Letrozole for unexplained infertility?

[wtbpg]

TTC for 8 cycles, confirmed that I do ovulate, I have regular cycles, all blood tests I've ever done, all hormone levels etc have come back normal. DH's sperm is normal although his DNA fragmentation is ever so slightly on the high side. So basically it's unexplained infertility.

My dr prescribed me 2.5mg letrozole but I'm unsure how that would help if I already ovulate? Anyone taken it who already ovulated and it helped?

Yeah, I took Letrozole after about 8 cycles TTC without success. We actually did Letrozole and IUI together just to give us the extra helping hand as, like you everything was working fine and we already had a child we conceived without any problems 2 years previously - so been a mystery why this time much harder.

We did two Letrozole cycles - first time didn't work and 2nd time I got pregnant. Sadly, have miscarried at 8 weeks but once my cycles start again I will definitely be doing Letrozole again.

The way I see it, it just increases your chances as it meant I released 2 eggs instead of 1 each month so doubled the odds, which worked for us.

@AnnieStar12 so sorry to hear about your miscarriage!! 💔
Did you do 2.5mg or 5mg?

Started with 2.5 then went up to 5. Everyone needs a different dose, I responded better to 5, but it’s normal to be started lower.
I will be doing 5 again next time

Hi @wtbpg out of interest did your doctor suggest Letrozole or did you have to push? I only ask because I’ve been ttc for a year now - bloods and ultrasound all normal and suggest I’m ovulating, and I just had a Hycosy and that was all clear too. DH’s semen analysis was normal (although on the low end of normal) although we haven’t had a sperm dna fragmentation test yet. Anyway I tentatively asked about Letrozole and doctor said no point as I’m already ovulating! So a bit confused and tempted to go back and ask again as I want to try something before IVF!!

It's a private gynaecologist / obstetrician and she saw that I was getting v impatient so suggested it. I think NHS are normally more reluctant to prescribe it?

Hmmm probably true but I’m actually seeing someone at a private fertility clinic! They just told me to keep trying until we feel ready for IVF which just feels like such a big jump so I want to try something before, but like you am not sure how exactly Letrozole helps if you are already ovulating…

@hopingforapeainapod try a different fertility doc or push a bit harder with this one?
Hoping you get your pea in a pod soon!!

@hopingforapeainapod we are also with a private clinic and they suggested we try low level fertility treatments before jumping to ivf. I would try a different clinic, as a Letrozole prescription is about 10 quid compared to thousands you’d have to spend on IVF! So a medicated cycle is defo worth trying first to see if it helps.

Which clinic are you with, out of interest? We have unexplained secondary infertility and, aside from a DNA fragmentation test (which we had to push to find out was an option), our clinic (Create) said IVF is the next step. GP (NHS) can’t do anything for us but did recommend talking to the clinic about stimulation, so it was interesting to find this thread today!

Hi @GreenTurtle75 not sure if this is directed at me but I am with Oxford TFP fertility. I went back to my fertility doctor and pushed and she agreed to give me a prescription for Letrozole, so if af comes next month I will try that next cycle. I have a friend who had 3 early miscarriages (and so was clearly ovulating) and she was given Letrozole and she conceived her DD first month, so I think advice does seem to really vary from clinic to clinic. I also pushed for a sperm dna fragmentation test - again it wasn’t offered - and so just waiting for the results for that. I hadn’t realised that I would need scans and progesterone tests on Letrozole so it’s actually a lot more expensive than I thought (£750 a month!!) so didn’t want to start until we had ruled out everything on the male factor side.

Thanks, that’s good to know! I’ll need another scan anyway as the previous one was about 5 months ago now, so they’ll need an up-to-date scan along with the DNA frag. I almost hope something turns up so we can do something about it. The thought of paying so much for a single shot at IVF is terrifying!

@GreenTurtle75 hiya, if you’re London based I would really recommend our clinic which is Bridge London - it’s a new clinic based in Kings Cross, they are very good and a lot cheaper and more personal than Create.

After lots of research, I actually went for a consultation and initial tests with both Create and Bridge and found the experience really incomparable. Create were keen to get us straight on really expensive IVF with all the extras, whereas Bridge suggested we try IUI first - which saved us thousands! Their prices are package based so what you pay includes everything - all scans, tests, procedures etc. just the medication is separate, but the Letrozole is only about £10 for the whole box!

@AnnieStar12 out of interest have you had any success with IUI? Our clinic have basically suggested not to bother with IUI because success rates aren’t great for heterosexual couples with unexplained infertility but I’m still wondering whether to give it a go before IVF…

@hopingforapeainapod yes, we did IUI with Letrozole twice. Both times I got two eggs. First time didn’t get pregnant, and second I got pregnant with one baby but sadly had a miscarriage at 8 weeks. We’re planning to try IUI again after my cycles return to normal.

Yes, success rates are low overall so we’re lucky to have 50% success rate so far! Whether it makes sense will be unique to each couple - for us it made sense to try this before IVF as we had convinced naturally twice before (one DC and one CP) and I’m approaching 40 so the stats for IVF success are also very low.

Hi @AnnieStar12 I’m really sorry to hear about your losses. Best of luck with your next IUI round 🤞🤞🤞it probably makes less sense for us to try it as I have never yet conceived naturally…

Also all I forgot to ask but did you also take progesterone alongside Letrozole?

Hey, iv done 4 rounds now of letrozole! I'm 8dpo so waiting to see has it worked, secondary infertility is no joke 😪 my 21 day progesterone tests have been around 33-38 which does confirm ovulation but my doc hasn't been happy with those levels. This cycle and the previous cycle iv been taking progesterone suppository's since 3dpo so hoping it works and then Il continue on until 12 weeks along with steroids and aspirin. Iv had 2 miscarriages in 2022 and 1 chemical last year.

Hi @wtbpg @AnnieStar12 @Daniki @GreenTurtle75 @hopingforapeainapod i know this is an old-ish thread but just wanted to ask how you’re all getting on? I’m on the same boat. I was prescribed letrozole to start on d2-6 of my next cycle, with scan monitoring and blood tests, and also cyclogest post ovulation. I do ovulate every month I think although the last one was d17 of my cycle and sometimes i have short cycles too (24 day cycle was my shortest). I have low AMH but the doctor we saw said that doesn’t really explain why we’re struggling to conceive and therefore we fall under explained infertility. I hope you guys had a positive outcome! We will try letrozole for around 3 mos then will do IVF. We’re with Lister clinic in London. Xx

@Pep1952 After 3 rounds of Letrozole (one was successful but ended in a miscarriage) I moved to IVF. After my second IVF cycle, I’m
now 10 weeks pregnant.
Tbh, my AMH was so low that I produced about the same amount of follicles when on Letrozole as when I was the maximum dose IVF drugs!

Hi @AnnieStar12 thank you so much for replying! I also have low amh (3.5 and I’m 36 y/o, 9 follicles on a recent AFC, DH’s SA is good) and the consultant suggested we do around 6 cycles of letrozole although DH and I agreed we’ll only do 3 mos but now I’m thinking twice if we should just go straight ahead with IVF! Sorry to hear about the miscarriage but congrats on your eventual success, very pleased for you and can’t wait for our time!

@Pep1952 of course do whatever is right for you, but after everything I’ve been through and learnt in the past year and a half on this journey - I would say if you’ve got low AMH then don’t wait about too long before moving to IVF!

Hopefully you’ll be lucky with just the Letrozole, but most people end up at ivf in the end! And low AMH can mean it takes a few attempts as you’re not going to get lots of eggs. My doctor also wanted me to keep going with Letrozole and IUI, but after three rounds I said I wanted to just get on with the IVF.

Thanks @AnnieStar12 i think we’ll give letrozole a chance for maybe 2-3 cycles then do IVF. We ‘re trying ‘naturally’ with letrozole and cyclogest (not doing IUI). I really hope it works!

@Pep1952 hi! I'm currently about to start stims in preparation for IVF which we'll be doing on my next cycle!

Hi @Daniki very exciting! I wish you the very best of luck xx