Dr. Natalie Crawford, board-certified OB-GYN and REI, answers your fertility questions.

I’ve been on the progesterone-only pill for three years due to other medical concerns, and I recently stopped taking it because my husband and I are ready to start trying to conceive. What should I expect when coming off this type of pill? Are there any body changes to look out for, and how long does it typically take for cycles to regulate after stopping?

My husband and I have been trying to conceive for a year. I’m 30 and he’s 32. He was diagnosed with a varicocele, and his only borderline parameter is motility at 36%. I’ve been diagnosed with mild PCOS and had an HSG that suggested possible adhesions in one tube. Our fertility doctor recommended holding off on varicocele surgery and starting a medicated cycle. In cases like this, is surgery worth pursuing, or are treatments like medicated cycles or IUI typically sufficient?

I’m 38, have been trying to conceive for nearly two years, and have mild PCOS with regular cycles. I’ve had two chemical pregnancies and recently moved forward with IVF with PGT-A. I’m currently in the two-week wait after transfer but am experiencing brown spotting again during the luteal phase. With normal labs and no structural issues, what could be causing this recurring spotting?

I’m 33 with a history of severe endometriosis and large fibroids. I’ve had surgery that resulted in the loss of one ovary and tube. My AMH is 0.38, and there may be tubal blockage, though I haven’t had an HSG yet. I also froze eggs five years ago. How do you approach decision-making between continuing to try naturally, completing further testing, or moving directly to IVF in a case like mine?

I’m 43 and hoping to have a child through IVF. I have regular cycles, a history of miscarriage, ovarian cysts, and fibroids—one of which protrudes into the uterine cavity. My doctor has recommended laparoscopic surgery with a six-month recovery. Would you recommend pursuing egg retrieval and fertilization before surgery? And what are your thoughts on PRP for ovarian or uterine rejuvenation after surgery?

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