关于您生物钟的真相：卵子质量、AMH 与生育力，与娜塔莉·克劳福德博士对话

青少年怀孕减少了，更多女性在年纪更大时怀孕。

We see less teen pregnancies, more women getting pregnant older.

这充分反映了社会的变化。

That's really reflective of societal change.

但说‘你得先试一年失败了，我们才给你做检查’，这根本说不通。

But it does not make sense to say, I'm not even going to do testing on you until you've failed, and then we'll do the testing.

因为我们讨论的是评估你的生殖系统是否正常运作。

Because what we're talking about here is the evaluation to see if certain parts of your reproductive system are intact.

比如盆腔超声检查、评估卵巢储备功能、看看你伴侣的精子情况。

A pelvic ultrasound, checking your ovarian reserve or how many eggs you have, checking to see if your partner has sperm.

我明确说一下，你知不知道有多少人来找我时，已经尝试怀孕超过一年了？年龄各不相同。

Let me be clear, do you know how many people come to see me and they've been trying for more than a year, you know, a variety of ages?

结果一查，发现对方根本没精子。

And then we go find another partner who has zero sperm.

想想看，回头再想起之前见过的那对夫妻，真让人震惊。

And think about looking back saying, my gosh, I just saw a couple like this.

他们已经尝试了三年。

They've been trying for three years.

三年了，他的精子数量为零。

Three years and he has zero sperm.

于是她看着我，说：那这三年、这好几个月，我们一直在努力，还总想着是不是压力太大。

So she looks at me and she goes, so those three years, all these months, we were trying and thinking about Stress.

全都白费了。

All of that.

是啊。

Yeah.

每个月的受孕几率都是零。

We had a zero percent chance of conceiving each one of those months.

我说，确实如此。

And I said, that's true.

对吧？

Right?

这不公平。

That's not fair.

除了治疗不孕问题本身需要时间，我真觉得随着不孕率上升，女性推迟生育年龄——这本身没错，去追求远大梦想嘛——我们更需要主动出击。

In addition to the fact that it takes time to work these problems up, I really think that as infertility is rising, as women are waiting to start families later, good for them, chase big dreams, right?

我们需要一种更积极的应对方式。

We need a more proactive approach.

比如更早地做检查，对吧？

And this includes testing earlier, right?

一种更偏向预防性的医疗模式。

A more kind of preventive care model.

别一上来就让人去试，试不成再回来，得先确认有没有问题。

Let's make sure there's no problems before we just say, go give it a go and come back if it doesn't work.

你有没有过一种感觉，觉得自己活在个B或者B+的人生里？

Have you ever felt like you were living just a b or b plus life?

过这种生活太危险了。

It's so dangerous to live that.

比B-或C+的生活更危险，因为你过着B或B+的生活时，根本不会想去改变。

More dangerous than a b minus or a c plus life because when you're living a b or b plus life, you don't change it.

你觉得这样已经够好了。

You think it's good enough.

真的够好吗？

Is it?

我是苏西·威尔奇。

I'm Susie Welch.

我主持一档叫《成为你自己》的播客。

I host a podcast called Becoming You.

很多人觉得，A+的生活跟我没关系，但其实是有办法的。

People think, okay, an A plus life is not available to me, but there is a way.

我们每个人都在不断成为更好的自己。

We are all in the process of becoming ourselves.

欢迎在你常用的播客平台收听《成为你自己》。

Listen to Becoming You wherever you get your podcasts.

本播客由MediHealth赞助。

This podcast is sponsored by MediHealth.

我之前跟你们聊过我的更年期管理方案。

You've heard me talk about my menopause toolkit.

这套方案包括饮食、运动、激素治疗和其他药物，还有减压和改善睡眠质量。把这些方面结合起来，不仅能缓解症状，更能长远守护你的健康。

It consists of nutrition, exercise, hormone therapy and other medications, stress reduction, sleep quality, When you put those pieces together, they don't just ease symptoms, they support your long term health.

所以我推荐MediHealth。

That's why I recommend MidiHealth.

他们会帮你把这套方案真正用起来。

They put your toolkit to work for you.

Midi是一家专为女性健康打造的线上诊所，由女性健康领域的专家组建，医生们深谙女性衰老的科学原理，也愿意花时间真正了解你。

Midi is a virtual clinic built by leaders in women's health with clinicians who understand the science of female aging and who take the time to understand you.

通过一对一的问诊，他们会倾听你的症状、目标和担忧，然后为你量身定制一套专属的护理计划。

Through one on one visits, they listen to your symptoms, your goals, and your concerns, then create a personalized care plan tailored specifically to you.

最重要的是，Midi的服务被大多数主流医保覆盖，让每位女性都能轻松获得专业、优质的医疗照护。

And best of all, MIDI is covered by most major insurance plans, making expert, high quality care accessible and affordable for every woman.

所以，Midi 应该成为每位女性更年期管理方案中的一部分。

All of which is why Midi should be part of every woman's menopause toolkit.

现在就去 joinmidi.com 预约你的在线问诊吧。

Book your virtual visit today at joinmidi.com.

就是 joinmidi.com。

That's joinmidi.com.

你书里提到的核心词是炎症。

The word at the center of your book is inflammation.

没错。

Yeah.

现在社交媒体上到处都在讲这个术语。

And it's a buzzword on social media.

确实如此。

Apparently, it is.

但你能说说，炎症到底对生育系统有什么影响吗？

But tell us what inflammation actually does to the fertility system.

顺便问一下，生育系统到底是什么？

So what is the fertility system, by the way?

要怀孕需要哪些条件？

What does it take to get pregnant?

这个问题问得真好。

Oh, lovely question.

很多女性其实不太清楚大脑、卵巢和子宫之间是怎么联动的，对吧？

Many women don't really understand how, you know, the brain, ovaries, and uterus are really connected, right?

我觉得可以把大脑看作中央指挥站，它会解读来自全身的激素信号，然后发出指令，让你排卵，明白吗？

So the brain, I like to think about as central command station interpreting hormone signals from your entire body, And then it's going to send out signals to allow you to ovulate, right?

我们得想想卵子。

And we want to think about the egg.

它会促使卵子发育。

It's going to allow an egg to grow.

这个卵子会分泌雌激素。

That egg is going to make estrogen.

雌激素会向大脑传递信息，表明成熟的卵子已经就位。

Estrogen talks back to the brain to communicate that a mature egg is there.

这个信号非常精确。

And it's really specific.

连续五十小时保持两百皮克每毫升的雌激素水平，才能触发大脑释放促黄体生成素高峰，促使排卵。

Two hundred picograms of estrogen for fifty hours is a signal high enough to get the brain to send out an LH surge to ovulate.

排卵之后，大脑会继续释放促黄体生成素，刺激孕激素的分泌。

And then you'll ovulate, and then the brain continues to send out LH to make progesterone.

大脑指挥卵巢，卵巢负责发育卵子并分泌激素。

So the brain talks to the ovary, the ovary grows an egg and makes hormones.

这些激素不仅会反馈给大脑，还会作用于子宫，为受孕做准备。

Those hormones talk back to the brain, but also talk to the uterus and prepare it.

雌激素让子宫内膜增厚，孕激素则调控着着床窗口的开启与关闭。

Estrogen grows the lining, progesterone then opens and closes the implantation window.

我们得想想，到底需要什么条件才能怀孕。

And we want to think about what it takes to get pregnant.

我们先只说女性的情况。

We'll just say in women.

男性先不谈，暂时搁一边。

We'll leave men out of it for a hot minute.

大脑必须能读懂激素信号，也就是说，它得听得懂。

The brain has to be able to interpret hormone signals, so it has to able to hear.

这种情况什么时候不会发生？

When does that not happen?

对。

Yeah.

所以你的大脑其实是看不到卵巢的。

So your brain doesn't see your ovaries.

而且我

And I

我觉得这是一个非常重要的概念。

think this is a really important concept.

它根本不知道发生了什么。

It has no idea what is happening.

它只能依赖这个信号。

It is relying on the signal.

咱们想象一下，你我拿着对讲机聊天，对吧？

So let's imagine we're friends on walkie talkies, right?

如果炎症就像收音机里的杂音，大脑就听不清卵巢想传递的信号。

If inflammation is static interference on the radio, the brain can't hear whatever signal the ovary is trying to send.

于是它就会误判，发出错误的指令。

And so it's going to misfire, send off abnormal signals.

而这种杂音可能来自好几种不同的原因。

And that static can come from a few different things.

最常见的就是慢性炎症和胰岛素抵抗。

So that static is most commonly coming in from chronic inflammation and from insulin resistance.

胰岛素抵抗正是导致慢性炎症的主要原因之一，我们可以深入聊聊。

And insulin resistance one of the top causes of chronic inflammation that we can dive into.

但说到底，炎症其实是免疫系统正常的一部分，对吧？

But essentially, inflammation is a normal part of your immune system, right?

你要是划了个口子，身体会自己愈合，这就是急性炎症。

You get a cut, your body heals, acute inflammation.

我想先说明一点，炎症其实对怀孕特别重要。

And I'd like to preface and say inflammation is actually really important in getting pregnant.

排卵的时候，卵泡里长着卵子，卵泡越来越大，然后破裂，把卵子释放出来，之后还得重新修复。

When you ovulate, that follicle, the egg grows inside a follicle, it gets bigger, it ruptures, allows the egg out, and has to reform.

这时候，你的炎症系统就会过来，把排卵后留下的那个小伤口修复好。

And so your inflammatory system comes and heals that little spot where you ovulated from.

如果你吃了抗炎药，比如布洛芬、萘普生、美林这类药，就会阻止卵泡破裂。

And in fact, if you take anti inflammatory medication like NSAIDs, ibuprofen, Aleve, Motrin, you'll prevent the follicle from rupturing.

你还是会经历排卵期的激素变化，但卵子就是不会被释放出来。

You'll get hormonal changes of ovulation, but you won't have an egg released.

这一点特别关键，因为有些女性在排卵期会感到不适。

So that's really important because some women have middle schmurts.

这种中间位置的疼痛，我有些患者跟我说，她们能感觉到自己在排卵，因为她们能感觉到囊肿破裂，或者感觉到卵巢因为那个变大的卵泡而变得沉重。

That middle pain, I have this patient people who say, I can feel myself ovulating because they feel that cyst bursting or they feel when the ovary's heavy from that bigger follicle.

如果你在那种感觉出现时吃布洛芬，就会阻止卵泡真正释放卵子。

And if you go take ibuprofen when you feel that, you can prevent that follicle from actually allowing the egg to be released.

所以炎症是重要的，但糟糕的是慢性炎症，对吧？

So inflammation is important, but what's bad is the difference in chronic inflammation, right?

当免疫系统持续处于激活状态时，我们就会看到身体反应方式的改变，因为身体本来就不应该长期暴露在慢性炎症中。

So when the immune system is constantly activated, then we see a shift in how your body is going to respond because it's not meant to be exposed to that chronic inflammation.

我跟患者解释的时候，会让他们想象有一个杠杆，我们管它叫炎症负荷，因为炎症无处不在。

I explain it to patients as imagine there is a lever, and we call this your inflammatory burden, because inflammation's all around us.

我们不可能把炎症降到零。

We're not going to go down to zero.

但我们努力做的是

But what we're trying

在任何一天、任何环境下，尽量把杠杆保持在尽可能低的位置，这样当遇到睡得少的那晚、压力特别大的那天，或者飞机上吃了不健康的东西时，我们才有足够的韧性去应对。

to do is actively keep the lever as low as possible on any given day in the environment that we're in so that we have the resilience to respond to the night you get less sleep or the day that you do have a lot of stress or the crappy food you ate on the plane over.

所以我们需要有能力应对并适应这些急性炎症时刻。

So we want to be able to have response to tolerate these acute inflammatory moments.

但如果你长期承受这么高的负担，细胞的功能就会在多个方面发生改变。

But when you constantly have a burden that's up here, what starts to happen, it changes how your cells function on multiple ways.

就像收音机里的静态干扰，大脑会变得非常焦虑，听不清信号，甚至不再发送它该发的指令。

So static interference in the radio, the brain gets really worried, it can't hear signals, starts to not send out the signals that it needs.

慢性炎症还会对卵巢造成深远的影响。

Also, chronic inflammation directly impacts the ovary profoundly.

现在，卵巢已经无法对 incoming 的信号做出反应了。

So the ovary now can't respond to the signal that's coming in.

它还会损害卵子周围的细胞。

It also is going to damage the cells around the egg.

这样一来，卵子就无法合成它所需的激素了。

So now the egg can't make the hormones it needs to.

炎症甚至可能侵入卵子内部，损伤染色体和线粒体。

And it can get inside the egg and damage the chromosomes and the mitochondria.

更严重的是，炎症是少数几种能进入卵巢内部——我称之为‘保险库’——的东西之一。

And then to double down more, inflammation is one of the few things that can get into what I like to call the vault inside the ovary.

你知道吧，你和我都特别熟悉那个图表，讲的是女性出生时有多少卵子，到青春期时还剩多少。

You know, you and I have the same favorite graph talking about how many eggs you're born with and how many exist when at birth and when you start puberty.

因为我们都知道，女性出生时卵子数量就定好了，之后只会越来越少。

Because we know we're born with all our eggs, we run out of them over time.

我常把它们想象成藏在卵巢保险库里的珍宝。

And I like to think about them as in that vault inside the ovary.

每个月，都会有一小批卵子从保险库里出来。

And every month you have a little group coming out of the vault.

能进入这个保险库的东西，少之又少。

Very few things can get into the vault.

大多数人出生时卵子数量就固定了，之后只是慢慢耗尽。

Most of us are born with a number and we just lose over time.

但慢性炎症却能钻进这个保险库里面。

But chronic inflammation gets inside the vault.

所以当我们长期暴露在炎症中时，不仅会损伤卵子，改变卵巢的反应，影响大脑对这些信号的解读，还会直接减少储存在卵巢‘保险箱’里的卵子数量。

And so when we are exposed to chronic inflammation, not only does it damage our eggs, changes our ovarian response, changes our brain's interpretation response, it actually decreases the number of eggs we have inside the vault.

因此，我们的卵子会更快地耗尽。

So we run out of eggs faster.

那当我们过了生育年龄之后，炎症还会对我们产生什么影响呢？

How does inflammation impact us, you know, once we're past the fertility age?

影响方式其实完全一样，对吧？

Exactly the same way, right?

我们俩都特别坚信，卵巢是我们身体里最值得关注、对健康至关重要的器官。

You and I are very passionate that the ovary is the most interesting part of our body and so important for your health.

所以不要只在备孕时才考虑炎症的问题。

So we want to think about inflammation just as you're trying to get pregnant.

卵巢健康、激素功能，以及身体信号的解读能力，全都受到炎症的干扰。

Ovarian health and hormone function and being able to interpret your body's signals is all interfered by inflammation.

尤其是进入围绝经期和绝经期后，我们不再有稳定高水平的雌激素——而雌激素本身具有抗炎作用——这时候炎症带来的负担就会更加明显。

And then especially once we get into perimenopause menopause, we don't have that reliable high estrogen, which is anti inflammatory, we start to feel the burden of this inflammation even more.

所以每当激素发生变化时，我们更要主动调整那些能掌控的因素，让自己状态达到最佳，同时也让卵巢发挥到最好。

So it's even more important anytime we have this hormonal change that we are moving the levers where we can so that we can feel the best that we can, but also so that our ovaries can function in the best way that they can.

毕竟卵巢里的卵子数量已经在减少，我们可别再给它们增加负担了。

We don't even make it harder for them as they're already getting to a place where they're starting to have less eggs.

你在书里提到过一点，我想再强调一下，你说过生育跟运气没关系。原话是：生育不是靠运气的事。

You say something in the book that, and I wanna reiterate this, you talked about luck and you say, and this is a quote, Fertility is not a matter of luck.

我以前接受培训时，老师教我说，很大一部分原因其实就是运气不好。

I was taught, you know, I trained a few years before you that a huge percentage of it was just bad luck.

对吧？

Right?

我们知道存在一些染色体异常和遗传方面的问题。

We knew that there were some chromosomal abnormalities and some genetic things.

但除此之外，大家并没有讨论过饮食、营养、运动、减压、睡眠这些因素如何影响生育能力。

But outside of that, there was no discussion around diet, nutrition, exercise, stress reduction, sleep, and how all of that could affect your fertility.

说实话，我在住院医期间还能怀上孕，简直是个奇迹。

I mean, it's a miracle I got pregnant in the middle of a residency Same.

你懂的。

You know?

所以在那段时间里流产，其实也不奇怪。

And not a shock that I lost pregnancies during that same time.

接着刚才那句话，是你一生中所有选择的总和。

And so to continue the quote, it is the net sum choices you make throughout your life.

这话是什么意思？

What does that mean?

没有哪一个单一的选择能直接让你怀孕或者阻止怀孕。

So there's no one single choice that's going to get you pregnant or prevent a pregnancy.

但当我们认真思考慢性炎症如何在方方面面影响身体时，它确实会严重影响你的受孕能力。

But when we really start thinking about how chronic inflammation can impact us in so many different ways, it really does impact our ability to get pregnant.

如果再往‘运气’这个说法上想，你根本控制不了运气。

And if we want to think about luck even more, you don't control luck at all.

但我们知道，如果你在排卵当天同房，受孕几率会明显更高；要是排卵两天后才同房，那基本就没戏了。

But we know if you have intercourse the day you ovulate, you have significantly higher chance than if you have intercourse two days after ovulation when the chances are zero.

这可不是运气。

That's not luck.

这是知识。

That's knowledge.

我们还得考虑，所有这些生活方式因素都会显著加剧炎症。

We also want to think about the fact that all of these different lifestyle factors significantly increase inflammation.

大量研究数据表明，这会让怀孕变得更困难，也会降低试管婴儿的成功率。

And we have a plethora of data that it can take you longer to get pregnant and you can have worse outcomes with IVF.

这些数据都不是非黑即白的，对吧？

None of this data is all or nothing, right?

如果你抽烟，我会坐在这儿说你根本不可能怀孕吗？

So if you smoke cigarettes, am I going sit here and say, You can't get pregnant?

绝对不可能。

No way.

绝不。

No.

但我能说，对你来说会更困难吗？

But can I say, It will be harder for you?

你更容易流产，胎儿染色体异常的风险也更高。

You'll have more miscarriage, more genetic abnormalities.

你还会更早进入更年期，对吧？

You'll actually go into menopause earlier, right?

早产的概率也会增加，所有这些并发症，都跟这种单一暴露有关。

You'll have higher rate of preterm birth, all the complications that come from, we'll say, one exposure.

这是一个很有趣的例子，因为大家很快就接受了吸烟确实有害这个事实。

And this is an interesting example because everybody accepted cigarette smoking was really bad really quickly.

但还有很多其他会引发炎症、对身体有害的因素，有时还多重影响，我们作为社会却更犹豫要不要承认。

But there's so many other things that cause inflammation that are also harmful to our body, and sometimes in multiple ways, that we are more hesitant as a community to accept.

我遇到的最大反对意见是，这属于制造恐慌，会让人感到被指责。

The biggest pushback I get is that it's fearmongering, you know, that it causes blame.

我要说的是，因为我亲身经历过，你也一样。

And here's what I have to say because I went through it and you did too.

生育能力是一个健康指标。

Fertility is a health marker.

有一整期关于生育和不育的期刊，讨论了不孕女性日后患其他疾病的风险更高。

An entire issue of fertility and sterility was talking about how women who have infertility have higher risks later in life.

比如心血管疾病、癌症、代谢综合征、中风，甚至更早去世。

Cardiovascular disease, cancer, metabolic syndrome, stroke, earlier death.

不孕本身会导致这些病吗？

Does infertility cause any of those?

绝对不会。

Absolutely not.

但它是一种潜在的健康状态，让你更容易出现不孕。

But it is the predisposing state that puts you at risk for infertility.

所以慢性炎症既可能导致不孕，也会增加你得其他病的风险。

So chronic inflammation can cause infertility and puts you at risk for these other things.

我觉得这特别重要，因为女性通常聪明又受过良好教育，我们能承受得了严峻的事实。

So I think it's really important because women specifically are brilliant, educated, and we can tolerate really hard news.

但我们不能因为觉得太可怕就直接忽略它。

But we have to know it to just dismiss it and say, that's too scary.

我不会告诉玛丽·克莱尔说她的不孕会让她将来更容易得这些病，因为这事她也改变不了。

I'm not gonna tell Mary Claire that her infertility is gonna cause her to be at risk for these diseases later because there's nothing she can do about it.

是的，我们没法倒回时间去改变不孕的问题，但从今天开始，我们可以彻底改善自己的健康。

Yeah, we can't rewind the clock and change the infertility, but we can change our entire health starting today.

对。

Yeah.

而且我们有权利知道这些信息。

And we deserve to have that knowledge.

我觉得女性其实很适合把生育当成一个健康检查的契机，对吧？

And I think women really Fertility is a nice time, right?

生育能力是一个健康指标，不只是为了怀孕，它反映的是你身体的整体状态。

It's a health marker, not just getting pregnant, it's a state of your body's health.

但对年轻女性来说，这往往是她们第一次主动去关注一些不寻常的健康问题，对吧？

But it's often the first time in a young woman's life that she is trying something outside the norm, right?

我们会经历一个比较特殊的阶段，小时候看儿科医生，然后去上大学，之后可能再看妇科医生，拿点避孕药，但在那之前通常没什么明显的健康问题被诊断出来。

We go through this weird phase where you see a pediatrician, and then you go off to college, and then maybe you see an OBGYN and get some birth control, but you don't usually have any medical problems that get diagnosed before then.

所以突然之间，如果你没怀上孕，这可能是身体发出的第一个警示信号，特别是如果你之前没学会记录自己的生理周期，或者没养成关注身体信号的习惯。

So suddenly you're at this position, if you're not getting pregnant, it's the first red flag your body might be waving, you know, especially if you haven't learned to track your cycles or listen to your cycle for a clue.

跟我聊聊关于不孕症的一般情况。

Talk to me about infertility in general.

你刚才提到了男性。

You mentioned men.

所以如果一对夫妻来找你们，尝试了一年还没怀孕，其中有多少比例是女性因素导致的？

So if a couple comes to you and they've tried for a year and they're not pregnant, how much of it is female?

我希望大家都明白这一点。

And I want people to understand this.

你们知道，到底多少是女性原因，多少是男性原因？

You know, how much is female, how much is male factor?

不孕症中，百分之五十是女性因素，百分之五十是男性因素。

Fifty percent of infertility is female, fifty percent is male.

你们有没有想过

Do you guys

五成是女性原因，五成是男性原因。

50 hear 50.

如果要更精确一点，三分之一是纯粹的女性因素，三分之一是纯粹的男性因素，还有三分之一是男女双方都有问题。

If you wanna be actually more specific, one third is only a female factor, one third is only a male factor, and one third has combined factors, both female and male.

这一点也很重要，因为经常有女性来跟我说，

And that's important too, because I'll often have women come in and say,

那为什么总是先让女性去检查呢？

Well, then why is it always the woman who goes first to go get evaluated?

因为医疗体系根本不是以女性为中心的，对吧？

Well, because healthcare is not female centric, right?

总是把责任推给女性。

It is always placing blame on the woman.

女性一直承担着怀孕、妊娠和胎儿健康的全部负担。

Women have always carried the burden of the pregnancy, of the gestation, of the health of that baby.

但精子的健康会影响胎盘，对吧？

But sperm health contributes to the placenta, right?

精子质量差会增加胎盘疾病、子痫前期和早产的风险。

You have higher risk of placental disease, preeclampsia, earlier birth based on the health of the sperm.

这就是精子基因组所参与的部分。

That's part of what the sperm genome contributes to.

所以男性也必须参与到这个讨论中来。

So men have to be a part of this discussion.

对他们来说好消息是，精子每天都在不断新生。

And the good news for them is that sperm is constantly made every single day, right?

每秒产生一千五百个精子。

1,500 sperm a second.

男性每天都在把全新的DNA包装进精子里。

And so men are packaging up brand new DNA into sperm.

这给了我们一个绝佳的机会：哪怕只是做一点小小的改变，也能显著改善精子数量。

It gives us an incredible opportunity to make a change that might seem like not very much and have completely different sperm counts.

精子非常敏感。

Sperm are highly sensitive.

所以跟女性不一样，女性的卵子有一定的韧性，通常不会因为某一个单一因素就彻底成功或失败；但对男性来说，一个单一的决定就可能直接摧毁你的精子数量。

So unlike women, where your eggs do have some resilience and there's not one single change that would usually make it or break it, for men, one single decision can actually destroy your sperm counts.

不过好消息是，这种情况往往是可以逆转的。

Now the good news is it's often reversible.

是的。

Yeah.

咱们拿大麻来说吧，这可是大家的最爱，对吧？

But let's use cannabis, everybody's favorite, right?

所以，使用大麻会降低精子质量。

So cannabis use can decrease this.

如果你不知道大麻是什么的话，那就是 marijuana。

That would be marijuana if you don't know what

大麻，包括那些含有大麻成分的零食，对吧？主要是 THC。

Marijuana cannabis and including in edibles, right, THC.

所以你看，其实不用非得抽烟。

So see a lot of- you So don't have to smoke it.

你根本不需要抽烟。

You don't have to smoke it.

问题不在抽烟这个动作本身。

So it's not the act of smoking.

真正影响你的是它在体内产生的作用。

It's actually what it's doing inside your body.

它还会引发炎症。

And it does cause inflammation.

同时影响大脑功能和睾丸功能。

It also impacts brain function and testicular function.

男性会出现精子和睾酮产量下降的情况。

So men have lower production of sperm and testosterone.

因为精子和睾酮是协同产生的，都由大脑调控。

Because sperm and testosterone are made together, the brain signals them.

而且更让人担心的是，我们会发现精子头部的DNA碎片化程度增加了。

And then also, and more concerning, we see increase in fragmentation of the DNA inside the sperm head.

所以这会影响DNA的包装方式。

So it's impacting how the DNA is packaged.

如果男性以任何形式使用大麻，比如说抽大麻，那么他的伴侣发生流产的概率会显著升高，即使她完全没有接触过这东西。

If a man is using cannabis in any form, so we'll say he's smoking weed, his partner has a significantly higher rate of pregnancy loss, even if she's never around it at all.

你看，一个小小的决定就能影响你的生育能力。

Talk about one single decision that is impacting your fertility.

每次我提到这点，总有人会说，我抽了那么多大麻，不也照样有孩子嘛。

And every time I say this, people will say, I smoked all this pa and I have babies.

确实，每个人的体验都不一样，这很正常。

And there's always going to be individualized experience, and that's great.

但如果你年纪稍大一些，这点就显得更为重要了。

But this is even more important if you are, let's say, you're older.

也就是说，当你年纪稍长才开始备孕时。

So you're starting to try for your family older.

我们可不想浪费时间，等发现问题了才后悔，还得等三个月精子才能重新生成。

We don't want to waste time and then find this out and then have to wait three months for sperm to regenerate.

早点主动行动，我很喜欢‘孕前三个月’这个说法。

Being more proactive, And I love this talk of trimester zero.

在怀孕之前，我们能做些什么呢？

Like, what can we do before we get pregnant?

孕前这三个月，正好是精子的生命周期。

The three months beforehand, that's the lifespan of sperm.

我们发现，卵子在排卵前的六十天内最为敏感。

And we do see that eggs are most sensitive in the sixty days before they ovulate.

当有夫妻说‘我们想尽快怀孕，但还没准备好’，这其实是个绝佳的机会——不如趁这三个月，反其道而行之，别光想着试，先好好准备。

So when I see a couple who says, well, we want to be pregnant soon, but not yet, this is an incredible opportunity to say, Let's take these three months, do the opposite of what we did, which was just try.

没错。

Right.

咱们应该好好调理，尽量减少炎症，让精子和卵子都达到最佳状态，再开始备孕。

But let's actually prepare and try to decrease inflammation as much as possible so that we have the best egg and sperm quality leading into this pregnancy attempt.

好了，我们来详细聊聊，欢迎回到又一期《Midi Pause》。

Okay, we'll dig into some of the particulars around Welcome back to another Midi Pause.

我是医生。

I'm Doctor.

玛丽·克莱尔·哈弗，《UnPaused》节目的主持人。

Mary Claire Haver, host of UnPaused.

说到皮肤护理，没有一种方法能适合所有人。

When it comes to your skin, there is no one size fits all solution.

雌激素和睾酮这些关键激素会在人生不同阶段波动，对皮肤产生各种影响，尤其是在中年时期。

Key hormones like estrogen and testosterone fluctuate during various life stages and can have a variety of effects on your skin, especially during midlife.

当雌激素在围绝经期和绝经期下降时，你可能会注意到一些变化。

When estrogen declines in perimenopause and menopause, you may notice changes.

这都是正常且自然的现象。

It's all normal and natural.

好消息是，Midi Health 提供针对激素变化所致皮肤问题的有效疗法。

The good news is Midi Health offers effective skin treatments for visible signs of shifting hormones.

Midi 的科学护肤方案能帮你滋养、焕活并保护肌肤，不仅现在有效，未来多年也能持续发挥作用。

Midi's science backed solutions can help nourish, revive, and protect your skin now and for years to come.

更年期雌激素流失会加速衰老，其速度远超你以往经历过的任何阶段。

The loss of estrogen during menopause accelerates the aging process faster than anything you've experienced up to this point.

在更年期的头五年里，我们可能会流失高达 30% 的胶原蛋白。

We can expect to lose 30% of our collagen in the first five years of menopause.

没错，你没听错。

Yes, you heard that right.

百分之三十。

30%.

我在病人身上经常看到这种情况，我自己也经历过。

I see this all the time in my patients and have experienced it personally.

很多女性会说，我的皮肤看起来跟以前不一样了，或者不管用什么护肤品都没效果了。

Women will say, My skin just doesn't look like it used to, or Nothing I'm using is working anymore.

她们说得对，因为激素变化后的皮肤，需要采取跟三十多岁、四十多岁时不同的护理方式。

And they're right, because hormonally changing skin needs a different approach than what worked in our 30s and 40s.

很多护肤成分，比如维生素A、B和C，常被用于帮助中年肌肤的日常护理。

Many skin care ingredients, including vitamins A, B, and C, are commonly used in routines focused on supporting skin during midlife.

一些研究显示，外用雌三醇乳膏能显著改善衰老迹象。

Some studies have shown that topical estriol cream may significantly improve signs of aging.

我们知道雌激素对皮肤健康至关重要，比如保湿、弹性以及胶原蛋白生成，补充它真的能带来明显改变。

We know estrogen plays a key role in skin health things like hydration, elasticity, and collagen production and supporting that can make a real difference.

Midi推出了一款专为这个阶段设计的雌三醇Plus面霜。

Midi offers an Estriol Plus face cream, which is designed specifically for this stage of life.

改变，从制定个人方案开始。

Progress starts with a personal plan.

预约一次MediHealth的在线初诊，不到十分钟就能搞定。

Booking your first virtual visit with MediHealth takes less than ten minutes.

找一个真正理解你处境的医生沟通，非常重要。

It's important to talk with a clinician who really understands what you're experiencing.

这才叫个性化护理。

That's personalized care.

MIDI Health 正在重新定义医疗保健的标准。

MIDI Health is setting a new standard for health care.

作为全美增长最快的女性远程医疗公司，MIDI 提供便捷且医保覆盖的服务。

As the nation's fastest growing women's telehealth company, MIDI provides accessible insurance covered services.

MIDI 填补了女性在围绝经期和绝经期所面临的重大健康空白。

MIDI fills the critical health gaps women face in perimenopause and menopause.

如果你希望有一位真正懂你身体和肌肤需求的医生支持你，那正是 Midi 的使命。

If you want a clinician in your corner who understands what your body and skin need right now, that's exactly what Midi is there for.

前往 joinmidi.com 了解更多。

Go to joinmidi.com.

访问 joinmidi.com，今天就联系他们的专业医生。

Join midi.com and connect with one of their clinicians today.

如果问题不在你的皮肤上呢？

What if the problem isn't your skin?

而是你的化妆品。

It's the makeup.

因为到了某个阶段，以前好用的产品就突然不管用了。

Because at a certain point, the products that used to work just don't anymore.

粉底一上脸就显得干巴巴的，没光泽。

Foundation starts to look flat.

腮红怎么涂都感觉不对劲。

Blush sits differently.

到了下午三点，整个人感觉又干又重，妆容还特别假。

And by 3PM, everything feels dry, heavy, or overdone.

其实，很多传统彩妆根本没考虑过皮肤会随年龄变化。

The reality is a lot of traditional makeup was never designed with changing skin in mind.

这时候就轮到OG登场了，一个获得认证的有机护肤彩妆品牌，效果却毫不逊色于高端大牌。

That's where OG comes in, a certified organic beauty brand that delivers luxury level performance.

OG的晶石轮廓系列不靠填充剂和厚重色素，将近90%的成分都是护肤精华——绿咖啡油、荷荷巴油、接骨木莓提取物，上妆的同时也在滋养肌肤。

Instead of loading products with fillers and heavy pigments, OG's Crystal Contour Collection is made with nearly 90% skincare ingredients: green coffee oil, jojoba, elderberry extract, ingredients that nourish the skin while you're wearing the makeup.

最棒的是？

And the best part?

OG获得了NSF有机认证，这是美容行业最严格的标准之一，所有产品都不含合成香料、人工填充物或不必要的添加剂。

OG is NSF certified organic, one of the most rigorous standards in the beauty industry, so every product is made without synthetic fragrance, artificial fillers, or unnecessary additives.

这套护肤彩妆流程简单到不能再简单。

The routine itself could not be easier.

铜色增添温暖感和立体感。

Copper adds warmth and definition.

玫瑰石英带来自然的红润气色，而蛋白石则打造出最迷人的光泽。

Rose Quartz gives that fresh pop of color, and Opal creates the prettiest glow.

所有产品都轻松融合，仿佛直接融入肌肤，让妆容看起来自然、透亮，像是在呵护你的皮肤，而不是与之对抗。

Everything blends effortlessly and melts right into the skin, So your makeup looks natural, radiant, and like it's working with your skin instead of against it.

如果你准备好提升自己的美妆标准，OG完全能满足你。

If you're ready to raise your beauty standards, OGE's got you covered.

前往 og.com/unpaused，使用代码 UNPAUSED 可享八折优惠。

Go to og.com/unpaused and use the code UNPAUSED for 20% off.

访问 ogee.com/unpaused，输入代码 unpaused，立享八折。

That's ogee.com/unpaused and enter the code unpaused to get 20% off.

我们来聊聊生物钟吧。

Let's talk about the biological clock.

是的，没错。

Oh, yes.

因为实际情况和大多数女性所知道的——或者根本不知道的——差别很大。

Because the data is really different than what most women have been told or not told.

你说生育能力通常在绝经前十年就因卵子质量而下降了。

You say that fertility is often capped ten years before menopause because of egg quality.

但这到底意味着什么？

But what does that mean?

对。

Yeah.

大多数女性以为到了35岁就会突然掉进一个悬崖。

Most women think that there's this magic cliff at age 35.

对。

Yeah.

我当初也是这么被告诉的。

I asked them I was taught that.

我当时属于高龄产妇。

I was advanced maternal age.

对。

Yes.

如果我问她们为什么这么想，大多数女性都觉得是因为快没卵子了。

And if I ask them to explain why, most women think it's because they're almost out of eggs.

我遇到的患者里，最常见的一种情况就是，一过30岁就赶紧来预约我。

The number of patients I have who schedule an appointment for me because it's their 30 birthday has passed, that's the number one appointment type I see.

我都35岁了，现在肯定没法生了。

Hey, I'm 35, so I'm infertile now.

或者我卵子快用光了。

Or I'm almost out of eggs.

其实大多数女性到了35岁，卵子还多得很。

The majority of women are nowhere close to out of eggs at age 35.

如果我们回到我最喜欢的那个比喻——金库，对吧？

If we go back to my favorite analogy, the vault, right?

你一生下来，所有的卵子就都在那儿了。

You're born with all your eggs.

每个月，都有一批卵子从金库里出来。

Every month, a group of them comes out of the vault.

其中随机挑一个排卵，其他的就自然凋亡，下个月又来新的一批。

One is randomly chosen to ovulate, the rest of them die, and the next month you have another group.

当你年轻的时候，金库还很满，每个月出来的卵子就多。

Now, when you are younger and the vault is more full, more eggs come out every month.

等金库慢慢空了，每个月出来的卵子就越来越少。

As the vault starts to get emptier, fewer eggs come out every month.

你可以想象，有个门卫在房间里维持人数平衡。

So imagine there's a bouncer at the room trying to keep the room at the right amount of people.

房间里人太多了。

Someone's really crowded.

他会让更多的卵子出来。

He's shoving more out.

随着卵子库变空，他就不想让那么多人离开了。

And as it starts to get empty, he doesn't want as many people to leave.

一个30岁的女性平均会有20个卵子从卵子库中出来。

An average 30 year old would have 20 eggs coming out of the vault.

所以她会有一个卵子排卵，其余的19个会死亡。

So she would ovulate one, and nineteen would die.

损失太大了。

So much loss.

一个40岁的女性，每个月大概会有8个卵子从储备里出来。

An average 40 year old would have eight eggs coming out of the vault.

其中1个会排卵，剩下的7个就会凋亡。

One would ovulate, seven would die.

对，数量确实是在减少的。

Yes, count does go down.

对我们所有人来说，我们都会达到一个卵子耗尽的临界点。

And for all of us, we will reach a threshold where we are out of eggs.

而且这个过程可能会提前到来。

And you can go through that earlier.

所以我们会出现卵巢早衰的情况。

So we can have premature ovarian failure.

这种情况确实会发生。

That does happen.

但真正对生育能力产生更深远影响的是，因为我们的卵子从出生起就一直在体内，它们会不断承受外界环境带来的损耗。

But what happens and is more profoundly impactful for our fertility is that since our eggs are inside our body our entire life, they absorb the wear and tear of the world around us.

我们会看到卵子的基因正常性以及卵子的功能、质量或健康状况都发生了变化。

And we see a change to both the genetic normalcy of our eggs and the egg function or quality or health.

你可以想想线粒体的功能，也就是卵子制造激素以及完成其他各种功能的能力。

Think about mitochondrial function, the ability of the egg to make hormones and do all of its other function.

我常跟患者打比方说，你可以把染色体想象成按字母顺序排好队的小班小朋友。

What we know, and I like to tell my patients, imagine your chromosomes are like kindergartners in alphabetical order.

因为女性的染色体是46XX。

Because female chromosomes are 46XX.

所以你的卵子里面，那23条X染色体和另外23条X染色体，被一些微小的纺锤体蛋白分隔着，一直保持分离状态。

So inside your egg, they're held 23X, 23X, held apart by these meiotic spindles proteins, held apart by little proteins.

从你一出生起，它们就处于这种冻结状态。

And they stay that way from when you're born- They're frozen.

直到你排卵的时候才会动。

Until you ovulate.

这事儿其实特别不可思议。

This is the wildest thing.

对，然后它们就会分开。

Yeah, and then they split.

所以当你排卵时，它们会分开，其中一半进入卵子。

So then when you ovulate, they split apart and half of them go into the egg.

问题在于，你二十岁的时候，那些蛋白还很结实，所以染色体大多能保持在正确的位置。

The problem here, well, when you're 20, your proteins are really strong, so most of them are in the correct spot.

但到了四十岁，长期的损耗让这些蛋白质大多已经老化了。

But when you're 40, absorbing that wear and tear, a lot of these proteins have broken down.

所以你的染色体没法正常分离。

So your chromosomes don't split normally.

它们已经乱了套。

They've gotten out of line.

这就像是让幼儿园的孩子们在原地待了四十年，而不是二十年。

It's like if I've asked the kindergartners to stay in there for forty years instead of twenty years.

更糟糕的是，炎症在这里又火上浇油，因为它直接影响卵子的功能和线粒体的健康。

And then to make matters worse, this is another place where inflammation doubles down because inflammation impacts egg function, mitochondrial health directly.

再想象一下，就像把一群小狗放进了你染色体的房间里。

But also, imagine us like bringing puppies into the room of your chromosomes.

孩子们一下子就全乱了。

Like the kids get out of order.

直接干扰了那些把染色体维持在完美位置的蛋白质。

Directly impacting those proteins, holding your chromosomes in a perfect position.

所以确实会变难，因为这涉及到卵子质量、基因是否正常以及卵子的能力。

So it does get harder because of this egg quality, genetic normalcy and egg competency.

但通常不是在35岁就变成这样。

But it's not usually at age 35.

到了35岁，大概一半的卵子基因是正常的，另一半则不正常。

At age 35, about half your eggs are genetically normal and half are not.

这一点非常重要，我要说明的是，我现在还没有检测卵子质量的测试方法。

It's really important for somebody to know, I don't have a test for egg quality right now.

我没法直接检测你卵子的功能。

I cannot test the function of your eggs.

明白吗？

Okay?

等卵子受精变成胚胎，也就是做试管婴儿的时候，我可以检测胚胎的基因。然后利用这些数据，推算出你在不同年龄时，基因正常的卵子大概占多少比例。

I can test genetics of the egg once it's been made into an embryo, an IVF, and we use that data to extrapolate the percentage of genetically normal eggs at any given age.

比如35岁的时候，这个比例大概是50%。

So fiftyfifty at age 35.

在30岁的时候，正常比例大概是60%到70%，所以确实有所下降。

Well, at age 30, it was about 60 to 70% normal, so it has dropped.

不过你的卵子数量还是挺好的。

But you still have a good egg count.

大多数35岁的女性，取卵后大概会有14到15颗卵子。

Most women at age 35 will have around fourteen, fifteen eggs outside the vault.

所以即使只有一半是正常的，这个数量也已经相当不错了。

So fifty percent of that's still a really good number.

问题是，随着年龄增长，这个比例会下降得更快。

The problem is that number starts to more rapidly drop as we get older.

所以到了38岁，大概只有40%左右。

So at 38, it's more like 40%.

而到了40岁，就更低了，大概只有25%左右。

And then at 40, it's more like 25%.

因此，过了38岁之后，我们能看到基因正常的卵子数量出现更明显的下降。

So we start to see a more profound drop after age 38 in the number of eggs that are genetically normal.

不过，38岁的女性也不是都一样，这点也很重要。

Now, not all 38 year olds are created equal, and this is important too.

随着年龄增长，整体人群的代谢健康状况往往会变差。

As a population, we get more metabolically unhealthy as we get older.

所以，时间本身有影响，但生活方式和炎症的累积作用也不容小觑。

So there is both tincture of time, but the lifestyle choices and inflammation add up a lot.

我觉得在这个话题里，你很可能也会问到，我们得聊聊卵巢储备检测，以及它和生物钟的关系。

And I think it's important in this discussion, and you'll probably ask, but we should talk about ovarian reserve tests and how that play into the biologic clock.

对。

Yeah.

大多数人以为，卵子数量就是全部答案了。

So most people think, oh, egg count is the end of the puzzle.

确实有个检测能知道你还有多少卵子，但说实话，这个检测的争议性让我很意外。

And there is a test for how many eggs that you have, and it's pretty controversial, shockingly, to me.

说到这个，我也说不准我们什么时候会彻底没卵子。

When we think about this, I don't know when we'll run out of eggs.

但我可以在体外评估这些卵子。

But I can evaluate the eggs outside the vault.

我看不见 Vault 里面的情况，所以真的不知道。

I can't see inside the vault, so I don't know.

不过一般来说，如果 Vault 里卵子多，释放的也多，那我通过体外检测，至少能大概推测里面的情况。

But if in general, when the vault's more full, sends out more, if I test the eggs outside the vault, I can at least get an idea what's inside.

所以我更愿意把卵巢储备检测看作是把你归入某个类别。

So I like to think about these tests of ovarian reserve as putting you in a category.

你的卵子数量和同龄人相比是正常水平吗？

Are you normal for your age?

是高于平均水平？

Above average?

还是低于平均水平？

Below average?

还是严重偏低？

Critically low?

这个检测是什么？

What is that test?

有好几种，但最好的是AMH。

There's a couple different, but the best one is an AMH.

AMH。

AMH.

抗苗勒管激素。

Anti Mullerian hormone.

AMH是由颗粒细胞产生的，这些细胞包裹着每一个卵泡。

AMH is made from the granulosa cells, the cells that surround every follicle.

卵子多，排出的也多，AMH水平就高。

So more eggs in, more eggs out, more AMH.

身体并不是完全精确的。

The body's not perfect.

所以，一个30岁、体外有20个卵子的女性，AMH值每个月可能有25%的波动。

So again, the 30 year old with 20 eggs outside the vault, you can see a 25% variation month to month.

所以可能这个月是21，下个月变成16，再下个月又变成22。

So she might have 21 month, then sixteen, twenty two.

如果我在每个月都测一次AMH，数值就会上下波动。

And if I point checked an AMH each of those months, it would fluctuate.

不过，这些数值都会落在她所属的那个等级范围内。

However, it would all stay within her category.

所以咱们不建议只看某一个具体的数值，因为女性对此感到焦虑是很正常的。

So that's why we don't want to think about a point value because women do get really freaked out, rightfully so.

我们不太明白这个检查。

We don't understand the test.

假设你第一次测出来是2.5，一年后变成了1.5。

And let's say you had one that was 2.5, and then a year later it's 1.5.

你心里一算，就会想：糟了，我可能没几年卵子就耗尽了。

You're going to do the mental math and say, Man, I'm going to be out of eggs in a few years.

但这并不符合实际情况，因为数值本来就会上下波动。

And that's not reality because it does hop back and forth.

所以它并不能说明你是否具有生育能力。

So it's not telling us that you are fertile.

它也无法告诉你你将来会不会怀孕困难，或者会不会顺利怀孕。

It's not telling us you will have any problem getting pregnant or that you won't.

但它确实提供了一个重要信息，就是你目前有多少个卵子。

But it is an important data piece telling me how many eggs you have right now.

这一点很重要，因为即使你的卵巢功能正常，其他方面也都健康，但如果你的卵巢储备偏低，我最想知道的是：为什么？

And that's important because even if your ovaries still function and everything else is perfectly normal, if you have low ovarian reserve, my big question is, why?

为什么？

Why?

对吧？

Right?

因为你可能会得到一个诊断结果。

Because you might get a diagnosis.

也许你患有自身免疫性疾病。

Maybe you have an autoimmune disease.

也许你有桥本甲状腺炎。

Maybe you have Hashimoto's.

也许你有子宫内膜异位症。

Maybe you have endometriosis.

也许你接触过某些有害物质，而这些是可以避免的，对吧？

Maybe you have a toxic exposure that you could change, right?

也许拿到这份检测结果后，你会决定戒烟。

Maybe you stop smoking cigarettes when you get this data.

所以，无论你有没有生育计划，这都可能直接影响你的健康。

So it might impact your health right now, regardless of children.

但同时，它也可能对你的生育规划产生重大影响。

But also, it might impact your family plan immensely.

正因如此，它违背了ACOG的建议，才显得特别不合理。

And so this is why it's kind of crazy that it goes against ACOG's recommendation.

要明确一点，ACOG是美国妇产科医师学会，他们认为只有在考虑做试管婴儿时，才应该做AMH检测，对吧？

And to be clear, ACOG is American College of OBGYN, and they do not recommend doing AMH testing outside of are you a candidate for IVF, right?

没错。

Correct.

他们只建议在不孕不育评估时才做AMH检测。

They don't recommend AMH outside of an infertility evaluation.

问题在于——但你还是在做。

The problem here is that- But you do it.

我在做。

I do it.

还告诉每个人都应该做。

And tell everybody they should do it.

我也会跟所有妇产科同行这么说。

I tell all my OB GYN colleagues too.

我说，如果你对面坐着一位女性，问她：你打算怀孕吗？

I said, If you sit across the table from a woman and you ask, Are you trying to get pregnant?

不打算。

No.

你打算用什么避孕方式？

What birth control do you want?

下一个问题应该是：你将来想生孩子吗？

The next question should be, Do you want kids one day?

我们该不该检查一下你的卵巢储备功能？

Should we test your ovarian reserve?

原因就在这里。

And here is why.

ACOG认为，如果女性不是在备孕，得知自己卵巢储备低会让她非常焦虑。

ACOG says that it's too distressing for a woman find out she Stop.

太有压力了。

Has It's too stressful.

对女性来说太难受了。

Too distressing for a woman Stop.

如果她没打算怀孕，得知卵巢储备低反而会让她误以为自己永远没法生孩子，但其实不是这样的。

To find out she has low ovarian reserve if she's not trying to get pregnant because it does not mean you can't get pregnant.

娜塔莉。

Natalie.

什么？

What?

这整本书的核心观点就是这个。

Literally the thesis of the whole book.

你连数据都不知道，怎么做决定？

Can't make decisions on data you don't know.

所以他们以一种假设为由，剥夺了女性的自主权——

And so they are taking agency away from women out of the presumption- because

因为我们承受不了真相。

we can't handle the truth.

他们觉得你拿到的数据会让你压力太大，从而做出不一样的选择。

That the data you are gonna get is too stressful and that you won't make different decisions about it.

但女性每天都会根据这些数据做出不同的决定。

But women will make different decisions based on this data every single day.

而且要不要这么做，不是美国妇产科医师学会说了算。

And it's not ACOG's decision about what you do.

这应该是你自己的决定，因为确实有一部分女性会提前耗尽卵子。

It should be yours because women will there are a group of women who will run out of eggs.

她们会坐在我对面，我们就会有这么一段对话。

And they will sit across from me, and here's the conversation we have.

第一，为什么会这样，对吧？

One, why, right?

所以我们先来搞清楚原因，做个全面评估。

So we're going do the why, do an evaluation.

但第二，如果你的卵子数量偏低，你就更早进入更年期。

But two, if you have a low egg count, you will go through menopause early.

你用来组建家庭的时间就更短了。

You have less time to grow your family.

做试管婴儿或者冻卵时，你的卵子数量也会更少，那过程就会更艰难。

You will have fewer eggs with IVF and egg freezing, so that'll be an uphill battle.

所以越早做越好，因为那时候卵子质量对你更有利。

Therefore, the sooner you do it, the easier it will be because quality will be more in your favor.

还要控制好生活方式方面的因素，这尤其重要，因为你的卵子数量不多了。

And controlling the lifestyle factors because it's even more important because you don't have as many eggs to work with.

当然，你要尽量降低炎症，让卵子质量达到最佳。

So of course you want to decrease inflammation have the best quality possible.

我在想骨质疏松、心血管疾病这些后续影响，以及早绝经带来的各种已知风险。

You know what I'm thinking of the downstream effects of osteoporosis, cardiovascular disease, and all the things we know that ELO puts you at risk for.

如果你知道自己有卵巢早衰的风险，对吧？

If you know you're at risk for going into ovarian failure early, right?

对。

Right.

单从生育规划的角度来看，你可能得早点行动。

From a family planning lens alone, you might try sooner.

也许你有伴侣，一直在等那个完美的职业时机，但现实可能是，这机会未必会降临在我身上。

Maybe you have a partner and you are waiting for this perfect career moment, but you're faced with, That may not happen for me.

如果我现在不开始，也许就无法拥有想要的家庭规模了。

Or maybe I won't have the size family I want if I don't start now.

也许你可以考虑冻卵。

Maybe you will freeze eggs.

也许你可以冻胚胎。

Maybe you will freeze embryos.

也许你可以自己用捐精者受孕。

Maybe you'll get pregnant on your own with a sperm donor.

也许你一样都不做，但你得做出决定。

Maybe you'll do none of those things, but you will say, I got to make the decision.

我不让时间替我做决定。

I didn't let time make it for me.

至于你提到的，如果你不知道未来会发生什么，就会在多年里一直感觉糟糕，直到最终确诊。

And then to your point, if you don't know something's going to happen in your future, you will go through years of feeling like crap until you get that diagnosis.

相反，我会对女性说：你的AMH值偏低。

Versus women, I say, Your AMH is low.

你的AMH值不到一，而你才三十岁。

Your AMH is under one, and you are 30.

我会告诉一位女性，你不可能撑到五十一、五十二岁才绝经。

I will tell a woman, There is no way you're going to go through menopause at 51, 52.

说真的，你熬不到那时候的。

Like, you're not going make it.

你在这么年轻的年纪，卵子数量就已经很低了。

You are already in a low egg count at a really young age.

你明天不会突然进入更年期。

You're not going go through menopause tomorrow.

但你要知道，一旦开始出现这些症状，就说明你在三十多岁时就会迎来围绝经期。

But you should know when you start having these symptoms, you are the candidate who perimenopause will strike in your thirties.

如果你不想提前患上痴呆症、心脏病或骨质疏松症，你就需要更早地进行激素替代治疗。

You will need earlier hormone replacement therapy if you do not want to have earlier onset of dementia, heart disease, osteoporosis.

但女性甚至没有机会去思考这些，比如提前规划多年的预防性保健、骨骼养护，或者如何重新规划整个人生，更不用说孩子的事了。

But women are not even given that opportunity to think about, think about the years of preventive care, of bone building they could be doing, of how they could restructure their entire life, let alone children.

我处理的是这些问题的后续影响。

I treat the downstream of all of this.

你明白吧？

You know?

我看到我们国家正面临严重的虚弱、骨质疏松和痴呆问题。

And I see the epidemic of frailty and osteoporosis we have in this country and dementia.

完全同意。

A thousand percent.

我们现在正站在一个关键的机遇面前。

So we are sitting at the opportunity.

我知道你认同我，所以我才这么说。

I know you agree with me, so I'm gonna say this.

我坚信，作为医生，我的职责不是阻止你获取关于自己身体的数据。

I strongly believe that as a physician, my job is not to be the gatekeeper of you getting data about your body.

在2026年这个科技发达、抽血化验触手可及的时代，我相信你足够聪明，能理解我是如何帮你解读这些信息的。

I do not believe that in this calendar year of 2026, where we have easy access to technology, lab draws, and tests, I also think you are smart enough to understand how I'm helping you interpret it.

对吧？

Right?

是的，AMH这项检测挺复杂的，但只是一个例子。

Yeah, AMH is a complicated test, but it's one example.

你可能会根据它现在或将来做出不同的决定。

But you very well may make different decisions now and in the future based off of it.

最终，是否做这个决定应该由你自己说了算。

And at the end of the day, that should be your right to make.

AMH检测要多少钱？

How much is an AMH?

如果保险不报销，大概是79美元。

$79 if your insurance does not cover it.

对吧？

Right?

很便宜。

Cheap.

这太离谱了。

That's crazy.

对于那些在三十七八岁甚至四十出头才生孩子的女性，我2018年就不做产科了。

So for women who have had a child in their late thirties, early forties, and I stopped doing obstetrics in 2018.

我那时候还在医院接生，但只是在医院环境里。

I was still delivering babies, but just in a hospital setting.

现在有了这种情况，越来越多高龄女性生孩子，我们直接从产后就过渡到围绝经期了。

Now that we have this, you know, older cohort of women having children, we're rolling right from postpartum into perimenopause.

对。

Yes.

那您什么时候会给这些患者做咨询呢？

And when are you counseling those patients?

这是个很好的问题，因为很多女性根本得不到基本的信息，哪怕医生其实知道或者以为自己说过了。

This is a great question because so many women are just not given basic information, even if their doctor knows or thinks it across from them.

我经常跟人强调的一点就是，简单说一句就行，比如‘玛丽·克莱尔，你的卵子数量偏低。’

And this is one thing I stress to people is just one phrase like, Hey, Mary Claire, your egg count is low.

所以，在经历了九个月的孕期和产后恢复之后，你可能不会再恢复排卵了。

So after you go through growing this baby for nine months and recovering postpartum, you may not resume ovulating again.

你可能已经进入了更年期或围绝经期。

You may be in menopause or perimenopause.

这就是你需要留意的地方。

And this is what you should look out for.

这句话我只用了一分钟不到，但它会彻底改变你对产后经历的看法，让你不再忽视自己的症状，不再自我怀疑。毕竟我们都知道产后那段时间很特殊，但有了这个关键信息，你就能更早地获得医疗帮助。

That sentence took me less than one minute to say and completely changes how you think about your postpartum experience and will allow you to not dismiss yourself, gaslight yourself from your symptoms, because we all know postpartum is a crazy time, but you'll be able to get care earlier because you've had that nugget of information.

所以我真心觉得，作为医疗专业人员，当我们把数据摆在患者面前时，就必须开始赋予他们力量。

So I really believe as healthcare professionals, we have to start empowering patients when we have the data in front of them.

所以任何年龄较大的女性，比如40岁及以上，在怀孕的那几个月里，你仍然在持续流失卵子，所以生完孩子后情况可能就是这样。

So any woman who's older, you're 40 and older, you may come out of that pregnancy because you're still losing eggs all of those months.

目前我们还没有任何办法能减缓卵巢储备中卵子流失的速度。

There's nothing we can do yet that can slow down the rate of loss of eggs from the vault.

所以无论你是处于孕期、哺乳期，还是产后阶段，你都在持续流失卵子。

So while you are pregnant, while you are breastfeeding, while you are postpartum, you are still losing them.