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The Science Behind Fertility Decline: What’s Causing the Drop? · hol+ with Dr. Taz MD | The Future of Medicine is Holistic

• The Science Behind Fertility Decline: What’s Causing the Drop? === Are we at the brink of extinction? Is our planet doomed? Where did all our eggs go? The fertility rate here in the United States decreased by 3 percent from 2022, reaching a record low. The struggle that I see day in and day out in terms of fertility and trying to start a family. Is real. We're seeing more and more declining sperm counts at younger and younger ages across the globe. Again, the question, what's going on? Why is this happening? Are we at the brink of extinction? Is our planet doomed? Where did all our eggs go? It seems like everywhere we go nowadays, we see a headline, we see an article, or it's just in conversation where somebody is talking about their fertility struggle. More and more, I hear of younger and younger women and men talking about infertility, the struggle to start a family, begin a family, or even questioning whether they want a family at all. Understanding fertility today is like trying to take a masterclass in science, all kinds of sciences, but still not really getting the answer. There's so many options. There's so many roadblocks. But again, like many conditions. The exam room and the information oftentimes are not meeting in a healthy place for patients. I've got to share a story straight from our exam rooms where a young woman came in struggling to get pregnant. She was maybe 25, 26 at the most. She had gotten married, finished her career, started her job. She was ready to start the family she had always dreamed of. She describes what, to me, is again, a classic example of gaslighting, a broken medical system, and so much more. A lot of the reasons why we have this podcast and we're talking about a new way, the holistic way of really seeing so many different issues out there. As she continued to recount her experience with visiting doctors, she described going from doctor to doctor much like I did in my early years, trying to get answers on why she was struggling to get pregnant at her last visit to an infertility specialist, she describes walking in the room. Doctor sitting at the desk, stack of papers, lots of her labs, thumbing through her labs, not greeting her, not mentioning her by name, but finally looking up and saying, after looking at her head to toe, you have no eggs. Your AMH is terrible. There is no hope. You might as well get a dog. And then closing the door and walking back out. Of course, she was in tears telling me the story, describing how she felt, her emotions, what she thought. Was the end of her dream of starting a family at the young age of 25. Well, there's so many problems in this story, right? First of all, the bedside manner. Secondly, looking at data and making that decision. Thirdly, her journey of getting gas lit and not getting answers. All of it problematic and very symptomatic of what many people go through today. Well, her story, as it continued to unfold in her journey with me and within our practices was quite the opposite. As we dug into her history and her science and her lab work, and even her lifestyle, where her personality was not aligned to the career that she had chosen, creating a lot of stress and chronic high cortisol. We could help show her all the different reasons why. She was having trouble getting pregnant. Fundamentally, she had high blood sugar. She had high insulin. She was not ovulating completely. And that in turn was the reason why she was having issues. Well, she then proceeded to make a number of different changes, including changing her diet, making sure she was sleeping specifically sleeping between the hours of 11 PM and 5 AM. As many people in Chinese medicine and Ayurvedic medicine suggest as being critical for optimal fertility. In addition to that, she started acupuncture and really worked hard on releasing and lowering her overall stress load. Well, sure enough, it took, I believe about 90 days to four months, if I remember correctly, she got pregnant and yes, she also got a dog. But I tell that story to tell the story of so many women who have been on this journey of fertility and have gotten blanket answers where either they had no hope. Or the only hope was IVF or IUI or a really extreme measure of assisted reproductive fertility. And there's a lot of space in between, between going through one of those procedures and understanding your body and balancing it correctly. I want to talk a little bit about the science around fertility treatments today and just again about the general framework we're working in and the general construct. Again, the fertility rate here in the United States decreased by 3 percent from 2022. reaching a record low. This was a 2024 study in particular. This is the second year in a row where there's been a decrease in overall fertility and fertility has been decreasing over the last decade in general. There are a couple of different reasons for this. Many of them rooted more in just our lifestyles and how we're building family and how we're constructing our lives. Overall, women are choosing not to have as many children. The birth rate for teenagers is down, which is probably a good thing. There is less, there are fewer and fewer C sections while the preterm birth rate remained unchanged at about 10%. Here's another explanation for declining fertility, which is actually fairly interesting. It's tracking declining fertility rates as population density. Increases meaning as we start to crowd out environments, the fertility rate goes down. Now there are, there's a lot of conjecture around that. Is it because there are fewer resources or less access to medical care or to even the necessary sort of support to get pregnant? What this particular study found, this is from 2021, by the way, there's a robust association between density, population density and fertility over time, both within and between countries. So again, this issue being global, not just localized to the United States. And in fact, this talks about all countries. Having an issue with declining fertility rates. Let's look at one more. This one all about the changing tide of human fertility. I found this particularly interesting because it brings up something that honestly, even I have never thought about before. This is in the journal human reproduction, uh, published in 2022, and it's talking about the worldwide steep decline in overall fertility on every country, every country in the earth. But this is interesting. It is saying we should recognize that with increased prosperity associated with this sort of transition in populations, it reduces the selection pressure on high fertility genes. By lowering the rates of infant and childhood mortality. So let me translate that for just a second. Essentially it's saying because we are able to keep children alive longer, infants alive longer because we are able to decrease the amount of sort of, you know, in utero deaths that happen or deaths that happened during pregnancy with children, the genetics are selecting essentially for weaker and weaker fertility. Super interesting. Never thought about that before. This goes on to say that the use of assisted reproductive fertility, whether it's IVF, IUI, egg transfer, all these different modalities is allowing for weaker fertility genes to be expressed across the population. Meaning because there's all this support, the weaker fertility genes are actually hanging around the population and a part of the conversation around why fertility rates. are going down. Super interesting. I didn't think of this before. Do I buy it? Maybe, maybe not. But I do know that the struggle that I see day in and day out in terms of fertility and trying to start a family is real. And as somebody with PCOS, while I personally did not struggle with infertility, I know that members of my family have, and I know that so many of my patients do as well because they are not able to obtain that proper ovulatory response. There's another piece to this fertility equation that we have to think about. It's not just all about female fertility, right? There's an increase in male infertility and we're seeing more and more declining sperm counts at younger and younger ages. Across the globe, again, the question, what's going on, why is this happening? Well, there's lots of different explanations for it. One in particular is looking at the environment and the role of the environment in these declining sperm counts. Here's again, a journal, current opinion of urology. This is from 2020 and saying there's substantial data to suggest a decline in sperm count over time is due to causative factors. While they have been. Um, not maybe fully elucidated include increased rates of obesity, poor diet and exposure to environmental toxins. And this in turn is impacting overall fertility. So again, yet another environmental trigger. Really kind of caught up in this fertility conversation. Okay. Let's do one more. These were so interesting to me and I really felt like we should go through this before we talk about a different way to think about fertility and building your family. And there again, everything is multifactorial, I'm sharing these journal articles to help you understand where the science is, but at the end of the day is putting a plan together for you that is ultimately so important. All right, the circadian rhythm and environmental circadian disruption from follicles to fertility is super interesting study as well. This is from endocrinology published in 2016. Essentially what this is talking about is something that I've experienced in a different way, saying that our fertility cycle is on a circadian rhythm. Just like our hormonal cycle, right? So for all of us who are out there kind of burning the candle at both ends, not sleeping as Chinese and Ayurvedic medicine ask us to from roughly 10 PM to 11 PM, all the way to five or 6 AM is a disruption, not just to our natural sleep. sleep rhythms, but to our reproductive rhythms as well. Super interesting. Again, remember my background is doing ER and doing shift work and going from night to day and day to night and all these different things. And I definitely saw amongst my colleagues and coworkers, the epidemic of infertility that they were experiencing because of that schedule, so to speak. But to quote from the article directly, the internal or circadian timing system is deeply integrated in female reproductive physiology. Nobody ever tells us that. It's so important to understand that. In fact, environmental circadian disruption, they call it ECD in particular, is the disturbance of temporal relationships within and between two internal clocks, your brain circadian rhythm and your organ circadian rhythm and how a disconnect between those circadian rhythms is leading to infertility. So external timing cues like light, like nutrients. Social dysfunction, rotating work shifts. And even this was so interesting to me, I'm thinking about all my superwomen and executives traveling across the globe, even trans Meridian travel, meaning you're moving from one time zone to another across countries can impact the circadian rhythm of both the brain and your organ organs impacting fertility overall, and ultimately reducing it. And then to that, we add the chemical load, environmental toxins, and overall hormone levels during sexual development as a part of this infertility conversation. So a lot to think about there and a lot to think about with our environment. Okay, let's do one more and then we're going to move on. This one's talking about the impact on male fertility and environmental toxins, and specifically is calling out specific toxins in pesticides and heavy metals. Accounting for potentially the idiopathic infertility scene among males, which right now is about 44 percent of all infertility cases in men, meaning they don't have a reason they don't have an explanation. So a lot of that may indeed be environmental. Synthetic chemicals impact the hypothalamic pituitary gonadal access, the HPA access and impact sperm formation. There are more than 80, 000 chemicals. Currently registered in the United States national toxicology program and an additional 2000 getting introduced every year. This is a problem. These include things like phthalates, polycyclic, uh, aromatic hydrocarbons, aromatic amines, organophosphates, and more. And the worst part of this is it contrasts to other chemicals that are regulated in somewhere like the EU, where their EU reach program. Is restricting and regulating chemicals in a much more comprehensive way. So we know that there's a chemical load that's impacting fertility overall. We know there's a change in our lifestyle that's impacting fertility as well. And all of this is working together to create this epidemic of infertility. So now that I've painted the background and the landscape of infertility across the globe, I want to get into more of what the options are. If you're thinking about starting a family, Or you have a loved one that is on a fertility journey. And even if you know, you don't have any issues, I still feel like this conversation is super important to help you build a plan. That's going to be preventive and proactive for you. All right, so let's get into it. What is the state of fertility treatments today? And again, I want to go with just sort of what's out there, what people are talking about, what you are able to do, and then we're going to flip it and talk a little bit more about the holistic way and what becoming whole on a fertility journey should look like. So what does the current landscape of fertility treatments look like? Now currently about 85 to 90 percent of infertility is treated with medications, surgery, or assisted reproductive fertility treatments like IVF and IUI. Many of these Try to, uh, identify the cause of the problem, factor in the age of the woman, look at her history of previous pregnancies, and then definitely look at male infertility as well. Now let's first begin with what the definition of infertility is. So infertility is defined as trying to get pregnant for over a year without any success. And then the workups and the treatments begin. Sort of the first line of treatment overall is to start with something called clomiphene or clomiphene citrate, clomid as we, uh, most of us know it. Clomid is usually taken at the beginning of a menstrual cycle. Cycle and it causes ovulation in about 80% of women. It does increase the risk of having multiple pregnancies. Again, Clomid has been successful in practice. We've seen it stimulate ovulation in women for sure. The next line of action is usually something called letrozole, and it's a pill that decreases the amount of estrogen. A woman will make stimulating her to release eggs. After letrozole, there's HCG, which is also used to stimulate fertility, the FSH hormone in particular. And then there's also the medications, bromocryptine or cabergoline, which are targeting a hormone called prolactin, which can often be a block to ovulation. Prolactin by the way, is the breastfeeding hormone. Many women nowadays are walking around with high prolactin levels. I have some theories about that as well. Now for some women, it's actually endometriosis or severe PCOS. That is their block to fertility. Those women sometimes will need surgery and will then, uh, see their fertility issues resolve. And then for others, they have to move on to what we call assisted reproductive fertility treatments, which include things like IVF, IUI. egg transfer, embryo transfer, and egg retrieval, uh, and egg donation, that whole family of, uh, assisted reproductive technologies. For men, it's important to evaluate their sperm counts, and there are medications as well that help with male fertility and actually also help with hormone balances and erectile dysfunction. So for most women and men trying to start a family today, a fertility journey looks like this. It typically starts with, Hey, let's start a family. Hey, let's try. And then trying moves to sort of a frenzy schedule when things aren't starting to play out the way they want to. And I find a lot of couples just frustrated with what's happening. Why am I not pregnant? And then disappointed, you know, month to month when they don't get the results that they want at some point in that journey. You, if this is you may enter an exam room of a reproductive endocrinologist or a GYN, somebody on your medical team, which may begin a workup to see what's going on. Is it your hormones? Is it your nutrients? What's happening here? And often the male is evaluated as well. Whereas the sperm count, is that potentially the problem? The next step for many of these couples is to walk onto and into. A path of assisted reproductive technology. And that can be expensive costing anywhere from 24 to 40, 000 for a couple. It can more importantly though, be draining. There's a lot of procedures, a lot of steps, a lot of hormones, and so much more. Now it has resulted in beautiful outcomes for so many families. So we're not trying to take away from it by any means, but the process and the cost often starts. Without first an internal look at the dynamics and the chemistry of the people involved at the parents involved. And that's where we have to change our thinking and turn this conversation around and really start to build a holistic fertility roadmap. One of the things I love so much about Chinese and Ayurvedic medicine and Eastern systems of medicine. As they stressed the importance of a preconception plan, thinking about how to build your health, how to restart it before you even begin thinking about getting pregnant. I've often told the story of my mentor, my Chinese medicine mentor, like wagging his finger at me and saying, low chi, low chi. I feel like honestly, sometimes I've sat across from a patient and I've wanted to do the exact same thing. You have no energy. There's no sustenance in you. How in the world are you going to get pregnant when you're not even a hundred percent yourself yet? So I think when we start a fertility journey without first taking care of ourself, we're starting kind of with the negative bank account. And I don't want any of you guys to be doing that. Now, I know we get caught up in our head. I'll never forget. I had a patient who still comes to us, amazing woman, but I remember her looking at me. She's like, I need to get pregnant by this date. And if I'm not pregnant by this date, then I'm going straight to IVF. And I was like, are you giving me an ultimatum? I'm not God. I don't think I can make it happen that fast. Right. But I reassured her. And I said, if you can just give us 90 days to six months, that's what it takes. To rebalance you. And if we can rebalance you, we may save you the heartache of all of these different steps in a reproductive journey. And I think I was able to calm her down, but I meet a lot of you who have this timeline in your head and you are hell bent on meeting those deadlines. And if you don't meet those deadlines, then you're going to do whatever it takes to make it happen. And one of the gifts of Eastern Systems of Medicine is to understand the nature of flow and the flow of energy and how that sort of resistance and that resolve, while it works in a career, it may work in terms of accomplishing your goals and your vision board, it works against you when it comes to getting pregnant. So what are you supposed to do? Hands up. Nothing. No. What we are going to do and what we're going to work on over the next few minutes is trying to understand what a preconception holistic fertility roadmap looks like. Actually looks like as we start the journey towards fertility, and as I've shown you in some of the studies that I've shared, I feel like it's so important to really dial into these different ideas around health around your health and your partner's health that make a difference when it comes to getting pregnant. And I'm so excited about having this conversation because it's not really just about getting pregnant. It's also about you and your energy and your vitality, your chi, as we often call it, and making sure that it is guided and directed in the right way. Before we build this preconception plan for you and your partner, I want to dive a little bit more. into the holistic way of thinking around fertility. Now we've talked about low Qi, and that's honestly our starting point. Improving Qi, which is the word for energy, should be the primary goal before you even think about trying to get pregnant. And that serves you well, not just for getting pregnant, but actually makes the postpartum period much better. And actually makes that entire first year after you've had your baby. so much easier. So again, it's like kind of depositing money into a bank account and being prepared before you hit the big decision. Now, improving Qi in Chinese medicine was all about the kidney meridian. The kidney meridian in Chinese medicine was thought to be the energy you were sort of gifted with at birth. And it was your responsibility to replenish it. Or if you lived in a particular way, you would deplete it more rapidly. The kidney meridian was so important. It was connected, not just to fertility, but it was connected to all the hormones, to the quality of hair, the quality of skin, even the brightness of your eyes, all of which determined your vitality. I had low chi at one point due to the lifestyle that I led and my diet of diet Coke and popcorn certainly didn't serve me well, but assessing your chi and understanding. Where it is is very important. The fundamental elements of Qi in Chinese medicine were nutrition, gut health, hormone balance, sleep, and of course, stress. And where was your overall stress? From a Chinese medicine standpoint, they could diagnose you very quickly with low Qi. If you had circles under your eyes, your skin was pale and thin, your tongue was sort of flat. All of those were signs of low Qi, including of course, hair loss and general weakness. In Ayurvedic medicine, the idea around this was vada being imbalanced. Remember Ayurvedic medicine talked about people in the context of doshas or types. And when it came to infertility, the vada dosha was very imbalanced. So the importance was to bring that back into balance and settle it and ground it so that fertility or pregnancy could actually happen. A lot of this, both systems of medicine and additional Eastern systems of medicine were about balancing yin and yang energy, male and female energy. And all of those were critical in helping somebody get pregnant. They use words like Cold womb syndrome, who wants that? Right. But that was the idea where nothing cold should go on the womb. And we shouldn't be wearing things that are tight and constricting because it blocked the flow of energy there. They would advocate for things like castor oil packs that would heat the uterus or heat the womb and allow blood flow to that area or acupuncture, right? Yoga, all of these things that opened up the pelvic floor and improved energy overall. So the primary goal in Chinese and Ayurvedic medicine when it came to fertility was essentially to improve qi, improve the flow of energy and look critically at nutrition, at gut health, at hormone balance, at sleep, at stress, and don't restrict and control the womb, allow energy to flow through that pelvic region. The second concept that was incredibly important was all about the liver. You know, we've talked a lot about the liver in the past and how the liver is responsible for so many different things, but the liver, the liver meridian in Chinese medicine regulates the ability of the body to eliminate toxins, to move them through so much so that they believe if the liver gets boggy and bogged down with either stress. Or too many toxins. There's the emotional expression of anger and anxiety. There's the physiological expression of high cortisol. Classic sign is waking up between two and four o'clock in the morning. And then more importantly, there's the hormone crash and it creates a stagnation. They talked a lot about stagnation where energy just wouldn't move. The liver would get boggy, heavy, and it wouldn't move the hormones through. One of the patterns of infertility in Chinese medicine was liver blood stasis, meaning things weren't moving through the liver, or cold liver, liver yin deficiency, where the liver just couldn't do its job. So they translate this idea of the liver to today's world in terms of eliminating and detoxing the liver and really lowering your toxic load. I mentioned some of the toxins and chemicals involved in fertility. And it's true. They already knew it thousands of years ago, that this was an important piece of the fertility and the conception puzzle. And then the last concept, when we think about how holistic or sort of East West strategy around fertility and preconception is taking that idea of stagnation, but moving it away from the liver, but moving it more to the heart and where you are emotionally. They believe that if you were in a relationship where the energy was not flowing, or in a life situation where energy was not flowing, then you were stagnant, you were boggy, and the hormones and the conception factors could not do their thing. So they would spend a lot of time talking to their patient about what do we need to do. To get you unstuck because part of your fertility issue and part of your preconception blocks may simply be you being stuck in a position or relationship that's not necessarily working for you. And they would counsel both partners to that end. So there was a lot of emotional work involved too. And this is something I can a hundred percent. Again, relate to when I think about the many patients I've seen, I had again, a classic patient who, by the way, have since has since become a friend who at the time I was just like, this woman's never going to get pregnant. And honestly, she didn't, she ended up doing IVF, but she was type a executive hopping on a plane, jumping to a different city every week, jumping to a different country, you You know, that type of person, just a hundred percent go, go, go all the time. And she was shocked that she couldn't get pregnant. And sure enough, she was not in a position mentally or physically to start to make big changes with her life. So she and her partner chose to go down the IVF path. And this is something I've seen over and over again, a Chinese medicine practitioner and Ayurvedic medicine practitioner would say, okay, let's pull back if you want to get pregnant. If you want to start a family, have you created an environment of nurture? Are you nurturing yourself before you can nurture somebody else? So again, when we bring that methodology in. To the fertility equation, we get results that are so much more gratifying and less expense and less emotional wear and tear on the couple. But doing those things may not be enough, right? And in the literature around fertility, when we look at. Some of the Eastern medical systems, there are many modalities. I mentioned a few acupuncture was one. There is a rich literature around herbal medicine, everything from herbs like Baishou to Dongquai and other herbal tonics, really helping to get people pregnant. But at the end of the day, they would look at the whole picture and they would look at the whole sort of situation between physical, mental, emotional, spiritual, energetic, and community health. And if there was alignment, Then that was a good recipe for fertility. All right, let's get into some brass tacks and talk about, um, a little bit more around what you can actually do and build that sort of treatment plan, you know, around, uh, getting pregnant in general. And I do want to mention again, I love looking at the research as we do some of these things, but there are multiple studies talking about the effectiveness in Ayurveda or of Ayurvedic interventions for the management of infertility and how certain herbs and certain products do seem to be helpful when we're having a conversation around trying to get pregnant. And again, there's a lot of. Different Ayurvedic treatments, purification, balancing, uh, you know, really things that help to get the body to a state where there is, uh, optimal levels and optimal balance for fertility. This particular study looking at the effectiveness of Ayurvedic intervention in the management of infertility. This is a 2024 study. I get super excited seeing these things come out, you know, over time. But it's saying there is a research gap for some Ayurvedic treatments. However, it is showing that there are some protocols that do help with fertility when it comes to Ayurvedic treatments, super, super exciting. In addition to that treatment progress and diminished ovarian reserve, finding that an effective ovarian reserve therapy would improve. function, fertility, and quality of life in patients, and is seeing that both a combination of Western medicine and Chinese medicine seems to be successful when we look at that, at the strategy overall. Same with this next study also released, uh, this is actually older 2008. Talking about the integration of Chinese medicine and Western medicine and how that improves fertility outcomes. And then lastly, looking at traditional Chinese herbs and its role in the overall fertility equation and finding favorable outcomes there as well. So a lot of promising research, and I think if we can all be open to this, then we're going to find more and more sort of, you know, remedies in the literature from a long time ago that are going to help really push this fertility equation even. Okay, let's build this plan. What do we need to do? First of all, we're trying to form a preconception plan. And remember, we're going to steal right from some of these older systems of medicine. What do you need to do? I would ask yourself to build chi. How do you build energy? How do you build vitality? It starts with eating a diet. that provides energy. One of the key ways we all nourish ourselves is through the foods we eat. So eating cleaner foods, right? Eliminating junk or processed foods, eating consistently throughout the day, and then getting in things that support the gut, whether these are broth based soups that were such a part of the sort of the recipe book for fertility in Chinese and Ayurvedic medicine, getting enough healthy fat, getting enough protein. All of these were critical in building a good preconception plan, but more importantly, building chi or building energy. In addition to that, sort of tied to that almost is looking at gut health. You know, these older systems of medicine believe that the gut was ground zero. I've written about that many times, that your microbiome, your ability to digest your ability to assimilate food and hormones and make it all work for you is an essential part of having a good preconception plan. So making sure you're doing things like taking digestive enzymes. You know, taking things that line the gut and getting in the right nutrients for you all a part of a fertility plan that's supposed to work for you. I think understanding your hormones is really important. I meet too many patients, honestly, with endometriosis or PCOS who are in what I would call a hormone block or hormone stagnation of some kind, but finding patterns of estrogen dominance. Androgen dominance, insulin resistance, low testosterone in men. These are all patterns that need to be fixed. I feel like your thyroid needs to be optimized as well. And things like cortisol need to be in balance, not too high, not too low, just in that sweet spot that we talk about all the time. So hormone balance is an essential part. of a good preconception plan as well. I think the concept of inflammation presents itself here too. I see a lot of sort of autoimmune type infertility where, you know, it's almost like the body's reacting against itself that happens because the inflammatory load is too high. So learning to manage inflammation, screen for inflammation and dial inflammation down is also a very important part of sort of this holistic fertility roadmap. Finally, I think looking at your toxic load, looking at a concept called oxidative stress, we work a lot on that in practice where you almost want to improve energy and oxygen within all of your different cells to release good quality and high quality eggs. That makes a difference in fertility to the point that even something like glutathione is something we recommend over and over again in practice as we try to support fertility overall. So those are the key kind of scientific elements of a good holistic fertility roadmap. And I would pair that very technical conversation with a life conversation. Where's your stress? Where's your relationship? Are you sleeping? Are you moving? What do you do for self care? And do you. Or don't you budget a couple of hours every week to make sure cortisol levels are coming down and your hormone levels can get balanced naturally. All of that is critical. If you're a frequent flyer or a trans Meridian traveler. What's your recovery plan? Do you have one in place? Because all of this will impact your ability to get pregnant. And when we put all of these pieces together, the physical, the mental, the emotional, the social, the community, then we have a good plan that's going to work and takes the stress down and away out of getting pregnant. I should probably add a community plan as a part of this. Who's going to be involved in your childbirthing process, in your pregnancy, in your postpartum period? Who's going to support you? What will childcare look like? What will the duties of parenting look like? Are you ready? Ask yourself these questions before you stay on this linear goal oriented plan of I'm going to get pregnant then and then start to experience disappointment. I continue to believe that a holistic fertility roadmap really is our next best option. While the future of fertility continues to look at all kinds of procedures, everything from ovarian stem cells to lengthen the age of the ovaries to uterine transplants, where you can go get a uterus from somebody else. And does that allow pregnancy to happen later and later? to finding and using techniques where you pull out pockets of sperm and you pull out optimal eggs and then create embryos that you then implant. There's a lot going on when it comes to the technology around fertility. But again, if we can start with the basics before we go to the extremes and the basics, again, really are all about asking those questions. Where's your energy? Where's your cheat? Have you built the life to match fertility and conception and pregnancy? Have you taken care of yourself? And how much self nurture have you done before you take on nurturing others? And what does this mean for your relationship, for your existing family, and even for your work and community? And how much of all of these different aspects of your life Fulfill you because once you are pregnant and you have a child, it is 24 seven for a really long time. I hope this has been helpful in understanding the landscape of fertility, where we are today, what your options may be, and where I personally hope fertility starts to go, where we think about the whole picture and put all the different pieces of your health together. not just for you, but for your partner and for the family that's waiting for you. Thank you for joining me for this episode of Holt Plus. Be sure to share this episode with your friends and family and subscribe wherever you get your podcasts. And don't forget to follow me on all social channels at Dr. TazMD. I'll see you next time.