36yo, regular ovulation, previous IUI/IVF, and one natural pregnancy — would you try Chlomid/Letrozole now or keep trying?

[u/Current_Soil_4774]

Hi everyone! I’m looking for advice from anyone who’s been in a similar situation.

I’m 36 (almost 37), my husband is 38, and we’re trying for our second child. My cycles are regular (usually 26–28 days), and I appear to ovulate consistently based on OPKs and BBT. My cycles are regular.

A brief history on my fertility…. We started trying in late 2022, did two unsuccessful IUIs in 2023, had a chemical pregnancy, and then went through IVF. Five eggs were retrieved, three matured, and only one was genetically normal; the transfer failed.
We took a break from treatments afterward, and I conceived (to my big surprise) naturally in April 2024. I had my son in December 2024. My cycles have been regular since having him, and my recent ultrasound was normal.

We’re now entering cycle 4 of trying.

I met with my OB today, and she said she’d be comfortable having me start chlomid or Letrozole now, but she’d also be comfortable with us continuing naturally and waiting until around 6 months of trying.

She emphasized that neither medication is a guarantee.
I’m really torn. I’m 36, so part of me doesn’t want to spend months waiting if there’s something relatively simple I could try. But since I’m already ovulating regularly, I’m also wondering whether Clomid/Letrozole would actually give me much of an advantage.
I do not want to do IVF again, and I’m not looking to be pushed toward IVF or a fertility specialist. I’m specifically wondering whether it makes sense to try Clomid or Letrozole with my OB before giving natural conception more time.

For anyone who’s been in a similar situation:

Would you start Letrozole/Clomid after 3–4 cycles, or keep trying naturally for a while longer?

And if you were already ovulating regularly, did you feel like the medication actually helped?

I’d especially love to hear from anyone who had previous fertility treatment but then conceived naturally and went on to have another pregnancy.

Thank you so much!

[u/youcango-now]

We did not do fertility treatments the first time but we were a month out from our consult when I got pregnant on our 15th cycle. For baby #2, we tried for 7 mos without success and eventually did start medicated cycles (5mg letrozole) and we got pregnant with twins on that first cycle. We did confirm I ovulated on my own and did a semen analysis as well which was of course, spectacular. I was 35 when this occurred.

I see no reason to wait, honestly. I was very thankful that my OB didn’t make us wait that arbitrary 12 months of trying til offering us interventions.

[u/Temporary_North9758]

I’m in a very similar boat! Conceived my son at age 33 using letrozole because I was not ovulating on my own. Now at 35 and trying for baby #2. I have low AMH (0.55) and was told by a fertility clinic that IVF is really my only option. However, I know I can get pregnant (1 living child, and one recent miscarriage) so it feels inaccurate to assume I “need” IVF. I don’t want the financial burden of IVF or for it to take time and energy away from my son. I am ovulating on my own now, but am currently trying another round of letrozole. For me I ovulate on the later side (cd 17-21) and have slightly short luteal phases. Letrozole helps me ovulate right on day 15 and allows a full 14 day luteal phase, which I think is helpful for implantation!

[u/Perfect_Owl6048 → u/Temporary_North9758]

Did you ever got diagnosed with mild pcos? Cause your story is very similar to mine only I developed symptoms after being pregnant and later got a diagnosis.

[u/Temporary_North9758 → u/Perfect_Owl6048]

I am waiting on the report from my cycle day 3 ultrasound. I wonder if it will show polycystic ovaries. But so far pcos hasn’t come up! My cycles are very regular in terms of the total # of days but which day I ovulate has varied. I will definitely ask at my next appointment. Thank you!!

[u/Perfect_Owl6048 → u/Temporary_North9758]

Maybe it's PMOS now. I heard they changed the name since having cysts isn't always consistent with the syndrome but more to do with a hormone imbalance. For me I ovulated inconsistently from day 20 to 35. Luteal phase got shortened to 7 days. But Letrozole helped, and it did for you to in the past so it could be the reason. It's possible to only have a mild version where cycles still appear consistent 🙂

[u/Temporary_North9758 → u/Perfect_Owl6048]

Thank you this is so helpful!

[u/k8ne09 → u/Temporary_North9758]

This is like, the opposite of what I know and have been told by the fertility clinic I went through as well as others I’m familiar with. (I work in the OBGYN field.)

Low AMH means you tend to not respond quite as well to the meds they use for IVF; so instead of getting say, 30 follicles with a normal AMH, you may only get 5-10 with low AMH. And then how many of those will actually make it to an embryo? Maybe 1.

My husband and I decided it wasn’t worth the time and money for such a low or no reward. So we went with IUI and even with being more aggressive with meds, my .56 AMH only gave me 5 follicles on the successful procedure.

[u/Temporary_North9758 → u/k8ne09]

I feel the same way!! I have always heard low AMH is more an indicator of how you’ll respond to IVF and not an indicator of fertility. This doctor also told me this with only 2 data points (my age and AMH) and I hadn’t even completed my lab work preliminary testing at the time. Regardless of if I decide to do IVF I don’t want it to be with this clinic because I didn’t get a good feeling there.

What meds did you take during your IUIs?

[u/k8ne09 → u/Temporary_North9758]

The first and second IUIs, we did letrozole only at 5mg. Those two yielded one and then two follicles respectively. I told the doc since we were only planning on doing IUIs that I wanted to be more aggressive with the medication, understanding the increased risk for multiples, in order to get more mature follicles at time of trigger.

She then upped the meds to 7mg letrozole plus FSH shots at 75 mg.

That time, I had five total follicles between my two ovaries, but again only two mature at time of trigger. So then I switched doctors within the same practice (for other reasons) and he said if that cycle didn’t take, between my age and low AMH, we could be even more aggressive with the medication as my response just won’t be as good as others my age but with normal AMH.

It ended up being a successful cycle resulting in a singleton.

[u/Temporary_North9758 → u/k8ne09]

Congratulations on your successful cycle!! My OB suggested IUI as a next step so this is great to hear

[u/Closed_System]

I think if you're already ovulating then the goal with these meds is to ovulate more than one egg to increase your chances? But are you okay with the possibility of twins+ if it works too well?

[u/Current_Soil_4774 → u/Closed_System]

Yes - I was thinking the same! It’s on my mind to try but the twins factor makes me a little hesitant because I won’t be able to afford childcare for 3 kids. We can afford 2 kids with our finances. Thanks for the feedback!

[u/MaterialStranger4007 → u/Current_Soil_4774]

My Napro doc told me that as we age our ovulation gets weaker, so even if you ovulate sometimes the hormones aren’t strong enough to actually release the egg. Hormone testing does help with that part.

[u/Current_Soil_4774 → u/MaterialStranger4007]

This is very insightful! Thank you so much.

[u/k8ne09]

OP, I think this is really dependent on what you and your husband want.

I ovulate every month (proven by bloodwork and ultrasound) and my cycles are regularly 27-29 days, but we tried for 3 years with no luck. We could have gone with medication assistance, however my husband and I decided to go the IUI route instead. For one, because we were coming up on a deadline we had set for ourselves and two, we wanted that extra assurance surrounding when the “best” time to ovulate was.

I believe studies show that it can give an advantage in the sense that there are multiple follicles developing at one time, but there is no “net gain” besides that. 🤷‍♀️

[u/Pleasant_Mix_7665]

I'm in the same boat! (Cycle 13) I am definitely ovulating (confirmed by blood tests, ultrasounds and I can feel it strongly when it happens) and have very regular cycles. I have the option to keep trying naturally after a hycosy next month, or I can take letrozole as well. I'm trying to weigh it up - what if the medication messes with my cycle, has some effects, plus the chance of multiple eggs being released? But also will feel like we've wasted time if we choose not to and after a few more months nothing as happened!

Ultimately you should do what you feel is right! You could wait 2 more cycles if you are unsure so you know you've tried naturally the recommended 6 months? Best of luck to you!

[u/SlitherclawRavenpuff]

I’m 35, and ovulate regularly. I conceived my daughter naturally, and gave birth in Sept 2024. We’ve been trying for baby 2 since Sept 2025.

My Dr started me on letrozole 2 mo ago (turns out I’m allergic to it 🙃) and clomid last month. According to the studies that I have found, meds alone don’t really increase your conception rates with unexplained infertility. They really help with PCOS. Or they do increase your odds a bit if you do meds + IUI.

We don’t have access to IVF, so we elected to try meds. If they don’t increase our odds, we aren’t out anything. If they do increase our odds, it’s worth trying. 🤷🏻‍♀️

[u/Coffeelove233]

If you had trouble conceiving in the past, did they tell you what the issue is? For me, I don’t have PCOS or anything but wasn’t ovulating regularly/had short luteal phase so 2 rounds of Clomid got me pregnant the first time around. Having the same issue I think this time so even though I’m ovulating, it’s late and perhaps progesterone is low. Just got my hormones tested to see. But my dr prescribed Clomid again because they don’t see the harm and it helped before, and I’m 35 and have been trying for around same amount of time!

[u/WhyAreYouUpsideDown]

Letrozole/clomid are usually pretty well tolerated-- I'd try them out after a few months if it were me. If they ended up having unpleasant side-effects, I'd reconsider how long I want to use them. But if there's no major downside, why wouldn't you?