letrozole before IVF for unexplained infertility

[lankyliscuits]

So to try and summarise, our diagnosis is unexplained infertility. Been trying since August 2018 and never been pregnant.

After our last consultation with our infertility clinic consultant before her referred us to the Assisted Conception Unit, he said he was referring us for IUI. Turns out, there's no longer NHS funding for IUI for unexplained infertility since the beginning of this year so we've been advised to try letrozole for anything up to 6 months (but from the doctors experience of success of that with unexplained, she said really only up to 3 months) and then next step is IVF

Anyone in this situation or have been in the past?

Keen to hear more about letrozole success stories for unexplained infertility

I would not accept unexplained as any sort of diagnosis at all. What this means is that they have failed to find out what is wrong and this can be given to couples when they have not been properly investigated.

What tests have both of you had to date and particularly within the last 6 months?. I would be looking at this area for both of you very carefully as it is likely that not all the tests have been performed. Any test result too over 6 months should be discounted.

Why letrozole and then IVF, it’s a huge leap. It seems they have no idea whatsoever what to do with you here and so I would consider going to another sub fertility unit. It is fair to say that some of them are far better than others.

Thanks for your reply.

Within the last 6 months we've had all the typical fertility tests e.g. bloods, sperm analysis, I had my tubes checked with the dye test etc. She did mentioned my ovarian reserve results were a bit squiffy so she wants to do that blood test, for FSH, again - maybe this will offer an explanation, but we'll see!

When you say a big leap - what other middle ground options are there than between medication and IVF? Having been told IUI wouldn't be NHS funded and being advised not to pay privately for that due to low success rates.

You need a diagnosis first and foremost, never accept unexplained from them. They have failed to find out what is wrong and they should certainly reexamine your ovarian reserves (particularly LH and FSH) as that may well be a reason for the subfertility.

The most common tests that tend to be omitted are:-

Adequate x-rays of the uterus which may show abnormalities not otherwise seen at laparoscopy.

Hysteroscopy - telescope inspection of the inside of the uterus which may occasionally show abnormalities not seen otherwise

Repeated sperm counts over several weeks and months to make sure there is no subtle abnormality

Testing the sperm in special media such as swim up tests and velocity testing. However, when they are done, they often uncover a hidden cause for the supposed unexplained problem

Thorough hormone tests to detect abnormalities of male hormone or early falls in progesterone

Scanning of the ovaries to see if follicles really are developing and there are no sign of polycystic ovaries.

At the very least all of the above should be done.

Hi lankyliscuits,
Not sure if you are still following this but Im (sadly) in the same situation as you. I also started TTC # 1 in Aug 2018 & no hint ever of a bfp. I start IVF this Dec however Ive just done 2 rounds of clomid & about currently doing Letrozole this month & next month as a last attempt before IVF. Im doing it privately. Clomid was great in that I had 2 big follicles etc but sadly didnt work. My RE switched to Letrozole just to shake things up! Of course Im still hopeful but we shall see. I have had every test under the sun, prob just my age... 38. Anyhow, i hope to hear you are getting on with letrozole.

We used Clomid which is similar. It didn’t work, at that time we were unexplained. More recently we have found it was a sperm issue so it probably never would have done. Like others have said then l would push for a proper diagnosis, unexplained isn’t a real diagnosis