How Women Can Improve Their Fertility & Hormone Health | Dr. Natalie Crawford

What It Covers

Dr. Natalie Crawford, double board-certified reproductive endocrinologist, outlines concrete steps women at any age can take to assess and improve fertility and hormonal health. She covers AMH testing, ovulation tracking, egg quality biology, IVF mechanics, birth control effects on fertility, lifestyle factors that reduce chronic inflammation, and why the current medical framework forces women to fail before receiving evaluation or treatment.

Key Questions Answered

• •AMH Testing: Every woman who wants children should request an AMH (anti-Müllerian hormone) blood test, which costs approximately $79 out-of-pocket at LabCorp, Quest, or platforms like Function Health. Despite the American College of OB-GYN advising against routine testing, AMH reveals how many eggs remain outside the ovarian vault. A low result warrants investigation into causes like Hashimoto's, endometriosis, or insulin resistance — conditions that are treatable and directly affect fertility outcomes and timing decisions.
• •Ovulation Tracking vs. Cycle Tracking: Tracking when ovulation occurs is a more sensitive hormonal health marker than simply logging period dates. The first sign of an ovulation disorder is a luteal phase shorter than 11 days — detectable only by tracking ovulation — while cycles may still appear regular. A long follicular phase signals the second stage. Progression continues to irregular cycles and eventual amenorrhea. Women who only track bleeding dates miss these early warning signs that warrant investigation into prolactin, thyroid, AMH, and PCOS.
• •Age-Related Fertility Decline: Natural fertility data from the Time to Conceive cohort study quantifies monthly pregnancy probability (fecundability) as follows: 20% at age 30, 11–12% at ages 35–36, 5% at age 38, and 3% at age 40 and beyond. Women with a prior live birth with the same partner maintain roughly 18–20% monthly probability until age 37, then decline. None of these figures reach zero, but they underscore why waiting significantly compresses the viable conception window.
• •Egg Quality vs. Egg Quantity: Egg quality refers to genetic normalcy and mitochondrial competency — there is no direct clinical test for it. Quality declines with age because chromosomes held in metaphase of meiosis II for longer periods are more likely to misalign, and because metabolic decline increases oxidative stress and DNA damage to meiotic spindles. Egg quantity, measured by AMH, is separate. A woman can have low AMH but normal egg quality, or vice versa. Both factors independently affect fertility outcomes and IVF success rates.
• •Egg Freezing Does Not Deplete Ovarian Reserve: A common misconception is that stimulated egg retrieval cycles accelerate egg loss. In reality, women lose eggs continuously regardless of pregnancy, breastfeeding, or birth control use. IVF stimulation uses FSH to mature eggs already exiting the ovarian vault that month — eggs that would otherwise die naturally. The procedure does not access the vault itself. One retrieval cycle therefore maximizes a single month's cohort rather than depleting future reserves, making earlier freezing cycles more efficient due to higher egg counts per cycle.
• •Birth Control and Fertility Return: The combined oral contraceptive pill has a 28-hour half-life, meaning ovulation typically resumes the following month after stopping. However, stopping the pill often reveals underlying conditions — particularly PCOS — that were masked rather than treated. The progesterone IUD suppresses ovulation for approximately two years, then thins the endometrial lining; endometrial receptivity can remain reduced for up to six months post-removal. Depo-Provera, a single intramuscular progesterone injection, can suppress ovulation for up to 18 months from one dose.
• •NSAIDs Block Ovulation: Women trying to conceive should avoid NSAIDs — ibuprofen, naproxen (Aleve), and similar medications — except during menstruation. These drugs inhibit the prostaglandin-mediated inflammatory response required for follicle rupture. A woman can undergo all hormonal changes associated with ovulation, including the LH surge, yet the egg will not be released if NSAIDs are present. This effect is reversible and dose-dependent, but the window of risk spans the follicular phase, making period-only use the safe protocol during active conception attempts.