Fertility online: tracking, supplements, clomid, and when to escalate
Fertility telehealth handles the early-stage workup well: ovulation tracking guidance, prenatal optimization, basic hormone testing, and first-line ovulation induction medications. IVF, ICSI, and surgical fertility care require in-person reproductive endocrinologists.
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Pre-conception optimization
Folic acid 400-800mcg/day for at least 3 months before conception. Comprehensive prenatal vitamin with iodine and choline. Vitamin D if deficient. CoQ10 (200-600mg) has weak evidence for egg quality in women over 35. For men: zinc, selenium, antioxidant blends — evidence weaker, but probably not harmful.
Tracking ovulation
Mid-luteal progesterone confirms ovulation (>3 ng/mL). OPK (urine LH) kits time intercourse. Continuous-temperature wearables (Apple Watch, Oura) detect ovulation retrospectively. Telehealth programs bundle these with coaching for $40-100/month.
Ovulation induction
Letrozole (Femara, off-label) is now first-line for PCOS-related ovulation problems — better live-birth rates than clomid in trials. Clomid (clomiphene) is second-line. Both are telehealth-prescribable with proper workup. Cycle monitoring (transvaginal ultrasound) is sometimes needed and not telehealth-doable.
When to escalate
After 12 months of unprotected intercourse without conception (or 6 months if over 35), or earlier with known risk factors (history of PID, irregular cycles, male-factor concerns) — see a reproductive endocrinologist in person. Telehealth fertility programs that try to handle these cases without referral aren't worth their fee.