Day 12 scan- Letrozole

[Purplemonkey23]

I had my day 12 follicle scan today after my first round of letrozole (2.5mg) due to PCOS. The dr said he couldn't see any 'obvious' follicles and I didn't think to clarify what that meant as I was quite upset with the negative news.

He said the course of action is now to stay on 2.5mg for two more cycles but I do not require any further scans. I'm just confused and deflated as I thought if I didn't respond to 2.5mg that he would increase it. Also surely I need a scan to check if I'm responding?

I also had ovulation pain (usually get and then my period starts 14 days later although ovulation not confirmed) on day 10. I was wondering if it was possible that I already ovulated? Would the doctor be able to pick this up on the scan?

Just looking for other people's experiences really.

Hey! Sorry you're feeling in a bad place with all this. I'm going to give my thoughts below but obviously not a Dr or professional so are just my personal ramblings!

Are you with a fertility clinic or going through your general Drs? I don't know if it's different with how many scans they do or prescriptions etc if you're going with the NHS, say than going private?

We've gone through a fertility clinic so pay through the nose for everything but I will say it is thorough, eg they do lots more scanning, we have regular scans from like 7 days after the letrozole as they track the follicles. On our first IUI they nearly cancelled as my follicles were small until like day 17! Which is pretty late.

I can only assume if by day 12 he saw no activity at all, then maybe he knew there wasn't enough time in the rest of your cycle for follicles to grow to the required size? Still I'm surprised, as you are, that they didn't want to at least see what was going on with a confirmatory scan.

Re: seeing evidence of ovulation, I think they can scan to see if there is a "corpus lutuem" which basically is evidence of the popped follicle, I think they can also run bloods to see if you've ovulated.

I have mild polycystic ovaries and our Dr put me straight onto 5mg of Letrozole so I'm wondering if you can ask your Dr about an increase and if not ask the reasons why? Usually Drs have their good reasons!

Please do feel empowered to ask your clinic / surgery to set up a call with the Dr so you can get answers to your Qs. It's your body and you shouldn't be in the dark - feel free to write a list of Qs and get your answers!

I have PCOS and did 5 cycles of letrozole. Like PP I went privately, paid through the nose and got a lot of regular tracking scans. I'm surprised your doctor seems to think you haven't ovulated but wants to keep you on the same dose without any scans, seem's kind of strange to me.

It's unlikely (but not impossible) that you ovulated already as you can see an ovulated follicle on an ultrasound and I imagine the doctor would have checked for this/mentioned it if they had seen it.

If you want to be sure I would do two things. Go on medichecks and buy yourself and day 21 progesterone test and take it 7 days after you think you ovulated - that'll confirm if you did in fact ovulate on or around day 10. I would also get some easy@home LH testing strips from Amazon and check your LH levels every day - it might be you're just going to ovulate later, you can do this until you start your period.

Next cycle, use the LH ovulation strips every day from the end of your period until you either get a positive, or you start your next period. If you don't get a positive then I think you need to be telling your doctor that you aren't ovulating and they need to try something else (higher dose, different medication or something) it's not right to keep you on medication if it's not helping you.

Hi @Purplemonkey23 sorry to hear you’re having a tough time. I’m currently on my first cycle of letrozole and my NHS clinic prescribed my 5mg straight off. I don’t have PCOS but do have very irregular cycles (28-50 days!)

They also said that they’d scan me as many times as needed to see if I ovulate, so I’m surprised that you haven’t been offered another scan in a few days to see if any follicles start to grow. Day 12 could just be too early?

My first scan is on CD16 which feels a little late, so I’m going to start testing lh once my period finishes just in case I ovulate earlier. Are you doing lh tests as well?

Hey @Purplemonkey23 how are you doing?

Sorry everyone, completely forgot to check back here!

Thank you for all your responses. <3

I am going through the NHS mainly because there are no private clinic near me. We are based in quite a rural location so the nearest clinics are 2.5 hours awa. The NHS is fantastic but can't help but think we would have more thorough monitoring if we did go private.

I am using LH sticks and checking CM. I had a surge (although not quite positive) around day 10 of my cycle but the lines are faint now. CM has been eggwhite and stretchy for a few days now.

I called the hospital and asked whether the doctor would up my dosage to 5mg and explained that I am anxious that since the 1st cycle didn't work on 2.5mg, the likelihood of the 2nd or 3rd cycle working is small. I also said that I am worried that we are wasting 3 out of the 6 cycles we get. The nurse asked the doctor and all he said was that is his protocol and he will not up the dose. No reassurance or anything, just to continue on 2.5mg (unmonitored). If it doesn't work call them on cycle 4. I am feeling quite deflated about it all! We have been trying to conceive for nearly 2 years now, so I feel that I am losing hope!

All I get from the Dr at the appointments is keeping taking metformin and losing weight as these will help. However, I have been taking metformin for about 5 years now and I have lost 3.5 stone and I am still not ovulating.

I'm trying to channel my frustration and anxiety into more positive things like eating better and exercising more as I can't keep worrying about the fact that there's a possibility that this might not happen for us. I am naturally an overthinker and have read absolutely everything on PCOS, infertility etc. It doesn't help that if feels as if EVERYONE around me is getting pregnant without even trying.

Sorry for my ramblings!!!

@Purplemonkey23 I know the feeling about everyone being pregnant. I know in reality there are 1000s of other people going through fertility struggles but it's hard to remember when there are bumps everywhere!

I'm guessing as you're with NHS that you can't ask to change Dr...or if you did the wait would be forever? I'm wondering if it might be worth the laborious 2.5 hours just to get the treatment you need...but I appreciate that is a very very long round-trip drive esp. for scans etc. It's difficult. At least you know they will address it after round 4 if no success and the rounds are (I assume) free so it's not like you're out of pocket for each round, is that right?

It all sounds a bit stressful OP, I'm sorry it's not going smoothly for you right now. But can I just say a huge WOW and WELL DONE for your weight loss - that is super impressive and you should be v proud of yourself <3

@lisbeth1 The Dr is the ONLY fertility consultant in the trust!! Like I said very rural area 😅

I am honestly considering investigating the private route although not sure I can justify paying for the treatment and travel costs esp for scans etc when the treatment we are receiving is free (if a bit subpar).

How is your treatment going? How are you feeling? I think I may have a nervous breakdown if I don't stop worrying about it all!! 😂

@Purplemonkey23 Oh god how frustrating. It's lovely being rural but it does come with its annoyances!! Maybe wait the two more rounds and if no luck Dr might up your dose?? Sounds like the Dr is very "my way or the highway".

I know exactly what you mean about the worrying!! You are not alone in having a breakdown 😫😅I have become super obsessive about the whole thing and it's only our second IUI. I am constantly testing or on Mumsnet, it's exhausting! At 11 DPO today and BFN so not feeling too confident this round. I think we will do one more IUI before considering moving to IVF...

@lisbeth1 Yes, it is exhausting!! My husband doesn't get it either, he's a very patient and relaxed person. Whereas I am the complete opposite! He thinks I'm stressing myself out with researching and testing but it actually makes me feel better because I feel like I'm actually doing something rather than just sitting and waiting for something to happen!

Hopefully the next IUI works (if this one doesn't) and if not you sound like you're with a really good clinic who will make sure you're getting the best treatment and options! 💝

@Purplemonkey23 I am exactly the same as you, I have to be doing something. It makes me feel a bit more in control when in reality I could just "chill out" until test day but I can't imagine that happening! Doesn't help that I'm going through a quiet spell at work so I don't have anything to distract myself with.

@Purplemonkey23 I'm really sorry you aren't getting enough support from the NHS :( It does really suck. I also have PCOS and I went to my GP in Dec 2021 for a referall for fertility services - I had no cycles at all (no period, no ovulation, nothing). I am in London and while I did get my referall, the appointment the the fertility service isn't until APRIL 2024. So I felt I had no choice but go private because waiting over 2 years for even a starter appointment wasn't an option for me as I am already in my 30's

After my 5th private cycle with letrozole ended in an ectopic pregnancy I was basically out of both money and hope to be honest, and I spoke to a nurse at the early pregnancy unit who was treating me while I was in the hospital managing the ectopic about everything I had been going through, and she recommended I give infolic alpha from fertility family a try. You might already know all about it from your PCOS research and being on mumsnet but I hadn't heard about it. Anyway it's a damn sight cheaper than private fertility treatment so I gave it a go and low and behold after a couple of months I actually started ovulating and having periods on my own which was a bloody miracle (if you'll pardon the pun!) I'd really recommend it, it might help you and even if not I think it helped me mentally as well with that "got to feel like i'm doing something" thing

@LavenderSweetPea 2024?!?! That's absolutely crazy! I'm so sorry you're having to pay for your treatment. It can feel like a ticking clock but I was reading that a lot of the research done around age and fertility is out dated so I'd try not to worry about that too much!

I went to the GP in October 22, attended my first appointment in April 23 and received Letrozole last month. I did have to push for the consultant to give me Letrozole as he wanted to prescribe Clomid. I just feel like there's a huddle every step of the way whether its BMI, wait times, cost or uninformed doctors. It hard enough that we can't get pregnant naturally never mind having fight or pay for treatment.

I have been taking inositol (one of the ingredients in infolic alpha) for a couple of years now. It helps with my other PCOS symptoms but not ovualtion. I have just started taking maca root as there's some interesting research and personal experiences with this. I'm so glad its working for you. Have a look into maca root if you haven't already!