Should I try Letrozole if I’m already ovulating?

[Goldendoodlelover]

Hi all, was wondering if anyone could give me any advice on taking Letrozole/Clomid for unexplained infertility? I’m 30, been ttc for almost a year with no luck; tests have all come back normal so far and BBT, OPKs and ultrasound all suggest I’m ovulating. Doctor has suggested that I have a HSG/Hycosy and then if tubes all clear to keep trying naturally until I feel ready for IVF, which seems like a big step. I’m wondering if I should push to try Letrozole? My day 21 progesterone test was fine/borderline but I’m worried my progesterone drops off too early as I always spot before my period, and so maybe Letrozole would give me a ‘boost’? However don’t want to throw money down the drain either so would be really interested to hear other people’s experiences if anyone is in the same position!

Hello. I have used Letrozole although coming from a different position I think I can give some insight.
I’m 43yo with a history of recurrent miscarriage and although conceiving was never my issue, I decided to try superovulation with Letrozole through this private fertility clinic on account of

• by pusing the production of multiple eggs there’s a better chance of at least one being good enough quality to create a viable embryo
• as it had been almost a year since my last natural pregnancy (we paused that due to trying one very long round of IVF) I thought I may stand a better chance by pushing my ovaries a bit more

I ended up having 3 back to back cycles on the stuff with monitoring scans and trigger injection to time ovulation and intercourse properly. I responded well to the drug each time with minimal side effects, I definitely ovulated each time and I had more that one mature follicle each time (2, 3, 3) but despite the timed intercourse we had no luck getting pregnant so I stopped. I’ve been speaking to other women in a similar situation on here who would get pregnant naturally, but haven’t been able to since using Letrozole. To me it sounded totally counter-intuitive at first, but I think the problem may lie with trying to guess when eggs may be mature and push ovulation manually rather than letting the lead mature follicle doing its job, meaning all eggs triggered may not actually be mature at all.
It may offer better odds of success if taken without ovulation induction, it’s quite a cheap drug so if your GP is willing to prescribe, even on a private prescription, it may be worth a try.

I’d say though, if your primary concern is progesterone potentially dropping off too soon during your luteal phase, you may want to request a prescription of cyclogest or other progesterone supplements you can use after ovulation up until a PT (stop is BFN, continue if BFP), I haven’t heard Letrozole is usually prescribed for progesterone issues, but I could be wrong.

I hope you can be offered some kind of support or plan as I know unexplained infertility can be awfully frustrating.

Hi @clhiu , many thanks for taking the time to respond; your answer was really helpful and that all makes sense!

I’m really sorry to hear about your losses and I hope you have more luck soon.

Tbh I’m not sure what my primary concern is at the moment, and I don’t feel like my doctor has been super supportive so far: for example she told me that mid-cycle spotting/spotting before my period is ‘normal’ and there’s no link to low progesterone, but that seems to contradict everything I have read online! And I feel like there are other tests to consider (eg sperm dna fragmentation, laparoscopy for endometriosis) that she hasn’t even mentioned: she just keeps saying that IVF is the only option really. If that is the case, I may actually switch clinics anyway as there’s another one locally to me that actually has better success rates and offers mild/natural IVF which sounds intriguing, so maybe I should get a second opinion from there anyway.

I know in the grand scheme of things a year isn’t that long I just find the ‘unexplained’ diagnosis infuriating: I’d almost rather they had found a problem cause then there would be something to ‘fix’ and focus on - it’s the emotional rollercoaster of the two week wait and getting my hopes up every month that is driving me nuts!

Anyway thanks again and sending baby dust your way! ✨

I don't see what would be the purpose? Your already ovulating.
Doing so could put your ovaries at serious risk of hyperovulation which can be quite a serious condition and can in rare cases damage your ovaries. Letrozole won't give you a progesterone boost .

Your only 30. Its different if say you were 40 as chances are multiple follicles wouldn't be viable anyway so the risk is less and sometimes its recommended for women of ama but not someone your age.
Try not to worry yourself to he honest almost a year isn't that long to be trying . Nhs guidelines state you should seek help after 24 months if under 35.
Spotting can be quite normal before a period. Unless your dealing with a luteal defect and your levels are under 30 then you don't need a progesterone boost and doing so in some cases can be detrimental

Mild / natural ivf is used in short protocols. If at risk of ohss or advanced age. Your protocol will be given to you by your doctor based on several factors
Ivf is not really about picking whichever protocol you want. It's about what's the safest and most effective protocol for you specifically . Doctors put you on the protocol they decide is best to give you

@BlackLotus I’m pretty sure the NHS guidelines are talk to your gp if you’ve been trying for a year under 35 and six months if over 35. I know a year really isn’t that long in the grand scheme of things; I think my perception has been skewed by the fact two of my best friends/bridesmaids and my sister in law have all announced their pregnancies in the last couple of months and have all fallen pregnant within a month or two of trying, and my anxious brain is convincing myself that there is something wrong and we just haven’t found it yet. Obviously I just need to have another conversation with my doctor and of course if we do go down the IVF route then I will go with whatever protocol they suggest - I just hadn’t heard of mild IVF / didn’t realise it was an option and if the success rates are the same but involve fewer drugs then that sounds like a good thing!

@Goldendoodlelover I wouldn't worry about other people! Everyone's journey is different. Some people get pregnant easy and others take time but at one year I don't think you've any reason for concern. Some couples just take longer.
I was told by my gp I was eligible after 2 years of unexplained infertility. Unless you have an already diagnosed issue condition/ abnormal sperm you can get referred sooner. I'm pretty sure most women ive seen on here have stated 2 years aswell . It might vary in area but in most its 2 years.
As for mild ivf ..mild produces much less eggs. Which is better when quality due to age 40+ is an issue or risk of ohss due to pcos . If you don't fall in either category then you wouldn't be benefiting your success by doing mild ivf.
It's tough when everyone is falling pregnant so easily but try not to worry. It's truly not that long I know many couples who took 2-3 years

Hi @Goldendoodlelover just wanted to come on to offer a bit of support. It is absolutely after 1 year ttc that you should seek out help and I dont think being told not to worry is helpful. I'm so glad we went to seek support at the 1 year mark as we are now at the 2 year mark and havent conceived naturally as of yet. I too am curious about trying letrizole while on the IVF waiting list even though I'm ovulating. Going to email my consultant today to ask if there would be a benefit to it and will let you know.

Hi @Eagerlywaiting1990, sorry to hear you are in the same / similar position! Let me know what your consultant says as I would be interested to know. Best of luck with everything 🤞🤞🤞

Hi @Goldendoodlelover , I could have written your post word for word! Incl the spotting.

Except, I’ve already had a HyCoSy and am in my third cycle of letrozole (2.5mg which is the low dose, and without the trigger shot). Currently 8dpo and if this doesn’t work we’ll be going for ivf.

I’ve shared quite a lot on other threads so I’ll try link to them tomorrow!

Otherwise ask me anything and I’ll try share my experiences x

So my journey so far is..

Went to gp in May who referred to specialist. had already paid to have most of the tests done privately, and had private HyCoSy in June. It was painful.

Appt with nhs fertility specialist happened in Sept. It was… difficult. She didn’t really listen. Kept interrupting. Appt was very slow and disjointed. Other staff members kept coming in to the room to talk to her. She left the room twice. Her pers phone kept ringing and she answered it once. Kept calling my DH by his surname even though he said three times “my first name is…”. My referral letter was left on a table outside for everyone to see which fortunately my DH spotted and grabbed.

Felt so let down by the whole experience, given how important this is.

She wanted to refer straight to ivf which we’re very open to but I’d expected a more experimental approach to start with. Maybe seeing all my bloods she quickly determined ivf would be best option as reason for our subfertility can’t be determined.

Anyway - I had to bring up option of medicated cycle (she didn’t offer) and she said yes, despite me having no ovulation issues, and gave me letrozole (with a clomid info sheet lol - I know they’re same protocol but just update the heading?! 😂 ).

I also asked about progesterone/luteal phase support for my spotting but I was dismissed straight away as my day 21 bloods were good. Fair enough, but I’m still worried about it.

Im now on cycle 3, I’ve been having scans each month to monitor, and have appt next week to discharge and refer to ivf clinic if this month isn’t successful.

A couple of other handy threads below!

https://www.mumsnet.com/talk/infertility/4888007-letrozole-without-pcos?reply=128967129

https://www.mumsnet.com/talk/conception/4834310-letrozole-first-cycle?page=12&reply=130764028

Hi @Sierra26 , many thanks for sharing your story and the links! I’m hopefully going to have a Hycosy next month and then if all clear push to maybe try Letrozole in the new year. I feel like I need to try SOMETHING in between completely naturally and IVF; I’ve also been tracking my BBT and whilst my temps do rise after ovulation they are not overly high (normally between 36.4-36.5) which again to me suggests I’m not producing tonnes of progesterone or my ovulation is not quite as strong as it could be. I’m sorry you had such a poor experience with your NHS fertility specialist; I understand that most of them are overworked and overstretched but it’s really hard when they are so dismissive! How many months have you been ttc if you don’t mind me asking? Best of luck with the Letrozole 🤞🤞🤞

Hi @Goldendoodlelover

My situation is almost identical to yours! My progesterone levels were "normal" (but on the lower side) and I spot every month the week leading up to my period.

I've been prescribed both Cyclogest (progesterone) and Letrozole (even though I ovulate). I'm on my second month of it now and the spotting has continued (but marginally less) so I'm not sure what the answer is but definitely worth exploring progesterone pessaries as an option if you're on the lower side.

Hi @Emi88 , thanks for sharing! How did you convince someone to prescribe cyclogest? I’m continually dismissed when I ask for it!

I had been to my GP so many times about my spotting so when I started ttc she referred me to a gynaecologist who was able to prescribe it. I'd definitely keep pushing for it (exaggerate your symptoms if needed - sometimes the only way they'll listen! 🫣)

Hi @Emi88 that’s really interesting to hear, thank you for sharing! Did you have to push to get these prescribed or not? My doctor keeps saying that spotting is normal and I know that lots of doctors are reluctant to prescribe progesterone, although I really don’t see why!

@Goldendoodlelover hey, I'd love to know how you're getting on. I'm in exactly the same position as you and I'm due to start Letrozole next cycle

@Goldendoodlelover I'm intrigued to hear how you're getting on too. I got put on letrizole despite ovulating (my suggestion) but unfortunately no luck as of yet. I'm on 8dpo of my third cycle but don't see this being the answer for me. I do however have a blocked tube so that is undoubtedly a factor. All the best to you @Angelselevenx xx

@Eagerlywaiting1990 sorry to hear you haven't conceived as yet, will they perform a hycosy? X

Hello everyone, hope you don’t mind me resurrecting an old post! I hope you are all well. Just wondering how you’re getting on - I’m on cycle 16 with similar issues xx