Fertility Q&A: Secondary Infertility, Birth Control Effects, Metabolic Health & More

I’ve been trying to conceive for a year for our third child. We’re both 35, live a very health-focused lifestyle, and I’ve done five rounds of letrozole without success along with extensive testing. What should the next step in evaluation or treatment look like?

When using letrozole, does it make a meaningful difference if it’s taken on cycle days 3–7 versus 5–9, especially depending on whether you ovulate regularly?

I have high cholesterol, pre-diabetes, and am about 50 pounds overweight, with two miscarriages in the past year. How do metabolic factors like these actually impact fertility and miscarriage risk, and what should be addressed first?

I’ve been on birth control since my teens and currently have a hormonal IUD. Does long-term use affect future fertility, and how far in advance should I stop contraception if I want to plan for pregnancy?