Getting started

  • If your cycles are irregular, you're unsure whether you're ovulating, or fertility preservation is on your mind, it's worth a conversation now. If you've been trying to conceive without success, the general guidance is about a year — or six months if you're over 35. A reproductive endocrinologist can clarify what may be affecting your fertility, explain your options, and help you decide when evaluation or treatment makes sense.

  • A first visit is mostly a conversation, and an unhurried one. Dr. Cameron almost always starts by going back over some reproductive biology basics, so that everything is built on the same foundation — it makes every conversation afterward clearer as things get more detailed. There's time to talk through your history and whatever has brought you in, and depending on your situation, some initial evaluation may begin, such as bloodwork or an ultrasound. You won't leave with every answer that day, but you should leave understanding what's being looked at and what the next steps are — and knowing that coming in was the right call, because there's real value in simply getting clear information early.

Recurrent pregnancy loss

  • Evaluation is generally recommended after two or more pregnancy losses; you don't need to wait for a third. By far the most common cause of early loss is a chromosomal abnormality in the embryo — random, and common — which is why a loss, or even two, doesn't necessarily signal an underlying problem. The most significant recent change in how recurrent loss is evaluated is that, when possible, the workup now starts by testing the genetic makeup of the miscarriage tissue itself. That single step helps triage everything else: if the tissue shows a chromosomal abnormality, it often explains the loss and can spare you an extensive workup; if it's chromosomally normal, that's the signal to look further. Combined with the standard evaluation — assessment of the uterine cavity, testing for antiphospholipid syndrome, thyroid and other bloodwork, and parental chromosome testing in selected cases — this approach now identifies a likely cause in the large majority of patients. [cite: ASRM Recurrent Pregnancy Loss committee opinion, 2026]

  • First, the reassuring part: with the tissue-first approach, far fewer patients now end up truly unexplained than in the past. And even when no cause is found, most patients still have a meaningful long-term chance of a successful pregnancy if they continue to try. Patients often ask whether IVF with embryo genetic testing is the answer here. Sometimes it's reasonable — particularly for someone who feels they can't move forward emotionally without doing everything possible to lower the risk of chromosomally abnormal pregnancy — but the data don't show it's automatically better for everyone, and in some studies the time to pregnancy is actually shorter without it. The approach is to lay out what's known honestly and help you choose the path that fits your situation and your emotional readiness, rather than defaulting to the most aggressive option. [cite: ASRM Recurrent Pregnancy Loss committee opinion, 2026]

IVF

  • Ovarian reserve is an estimate of your egg supply — roughly how many eggs may be available to respond to fertility treatment in a given cycle. Each month your ovaries designate a group of eggs that could potentially grow; ovarian reserve reflects the size of that group. It's estimated with a blood test (AMH) and an ultrasound count of small follicles. It's also one half of the equation that shapes IVF planning. The other half is egg quality — whether an egg will pass on the right amount of genetic information — and that tracks largely with age, not with reserve. An important and often-missed point: ovarian reserve tells you about quantity, not quality. A high number doesn't guarantee success, and a lower number doesn't rule it out.

  • This is one of the most common and most important misunderstandings, partly because of how IVF is portrayed in popular culture. IVF is a powerful tool, but when you're using your own eggs, it does not fully overcome the biological effects of age. Success in IVF hinges on two things: how many eggs can be retrieved (egg supply) and what proportion of them will create chromosomally normal embryos when fertilized (egg quality). Beginning around age 35, the proportion of good-quality eggs starts to decline, and IVF can't reverse that — it can only work with the eggs that are there. None of this means IVF won't help; it means honest expectation-setting matters, and the realistic picture is different for every individual.

  • The biggest one is that IVF can help anyone conceive at any age using their own eggs — it can't, because it doesn't undo the effect of age on egg quality. The second is that IVF is a black box. It isn't, and understanding it gives patients back some control. The short version: every month your ovaries identify a group of eggs that could grow, but your body normally makes only enough hormone to mature one, and the rest of that group is lost — a use-it-or-lose-it system. IVF simply provides extra hormone so that more of that month's available group can grow at once. How many that is depends on your own egg supply, which is why two people can respond very differently to the same medication.

  • Not everyone who comes in needs IVF, and Dr. Cameron won't recommend it if she doesn't think it will benefit you. For some patients — say, someone with open fallopian tubes and a partner with normal sperm — a less intensive approach like ovulation-inducing medication paired with intrauterine insemination (IUI) can offer a comparable chance of success without the cost and intensity of IVF, especially if egg supply is low. A point worth holding onto: you may need less treatment than you fear. That said, IVF genuinely is the right answer in certain situations — for example, with a significant sperm factor, concerns about the fallopian tubes, or when creating embryos in the lab allows for genetic testing that would meaningfully help. The goal is to match the treatment to your actual situation, not to default to the most aggressive option.

  • PGT-A is genuinely useful for some patients and unnecessary for others, so it's a decision made individually rather than by default. Dr. Cameron generally doesn't recommend it when the age of the egg is under 35, because most embryos at that age already carry the right amount of genetic information, so testing mostly adds cost and embryo handling to prove what would be expected anyway. She's also cautious about it for older patients with low egg supply, who may have only one embryo — in that case the most informative step is often simply to transfer it. Where it tends to help most is for patients over 35, especially 37 and up, with good egg supply and several embryos to choose from, where it can streamline the path to pregnancy. It's a screening test, though — very good, but not 100%.

  • The most common discomfort isn't the retrieval itself — it's the days of hormone injections beforehand, which often leave the injection sites a little red, swollen, or sore. That's bothersome but not harmful. The retrieval is a short procedure done under anesthesia, so you're asleep and don't feel it. Afterward, most people have period-like cramping, mostly the day itself and usually well controlled with over-the-counter medications, along with some bloating and light bleeding for a few days.

    Serious complications are real but uncommon. Bleeding from the needle site, infection, or injury to a nearby structure happen in well under one percent of retrievals, and ultrasound guidance is used specifically to avoid them. The risk I spend the most time discussing is ovarian hyperstimulation syndrome (OHSS) — when the ovaries overrespond to the medication, which is more likely with a very high egg supply, including some patients with PMOS (PCOS). With modern care it's much less common: how the medication is dosed, which trigger shot is used, and whether embryos are frozen rather than transferred right away all give us ways to keep that risk small as your response is monitored.

Fertility preservation

  • If it's crossed your mind, it's worth a conversation — because the right answer is genuinely individual. Earlier is generally better: the proportion of good-quality eggs begins to decline around age 35, so freezing before then tends to be more favorable. At the same time, the likelihood you'll ever actually need frozen eggs is its own question, and some data point to an inflection around the late 30s — which is worth understanding so the decision fits your real reproductive goals and timeline. Dr. Cameron is honest with patients that egg freezing is, in a sense, an insurance policy with terms you probably wouldn't agree to in any other context: you don't find out how good your inventory is until the moment you need to use it, and by then you may not be able to add more. That's not a reason to avoid it — it's a reason to go in with a clear, realistic picture.

  • With a new cancer diagnosis, timing can be urgent — sometimes a matter of days, around your treatment schedule. The mainstay is mature egg freezing (oocyte cryopreservation); it has the strongest real-world outcome data, with tens of thousands of babies born from frozen eggs, and it fully preserves your future reproductive autonomy. If you have a partner you're certain you want to build a family with, embryo freezing is an option and gives a clearer sense of inventory up front, though it raises future-disposition questions worth thinking through. For patients who can't wait the two to three weeks egg freezing requires, or who haven't yet reached puberty, ovarian tissue freezing may be part of the conversation — an emerging approach with real promise but meaningful limitations. Which path makes sense depends on your specific diagnosis, your timeline, and how much your treatment is likely to affect your ovaries — a discussion best had together with your oncologist.

PMOS (formerly PCOS)

  • No — the "try for a year first" guidance only applies to people with regular, predictable cycles. If you have polyendocrine metabolic ovarian syndrome (PMOS — the condition long known as PCOS) and you're skipping periods or not having them, you aren't getting regular monthly chances to conceive in the first place, so waiting a year just means waiting without opportunities. You should see a fertility specialist or your gynecologist sooner rather than later. The encouraging news is that patients with PMOS often need the least intensive treatment to succeed: because egg supply is frequently strong, restoring ovulation — often with oral medication — is enough for many people to conceive. (You may still see this called PCOS in most places; the name was formally updated in 2026 to better reflect that it's a whole-body hormonal and metabolic condition, not a problem of ovarian "cysts.") [cite: Teede et al., The Lancet, 2026 — PMOS consensus]