that this is an important one because it can leverage that inflammatory burden in both ways, and I know you're a big fan of sleep, so this isn't going to take much to convince you.
对我来说，第一是睡眠，我认为这是一个重要的因素，因为它可以以两种方式利用炎症负担，而且我知道你是睡眠的忠实粉丝，所以这不需要太多就能说服你。
When you sleep, this is when your body's going to get rid of some excess chronic inflammation, lowers our inflammatory markers.
当您睡觉时，您的身体将摆脱一些多余的慢性炎症，降低我们的炎症标记物。
We know that when we get less sleep, it's going to cause us to have more cellular stress, more oxidative stress.
我们知道，当我们睡眠不足时，就会导致我们产生更多的细胞压力和氧化压力。
Your gonadotropins, so FSH and LH, are released from the brain in the early morning hours, so when you don't sleep long enough, you're not going to have the same hormonal response.
您的促性腺激素（FSH 和 LH）会在清晨从大脑中释放，因此当您睡眠时间不够长时，您将不会产生相同的荷尔蒙反应。
And we know really directly, men who get less sleep, they have lower testosterone levels and lower sperm counts.
我们直接知道，睡眠较少的男性，睾酮水平较低，精子数量也较低。
Women who get less sleep get fewer eggs at IVF cycle.
睡眠不足的女性在试管受精周期中获得的卵子较少。
And we see that if you say you have poor sleep, you have double the rate of infertility.
我们发现，如果你说你睡眠不好，你的不孕率就会增加一倍。
If you just subjectively say, "Yeah, I have poor sleep," you have double the rate.
如果你只是主观地说，“是的，我睡眠质量很差”，那么你的比率就会翻倍。
And that people who are not sleeping well, either partner, it will take them longer to get pregnant.
睡眠不好的人，无论是伴侣，都需要更长的时间才能怀孕。
They have lower fecundability, that month-to-month pregnancy rate.
他们的生育能力（即每月怀孕率）较低。
So it's not just me sitting over here saying, "Oh, yeah, you need to sleep better." Your physiology is meant to sleep.
所以不仅仅是我坐在这里说：“哦，是的，你需要睡得更好。”你的生理机能是为了睡觉。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It is a sign to your brain, if we go back and we view that hypothalamic response as central command station looking for clues that your life is stable enough, you're healthy enough to carry a pregnancy for a woman, which is a huge metabolic spend.
这是向你的大脑发出的信号，如果我们回头看，我们将下丘脑反应视为中央指挥站，寻找你的生活足够稳定的线索，你足够健康，可以为女性怀孕，这是一个巨大的代谢支出。
It's looking to make sure you're taking care of yourself primarily, and sleep is one of the most powerful markers that we can move.
它希望确保您主要照顾好自己，而睡眠是我们可以移动的最有力的标志之一。
Seven to nine hours.
七到九个小时。
Most women need closer to seven and a half, especially in the luteal phase.
大多数女性需要接近七个半的时间，尤其是在黄体期。
Making progesterone is a big body spend.
制造黄体酮是一项巨大的身体开支。
We really have to cultivate better sleep.
我们确实必须培养更好的睡眠。
All the things you talk about.
所有你谈论的事情。
Dark room, sound machine, a sleep mask, a cooler temperature.
暗室、音响、睡眠面罩、凉爽的温度。
Takes two to tango, so if you sleep in the bed with somebody, they need to be on board.
探戈需要两个人，所以如果你和某人睡在床上，他们需要在船上。
You need to go to bed at the same time, and you have similar sleep practices.
你们需要同时上床睡觉，并且有相似的睡眠习惯。
And we know that day-to-day consistency is also impactful in fertility, so not just the length of time, but really having that good circadian rhythm is so important for your hormones.
我们知道，日常的一致性对生育能力也有影响，所以不仅仅是时间的长短，真正拥有良好的昼夜节律对于荷尔蒙也非常重要。
Melatonin is obviously released before you go to bed.
褪黑激素显然是在你睡觉前释放的。
Low doses of melatonin supplementation can impact fertility, so doses of one to three milligrams 30 minutes before you go to bed can improve your odds of getting pregnant as well.
低剂量的褪黑激素补充剂会影响生育能力，因此睡前 30 分钟补充 1 至 3 毫克的褪黑激素也可以提高怀孕的几率。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Can influence egg quality.
会影响卵子质量。
And we know that naturally, you make more melatonin when you ovulate to kind of counter some of the oxidative stress to the ovary.
我们知道，当您排卵时，您自然会产生更多的褪黑激素，以抵消卵巢的一些氧化应激。
Really have to be careful, though.
不过，确实必须小心。
A lot of over-the-counter products have 10 times the amount of melatonin.
很多非处方产品的褪黑激素含量是其 10 倍。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, right.
是的，对。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So I always want to tread lightly with that one in recommending it to patients.
因此，在向患者推荐它时，我总是想谨慎行事。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Often, a pediatric dose is one milligram, and that's the perfect amount.
通常，儿科剂量是一毫克，这是完美的量。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Just to augment.
只是为了增强。
Again, we're not trying to replace your body's melatonin.
再次强调，我们并不是试图取代您体内的褪黑激素。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We want to augment it and to kind of help your body, I always like to think about like a toddler.
我们想要增强它并帮助你的身体，我总是喜欢像一个小孩一样思考。
Really get good consistency with your wind-down routine so that you can get enough sleep.
真正保持与放松习惯的良好一致性，这样您才能获得充足的睡眠。
Andrew Huberman:
安德鲁·休伯曼：
I don't want to disrupt your flow.
我不想打乱你的流程。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
You're fine.
你很好。
Andrew Huberman:
安德鲁·休伯曼：
But if a woman is already sleeping well-
但如果一个女人已经睡得很好——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
should she take melatonin?
她应该服用褪黑激素吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I would say for the average person, probably don't need to.
我想说，对于一般人来说，可能不需要。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I would say the exception to the rule would be that if we know we have increased chronic inflammation, maybe we have endometriosis or an inflammatory autoimmune disease, or we're going through IVF with unexplained infertility, or ever been kind of told you have, quote, "bad egg quality," then the anti-inflammatory properties of it might be advantageous.
我想说的是，这个规则的例外是，如果我们知道我们的慢性炎症增加，也许我们患有子宫内膜异位症或炎症性自身免疫性疾病，或者我们正在经历不明原因不孕的体外受精，或者曾经被告知你有，引用，“卵子质量不好”，那么它的抗炎特性可能是有利的。
Andrew Huberman:
安德鲁·休伯曼：
Since NSAIDs can disrupt the inflammation requirement for ovulation-
由于非甾体抗炎药会破坏排卵所需的炎症-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
I'm curious about other things that are known to potently reduce inflammation.
我对其他已知能有效减轻炎症的东西很好奇。
I think enough terrible things have been said about cold plunges that we don't need to add any more, but we're seeking reality here.
我认为关于寒冷暴跌的可怕事情已经说得够多了，我们不需要再添加更多了，但我们在这里寻求现实。
And despite common belief, I don't have anything inherently attached to cold plunges.
尽管人们普遍认为，我对寒冷的暴跌并没有任何内在的依恋。
I do them sometimes.
我有时也会这么做。
But we know that one shouldn't do them after resistance training or any kind of exercise where you want the inflammation to get the adaptation to the exercise.
但我们知道，在阻力训练或任何一种想让炎症适应运动的运动之后，人们不应该做这些运动。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm.
嗯。
Andrew Huberman:
安德鲁·休伯曼：
We know that.
我们知道这一点。
And it's a pretty potent inhibitor of inflammation.
它是一种非常有效的炎症抑制剂。
So Is there any reason to think that in the time where somebody's trying to conceive that perhaps they should avoid the cold plunge?
那么，是否有任何理由认为，在某人试图受孕的时候，也许他们应该避免骤冷呢？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I usually recommend against them for reasons stated here.
由于此处所述的原因，我通常建议不要使用它们。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I think there's very few things we have that are going to really turn off that acute inflammatory response to the degree that NSAIDs do, but we should proceed with caution in doing those things.
我认为我们很少有什么东西能够像非甾体抗炎药那样真正消除急性炎症反应，但我们在做这些事情时应该谨慎行事。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Most everything else is trying to just get rid of the excess inflammation we have.
大多数其他事情都是为了消除我们多余的炎症。
But if something's dampering down into that acute inflammatory response-
但如果有什么东西抑制了急性炎症反应——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
then I think we have to be a lot more judicious in saying, "Yeah, go for this." So I'm not a fan of cold plunges when trying to get pregnant.
那么我认为我们必须更加明智地说：“是的，去做吧。”所以我不喜欢在尝试怀孕时经历冷水。
Andrew Huberman:
安德鲁·休伯曼：
A lot of people will be very happy to hear that because I don't-- Unlike the sauna, nobody likes the cold plunge.
很多人会很高兴听到这个，因为我不喜欢桑拿，没有人喜欢冷水。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I mean, I hate a cold plunge.
我的意思是，我讨厌冷落。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
That's what, that's all-
就是这样，就是这样——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I've tried it one time-
我试过一次——
Andrew Huberman:
安德鲁·休伯曼：
Yeah
是啊
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
and that was one time too many.
这实在是太多了。
Andrew Huberman:
安德鲁·休伯曼：
I always say if you like it, great.
我总是说如果你喜欢它，那就太好了。
If you think you benefit, great.
如果您认为自己受益，那就太好了。
But otherwise, don't worry about it.
但除此之外，不用担心。
One thing that's commonly used is curcumin.
常用的一种物质是姜黄素。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And it's a pretty potent anti-inflammatory.
它是一种非常有效的抗炎剂。
Do you recommend people stay away from, let's not cooking with curcumin, but the high-dose curcumin that comes in a lot of supplements?
您是否建议人们远离大量补充剂中的高剂量姜黄素，而不是用姜黄素做饭？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah, I don't usually recommend it in a supplement form.
是的，我通常不推荐它以补充形式。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I never recommend it.
我从不推荐它。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I think if you have a doctor who's giving it for a very specific purpose, you might be a unique person who has excess inflammation they're trying to target.
我认为，如果您的医生出于非常特定的目的而给予它，那么您可能是一个独特的人，患有他们想要针对的过度炎症。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
But that's not something that I recommend.
但这不是我推荐的。
But cooking with it is fine.
但用它做饭还是没问题的。
Andrew Huberman:
安德鲁·休伯曼：
NAD and NR-
NAD 和 NR-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
are, I get asked about them thousands of times-
是的，我被问到了数千次——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh, same
哦，一样的
Andrew Huberman:
安德鲁·休伯曼：
...
...
per week.
每周。
And I'm more or less a fan of NR or NMN if one is trying to, I don't know, I don't think it'll extend lifespan, but it does seem to, at least in my experience, increase energy, these kinds of things.
我或多或少是 NR 或 NMN 的粉丝，如果有人试图这样做，我不知道，我不认为它会延长寿命，但至少根据我的经验，它似乎确实会增加能量，诸如此类的东西。
But it's NR in particular, there are data that it can be very anti-inflammatory.
但它特别是NR，有数据表明它可以很好地抗炎。
So if a woman is trying to conceive, should she stay away from NMN, NAD, and NR?
那么，如果女性想要怀孕，她应该远离 NMN、NAD 和 NR 吗？
Because I often see it listed in fertility protocols.
因为我经常看到它列在生育协议中。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I know.
我知道。
Animal data looks like NAD and NNM can be advantageous-
动物数据看起来 NAD 和 NNM 可能是有利的-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
especially for unexplained infertility, which to be clear, is different than, "I just want to get pregnant." Right?
特别是对于不明原因的不孕症，需要明确的是，这与“我只是想怀孕”不同。正确的？
In unexplained infertility, you're not conceiving.
在不明原因不孕症中，您没有怀孕。
We do the basic tests, anatomy, ovulation, ovarian reserve, semen analysis.
我们进行基本测试、解剖、排卵、卵巢储备、精液分析。
They're all fine.
他们都很好。
So I view that as chronic inflammation unless proven otherwise.
因此，除非另有证明，否则我认为这是慢性炎症。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And so that's a unique situation that patients may have potential benefit.
因此，这是一种独特的情况，患者可能会受益。
But unlike certain things across the population that we can feel really comfortable recommending, I don't recommend that to everybody.
但与我们可以放心推荐的某些事情不同，我并不向所有人推荐。
So I think that there might be utility in certain subgroups who are kind of really falling off the curve and we think there's excess inflammation that it could make sense for.
因此，我认为，对于某些真正脱离曲线的亚组来说，这可能是有用的，而且我们认为存在过度的炎症，这可能是有意义的。
So I don't ever say no, and I sometimes use it.
所以我从不说不，有时我也会使用它。
But on the flip hand, we could say like CoQ10, which has robust human data that is advantageous without a negative benefit.
但另一方面，我们可以说像 CoQ10 一样，它拥有可靠的人体数据，是有利的，没有负面好处。
That's an easier place to leverage your supplement dollars-
这是一个更容易利用你的补充资金的地方 -
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
if you're going to spend.
如果你要花钱的话。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Because most of us don't want to spend endless amounts on all the things that we can craft for our supplement list.
因为我们大多数人都不想在我们可以为补充清单制作的所有东西上花费无尽的金钱。
But the human data is yet to be out, although animal data looks promising for the right patients.
但人类数据尚未公布，尽管动物数据看起来对合适的患者很有希望。
Andrew Huberman:
安德鲁·休伯曼：
I'm glad you mentioned coenzyme Q10.
我很高兴您提到辅酶 Q10。
CoQ10 and L-carnitine are the two, at least I'm aware of, there's some decent data on supporting sperm and egg quality.
辅酶 Q10 和左旋肉碱就是这两种，至少我知道，有一些支持精子和卵子质量的不错的数据。
So do you encourage patients to start taking that, what, 60 days before trying to conceive and then continuing that through pregnancy?
那么您是否鼓励患者在尝试怀孕前 60 天开始服用该药，然后在整个怀孕期间继续服用？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We usually stop CoQ10 in pregnancy just because of lack of data.
由于缺乏数据，我们通常在怀孕期间停止辅酶Q10。
We're very cautious in pregnancy of not exposing you to anything additional you may not need.
我们在怀孕期间非常谨慎，不会让您接触任何您可能不需要的额外东西。
So we just want to be really mindful of that.
所以我们只想真正注意这一点。
But I think it's in my, like everybody should take before you get pregnant.
但我认为这是我的，每个人在怀孕前都应该服用。
Yep, at your trimester zero, your, "Hey, we want to get pregnant soon.
是的，在你零三个月的时候，你的，“嘿，我们想尽快怀孕。
We should take a prenatal vitamin that has folic acid.
我们应该服用含有叶酸的产前维生素。
We should take CoQ10.
我们应该服用辅酶Q10。
We should take omega-3 fatty acids.
我们应该摄入omega-3脂肪酸。
We should take vitamin D." These are all going to optimize, giving you the nutrients you need for a pregnancy, helping support good mitochondrial health, which is important for egg quality, without risk of harm to any of these specific supplements.
我们应该服用维生素 D。”这些都会得到优化，为您提供怀孕所需的营养，帮助支持良好的线粒体健康，这对卵子质量很重要，而且不会对任何这些特定补充剂造成伤害。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Those are the universal we're trying.
这些就是我们正在尝试的通用性。
And then for sperm health, L-carnitine we like a lot, and then zinc and selenium can have benefits as well.
然后，对于精子健康，我们非常喜欢左旋肉碱，然后锌和硒也有好处。
Andrew Huberman:
安德鲁·休伯曼：
I know you cover specifics in the book, so we'll leave it to people to find it there.
我知道您在书中介绍了具体细节，因此我们将让人们在那里找到它。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I have supplement charts for everybody who's like very curious-
我为每个好奇的人准备了补充图表-
Andrew Huberman:
安德鲁·休伯曼：
Dosages and all of that
剂量和所有这些
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
based on disease state-
根据疾病状态——
Andrew Huberman:
安德鲁·休伯曼：
Yeah
是啊
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
and more info.
和更多信息。
Andrew Huberman:
安德鲁·休伯曼：
I'd like to take a quick break and acknowledge our sponsor, Function.
我想稍微休息一下并感谢我们的赞助商 Function。
Function provides over 160 advanced lab tests to give you a clear snapshot of your bodily health.
功能提供超过 160 项高级实验室测试，让您清晰了解自己的身体健康状况。
This snapshot gives insights into your heart health, hormone health, autoimmune function, nutrient levels, and much more.
此快照可深入了解您的心脏健康、激素健康、自身免疫功能、营养水平等。
They've also recently added access to advanced MRI and CT scans.
他们最近还增加了先进的 MRI 和 CT 扫描的访问权限。
Function not only provides testing of over 160 biomarkers key to your physical and mental health, it also analyzes these results and provides recommendations for improving your health from top doctors.
Function 不仅提供对您身心健康至关重要的 160 多种生物标记物的测试，还分析这些结果并提供顶级医生改善您健康的建议。
For example, in a recent test with Function, I learned that some of my blood lipids were slightly out of range.
例如，在最近的一次 Function 测试中，我发现我的一些血脂稍微超出了范围。
As a result, I decided to start supplementing with nattokinase, which can naturally help reduce LDL cholesterol, and it did.
因此，我决定开始补充纳豆激酶，它自然可以帮助降低低密度脂蛋白胆固醇，而且确实如此。
In a follow-up test, I could confirm that this strategy worked.
在后续测试中，我可以确认这个策略是有效的。
My blood lipids are now back where I want them, in range.
我的血脂现在回到了我想要的范围内。
Comprehensive lab testing of the sort that Function offers is so important for health.
Function 提供的全面实验室测试对于健康非常重要。
And while I've been doing it for years, it's always been overly complicated and expensive.
虽然我已经这样做了很多年，但它总是过于复杂和昂贵。
But now with Function, it's extremely easy and affordable.
但现在有了 Function，它变得非常简单且经济实惠。
To learn more, visit functionhealth.com/huberman and use the code Huberman for a $50 credit towards your membership.
要了解更多信息，请访问 functionhealth.com/huberman 并使用代码 Huberman 获得 50 美元的会员积分。
I'm sure there are sort of standards and a lot of communication in your field about how many follicles to try and mature, if one does IVF or is pulling eggs.
我确信在你的领域有一些标准和大量的交流，关于如果一个人进行试管受精或正在拔卵，要尝试和成熟多少个卵泡。
I don't know if that's the right term.
我不知道这个词是否正确。
Forgive me.
对不起。
There it is again.
又来了。
I think, pulling eggs.
我想，拉鸡蛋。
Taking eggs out carefully and for sake of freezing or fertilization.
小心地取出卵子，以便冷冻或受精。
But how much conversation is there at the various meetings and in the journals about things like coenzyme Q10, L-carnitine?
但是在各种会议和期刊上有多少关于辅酶 Q10、左旋肉碱等事物的讨论呢？
I'm not trying to punch holes in these.
我并不是想在这些事情上打洞。
I'm obviously a big fan of supplements.
我显然是补充剂的忠实粉丝。
My friends joke when people ask me, "Which supplements do you take?" They just shout-
当人们问我“你服用哪种补充剂？”时，我的朋友们开玩笑。他们只是喊——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
You like all of it
你喜欢这一切
Andrew Huberman:
安德鲁·休伯曼：
He takes all of them, which is not true, I don't take all of them, but I've been experimenting with them since I was in my teens.
他拿走了所有这些，这不是真的，我没有拿走所有这些，但我从十几岁起就一直在尝试它们。
And they're not the be-all, end-all, but some work.
它们并不是最重要的、最终的，而是一些工作。
So how much conversation is there about things like coenzyme Q10, L-carnitine?
那么，关于辅酶 Q10、左旋肉碱等事物的讨论有多少呢？
Is there a consensus, or is there sort of a distribution-
是否存在共识，或者是否存在某种分布-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Hmm
嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
of old school, new school?
老学校，新学校？
And I am very curious, not trying to be political or politically correct, whether or not this divides on male/female fertility docs.
我很好奇，不想政治或政治正确，无论这是否在男性/女性生育文档上存在分歧。
The culture within a field often tells us a lot, so I'm not asking you to throw any of your colleagues under the bus-
一个领域内的文化经常告诉我们很多东西，所以我并不是要求你抛弃你的任何同事——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh
哦
Andrew Huberman:
安德鲁·休伯曼：
...
...
but if you have to
但如果你必须
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
No.
不。
Andrew Huberman:
安德鲁·休伯曼：
No.
不。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I will say this.
我会这么说。
Over the past 10 years, we've seen a huge change in how we talk about fertility, even at meetings.
在过去的十年里，我们看到谈论生育的方式发生了巨大的变化，甚至在会议上也是如此。
The first ASRM, which is the American Society for Reproductive Medicine, that I went to was probably 15, 16 years ago, and it was so IVF heavy.
我去的第一个 ASRM，即美国生殖医学协会，大概是 15、16 年前，当时的 IVF 非常重。
Now, to be fair, the science was rapidly evolving.
现在，公平地说，科学正在迅速发展。
Genetic testing was just introduced for embryos.
胚胎基因检测刚刚引入。
But as we also see more patients, and the general public, really curious about, "Well, what can I do?" And I think this is such a good question because I look at people and say, "IVF's incredible, but I can only work with the eggs and sperm you give me.
但我们也看到更多的患者和公众真的很好奇，“我能做什么？”我认为这是一个很好的问题，因为我看着人们说，“试管受精是不可思议的，但我只能用你给我的卵子和精子。
So come to the table with the best eggs and sperm you can." Control all of these variables.
因此，尽可能带着最好的卵子和精子来到餐桌上。”控制所有这些变量。
That public curiosity drives research to a degree.
公众的好奇心在一定程度上推动了研究。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Because if you're hearing it from your patients, that's the formation of research questions that we're looking at.
因为如果你从病人那里听到这样的说法，那就是我们正在研究的研究问题的形成。
Now, granted, all data that exists is limited in its own form.
现在，诚然，所有存在的数据都以其自身的形式受到限制。
In general, when we look at cohort studies, of course, people who tend to take CoQ10 have other advantageous lifestyle factors than people who do not.
一般来说，当我们观察队列研究时，当然，倾向于服用 CoQ10 的人比不服用 CoQ10 的人有其他有利的生活方式因素。
When we do randomized control trials, though, which we often do in the IVF subset because we can look at more distinct criteria.
然而，当我们进行随机对照试验时，我们经常在体外受精子集中进行这种试验，因为我们可以查看更独特的标准。
I can say, well, how many eggs were mature, or how many embryos formed, or how many were genetically normal, or the pregnancy rate per embryo transfer, which is a little bit of a finer point than just how many people got pregnant per month.
我可以说，有多少卵子成熟，或者有多少胚胎形成，或者有多少基因正常，或者每次胚胎移植的怀孕率，这比每月有多少人怀孕要好一点。
We definitely see robust data that certain supplementation, CoQ10, vitamin D, omega-3 fatty acids, those are clearly associated with improved reproductive outcomes.
我们确实看到了可靠的数据，表明某些补充剂、CoQ10、维生素 D、omega-3 脂肪酸，这些显然与改善生殖结果相关。
And we're starting to see more, I don't want to say fringe, but of the specifics.
我们开始看到更多，我不想说边缘，而是细节。
Inositol for PCOS, decreases insulin resistance, huge benefit.
肌醇对于多囊卵巢综合症，降低胰岛素抵抗，好处巨大。
N-acetylcysteine for endometriosis or chronic inflammatory disease.
N-乙酰半胱氨酸用于子宫内膜异位症或慢性炎症性疾病。
So we're seeing more interest in the nuance.
所以我们看到人们对细微差别更加感兴趣。
It's a hard question on the field.
这是球场上的一个难题。
I think there's definitely an old school versus a new school approach.
我认为肯定有老派和新派方法之分。
I've always been slightly controversial because I've always been educating, and I think at the end of the day, my job's not to say, "Just do IVF."
我总是有点争议，因为我一直在教育，我认为归根结底，我的工作不是说，“就做试管受精”。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
My job's to explain what's going on, what the options are, and help you make that decision.
我的工作是解释正在发生的事情、有哪些选择，并帮助您做出决定。
I think a lot of older-trained physicians practiced medicine in the day where this field specifically, patients did not have knowledge and access to knowledge.
我认为很多训练有素的老医生在这个领域行医的时候，特别是患者没有知识和获取知识的途径。
Therefore, when a doctor said, "Do this," they just blindly said, "Okay." And they view that as a simpler way to practice, and therefore can be very dismissive of patient questions when they say, "What about CoQ10?" Or any merit of the other lifestyle factors that we talk about.
因此，当医生说“这样做”时，他们只是盲目地说“好吧”。他们认为这是一种更简单的练习方法，因此当他们说“CoQ10 怎么样？”时，他们可能会对患者的问题非常不屑一顾。或者我们谈论的其他生活方式因素的优点。
The plethora of research that exists, which is more and more now, is that these lifestyle factors matter a lot, that decreasing inflammation can influence your fertility from how your hormones function, how your ovaries respond, how many eggs you pull out, to what you say-
现有的大量研究（现在越来越多）表明，这些生活方式因素非常重要，减少炎症可以影响您的生育能力，这些影响来自您的荷尔蒙功能、卵巢反应、取出的卵子数量以及您所说的话——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
how many embryos you form, and that supplementation is one piece of the puzzle.
你形成了多少个胚胎，而补充是这个难题的一部分。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It's not the end-all, be-all.
这不是最终的一切。
I think we probably should always focus first on where we can move the needle the biggest.
我认为我们可能应该首先关注我们可以最大程度地发挥作用的地方。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So those more core lifestyle practices should be tenet number one.
因此，那些更核心的生活方式实践应该是首要原则。
When we feel like we've mastered those and we want to add to the puzzle, that's when we can start to say what supplements help me.
当我们觉得我们已经掌握了这些并且想要添加更多内容时，我们就可以开始说哪些补充剂对我有帮助。
And one thing that I really encourage is allowing ourself space in each patient to be their own N of one experiment.
我真正鼓励的一件事是给每个病人留出空间，让他们自己进行 N 次实验。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Meaning, how can I get so in tune with my body that I can say, "This makes me feel this way," and trust that sense for yourself?
意思是，我怎样才能与我的身体如此协调，以至于我可以说，“这让我有这种感觉”，并相信自己的这种感觉？
Because we are all unique, and our response will be different to different medications or different interventions.
因为我们都是独一无二的，我们对不同药物或不同干预措施的反应会有所不同。
And learning to trust that instinct about what's working for you or oh, this isn't, that's really important when it comes to optimizing your own health, regardless of what tenet of health that we're talking about.
学会相信什么对你有效的直觉，或者哦，这不是，这在优化你自己的健康方面非常重要，无论我们谈论的是什么健康原则。
Andrew Huberman:
安德鲁·休伯曼：
If we'd have been sitting here 15 years ago and I said red light therapy can be useful for skin and for offsetting-
如果 15 年前我们坐在这里，我说红光疗法对皮肤和抵消作用很有用——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
age-related vision loss, any reasonable physician would be like, "That's nonsense."
与年龄相关的视力丧失，任何理智的医生都会说，“那是胡说八道。”
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
That's bogus.
那是假的。
Andrew Huberman:
安德鲁·休伯曼：
I spoke to an ophthalmologist yesterday.
我昨天和一位眼科医生谈过。
There's been a clinical trial using red light and infrared light for what's called dry AMD, dry macular degeneration, to offset age-related vision loss.
有一项临床试验使用红光和红外光来治疗所谓的干性 AMD（干性黄斑变性），以抵消与年龄相关的视力丧失。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And it looks promising.
而且看起来很有希望。
It doesn't reverse age-related vision loss completely, but seems to help the mitochondria and the photoreceptors.
它并不能完全逆转与年龄相关的视力丧失，但似乎对线粒体和光感受器有帮助。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It makes sense.
这是有道理的。
Andrew Huberman:
安德鲁·休伯曼：
People are holding onto some vision that they would lose.
人们固守着一些他们可能会失去的愿景。
There was a cover of what I am told is the premier dermatology journal exploring the recent studies on red light and infrared light, so it's a common practice now.
据我所知，这是一本顶级皮肤病学期刊的封面，探讨了红光和红外光的最新研究，所以现在这是一种常见的做法。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So it takes time, but this stuff was considered super woo, niche, and nonsense by most, quote unquote, "traditional physicians" 10, 15 years ago.
所以这需要时间，但这些东西在 10、15 年前被大多数“传统医生”认为是超级受欢迎、小众和无稽之谈。
In the field that you're in, how are things like red light, infrared light therapy looked at currently?
在您所在的领域，目前如何看待红光、红外光疗法等？
And if they are used, where is it directed?
如果使用它们，又会指向哪里？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Is it actually on top of the ovaries?
它实际上是在卵巢的顶部吗？
Is that the idea?
是这个想法吗？
Or that it's just more of a systemic effect?
或者这只是更多的系统性影响？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Great question.
很好的问题。
I think, again, let's just think about the fact that chronic inflammation impacts your body when it comes to your hormones and your fertility in multiple ways, right?
我想，让我们再次考虑一下这样一个事实：慢性炎症会以多种方式影响您的身体，影响您的荷尔蒙和生育能力，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So if you have chronic inflammation, it's going to interfere with hypothalamic receptivity, so your brain can't interpret your hormonal signals as well.
因此，如果您患有慢性炎症，它会干扰下丘脑的感受能力，因此您的大脑也无法解读您的荷尔蒙信号。
It's also going to send out signals differently.
它还会以不同的方式发出信号。
You're also going to have distinct ovarian changes in how the ovary responds, and then, of course, for the egg quality.
您的卵巢反应也会发生明显的变化，当然还有卵子质量的变化。
So the bigger answer of what type of therapy matters maybe depends on the outcome that we're looking at or how we're trying to show benefit.
因此，什么类型的治疗重要的更大答案可能取决于我们正在研究的结果或我们如何试图显示益处。
And in short, data is inconclusive, but all appears to be beneficial for the reasons you stated, whether it is to improve ovulation patterns, which we've seen signs showing that.
简而言之，数据尚无定论，但出于您所说的原因，所有这些似乎都是有益的，无论是为了改善排卵模式，我们已经看到了迹象表明这一点。
That's more the systemic probably.
这可能更像是系统性的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
You're sitting in front of your red light panel-
你坐在红灯面板前-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
that's going to decrease some whole-body inflammation.
这会减少一些全身炎症。
That's the inflammation that's most likely contributing to some of the brain sensitivity, so you're improving the ovulatory pattern.
这种炎症很可能会导致大脑的某些敏感性，因此您正在改善排卵模式。
There have been some studies looking at ovarian-directed red light-
已经有一些研究着眼于卵巢定向红光——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
therapy, so through the abdomen.
治疗，所以通过腹部。
But there is now-- We don't have definitive data, but there's even a vaginal ultrasound wand that's got red light therapy.
但现在——我们没有明确的数据，但甚至有一根可以进行红光治疗的阴道超声波棒。
So we don't have data on that yet, but seeing intravaginally, you're much closer to the ovaries.
所以我们还没有这方面的数据，但从阴道内看，你离卵巢更近了。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
That's why we do vaginal ultrasound monitoring for IVF to try to see if directing the response closer to the ovary can have more benefit or could-
这就是为什么我们对 IVF 进行阴道超声监测，试图看看将反应引导到更靠近卵巢是否可以带来更多好处，或者可以-
Andrew Huberman:
安德鲁·休伯曼：
Mm
毫米
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
potentially benefit egg quality more.
可能更有利于卵子质量。
I think most people are going to say, "We don't have definitive data yet."
我想大多数人会说：“我们还没有确切的数据。”
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yet everything's pointing to likely benefit.
然而一切都表明可能会带来好处。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
I don't know if this study could be done, but the one arm of this, my podcast company, funds research, and the one thing I'd love to see the experiment done is either maintaining or doing fertilization of eggs under red light because so much of the proper chromosomal arrangement seem to be dependent on mitochondrial health.
我不知道这项研究是否可以完成，但这项研究的一个部门，我的播客公司，资助研究，我希望看到这项实验完成的一件事是在红光下维持或进行卵子受精，因为许多正确的染色体排列似乎依赖于线粒体的健康。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
That's a short-term exposure, but the more I learn about the different wavelengths of light and how they impact mitochondria, and I think about the horrible lab lighting that I lived under for many years of my life, I think, oh, such precious embryos, is there a way to put them under beneficial lighting as opposed to either neutral or, I'm not saying detrimental lighting, but I don't know.
这是短期暴露，但我对不同波长的光以及它们如何影响线粒体了解得越多，我想到我多年来生活在可怕的实验室照明下，我想，哦，这么珍贵的胚胎，有没有办法把它们放在有益的照明下，而不是中性的或，我不是说有害的照明，但我不知道。
It'd be a fun study to fund-
资助这将是一项有趣的研究——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
if there's a way to do it.
如果有办法做到的话。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Could it be done?
能做到吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It definitely could be done.
这绝对是可以做到的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We have incubators.
我们有孵化器。
That could definitely be done, and where you fertilize, too.
这绝对是可以做到的，而且在你施肥的地方也是可以的。
I was going to say off-topic, my daughter did her science fair project on chicken eggs, but they looked at blue light, green light, and natural light-
我想说题外话，我女儿用鸡蛋做了她的科学博览会项目，但他们观察了蓝光、绿光和自然光——
Andrew Huberman:
安德鲁·休伯曼：
Ooh, cool
哦，酷
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
to see if they-- They're all fertilized-
看看它们是否——它们都受精了——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
but to see if their hatchability was different.
但看看它们的孵化率是否不同。
And the group that was exposed to blue light actually had the highest hatchability, and-
而暴露在蓝光下的群体实际上孵化率最高，而且——
Andrew Huberman:
安德鲁·休伯曼：
Interesting
有趣
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
UV light was actually the lowest.
紫外线实际上是最低的。
But in their research, what's so fascinating is that red light is really detrimental to chicken eggs.
但在他们的研究中，令人着迷的是红光确实对鸡蛋有害。
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
Interesting
有趣
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
anyways, I think, like-
不管怎样，我想，就像——
Andrew Huberman:
安德鲁·休伯曼：
Yeah, well, that's why science is fun
是的，这就是科学如此有趣的原因
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
yeah.
是的。
So science is cool.
所以科学很酷。
Andrew Huberman:
安德鲁·休伯曼：
Oh, congratulations to her.
哦，恭喜她。
She should write it up.
她应该把它写下来。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I know.
我知道。
Andrew Huberman:
安德鲁·休伯曼：
There's a journal where kids can write up their-
有一本日记，孩子们可以在那里写下他们的——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh.
哦。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, I'll send you the link to it.
是的，我会把链接发给你。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
You'll have to send me it after.
之后你得把它寄给我。
She would love that.
她会喜欢的。
Andrew Huberman:
安德鲁·休伯曼：
She'll be published, and that's what's so cool about science.
她将被出版，这就是科学的魅力所在。
Sometimes we think, oh, the red light is going to be the beneficial one, or the blue light is going to be the bad one.
有时我们会想，哦，红光将是有益的，或者蓝光将是坏的。
But then vitamin D production is dependent on blue and UV.
但维生素 D 的产生依赖于蓝光和紫外线。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
So nature's mysterious.
所以大自然是神秘的。
That's awesome.
太棒了。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It keeps it interesting for us.
它让我们保持兴趣。
Andrew Huberman:
安德鲁·休伯曼：
Awesome.
太棒了。
Is she going to become a scientist?
她会成为一名科学家吗？
Or she's already a scientist, but-
或者她已经是一名科学家了，但是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
She's 11, but she's a scientist right now.
她今年 11 岁，但现在是一名科学家。
Andrew Huberman:
安德鲁·休伯曼：
I love it.
我喜欢它。
I'll send you that link.
我会把那个链接发给你。
It'd be cool if she would write that up.
如果她能把这些写下来就好了。
So red light, maybe.
也许是红灯吧。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And I should point out, red light and infrared comes from sunlight.
我应该指出，红光和红外线来自阳光。
And of course, there's good circadian effects of getting sunlight.
当然，接受阳光照射对昼夜节律也有良好的影响。
But-
但是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
All circadian benefits of getting sunlight are pro-fertility, pro-hormonal health, yes.
是的，接受阳光的所有昼夜节律益处都是促进生育、促进荷尔蒙健康。
Andrew Huberman:
安德鲁·休伯曼：
Great.
太棒了。
Yeah, I don't want to give people the impression that they have to purchase a panel.
是的，我不想给人们留下必须购买面板的印象。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Correct.
正确。
Andrew Huberman:
安德鲁·休伯曼：
There's no hidden agenda here.
这里没有隐藏的议程。
So those are the things that one can take.
所以这些都是人们可以拿走的东西。
The do nots, I think broadly is don't smoke, don't drink.
这些“不”，我想大致就是不抽烟、不喝酒。
I was shocked, but I need to ask to learn, what I found was that 15, one five, percent of women in the United States report having used cannabis in some form or another while pregnant.
我很震惊，但我需要了解一下，我发现 15%（即五分之一）的美国女性报告在怀孕期间以某种形式使用过大麻。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Does that concern you?
这与你有关吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Cannabis use is probably the most concerning thing that I see in clinical practice.
大麻的使用可能是我在临床实践中看到的最令人担忧的事情。
So both you can just say if that many are using it in pregnancy, let's extrapolate to how many are using it beforehand.
因此，您可以说是否有很多人在怀孕期间使用它，让我们推断一下有多少人在怀孕前使用它。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And ultimately, something that we are just now getting robust data on because it's hard to study something when it's illegal.
最终，我们刚刚获得了可靠的数据，因为当某些东西非法时很难对其进行研究。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
All cannabis use is hugely detrimental to sperm, for sure, across the board, right?
当然，所有大麻的使用都会对精子产生巨大的损害，对吗？
Both production, the quantity of sperm, testosterone production, also the quality of the sperm, specifically the DNA fragmentation inside the head of the sperm, to the degree that female partners who conceive from a male partner who's using cannabis have much higher miscarriage rates than partners who do not utilize cannabis.
无论是精子的产量、数量、睾丸激素的产生，还是精子的质量，特别是精子头部内的 DNA 碎片，以至于使用大麻的男性伴侣怀孕的女性伴侣的流产率比不使用大麻的伴侣高得多。
And I will say clinically in the IVF lab, when I see embryos halt at that male developmental stage on day three, we say, "Oh, here's a young couple.
我会说，在体外受精实验室的临床上，当我看到胚胎在第三天停止在雄性发育阶段时，我们会说，“哦，这是一对年轻夫妇。
They've got no embryos, and we were expecting them to have some." When we go back, nine out of 10 times, he is using cannabis that he previously denied.
他们没有胚胎，我们原本希望他们有一些。”当我们回去时，十分之九的他都在使用大麻，而他之前否认这一点。
So it is one of the most movable factors right now in this country for improving fertility outcomes.
因此，它是目前该国改善生育结果最可变动的因素之一。
For women, cannabis use in the prior year can decrease the eggs you get at egg retrieval by 25% and can decrease fertilization rates by 28% and can increase miscarriage rates, therefore decreasing live birth rates.
对于女性来说，前一年使用大麻会使您在取卵时获得的卵子减少 25%，使受精率降低 28%，并可能增加流产率，从而降低活产率。
So huge numbers in science, right?
科学上的数字如此之大，对吗？
We get excited when something's a few percentage points different, but these numbers are really high to the degree that it's really easy to sit here and say if you're trying to get pregnant the fastest, if you want to have the best pregnancy outcomes, or even you want to have the best hormones you can, have longevity of your ovaries, or have the best sperm counts or the most testosterone, cannabis use should not be a part of that.
当事情有几个百分点的差异时，我们会感到兴奋，但这些数字确实很高，以至于很容易坐在这里说，如果你想最快怀孕，如果你想获得最好的妊娠结果，或者甚至你想拥有最好的荷尔蒙，延长卵巢的寿命，或者拥有最好的精子数量或最多的睾酮，大麻的使用不应该成为其中的一部分。
And THC crosses the placenta directly, and THC levels in edibles are usually the highest.
THC 直接穿过胎盘，食物中的 THC 含量通常最高。
So I think it's really important that sometimes people are like, "Oh, well, I don't smoke it, so I'm okay." We want to be really careful that this is not something your body is meant to be exposed to when we want to think about the core of how your body's meant to function.
所以我认为有时人们会说“哦，好吧，我不抽烟，所以我没事”，这一点非常重要。当我们想要思考您的身体如何运作的核心时，我们要非常小心，这不是您的身体应该接触的东西。
Andrew Huberman:
安德鲁·休伯曼：
Critical message.
关键消息。
Thank you so much.
太感谢了。
I've been put through the wringer around this cannabis thing because I've hosted people that said it does increase the risk of psychosis in certain, typically young males-
我对大麻这件事感到很苦恼，因为我接待过一些人，他们说大麻确实会增加某些人（通常是年轻男性）患精神病的风险——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
although not everyone.
虽然不是每个人。
I've been accused of all sorts of things related to that, then had someone on who confirmed that, someone who refuted it.
我被指控与此相关的各种事情，然后有人证实了这一点，有人反驳了这一点。
And cannabis, I believe is Recently rescheduled from Schedule 1, at the federal level, it's assigned a no medical application to Schedule III, so there's going to be a lot more cannabis use going forward.
我相信大麻最近从附表 1 重新安排，在联邦一级，它被分配到附表 III 的无医疗申请，因此未来将会有更多的大麻使用。
It's so critical that people hear this.
人们听到这个消息是如此重要。
And the argument I always hear, and it's always dudes, typically on X, they'll say that they smoked a lot of weed or took edibles, and they got their wife or girlfriend pregnant-
我经常听到这样的争论，而且总是男人们，通常是在 X 上，他们会说他们吸了很多大麻或吃了很多食物，他们让他们的妻子或女朋友怀孕了——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh, yeah
哦，是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
X number of times, and it sort of becomes this point of boasting.
X次了，就有点成为夸耀的点了。
And then I never want to make the comment, but I'll make it now.
然后我从来不想发表评论，但我现在就发表。
It's like, yeah, but you're talking about brain development in your kid.
就像，是的，但你正在谈论你孩子的大脑发育。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And I'm not saying your kid is dumb, but I'm saying they're maybe not as smart as they could be, or as healthy as they could be.
我并不是说你的孩子很蠢，而是说他们可能没有他们应有的聪明，也没有他们应有的健康。
I'll just say that because I'm talking to the guys out there, and that's how we talk to one another.
我这么说是因为我正在和外面的人交谈，这就是我们彼此交谈的方式。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, you had a bunch of kids, but they could be a lot healthier.
是的，你有很多孩子，但他们可以更健康。
And so I think to me, it just seems like anything that one could do, since it's ostensibly a short-term decision, certainly for the man, right?
所以我认为对我来说，这似乎是一个人可以做的任何事情，因为这表面上是一个短期决定，当然对男人来说，对吧？
The woman who's going to breastfeed should probably avoid cannabis-
打算母乳喂养的女性可能应该避免吸食大麻——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
during breastfeeding, too.
母乳喂养期间也是如此。
You see where I'm going with this.
你知道我要说什么了。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Look, the outcome is so important, right?
你看，结果很重要吧？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And when we want to think about even just male cannabis use, yes, sperm count, et cetera, decreases the sperm quality.
当我们想考虑男性使用大麻时，是的，精子数量等都会降低精子质量。
That sperm quality is important for programming of the embryo, for how the placenta develops.
精子质量对于胚胎的编程和胎盘的发育非常重要。
If the placenta's not as good, association with earlier birth.
如果胎盘状况不佳，则可能与早产有关。
It's just not worth the risk-
只是不值得冒这个风险——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
when the outcome is so important, right?
当结果如此重要时，对吗？
We're all weighing risk every day with different decisions.
我们每天都在权衡风险并做出不同的决定。
To me, there's a lot harder decisions you have to make.
对我来说，你必须做出很多更艰难的决定。
But nicotine use, cannabis use, alcohol use, the data here, none of that is advantageous for your health, especially if we're looking primarily through a fertility lens, a hormone lens, or specifically a pregnancy lens.
但是尼古丁的使用、大麻的使用、酒精的使用，这里的数据，这些都对你的健康没有好处，特别是如果我们主要通过生育透镜、激素透镜，或者特别是怀孕透镜来观察。
There's no place for it.
没有地方放它。
You can choose to do what you want with that data, right?
您可以选择对这些数据执行您想要的操作，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And people will always say, "I know so and so who did this, and they got pregnant." And there will always be those people, but you're the one making decisions for your journey.
人们总是会说，“我知道谁谁干的，而且他们怀孕了。”总会有这样的人，但你是为你的旅程做出决定的人。
And the recommendation's even stronger if you are having infertility, if you are older, depending on your scenario, because you want to control what you can because you can't control everything.
如果您患有不孕症，如果您年龄较大，则建议会更强烈，具体取决于您的情况，因为您想控制自己能控制的事情，因为您无法控制一切。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So I call those the behavioral toxins-
所以我称这些为行为毒素——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
that there's really no place that we need to add these to the world if we're talking about how do we get my body to function optimally.
如果我们谈论如何让我的身体发挥最佳功能，那么我们确实不需要将这些添加到世界上。
Andrew Huberman:
安德鲁·休伯曼：
It's interesting that certain substances get politicized.
有趣的是某些物质被政治化。
In the past, I experienced this thing that you can tell with some degree of friction.
过去，我经历过这样的事情，你可以通过一定程度的摩擦来判断。
In the past, cannabis was associated with the left.
过去，大麻与左派联系在一起。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
It was like pro-cannabis was left.
就好像支持大麻的人被留下了。
Now, pro-cannabis is actually very strongly correlated with the-
现在，支持大麻实际上与-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I know.
我知道。
It's interesting
很有趣
Andrew Huberman:
安德鲁·休伯曼：
...
...
with the laws anyway, of this rescheduling.
无论如何，这次重新安排是符合法律的。
And you watch the media just kind of pivot, and it's just very clear that the traditional media isn't paying attention to the actual data.
你会看到媒体只是在旋转，很明显传统媒体并没有关注实际数据。
It's sort of like, how can we use this as a weapon?
有点像，我们如何使用它作为武器？
On both sides.
两侧。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
100%.
100%。
Andrew Huberman:
安德鲁·休伯曼：
And so depending on where people get their news, it can be very confusing to people.
因此，根据人们从哪里获取新闻，这可能会让人们感到非常困惑。
Along those lines, for whatever reason, nicotine has become this right-wing associated thing.
沿着这些思路，无论出于何种原因，尼古丁已经成为与右翼相关的东西。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I know.
我知道。
Andrew Huberman:
安德鲁·休伯曼：
I recently spoke to about 4,000 young men and women, and I would say about 30% to 40% of them raised their hand that they're using oral nicotine every single day.
我最近与大约 4,000 名年轻男女进行了交谈，我想说他们中大约 30% 到 40% 举手说他们每天都在使用口服尼古丁。
Anywhere from probably, I did a crude analysis by hand, so these aren't hard data, but it was somewhere between 12 and 70 milligrams of nicotine a day.
无论如何，我手工进行了粗略分析，所以这些不是硬数据，但每天的尼古丁含量在 12 到 70 毫克之间。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
That's wild.
那太疯狂了。
Andrew Huberman:
安德鲁·休伯曼：
So for women in particular, is oral nicotine use detrimental to either egg quality or probability of successful pregnancy?
那么，特别是对于女性来说，口服尼古丁是否会对卵子质量或成功怀孕的可能性有害？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It's definitely correlated because of how it works in the brain to ovulation, getting pregnant, hormone response.
它肯定是相关的，因为它在大脑中的工作方式与排卵、怀孕、激素反应有关。
So it should not be something that we're adding to our day-to-day life in any form if we're trying to get pregnant.
因此，如果我们想怀孕，就不应该以任何形式将其添加到日常生活中。
Most the egg quality data from nicotine comes from cigarette smoking-
大多数来自尼古丁的鸡蛋质量数据来自吸烟——
Andrew Huberman:
安德鲁·休伯曼：
Uh-huh
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
so I think it's a little bit more nuanced because smoking directly, if we want to look at that, I always say it's one of the few things that gets into the vault and decreases our egg count.
所以我认为这有点微妙，因为直接吸烟，如果我们想看看这一点，我总是说这是进入金库并减少我们的卵子数量的少数东西之一。
And as I say, chronic inflammation can get in there, but nicotine, cigarette smoking definitely does.
正如我所说，慢性炎症可以进入那里，但尼古丁和吸烟肯定会进入那里。
You go into menopause early, you'll get fewer eggs.
您提前进入更年期，获得的卵子就会减少。
The egg quality is detrimental.
对卵子质量不利。
It makes sense based on what nicotine does to your body and how it changes your cellular response, that it probably is impacting your egg quality also, even with these oral nicotine pouches that we're seeing everybody utilize.
根据尼古丁对您身体的作用以及它如何改变您的细胞反应，它可能也会影响您的卵子质量，即使我们看到每个人都使用这些口服尼古丁袋，这是有道理的。
And it's tanking sperm counts.
而且精子数量也会减少。
That one's really clear.
这个说的真清楚啊
Andrew Huberman:
安德鲁·休伯曼：
And then, of course, everyone's talking about the reduction in just population growth, which when I was growing up, we were told that the Earth is going to be overcrowded.
当然，每个人都在谈论人口增长的减少，在我成长的过程中，我们被告知地球将变得拥挤不堪。
Now we're told that there's not going to be enough people.
现在我们被告知人手不够。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
It's funny, right?
很有趣，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Everyone's going to be alone on their phones.
每个人都会独自一人玩手机。
I don't think either extreme is true.
我认为这两种极端都不正确。
But these are vitally important things for people to think about because these are easy decisions to make, and they can be short-term decisions.
但这些对于人们来说是非常重要的事情，因为这些决定很容易做出，而且可能是短期决定。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
They are.
他们是。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We make decisions every day, and you don't have to be perfect, and you don't have to be all or nothing, and it doesn't have to be forever.
我们每天都在做决定，你不必是完美的，你不必是全有或全无，也不必永远如此。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
A lot of these things, once you really start making a bunch of them and decreasing inflammation, you will tangibly feel better.
很多这样的东西，一旦你真正开始制作一堆并减少炎症，你会明显感觉更好。
I think we are creatures of our own world, and humans by nature adjust to the environment we put our body into.
我认为我们是自己世界的生物，人类天生就会适应我们身体所处的环境。
So even things like we talked about sleep, but chronic stress, how it's directly associated with insulin resistance, how building skeletal muscle is one of the top ways you can reverse insulin resistance.
因此，即使像我们谈论的睡眠这样的事情，但慢性压力，它如何与胰岛素抵抗直接相关，构建骨骼肌如何成为逆转胰岛素抵抗的最佳方法之一。
It's the best mechanism for hormonal health we have is to build more skeletal muscle.
我们拥有的荷尔蒙健康的最佳机制是构建更多的骨骼肌。
These things can impact your fertility and your health long term.
这些事情会长期影响您的生育能力和健康。
And so once we start to make these little decisions, eating more fiber, anti-inflammatory foods, cutting down the ultra-processed foods, removing the toxins, changing the toxic behaviors, sleeping more, really trying to manage stress in a more productive way Together, when your inflammatory burden lowers, people feel better, and then they get it.
因此，一旦我们开始做出这些小决定，吃更多的纤维、抗炎食物、减少超加工食品、去除毒素、改变有毒行为、睡得更多，真正尝试以更有效的方式管理压力，当你的炎症负担降低时，人们会感觉更好，然后他们就会明白。
Then they say, "Oh, this running on just caffeine and eating whatever food I could on the go and not getting enough sleep, and then using 100 nicotine patch, that was my body giving me 100 red flags that it is working overtime to deal with what I'm handing it." So how is it supposed to do its normal day-to-day function?
然后他们说，“哦，这种跑步只靠咖啡因，在路上吃任何我能吃的食物，而且睡眠不足，然后使用 100 片尼古丁贴片，这就是我的身体给我发出的 100 个危险信号，表明它正在加班加点地处理我正在处理的问题。”那么它应该如何执行正常的日常功能呢？
Which at its purest, that's where your body should try to be, especially when it comes to trying to get pregnant and have the best egg and sperm quality.
最纯粹的是，这就是您的身体应该努力达到的状态，尤其是在尝试怀孕并获得最佳卵子和精子质量时。
Andrew Huberman:
安德鲁·休伯曼：
I would never ask you to assign any validity to something for which there's no data.
我绝不会要求你对没有数据的事物赋予任何有效性。
But in your experience, your clinical and scientific experience, is there something that you've heard from your patients and then observed in terms of outcomes that is intriguing to you that you would like to see more science on?
但根据您的经验、临床和科学经验，是否有一些您从患者那里听到并观察到的结果令您感兴趣，并且您希望看到更多科学依据？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh, yes.
哦，是的。
Absolutely.
绝对地。
Andrew Huberman:
安德鲁·休伯曼：
And the reason I ask this is there's this incredible intuition that comes from just being in regular contact with a certain process.
我问这个问题的原因是，这种令人难以置信的直觉来自于定期接触某个流程。
For instance, any time I've spoken to an embryologist who does the kind of work that they do in your clinic, they read journals and there's a process.
例如，每当我与在你们诊所从事此类工作的胚胎学家交谈时，他们都会阅读期刊，并且有一个过程。
They learn protocols, but they develop an intuition to pick that sperm, to wait just a little bit longer, maybe even fertilizing that egg at the end of the day-
他们学习协议，但他们产生了一种直觉来挑选精子，等待更长的时间，甚至可能在一天结束时使卵子受精——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh, I know
哦，我知道
Andrew Huberman:
安德鲁·休伯曼：
...
...
even though it looks more mature than the-
尽管它看上去比——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It's a couple of hours.
已经几个小时了。
It's a little small, it's a little gray
有点小，有点灰
Andrew Huberman:
安德鲁·休伯曼：
This is the art, not the-
这是艺术，而不是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It's like the je ne sais quoi of medicine
这就像医学上的“je ne sais quoi”
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
The art, not the science of it.
这是艺术，而不是科学。
The same way cooking is chemistry, but there's an art to it, too.
就像烹饪是化学一样，但它也是一门艺术。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And that nothing can replace those millions of hours in contact with the process.
没有什么可以取代与该过程接触的数百万小时。
So you've had so many hours in this process at every level.
所以你在每个级别的这个过程中都花了很多时间。
Is there something that intrigues you and that you'd like to see more science on?
有什么东西让你感兴趣并且你想看到更多的科学知识吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I love that question.
我喜欢这个问题。
One thing I think I want most people to take away, and then I'll answer the question, is that you can make tangible improvement in your fertility.
我认为我希望大多数人明白的一件事是，你可以切实改善你的生育能力，然后我会回答这个问题。
By looking at these lifestyle factors and coming up with a plan to try to decrease your inflammatory burden, you can have a different outcome.
通过研究这些生活方式因素并制定一个尝试减轻炎症负担的计划，您可以得到不同的结果。
And I think that conversation's even more important if you're waiting longer to get pregnant, or if you're at an older age, or you have lower ovarian reserve because knowing that you are controlling all these variables to put the best egg and sperm forward is really important.
我认为，如果您等待怀孕的时间更长，或者您年龄较大，或者您的卵巢储备较低，那么这种对话就更加重要，因为知道您正在控制所有这些变量以提供最好的卵子和精子确实很重要。
The most intriguing part of the conversation for me right now is GLP-1s and their use for potential chronic inflammatory disease like endometriosis.
目前对我来说最有趣的部分是 GLP-1 及其在治疗子宫内膜异位症等潜在慢性炎症性疾病中的用途。
As a field, we quickly accepted that they are hugely powerful for PCOS and states of obvious insulin resistance for reasons that make sense to everybody.
作为一个领域，我们很快就承认它们对于 PCOS 和明显的胰岛素抵抗状态非常有效，原因对每个人都有意义。
They also help, obviously, patients lose weight.
显然，它们还可以帮助患者减肥。
Fat cells make estrogen.
脂肪细胞产生雌激素。
They impact the ovulatory process.
它们影响排卵过程。
Fat cells are inflammatory.
脂肪细胞有炎症。
So all the things that we said were negative.
所以我们所说的所有事情都是消极的。
So by simply losing weight, we can restore ovulation, we can have improved IVF outcomes, and it is just a more effective mechanism for weight loss.
因此，通过简单地减肥，我们可以恢复排卵，我们可以改善体外受精的结果，这只是一种更有效的减肥机制。
So easy to jump on and say, "I have a patient who needs to lose weight.
很容易跳上来说：“我有一个病人需要减肥。
I have a patient with PCOS." GLP-1 agonist can be a very powerful tool to that.
我有一位多囊卵巢综合症患者。” GLP-1 激动剂可以成为一个非常强大的工具。
Where I see right now are patients who have known endometriosis or what I call probable endo.
我现在看到的是患有子宫内膜异位症或我所说的可能子宫内膜异位症的患者。
They have unexplained infertility.
他们患有不明原因的不孕症。
50% of those patients will end up having endometriosis.
其中 50% 的患者最终会患上子宫内膜异位症。
One of the problems with endo is gold standard is a surgical diagnosis only.
内切酶的问题之一是金标准仅是手术诊断。
We don't have a lab test for endometriosis.
我们没有子宫内膜异位症的实验室测试。
But when we are getting unexplained IVF outcomes that do not match what we would expect, or we have these known chronic inflammatory diseases, I will have patients go on a GLP-1, low dose for three months.
但是，当我们得到无法解释的 IVF 结果与我们的预期不符时，或者我们患有这些已知的慢性炎症性疾病时，我会让患者接受三个月的低剂量 GLP-1。
We have to stop them and then go through a cycle of different IVF outcomes.
我们必须阻止它们，然后经历不同的体外受精结果的循环。
We will see more embryos in the lab.
我们将在实验室看到更多的胚胎。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And we don't have the study to say that, but-
我们没有研究表明这一点，但是-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
talking to colleagues across the country, we know that GLP-1s can be very anti-inflammatory and the way to kind of target what appears to be that inflammatory burden.
通过与全国各地的同事交谈，我们知道 GLP-1 具有很强的抗炎作用，并且是一种针对炎症负担的方法。
And I think that there will be utility there within the context of these chronic inflammatory disease that might be able to help a patient population that we've struggled with, with difficulty to get to a diagnosis or limited data points on what to do with it.
我认为，在这些慢性炎症性疾病的背景下，它会有用处，它可能能够帮助我们一直在努力治疗的患者群体，这些患者群体很难获得诊断或关于如何处理的数据点有限。
So the data's not out yet, but it is a tool I add to the box, especially if we're not getting outcomes we would expect, and we don't have another reason why.
所以数据还没有出来，但它是我添加到盒子里的一个工具，特别是如果我们没有得到我们预期的结果，并且我们没有其他原因。
Andrew Huberman:
安德鲁·休伯曼：
So do you think there could be direct effects of the GLP-1s on reducing inflammation that are independent of less adipose fat tissue?
那么您认为 GLP-1 对减少炎症的直接影响是否与脂肪组织减少无关？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I do because some of these patients do not have much adipose tissue.
我这样做是因为其中一些患者没有太多脂肪组织。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So I think obviously that person's going to get even more benefit if they have adipose tissue to lose that's causing inflammation.
所以我认为显然，如果人们失去导致炎症的脂肪组织，他们会获得更多的好处。
But I think especially if we think about autoimmune disease-
但我认为尤其是当我们考虑自身免疫性疾病时——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
where people's immune system, their inflammatory response is mis-triggering-
人们的免疫系统，他们的炎症反应被错误触发-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
I think that there's benefit for the GLP-1s in that population specifically that is giving them an added benefit to decrease inflammation in a really profound way.
我认为 GLP-1 对这一人群有好处，特别是给他们带来额外的好处，以真正深远的方式减少炎症。
Andrew Huberman:
安德鲁·休伯曼：
It's really interesting because I would've thought GLP-1s reducing body fat for a woman who isn't carrying excess body fat-
这真的很有趣，因为我认为 GLP-1 可以减少体内脂肪不过多的女性的体内脂肪 -
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Could be
可能是
Andrew Huberman:
安德鲁·休伯曼：
...
...
that might actually be detrimental to getting pregnant.
这实际上可能不利于怀孕。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It's a fair point that we have to be really careful when it comes to skinny culture.
公平地说，当谈到瘦身文化时，我们必须非常小心。
We are seeing just societal norms shift again to be very thin after being more body positive, be of a healthy weight.
我们看到，在对身体更加积极、健康的体重之后，社会规范再次转变为非常瘦。
We are definitely seeing celebrities go back to being extremely thin, and we know at both extremes of body weight, again, the hypothalamus is your checkpoint.
我们肯定会看到名人恢复到非常瘦的状态，而且我们知道，在体重的两个极端下，下丘脑都是你的检查点。
If you don't have enough body fat, we are worried that you cannot maintain a pregnancy, so it can stop how it's sending off hormones.
如果您没有足够的身体脂肪，我们担心您无法维持妊娠，因此它会阻止荷尔蒙的分泌。
And again, we can see a luteal phase defect is that first warning sign before you're in true hypothalamic amenorrhea.
再次，我们可以看到黄体期缺陷是真正的下丘脑闭经之前的第一个警告信号。
So I think we have to be really careful in that patient group, and it has to be done with the right person who has a lot of experience with GLP-1s that are super low doses.
因此，我认为我们必须在该患者群体中非常小心，并且必须由对超低剂量 GLP-1 有丰富经验的合适人员来完成。
The goal is not weight loss.
目标不是减肥。
It's really a different goal.
这确实是一个不同的目标。
And again, I don't have a paper to prove it, but we are seeing that clinical experience to say At the end of the day, we could say there's merit in trying to decrease inflammation, especially in people who we suspect is contributing to the circumstance they are in.
再说一次，我没有论文来证明这一点，但我们看到临床经验说，归根结底，我们可以说尝试减少炎症是有好处的，特别是对于那些我们怀疑是造成这种情况的人。
Andrew Huberman:
安德鲁·休伯曼：
And you said low-dose GLP.
你说的是低剂量 GLP。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Are these available in generic form now, or are they still under patent where they have to be-
这些现在是否以通用形式提供，或者它们仍然处于专利状态，它们必须是-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I don't know the answer to that one.
我不知道这个问题的答案。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
I don't know.
我不知道。
I know compounding pharmacies are making them.
我知道复合药房正在生产它们。
I know today, today the gray market for peptides in this country-
我今天知道，今天这个国家的肽灰色市场——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I know
我知道
Andrew Huberman:
安德鲁·休伯曼：
...
...
was shut down, so no more.
被关了，所以就没有了。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Well, you never can tell.
好吧，你永远无法判断。
Andrew Huberman:
安德鲁·休伯曼：
You can no longer buy that just for research purposes.
您不能再仅仅为了研究目的而购买它。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But compounding pharmacies seem to be protected.
但复方药房似乎受到保护。
But I just ask because of the GLPs, at least the non-generic forms in their full dosage, my understanding is that they can be rather expensive.
但我只是问，因为 GLP，至少是全剂量的非仿制药，我的理解是它们可能相当昂贵。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But the lower dosages in generic form perhaps have to be more affordable.
但仿制药的较低剂量可能更便宜。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
One would think, yeah.
有人会想，是的。
And I think, again, there's a lot of kitchen sink approach we do-
我再次认为，我们有很多厨房水槽的方法-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
in fertility medicine.
在生育医学中。
I've used human growth hormone for years and years and years.
我使用人类生长激素很多年了。
There's not an FDA approval to use HGH for egg quality, yet we see that it can improve egg quality in the right patient in the lab.
FDA 尚未批准使用 HGH 来提高卵子质量，但我们发现它可以在实验室中改善合适患者的卵子质量。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So if somebody has a cycle and they don't get as many mature eggs, or their embryos don't do as well, my partner actually did a study where she put them through the same protocol, so the same medications in a subsequent cycle, and the only change was adding human growth hormone and had improved embryo development and maturity of eggs.
因此，如果某人有一个周期，但他们没有获得尽可能多的成熟卵子，或者他们的胚胎表现不佳，我的伴侣实际上做了一项研究，她让他们接受相同的方案，因此在随后的周期中使用相同的药物，唯一的变化是添加人类生长激素，并改善了胚胎发育和卵子成熟度。
Andrew Huberman:
安德鲁·休伯曼：
Amazing.
太棒了。
So this is like an IU a night or something like that?
所以这就像 IU 一晚之类的吗？
Like some low dose of HGH-
就像一些低剂量的 HGH-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yes
是的
Andrew Huberman:
安德鲁·休伯曼：
...
...
during the IC.
在 IC 期间。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah, just during the STEM.
是的，就在 STEM 期间。
So it's like two weeks of use.
所以使用了两周左右。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And so then now that's starting to be extrapolated, and people are starting to look at it longer or before STEM.
所以现在这开始被推断，人们开始更长时间或在 STEM 之前关注它。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And so we have to take that-- I love the fact that my field's always viewed cutting-edge research.
所以我们必须接受这一点——我喜欢这样一个事实：我的领域总是关注尖端研究。
It's a double-edged sword.
这是一把双刃剑。
There's some good and there's some bad.
有一些好的，也有一些坏的。
But we really want to think about mechanistically if it could potentially help having a low threshold to attempt it in patients who are getting at the end of their journey specifically.
但我们真的想从机制上考虑它是否有可能有助于降低门槛，特别是在即将结束旅程的患者中进行尝试。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
When they've done all the basics.
当他们完成所有基础工作后。
They're controlling the lifestyle factors.
他们正在控制生活方式因素。
I will say one thing I dislike is this just do IVF mentality, meaning nothing you can do can impact your egg quality.
我想说的一件事是，我不喜欢这种“只做试管受精”的心态，这意味着你所做的任何事情都不会影响你的卵子质量。
Let's just do IVF, and then we're compounding dollars and dollars and dollars, yet we're not eating anti-inflammatory food, and we're drinking wine every night, and we're not getting enough sleep.
我们就做试管受精吧，然后我们把钱加起来，但我们不吃抗炎食物，我们每晚都在喝酒，而且我们睡眠不足。
So I think that we've got to really look at these five non-negotiable areas and optimize them to the degree we can, knowing each day will be different, but building our body the resilience to be able to respond as it's appropriate to.
因此，我认为我们必须真正关注这五个不可协商的领域，并尽我们所能优化它们，知道每一天都会有所不同，但要增强我们的身体的弹性，以便能够做出适当的反应。
Because sometimes you'll fly to Texas and get less sleep, or you'll go out to eat and you'll eat differently, and your body's meant to handle those challenges, but it can't when it's constantly challenged-
因为有时你会飞往德克萨斯州，睡眠会减少，或者你会出去吃饭，你的饮食方式会有所不同，你的身体本来就应该能够应对这些挑战，但当它不断受到挑战时，它就无法应对-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
every single day, all the moments of the day.
每一天，一天中的所有时刻。
So there's a ton of experimental stuff that we do that's really cool, and some of it will be introduced into practice in 10 years.
因此，我们做了大量非常酷的实验，其中一些将在 10 年内付诸实践。
Probably 15 years ago, if I had said human growth hormone, people would've scoffed, and now it's commonly added on-
大概15年前，如果我说人类生长激素，人们会嗤之以鼻，而现在它通常被添加——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
when we're not getting the outcome we want, and that's how medicine should be.
当我们没有得到我们想要的结果时，这就是医学应该做的。
We should not be afraid to say that the perfect study doesn't have to exist.
我们不应该害怕说完美的研究不一定存在。
If the physiology makes sense, if there's suggested studies, if we explain it to the patients, we help have shared decision-making with them because if we're always waiting for the perfect RCT, there will be thousands of patients we could've helped in the interim-
如果生理学有意义，如果有建议的研究，如果我们向患者解释，我们就可以帮助他们与他们共同做出决策，因为如果我们总是等待完美的随机对照试验，那么我们可以在此期间帮助成千上万的患者。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
that we didn't.
我们没有。
Andrew Huberman:
安德鲁·休伯曼：
What are your thoughts on platelet-rich plasma?
您对富含血小板血浆有何看法？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh, such a good question.
哦，真是个好问题。
Andrew Huberman:
安德鲁·休伯曼：
Which is not stem cells, by the way.
顺便说一句，这不是干细胞。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
No.
不。
Andrew Huberman:
安德鲁·休伯曼：
Sorry to just shout out there.
抱歉，只是在那里大喊大叫。
People think it's stem cells.
人们认为它是干细胞。
Stem cells are not allowed by the FDA in the United States.
美国 FDA 不允许使用干细胞。
A vision clinic, they were injecting them into the eye for macular degeneration, and the patients all went blind, and I'm very familiar with those cases.
一家视力诊所，他们把它们注射到眼睛里治疗黄斑变性，病人都失明了，我对这些病例非常熟悉。
It was that specific clinic that shut down stem cell.
正是那个特定的诊所关闭了干细胞。
You can't advertise stem cells online anymore.
您不能再在网上宣传干细胞了。
But PRP is not stem cells.
但PRP不是干细胞。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Okay.
好的。
Andrew Huberman:
安德鲁·休伯曼：
Forgive me for interrupting.
请原谅我打扰。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
PRP has two potential different mechanisms by which it can be used, and it's different.
PRP 有两种潜在的不同机制可供使用，而且它们是不同的。
So one is intrauterine PRP, where we are injecting it into the uterine cavity, similar to how we put an embryo inside or how we would do an intrauterine insemination.
一种是宫内 PRP，我们将其注射到子宫腔中，类似于我们将胚胎放入子宫内或进行宫内授精的方式。
So small catheter, not invasive, but kind of goes through the cervix right into the uterus.
这么小的导管，不是侵入性的，而是穿过子宫颈直接进入子宫。
The other is looking at ovarian PRP, which is a more invasive procedure.
另一个是检查卵巢 PRP，这是一种更具侵入性的手术。
This is using the same needle like we do for IVF, yet instead of extracting the follicular fluid and the eggs, I'm putting the PRP into the ovaries.
这是使用与 IVF 相同的针头，但我不是提取卵泡液和卵子，而是将 PRP 放入卵巢。
Looking at it for two different reasons, implantation failure or potential Asherman's scarring of the uterus in the uterine PRP group, and looking at it for low ovarian reserve or age-related fertility in the PRP of the ovary group.
考虑两个不同的原因，子宫 PRP 组中的着床失败或子宫潜在的 Asherman 疤痕，以及卵巢 PRP 组中的卵巢储备功能低下或与年龄相关的生育能力。
Where it shows the most promise is intrauterine PRP, which is nice because it's less invasive.
最有希望的是宫内 PRP，这很好，因为它的侵入性较小。
That's the minority of people who are having recurrent implantation failure.
这是反复着床失败的少数人。
Most people don't have success because they don't make enough embryos.
大多数人没有成功是因为他们没有制造足够的胚胎。
That's the rate-limiting step for most people with IVF, meaning if you have three genetically normal embryos, almost 95% of people will have a live birth.
对于大多数 IVF 患者来说，这是限速步骤，这意味着如果您拥有三个基因正常的胚胎，几乎 95% 的人都会活产。
So we're talking about a very small subset of the population here, but showing the most promise, though not universally accepted and isn't done everywhere.
因此，我们在这里谈论的是人口中的一小部分，但显示出最大的希望，尽管没有得到普遍接受，也不是在所有地方都这样做。
Ovarian PRP is a little bit more nuanced because clinics can charge a lot for it.
卵巢 PRP 有点微妙，因为诊所的收费很高。
It's a procedure.
这是一个程序。
You need anesthesia.
你需要麻醉。
I'm putting a needle in the ovary.
我正在把一根针插入卵巢。
I'm always a lot more skeptical of potentially damaging the ovary or potential developing eggs.
我总是对可能损害卵巢或潜在发育的卵子持怀疑态度。
Although no study has supported that it does do that.
尽管没有研究支持它确实可以做到这一点。
There are some more hypothetical concerns with that versus uterine, where you're not really damaging any structure, you're just adding it.
与子宫相比，还有一些更多假设性的担忧，在子宫中，你并没有真正破坏任何结构，你只是添加了它。
That being said, ovarian PRP is currently being studied.
话虽如此，卵巢 PRP 目前正在研究中。
We don't have definitive data.
我们没有确切的数据。
Potentially could be something to consider if you're really approaching that end game.
如果您真的接近最终游戏，那么可能需要考虑一些事情。
You're really not getting the outcome you want.
你确实没有得到你想要的结果。
You are older.
你年纪大了。
You have low ovarian reserve.
您的卵巢储备功能较低。
There are people who have some success stories.
有些人有一些成功的故事。
So I think it's, again, the exception, not the rule.
所以我认为这再次是例外，而不是规则。
Has potential benefit, but yet to be determined.
具有潜在的好处，但尚未确定。
Andrew Huberman:
安德鲁·休伯曼：
A few years back, there was more discussion about the age of the sperm and the probability of autism.
几年前，关于精子年龄和自闭症概率的讨论较多。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Could you update me on the The data?
您能给我更新一下数据吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
After age 50, we see a few different increases for sperm specifically.
50 岁以后，我们会发现精子有一些不同的具体增加。
So advanced paternal age is real, both when it comes to how you make sperm, but also the quality of that sperm.
因此，父亲高龄是真实存在的，无论是在产生精子的方式方面，还是在精子的质量方面。
We see overall, in a population base, increases of autism, of autosomal dominant new mutations, specifically certain types of dwarfism or very specific diseases that are ultimately overall rare that can happen.
总体而言，我们看到，在人口基数中，自闭症和常染色体显性新突变的增加，特别是某些类型的侏儒症或非常特殊的疾病，这些疾病最终总体上很少发生。
And then you also can see an increase in some other mental health diseases, like schizophrenia.
然后你还可以看到其他一些心理健康疾病的增加，比如精神分裂症。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
That data's scary, not the end-all be-all.
这些数据很可怕，但并不是最终的结果。
At the end of the day, when you have an opportunity to bank sperm younger, it would make sense, and utilize that preferentially.
归根结底，当您有机会在更年轻的时候储存精子时，这是有意义的，并优先利用它。
If somebody came to me and let's say they had banked sperm and it's gone now, and I have a 52-year-old man across from me, I mean, this is who we want to have children with, then this is who we want to have children with, and we accept that risk because on a population it's still very low, right?
如果有人来找我，假设他们已经储存了精子，但现在已经消失了，而我对面有一个 52 岁的男人，我的意思是，这就是我们想要与之生孩子的人，那么这就是我们想要与之生孩子的人，我们接受这种风险，因为对于人口来说，风险仍然很低，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
A small percentage point increase means still the most probable chance is you're going to have a very healthy baby.
增加一个小百分点意味着您仍然有可能生出一个非常健康的宝宝。
It plays more into, though, the idea that nobody's fertility is finite, that age-related impacts impact everybody.
不过，它更多地体现了这样一种观点：没有人的生育能力是有限的，与年龄相关的影响影响着每个人。
I would say the same thing is that if the mechanism is the DNA essentially or the quality of the sperm, then those lifestyle tenets in the 90 days prior to getting sperm or banking it or using it in an IVF cycle probably matter the most, and I would make sure I would want to be controlling all of those factors I was, so I wasn't adding to risk.
我想说的是，如果机制本质上是 DNA 或精子的质量，那么在获取精子、储存精子或在 IVF 周期中使用精子之前 90 天的生活方式原则可能是最重要的，而且我会确保我想要控制所有这些因素，所以我不会增加风险。
Andrew Huberman:
安德鲁·休伯曼：
No cannabis-
没有大麻-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
reduced heat, all the things that mutate DNA.
减少热量，所有使DNA突变的东西。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Nicotine out, that kind of thing.
尼古丁消失，诸如此类的事情。
Yeah, it's interesting.
是的，这很有趣。
I think about the sort of high signal-to-noise anecdotes, things like, "Oh, so-and-so smoked weed every day and has eight kids," or-
我想到了那种高信噪比的轶事，比如“哦，某某每天吸大麻，有八个孩子”，或者——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh
哦
Andrew Huberman:
安德鲁·休伯曼：
...
...
or, "So-and-so had another kid when he was," whatever.
或者，“某某当时还有一个孩子，”诸如此类。
I'm thinking of some actors or something.
我正在考虑一些演员什么的。
I don't follow this stuff closely.
我不太关注这些东西。
It was when he was like 78 or something.
那是在他78岁左右的时候。
The problem with stories like that is that they grab people's attention because they're high signal-to-noise, and they distract from the stuff that really matters to most everybody.
此类故事的问题在于，它们会吸引人们的注意力，因为它们的信噪比很高，并且会分散人们对大多数人真正重要的事情的注意力。
Like freezing eggs is not going to take more eggs out of your reserve than you need.
就像冷冻卵子不会从你的储备中取出比你需要的更多的卵子一样。
The NSAIDs, I mean, I'm just still wide-eyed about this NSAID thing.
非甾体抗炎药，我的意思是，我对非甾体抗炎药这个事情仍然睁大眼睛。
It's something to avoid-
这是要避免的事情——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
while trying to get pregnant.
在尝试怀孕时。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Okay, let's do another one.
好吧，我们再做一个。
Taking a biotin supplementation of 300 micrograms or more for seven days can actually influence your lab assays for sex hormones or for any steroid hormone, actually.
连续 7 天补充 300 微克或更多的生物素实际上可以影响性激素或任何类固醇激素的实验室检测。
So when I will sometimes see patients who are going through an IVF cycle and their estradiol levels are not matching what we're seeing for follicular development, if we go and talk to them and they're taking hair, skin, and nail supplements or something with a high dose of biotin because commercial supplementation-- There are certain very popular hair supplements that have 10 to 30 times that amount in them.
因此，当我有时会看到正在经历 IVF 周期的患者，他们的雌二醇水平与我们所看到的卵泡发育水平不符时，如果我们去与他们交谈，他们正在服用头发、皮肤和指甲补充剂或含有高剂量生物素的东西，因为商业补充剂 - 有些非常受欢迎的头发补充剂的含量是其 10 到 30 倍。
This is binding to the lab test, so we're getting false reads on these labs.
这与实验室测试有关，因此我们在这些实验室上得到了错误的读数。
It's not changing in your body-
你的身体并没有改变-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
but this is an REI board question, an oral board question, is that it binds to the steroid assay, so this can happen to estradiol, to progesterone, to HCG, to TSH, to testosterone.
但这是 REI 委员会的一个问题，一个口头委员会的问题，它与类固醇测定结合，因此雌二醇、黄体酮、HCG、TSH 和睾酮可能会发生这种情况。
So if you are back where we started and you want to get data about your body, maybe you feel off or you're going through IVF, or you want to get a hormone panel done, if you're taking a supplement that has more than 300 micrograms of biotin, you're going to have results that are inaccurate and we cannot trust.
因此，如果您回到我们开始的地方，并且想要获取有关您身体的数据，也许您感觉不舒服，或者您正在接受 IVF，或者您想要完成激素检测，如果您服用的补充剂含有超过 300 微克的生物素，您将得到不准确的结果，我们无法信任。
So really making sure that you're looking at what's in your supplements, and biotin is that specific one that I want to make sure we're not taking excess amounts of.
因此，请务必确保您正在查看补充剂中的成分，而生物素就是我想确保我们不会服用过量的特定物质。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
As long as we're talking about things that people take or put on their body, the last time we sat down and spoke, we had a conversation about endocrine disruptors.
只要我们谈论人们服用或穿在身上的东西，上次我们坐下来说话时，我们就讨论了内分泌干扰物。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh, man.
哦，伙计。
People really-
人们真的——
Andrew Huberman:
安德鲁·休伯曼：
And that went-
然后就是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
loved and hated us for that.
为此又爱又恨我们。
Andrew Huberman:
安德鲁·休伯曼：
Well, I will say, because it's tricky with comments, again, signal to noise.
好吧，我会说，因为评论很棘手，再说一遍，信噪比。
I think many, many more, meaning millions of people, appreciated it as opposed to had issues with it.
我认为还有更多的人，即数百万人，欣赏它，而不是对它有疑问。
I mean, you can tell how frustrated I get with-- My frustration is not with medicine or with science.
我的意思是，你可以看出我有多沮丧——我的沮丧不是医学或科学。
It's with the lack of open ears-
这是由于缺乏开放的耳朵-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Hmm
嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
in a certain generation of physicians and scientists.
在某一代医生和科学家中。
My colleagues at Stanford are very open-minded, and by the way, many of them call me saying, like, "What should I take for this?" Or like-
我在斯坦福大学的同事们思想非常开放，顺便说一句，他们中的许多人打电话给我说，“我应该为此采取什么措施？”或者像-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I love that
我喜欢那个
Andrew Huberman:
安德鲁·休伯曼：
...
...
"What can I do that's not TRT for testosterone?" They're humans, too, and I think the issue around endocrine disruptors for the longest time was seen as kind of hippie science with no data.
“除了睾酮 TRT 之外，我还能做什么？”他们也是人类，我认为有关内分泌干扰物的问题在很长一段时间内被视为没有数据的嬉皮科学。
And then now, because the Environmental Working Group started getting-
然后现在，因为环境工作组开始——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
really vocal about this, and Shanna Swan, who's-
对此，莎娜·斯旺（Shanna Swan）非常直言不讳，她是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yes, lovely
是的，可爱的
Andrew Huberman:
安德鲁·休伯曼：
...
...
a long-time researcher.
长期研究员。
Yeah.
是的。
But then there was this sort of political backlash because somehow people decided to slot her and the Environmental Working Group as kind of anti-standard science.
但随后出现了这种政治上的强烈反对，因为不知何故人们决定将她和环境工作组视为一种反标准的科学。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I know.
我知道。
Andrew Huberman:
安德鲁·休伯曼：
But you sit down with her, that's the furthest thing from the truth.
但你和她坐在一起，这与事实相去甚远。
She's all about data.
她只关心数据。
So I think as we tiptoe into this endocrine disruptor thing, I'll just say it for you, and then if you want to add, none of what we're about to talk about negates anything about standard medicine.
所以我认为，当我们小心翼翼地讨论内分泌干扰物的问题时，我会为你说出来，然后如果你想补充的话，我们将要谈论的任何内容都不会否定标准医学的任何内容。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
No.
不。
Andrew Huberman:
安德鲁·休伯曼：
It's just ways and places to be additionally cautious about things that you are around and might go into you.
这只是让你对周围和可能进入你体内的事物更加谨慎的方法和地点。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
You make decisions every day.
你每天都会做出决定。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
You should be making it from a place of knowledge.
你应该从知识的角度来制作它。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And the things that you're exposed to more frequently matter the most, right?
你经常接触到的事情最重要，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So a one-time exposure because you used hand soap and it had lavender or tea tree oil or whatever, I'm much less concerned about than the products you buy for your home that you're using every single day.
因此，由于您使用洗手液并且其中含有薰衣草或茶树油或其他什么而一次性接触，我比您每天使用的家用产品更不担心。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Because when it comes to endocrine disruptors, a lot of it is the quantity of exposure that really adds up, and this typically comes from frequency because typically it's low levels in a variety of different products.
因为当谈到内分泌干扰物时，很大程度上是接触量的增加，这通常来自频率，因为通常在各种不同的产品中含量较低。
But they absolutely can disrupt hormone function.
但它们绝对会破坏激素功能。
They cause longer time to pregnancy.
它们会导致怀孕时间延长。
There's now been robust data looking at one of the biggest cohort studies we have, and it's called the EARTH Study, where they're looking at different environmental compounds on reproductive health, and they're looking at cohorts of people trying to get pregnant naturally, and they did a sub-study looking at endocrine-disrupting chemicals specifically of those people who went on to do IVF and showed that those who had higher levels of endocrine-disrupting chemicals had a harder time getting pregnant, even with IVF, and their IVF markers, fewer eggs retrieved, fewer embryos, poorer sperm counts.
现在有可靠的数据来审视我们最大的队列研究之一，它被称为“地球研究”，他们正在研究不同的环境化合物对生殖健康的影响，他们正在研究试图自然怀孕的人群，他们还做了一项子研究，专门针对那些继续进行体外受精的人，研究内分泌干扰化学物质，结果表明，那些内分泌干扰化学物质水平较高的人，即使进行体外受精，也很难怀孕，和他们的体外受精标记，取出的卵子更少，胚胎更少，精子数量更少。
So it's definitely not hippie science at this point.
所以在这一点上这绝对不是嬉皮士科学。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
It's well demonstrated that it impacts our bodies in multiple ways.
事实证明，它以多种方式影响我们的身体。
Andrew Huberman:
安德鲁·休伯曼：
And as I recall, the things to be cautious of are lavender, evening primrose, or basically anything with a scent-
我记得要小心的是薰衣草，月见草，或者基本上任何有香味的东西——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Essential oils, for the most part, tend to be fine, but it is lavender, tea tree, and evening primrose that have more endocrine properties for them.
精油在大多数情况下都很好，但薰衣草、茶树和月见草对它们来说具有更多的内分泌特性。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
When it comes to other products, scented products have a lot of phthalates in them, and then that's an endocrine-disrupting chemical.
当谈到其他产品时，香味产品中含有大量邻苯二甲酸盐，这是一种干扰内分泌的化学物质。
And an important note here, which is wild to me because we see so much greenwashing on products where they'll slap a label on it and they'll say "Unscented," but unscented is a scent to mask other scents.
这里有一个重要的说明，这对我来说很疯狂，因为我们在产品上看到了太多的绿色清洗，他们会在上面贴上标签，并说“无味”，但无味是一种掩盖其他气味的气味。
Andrew Huberman:
安德鲁·休伯曼：
Really?
真的吗？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So unscented just means you've masked a scent.
所以无味只是意味着你掩盖了气味。
What you really want to look for is fragrance-free.
您真正想要寻找的是不含香料的。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Because fragrance-free means we added no fragrance to it.
因为无香料意味着我们没有添加任何香料。
To be called unscented, we could have added something to counter the fragrance that was in it.
为了被称为无味，我们可以添加一些东西来抵消其中的香味。
Andrew Huberman:
安德鲁·休伯曼：
Amazing.
太棒了。
And Uber drivers, I'm not saying riding in your Uber with your terrible air freshener is going to prevent people from getting pregnant or conceiving with their partner, but take the freshener out of your Uber-
Uber 司机，我并不是说带着糟糕的空气清新剂乘坐 Uber 会阻止人们怀孕或与伴侣一起受孕，而是说把清新剂从你的 Uber 中拿出来——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Please
请
Andrew Huberman:
安德鲁·休伯曼：
...
...
because you might not be able to have children.
因为你可能无法生育。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
But also for you.
但也为了你。
Like for your-
就像你的——
Andrew Huberman:
安德鲁·休伯曼：
Yeah, no, I was saying for the drivers are the ones exposed to it the most.
是的，不，我是说司机是最容易受到这种影响的人。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Well, for these things, one of the top exposures of BPA right now is actually thermal paper, so receipts.
嗯，对于这些事情来说，目前 BPA 的最大暴露之一实际上是热敏纸，也就是收据。
So think about receipts-
所以想想收据——
Andrew Huberman:
安德鲁·休伯曼：
Mm
毫米
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
at the grocery store or the airline counter.
在杂货店或航空公司柜台。
So for getting it one time and touching it, it's probably not a big deal.
所以，拿到一次、摸一摸，可能也没什么大不了的。
But for the people who do that job and are exposed all the time to thermal paper, that actually can be such a high-level exposure.
但对于从事这项工作并一直接触热敏纸的人来说，这实际上是一种高水平的接触。
So that's a good example where I say you need to use gloves if that's your industry that you're going to be exposed to thermal paper a lot.
这是一个很好的例子，我说如果您所在的行业会经常接触热敏纸，那么您需要使用手套。
So same thing for, let's say, the Uber driver.
比如说，优步司机也是如此。
This is what you're spending your time doing.
这就是你花时间做的事情。
You don't need that fragrance for your own health.
为了您自己的健康，您不需要那种香水。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And certainly, we don't want to get in the Uber with, I know I'm so mean, if this smells, I'll star them lower.
当然，我们不想和 Uber 打车，我知道我很刻薄，如果这味道不好，我会给他们降星。
Because it's like I think-
因为就像我想的那样——
Andrew Huberman:
安德鲁·休伯曼：
No, that's fair
不，这很公平
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
you should know.
你应该知道。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
You're paying for a service.
您正在为一项服务付费。
I usually roll the window down and stick my head out the window.
我通常摇下车窗，把头伸出窗外。
If they're coughing, I hate being sick, and I'm like-
如果他们咳嗽，我讨厌生病，我就像——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I know
我知道
Andrew Huberman:
安德鲁·休伯曼：
...
...
"I didn't pay to get sick." So, I try to be polite about it, but there's just-
“我没有花钱买病。”所以，我试着保持礼貌，但只是——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
But again
但再一次
Andrew Huberman:
安德鲁·休伯曼：
...
...
you got to take care of-
你必须照顾-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
We control the things we can, right?
我们可以控制我们能控制的事情，对吗？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
So let's control the fragrance in our home and in our products-
因此，让我们控制家里和产品中的香味——
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
because to your point, we can't control what's in the Uber.
因为就你而言，我们无法控制 Uber 中的内容。
And so we're not going to stress about it.
所以我们不会对此感到压力。
That's the argument I get, number one, is that you're causing people to be stressed about toxins that otherwise they wouldn't be.
这就是我得到的第一个论点，那就是你让人们对毒素产生了压力，否则他们不会有这种压力。
And again, that's paternalistic.
再说一遍，这是家长作风。
Toxins are impactful to your health.
毒素会影响您的健康。
I should give you the data so that you can cultivate the day-to-day life that is to the degree where you don't stress about it when you're on the plane or you're in an Uber or you're at a party because that one-off isn't such a big deal because you're not exposed to it every single day inside your home.
我应该给你这些数据，这样你就可以培养日常生活，当你在飞机上、在优步或在聚会上时，你不会感到压力，因为一次性的事情并不是什么大问题，因为你不会每天在家中都接触到它。
Andrew Huberman:
安德鲁·休伯曼：
I like to think that people want information.
我喜欢认为人们想要信息。
I realize they can feel overwhelmed by too much information-
我意识到他们可能会对太多信息感到不知所措——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
but in the end, even though what we're talking about here seems like a lot of to-dos and not to-dos, there's a logic to it.
但最终，尽管我们在这里谈论的事情看起来像是很多待办事项而不是待办事项，但它是有逻辑的。
I think the logical backbone is you do what you can.
我认为逻辑支柱是你尽你所能。
You do your best to control the key variables.
您尽力控制关键变量。
The point about cannabis, I think, is really important that especially men hear, because I think most people don't know, and women don't know they should get their AMH checked.
我认为，关于大麻的观点非常重要，尤其是男性听到的，因为我认为大多数人不知道，女性也不知道她们应该检查 AMH。
That's changing because of people like you being out there doing public education.
由于像您这样的人在那里进行公共教育，这种情况正在发生变化。
But I like to think that people want knowledge.
但我喜欢认为人们想要知识。
I really do.
我真的这么做。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I actually think people do want knowledge, and I don't think they're the ones giving the counterargument, to be honest, right?
我实际上认为人们确实想要知识，而且说实话，我不认为他们是提出反驳的人，对吧？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
I think it's our colleagues who say, "Oh, people don't want to hear that," or they make assumptions.
我认为是我们的同事说，“哦，人们不想听这个”，或者他们做出假设。
And again, in today's world where we have data, why are we talking about assumptions?
再说一遍，在当今世界，我们拥有数据，为什么我们还要谈论假设呢？
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Let's give people data and let them make the choices they make.
让我们为人们提供数据，让他们做出选择。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Ignorance is not bliss when you're running up against a health challenge.
当您面临健康挑战时，无知并不是幸福。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
If you haven't had your own health challenge, maybe it's hard to understand what it is.
如果您自己没有遇到过健康挑战，也许很难理解它是什么。
And for infertility, for most people, this is their first time their health is really being challenged, usually because of the age range of which it hits.
对于不孕症，对于大多数人来说，这是他们的健康第一次真正受到挑战，通常是因为它所影响的年龄范围。
That was my story.
这就是我的故事。
A decade later, I got diagnosed with celiac disease despite having unexplained recurrent pregnancy loss.
十年后，尽管我有不明原因的反复流产，但还是被诊断出患有乳糜泻。
I can tell you that this collided with my fertility fellowship when I advocated for doing vitamin research and all this epidemiology.
我可以告诉你，当我主张进行维生素研究和所有这些流行病学时，这与我的生育奖学金发生了冲突。
I saw the word inflammation in all of that text, yet we weren't talking about it with our patients.
我在所有文字中都看到了“炎症”这个词，但我们并没有与患者谈论它。
And I went on this journey to get rid of Teflon in our kitchen because I studied PFCs, and we changed the foods that we ate, changed how we exercised, and how we slept.
我踏上了摆脱厨房中的聚四氟乙烯的旅程，因为我研究了全氟化碳，我们改变了我们吃的食物，改变了我们的锻炼方式和睡眠方式。
And one of the things that I cut out learning to listen to my body was gluten at the time.
当时我放弃学习倾听身体的事情之一就是麸质。
Even though I would have never said I had GI symptoms from it, I just said I felt more inflamed, like-
尽管我从来没有说过我有胃肠道症状，但我只是说我感觉更发炎，就像-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
vague symptoms, kind of headache, kind of more fatigued.
症状不明确，有点头痛，有点更疲劳。
And when I conceived my children, before we ever had to do IVF, we got pregnant naturally in that time period when I didn't have gluten.
当我怀上我的孩子时，在我们必须进行体外受精之前，我们在我没有麸质的那段时间自然怀孕了。
So decade later, get the diagnosis that was actually contributing to why we had these different pregnancy losses.
所以十年后，得到的诊断实际上是导致我们出现这些不同的流产的原因。
So it wasn't unexplained at all.
所以这根本就不是无法解释的。
And not that everybody needs to cut gluten out, but understanding how chronic inflammation impacts our bodies and learning to listen to our body is one of the most powerful tools that we have.
并不是说每个人都需要戒掉麸质，但了解慢性炎症如何影响我们的身体并学会倾听我们的身体是我们拥有的最强大的工具之一。
Andrew Huberman:
安德鲁·休伯曼：
Mm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And it starts with education and knowledge, learning how to advocate for ourself, right?
它从教育和知识开始，学习如何为自己辩护，对吧？
When you know what's normal, you can sit in front of somebody and say, "This isn't normal," and mean it with your full heart.
当你知道什么是正常的时，你可以坐在某人面前说：“这不正常”，并且全心全意地说。
And then how do you optimize all the things at home?
那么你如何优化家里的所有东西呢？
Because back to the other point, even if you need IVF, I can only work with the eggs and sperm you give me.
因为回到另一点，即使你需要试管受精，我也只能用你给我的卵子和精子。
And maybe if we're focusing on some of the stuff earlier, there's probably a subset of people who can get pregnant without IVF, or who can freeze eggs and have an easier journey because they had this information, and they made choices based off of it.
也许如果我们早些时候关注一些事情，可能会有一部分人不需要体外受精就能怀孕，或者可以冷冻卵子并有一个更轻松的旅程，因为他们有这些信息，并且他们根据这些信息做出了选择。
Andrew Huberman:
安德鲁·休伯曼：
What I'm realizing hearing you today is that we need to listen to our bodies.
今天听到您的讲话我意识到我们需要倾听我们的身体。
Women need to listen to their bodies because we're mainly talking about women's health here.
女性需要倾听自己身体的声音，因为我们在这里主要讨论女性的健康。
Men do too, but we're talking about women.
男人也这样做，但我们谈论的是女人。
But also learn to be scientists of our bodies.
但也要学会成为我们身体的科学家。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And when it comes to nutrition, I'm very curious because of your example Do you think there's any value to people experimenting with a "cleaner" diet, if for no other reason than to figure out which ingredients don't work for them?
当谈到营养时，我很好奇，因为你的例子，你认为人们尝试“更清洁”的饮食有任何价值吗？如果没有其他原因，只是为了弄清楚哪些成分对他们不起作用？
Meaning, if you have granola for breakfast and a side of eggs and some toast, or one day you have eggs and the next day you have toast, or both, whatever, and then for lunch you're having a sandwich-
意思是，如果你早餐吃格兰诺拉麦片、一面鸡蛋和一些吐司，或者有一天你吃鸡蛋，第二天你吃吐司，或者两者兼而有之，然后午餐你吃三明治——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
and then for dinner you're having some pasta with some sauce, and you don't feel well.
然后晚餐时，你吃了一些意大利面和一些酱汁，你感觉不舒服。
You don't know what the problem is.
你不知道问题是什么。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
So I'm not advocating for a spartan diet where it's chicken breast next to rice next to broccoli with a tablespoon of olive oil next to it, although that sounds pretty okay.
所以我并不提倡斯巴达式的饮食，即鸡胸肉、米饭、西兰花、一汤匙橄榄油，尽管这听起来不错。
I'd prefer-
我更愿意-
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
There's worse
还有更糟糕的
Andrew Huberman:
安德鲁·休伯曼：
...
...
steak.
牛排。
There's worse.
还有更糟糕的。
But when you eat that way for a short period of time, the sort of cleaner and more or less individual ingredients-
但当你短时间这样吃的时候，那种更干净、或多或少个别成分的——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
I do think that you can get insight into what works for you and what doesn't, independent of all the other information out there.
我确实认为，您可以独立于所有其他信息而深入了解什么对您有用，什么对您无效。
Like for instance, there's certain forms of fibrous foods, I definitely believe in fiber, that I just don't feel well.
例如，有某些形式的纤维食物，我绝对相信纤维，但我只是感觉不舒服。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And then my sister, who is not a scientist, she'll chuckle at that.
然后我的妹妹，她不是科学家，她会笑起来。
But she had this intuition about histamine-
但她对组胺有这样的直觉——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
that has now been confirmed by two guests on this podcast who are MD PhDs who work on these sorts of issues.
该播客的两位嘉宾现已证实了这一点，他们是研究此类问题的医学博士。
In one case pain, in another case gut inflammation.
一种情况是疼痛，另一种情况是肠道炎症。
And she was convinced that she had some histaminergic thing that she read about in some book.
她确信自己在某本书中读到过一些具有组胺活性的物质。
Suggested I take this histamine enzyme tablet before I eat, and it's opened up this whole array of other foods that I can eat.
建议我在吃饭前服用这种组胺酶片，它打开了我可以吃的所有其他食物的大门。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Oh, fantastic.
哦，太棒了。
Andrew Huberman:
安德鲁·休伯曼：
But for years, I would get super sleepy after I would eat certain foods.
但多年来，我在吃某些食物后会变得非常困。
I'm like, "This makes no sense.
我想，“这没有意义。
I like starches, I like fiber." Turns out I have a sort of mild histamine sensitivity to four different foods.
我喜欢淀粉，我喜欢纤维。”事实证明，我对四种不同的食物有轻微的组胺敏感性。
I don't think you can figure that out unless you separate out the ingredients.
我认为除非你把成分分开，否则你无法弄清楚这一点。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Absolutely.
绝对的。
It's like I planted this question for you, even though I didn't, because I advocate, especially if you are falling off the curve.
就好像我为你提出了这个问题，尽管我没有这样做，因为我提倡，特别是如果你正在脱离曲线。
I think if you're trying to learn to listen to your body, you say, "I want to optimize my own health," for a very temporary but restrictive clean eating pattern where you're having lots of fruits and vegetables and fiber, and you're cutting down some of the things that more commonly cause certain reactions.
我认为，如果你想学会倾听身体的声音，你会说，“我想优化自己的健康”，这是一种非常暂时但有限制性的清洁饮食模式，摄入大量水果、蔬菜和纤维，并减少一些更常引起某些反应的食物。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Cutting out gluten, cutting out dairy, cutting back on red meat, and then you add them back in and start to listen to how your body is functioning.
戒掉麸质，戒掉奶制品，戒掉红肉，然后你把它们重新添加进去，开始倾听你的身体机能如何。
But you have to really eliminate first, and then you can add back and see, oh, I feel better, worse, the same.
但你得先真正排除掉，然后你可以加回来看看，哦，我感觉好一点，坏一点，都一样。
Okay, well, if it's worse, that's maybe not something you should have.
好吧，如果情况更糟，那可能不是你应该拥有的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
And then learn to listen for it.
然后学会倾听。
The tenets of a fertility diet are really not eye-opening.
生育饮食的原则确实不令人大开眼界。
Fiber is hugely important for the gut microbiome and hormone health and inflammation and insulin resistance.
纤维对于肠道微生物组、激素健康、炎症和胰岛素抵抗非常重要。
So high fruits and vegetables, high-fiber diet, whole grain carbohydrates over your refined carbohydrates.
因此，高水果和蔬菜、高纤维饮食、全谷物碳水化合物超过精制碳水化合物。
Ultra-processed foods don't have a place in the modern diet.
超加工食品在现代饮食中没有一席之地。
Added artificial sugars, those non-nutritive sweeteners, they don't have a place in this.
添加人工糖，那些非营养性甜味剂，它们在其中没有一席之地。
We want to have quality of our protein.
我们想要保证蛋白质的质量。
Most people could benefit from some increased plant protein due to the increased fiber than they actually get in the standard American diet.
大多数人可以从增加的植物蛋白中受益，因为纤维含量比标准美国饮食中实际摄入的纤维含量增加了。
But meat is not universally bad nor necessarily good.
但肉并不一定都是坏的，也不一定是好的。
It's the quality of the meat that probably matters a lot.
肉的质量可能很重要。
The meat data to notice is that for every serving of plant-based protein over animal, people tended to ovulate better and had higher fertility rates.
值得注意的肉类数据是，与动物相比，每吃一份植物性蛋白质，人们的排卵能力就会更好，生育率也更高。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Probably more suggestive of an overall healthier fiber-first dietary pattern on the population-based level, because ultra-processed foods don't have a lot of fiber in them or any fiber in them.
可能更能暗示在人群层面上整体更健康、纤维优先的饮食模式，因为超加工食品中不含大量纤维或任何纤维。
Animal-based products don't have fiber in them, so we want to be mindful of that ratio.
动物性产品不含纤维，因此我们要注意这个比例。
Red meat's the really controversial one, and increased servings of red meat, of course, dietary studies quartile it, lowest exposure, highest exposure.
红肉是真正有争议的一种，当然，饮食研究将红肉的摄入量增加了四分位数，最低的接触量，最高的接触量。
Highest exposure groups had poor embryos develop, worse outcomes with IVF, and an increase in staging of endometriosis when they went to surgery.
暴露程度最高的群体胚胎发育不良，体外受精的结果较差，并且在接受手术时子宫内膜异位症的分期增加。
That doesn't mean to me that all red meat is bad, but it probably is for a subset of people, more inflammatory, causes more IGF-1.
对我来说，这并不意味着所有的红肉都是不好的，但它可能只适合一小部分人，更容易产生炎症，导致更多的 IGF-1。
We want to be mindful of it.
我们要注意这一点。
The question I always get is does source matter.
我经常遇到的问题是来源重要吗？
Probably, but we weren't looking at it in any of those studies.
可能吧，但我们在任何这些研究中都没有关注它。
So I think being very mindful of where your animal-based protein is coming from is really important in today's kind of food world.
因此，我认为在当今的食品世界中，非常注意动物性蛋白质的来源非常重要。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Not all foods are created equal, even when they fall into the same category.
并非所有食物都是一样的，即使它们属于同一类别。
And it's worth saying that healthy fats are really, really important.
值得一提的是，健康脂肪非常非常重要。
Cholesterol is the backbone for steroid hormones, so you need cholesterol in your body.
胆固醇是类固醇激素的支柱，因此您的体内需要胆固醇。
So we really want to encourage those monounsaturated, polyunsaturated fatty acids.
所以我们真的想鼓励那些单不饱和、多不饱和脂肪酸。
So the nuts, olive oil, fish, algae, chia seeds, flax, those things have so many benefits when it comes to the omega-3 fatty acids they have.
因此，坚果、橄榄油、鱼、藻类、奇亚籽、亚麻，这些东西在含有 omega-3 脂肪酸时有很多好处。
But also, they're great healthy sources of cholesterol, which your body needs.
而且，它们也是身体所需的胆固醇的重要健康来源。
And in fact, if you don't intake enough, you're not going to make progesterone as well.
事实上，如果您摄入不足，您也不会产生黄体酮。
We want to be really minute.
我们想要变得非常微小。
Need progesterone for implantation, don't have enough unsaturated fat in your diet, you're not going to make as much progesterone.
着床需要黄体酮，如果你的饮食中没有足够的不饱和脂肪，你就不会产生那么多的黄体酮。
So there's some nuance there, but to the heart of your question, I'm a huge advocate for that, especially if you're struggling with something, you're not feeling your best.
所以这里面有一些细微差别，但对于你问题的核心，我是这一点的大力倡导者，特别是如果你正在为某事挣扎，你感觉不是最好的。
If you say you kind of hit the marker on a lot of these inflammatory symptoms and you don't know what's going on, it can be a really helpful tool once you're controlling the other ones to try to leverage.
如果你说你在很多炎症症状上都击中了标记，但你不知道发生了什么，那么一旦你控制其他炎症症状并尝试利用它，它可能是一个非常有用的工具。
But again, sleep, stress, building muscle, avoiding those excess toxins, those are a huge piece of the puzzle, too.
但同样，睡眠、压力、增强肌肉、避免多余的毒素，这些也是这个难题的重要组成部分。
And a lot of them go hand in hand.
其中很多都是齐头并进的。
A lot of times we eat a food that's also wrapped in something that has toxic chemicals in it.
很多时候，我们吃的食物中也含有有毒化学物质。
So we really want to think about the fact that when you work from home, when you have access, whole foods is really important.
所以我们真的想考虑这样一个事实：当你在家工作时，当你有机会时，天然食品非常重要。
As always, leveraging processed or ultra-processed versions.
一如既往，利用经过处理或超处理的版本。
Andrew Huberman:
安德鲁·休伯曼：
Would you say that what you just described, in fact, everything we talked about, also pertains to perimenopause and menopause?
您是否会说，您刚才所描述的，实际上我们所谈论的一切，也都与围绝经期和更年期有关？
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Absolutely.
绝对的。
It's so fascinating because when I sit with a lot of people who just do menopause, we have the same recommendations for lifestyle and decreasing inflammation because it's going to improve ovarian response.
这太令人着迷了，因为当我和很多刚刚经历更年期的人坐在一起时，我们对生活方式和减少炎症有相同的建议，因为这会改善卵巢反应。
It's going to improve how your body feels, decreasing inflammation.
它将改善您的身体感觉，减少炎症。
We know that when you go into menopause, estrogen has such profound anti-inflammatory benefits that one of the biggest problems is a baseline increase in your inflammation.
我们知道，当您进入更年期时，雌激素具有如此深远的抗炎作用，因此最大的问题之一是炎症的基线增加。
So don't wait till you're in perimenopause or menopause to start to learn these things.
因此，不要等到更年期或更年期才开始学习这些东西。
Learn them whatever point you are at now is the perfect time-
无论你现在处于什么时刻，学习它们都是最佳时机-
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm
嗯嗯
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
...
...
where we can start to make a difference, both for hormonal health now, fertility now or later, but also your ovarian function long term.
我们可以开始做出改变，无论是现在的荷尔蒙健康、现在或以后的生育能力，还是您的卵巢功能的长期功能。
Andrew Huberman:
安德鲁·休伯曼：
Amazing.
太棒了。
Dr. Natalie Crawford, thank you so, so much.
娜塔莉·克劳福德博士，非常非常感谢您。
I can't tell you how much I learn every time you speak on this podcast and elsewhere.
我无法告诉你每次你在这个播客和其他地方演讲时我学到了多少。
People should definitely get your book.
人们绝对应该得到你的书。
Again, I've read it.
再说一遍，我已经读过了。
I read it cover to cover.
我从头到尾读了一遍。
"The Fertility Formula: Take Control of Your Reproductive Future." Natalie Crawford, MD, did all the training, runs a clinic, is out there doing public education amidst everything else, co-managing a family, and just really expanding the field.
“生育公式：掌控您的生育未来。”医学博士娜塔莉·克劳福德（Natalie Crawford）接受了所有培训，经营一家诊所，除此之外还从事公共教育，共同管理一个家庭，并真正扩大了领域。
You're taking it in new directions, which is really, to me, the most important thing, that you're out there teaching people, but you're also going back to the clinic and you're paying attention to the science and evolving the science, because this field is just going to improve over time.
你正在把它带向新的方向，对我来说，这确实是最重要的事情，你在那里教人们，但你也回到诊所，你关注科学并发展科学，因为这个领域只会随着时间的推移而改进。
But you've given people so many actionable things to contemplate, to definitely do-
但你给了人们很多可行的事情来思考、去做——
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
if I may insert my own beliefs there, and just a lot to think about in terms of the general landscape of how we think about reproductive health, both our own and societally.
我可以在此插入我自己的信念，以及我们如何看待生殖健康（无论是我们自己的还是社会的）的总体情况来思考很多问题。
So thank you so much for coming back.
非常感谢您回来。
We will do it again, if you're willing, and I'm just grateful to you.
如果你愿意的话，我们会再做一次，我很感激你。
Dr. Natalie Crawford:
娜塔莉·克劳福德博士：
Always.
总是。
Thank you so much for having me and holding space for this discussion.
非常感谢您邀请我并为这次讨论提供空间。
I appreciate it.
我很感激。
Andrew Huberman:
安德鲁·休伯曼：
Absolutely.
绝对的。
Thank you for joining me for today's discussion with Dr. Natalie Crawford.
感谢您参加今天与娜塔莉·克劳福德博士的讨论。
To find links to her podcast and her new book, "The Fertility Formula," please see the links in the show note captions.
要查找她的播客和新书《生育公式》的链接，请参阅节目注释标题中的链接。
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 follow the podcast by clicking the follow button on both Spotify and Apple.
此外，请通过单击 Spotify 和 Apple 上的关注按钮来关注播客。
And on both Spotify and Apple, you can leave us up to a five-star review, and you can now leave us comments at both Spotify and Apple.
在 Spotify 和 Apple 上，您可以给我们留下五星级的评论，现在您可以在 Spotify 和 Apple 上给我们留下评论。
Please also check out the sponsors mentioned at the beginning and throughout today's episode.
另请查看今天节目开头和整个节目中提到的赞助商。
That's the best way to support this podcast.
这是支持这个播客的最佳方式。
If you have questions for me or comments about the podcast or guests or topics that you'd like me to consider for the Huberman Lab Podcast, please put those in the comments section on YouTube.
如果您对我有疑问，或者对播客、嘉宾或您希望我考虑在 Huberman 实验室播客中讨论的主题有意见，请将这些意见放入 YouTube 的评论部分。
I do read all the comments.
我确实阅读了所有评论。
For those of you that haven't heard, I have a new book coming out.
对于那些还没有听说过的人，我即将出版一本新书。
It's my very first book.
这是我的第一本书。
It's entitled "Protocols: An Operating Manual for the Human Body." This is a book that I've been working on for more than five years, and that's based on more than 30 years of research and experience.
它的标题是“协议：人体操作手册”。这本书是我花了五年多时间编写的，它基于 30 多年的研究和经验。
And it covers protocols for everything from sleep to exercise to stress control, protocols related to focus and motivation, and of course, I provide the scientific substantiation for the protocols that are included.
它涵盖了从睡眠到运动再到压力控制的所有协议，以及与注意力和动机相关的协议，当然，我为所包含的协议提供了科学依据。
The book is now available by presale at protocolsbook.com.
该书现已在protocolbook.com 上预售。
There you can find links to various vendors.
在那里您可以找到各个供应商的链接。
You can pick the one that you like best.
您可以选择您最喜欢的一个。
Again, the book is called "Protocols: An Operating Manual for the Human Body." And if you're not already following me on social media, I am hubermanlab on all social media platforms.
同样，这本书的名字是“协议：人体操作手册”。如果您还没有在社交媒体上关注我，我是所有社交媒体平台上的 hubermanlab。
So that's Instagram, X, Threads, Facebook, and LinkedIn.
这就是 Instagram、X、Threads、Facebook 和 LinkedIn。
And on all those platforms, I discuss science and science-related tools, some of which overlaps with the content of the Huberman Lab Podcast, but much of which is distinct from the information on the Huberman Lab Podcast.
在所有这些平台上，我讨论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上的信息不同。
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 Neural Network Newsletter, the Neural Network Newsletter is a zero-cost monthly newsletter that includes podcast summaries as well as what we call protocols in the form of one- to three-page PDFs that cover everything from how to optimize your sleep, how to optimize dopamine, deliberate cold exposure.
如果您还没有订阅我们的神经网络时事通讯，神经网络时事通讯是一份零成本的月度时事通讯，其中包括播客摘要以及我们所说的一到三页 PDF 形式的协议，涵盖从如何优化睡眠、如何优化多巴胺、故意冷暴露等所有内容。
We have a foundational fitness protocol that covers cardiovascular training and resistance training.
我们有一个基本的健身方案，涵盖心血管训练和阻力训练。
All of that is available completely zero cost.
所有这些都是完全零成本可用的。
You simply go to hubermanlab.com, go to the menu tab in the top right corner, scroll down to Newsletter, and enter your email.
您只需访问 hubermanlab.com，转到右上角的菜单选项卡，向下滚动到新闻通讯，然后输入您的电子邮件。
And I should emphasize that we do not share your email with anybody.
我要强调的是，我们不会与任何人分享您的电子邮件。
Thank you once again for joining me for today's discussion with Dr. Natalie Crawford.
再次感谢您参加今天与 Natalie Crawford 博士的讨论。
And last but certainly not least, thank you for your interest in science.
最后但并非最不重要的一点是，感谢您对科学的兴趣。
Speaker 4:
演讲者4：
"I didn't like what you said." Odin pauses.
“我不喜欢你说的话。”奥丁停了下来。
"About the future." This is the love story of real Hinge couple Odin and Edward, written and read by me, Curtis Garner.
“关于未来。”这是真实的铰链夫妇奥丁和爱德华的爱情故事，由我柯蒂斯·加纳撰写和阅读。
Listen to the free audiobook now.
立即收听免费有声读物。