Fertility Q&A: Hormones, Male Factor, IVF Challenges & More

As a Woman

Natalie Crawford

Medicine, Health & Fitness

4.8 • 1.1K Ratings

🗓️ 13 April 2026

⏱️ 13 minutes

🔗️ Recording | iTunes | RSS

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Summary

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? Pre-order Dr. Crawford's debut book, The Fertility Formula, now!https://www.nataliecrawfordmd.com/book Want your questions answered on the next episode? Ask them here!https://www.nataliecrawfordmd.com/qa-submissions Learn more about your ad choices. Visit megaphone.fm/adchoices

Transcript

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0:00.0	Hi, friends, and welcome back to the As a Woman podcast.
0:06.3	I'm your host, Dr. Natalie Crawford, and we are doing one of your favorite episodes.
0:10.0	This is a fertility Q&A.
0:12.3	So to joining me today is Emily Whitlock, and we are going to be answering some questions that you have asked.
0:16.9	You can ask these questions online at Natalie CrawfordmD.com slash podcast.
0:37.8	You'll see a question box where you can put it in. I think Emily just said some of these are very long, so the shorter you are, the more likely it might be to be chosen. But let's jump in. Perfect. Okay. Erin says, hi, Dr. Natalie. When everyone talks about oral contraceptives, they often talk about the combination pill.
0:41.5	Due to other medical concerns, my doctor placed me on the progesterine-only pill.
0:48.5	She said that she's been on it for three years, but recently came off the pill since her husband and I are going to start trying.
0:52.8	She said, is there anything that she should be aware of coming off of this type of pill?
0:54.4	Any body changes to look out for it? And how long does it usually take your body to reset of coming off of this type of pill? Any body changes to look out for?
1:11.0	And how long does it usually take your body to reset after coming off this specific type of pill? Honestly, any information on this pill would be helpful since it's not often talked about. Thank you. So that's a great point that we often just say the pill. and we're always talking about the traditional birth control pill, which is a combination of ethanol
1:11.0	esteridial, a synthetic type of estrogen, and a type of progestin.
1:14.9	And most pills have ethanol esterial just in various doses.
1:19.1	If you think about like low estrogen or low, low, that's talking about the amount of the esteridial.
1:23.4	And then there's a variety of different progestin.
1:25.7	So just to say if you have symptoms or side effects on the pill, we're often changing to see if a different progestin type of progesterone, if you respond differently. The combined pill does have more side effects in the progesterone-only pill. So the combined pill does increase the risk of some clotting factors. So the number one reason people are not on it is that they have personal history of a blood clot, a clotting disorder, migraines with aura, something that a clot could pose
1:49.0	a potential risk to. The progester-only pill does not have those side effects, so it can be a good
1:54.5	option for certain patients. The problem with the progestin-only pill is it is so short-acting.
2:00.4	And so you have to take it at the
2:02.1	exact time of the day in order for it to work. And that is limiting as far as it being a contraceptive
2:09.2	and being effective because many people are not excellent at taking a pill at the exact same time
2:13.7	every day. So if you are using it and you're just listening to this, it's something I want
	...

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