Welcome back to the As a Woman podcast. I'm your host, Dr. Natalie Crawford, and joining me is Emily Whitlock, and we are in one of your favorite episodes. This is Fertility Q&A, questions you have submitted, and I don't know what they are. So let's get to it. I love it. Thank you guys for submitting questions. Here we go. Hi, Dr. Crawford. I have been TTC for a year now for our third child. My husband and I are both 35 and live a very healthy biohacker lifestyle. I have tried five rounds of lettrosol because my OBGYN wanted to give my ovulation a little more oomph. Okay. She says, so far, they haven't worked. I've done blood work,

vaginal microbiome testing, pretty much everything you can think of. What are my next steps?

So I definitely want to make sure that we have had the full evaluation. Sometimes we'll see your

OB really try to do what they can, which is do some easy low-dose ovulation induction just to

see if that can get to there.

Statistically, though, if your cycles are perfectly regular and you don't have a ludial

phase defect, adding in an ovulation induction medication does not raise your chance of getting

pregnant. That can be frustrating to find out because you're thinking you're increasing the odds,

and reality is you're not. So we want to make sure we've had an evaluation of our uterus, our fallopian tubes and a semen analysis completely. I will say the inside of the uterine cavity is going to be a big one in somebody who's had multiple children in the past that often gets overlooked and they'll hear them say the same thing. Oh, you've gotten pregnant in the past. I know your tubes are open. Your uterus is fine. Without understanding that pregnancy is such an interesting time is a huge

challenge to the body and the uterus. And the assumption that everything is healed up properly

can sometimes be false. Similarly, we've had the same thing said about sperm. Oh, we know he has

sperm because you've gotten pregnant but sperm changes every three months

then we want to think about the things for secondary infertility especially that come with age or time

this is notably going to be endometriosis adenomyosis and autoimmune disease there may not be a way

to biohack our way out of this but what i would start by saying is we've done some testing

i want to make sure you've had the full complete picture of testing. Somebody's really getting a good menstrual history, thinking about inflammation

in general. And it might be time where statistically we do have to start to go down the fertility

treatment road. If we truly have unexplained infertility, the two things that move the needle

are going to be ovulation deduction with getting two or more eggs.

So that's very specifically looking with ultrasound and making sure you're getting two or more

eggs and an IUI. So the combination of those together, that doubles your rate of getting pregnant

or doing IVF. And so sometimes those are the things that we're left with. We don't always have

...