Fertility Q&A - IVF, GLP1s, IUI, and More!

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

Questions Answered:

1. A 30-year-old in a same-sex couple with anovulatory PCOS managed on metformin, high AMH, and otherwise normal labs moved from failed IUIs to IVF and had 19 mature eggs but only 4 fertilized despite good donor sperm—what could explain low fertilization rates and how should the next steps be approached?

2. 35 and trying for baby number two, and her 40-year-old husband has been on the GLP-1 medication Zepbound for four months—are there known effects of GLP-1s on male fertility, and should men discontinue them while trying to conceive?

3. A patient with PCOS and mildly elevated thyroid levels is experiencing medication interactions and was prescribed 2.5 mg of methylfolate— is this dose appropriate, and should she be taking methylfolate, folic acid, or both?

4. A patient with endometriosis underwent two egg retrievals, one with estrogen priming that triggered an endometriosis flare and resulted in very high estrogen levels and poor egg maturity—are there stimulation protocols better suited for patients with endometriosis undergoing IVF?

5. A 38-year-old planning IUI with donor sperm, normal fertility workup, AMH of 3.3, and a personal history of being a twin is deciding between natural versus medicated cycles— which approach is more successful while minimizing twin risk and preserving future fertility goals?

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

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