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#352 ‒ Female fertility: optimizing reproductive health, diagnosing and treating infertility and PCOS, and understanding the IVF process | Paula Amato, M.D.

Jun 9, 2025 2h 23m 24 insights
<p><a href="https://peterattiamd.com/paulaamato/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250609-pod-paulaamato&amp;utm_content=250609-pod-paulaamato-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250609-pod-paulaamato&amp;utm_content=250609-pod-paulaamato-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&amp;utm_medium=referral&amp;utm_campaign=250609-pod-paulaamato&amp;utm_content=250609-pod-paulaamato-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>This is part two of a two-part mini-series on fertility and reproductive health. Paula Amato is a leading expert in female reproductive health and infertility, widely recognized for her contributions to advancing fertility treatment and research. In this episode, which follows last week's conversation on male fertility, Paula explores the biology of female fertility, including how hormonal changes regulate the menstrual cycle and ovulation, what those patterns reveal about fertility potential, and why both partners should be evaluated early in infertility workups. She discusses the role of the fallopian tubes, the causes of miscarriage, the impact of age and lifestyle on fertility, and treatment options for conditions like PCOS—including the emerging use of GLP-1 agonists. The episode also covers the evolution of IVF, advances in pre-implantation genetic testing, egg freezing, and the promise and limitations of next-generation reproductive technologies.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>The finite nature of a woman's egg reserve, how it changes over time, and the basic process of ovulation and fertilization [3:00];</li> <li>How hormones influence egg selection, and how and why chromosomal errors lead to most miscarriages [5:30];</li> <li>The full journey of conception—from hormonal cues triggering ovulation, to fertilization, embryo development, implantation, and early pregnancy risks [16:30];</li> <li>How infertility is defined and diagnosed, and the broader trends contributing to rising infertility rates [25:15];</li> <li>Fallopian tube damage: how STDs and scarring impact fertility and raise ectopic pregnancy risk [31:30];</li> <li>Unexplained infertility: how doctors evaluate ovulation and cycles—and why more research on women's health is needed [41:00];</li> <li>The defining symptoms of polycystic ovary syndrome (PCOS), its hormonal characteristics, and its relationship with insulin resistance [44:00];</li> <li>Managing PCOS without pregnancy: cycle regulation, androgen suppression, and insulin resistance treatment [46:00];</li> <li>The treatment approach for women with PCOS who are trying to conceive: GLP-1 use, ovulation induction, and timing protocols [49:45];</li> <li>Barriers to getting informed fertility care for PCOS: limited provider knowledge and access, insurance gaps, and next steps when ovulation treatments don't lead to pregnancy [55:45];</li> <li>Fertility treatment for women with unexplained infertility, risk of multiple pregnancies with superovulation, and more [1:03:00];</li> <li>Intrauterine insemination (IUI): process, success rates, and when in vitro fertilization (IVF) becomes the better option [1:07:00];</li> <li>The history of in vitro fertilization (IVF), and how access and acceptance have evolved over time [1:16:45];</li> <li>The step-by-step process of IVF [1:19:30];</li> <li>The IVF lab process: egg retrieval, fertilization, embryo culture, and freezing [1:26:30];</li> <li>Genetic testing and embryo selection in IVF: aneuploidy screening, polygenic traits, and ethical concerns [1:41:15];</li> <li>Embryo transfer in IVF: timing, uterine preparation, and implantation support [1:47:30];</li> <li>Egg donation in IVF: indications, donor guidelines, and other considerations [1:50:45];</li> <li>How to choose the right IVF clinic [1:54:45];</li> Innovations in fertility on the horizon, advice about freezing eggs, and more [2:02:00]; <li>Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45];</li> <li>Promising areas of fertility research [2:15:45]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights

1. Monitor menstrual cycle health early

Pay attention to your menstrual cycle health (regularity, pain, heaviness) from a young age, and don’t wait until you’re trying to conceive to address any irregularities. Menstrual cycles are a marker of overall health, and early detection of issues can prevent future fertility problems and other health complications.

2. Address cycle irregularities early

If you are a young woman (teens or twenties) experiencing any irregularity in your menstrual cycle, seek medical evaluation promptly. Early intervention can help prevent or mitigate future infertility problems and other health issues.

3. Seek fertility help sooner with irregular cycles

If you suspect a fertility problem, especially if you have irregular menstrual cycles or symptoms of polycystic ovary syndrome (PCOS), consult a healthcare provider sooner than the standard one-year waiting period for infertility diagnosis. This allows for earlier intervention and assessment of potential underlying issues.

4. Don’t blame yourself for early miscarriage

If you experience an early miscarriage, understand that it’s highly likely (greater than 90% chance) due to a chromosomal abnormality and not something you did wrong, such as consuming too much coffee or being under stress. This understanding can help alleviate self-blame and emotional distress.

5. Men should get semen analysis periodically

Men should consider assessing their semen analysis periodically, even if not actively trying to conceive. This can serve as an important marker for other underlying health problems.

6. Adopt healthy lifestyle for fertility

Embrace general healthy lifestyle factors, including a healthy diet, exercise, and good sleep, as these promote overall health and can positively impact fertility. While rarely the sole cause of infertility, these habits can mitigate factors that exacerbate it.

7. Follow a Mediterranean diet for fertility

Adopt a Mediterranean diet, rich in fruits, vegetables, whole grains, and protein primarily from fish and olive oil. This diet is palatable, reasonably healthy, and generally recommended for overall well-being, which extends to fertility.

8. Maintain a healthy weight for fertility

Maintain a healthy body weight, avoiding both being overweight/obese and severely underweight. Both extremes can negatively impact fertility by disrupting ovulation and menstrual cycles.

9. Avoid extreme exercise impacting cycles

Avoid extreme levels of exercise that cause changes in your menstrual cycle, such as periods stopping altogether (amenorrhea). Extreme exercise can lead to Relative Energy Deficiency in Sport (RED-S), signaling to the body that there isn’t enough energy to support a pregnancy, thereby impairing ovulation and fertility.

10. Develop stress coping mechanisms

Actively find and practice coping mechanisms for stress, such as exercise, meditation, or mindfulness, as stress can negatively impact fertility and overall health. Personalized strategies are effective in managing stress.

11. Supplement to correct nutrient deficiencies

Supplement with iron if deficient, take folic acid when trying to get pregnant, and consider vitamin D if you live in areas prone to deficiency. Correcting known deficiencies and ensuring adequate folic acid intake are important for overall health and pregnancy preparation.

12. Stop GLP-1 agonists before pregnancy

If you are trying to conceive, you should stop taking GLP-1 agonists (e.g., semaglutide, tirzepatide) for at least two months prior to attempting pregnancy. There is currently no data on their safety during pregnancy, and it’s a current recommendation to avoid potential unknown risks.

13. Weight loss helps PCOS symptoms

If you have Polycystic Ovary Syndrome (PCOS) and are overweight or obese, prioritize weight loss through a healthy diet and lifestyle. Weight loss helps alleviate all symptoms of PCOS, regardless of whether you are trying to conceive.

14. Freeze eggs in early to mid-30s

If you anticipate delaying childbearing, consider freezing your eggs in your early to mid-30s. This age range is considered the ‘sweet spot’ where it’s most cost-effective, as it’s before the significant decline in egg quality and increases the likelihood of needing them later.

15. Freeze 10-20 eggs in your 30s

If you are in your 30s and decide to freeze your eggs, aim to retrieve and freeze 10 to 20 eggs to provide a decent chance of success. Understand that younger age may require fewer eggs due to higher quality, but no guarantees exist.

16. Seek testing after two consecutive miscarriages

If a woman experiences two miscarriages in a row, she should seek additional medical testing. This warrants investigation into potential underlying causes that might be treatable, even if chromosomal abnormalities are the most common reason for early losses.

17. Research IVF clinic success rates

When considering IVF, research clinic-specific success rates by visiting sart.org (Society of Assisted Reproductive Technology) to compare clinics in your area. This allows for an informed decision based on objective data, though population differences between clinics should be considered.

18. Choose high-volume IVF clinics

Select an IVF clinic that performs a sufficient volume of cycles, ideally more than 100 cycles per year. Higher volume clinics generally indicate more experience and potentially better outcomes.

19. Inquire about clinic philosophy on add-ons

When interviewing an IVF doctor, ask about their philosophy on protocols and add-ons like genetic testing. Ensure they discuss pros and cons and allow patient autonomy in decision-making, rather than pushing unnecessary treatments.

20. Prioritize clear clinic communication

Pay attention to the quality and smoothness of communication with clinic staff (nurses, coordinators) when evaluating an IVF clinic. Poor communication can add significant stress to an already demanding process.

21. Evaluate patient reviews cautiously

When looking at patient reviews or word-of-mouth recommendations for IVF clinics, take them with a grain of salt. Not all positive experiences are reported, leading to a potentially unrepresentative view of a clinic’s overall quality.

22. Consider academic IVF centers

When choosing an IVF clinic, consider academic centers, as their missions often include education and research, which can contribute to high-quality care. However, several excellent private clinics also exist.

23. Avoid rapamycin when trying to conceive

Do not take rapamycin if you are trying to conceive. Animal data on its effect on fertility is mixed, and its safety and efficacy in humans for fertility extension are not established, with potential for harm.

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