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Infertility

Our Infertility Support forum is a space to connect with others in the same position, discuss causes, treatment and IVF, and share infertility stories of hope and success.

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Original poster

Letrozole, high AMH and PCOS

35 replies

Jaydrives · 02/07/2023 23:27

This is my first cycle using letrozole for ovulation induction. I was prescribed 2.5mg on CD 2-6 and am due to have a scan tomorrow (CD13) to see if it's working.
I've just got myself so stressed out convinced that because of the fact that i have PCOS and very high AMH that the low dose isn't going to work and I'll just be wasting cycles (I've been told that they will only increase dose by 2.5 each cycle to a maximum of 10mg, and that i can only do this for a maximum of a year). So I'm just hoping that there is anyone out there who has been in a similar position and actually successfully ovulated on a low dose?

I'm trying to calm myself down before my appointment tomorrow, we've been TTC for so long now that every new issue just feels insurmountable.

OP posts:

SunsetsAndSandwiches · 22/08/2023 11:12

Hi @Jaydrives ,
Yes I'm on the NHS and am getting trigger shots and day 21 bloods done. I should probably add that I think you are only normally offered trigger shots if they see dominant follicles on the scan but then don't see that ovulation occurred from your bloods. I'm not quite sure why I have been offered them as they said I was probably ovulating already but this would just make sure it definitely happened.
So maybe don't expect a trigger shot, but a day 21 blood test seems to be very standard (at least for the first few rounds) at my hospital. Hope all went/goes well with the day 12 scan.

@Gkb90 I'm also in the two week wait. I only took the trigger shot on day 16 this month, not sure why ovulation was delayed (possibly the stress of moving house the previous week?!) so my ovulation day was the 14th so a day behind you. I'm not feeling any symptoms this month, even from the trigger shot, so not feeling confident but I'm just staying focused on the fact we are seeing the doctor in less than a month to start IVF or ICSI so at least we have Plan B lined up. Fingers crossed that this is your month! Have you had day 21 bloods?

JohnnysMama · 22/08/2023 12:09

I was never given a trigger shot as I ovulated without one each cycle on 5 mg

sl7uk · 22/08/2023 16:24

@Jaydrives I’m doing Private and I haven’t been offered mid-cycle scans to check for follicles. My consultant doesn’t see the point which doesn’t feel that helpful!

I do however have a 21-day blood test as that’s the only way to 100% confirm you’ve ovulated. That then dictates what to do for the next cycle, so I would suggest it’s good to have that!

I have my second cycle (first on 5mg Letrozole) 21 day blood test tomorrow and I’m 90% confident I’ve ovulated for the first time since coming off the pill a year ago, so fingers crossed 🤞🏼

Carlotta27 · 29/08/2023 08:37

Hello all!

Hope you don’t mind me joining. I’ve been having treatment for over six months now (letrozole 5mg, trigger shot, progesterone suppositories), initially for short (5 day!) Luteal phase but it was discovered recently I have PCO (over twenty follicles per ovary and over 100 AMH).

@SunsetsAndSandwiches interesting to hear about Lean PCOS. I’ve still not got a clear diagnosis - inhave high AMH and PCO but a normal BMI and LH ration. Some Drs say it’s PCO and others say it’s a type of lean PCOS! Clearly an area with little clarity …

Anyway, I’ve recently started to worry about treatment. I’ve had six cycles in letrozole - always had one big follicle by day 12 in the last. This cycles on day 10 there were four 9mm small follicles. It’s so weird that I thought I’d found a regime that works to get me ovulating and then have this odd cycle. I’m going back in tomorrow (day 12) to see if there’s any growth and may have to abandon the cycle. I’m waiting to see if I’ll be approved for IVF on the NHS as (bar one chemical) the letrozole hasn’t been the answer for me!

Hope you are all getting in well x

sl7uk · 31/08/2023 08:38

Hi all, hope you're all getting on well. Hoping someone might be able to help. I

I've ovulated for the first time after my 2nd Letrozole cycle and I had to take Norethisterone at the start of the cycle to induce a period (as I don't have my own). I'm now waiting to take a pregnancy test before I start 3rd Letrozole cycle, but as I don't have my own periods, I can't wait for a missed period to test. Does anyone know when I should be testing and also if it is a BFN when I can start my next Letrozole cycle. I'm very impatient...😅

JohnnysMama · 31/08/2023 11:54

I tested at 8 DPO and 9 DPo and had very very faint BFPs. If you ovulated and did not get pregnant this cycle you should get a period. If for some reason the period would not start after ovulation and negative tests I think you can start taking Norethisterone at 14 -15DPO again.

Carlotta27 · 31/08/2023 11:57

Hello @sl7uk pleased that you ovulated on letrozole - got to celebrate the small wins even if it’s not a pregnancy yet!

Do you know what day you ovulated? I am told to do a pregnancy test 14 days after as by then any embryo that fertilised should have implanted and would show on a test. I also use the extra sensetive ones to make sure I don’t miss it. If it’s negative then in to the next cycle. That’s the advice I’m given so may also be worth checking with your Dr as I know they sometimes vary in what they advise. Good luck! X

sl7uk · 01/09/2023 13:39

@JohnnysMama and @Carlotta27 thank you for your replies, both very helpful! My AF arrived this morning so that's stopped the pregnancy test date confusion. It's my first AF in 9 months since being diagnosed with PCOS, so at least the Letrozole is giving me a cycle, even if no pregnancy!

Carlotta27 · 01/09/2023 14:07

@sl7uk ugh sorry to hear it wasn’t a successful conception cycle. I guess you’re right that we have to take the small wins and it’s a step in the right direction :)

Carlotta27 · 01/09/2023 14:11

Also just sharing for anyone who experiences similar. I’ve had six cycles of letrozole and always around day 11 I had a big 20mm follicle ready for the trigger shot.

Weirdly this cycle, my 7th, I took exactly the same letrozole dose (5mg days 2-6) and responses differently. I had about four 10mm follicles on day 10 and no dominant one, finally today in day 14 there was a follicle about 18mm but it will apparently be a few days still until I ovulate. It was so weird that for many months my response was exactly the same and of course this months when we didn’t see a dominant follicle I got so worried I wouldn’t ovulate!

So just sharing in case anybody else experiences similar (and goes through the same sorry I did!) - the nurse explained our bodies can react differently each cycle and luckily for me I just had to wait a bit longer … it’s all such a minefield! x

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