I'm curious whether or not we can just touch on a few of the things that a lot of people wonder about in terms of egg quality. And if they touch on sperm quality, maybe we can also just mention that. But for instance, does cannabis, either by edible or by smoking cannabis, impact egg quality in either direction?

Alcohol would be the next. And then I'm going to assume, and I have to do this strictly because of what I understand about drugs of abuse like cocaine and amphetamine, methamphetamine, that none of those can be good for systems of the body because they create so much stress for the body.

But let's just say alcohol and cannabis. I read a statistic when researching the episode on cannabis that shocked me, which is that 15%, 1.5%, not 1.5, 15% of American women, at least in this one study, survey, reported having consumed or smoked cannabis during known pregnancy, which is wild. Wild.

Unless, of course, I'm just naive and THC is not harmful to the fetus, but I have a hard time believing that. So what gives? And there, I actually just threw in fetal development. So is cannabis, is alcohol bad for egg quality? So they're different things and they're the same thing in one.

So let's answer them each individually. So we'll go with the one that everybody knows and has accepted now that they wouldn't have accepted 40 years ago, right? Smoking cigarettes. So that's obviously bad. Decreases the number of eggs you have in the vault. Smoking cigarettes actually gets into your vault, decreases the number that you have.

You have a higher chance of going into menopause earlier, and it increases the risk of having abnormal chromosomes, which is what we really think about when we think about egg quality, right? Impacting those meiotic spindles inside the eggs, which hold the chromosomes in their perfect position. They are associated, they get wear and tear from things that cause inflammation or are toxic.

So cigarette smoke, we know, decreases egg quality, egg quantity, increases miscarriage, and then, of course, has fetal impacts. Could I just ask you, because when we talk about – there's nicotine, which itself is not carcinogenic, and then there's the smoking process, which brings in a bunch of other things.

The question I know is burning in everybody's mind is vaping, right? Because vaping is – I'm very bullish on this. I mean, it's very clear that the chemicals associated with vaping are just oh so bad for everybody's health, but it's distinctly different from saying that nicotine is bad for one's health.

I mean, it can be, but without doing too much of a deep dive, are there any data that show that vaping is bad for egg quality? Of course, there's not as much data because it just hasn't been around as long, but yes, vaping definitely has chemicals that looks like it's associated with poor success rates in IVF cycles.

And that's really kind of one of the most finite measures of egg quality we can see because we're really testing the egg at a level in a lab versus just are you getting pregnant naturally. And sorry to interject again, but any time a conversation like this comes up, especially between two people in the health science space, there are these shouts because I hear them literally, where people say, "Well, listen, I vaped every day and I've had three healthy babies." And I think my response is always, okay, there's going to be a distribution of responses.

And then, of course, how much healthier could your babies have been had you not vaped during pregnancy or vaped prior to pregnancy or – I mean, I think these are the key issues that like you can't rewind the clock as far as I know, right, in the absence of a time machine.

You can't rewind the clock. So I mean, basically everything you're saying is that smoking cigarettes or vaping nicotine just can't be good for egg quality. We know that. We know that it's not good for getting pregnant. We know that it's not good for sperm. And therefore, we also know it's going to impact pregnancy rates.

Things like cannabis, right, decreases sperm production, decreases sperm motility, changes sperm morphology, the shape of it, changes the DNA, increases the fragmentation of the DNA. If your partner uses cannabis and you get pregnant, you have a higher chance of miscarriage because of the sperm association with the cannabis. Now – Edible cannabis as well as smoked cannabis.

I don't know, right, because you can't study something that's illegal. So a lot of this data is just more new and a lot of it's going to be observational. Even in states like Colorado and California where cannabis is essentially legal, I'm assuming there are more data. But okay, so smoking and/or vaping nicotine, cannabis, either edible or smoked, very likely detrimental to egg quality and sperm quality, which is not to say that one can't conceive.

It just means that the quality of your baby, your child, will not be as high as the quality of that baby if you didn't do that. Is that right? And I'm not trying to demonize anyone that did do this during pregnancy. A lot of people didn't know. But this is really about people trying to make choices in anticipation of future pregnancy.

Yeah. And when you're trying to set yourself up for success, because we know infertility is becoming more common. We don't always know who is going to have it. And when you find yourself in that position specifically, you now want to optimize everything you can. So if there's something that is going to make the sperm quality worse and the egg quality worse and your success with treatment lower and your miscarriage rate higher, we're going to recommend that you not do it.

If you're trying to get pregnant naturally, all these things correlate over. But of course, there's always going to be outliers and exceptions. I'm going to sit here and tell you that the odds of getting pregnant at age 43 are less than 3% per month. And every single person is going to be like, "But my Aunt Barbara or I know this person who did," because 3% is not zero.

And you're talking about natural pregnancy there by intercourse. Old-fashioned way, yes. Right. But yes, so people will get pregnant. People will have healthy children who do have exposures to nicotine, to cannabis, even to alcohol. Even though we know that alcohol can cause fetal alcohol syndrome, 0% of alcohol should be the acceptable level in pregnancy.

And then does alcohol impact fertility? Such a complicated question, and this is probably due to the amount you consume and the frequency of which you consume it. Alcohol is a toxin that your liver must filter out, and we know it causes inflammation. Anybody who's had a fun night with alcohol knows they can wake up the next day and they feel different.

Their body is processing that alcohol. And that inflammation, especially if it's chronic, chronic exposure, we know chronic inflammation is one of the things that we see impacting egg quality and sperm quality. So certainly if you enjoy alcohol, it should be something that is done in moderation, one or two drinks a week at the most, and you should not do it at all once you find out you're pregnant.