If you’ve ever left a doctor’s appointment feeling confused, dismissed, or underwhelmed by the information you were given about your fertility, you’re not alone. Fertility challenges are rising, and many women spend years trying to understand what their bodies have been telling them before they get clear answers.

Dr. Sasha Hakman is a double board-certified OB-GYN and reproductive endocrinologist in Los Angeles who brings both evidence-based medicine and a whole-person lens to her work. She looks beyond the labs to how patients are eating, sleeping, and moving, and what they’re exposed to every day. She also knows this journey from the patient’s side, from years of irregular cycles and a PCOS self-diagnosis that later turned out to be something else, to going through IVF herself.

In this conversation, Rachel and Dr. Sasha talk about why fertility challenges are rising, the commonly missed signs of endometriosis and PCOS, what age really means for fertility, how to think about egg freezing without fear or pressure, and which wellness trends are worth your time. This is a conversation about getting informed, asking better questions, and taking an active role in your reproductive health.

⭐️ Why fertility challenges are rising—and how age, genetics, and environmental exposures can play a role

⭐️ The differences between endometriosis and PCOS, including symptoms and commonly missed signs

⭐️ How metabolic health, labs, prenatals, and supplements can affect fertility

⭐️ How fertility changes with age and what to consider before freezing your eggs

⭐️ Practical fertility-supporting habits, popular wellness trends, and stress regulation

Dr. Sasha Hakman is a double board-certified OB-GYN and reproductive endocrinologist based in Los Angeles. Her approach combines the latest evidence-based medicine with a deep understanding of how lifestyle and environment, including nutrition, sleep, stress, and everyday chemical exposures, can shape reproductive health.

Dr. Sasha also brings her own experience as a patient. After years of irregular cycles, she believed she had PCOS, until expanded genetic testing revealed a different diagnosis: non-classical congenital adrenal hyperplasia. Having gone through IVF herself, she is passionate about helping women recognize the red flags, ask better questions, and advocate for the care they need.

To connect with Dr. Sasha Hakman:
⭐️ Instagram: @sashahakmanmd
⭐️ Website: sashahakmanmd.com

✦ Age matters for both partners, but it isn’t the whole story. Female age is still the strongest predictor of reproductive outcomes, but male age plays a role too, which is why Dr. Sasha encourages men who are postponing parenthood to consider freezing their sperm. Even after accounting for age, infertility is rising, and genetics and endocrine-disrupting chemicals are part of that conversation.

✦ Endometriosis and PCOS are often missed or misunderstood. Endometriosis can show up in subtle ways, like bladder or bowel symptoms during your period, unexplained infertility, or an unexpectedly poor response to IVF, and a clear ultrasound doesn’t always rule it out. PCOS, on the other hand, is an endocrine condition, not a painful one. If you have pain, or a PCOS diagnosis with low egg reserve, it may be worth asking more questions.

✦ Fertility declines gradually, not overnight at 35. Dr. Sasha compares the ovaries to a prepaid card with a monthly withdrawal and no deposits. Most women can still conceive at 35, it may just take a little longer, while the steeper change tends to happen around 37 to 38. Egg freezing is a personal decision, and understanding your options earlier can give you more of them.

✦ When it comes to supplements, less can be more. Dr. Sasha calls herself a supplement minimalist. A quality prenatal with folic acid is the foundation for women of reproductive age (with a male version for men), and anything else should be added based on individual needs. Supplements are largely unregulated and can interact with medications, so look for third-party testing and always loop in your doctor.

✦ Small, consistent changes count. You can reduce exposure to endocrine disruptors by skipping plastic for food and drinks, cooking at home with stainless steel or cast iron, filtering your water, and cutting out synthetic fragrance. Lean toward a Mediterranean-style, plant-forward way of eating and move your body in a way you can keep up. It doesn’t have to be perfect to be meaningful.

There’s so much about this episode that I really loved and resonated with but I appreciated Dr. Sasha’s perspective on egg freezing. When I froze my eggs and talked about it openly, so many of you sent me messages asking whether you should do it too. It’s such a personal choice, and I loved that Dr. Sasha framed it not as admitting defeat, but as taking charge of your own life and getting clear on what you want.

And I also loved our rapid-fire round on wellness trends. In a world where it feels like we’re told to take every supplement and try every protocol, it was refreshing to hear a doctor say you don’t have to do it all. Her final piece of advice stayed with me most: educate yourself, so you can take control of the parts of your reproductive health that are within your control.

If this conversation opened something up for you, there's more where this came from.

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