LG Quickie: Everything You Thought You Knew About Your Cycle Is Wrong!

该来个快速环节了。

It's time for a quickie.

Podcast One 呈现 LadyGang——由 LadyGang Quickie 带来的好莱坞女孩团体。

Podcast one presents the LadyGang, the Hollywood girl posse with LadyGang Quickie.

以下是 Kelty Knight、Becca Tobin 和 Jack Vanick。

Here's Kelty Knight, Becca Tobin, and Jack Vanick.

咱们快点开始吧。

Let's make this quick.

今天，

Today,

LadyGang，我们和 Natural Cycles 的朋友们一起开启一个迷你系列，因为显然，我们所有人都经历了数十年的月经周期，却完全不知道身体内部发生了什么。

LadyGang, we are kicking off a little miniseries with our friends at Natural Cycles because apparently, we have all had menstrual cycles for decades, and we absolutely have no idea what is happening inside our bodies.

比如，为什么我们有一周感觉所向披靡？

Like, why do we feel unstoppable one week?

接下来的一周却又变得狂野不堪。

Then we're feral the next week.

我们每个月都想和生活中所有人的关系断开一次。

We wanna break up with everyone in our lives once a month.

你知道吗，我们在学校里学过怎么在《俄勒冈小道》游戏中度过痢疾，却没人教过我们激素是怎么回事。

And, you know, we are taught how do you make it through dissephoria in the Oregon Trail in school, but not how our hormones are.

痢疾。

Dysentery.

是叫这个吗？

Is that is that what it's called?

失调疗法。

Dysytherapy.

随便吧。

Whatever.

差一点。

So close.

所以今天，我们从基础开始，邀请了出色的医生娜塔莉·克劳福德。

So today, we are starting with the basics, and we're joined by the amazing doctor Natalie Crawford.

她是一位获得认证的妇产科医生。

She is a board certified OBGYN.

当你看到这个词时，你会觉得：我不知道该怎么说。

You know when you see that word and you're like, I don't know how to say this.

有些人会说OBGYN。

Some people say OBGYN.

她是一名生殖内分泌专家，同时担任Natural Cycles的医学顾问。

Reproductive endocrinologist and serves as the medical advisor for Natural Cycles.

她专长于生育、荷尔蒙健康，以及帮助女性更好地理解自己的生理周期，无论她们是想避孕还是备孕。

She specializes in fertility, hormonal health, and helping women better understand their cycles, whether trying to prevent pregnancy or conceive.

她还是德克萨斯州Fertility Four的创始人，以将复杂的生殖科学转化为清晰、有力的信息而闻名，这正是我们邀请她来与我们交谈的原因。

She's also the founder four fertility in Texas and is known for breaking down complex reproductive science into clear, empowering information for women everywhere, which is why we invited her to come talk to us.

从这里开始。

Start here.

谢谢你们邀请我。

Guys for having me.

是的

Yeah.

我们非常高兴您能来。

We're so excited to have you.

首先，您能用通俗易懂的方式描述一下月经周期的四个阶段吗？

First of all, let can you describe in feralness the four phases of the metro cycle?

因为我们在准备这个内容的时候，我就想，如果现在被逼着走跳板，有人问我：说出月经周期的四个阶段，我会说：黄体期？我不确定。

Because as we're putting this together, I was like, if I was being, like, held, had to walk the plank, and someone was like, name the four phases of the menstrual cycle.

我会说：黄体期？我不记得了。

I would be like the luteural I don't know.

您能给我们简单地复习一下我们该知道的那些内容吗？

Can you just give us a, like, a a brief refresh on things we should know?

让我们深入探讨一下。

Let's let's dive in.

因为大多数人在成长过程中，尤其是在生育年龄的大部分时间里，都认为月经周期只是来月经，而没有意识到其实是荷尔蒙在控制着身体内部的一切。

Because most of us grow up in the majority of our reproductive years thinking that the menstrual cycle is just about having a period and not understanding that it's really hormones that control everything inside your body.

所以我喜欢这样理解：第一阶段是月经期。

So the way I like to think about it is the first phase is considered menses.

这时你会出血。

This is when you're bleeding.

这就是我们都熟悉的月经。

This is your period that we all know about.

在这个阶段，根据定义，你的激素水平非常低，子宫内膜正在脱落。

By definition, your hormones are super low in this time frame, and your uterine lining is shutting.

在你的卵巢里，有许多非常小的卵子。

What's happening in your ovaries is you have a bunch of eggs that are really super small.

然后它们开始在所谓的卵泡期生长，这个名字很贴切，因为每个卵子都生长在一个卵泡内。

They then start to grow in what we call the follicular phase, and it's actually well named because each egg grows inside a follicle.

所以这个卵泡会受到刺激而生长。

So this follicle gets stimulated to grow.

这就是卵泡期。

This is the follicular phase.

大脑分泌的一种激素叫做FSH，即促卵泡激素。

Hormone from the brain is called FSH, follicle stimulating hormone.

卵子在卵泡内生长，并产生雌激素。

Egg is growing inside the follicle making estrogen.

实际上，正是雌激素的分泌停止了出血，因为子宫内膜开始增厚。

It's actually estrogen production that stops you from bleeding as the lining starts growing.

所以在子宫内，新的内膜正在生长。

So in the uterus, you have a new lining growing.

在你的卵巢里，卵泡和卵子正在变得更大。

Inside your ovaries, you have a follicle and egg growing larger.

但在你的身体里，雌激素水平会越来越高。

But in your body, you're gonna have more and more estrogen.

因此，随着卵泡期的推进，你会开始注意到一些雌激素带来的变化，比如感觉更有掌控力、注意力更集中、性欲增强，通常觉得自己处于最佳状态。

So as the follicular phase goes on, you're gonna start to notice some of those estrogen changes, notably feeling more like a boss bitch, having more concentration, having a higher sex drive, just feeling like you're really peak self most of the time.

这是正常的反应。

That's the normal response.

只有雌激素，没有孕激素。

Estrogen only, no progesterone.

我们称之为雌激素主导。

We call this estrogen dominant.

当雌激素达到峰值时，它会向大脑发出信号：我有一个成熟的卵子，接下来就是排卵，这是一个非常短暂的阶段。

When estrogen is at its peak, that actually tells the brain I have a mature egg, And then this is going to be ovulation, which is a very short lived phase.

雌激素向大脑发出信号，促使长出卵子的卵泡破裂。

Estrogen signals the brain, the follicle that grew the egg actually ruptures.

这是一个囊肿破裂的过程，卵子被释放到腹腔中。

This is a cyst that bursts, and the egg is released into the abdominal cavity.

这就是排卵期。

And then that is the ovulatory phase.

如果你正在备孕，这个卵子只有24小时的时间可以被受精。

That egg, if you're trying to get pregnant, only has twenty four hours to get fertilized.

但在这一时间段内，卵泡会重新形成并被称为黄体，这是一个听起来很专业的说法，其实就是脂肪囊肿，现在它开始分泌孕激素。

But within that time frame, that follicle is going to reform and become known as a corpus luteum, fancy word for fatty cyst, and now it makes progesterone.

所以我们现在进入了黄体期。

So now we're entering the luteal phase.

因此，来自大脑的黄体生成素（LH）刺激这个囊肿产生孕激素。

So LH, luteinizing hormone coming from the brain, stimulating progesterone production from this cyst.

孕激素是一种促孕激素。

And progesterone is the progestational hormone.

我的意思是，它完全改变了你的新陈代谢，为怀孕做好准备，不管你是否想要怀孕。

I mean, pro pregnancy totally shifts your metabolism to get ready to have a pregnancy whether you wanna be pregnant or not.

这意味着你需要更多的热量。

Meaning, you need more calories.

你需要更多的睡眠。

You need more sleep.

你的能量水平下降了。

Your energy goes down.

你开始消耗某些资源。

You're starting to consume certain resources.

都是孕酮的错。

Progesterone's fault.

这全是孕酮的错。

It is all progesterone's fault.

我是个雌激素爱好者，我把所有问题都归咎于孕酮。

I'm an estrogen lover, and I blame progesterone for everything.

然后，如果你没有怀孕，这个黄体只能存活两周。

And then when you don't get pregnant, that corpus luteum can only live two weeks.

它会死亡。

It'll die.

接着你会再次来月经，因为孕酮水平下降会向身体发出信号：没有发生怀孕，于是整个过程重新开始。

You'll then get a period again because it's that progesterone drop that signals no pregnancy happened and the process starts over.

所以我们喜欢用这种原始的方式来理解它。

So we like to just think about it in those feral terms.

你的月经期，显然处于激素水平低的状态。

Your period, you're obviously bleeding hormonally low.

大多数人感觉状态不太好。

Most people feel not great.

头痛、痛经，而且激素敏感度很高，因为你没有任何缓冲。

Headaches, cramps, really hormonally sensitive because you don't have any buffer.

卵泡期，雌激素水平高，那段时间你会像性感的女老板一样。

Follicular phase, high estrogen, sexy boss bitch in that time frame.

排卵期通常是性欲最高的时候，你会明显感觉到自己想要亲密。

Ovulation is usually that peak sex drive when you really are noticing that you're wanting to get it on.

然后到了黄体期，你就更倾向于独处。

And then the luteal phase, you're more of a recluse.

你不想和朋友出去。

You don't wanna go out with friends.

你只想吃遍所有东西，瘫在沙发上，然后这个过程再次开始。

You wanna eat everything, sit on the couch, and then the process starts over again.

哇。

Wow.

这是我听过的对月经周期最详尽的解释了。

That's the most thorough I've ever heard our cycles explained.

这简直是一堂大师课，而且我们都年纪不小了，所以我觉得，你知道的，

That was honestly a masterclass and we're old so we should like I, you know,

我的月经现在是

I mean, my period's

正要结束，而我刚刚才了解到这些。

on its way out and I just learned about it.

这太不可思议了。

So this is crazy.

但是，比如说？

But like what?

这引出了一个很好的观点，因为人们通常只有在出现问题或遇到困难时才会去学习。

Well, it brings up a good point because people don't learn until there's a problem or you're struggling in some way.

而这才是我们身体的正常运作方式。

Whereas this is how our bodies function.

我们小时候居然没人教这些，这难道不疯狂吗？

Isn't it crazy that we're not taught this at a much younger age?

令人震惊。

Shocking.

作为女性，关于追踪月经周期，有什么事情是我们会感到震惊的，而如果我们真正理解身体在做什么，这些知识又能帮助我们？

What is one thing about tracking our menstrual cycles, like as women that we would be shocked to learn and could help us if we actually understood what our bodies were doing?

你用来记录月经的那些应用。

Apps that you track your period in.

大多数月经追踪应用，如果你输入‘我的月经来了’，它给出的排卵窗口，其实只有大约20%的时间能准确检测到排卵，我觉得这太惊人了。

So the majority of period tracker apps, if you are putting here's my period and it gives you a fertile window, it's only detecting ovulation correctly about 20% of the time, which I think is shocking.

这就是为什么像Natural Cycles这样的应用会更有帮助。

This is why apps like Natural Cycles can be so much more helpful.

我认为让人们理解这一点很重要，因为它也用到了我们所说的生育意识信号。

And I think it's important for people to understand because it's also using a sign of what we call fertility awareness.

它利用的是你的体温。

It's using your temperature.

所以这是身体发出的一个信号。

So a sign from your body.

当你的身体产生孕激素时，正如我们所说，它会减缓一切进程。

When your body makes progesterone, as we said, it's gonna slow everything down.

它的一种方式就是提高你的基础体温。

One of the ways it does that is it raises your core body temperature.

因此，你可以在黄体期观察到体温的升高，从而确认排卵的发生。

And so you can see an increase in your body temperature in the luteal phase that confirms ovulation.

所以使用Natural Cycles，还有许多可穿戴设备。

So utilizing Natural Cycles and there's so many wearables.

Natural Cycles有一个手环。

Natural Cycles has a band.

还有Oura Ring、Apple Watch。

There's Oura Ring, Apple Watch.

所以你甚至不需要刻意去关注或过度纠结。

So you don't even have to think about it or obsess over it.

是的

Mhmm.

可以确认你何时排卵。

Can confirm when you ovulate.

这一点很重要，因为身体发出的最初信号是周期各阶段长度的变化，比如黄体期变短或卵泡期变长。

And this is important because the first signs your body gives you that things are off is a switch in the different lengths of these phases of your cycle, meaning a short luteal phase or a long follicular phase.

但你必须知道何时排卵，才能确定这些阶段的长度。

But you have to know when you ovulate to know the lengths of these phases.

很多女性只看到自己的月经很规律。

So many times women just see my period's regular.

她们不知道自己何时排卵，因而错过了重要的警示信号——哦，我的黄体期现在变短了。

They don't know when they're ovulating, and they're missing the red flag warning signs that, oh, my luteal phase is actually short now.

也许我有甲状腺问题。

Maybe I have a thyroid problem.

开始进入围绝经期。

Starting perimenopause.

也许有什么问题。

Maybe something's going on.

所以我们没有被赋予利用身体发出的激素变化信号的主动权，因为我们不知道如何准确追踪排卵。

So we've not been given the agency to utilize the signs our body is giving us that things are hormonally changing because we don't know how to track ovulation specifically.

真有意思。

So interesting.

我嫂子生她儿子的时候，他现在二十二岁了，但当时她备孕遇到困难，医生告诉她把体温计放在床边，每天早上一醒来第一件事就是把体温计放好，然后在笔记本上记录体温。

My sister-in-law started her, she has a twenty two year old son now, but when she was trying to get pregnant with him she was having issues and her doctor told her to put a thermometer next to her bed and every morning the first thing she was supposed to do was like pop the thermometer in and track on a notepad like what her temperature was.

所以真让人难以置信，

So it's so crazy that

花了这么多年才有了不需要这样做的技术。

it's taken this many years to have the technology to not have to do that.

贝基，你说得对。

Becky, you're right on.

我以前常说，别测基础体温了，太让人沮丧了。

I actually used to say, please don't check BBT because it's so frustrating.

那只是一次体温测量。

It would be this one time thermometer measurement.

是的。

Mhmm.

你还需要专门的坐标纸来记录发生了什么。

Had you'd have specific graph paper to, like, know what was happening.

甚至在我十二年前试图怀孕的时候，我也在用这种方法追踪。

And even when I was trying to get pregnant, you know, twelve years ago, I was trying to track with it.

即使作为专家，这也太让人沮丧了。

It was so frustrating even as an expert.

正是在这种情况下，可穿戴技术和Natural Cycles算法真正改变了局面，是的。

This is where truly, like, wearable technology, the Natural Cycles algorithm has changed the game Mhmm.

因为现在你不必再为此费心了。

Because now you don't have to think about it.

所以你知道，技术既有好也有坏，但在女性健康领域，了解自己身体内部的变化而不必过度纠结，这无疑是一个巨大的优势。

And so, you know, technology can be good and bad, but this is a place for women's health that it's, I think, a huge advantage to know what's happening within your body and not have to obsess over it.

这会不会帮人们省下大量金钱，因为他们能在必须去看昂贵的医生之前，就弄清楚自己身体的情况？

Could it essentially save people so much money because they're figuring things out about their bodies before they have to go see someone who's quite expensive?

当然。

Absolutely.

如果你打算去看医生，并借助这些数据，你就能提供更充分的信息来说明你的状况。

And if you are going to see somebody to piggyback off of that, you're gonna have more data to know what's going on.

因为如果医生问你：你的周期规律吗？

Because if your doctor says, are your cycles regular?

你回答说规律，然后就直接进入下一个问题。

And you say yes, move on to the next question.

如果他们问：你的周期规律吗？

If they say, are they regular?

而你回答：其实我的周期比较短。

And you say, well, they're actually shorter.

而且我的黄体期现在只有八天，等等这些情况。

And my luteal phase is now eight days and this and that.

突然间，你引导他们走上了一条更快找到答案的路径。

Suddenly, you're leading them down a pathway to help get to an answer sooner.

我经常告诉患者，作为医生，我会根据你们提供的信息来决定该安排哪些检查。

One thing I tell patients all the time is as a doctor, I am leveraging the information you give me to decide what tests to order.

因此，向医疗提供者提供更优质的数据，是应对这个常常令人沮丧的医疗体系的第一步。

And so having better data to give your providers is step number one to working within a healthcare system that can be really frustrating.

这太棒了。

It's awesome.

当有人来找你时，你是怎么决定的？我们刚刚为一期节目采访了一些女性，她们分享了自己的生育经历。

How do you decide, like, when someone comes to you and they we just recorded with some women for an episode that's gonna come out, they were sharing their fertility journeys.

显然，在我们这个人生阶段，我们都认识经历过这些历程的朋友。

And obviously, at this point in our lives, we all have had friends that had these journeys.

那么，你是怎么决定该让对方再尝试一年后再回来，还是现在就深入调查呢？

Like, when do you decide to send someone and say, try for a year and come back to me or the, like, let's dig in now?

也就是说，判断一个人是应该继续尝试，还是应该尽快来找你的关键因素有哪些？

Like, what are the deciding factors of if someone should just keep trying or if they should really try to find a you?

这说得通吗？

Does that make sense?

不。

No.

我认为有一个医学上的答案，但还有一个我认为才是最好的答案。

I think there's the medical answer, and then there's what I actually believe is the best answer.

医学上的说法是，每个人都应该尝试怀孕一年，等失败了再做检查。

The medical answer says that everybody should just try to get pregnant for a year, and then we do testing when you have failed.

如果你年满35岁，我们应当在六个月时就开始检查。

If you are 35 and older, we should do that testing at six months.

但我对此持不同意见，因为我不认为女性应该在失败之后才去了解自己身体的基本情况。

I push back on this because I don't think women should have to fail before we get basic data about our bodies.

这些检查甚至都不包括卵子数量、精液分析。

That testing, they're not even recommending an egg count, a semen analysis.

我见过一些夫妻尝试了一年，结果男方根本没有精子，整个期间怀孕几率为零；或者有人卵子数量远低于同龄人，如果早知道这些信息，她一定会更早采取更积极的措施，但她根本不知道。

I've seen couples trying for a year who had no sperm, zero percent chance of getting pregnant that whole time, or somebody who's has a very low egg count for her age and would have definitely chosen to be more aggressive sooner, but she didn't have that knowledge.

所以我认为，如果孩子在你的计划中，如果你真的想要孩子，那么先获取这些数据永远是最明智的策略，但你需要为自己争取。

So I think if kids are on your plan, if this is something you want, getting the data first is always going to be the smartest game plan, but you're gonna have to advocate for it.

这将包括对你身体结构的评估、你的卵子数量，以及精液分析，再加上我们之前提到的月经周期追踪——无论你打算在怀孕前采取自然周期还是其他方式，都要确保一切正常后再开始尝试。

This is gonna be an evaluation of your anatomy, how many eggs you have, and a semen analysis in addition to tracking your cycle, like we said, natural cycles, whatever you wanna do before you get pregnant so that you can know everything's in working order before you just start trying.

这让我感到非常沮丧。

I it's really frustrating to me.

有时候我们做了这些检查，结果一切正常。

And sometimes we do this testing and everything comes back fine.

我会告诉某人，嘿。

And I'll tell somebody, hey.

百分之七十的人在前六个月就能怀孕。

Seventy percent of people will get pregnant the first six months.

我们可以有信心进入下一阶段，因为我们已经完成了所有检查，确认没有问题。

We can feel confident moving into this stage that we've done all the testing and we don't have anything wrong.

这样我们对自己的决定也会感到更加安心。

And we can feel so much more comfortable with the decisions we're making.

我厌倦了看到那些聪明、受过良好教育的女性坐在我对面说：如果我早有这些数据，我本会做出不同的决定。

What I am sick of seeing is really smart educated women sitting across from me saying, if I'd had this data, I would have made a different decision.

在这个信息爆炸的时代，对我来说，这完全说不通。

That to me doesn't make sense in this era of information that we live in.

这太疯狂了。

It's crazy.

我觉得如果没有这些，我根本不可能成功。

I don't think that I would have had a successful anything.

我33岁时经历了多次流产，但我的医生不知为何只是告诉我，你可以继续尝试。

I was 33 and had a bunch of failed pregnancies and my doctor for some reason, she just told me, you could keep going through this.

你可以不断尝试，不断失去，不断经历这些心碎的育儿遗憾。

You could keep trying and keep losing and keep having all these baby heartbreaks.

她还说，但如果你想要不止一个孩子，就去做个取卵手术，冻一些胚胎吧。

She's like, but if you want more than one kid, just go do a neck retrieval, go make some embryos.

于是我去了，做了这件事，结果发现我几乎已经站在了能够完成这一切的终点线上。

And like I went and I did that and it turns out I was like literally at the finish line of probably being able to have done that.

这太疯狂了。

And it's crazy.

想到这么多女性没有从她们的妇产科医生那里得到这样的信息，直到为时已晚，这令人心碎。

It's heartbreaking to think so many women don't get told that from their OBGYNs and they get to a point where it's too late.

我的意思是，就在本周，我遇到了两位患者，我想提一下。

I mean, just this week, I saw two patients that I should bring to light.

一位已经尝试了四年，向她的产科医生要求检查，却被告诉别太紧张。

One had been trying for four years, asked her OB for an evaluation and was told not to stress about things.

这对我来说太荒谬了。

Like, that's crazy to me.

第二位女性主动去找医生，说：我们想怀孕。

The second one went proactively to her doctor and said, we wanna get pregnant.

我们该怎么做？

What should we do?

我该怎么监测我的周期？

How should I track my cycle?

什么？

What?

她的医生说，我们不需要做任何检查，也绝对不要追踪你的周期，因为那只会让你为此感到压力。

Her doctor said, you we don't need to test anything and definitely don't track your cycle because it'll just cause you to stress out about it.

我们有两个患者在寻求答案，却遭到情感操控。

We have two patients trying to get answers, being gaslit.

这充分说明，你必须了解自己的身体，才能知道哪里出了问题。

So this really shows that you have to understand your body to know what's wrong.

你必须为自己发声。

You have to advocate for yourself.

尤其是在生育问题上，如果你有直觉或警觉，觉得对面的人并没有真正为你着想，那么寻求第二意见绝非可选，而是必需的。

And especially when it comes to fertility, If you get that gut feeling or that red flag that the person sitting across from you is maybe not looking out for your best interest the same way, getting a second opinion is not optional.

这真的至关重要。

It's really essential.

天啊。

Wow.

但是，医生。

But, Dr.

克劳福德，好吧，我来当一下反方观点，因为我本身没有切身利益，我也不懂。

Crawford, okay, devil's advocate here, and I don't have skin in the game because I don't no.

我有个问题想问你。

I have a I have a question for you.

如果我们一遍又一遍听到的故事都是这些女孩被医生告知要放松、别紧张。

If the story we hear over and over and over again is all of these girls getting told by their doctors to chill out and to relax.

那么，有没有一项全面的研究，探讨压力与这些女孩——你知道的，人们确实会焦虑，然后过于专注，反而导致无法怀孕？

So are is there some sort of comprehensive, like, study on stress versus, like, these girl you know, people do stress out, and then they get so focused on it that that doesn't happen?

为什么大家总是被这样告知？

Like, what Why is this the thing that everyone's being told?

因为这并不是你第一个这么说的人。

Because this is not you're not the first person to say this.

我们每个人都有七个朋友经历过完全相同的事情。

Every one of us has seven girlfriends that have gone through this exact same thing.

是的

Yeah.

那为什么是懒惰呢？

What like why is it laziness?

压力？

Stress?

绝对如此。

Absolutely.

好的。

Okay.

好的。

Okay.

我这里有几个答案。

Have a few answers here.

我试着快速说一下。

I'm a try to hit them really fast.

第一，压力绝对会影响生育能力。

One, stress absolutely impacts fertility.

压力本身会使你的身体进入一种不同的代谢状态，导致胰岛素抵抗和炎症。

Stress by default causes your body to go into a different metabolic state that causes insulin resistance, inflammation.

如果我们仔细想想，你的大脑并不知道你为什么感到压力，而压力可能来自许多不同的方面。

And if we just think about it, your brain doesn't know why you're stressed, and stress comes from a lot of different things.

我认为，未知或不确定自己是否走在正确的道路上，比我能提供的任何数据都更让人压力山大。

I would argue the unknown or not knowing that you're on the correct path is much more stressful than any data point I can give you.

女性正在表现出韧性。

Women are being resilient.

如果你向她们提供关于身体的数据，她们就能制定出应对策略。

And if you give them data about their body, they can come up with a game plan to tackle it.

而没有获得这种机会，反而更加令人压力重重。

And not being given that opportunity, way more stressful.

所以我认为，当患者被这样告知时，这种说法在某种程度上是非常草率的。

So I think, like, that answer to me when patients are told that, I think is really sloppy in some ways.

现在我们必须承认，医疗系统并没有为全面的对话做好准备。

Now I think we have to acknowledge the medical system is not set up for comprehensive conversations.

这是另一个完全不同的问题。

That's a whole another problem.

如果我们有全民医疗保健，每个人的医疗费用都来自同一个资金池，我们就必须非常谨慎地决定谁该接受哪些检查。

And if we had universal health care and everybody's dollars had to come out of the same pot, we have to be very judicious about who gets what tests.

这在美国并不是医疗的运作方式。

That's not healthcare in America.

当有人坐在一位女性面前，告诉她一项79美元的血液检测能告诉你有多少卵子，而我却要成为你获取这一信息的守门人，因为你还不够‘失败’时，这合理吗？

And for somebody to sit across from a woman and say a $79 blood test that's gonna tell you how many eggs you have, I'm gonna be the gatekeeper to you getting that information because you haven't failed hard enough.

这对我来说有意义吗？

Does it make sense to me?

就连美国妇产科医师学会（ACOG）——这个妇产科领域的医学组织——也表示：不要对没有不孕问题的女性进行AMH检测，因为这会带来不必要的压力。

And even the American College of OBGYN, ACOG, the medical organization for OBGYN says, do not test AMH in women who do not have infertility because it will cause undue stress.

天哪。

Oh my god.

这不总是医生的问题，有时是医生在糟糕的系统中行医，根本没有考虑坐在他们面前的患者，以及患者会如何使用这些信息。

It's not always bad doctors, but sometimes it's doctors practicing in a bad system and not really thinking about the patient who's sitting in front of them and how they might use that information.

哇，这太疯狂了。

Wow, that's so crazy.

本集《Lady and Quickie》由Natural Cycles赞助，该公司开发了首款获美国FDA批准的避孕应用，通过追踪您的体温和其他生育指标，帮助您了解自己的生理周期和生育能力，从而规划或避免怀孕。

This episode of Lady and Quickie is brought to you by Natural Cycles, the company behind the first FDA cleared birth control app that uses your body temperature and other fertility indicators to help you understand your cycle and fertility and either plan or prevent pregnancy.

我们正在讨论一种影响半数人口的问题，但我们在学校里却从未真正学过月经周期和生育知识。

We're talking about something that somehow affects half the population but we were never really taught in school, our menstrual cycles and fertility.

因此，像Natural Cycles这样的应用确实很有帮助，因为它不仅仅是记录您的经期。

So this is where something like the Natural Cycles app is actually helpful because it's not just tracking your period.

它利用您的生物标志数据，为您提供每日的生育状态，以及关于您的周期、身体模式和症状的个性化洞察，这确实是我们多年前就应该获得的教育。

It's using your own biomarker data to give you your daily fertility status and personalized insights into your cycle and body patterns and symptoms, which honestly feels like the kind of education we should have gotten years ago.

感谢Natural Cycles赞助这次对话，帮助女性真正了解自己的身体。

So thank you to Natural Cycles for sponsoring this conversation and helping women actually understand their bodies.

现在，您可享受Natural Cycles应用年订阅15%的折扣，并免费获得一条仅需在睡觉时佩戴的NC手环。

And right now you can get 15% off your yearly subscription to the NC app and a free NC band that you only need to wear while you sleep.

访问 naturalcycles.app/lady，享受全年订阅15%折扣并获得免费可穿戴设备。

Visit naturalcycles.app/lady for fifteen percent off your yearly subscription and a free wearable.

访问 naturalcycles.app/lady，享15%折扣和免费可穿戴设备。

That's naturalcycles.app/lady for 15% off and your free wearable.

我想请杰克发言，因为我知道她在计划生育方面很有经验。

I wanna open the floor for Jack because I know she's a, you know, in her family planning.

你有什么想问医生的吗？比如你的体温应该是多少？

Is there anything you wanna ask doc about what your temperature should be?

比如，如果她要进行胚胎移植，是否需要保持正确的体温？

Like, if she's going to implant, does she need a right a correct temperature?

她需要持续追踪吗？还是现在就可以了？

Should she be tracking or is she good?

是的。

Yeah.

我们还处于非常初期的阶段，正计划在今年十月备孕。

I'm kind of like in the very, very beginning stages like we're trying for our October of this year.

我们有六个冷冻胚胎。

We have six frozen embryos.

所以我们将会进行试管婴儿。

So we'll be doing IVF.

所以，是的，我的意思是，我去看了妇科医生，跟她说我觉得接下来六个月左右可能会尝试，然后问她有没有什么建议？

So yeah, I mean, is there I went to my gyno and I was like, Yeah, I think in the next like six months, I'm like, is driving doing anything?

她让我连续六个月服用孕期维生素。

She's like, take prenatals for six months.

除此之外，她就没再告诉我别的了。

And then that was about all she told me.

但我之前在看医生时遇到过很多问题，不得不为自己争取权益，应对各种健康问题。

But like, I've had a lot of issues with doctors where I've had to advocate for myself and different health issues that I've had.

所以我有过这样的经历：除非找到一个让我感觉合得来的医生，否则我很难信任医生。

So I've had that experience where it's just like, I can't trust doctors, you know, until I find one that I feel like is kind of vibing with me, in a sense.

所以，对于像我这样显然不会自然受孕的人，你一般会推荐些什么？

So like, is there anything generally that you would recommend for somebody that's in my position that's obviously not gonna try naturally?

而且我就要39岁了。

And I'm gonna be 39.

所以，无论你是打算自然受孕还是准备移植胚胎，你身体的状态都极其重要，尤其是当涉及到胚胎能否成功着床，以及炎症问题时。

So regardless of if you're gonna try naturally or you have embryos that you're looking to implant, the state of your body is extremely important and if that pregnancy is going to implant, and especially when it comes to inflammation.

为了简化来说，我喜欢把这称为‘孕前零期’。

So to simplify it, I like to consider this what people call trimester zero.

这是你在怀孕前、有机会为体内环境打下基础的时期。

This is the time period before you get pregnant where you have the opportunity to set the stage for your internal body's environment.

因此，可以通过采用抗炎饮食、多吃水果、蔬菜和纤维，避免饮酒和超加工食品，增加睡眠，尽量避开你能避免的毒素来实现。

So leveraging things like eating an anti inflammatory diet, high in fruits, vegetables, and fiber, avoiding alcohol, ultra processed foods, getting more sleep, trying to, you know, avoid toxins where you can.

并不是说有一个单一的决定会直接决定移植是否成功。

It's not that there's one single decision that's gonna be like, this is gonna make or break if the transfer works.

但如果我们考虑每一天，我们都会通过这些不同的因素接触到炎症。

But if we think about every day, we're exposed to inflammation through all those different things.

因此，我称之为‘炎症负担’。

So we have what I call the inflammatory burden.

这些小小的决定都会累积起来。

And these little decisions can add to it.

对吧？

Right?

我们整天待着。

We stay all day.

我们吃蛋糕。

We eat cake.

我们喝酒。

We drink alcohol.

我们吃一大堆垃圾食品。

We eat a bunch of crap.

我们压力很大。

We are really stressed.

我们从不活动身体。

We don't move our body.

或者它们也可以减轻负担，因为我们吃了蔬菜。

Or they can reduce it because we ate vegetables.

我们睡了个好觉。

We got a good night's sleep.

我们，你知道的，增加了一些骨骼肌。

We, you know, built some skeletal muscle.

因此，我们掌控着影响炎症负担的杠杆，而这个信号会传递给我们的大脑和子宫，告知身体的状况。

So we control the lever on that inflammatory burden, which is a signal to our brain and our uterus about the state of our body.

这并不是说你必须完全禁止某些行为或制定严格的硬性规则，但通过将抗炎的生活方式融入日常，这将帮助你平衡那些你想熬夜或喝酒的时刻。

So not to say you need to you can never do anything or have a set strict of hard rules, but that by making anti inflammatory lifestyle practices a part of your common life, this is going to leverage that, you know, you wanna stay out late or you do wanna have alcohol here.

这没什么大不了的，因为你的身体能够承受这种炎症负担。

It's not a big deal because your body can tolerate that inflammatory burden.

但当我们持续不断地受到挑战时，这才是最大的影响因素。

But when we're just constantly being challenged all the time, that's one of the biggest levers.

对于准备进行胚胎移植的患者，我认为最主要的问题是睡眠不足。

I would say for my patients going into embryo transfer, it's not getting enough sleep.

这将是关键因素之一。

That's gonna be one of the key ones.

我们只是长期习惯于睡得比所需更少。

We're just chronically okay with getting less sleep than we need.

在黄体期，我们至少需要七到七个半小时的睡眠。

We need at minimum seven, seven and a half hours in our luteal phase.

当我们有孕酮时，需要更多的睡眠。

When we have progesterone, we need more sleep.

所以真的要培养这一点。

So really trying to cultivate that.

其次是要增加骨骼肌，这一点尤其是我们看不到女性做得足够的。

And then two is gonna be building skeletal muscle, something that especially we don't see women doing enough.

简而言之，骨骼肌在被使用时，能帮助身体轻松清除炎症。

Long story short, skeletal muscle, when you use that muscle, allows your body to clear inflammation in an easy way.

因此，这些是在胚胎移植前可以利用的两种抗炎生活方式。

So these are two kind of anti inflammatory practices that we can leverage leading up to an embryo transfer specifically.

当然，服用产前维生素也会有帮助。

And of course, yes, taking a prenatal vitamin, that's going to be advantageous as well.

但要考虑到，我会在这个时期开始为怀孕做好身体准备，这样就不必在胚胎移植失败后，后悔没有早点采取不同的做法。

But thinking about, okay, I'm going to start to get my body prepared for pregnancy in this time period so I don't have to sit on the other end of a transfer that maybe doesn't work, wishing I'd done something different.

另外，查克，我认为很重要的一点是，即使使用了基因检测过的胚胎，每个胚胎的成功率也只有大约65%。

Also, Chuck, I think it's important to say, right, even with genetically tested embryos, only about a sixty five percent chance of success per embryo.

这相比自然受孕率已经非常惊人了。

Incredible compared to natural fertility rates.

但科学上我们还有很多未知之处。

But there's a lot in the science we don't know.

我们觉得很多因素可能与我们身体或胚胎的环境有关。

We think a lot of this could be, you know, environmental of our bodies or even of the embryo.

因此，知道自己充满信心，并且已经尽了全力，把最好的状态带到了这里，胚胎也已经就位，我认为这是这个过程中非常关键的一环。

So knowing that you have confidence, and I did what I could, I brought my best to the table, we have the embryo here, that I think is a really important piece of this puzzle.

我有个问题。

Have a question.

说吧。

Go.

骨骼肌吗？

Is skeletal muscle?

这正是我想问的。

Literally my question.

我喜欢这个。

I love it.

医生。

Doctor.

克劳福德。

Crawford.

哦。

Oh

天啊，男人们真厉害。

my god, guys are so good.

你的大肌肉，比如肱二头肌、肱三头肌、股四头肌，这些骨骼肌是你通常会想到的肌肉。

Your big muscles like your biceps, your triceps, your quadriceps, like skeletal muscles are the muscles you think about.

你的身体内部，比如肠道里，还有平滑肌。

Your body has like smooth muscle in your intestines.

你知道，你的心脏也有不同类型的肌肉。

You know, your heart has different type of muscle.

所以这就是举重和抗阻训练。

So this is lifting weight resistance training.

并不是有氧运动或高强度间歇训练不好，而是女性每周至少需要三天进行举重训练，最好能增强这些肌肉，因为这种荷尔蒙优势会在孕期、产后、围绝经期及以后持续为你带来益处。

And it's not that cardio is bad or HIIT is bad, but it's that women need at least three days a week of picking up weights ideally and trying to build up those muscles because of the hormonal advantage it's gonna carry you now during the pregnancy, postpartum, in perimenopause and beyond.

我们需要比过去被告知的更多地增加肌肉量。

We need to pack on some more muscle than we historically have been told.

哦。

Oh.

我有个问题想问你。

I have a question for you.

对不起，杰克。

Sorry, Jack.

说吧。

Go.

不。

No.

不。

No.

我只是说，谁知道呢？

I just said who knew?

说吧。

Go ahead.

哦，好的。

Oh, okay.

我们非常高兴你来了。

We're so excited you're here.

你能看出来吗？

Can you tell?

这可能太专业了，但我是在为杰克和其他所有女性问这个问题。

This might be too inside baseball, but I'm asking for Jack and any other woman.

所以现在正发生着这样一场对话。

So there's like this conversation being had.

我有个朋友，四十出头，只剩下一个胚胎，他们即将进行移植。

I have a friend in her early forties who has one singular embryo left and they're about to transfer.

她告诉我，他们打算进行一次非药物移植。

And she told me that they're gonna do a, an unmedicated transfer.

所以，我相信现在每个人对试管婴儿都多少有些了解：在移植之前，你需要自己注射孕酮。

So like, I'm sure everybody at this point in time, like knows a little bit enough about IVF where like, before you put, you transfer, you shoot yourself up with progesterone.

她说，他们知道她的周期是规律的，可以预测排卵时间来安排移植。

So like she's saying they know that her cycle is quote regular and they can predict her ovulation to time her transfer.

但这一切最终都归结为：自然周期是否能让她绝对确认这是一个正常的周期？

But this all comes down to is the natural cycles something she could be using to absolutely confirm that it's a normal cycle?

哦，这是个很好的问题。

Oh, this is a great question.

如果有人不知道如何用一句话解释试管婴儿，那就是：我们在实验室里用卵子和精子培育胚胎，然后将它们冷冻起来。

If somebody doesn't know to give the one sentence explanation for IVF, we make embryos with eggs and sperm in the lab, and then they are frozen.

然后我们试图营造一个子宫环境，使其处于最佳状态，以便将胚胎植入。

And then we're trying to line up the environment where the uterus is perfect to put the embryo inside.

我们有多种方法可以实现这一点。

There are different ways we can do that.

传统的方法是进行所谓的药物周期，即我们给你服用雌激素，促进内膜生长，然后注射黄体酮。

So the traditional way is to do what we call a medicated cycle where we're essentially giving you estrogen, making the lining grow, and then shooting you up with progesterone.

我们人为地控制时间，使其处于排卵后的阶段。

So we're timing artificially when it would be that postovulatory time frame.

另一种选择是所谓的自然周期或改良自然周期。

The other option is what's called a natural cycle or a modified natural.

在改良自然周期中，我们会给你用药以促使你排卵。

They're slightly In a modified natural, we give you medications to make you ovulate.