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Fertility, Longevity and The Cost of Chronic Inflammation w/ Dr. Natalie Crawford · The Resting Stitch Face Podcast

• Sarah Harding: Hello and welcome back to the Resting Stitch Face Podcast. I'm your co-host, Dr. Sarah Harding, along with Erin Sheffield: Dr. Erin Sheffield, welcome back. We are so excited today to have Dr. Natalie Crawford joining us on the Resting Stitch Face. She is a double board certified fertility doctor and author of the Fertility Formula living in Austin, Texas. Unlike many physicians, Natalie has a whole body approach to medicine, fusing lifestyle and functional medicine with science-backed facts to help people conceive and understand their bodies. Sarah Harding: Back. Erin Sheffield: Dr. Crawford has helped thousands of patients and followers learn about their bodies and their fertility, empowering them with education and learning to advocate for themselves and their own fertility journeys. She is the author of the Fertility Formula and hosts the successful as a woman with over 5 million downloads. Welcome, Dr. Crawford. Natalie Crawford MD: Thank you guys. I'm so honored to be here. Erin Sheffield: Thank you. Sarah Harding: Yes, we are excited to have you here. I will say first thing, I was listening to you when you went on the Huberman Lab podcast. And it gave me all kinds of nostalgia. And the reason for it is I remember sitting in the parking lot down at Balboa, because I'm in I was in the Navy. And I was going to meet with I think an OBGYN to figure out what was going on, you know, and I was listening to your podcast. And so then when I heard your voice and talking about all the same things, I was like, gosh, wow. It like brought me back to that parking lot, back to my car, just listening to your voice. But it was a it was a wonderful feeling of nostalgia. You know, it wasn't like a troubling time nostalgia, if you know what I mean. So that was really special. Natalie Crawford MD: Ha ha. well, well, thank you. And that's so wonderful to hear too. And you know, I just gotta be honest. I mean, I'm so grateful to be here and spending time with you guys. One thing that luckily writing the book has taught me and given me is the opportunity to sit across from so many incredible people and really appreciate the fact that when somebody gives you their time and their willingness to share what you're so passionate about with their audience using their platform. It truly is such a gift. And not taking that for granted because these are conversations and topics that we we don't even know very often that we need. And when we go through it, we realize just how much of a deficit there is. And the more we can speak about things proactively to decrease stigma, to increase awareness and just baseline knowledge, the easier it's gonna be for everybody. The easier for us to support our friends, the easier for us just to understand our body, regardless if we want to get pregnant. But if we are walking a difficult road, whether it's just our own health, trying to get pregnant and fertility IVF or perimenopause beyond, and starting to question our own body, step number one is education. You can't even advocate for yourself if you don't know what's going on. So these are conversations that I am really grateful to be having forefront. I'm grateful to you guys. And it was great for for Andrew to have me on as well, you know, in a lot of His audience hasn't covered this topic. So it's really wonderful to be able to expose it to new people. Sarah Harding: Right. Erin Sheffield: I loved in your book, you were talking about how you wanted to write this book. And originally when you pitched it, they're like, Yeah, no, no one wants to know about that. Which is so crazy to me. Because as a fertility, infertility survivor, myself, an IVF mama, all of the things. When you go through infertility, it seems like both with my own personal experience and from the outsider view, watching other people go through it. It becomes such an all-consuming part of your life and a lot of times your identity. And I remember making a conscious decision, like, I am not gonna let my infertility become what my whole life is about. Why do you think it is about infertility that is so powerful, that is kind of all consuming, becomes this identity thing? Is it the shame that we often associate with it, or do you think it's something else? Natalie Crawford MD: Lovely question, Erin. I mean, to be fair, sitting across from thousands and thousands of women and then also walking the road myself, anytime your sense of self is questioned in who you are or who you're going to be, it is it is life-shattering in a way. And we'll use parenthood as an example. I grew up thinking I would be a doctor and I would be a mom, like I didn't know who I'd marry, I didn't know where I'd live, but like those two things. felt like certainties for what my future would hold. And yet we approached becoming a professional in a very pragmatic way, right? I I was in pre-med, I was a nutrition major, I took the MCAT, I did an internship, I did these things to help that goal have a higher chance of working. Yet for fertility, it's like, well, there's really nothing you can do until you're ready to get pregnant. And that was at least how it was, you know, when I was trying. And luckily we're a little bit more Erin Sheffield: Yeah. Natalie Crawford MD: Of we have different knowledge and different options at the current state. But to have this be a life goal for so many people, a sense of self in your own identity, and then to have it questioned, I think that's why it becomes so all-consuming because you start to say, I don't even know what my future looks like if I don't have this piece of the puzzle. And yet what what can I do? It's a scenario that feels very out of control. And so the grasp for control is to learn, to know as much as you can. And then to try to control what you can. And I'll admit, as a field, I think we've done a really bad job at being empowering. I I hate, I don't use the word like I hate the current approach to fertility, right? That is, hey, just try and see if you have success. And then if you fail, then we will pay attention. And we will then do a semen analysis to see if your partner even has sperm. And then we will do a test to see, are you running out of eggs early? And That doesn't make any sense to me after over a decade of this work to make people spend their most valuable commodity, their time, doing something when we could test to see are there going to be potential hurdles or difficulties in the road ahead. So in addition to just testing earlier awareness, learning to track your cycle, looking for warning signs, there's also the idea of there's a lot when it comes to your ego. Quality or your sperm quality that you control. And we've done a bad job as a field of saying egg quality equals age. I'm just simplifying it. There's nothing else you can do. Your age is your age. And yes, your eggs are in your body your whole life. So age is an important variable, but it is not the end-all be-all. And we know that levels of chronic inflammation, insulin resistance, and the things that cause those circumstances contribute to higher rates of infertility, decrease in egg quality. So I find that a more empowering narrative to tell somebody, look, we can't rewind the cloth, can control our age. But it's even more important in that circumstance to say, how do we decrease any additional damage? How do we improve our egg quality and our mitochondrial health? And I think that piece of the puzzle has been really missing for a long time from the fertility narrative. We do see a switch. It's something that I'm really personally passionate about. I was a nutrition major and just thought it was strange that we were never connecting these dots and that what I went through my own pregnancy losses. I had four of them that I was told nothing mattered. There's nothing you can do. None of it mattered. It's just bad luck. Just do IVF. And yet even with IVF, I sit across from people and I can only work with the eggs and sperm we're given. Right? Egg quality and sperm quality inherently matter a lot. So back to how you started, I I Sarah Harding: Yeah. Natalie Crawford MD: I'm such a type A girly that when I had an agent reach out to me in 2019 and say, you want to write a book, and we made this book proposal and we took it to market, and I met with zero publishers, zero. And I was told over and over that women don't care about this topic proactively. Cause it was the same book. It was this proactive approach to your fertility and talking about the lifestyle factors, that there's no market for it, that infertility women don't want to talk about. And I took that really hard, I'll be honest. I then left that agent because she said I couldn't sell the book. Maybe somebody else can. I talked to many agents over the next few years who many of them said the same thing. This is too small of a demographic to want to market to and sell a book. And I kept thinking, but it's everybody. It's not just infertility, it's it's all people, you know, thinking about your hormone health and your fertility as a health marker. So Sarah Harding: Right. Natalie Crawford MD: Luckily the world works as it's supposed to, you know. And I finally got in front of my agents who are my agents now, and I was very direct. And I said, Look, I've been told over and over there's no market for this book. I'm gonna tell you about it in five minutes. If you don't see it, the end. It's okay. Like you don't have to see it. I believe now you can't sell a book that you don't believe in. And I, you know, rambled off like, here's why the book needs to exist and why it's different than just it's not just a book of facts. It's Erin Sheffield: Yeah. Natalie Crawford MD: Yes, facts, but also teaching you how to advocate and how to optimize. And, you know, I have two agents, but the one I was sitting across from was 30. And she's like, Everybody's an idiot. This is all my friends and I are talking about is we want kids one day, but not yet. And what do we need to do? And I'm watching friends walk the road of IVF and not feel supported. And they have so many questions. So we went from that meeting to a book deal three months later. And then then it's a long process, two years to get it out into the world, which Erin Sheffield: Wow. Yeah. Natalie Crawford MD: I kept trying to push it faster, but you know, things work out how they're supposed to. And I'm glad the book exists now. I always say it's the book I wish I could have had back when I needed it. But Sarah Harding: Huh. Erin Sheffield: my gosh, I wish we could Sarah Harding: Mm-hmm. Same. Yeah. Same. That's right. Yeah. can we talk a little bit about your journey to this point? Because I can't help but to think that everything that has every hiccup, every roadblock that you've met in your life has brought you to this point. And so like we don't want to hit the roadblocks. We don't want to hit the hiccups. we want to have a nice straight road, pre-med. Erin Sheffield: have had it when we needed it. Natalie Crawford MD: But but at least it's here now to help, you know, a new generation of women as well. Erin Sheffield: Totally. For Sarah Harding: nutrition major, med school, residency, fellowship, kids, great husband, great life. But it doesn't always work out that way. And thank God it doesn't, right? Because I I just can't help but to wonder if all of that brought you here. What do you think? Natalie Crawford MD: So I am a big believer that the world needs to make sense and that things don't just happen. They're not just coincidence or it's not just, you know, luck that we grow and evolve as a circumstance of how we respond to the challenges in front of us and that they have a greater purpose than than just being struggle. You know, I I didn't go into medicine to be a fertility doctor and I love my job, but I actually matched into emergency medicine because I just love taking care of patients. I loved the diagnostic challenge, but I quickly realized that I wasn't getting what I needed from that career. And it's not that it's not an amazing, wonderful, necessary job. But for me, I needed to follow somebody through the end of a problem to get what I needed out of the doctor patient relationship. And so I knew that three months into my intern year. And I was told over and over that I was crazy. it's just intern year Blues, it's just hard. And that was one of those moments, Erin, like we talked about earlier, too, where I really questioned what my future was going to look like because I had set a goal, achieved it, been happy, got to the next one. And doctor was always one of them. And then now here I was, and I was really, really unhappy and made the decision to switch into OBGYN because I just felt this strong pull to take care of women. And it meant I had to do an extra year of residency. So I finished my ER year. And then I started over an OBGYN. And that's sucked. Like nobody wants to be a resident an extra year. You don't get paid much. And ER year is horribly hard. Sarah Harding: And the stigma of that too. Natalie Crawford MD: Yeah, but I really I was a different OBGYN resident because of it. I was able to have some extra research months. I was excellent in emergencies. You know, I mean, like when things hit the fan, like I very quickly it didn't phase me. It allowed me to approach that stage with such confidence. And I felt really passionate that I wanted to do a fellowship. I wanted to follow somebody through that problem and Having more research months, having more confidence in my clinical experience, I think helped me match to fellowship. You know? And so then I was able to match to fellowship. Going through my own pregnancy loss in residency and in fellowship made me really confident in saying, I don't want to do an IBF research project. I want to study natural fertility. Like I want to study natural fertility. I want to know why. Why is it harder for me to get pregnant? Why do some people get pregnant and some people do not? And I was told that's really a hard project because fellowships three years and a year and a half is research and a year and a half is clinical. And many people don't know you have to publish your thesis, you have to defend it at your oral boards. It has to be a you a very substantial project. And so epidemiologic projects are much harder and take more time and harder to defend. So they said, You have to get a master's of science in clinical research. And I said, sign me up because these are the questions I have. I had when I went through. I know my patients have them. And the only way to to get to that end goal is going to be to understand the studies that are being done. And I studied, you know, nutrition. It came full circle and vitamin levels. And I studied endocrine disrupting chemicals and the luteal phase. And that's at the stage for me thinking about the whole world different because that research really, despite it all being different, there was this common theme of inflammation. And at that time in medicine, inflammation was like caused by disease. I view right now that inflammation predates disease. It's, on the disease trajectory. And if we learn to intervene earlier, we're going to change our ability to get pregnant, but also improve our entire health and our longevity. And this is why, you know, your fertility is a health marker, because if you have infertility, which is terrible, you know, the data that it increases your risk of a heart attack, of a stroke, of early death. That's scary data. And it's not because your infertility causes it, but that it can represent an underlying metabolic state that is not optimal health and really allowed me to zoom out and think about the world different. And not that I wanted to go through those pregnancy losses and nor would I wish it on anybody, but it did change my professional trajectory. And it also, you know, gave me the kids I'm supposed to have. And I always say if any of those pregnancy losses, no matter how heartbreaking they were, had had resulted. In a child, like I would never have had my daughter, right? Because I would have been, you know, pregnant or postpartum or something at that time period. So that gave me comfort even in those hard moments when I was told that, you know, these moments that challenge you are going to help help you be who you're going to be, however, this is going to work out. Not in some rosy colored glasses, it's all gonna work out great and you're gonna have a good outcome, but just saying, you know. Your job right now is just to survive, but understand it's going to change you and that's okay. It's going to change you into who you're going to be. And you know, those challenges persist in different ways, right? Like not getting the book deal resulted in a better one later. I'm open to practice, not because I came out knowing I wanted to run a practice, but I had a terrible employed experience. And so, right, at some point you say, This is important enough to me that I want to take care of patients in the way that I want to. And if that means I'm going to take a risk and bet on myself, I'll bet on myself. So Sarah Harding: Mm-hmm. Natalie Crawford MD: Anyways, Sarah, yes, the longest answer to your question. I do think these challenges shape shape us and ultimately in a way that you couldn't imagine had you not gone through them, because I wouldn't be sitting here where I am today. Sarah Harding: Yeah. Yeah. Right. Yeah. Erin Sheffield: The thing I really admire about your story, there seems to be this through line of courage to do what was right for you. Like so many people get stuck. They start the residency and they hate it, but gosh, we got this far and starting over would be too hard, or maybe I can't get a spot. And so you just stick that out and only do stick it out through residency, but the rest of your life, or the research project that you wanted to do. People. Sarah Harding: Yeah. Erin Sheffield: telling you that's maybe not the smartest. You are willing to take that leap. You were willing to have the courage to create your own clinic. I think that that's so fascinating when so many people, I think in medicine were so used to, you know, A, B, C, D and going in order, it can be hard to reassess and say, like maybe it's worth the pivot. And so we on here love a good pivot story. What do you think gave you that courage to kind of have your North Star and to always choose you in these situations? Natalie Crawford MD: Yeah. Sarah Harding: First, how did you know like how do you did you always have such a sense of self? Like who you were and who you knew that you could be? Natalie Crawford MD: You that's a great question. I will say I'm very I I did not grow up in a family from like a lot of means. We we moved around a lot when I was younger. And I was a very shy, introverted child. But if you have to change schools a lot, you kind of learn to that you're enough. And you have to learn to believe in your truth a little bit more than everybody else's around you because you can't control them. You can control you. And I also had a really supportive family. Like I never heard from my parents or my grandparents that like. is being a doctor gonna be too hard or that pathway would be too much? You know, I never heard that. So I never had that internal narrative. When I said I wanted to be a doctor, they said, incredible, do it. And then from then on, it was, it was support. And I try to think about that now for my own kids. That like I, the world can be negative enough. That voice should never come from me, right? Because we craft our own internal narrative too easily in a negative way. And I just really always believe like. If I'm not gonna bet on me, who will? Right. If I'm not gonna take that bet and believe that I can do it, like why would anybody else bet on me? And I've I felt that way for a really long time, right? From when it comes to interviewing for you know medical school or residency or fellowship. And you know, what's the worst that can happen from betting on yourself? I'm not gonna act like every time it's been easy. I mean, there has been a lot of therapy and some of these moments that, you know, help you reaffirm. That sense of saying, at the end of the day, it's your one life. You have these big dreams. What's the worst thing that happens from believing that you can achieve this next thing? I could clearly see the worst thing that could happen from staying put, right? If I stayed in ER, I would have finished residency because I was going to be a doctor. I would have had an ER job and I would have burnt out and left because I wasn't getting the personal satisfaction I needed. And I felt like I'd invested too much into this and believed that I deserved a job. That I could also love as a career more than just showing up to as a job and that I had good to do with that. And so like betting on that felt worth the risk because I saw what staying would do. but it's hard. And a lot of times, especially as women, we're we're not taught to trust ourselves or to bet on ourselves. And I was certainly raised to be a people pleaser. And so hearing negatives like, that's hard or that's not the right decision. it was hard, but I did learn to just tune it out and to say, okay, I appreciate that feedback. However, I believe this, because again, who's gonna butt on you if you don't? And what's the worst that can happen by believing in yourself and and giving you that chance? And then the more you do it, it spirals off itself. Cause then you're like, I'll start a podcast. I'll start a practice, you know. And I will say, my husband, when we love to start this practice with my my work partner and I, she and I Put in our notice at our employee job on May 1st of 2020, COVID, early COVID. I say the middle COVID early. And we opened our doors July 1st of 2020. And when I told my husband, I said, Hey, Amanda and I just quit and we're starting a practice. He's like, You know, there's a global pandemic and IVS is shut down right now. And I was like, Aware, aware, but we still think this is the right time. This is what we need to do. And he said, Well, there's nobody I'm gonna believe in more. So go for it. And you know. Erin Sheffield: wow. Sarah Harding: wow. Yeah. Erin Sheffield: Well Natalie Crawford MD: I can't imagine if I had a a husband who had a different narrative than that, right? So really choosing the people who you surround yourself with when it's your marriage and your friends and and I've stopped being friends with people who who don't believe in me or who are that negative voice because I've just said, like, I don't I don't have space in my world for that negative that negativity or that mean girlness. I will unfollow you. We don't have to be best friends because the people I surround myself with. Are the first ones to say, Yes, go try, do. And that's how I wanna live my life. And that's how I want my kids to live their life as well. Sarah Harding: Mm, absolutely. Erin Sheffield: So inspiring. I love that. I think it's hard to the obvious choice is to be the one to bet on yourself, but that's harder to do than you think. I think sometimes when I've had negativity, I'm the okay, fine, you know, pity party. I wanted to do that. Yeah. Natalie Crawford MD: It's really it's really hard. And I would say I think all women have a gut intuition sense. And we use medicine or having health challenges, you learn to dismiss it because you get dismissed, right? So when you sit across from somebody, you say, I've had two pregnancy losses and I think something's wrong, and they say no, everything's fine. You you start to diminish that gut feeling that something is wrong. And that is an example in many times of life. If you have a mentor who's not supportive of you or Erin Sheffield: Yeah. Yeah. Natalie Crawford MD: A parent or a spouse, you start to then change your own internal narrative. But to say, if I have this gut feeling, why do I have it? And being willing to get real and vulnerable. I mean, like I love journaling. That helps me bring up my thoughts out. Like I said, I've gone to therapy. Like, I don't think this is something you just solve on your own, but that inner voice is really powerful if we learn to tune into it. Erin Sheffield: So when you started your podcast, kind of on a similar thread here, you do so many of your episodes by yourself. How did you have the courage early on to talk into the interwebs, not knowing if anyone was listening? How how you're being received, how to even just keep going? Were you scripting things out? How are you coming up with? The topics and how did you keep that courage to keep going? Natalie Crawford MD: I started my podcast in January of 2019. So I do like to say it was like a different era. Like it wasn't video. I didn't to be on screen. I could hit pause and, you know, compose myself and then like come back to it. But I honestly I'm very blessed and lucky, and I put in a lot of hard work for the podcast to be as far-reaching as it is. And I don't take that lightly. But the initial reason why I started the podcast was that I said the same things every single day to patients. Sarah Harding: Yes. Natalie Crawford MD: And yet they are going through so much that I knew they were absorbing like a tenth of it. And so I felt compelled to say, okay, well, I explained PCOS more in this podcast episode. Or if you wanna, you know, have your partner, especially then we weren't doing telemedicine visits. And a lot of times I'd have a woman sitting across from me and her partner couldn't be present because he was at work. And so she then would be put in the really terrible position of having to go home. Sarah Harding: Okay. Erin Sheffield: Yes. Yeah. Natalie Crawford MD: relay information, really bad statistics to her spouse who would have a lot of questions. And then she had to be this, you know, in-between go-getter. So I'd say, okay, well, I have an episode talking through IVF and the statistics that you can share with your husband. And then you know, you guys can ask questions after that. So I really started it for the reason to make my job easier, to make the patients who sat across from me be able to get more just to hear the same thing again. Erin Sheffield: Brilliant. Sarah Harding: Yeah. Natalie Crawford MD: Or to get a little bit deeper than I could go in the time that I had, be able to review some of the stuff. And we we changed that quickly to where I made some episodes about before your visit. And then we started telling patients, hey, before you come in, here's a couple episodes about what to expect or about some of the initial testing. And I realized really quickly that my patients felt more comfortable with me right away. They'd already heard me talk in counsel. A lot of the baseline information that I'm breaking that can be really unfortunate news, they'd already heard it once. So they were at a place where it wasn't just shock. We were, we were into action. So our visits became a lot more productive because we'd already overcome some of that bad news. And I was not expecting the podcast to change how I practiced in that way. I thought it would just be here, you can go hear this. But it started to change how I practiced. And then my goal shifted. I started that. Erin Sheffield: Yeah. Natalie Crawford MD: Thinking I can reach more people who can never see me in clinic and I can support the information that they're not able to get from their doctor because of how the medical system is. And maybe they can start to make different decisions to have a different trajectory of their journey because they are armed with that first piece knowledge. But there was no camera. And I just started with the stuff I said every day that I knew and I felt comfortable with. And I branched out from there, you know, and then started talking about more things and started reviewing research and seeing. When the podcast first started, interestingly, I was about half fertility medical topics and then half being a woman in medicine topics because I wasn't really sure that people wanted just these really what I felt like were dry episodes. Let's talk about endometriosis or age infertility. And I thought some of the other more Erin Sheffield: Mm-hmm. Natalie Crawford MD: you know, real world applicable topics would feel more compelling. And there was no question the the medical topics is is what had all the downloads. You know, episodes on PCOS or diet and fertility or AMH. I mean, those were episodes that quickly had twenty, thirty thousand downloads each. And so, you know, as you do when you make content or I mean thank you. Sarah's ten thousand of those. No. Sarah Harding: You're welcome. Erin Sheffield: Ha ha ha! fan. She's original fan. Natalie Crawford MD: Yeah. So then I just thought, okay, there's there definitely that just shows, you know, what I felt first is that there's a need for this. And so let's just let's just pour more into that and start having some episodes that are very niche so that that person can get more information on it. As the internet became more of a good and bad source, harder to know what was good health information. I feel like the podcast could be a place where you could know you could get trusted health information. And It's a good question now. What do I do in the calendar year 2026? You know, how many years can you talk about the same topics over and over again? Because I have a really robust back catalog. Meaning, if somebody enters my content right now and they wanna search PCOS, I mean, there's probably 10 episodes they can listen to. And I don't know that I need to make more on that. So it's a good question on what I'm gonna do, you know, upcoming with the podcast. But I'm I'm thankful that women have changed the narrative here and they've really pushed forward and saying we do want to know about our bodies and our fertility and our health. Erin Sheffield: So have you talked about oral health in any of your podcasts and systemic inflammation coming from your mouth and your dental health? Is that in the I didn't finish the book yet. Natalie Crawford MD: you even Sarah Harding: Mm-hmm. Natalie Crawford MD: I know, I that's a good we I have not talked about that. That is a good thing to add to the list of things as we're expanding. That's that's kind of where I'm right now, kind of expanding this talk from just like your core fertility diseases and topics to some of these more broader categories and zooming out a little bit on those factors that we can control. So lovely idea. Erin Sheffield: If you need any oral health experts to come and help you talk. Sarah Harding: Yeah. Natalie Crawford MD: Okay, I love it. We should do it. Erin Sheffield: We should. Sarah Harding: You know, it's funny, yeah. And it's funny because in dental school we learn about this stuff and we learn about how our oral health affects premature birth weight and premature losses and miscarriages and all of this stuff. And we don't we don't connect the dots necessarily. Like this is because of systemic inflammation. We understand that as a baseline, but we talk about that as a way to counsel patients on why you should be brushing your teeth. you're pregnant and we can only see you to do surgical procedures during Natalie Crawford MD: Mm-hmm. Sarah Harding: this part of your pregnancy because of these risks and all of this stuff. But we don't necessarily like dive deep into how it's actually affecting your fertility and your longevity and all of the things. And I think it's it's coming now and it's exciting. Natalie Crawford MD: Yeah. I agree. Right. Medicine in general, we've been too segmented and we're starting to see we'll use inflammation. I get really upset and I don't like to get upset at my peers, but there's some people saying, inflammation's a buzzword. And that really actually annoys me because I feel like, no, inflammation's the connecting dot, right? Like, look at us talking about oral health and fertility and look at our gastroenterologist friends. And like no, actually, this is it's one body. Erin Sheffield: I d go ahead. Sarah Harding: Mm-hmm. Natalie Crawford MD: If you're inflamed in one place, it's impacting everything. It's actually, you know, one of these true root causes of so much disease that we shouldn't be dismissing it, saying it's a buzzword or it's just trendy. It's just we're late in the medical field to connect all the dots together. Erin Sheffield: I wanted to ask you about that, doing your project on inflammation. I did my IVF at the University of Iowa, which they make it sound like at least that they're this top-notch research facility for RE and everything felt so academic and by the book and by the numbers. And so I'm imagining going to your faculty mentors and being like, I want to learn about inflammation. Was that well received or were there eye rolls or What were the comments when you decided to do that? Natalie Crawford MD: You see? So that's a great question. I was really lucky to do my fellowship at UNC. And Anne Steiner was there, and she's one of the top she had a huge cohort in what we call fecundability or natural fertility. There was also a really robust, lab for endometriosis and IVF research. That's where most fellows did their research. It was kind of like, yeah, of course you'll get a project in this lab. and do some basic science research. I I did basic science research in residency. I pipetted pituitary cells and grew them and all this stuff. And so I really pushed and, you know, I got a little bit of eye rolls, but I also was lucky to be at a place that said, This is how you change science by clinical curiosity. And if this is something that you're more passionate about, you'll do a better job and we should help nurture that versus saying this is the project that our fellows do or the lab that they go into. So I was lucky to have that. And, you know, getting a master's in clinical research was incredible. And I thought I'd go into academics, I'll be honest. I thought I'd be a clinical researcher and I Erin Sheffield: Yeah. Natalie Crawford MD: Married a Texas boy who wanted to come back here and there just weren't any academic jobs. And at the time, I was like, well, let's try private practice. And what's the worst that can happen? I can go back to academics later. But I really love taking care of patients. And that's really what drew me to medicine. And I love the personalization that can happen in a private practice, right? You don't have to have this committee approval to have a new protocol, right? We can say, this new study came out. Let's try this drug immediately. And let's see how it helps this one person who's failed, these other things. And being able to personalize medicine to that fine tune really filled my needs of taking care of patients, but also being somebody who loves clinical research, right? Because when clinical research comes out or when there starts to be hints of things, being able to not have a lot of logistics before you can impl implement trying that in the right patient, that was really important to me because. Fertility is finite. Women are going through so much. It's expensive. It's time consuming. Sometimes we don't have the time to wait for the perfect trial to show the perfect results. And we want to be able to start to offer certain things. And I believe women are really smart and brilliant and resilient. And when given the opportunity to understand risk, benefits in different scenarios, that they can help play a role in their health. And I tell every patient, I cannot control the outcome. I try. Erin Sheffield: Yeah. Natalie Crawford MD: What I control, what I right? Sarah Harding: what? Natalie Crawford MD: I control that you feel confident that we made the best decisions we could along the way. So that when we get to the end of this, yes, hopefully it's with a baby. But if it's not, you're not looking back with regret. You're saying, I knew what I needed to, I did everything I could, I feel confident in the decisions we made, and this is how you know my story is supposed to go, and I feel comfortable with that. And That is how I frame my goal. And that means I'm not a dictator saying this is what we do. We are having discussions about what makes sense for you in your scenario. Sarah Harding: Yeah. Erin Sheffield: I love that so much. I wish she'd been my doctor. My infertility journey was fraught with drama. I did multiple rounds of IVF. I have PCOS, or is it PMOS now? Am I up to date? Okay, I'm feeling really smart right now. Sierra's laughing at me. but I started Natalie Crawford MD: Mm. Yes, it's PMOS now. Sarah Harding: Yes. What? Erin Sheffield: IVF pretty soon in my journey. Luckily, they didn't make me wait like the full year because I had that diagnosis. So we got going pretty quickly. And then I stayed in the Clomid, Letrazol, hamster wheel for like nine months. And it was terrible. Like I was like crying in clinic and having hot flashes. And I didn't ovulate a single time. And they had me on metformin and then thyroid hormone and all these things. And I was like puking my guts up and thinking Natalie Crawford MD: No. Aaron. Erin Sheffield: You know, I think it's from the Metformin, but we thought maybe it was the Clomid. And so finally they're like, if you want to get pregnant, it's IVF for you. And that was really hard pill to swallow. I remember telling people, yeah, they said if I want to have a baby, I'm gonna have to try IVF. And people were saying, Congratulations, as if I'd already had a baby. And I was like, What do you mean? Congratulations. I was mourning my fertility so much, like Natalie Crawford MD: Yeah. Erin Sheffield: This isn't a congratulations. Like I'm gonna have to go through all of this stuff and it might not work. I have to pay the equivalent of a car and go through thousands of shots to get pregnant. I'm a needle phob, like all these things. So it was very difficult. And so when I did my harvest, I was trying to time it just perfectly. As finishing residency, we were gonna like harvest the night before I started my job. And then I wasn't. Natalie Crawford MD: It's not fair. Erin Sheffield: On track. So by the time we finally harvested, I was a little overstemmed, maybe. So the day that they wanted to do the transfer was my first day of work in my new job. And I was like, I don't know what to do. Because how do you call your boss and say, Hey, I'm not coming in today? I'm trying to get pregnant, like, just not the vibe on day one. Yeah. Natalie Crawford MD: On day one. Yeah. It's that's a rough rough spot to be in. Yeah. Sarah Harding: Of a male dominated specialty. Erin Sheffield: So I was mortified. I was devastated and they're like, Well, let's throw them all the embryos in the freezer. You're kind of overstimmed anyway. So maybe it'd be better. So then I thought, okay, we'll wait a few weeks. And then they made me like really wait. Well, since you're overstimed and we're doing it 'cause of that, then you really have to wait. So it turned into waiting and waiting and waiting and waiting. And I finally got to the point where you have to tell your employer because like, gosh, you're all these appointments and everything. And then they're asking me to Push it back because don't get pregnant at a time that's bad for the practice and do all this stuff. And so I ended up getting quite a few embryos and they looked good. But then I did a transfer of one and didn't work. And I transferred one and it didn't work. And I transferred one and it didn't work. And they said, let's do two. We never say to do two, but let's do two. But don't be mad if you get twins. So then we did two and then one split. So I had three. Then I lost the third one a few weeks in. and then luckily the pregnancy went well. had some complications delivering, etc. But it's just a crazy ride. It is so hard to go through. And I can say it cured me of my needle phobia. Now I have like needle PTSD probably. But yeah, so in some ways it was empowering, but it's just so much to go through. And I remember someone saying there was a study or something. Tell me if this sounds right, but Natalie Crawford MD: It is. But you know, you can do hard things, right? So Erin Sheffield: You know, the feelings that you experience as a IVF, I'm gonna say survivor is similar as what you go through as like a cancer patient. And I don't wanna compare my journey to cancer. That sounds disingenuous or something, but that was so validating because it was so hard to go through. Natalie Crawford MD: Chair. It is, Erin. Yeah. The stress level of infertility is has been shown to be equal to the stress level of having a cancer diagnosis. And I think it goes back personally to what we said at the very beginning. When your sense of self and your future is questioned, it really rocks you to your core. And yet, a cancer diagnosis is terrible, but if you say you have that, it's understood how hard that is. Erin Sheffield: Yeah. Natalie Crawford MD: And yet infertility is often not supported socially quite the same way. So you end up having the same stress levels, often without the public recognition or the social support or the work support, for your example, that you would get in another. So you're questioning who you are, what your future will look like, feeling shame, stigma, why me? Will this happen? Spending money, spending time. It's really hard. And I think it really speaks to the fact that. Erin Sheffield: Yes. Natalie Crawford MD: When you can, if you are going through this, opening up to people in your world is really important. It's really hard to do. But the people who you would go to when you're having something terrible happen, letting them in, because it's a hard road to walk by yourself. And if you are the friend, let's say you have no idea, you you had babies easily. So this wasn't you, and your best friend opens up or your sister or your work colleague. When you can be the one to show up for them, it is so powerful. And it doesn't mean you have to do the right thing or say the perfect thing. In fact, just saying, I don't know what it's like, but I'm here for you. And tangible things that you can do mean the most. I always tell, friends when they ask, How do I support somebody? I said, don't say, What can I do? Because that's gonna be a really hard question to answer, but just do, right? Say, I know your partner's traveling for work. Can I go with you to that appointment? Or, I'm I'm a nurse, so I'm happy to help you with some of your shots. Or here's a Starbucks gift card, or I left dinner on your porch, or you know, I'm announcing my own pregnancy. I wanted to tell you independently first. Like those little things where we just acknowledge the difficulty, or even just saying, I'm here for you if you events. Like, even though I haven't been through it, I want to support you. If you want to tell me about it, I would love to receive that. can be really important because infertility is so isolating. And in addition to all the challenges we said, I felt left behind my friends, right? So I watch them getting to these life stages and I'm so happy for them. And I love their kids, but I wanted to be there too. And you just start mentally feeling the difference and feeling left behind. And not letting it be an elephant in the room, right? Whereas now you feel weird about things. So keeping those Communication lines open is really important if you're the person not going through the thing and that that alone can be really helpful and empowering. Erin Sheffield: I can echo that. That's the discovery I had going through it. I am a very open person, but I felt like everyone act like, don't talk about, don't talk about it. And so at first I didn't, and it was terrible. And even though my husband is kind of going through it with me, no one knew what it's not the same. Like I was carrying that load and I have PTSD from that. I wake up almost every night in a panic that I forgot something. Natalie Crawford MD: Yeah. It's not it's not the same. Erin Sheffield: Important because I worried every night if I forgot my shot, I was gonna lose my babies, you know? And I still carry that with me. 10, 11 years later, it's really hard. And when I started blogging about my IVF journey in the golden ages of blogging. And once I opened up about it, people were coming out of the woodworks. And that's what's crazy to me that they said the book wouldn't be successful because I had Sarah Harding: Yeah. Erin Sheffield: So many people in my life. I had no idea. Like my best friends from dental school, my cousin who never told a soul, even her mom. I had my husband's cousin tell me she's waking up in the middle of the night trying to do an egg harvest as a single woman, spending five hours because she didn't know how to draw up the medication, just struggling. You know, these are the kind of things where it's like, my gosh, you Natalie Crawford MD: Yeah. Erin Sheffield: should have called me. I could have helped. And when you have that person, even if it's just one person, that was a lifeline for me. But that shame and that stigma is so real and and it shouldn't be. There's nothing Yeah. Bodies are bodies and they do what they do. But it's it's so hard and you we can't do it alone. It's it's really hard. Sarah Harding: Yeah. Natalie Crawford MD: But it is. There's nothing to be shameful about. Sarah Harding: Yeah. Right. Well, and I think yeah. Yeah. I think too, Natalie, in your book, you talk a little bit about finding out that you were pregnant and being newly pregnant in, I think was it residency? And you were probably, yeah, and six weeks pregnant. And we have this thing where we don't tell anybody for the first trimester because the amount of people that miscarry within the first trimester is significant. but I think that's probably where this all comes from. Natalie Crawford MD: Yeah, an L and D. Sarah Harding: Because we can't talk about it so soon because we don't want people to know. And then then if we lose the pregnancy, then we have to, you know, keep telling about it. But at the end of the day, we need that support. If we do lose the pregnancy, and then you haven't told anybody that you were pregnant and you were really excited, and your hormones were already shifting, and everything was all your whole world changed already. And then here you are, but you can't talk about it because nobody knew, because you weren't supposed to talk about it. Erin Sheffield: Yes. Natalie Crawford MD: No, I felt so strongly. How do I tell you I'm miscarrying when I didn't even tell I was pregnant? And then how do I tell you it's my third if I didn't tell you about the other two? And I really felt like I dug myself into this isolated hole. And I tell patients this all the time. I was like, you don't have to tell the world. You don't have to tell the internet. I mean, people do share their infertility journeys in real time. And God bless them because it is so eye-opening to reduce the shame and the stigma, to be very transparent about what it's like. But That doesn't mean as an individual anybody has to do that, but you should tell the people in your world who will support you because you cannot. Be you should not be forced to navigate this alone. And yet they can't show up if they don't know. And so I really tell people, you don't have to tell the world, but like tell your person, tell your people, like let them know you're going through that you're doing IVF, that you're having a transfer, because then you're going to get some of that support early on if something doesn't go the way that we want it to. Because IVF is still far from a guarantee. You know, as far as we've come as a field, it's a dramatically different field now than it was, you know, a decade ago. Success rates are getting better. We love all of that, but It's not a guarantee. So we can expect there to be ups and downs along the road. And you need whoever your support people are to be, you know, activated and ready to be there. Erin Sheffield: Definitely. So on the same line of shame, one thing you hear all the time when you're trying to get pregnant is to stop stressing. And I hate that because for me it's like a shame thing. It puts it back in your court. Like, well, if you wouldn't have stressed so much, you wouldn't have got pregnant. And especially like during residency or you know, work. How am I not supposed to stress? Like, that's my life. So is stress really a significant factor is that kind of an inflammation piece and that's how that would be. What's your response to people when they say just don't stress? Natalie Crawford MD: I think saying don't stress about being stressed is one of the least helpful pieces of advice you can get. But I I similarly really dislike when my colleagues say, therefore, stress has nothing to do with it. Because that's not true. You know, your stress response system ultimately is made to do something very physiologic in your body and protect you. Sure, at high levels of prolonged stress, you'll stop ovulating, right? We'll have hypothalamic amenrhea. But outside of that, Sarah Harding: Mm-hmm. Natalie Crawford MD: The stress response system is meant to help you survive. And one of the pieces of the puzzle is it breaks down stored glucose, right? Gluconeogenesis from the liver pours some glucose into your blood. So you can run from the bear or have some extra energy because you're not eating enough or to stay awake longer because you're stressed. And yet we don't live in the world where we're utilizing that glucose. Like we're not running from the bear, using that glucose up and getting back to that homeostasis. What's actually happening is. We're stressed over an infertility appointment, a patient experience, bad news, the news, social media, being the target of all the online hate, whatever it is, you get stressed about it, and glucose glucose gets released, and then you don't deal with it. And that glucose then causes more insulin to be released. And this is why chronic stress directly causes insulin resistance. And insulin resistance is one of the top causes of chronic inflammation. So I say just knowing that piece can be helpful. Erin Sheffield: Yeah. We'll talk about that next. Sarah Harding: Yeah. Natalie Crawford MD: Right, not be that we can always prevent stress on the input, but how we manage it, we can change. Because many of us, when we get stressed, we stress eat or we stress drink, and we actually add to this glucose burden and worsen it more. Versus when I tell my patients, I say, look, the first thing you should do, activate your skeletal muscle because glucose can be used by skeletal muscle without needing insulin. So if you have this terrible appointment, like do 10 squats or go for a five-minute walk, do something to use up that glucose first. That's gonna help you get back to like running from the bare, you know, normalization before you leverage these kind of quote worsening behaviors. And yeah, cutting out stress where you can is great. We we can't always do that. And then also to just acknowledge each day will be stressful. It's going to be. Okay. I need to have some moment in my day where I can also lower that baseline cortisol. So Maybe that's working out, but maybe it's meditation at night for five minutes if I didn't get to it otherwise. You know, maybe it's an acupuncture session or, you know, sitting outside with my feet in the grass for five minutes. It doesn't have to be this big thing, but carving out those few moments where you're not on your phone or not online, those can be really important as well. So I think that that's a more empowering way saying, How are we going to deal with this? Cause it's going to happen versus the Don't stress about being stressed or stress doesn't impact fertility because it does. It definitely does. And it causes inflammation and changes hormonal response. So we need to be knowledgeable about how to handle that better. Erin Sheffield: I love your approach because so much of it is information to empower women. And it's not like overstepping like some of the wellness gurus. If you do X, Y, and Z and buy this, then this is going to happen. You know, you are not. I know, but I think information is so empowering, informed consent, all of that. So I want to pivot and talk a little bit about. Natalie Crawford MD: I mean, I wish it was that simple, That would be great. Sarah Harding: Yeah. Yeah. Erin Sheffield: Some of the steam you've been getting online after posting a professional opinion. when I saw your post, I thought it was amazing. I thought, wow, that's so interesting. And I moved on by. And then I started hearing chatter. And I'm like, what are they even talking about? What did what did she possibly say? What did I miss? To me, it was such a non-thing that I couldn't believe it was a thing. But part of what you were saying, Sarah Harding: Yes, same. Right. Yeah. Erin Sheffield: maybe you want to describe your video, but was, giving information for patients so that they can empower themselves to make decisions about how they want to move ahead. So can you describe a little bit about your video and what the point you're hoping to make? And then what do you think this says about medicine and our ability to tolerate nuance and question marks and debate online? Natalie Crawford MD: Yeah. Sarah Harding: And clinical curiosity, 'cause that's what we all decided in your fellowship was the most important part of moving science forward. Erin Sheffield: Yes. Right. Natalie Crawford MD: You know, no, I have a lot of thoughts on it. I'll say, you know, I'll say the CEO of ASRM emailed me afterward saying that, they were supportive of me and also proud to acknowledge the fact that in medicine we don't have all the answers. And that as subspecialist, we see a selected patient population and the things we see in practice should drive research. And yet we should be able to talk about them. Erin Sheffield: This is a big question to unravel, I know. Yes. Natalie Crawford MD: Before we have a perfect study to do so. I think anytime we talk about observations or science, it's always important not to give huge declarations of yes, this or no that. And honestly, I felt like I gave proper disclaimers that I have selection bias, that this can be a good contraceptive. I mean, I said hot take because I knew it would be controversial and it was, right? And Sarah Harding: Yeah. It was a hot take. That's right. Erin Sheffield: Yeah. Natalie Crawford MD: Part of that was because I know there hadn't been a study published on that. Right. And I think that's the thing I got. Some of the heat came like, you should only be presenting studies. And I think certainly if you're going to present an educational topic that has been studied, you should present it from the place of what that study shows or the limitations of such. But the idea that we shouldn't be able to talk about clinical observations in the absence of having evidence in support or against, I think is Really a disservice to patients because at the end of the day, we're making decisions every single moment of every single day that impact our life both now and in the future. And I believe women can handle nuance. And I believe when said, I don't have all the data, but I've seen this, and these are things to look out for, or this is what I might remove my IUD, or these are questions that I have. The worst scenario I see, and one of my north stars for when I make content in general is I still, after being on social media for a decade, writing a book, having hundreds of podcast episodes, I sit across from women every single day who said, I never knew this. And if I'd known this information, I may have made a different decision. And in my core, that's the phrase, I seek to not exist. Because we can say, I remember that. And but this was a this was a good option for me at this time. And I'm dealing with that because Sarah Harding: Mm-hmm. Natalie Crawford MD: We make informed decisions all the time, but too often women are making decisions from a place that is not informed. I think that there's too much in medicine of accepting the status quo as the status. And maybe it's because I have a master's in clinical research, probably because I'm in a field that changes every single year, right? I mean, like IVF is less than 50 years old. How I practice it is very different today than five years ago. That I'm okay, that. Erin Sheffield: Yeah. Natalie Crawford MD: How I have practiced in the past may not be how I'm always going to practice. And I'm constantly shifting how I do so. And yet I think some people feel threatened when their practice of medicine is questioned or they assume that you're saying that they're a bad doctor, they've done the wrong thing. And that's never what I'm trying to say. But I think we should all have space for clinical curiosity. I think when given proper disclaimers, I hope other specialists tell me what they're seeing in practice because, you know, I'll tell you. Erin Sheffield: Yeah. Natalie Crawford MD: Almost every REI messaged me and said they've seen the same thing. I'll tell you, I have plethora of patients in the comments. And I will tell you some, OBGYNs came in and said, you know, this is really good to know. Like I've not thought about this. I haven't paid attention. Now this gives me something else to think about. And that's what curiosity should lead to. And, there has been data done on this. And I'm actually, recording a video soon with a researcher from UCSF who has a pre-print of a paper on this topic. And because we're having these clinical conversations online, we're not gonna get earlier access to research. So in the end of the day, that's what my goal's always been more education so that you can make informed decisions. I tell patients every single day, I don't care what you do, but it's your decision to make it. The idea that it became such a personal attack, people saying that I'm anti birth control or I have a Erin Sheffield: Amazing. Sarah Harding: Right. Yeah. Natalie Crawford MD: paid by a political party to spiel certain narratives or No, I mean it's it's wild that I'm like I started a nonprofit for reproductive rights. Like it's so far from a reality that it in a way is is humorous. It's a sadder state to medicine because on a whole, it we see exactly why our patients don't trust us. And we see how if this is how colleagues will treat somebody whose opinion they disagree with, how intimidating it must be for a patient to sit across from somebody and ask a clinical. Erin Sheffield: a hundred percent. Natalie Crawford MD: question that they don't know the answer to. So I think it's a bigger representation. A lot of people took it on should we present question clinical observations online? But I think more than that, the professionalism we extend to each other, I think we really need we need to know that Erin Sheffield: Yes. Natalie Crawford MD: We're speaking to how we treat to patients by how we treat each other. And like I've I never stitch a colleague's video. I never present a colleague and say that they are wrong. I think that the practice of medicine is an art still, we're still learning and changing. And if somebody makes a video that I have a different point of view, I'll just make a different video and not bring them into it at all and just, you know, present a different educational opinion or take or thought on it. And I think that. Erin Sheffield: Hundred percent. Yeah. Natalie Crawford MD: I'm surprised how easy it is for people to jump on the bandwagon. How many people wanted to leave really mean, hateful comments? I don't even think watch the video. They just saw somebody else's hot take on my hot take. But ultimately, I think that's a sad state for what women do to each other, especially professional women. And I I don't know where that's rooted from, but speaks to a larger problem, you know, that exists ultimately in how we treat each other as women in medicine. Erin Sheffield: Yeah. Yeah. Sarah Harding: Yeah. Erin Sheffield: Yeah. I don't have a platform like yours, but I stumbled into similar waters a few weeks ago. I made a post about bone grafting for wisdom teeth of all things. And I had so many people coming for me and calling for me to lose my license and to quit before I embarrass myself further. And then just personal attacks on how I my voice sounds or just dumb personal things. And Natalie Crawford MD: dear. Sarah Harding: Yeah. Erin Sheffield: The most disheartening part to me was how come we can't tolerate debate? Why, when we have promised to do no harm, do we come in with daggers for our own colleagues? Like the ability to tolerate discussion on things that like, you don't know the research, go back to school, read this article. And I'm like, I literally just read that article and I got some different nuance and takes from it. You know, there's still so much in our field also that's We will never have answers to like your research, your group is so great. You guys are constantly building ours. It's so, well, maybe you can't ever do a study on this antibiotics. There's 42 different antibiotic protocols in one study. So how do you know which one to choose? You know, so there's so much that's just we're never going to know and nuance and Sarah Harding: It's so nuanced, it's so yeah. Erin Sheffield: I don't really care if you want a bone graft or not. That doesn't really matter to me. I love to hear your reasoning behind it. But when you come at me personally and attack me, that's really sad. And like I think you're exactly right. The way we talk to our colleagues, we probably talk worse to our patients. So I'm sorry that that happened to you. Natalie Crawford MD: Yeah. Sarah Harding: Yeah. Yeah. Yeah. Natalie Crawford MD: well thank you. I mean, I've been online a long time. So I would like to say it's not the first time. I mean, one of my patients now gave me a a troll doll one time and she was like, It's just 'cause like for everybody who wants to send you hate online, like there's ton who you are helping who are silent in the wings. So like don't forget about us. And Erin Sheffield: Yes. For sure. Sarah Harding: That was cool. Yeah. Yeah. Natalie Crawford MD: That was really sweet, you know. And I mean, I got I got a lot of support from it as well. So I like to think that I have thick skin and and you know, I'm I'm very confident in my ability to analyze research. I'm very confident how I take care of patients. So coming in and saying that I don't know anything or I'm an idiot or I'm a bad doctor, that I don't really put any sock to it because it's it's so far off from who I know that I am and and how I practice medicine. And I, you know, I have I have extra training that a lot of these people also don't have. Erin Sheffield: Sweet. Yeah. Right. Natalie Crawford MD: So it's it's interesting that we also don't respect the role of like if you were to tell me something about oral health. I mean, I am like, my gosh, of how interesting. And I should I should learn from that for how what I do. But at the end of the day, I think it just spoke more to me on how how sad it is for a woman to try to get information about her own body and then to see. Erin Sheffield: Yeah. Natalie Crawford MD: the people who are supposed to be online to provide information attacking somebody, like how much I how that would make me feel as a patient. So I don't know. Hopefully we can treat each other kinder. And we don't, I mean, I have dear friends in medicine who we we don't read the same study the same way, or we do practice different, or we, we view the fringe of evidence and Erin Sheffield: Definitely. Sure. Yeah. Natalie Crawford MD: These are the these are the fringe of evidence. When lack of evidence exists, you still have to care for for patients. And so what you choose to do in those moments is going to be different person to person. And we should have room and space for that. Erin Sheffield: Yes. Sarah Harding: Right. Erin Sheffield: Yeah. Sarah Harding: Right. Erin Sheffield: And the assumptions that people make off of a thirty second video about who you are and the clinical outcomes you have, et cetera. Like, you're the worst doctor in the world. I feel terrible for your patients. And I'm like, We're doing a lot of bone graphs, or we're not doing a lot of bone graphs, and my patients are happy. Like it's working. That's why we're doing it in this practice. But, you know, anyway, it's very interesting. Sarah Harding: Yeah. Natalie Crawford MD: Yeah. Sarah Harding: Yeah. Well, and I think that the best part of it all through the negativity is that it stimulates conversation. Because even when you posted that, I texted my OB from here and I said, Hey, did you know I was thinking about this because my HSG had like this weird thing on it. And I'm like, I wonder if that was from this. And I wonder if that's why it would be it became more difficult. She's like, gosh, that's so interesting. Because I prescribe IUDs all the time. And, you know, I just don't necessarily have the data about the long term effects. And so it's hard for me to counsel on that if I don't know that. And so that it stimulated conversation and curiosity. And I think that that at the end of the day is really what it's all about. Natalie Crawford MD: Yes, I agree. Erin Sheffield: Well, I love that it sounds like you're gonna get the last laugh. Some research is on its way. Vindication. Natalie Crawford MD: I mean, you know. I mean, like I want to hear all the hot takes people have because a hot take is something that is not studied yet, right? So, but maybe I'm just more of a clinically curious person. And I like I said, I believe women and I believe women can can handle nuance and understand the difference in what's been studied and what hasn't. But it's a really interesting, quite significant association, stronger than I thought that will be presented. And that is both yes. Erin Sheffield: Yeah. Natalie Crawford MD: validating to be like I was right. Not not that I was trying to be right, but it's it's important enough that, it has been studied and they're enrolling for a prospective study. So let's just kind of end the conversation with at the end of the day, all studies that exist so far on progesteron IUD use are retrospective. And you know, those that look at use greater than five years include very few patients. So this is a new generation of women who've had IUDs longer. And more time as the approval length has gotten longer to have them. And when I first entered medicine, we didn't give them to women who had not had a child. And now we've expanded that, which has been great for contraceptive options, but we need to know the long-term data on this. So UCSF is enrolling a prospective study on trying to get pregnant after having any contraceptive use, IUD included. And so that's something people should enroll in because at the end of the day, we need those prospective studies to really assess risk. Erin Sheffield: Interesting. Yeah. Natalie Crawford MD: Or we're just assessing, you know, association and these retrospective studies. Sarah Harding: Yeah. And when I was in residency, obviously it was me and a whole bunch of dudes, right? And so when you go to the OR, you know, I would drink a beer the night before so that I would be dehydrated, so that I wouldn't have to go pee. You know, so that I would not have to leave the OR and bring attention to myself. And then on top of that, if you have your period and you need to leave because you have to change your tampon, God forbid, you know? And so my first year of residency, I went and I got an IUD because I knew that. Erin Sheffield: Absolutely. Sarah Harding: The likelihood that I could not have a period would be excellent in residency, because then I could not have to leave to go change my tampon. And then, you know, like the reasons why we get it, every it's personal for everybody, you know. That's my story, but that's not everybody else's story. And, you know, then I left it in for seven years because I was like, well, I don't know. It's, you know, it's fine. And so then when I was ready to start trying, I took it out. And, you know, two months later I was pregnant. And so it's Natalie Crawford MD: Yeah. Sarah Harding: You know, but I'd already had it in for seven years and I could tell that the hormone levels had started to decrease just based on myself. And so I knew that that probably had a bigger part of it and to why I was able to get pregnant sooner after taking it out. because then after my first child, I had another IUD and then it was had it taken out, and then it was really difficult to get pregnant the second time. Natalie Crawford MD: Mm-hmm. Sarah Harding: but it just goes to show everybody's different, right? And so it's like, who knows? Who knows what the future holds? But there's reasons why we why we use certain modalities that are totally independent of anybody else and totally personal, you know. Natalie Crawford MD: Okay. Yes. And you know, in every season of life, you're gonna have a different goal and you're gonna make different decisions in that season of life, of course. And contraception is a really personal choice, but we don't have all the data, nor should we act like we do. And yet that doesn't mean that contraception is bad. You know, I've used a variety of different types throughout my life. And I'm thankful. I'm thankful I had access to the birth control pill and the progesterone IUD and different things that I used myself. But I also think we should be asking. questions before we make huge declarations like this has absolutely no impact is similarly a much bigger declaration than I had had when we should be able to have educated talks about the studies that exist in a really professional manner and hold space for those interesting discussions when there is lack of evidence as well. Erin Sheffield: Mm. Definitely. Sarah Harding: Yeah, I agree. Well, here's one question for you. Okay, so when I was well, and I was the kind of a jerk when I was first trying to get pregnant with my first one. And so sorry to all of everyone. but I so I donated eggs when I was in dental school. And it was right after my first year of dental school, and it was so interesting because I had just gone through anatomy and physiology and I was learning about all of the hormones and all of the everything. Natalie Crawford MD: Okay. Yeah. Sarah Harding: And it was so cool, you know, and so clearly not a needle phobe because I was just you know I did. I thought it was so cool. And so then donated eggs. And then I remember when I wanted to get pregnant, I just wanted to have one pregnancy, but I wanted knew that I wanted two kids. And I was like, went and talked to an REI and I said, How can I have twins? She was like Natalie Crawford MD: Okay, not Aaron over there. You're good. Erin Sheffield: I was like, I had PTSD, but she just loved it. Sarah Harding: We don't recommend that. Like that's, you know, and it's just such a jerk, right? And so I knew about the risks and stuff, but I just thought that I was that I could do it. I could do that. I could I could handle that. She was like, We're not gonna do that. And of course I was in the Navy and she's like, We're not gonna do that. You know, the military, the government's not gonna pay for you to do that. And I was like, Okay. All right. But I did ask her this one question because I said I ovulate on the full moon. Erin Sheffield: You don't know what you're asking for, Sarah. Natalie Crawford MD: Yeah. Like we're definitely not do that. Erin Sheffield: Mm. Sarah Harding: And she was like, no, that's that's not true. You don't do that. And I was like, I I do though, you know? And so as time went along, I started tracking it. And after going on deployment and and having my circadian rhythm a little bit messed up, I started developing seasonal affective disorder. So in the winter time, I I hibernate, my body hibernates, I can't have new thoughts, new ideas, I can't start new things. and so when I started tracking it, I Natalie Crawford MD: Mm-hmm. Sarah Harding: was realizing that in the spring and summer I was ovulating on the full moon. But in the wintertime it reset almost. It's very interesting. And so when I got pregnant with my second child, we had, been trying already for a year and a half, I think at that point. And we had talked about doing Clomid and she prescribed Clomid and I pr I filled the prescription, but it was November and I was like, You know, I'm just gonna wait. My body doesn't, yeah, my body does not doesn't do it. And my body won't do it. And so then we waited and I and I was like, I'm just gonna try naturally again in the springtime. And so I remember on, I think it was, I forget what month it was, but I had been like religiously checking for ovulation. And I was on day 14 and I still hadn't had the surge. Natalie Crawford MD: Like this is not my season. Sarah Harding: Fifteen, nothing, sixteen, nothing. And I was like, what is going on? And then all of a sudden on day nineteen, I started to have that middle schmurtz, you know, the little bit of and I was like, this is interesting. And I went and I checked it and it was the highest it had ever been on day nineteen. And do you know what that was? The full moon. Natalie Crawford MD: Mm-hmm. You know, there's there is data that on large population-based scales, that there is some lunar cycle rhythm for women and their ovulatory pattern. there's also interesting data that like more women tend to start their cycle on Thursday and Friday than any other day of the week. Isn't that interesting? And that there's this seven-day kind of set to those four cycles. And of course, we always like. make the you know menstrual cycle this like 28-day perfect cycle, but that there it does tend to be in on population studies more women who fall into this like seven day, seven day, seven day, seven day and they're in sync with a lunar cycle. What's interesting though is it's it's not always the same. Like for where you may ovulate on the Sarah Harding: 'Cause I was always surging at day fourteen or fifteen, always. In the months leading up to this fascinating. Yes. Natalie Crawford MD: Yeah. It's fast fascinating though how the lunar cycle can impact on population base. I I think I don't know. I I I obviously love evidence-based medicine. I'm a huge nerd when it comes to clinical research. I also like love woo-woo and I love wellness. And I think the origin of medicine comes from nature, right? And so I think that there's also space for both where there's so much about the Miracle of the human body that we don't understand that we are influenced by the world around us when we start looking at these clues. That I find it so fascinating. Sarah Harding: Yeah. I mean just based on the amount of activity that the coyotes have on the full moon, you know, it is insane. So maybe I'm just like a coyote, I don't know. Natalie Crawford MD: I mean Ha. Erin Sheffield: Is that when they're coming on the porch? Sarah Harding: Yes. Natalie Crawford MD: I love it. Erin Sheffield: Sarah lives in like a wildlife preserve in San Diego. She just gets all this crazy stuff happening at her house. Yeah. Yeah. It's like two days in a row. She's like, look at this skunk that's on the porch. Look at the coyotes that are on my porch. Like, what is going on? Full moon. I didn't know. Well, we don't want to keep you longer than you have. I have one more question if you don't mind. I mean, I have 12,000 more questions, but we'll try to keep it bereaved. Sarah Harding: What? Natalie Crawford MD: fascinating. Sarah Harding: It's not really a preserve, it's just they just show up at my house. There's land. Erin Sheffield: So I started a women's wellness retreat for doctors. And so I love what you're doing with Pinnacle. It's a women's healthcare community. You are the CEO, am I right, of the Pinnacle. Can you tell us how that came about? Whose idea was it? How did that come into motion? And what have you seen come of that? What's your future goal there? Natalie Crawford MD: Yeah. Thank you, Erin. I think we can say that my social media experience where women are not always supporting other women in medicine is highly prevalent against many different life stages of a career of medicine. And it can be really hard to find support, especially if you want to think outside the box or you want to push some boundaries or you want to practice medicine in a way that's nonlinear, right? And you know. Erin Sheffield: Mm-hmm. Yeah. Natalie Crawford MD: I will say that we, you know, with my co-founders Ruper Wong and Pamela Meta, we, you know, connected online and through social media, just kind of knew each other. And this was Rupa, who's a pediatric ophthalmologist in Hawaii, was her idea. She originally said, I just would love to bring a group of women together who are in different specialties because we probably have so much to learn from each other. and we realized that there's so much we can offer each other, even from different fields. And what happens is once you get into practice, you only interact with the people in your bubble and you tend to lose these other ideas and outside perspectives. And not about healthcare topics per se, like the practice of medicine, but more some of the the art of it. How do you build a personal brand? How do you negotiate a contract? How do you set up a private practice? How do you advocate for a cause that you care about? All of these things are the underlying factors that really end up making you happy or unhappy in a practice or in whatever your career is going to look like. And Ruba said we should have a place where we bring this all together. And that's what we started our first conference was in 2019. And we realized that that time, I mean still today, as you guys know, More women are leaving, medicine across all fields and degrees of medicine than many other professions. It's very hard. It can be non-supportive. And having a group of women who, gosh, it changed my perspective. And I've been somebody who's we said I've been pretty confident to follow what I felt like was right. But to sit next to somebody who would say, like, what are you working on? What are your goals? I know so and so. Let me introduce you. how can I help you? To have people immediately care about you getting to this next stage with it being of no impact to them, that is so powerful to have people believe you and support you and put you in rooms and speak your name. And that was the heart of what Pinnacle was. It's not covering medical topics per se, but it's these other things. And we realized really quickly that, we wanted it to be a continuing education event because, you know, as an employed physician or an employed Practitioner, you have CE credits that you can use, right? And your company can pay for it. And yet we need these CE hours. So we wanted it to be that. It was actually really hard to get CE providers for a while. Like people would say, but you're not talking about hormones and periods, or these, these are not education. And we felt very strongly these are the education that you need. This is what you're not getting in medical training. Erin Sheffield: Yeah. Yeah. Right. Natalie Crawford MD: Which ultimately led us to through a very long process become a medical education company. So now we're a jointly accredited education company where we help accredit other conferences or courses and, you know, podcasts and books and thinking through the box of how people learn today is so different than where we used to, even as professionals. And providing avenues to support that medical education is our is our big goal and that it doesn't have to Sarah Harding: Yes. Natalie Crawford MD: always be so dull. And that truly, this is how I would unify all of what I spend my time doing is you can't make decisions on data you don't know. You've got to raise the fund of knowledge. And this goes whether you're talking about, I can't start a practice because I don't know how. Okay, well let's learn how. Or, I can't, make this decision on IVF because I don't know this. So really providing education is the start to opening up so many doors across the board. And That's really what Pinnacle is now. It's in medical education company. Our big goal is to help provide medical education in a way that doesn't have to be so linear. And we really are expanding to where clinicians are learning currently. And that has propelled Pinnacle to be more than just a conference, which Aaron, throwing an event is a big deal. It is hard. I mean, we take a lot of pride in how we do it. I know you throw a wonderful event. It's so much more work than anybody who attends really understands. Sarah Harding: Yes. Erin Sheffield: Yes. Natalie Crawford MD: But becoming a medical education company has been a whole new business. Yeah, I mean, we have all these, for real full-time employees and people who are totally dependent on you and we're really rapidly growing. And that's also exciting. And speaking to the fact that I think clinicians are so hungry to be able to learn some of this real world knowledge and trying to say how do we combat some of the problems in medicine of burnout or poor patient care? Erin Sheffield: Yeah. Natalie Crawford MD: is like, well, we've got to start to change what we're doing and how we're doing it. And I'm I'm proud that Pinnacle is more than just a conference now, but it's really helping provide that educational information for more people as well as they are chasing these, you know, nonlinear pathways to ultimately be a better practitioner and provide better care. Sarah Harding: Yeah. And visibility, right? Because you're finding people that probably wouldn't be on the stage at our national conferences. And I think one of your best attributes is that you're able to provide a wealth of information, but that is very relatable and that has your own experience and your own way of communicating with patients and people to make it something that people can digest. In a way that's very different from what I think we're all used to at our national meetings. Natalie Crawford MD: Sarah, such a good point. You know, I do believe the lived experience has educational merit, right? Whether that's a patient's experience or even you don't have to be this academician, like somebody who started a successful practice or who provides really good care to patients or who is, you know, helping solve a clinical problem that we don't have an answer for. those are the people I want to learn from right now, right? And so I agree. I think really trying to highlight those people and put them on stages and help. Sarah Harding: Absolutely. Natalie Crawford MD: Further spread their message is also a big passion. Erin Sheffield: I love that. And that I've been really appreciative of what you guys are doing. the Doctor is all in has partnered with Pinnacle in the past. And I think we'll probably continue for our continuing education for my event. And that was a really purposeful alignment for me, choosing your company because I love what you guys stand for. I love what you're doing. And so for me it was worth that collaboration, just knowing that, you know, I'm we're in the room. with women who have similar ideas. We're doing similar things, maybe different audiences or in different ways, but it's really about bringing that high impact education and connection to women who who need it. So Natalie Crawford MD: Agreed. I love it. We're happy to support you. Erin Sheffield: Thank you. Sarah Harding: Yeah. Awesome. Well, thank you so much, Natalie. We so appreciate your time. And how can people find you? And how can we spread the word about your book? Because my OB that I talked about earlier had not, she had not seen it. And I was like, This is this is for you. This is, you have all of these young patients. This is made for you. Natalie Crawford MD: Yes, thank you. Erin Sheffield: This is for every woman and even Natalie Crawford MD: I love it. Thank you. Well, I'm on Instagram at Natalie Crawford The book is the fertility formula and you can get it anywhere. Thank you. I wanted it I wanted it all my favorite colors. So I thought it could be feminine and empowering at the same time. And I have the As a Woman podcast. So I would love to connect with anybody. Erin Sheffield: man. It's so pretty too, by the way. It's like the prettiest book. Sarah Harding: Thank you. And if you ever want to do a little episode or anything, part two of your book on oral health and the role of inflammation stemming from the oral cavity. Natalie Crawford MD: Yes, we'll have to get you guys to Austin, see if we can get something recorded. Erin Sheffield: That'd be fun. Sarah Harding: That would be awesome. You can always sign me up to come to Texas. That's for sure. I'm like your husband. I'm ready to get back. You know. It's fine. Natalie Crawford MD: Ha ha I love it. Well, thank you guys so much for having me. It's been we could talk all day long. Erin Sheffield: Yes, we could. Sarah Harding: We could. We really appreciate it. Erin Sheffield: Yes, thanks for joining us for another episode of the Resting Stitch Face podcast. As always, please like, share, and follow. Until next time. Sarah Harding: Bye.