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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.

We discuss:

• The finite nature of a woman’s egg reserve, how it changes over time, and the basic process of ovulation and fertilization [3:00];
• How hormones influence egg selection, and how and why chromosomal errors lead to most miscarriages [5:30];
• The full journey of conception—from hormonal cues triggering ovulation, to fertilization, embryo development, implantation, and early pregnancy risks [16:30];
• How infertility is defined and diagnosed, and the broader trends contributing to rising infertility rates [25:15];
• Fallopian tube damage: how STDs and scarring impact fertility and raise ectopic pregnancy risk [31:30];
• Unexplained infertility: how doctors evaluate ovulation and cycles—and why more research on women’s health is needed [41:00];
• The defining symptoms of polycystic ovary syndrome (PCOS), its hormonal characteristics, and its relationship with insulin resistance [44:00];
• Managing PCOS without pregnancy: cycle regulation, androgen suppression, and insulin resistance treatment [46:00];
• The treatment approach for women with PCOS who are trying to conceive: GLP-1 use, ovulation induction, and timing protocols [49:45];
• 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];
• Fertility treatment for women with unexplained infertility, risk of multiple pregnancies with superovulation, and more [1:03:00];
• Intrauterine insemination (IUI): process, success rates, and when in vitro fertilization (IVF) becomes the better option [1:07:00];
• The history of in vitro fertilization (IVF), and how access and acceptance have evolved over time [1:16:45];
• The step-by-step process of IVF [1:19:30];
• The IVF lab process: egg retrieval, fertilization, embryo culture, and freezing [1:26:30];
• Genetic testing and embryo selection in IVF: aneuploidy screening, polygenic traits, and ethical concerns [1:41:15];
• Embryo transfer in IVF: timing, uterine preparation, and implantation support [1:47:30];
• Egg donation in IVF: indications, donor guidelines, and other considerations [1:50:45];
• How to choose the right IVF clinic [1:54:45];
• Innovations in fertility on the horizon, advice about freezing eggs, and more [2:02:00];
• Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45];
• Promising areas of fertility research [2:15:45]; and
• More.

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View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

Sign Up to Receive Peter’s Weekly Newsletter

This is part one of a two-part mini-series on fertility and reproductive health, with next week's guest, Dr. Paula Amato, focusing on the female side of the equation. Paul Turek is a world-renowned expert in male fertility and reproductive health, the founder and medical director of the Turek Clinic, and host of the Talk with Turek podcast. In this episode, Paul explores the topic of male fertility, offering a detailed look at the complex and highly coordinated process of conception and the many challenges sperm face on their journey to fertilizing an egg. He shares fascinating insights into how sperm work together to navigate the female reproductive tract, how environmental factors like heat, stress, and toxins impact sperm quality, and what men can do to improve their reproductive health. Paul also dispels common myths about testosterone replacement therapy and its effects on fertility, providing strategies for preserving fertility while on TRT. The episode also highlights cutting-edge advances in reproductive medicine, from genetic testing and sperm sorting to emerging treatments for infertility.

We discuss:

• The incredibly complex and hostile journey sperm must take to fertilize an egg [3:00];
• How sperm are made: meiosis, genetic variation, and the continuous renewal influenced by environmental factors [9:00];
• The built-in filter that weeds out genetically abnormal sperm [14:45];
• How sperm are finalized in form and function: tail formation, energy storage, and chemical sensing abilities [18:30];
• How to optimize conception through the timing of sex, ejaculation frequency, and understanding the sperm lifecycle [26:30];
• Male infertility and Paul’s diagnostic approach: detailed history, a physical exam, and identifying red flags [33:30];
• Viral infections that can affect the testes and potentially lead to sterility [40:30];
• Semen analysis: morphology, motility, and hormonal clues to male fertility [45:45];
• Effects of medication, microplastics, stress, and exercise on fertility [57:15];
• Testosterone replacement therapy (TRT) and male fertility [1:06:00];
• Restoring fertility after prolonged use of exogenous testosterone [1:25:00];
• Effects of heat and cold exposure on fertility and sperm quality [1:36:00];
• How different levels of exercise—especially cycling—affect male fertility [1:41:45];
• How alcohol, marijuana, and nicotine affect male fertility [1:46:00];
• Why type 2 diabetes is a risk factor for male infertility [1:50:00];
• How varicoceles—a common cause of male infertility—are diagnosed and treated [1:51:15];
• Genetic factors that affect fertility [1:54:00];
• The impact of lifestyle and environmental exposures on fertility [1:56:30];
• The evidence (or lack thereof) behind stem cell and PRP therapies for male infertility, and how lifestyle and non-invasive interventions often lead to successful conception [2:00:30];
• Considerations for sperm banking, and how paternal age impacts fertility planning and offspring health [2:05:00];
• Semen quality as a biomarker: linking male fertility, longevity, and preventative health through Medicine 3.0 and epigenetics [2:14:45]; and
• More.

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