letrozole questions (grad warning)

[DrHooch]

TW: loss and lc mentioned

I am trying to decide what to do next and I am hoping for some advice. I normally hang around on loss and SAIF, but I was hoping to get the IF ladies' input on this. I'll apologize in advance that this will be a little disorganized and hard to follow.

I struggled with IF for a little over a year (started trying right before my 33rd birthday) before my first pregnancy, which finally happened the cycle immediately after my HSG and my first visit to the RE and going on levothyroxin. Normal pregnancy, healthy baby. We started trying for #2 last January, right before my 36th birthday (so now AMA). Took a couple of months of just TI but got pregnant, but lost it at 6.5 weeks. Two cycles later I got pregnant again, but this one was a mmc. Finally mc at about 11 weeks in early October. Genetic tests showed the loss was due to a trisomy incompatible with life. I've had two normal cycles since then, but no BFP.

I am turning 37 next month, so I am starting to feel like time is running out. Fertility monitor showed no FSH spike last cycle. RE said I could do an unmedicated cycle where we just check progesterone on day 21 to look for ovulation, or I can do an u/s and try femara. I don't know why I'm so reluctant to go on femara (maybe because I don't even know if I need it? Or because I remember horror stories about bad things happening?), but I just wanted to check in and see what you ladies would recommend. My problem lately hasn't been getting pregnant, it's been staying pregnant. But I also feel like IF and loss is so.much.waiting and I'm not getting any younger. TIA.

[bonzo]

Has your RE done any testing before recommending Femara? My personal feeling is that I wouldn't want to start medicating unless we knew there was a reason to do so.

[DrHooch]

bonzo we did a whole slew of testing before pregnancy #1, but haven't redone any of it recently.

[obscureference]

Yea I would see if the RE wanted to do new tests and then I would do the femara if it were me.

Time is definitely ticking! 37 isn’t that old but I would do anything that gave me a leg up!

[librariangirl]

I agree with the other girls. I would do all the testing again (as time can change the results) before starting on femara.

[orangehibiscus]

I agree with the others that I would ask about new/repeat testing before starting treatments.

[hoosiermama76]

I’m 42 and would do femara (I’ve done IVF). I, too, and secondary infertility. First pregnancy was easy. My doc said to repeat those tests each year because so much changes in that time:-)

[sunshiney]

My RE also repeats testing every 1-2 years. I think it would be worth seeing where your FSH, AMH and ovarian reserve are now (and certainly check for any polyps or anything else structural that could contribute to losses). To my mind, treatment to help you get pregnant is worthwhile even if the issue is staying pregnant, because it can be a numbers game - the more time between BFPs, the less chance for your THB. Also, having an indication of an anovulatory cycle sounds like a good impetus for testing and treatment.

I did three cycles on Letrozole and it was not a big deal - monitoring to make sure I didn't have too many follies (I always had one - Letrozole is less likely than Clomid to give lots of follies), headache that increased each of the 5 days of taking the med but that went away after the last day, ovulation at a more normal time (closer to CD14 rather than CD20 which is common for me), and an LP that was slightly shorter but without spotting (RE said it can lead to "stronger" ovulation, so the corpus luteum pumps out better progesterone levels but can finish up a day or two earlier).

I liked Letrozole over Clomid because of the mechanism it uses - instead of binding to FSH in your blood to remove it (the way Clomid does, causing lots of side effects), it allows your natural hormones to be there but simply interferes with your brain realizing that there are already higher FSH levels in your bood. According to my RE's explanation with a very handy hand drawn diagram!

[lemonliz]

What kind of fertility monitor are you using?

Would consider investing in the good kind of fancy monitor that tracks E2 then LH surges with happy faces, and then get the P4 test strips that confirm ovulation that one of our IF grads invented.

Don’t personally know of one that tracks the FSH. Plus also that’s not a great indicator of ovulation. If your FSH is high, you might not want it to be. DOR isn’t fun.

I might just start there with some low techy stuff. Give it 6 more months then do a letrozole cycle.

PS: time isn’t running out. All of that supposed fertility data is based on 15th century France or something. Deep breaths. Smile. Repeat the deep breaths.

[DrHooch]

Thanks everyone for your input.

lemonliz you're right, I'm an idiot, I meant LH surge, but I'm out of practice talking about this stuff. It's a Clear Blue that tracks estrogen and LH. Also, I'm less worried about fertility with my age, more worried about genetic defects that increase as you age and increasing mc risk.

[teachermomtobe]

*TW*

I did 3 cycles of Clomid and 2 of letrozole. I got pregnant on my last cycle of Letrozole but it was a CP. We then moved on to IVF. I remember having fewer side effects on letrozone than Clomid. Although I did have to sign scary releases for letrozole because its use for infertility is “off label”.

[aprilz81]

***grad warning***

I would re-do some of the testing to make sure there are no underlying issues before starting treatments, but in my opinion Letrozole is no big deal. I've done about 8 cycles total and no side effects whatsoever. I had minimal side effect on Clomid, but I responded better and faster to the Letrozole. I took the meds CD 3-7 and usually ovulated around CD16 (clomid cycles I usually ovulated around CD 21) and rarely had more than 2 mature follies.

It will help produce a more mature egg with a stronger corpus luteum which will help sustain any resulting pregnancy without further medications (at least in most cases).