TTC naturally or straight to Letrozole? (PCOS, long cycles)

[lenalove]

Hi everyone,

Hoping for some advice here, thank you for reading.

I am 28 just for background. After being on the pill for c. 10 years, I finally came off last year. I then had no period for around 9 months, but I have finally had 5 consecutive periods with around a 42-47 day cycle each time. Each period has been light and around 2 days long. I have been tracking on the Flo app and do feel symptoms of ovulation coinciding with the window it predicts (high sex drive and clear discharge).

I went to see a fertility consultant as DH and I would like to TTC. The consultant detected some cysts on my ovaries (no other physical PCOS symptoms other than this and the long cycles) but other than that everything is apparently normal (hormone levels, fallopian tubes etc all OK).

She prescribed me 3 cycles worth of Letrozole which she said I could take to induce ovulation and be monitored during the process. I asked if she thought this was necessary given I am having cycles (albeit long ones) and she said the issue is it would be very hard to predict ovulation and so we would essentially be stabbing in the dark. Ideally I would like to TTC "naturally" before using the Letrozole, but am I being overly optimistic in doing this? For this cycle, we are aiming to DTD every other day around the time the app predicts ovulation will occur, in the hopes that it can coincide.

Does anyone have any experience with anything similar? Should I just stop being stubborn and go straight on the Letrozole?

Any advice or shared thoughts would be much appreciated.

Hey, what made you go see the consultant prior to starting to TTC?

I'd say give it a few months of trying naturally before investigating or starting treatment.

I also have ovarian cysts, I think certain types are really common tbh, I was so anxious that it would effect us when TTC but it didn't and touch wood so far no issues albeit I'm very early on.

I'd recommend using the clear blue ovulation tests, they are really useful and will tell you if you are ovulating!

Best of luck and sending you lots of baby dust for this new exciting chapter x

@Ihatewashingdishes thank you for your supportive message!

I first scheduled in the consultant appointment when I still hadn't had a period after coming off the pill as I knew we would soon want to start TTC.

Good tip re the clearblue tests, I just started using the basic strips but they're a bit tricky to read... I will try these instead.

Best of luck to you too with your own exciting journey xx

I was you a few months ago- we decided to try naturally for a few months, it’s not a “stab in the dark” if you’re able to identify ovulation? I was using Lh tests to help me but I now know well enough without them. I use BBT to confirm I’ve ovulated. That all being said I’m currently in the TWW for cycle 6 and no luck yet, so we have initiated the process to get help!

And just to be clear - I don’t think any Lh test can confirm you’re ovulating? It can confirm you have a surge, but the only way to confirm you ovulate is a sustained BBT increase or a progesterone test.

@CRbear thanks for sharing. My issue with identifying ovulation time is the irregularity of my cycles, but I am hoping using the LH tests will help. Like you say though, I do worry this won't actually confirm ovulation only the surge. Due to my short periods I wonder if I am actually ovulating at all.
I hope all goes well for you on this process.

Just bumping to hopefully get any other perspectives!

I have now confirmed ovulation using a blood test so as I suspected my cycles are long at c. 42-45 days but not anovulatory. Ovulation and AF consistently been happening in line with OPKs and Flo app so it is "predictable".

I am currently 11 DPO and took an early detection test that came back negative

I just don't know whether to keep trying naturally or start taking the Letrozole prescribed by the consultant. Having the long cycles means having to wait so long before the next attempt! But is it worth taking something to induce ovulation if I am already doing so naturally (albeit slowly)?

I don't want to waste our time - is it really possibly to have viable 40 day + cycles?

Thanks

I’ve found out I’m pregnant- naturally, on our 7th cycle with PCOS. I think if you’ve confirmed you’re ovulating with a blood test you might as well try!

@CRbear ohh that's lovely news congratulations!!!

I just hate the fact my long cycles will mean waiting aaaages between attempts but you're probably right it's worth giving it a couple of gos naturally...

if 28-35 days is normal, then you’re only a week off what you could realistically achieve with letrozole. And it feels long whether you’re waiting 2 weeks or 3 weeks to be honest! But I can’t see a negative impact of doing letrozole if you want to?

@CRbear that's true! In the scheme of things I suppose it's not that long of a time difference... did you have any cycle irregularities yourself (if you don't mine me asking) due to PCOS? I also have very light periods that last only 2 days so which I initially thought meant I wasn't ovulating but seems I am so might just be normal for me!

Hi,

I have PCOS but hardly ever ovulate (I have about 2 periods a year) so it made sense for me to start on letrozole (also the fact I'm 32 and very much ready for a baby!)

I think there's a few things to think about. Firstly, trying naturally might take a bit longer but if you're happy enough to accept that (letrozole is no guarantee either) then crack on and know you can swap to letrozole at any time. The second thing id bear in mind is that letrozole could result in multiple eggs releasing, especially if you do ovulate on your own anyway. So if you have strong feelings about a multiple pregnancy, perhaps bear that in mind!

Good luck

@SunsetsAndSandwiches thank you for your reply, some very good points!

I was surprised when the consultant straight away prescribed me the Letrozole despite knowing that I do ovulate naturally, and the first thing that sprung to mind for me was the multiples!

I suppose I am struggling to see what the Letrozole would contribute other than maybe slightly more "opportunities" (by decreasing gap between cycles) and greater opportunity to track by having all the scans...

There seems to be limited info available for people who have been prescribed it BUT do ovulate naturally

@lenalove - my cycles were all over the shop! I had a random short one last which is when I conceived. I’ve attached my list in case you’re interested. The only marked change after the two 52 day cycles was I actively tried to reduce my stress. So cutting off thought spirals about TTC etc.

@CRbear thank you very much for sharing!

I'm sure reducing stress plays a part but it's such a vicious cycle isn't it

To be honest part of me is just happy my cycle returned at all after going missing for nearly a year post coming off the pill!

@CRbear one other thing I don't know if you have any insight on - is there any disadvantage to late ovulation? Wondering if the egg is in less good shape when released or if that's just stupid of me to think

I have PCOS was diagnosed after my first child and had secondary infertility for 9 years after that. Turned my health around in Jan this year, quit all pharmaceuticals, started ZMA supplements, lost weight, kept my blood sugars under control and fell pregnant in June!! Just to add I never had cycles and when I did they were few and far between, starting Jan they came back on average 35 day cycles. I alway ovulated around day 21 x

That’s something I wondered about a lot. I did a lot of research and some people say yes - the egg is “tired” by the time you finally ovulate, and some (more reputable I would say) say it has no impact. I don’t think at the lengths you’re talking about you need to worry too much. I think it likely refers to people who have 50-60-70+ day cycles!

Hi everyone!

Thank you for all your responses.

I am 12DPO currently and had given up all hope (hence moaning away here!) but I figured why not take a test on a whim and I have just had faint line - I can't quite believe it!

yaasssss Lena! What a month for PCOS natural conception! Congrats!

@CRbear thank you SO much I can't quite believe it!??? Especially considering my weird cycles and being told it would be so hard naturally!
Trying to talk myself down from panicking about false positives and chemical pregnancy...

Please do let me know how you get on (if you'd like to of course!) it's nice to hear positive stories in the PCOS community!

I’m in exactly the same position just a couple of weeks ahead. It does get easier!

I took comfort in the fact I can get pregnant! I would obviously be devastated to lose the baby, but the odds of a live birth are so much higher after you have been pregnant once.

are you on any supplements for PCOS? That was my first biggest stress- what to continue and what to drop! I’ve carried on with inositol but dropped everything else in favour of pregnancy vitamins

And yes would love to keep in touch

Yes I feel the exact same I am happy to see that I can actually get pregnant at least.

I am too scared to take anything other than these FRER tests at the moment as I am still not due AF for 2-3 days!

Funny you should say - I have been taking myoinositol for the past 6 months and I am convinced that's what brought my period back (after a year of nothing!) in the first place! I will 100% continue to take that. I am otherwise just taking folic acid and vitamin D as read one should do that if TTC.

In terms of pregnancy vitamins beyond that I am totally clueless I must admit!

Oh fabulous news, so pleased for you! X