Increasing letrozole dose - help me decide?

[anotherscroller]

Hi!
I've done three failed IUIs on 2.5mg letrozole. They've asked if I would consider moving to 5mg. I really want to avoid increasing the risk of twins too much, as I don't think we could cope with twins.
Could you tell me what you think based on the cycles?

Cycle 1
1 big follicle on the left
Cycle 2
2 big follicles on the left, but then only one was big enough by the time of the IUI
Cycle 3
1 big follicle on the right

How many follicles are you getting? Do you think I can risk making more?

Thank you!

PS background info: almost 35, one daughter already aged 4, TTC for 14 months, irregular-ish periods (32-38 day cycles) but without every getting a positive OPK, BMI 20, otherwise healthy, no male factor, first child conceived on second cycle after the pill

Tricky one!! Personally I did go to 5mg, ovulated twice but only conceived a singleton. It doubled my chance of conception and twins are still a slim probability, I think <10%? But I would have taken twins so it’s really a personal call!

Thanks! OK that sounds good, I'm going to put it to my husband tonight.
Of course I would take them!! And love them. It just scares me. But we would learn to cope. And change our whole lifestyles of course :D

Thanks again for this. In the end we decided to carry on with 2.5mg. It was basically a case of "do you realize that every single aspect of our lives would change if we had twins?" and me being freaked out at the toll it would take on my body. Even though the risk is only slightly increased and the chances of conceiving are WAY increased, we never wanted to feel like we had made twins on purpose! Don't mean to denigrate twins, it's just something that personally for us is too daunting.
Now we're so gonna get twins anyway after saying that haha.
I'm so happy it worked for you, anyway.

Totally understandable. Assuming I have to go on letrozole for a third, I don’t think I’d be so confident in the 5mg 😂 3 is my limit! Best of luck ☺️

Makes sense! Thank you ....

Hi crhendy. Just to update I got pregnant on the cycle I decided not to increase it :D
thanks again for helping me decide. All the best

@anotherscroller WOW! Congratulations :) looks like you were right to follow your instincts! So happy for you. Best of luck with the pregnancy xx

p.s. did you ever get to the bottom of why it took so long second time around? I'm just like you, conceived quickly first time but took 15 months second time around and only when I took the letrozole. So having my first must have messed up my cycle in some way? I just don't get it!

I have many theories!

• the mirena coil didn’t suit me, hormonally speaking (came off it dec 21)
• I was stressed for various reasons around the time of coming off it and it threw me off
• I was ALWAYS experiencing anovulatory cycles and my first baby was a fluke
• I conceived my first after coming off the progesterone only pill, and it worked because I have low progesterone (no evidence for this)
• it doesn’t suit my body to be slim (which I am), I should be chubby (as some in my family are), so I wasnt ovulating
• a bit teenage anorexia and binge eating messed up my hormones at a crucial age of developing

…. ha!
i have thought about it a lot. I don’t think any doctor would be able to tell me. I know from opks and Rocky Mountains temp charts that I wasn’t ovulating though, and my bleeds, though regular, were withdrawal bleeds, not periods.
you?

Regular-ish (between 28 and 38 days, usually 36 or so)

Interesting!! thank you, sheer nosiness.

I honestly have no idea. My periods never normalised after my first, I went from 30 day to 25 day cycles, so I’m pretty sure they were anovulatory (even though I had positive OPKs). Or perhaps my luteal phase was too short in a 25 day cycle and letrozole helped bring my ovulation forward, plus a bit of extra progesterone to help with the uterine lining. I’ll never know!

Doctors wouldn’t take me seriously because I’m in my early 30s and already had a baby, so they told me to just keep trying without really diagnosing me. So if want a 3rd, I don’t know what to expect…a month of trying, or a year?! I personally found the experience of secondary infertility really traumatising and what I went through was nothing compared to some women. I’m not sure I have the strength to do it all again!

so pleased it worked for you!

Hi everyone,

Jumping on this thread as I’m about to get my period (13 dpo, spotting) and I’m bracing for my 2nd round of Letrozole.
This cycle was my first and doctor started me on 5mg. I have no issues on scans and blood tests but I did have intestine endometriosis which I got surgery for last years so my body isn’t perfect.

I’ve just turned 33 and trying to conceive but I think I don’t ovulate.
So hence the Letrozole.

Should I increase it to 7,5 mg or continue with 5?
I’m using temping to find out my ovulation window, apps usually pin it to day 18, as my cycles are usually 31-32 days.

I’m feeling very depressed, I really thought it would work the first round. It was the first time I actually had fertile
cervical mucus but somehow the app pinned my ovulation day at the end of it when the mucus was more gummy and almost gone.

Also, what days are best for trying? Every day for 5 days leading to the O day, maybe after as well?

🥹Grateful for any response

I'm sorry to hear that! Don't be disheartened, a lot of the first few months is ensuring your body is responding to the hormones correctly. I hope you're getting lots of support, it's so difficult.

Are you having scans to confirm ovulation and see how many follicles there are? Apps were inaccurate for me, I paid privately for scans. Personally I wouldn't increase the dosage without this, because if you produce loads and loads it poses a health risk to you and multiples - beyond twins to like, quadruplets 😂I know it increases odds of conception but progressing to a successful pregnancy might be harder.

It's expensive but confirming you are definitely able to ovulate is a big thing! If not, then you know you need to look at other options.

Good luck!!!

@crhendy AF just arrived today, I was expecting it and honestly I feel relieved.

I’ve chatted to my doctor and said I can up the dosage to 7,5mg and take one pill in the morning, one at noon and one at night (dunno why I can’t take them together).

She basically told me that my body’s issue is with estrogen, I produce too much, that’s why I had endometriosis apparently, though I was “lucky” it didn’t affect my ovaries or uterus…

I’ve read about Letrozole and it doesn’t really lead to twin pregnancies, that’s more of a genetic trait I think.

I haven’t had any scan this cycle, might go for a private one around my ovulation time this new one.

I’ve never been so stressed in my entire life, job loss, job hunting, gran dying (we were very close, she raised me), I think my body is pumping cortisol like crazy. No wonder it didn’t work this cycle…

@alexalexalex18 hi jumping on this old thread, wondering how you got on?
I think I'm going onto my second round of letrozole, only 10dpo but iv been testing negative, AF due in 3 days 🫠
My doc may increase my dose to 5mg also, waiting on my progesterone results. They were low last month that's why I started letrozole.
I seem to be experiencing secondary infertility, I had no issues with my first pregnancy in 2020, got pregnant twice last year first cycle and lost them both, and haven't been able to conceive since. Incredibly frustrating! But like you my stress is high at the minute also lost my job in august and been job hunting since, while paying rent & a mortgage while we build 🙈