June 09, 2025

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

2 hours 23 minutes

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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];
Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45];
Promising areas of fertility research [2:15:45]; and
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By Peter Attia, MD

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