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

I’m almost 35 and currently going through IVF. I have PCOS and insulin resistance and have had four early miscarriages despite normal testing and blood work. I’ve also had two laparoscopic surgeries for cysts, one showing mild endometriosis, and a uterine biopsy that showed no inflammation. Given this history, how successful might IVF be for us?
What transfer protocol do you recommend after Lupron and letrozole suppression for positive ReceptivaDX results—modified natural or medicated—and what factors guide that decision?
Can autoimmune conditions contribute to secondary infertility? I have a four-year-old but have since experienced five miscarriages and have diminished ovarian reserve. After four cycles I’ve only had one embryo tested and it was aneuploid, and my doctor says autoimmune testing may be the next step if endometriosis testing is negative.
In a 28-day cycle, is it concerning if a positive LH surge happens around days 15–16? And when tracking cycles, do you count day one as the first day you see bleeding even if it starts midday, or the following day?
I’m 35 and planning for pregnancy. What are the most important first steps I should take now to set myself up for success?

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