Monitoring on Femara(Letrozole)? Did I overreact?

[tumbleweed]

I've never taken femara, but considering your cyst history, wouldn't they just want to cover their asses and do a baseline with you? Is it really that hard to look for what, 30 seconds?

[daydreamsam]

Um, no. You didn't overreact! If you were a long time patient, with no history of cysts and were OOP, I could see an RE saying, let's skip the baselines to save you money but not in your case. I actually asked my RE if we could skip the baseline one time because I was going to be out of town and he looked at me like I had just landed from mars, he gave me the option of skipping the cycle or cancelling my trip.

Good job on being your own advocate (although I'd expect nothing less from you )

[remylove1011]

You did not overreact and are right to ask for the ultrasounds (especially given your history). So kudos to you for making sure you get the baseline!! I will be calling in the next day or so on CD1 (starting spotting today so it's looming) and so we'll see what my RE says. I will also be doing Femera and from discussion when planning this cycle it did sound like I'd have a baseline ultrasound. I'll let you know!

[snd1231]

@ketchup no that is not normal, especially given your history of the clomid incident. It is less common to develop cysts on Femara as on Clomid, but it is still possible. I have always had a baseline. It was non-negotiable for my RE which was fine since insurance covers it all. My RE is very cautious with all my monitoring given my past medical history. You definitely have a right to be concerned and it's great that you were able to stand up for yourself and get the proper monitoring. Just this last cycle my RE went back to my baseline u/s to see where my follicles were at compared to where they were at at CD13 monitoring since I was responding super slow. I definitely would say that your RE needs to step up on the monitoring front. I think I remember you saying they only did one monitoring u/s last cycle and told you to wait two days and trigger even though your follicle wasn't totally ready??

[emmuffy]

I always get a day 3 u/s at my clinic. I don't have to ask. I don't like that you had to push for this, but good for you for being a strong advocate for yourself.

[lillee]

1. All the wine
2. You did not overreact. I've always had a baseline with Femara.

[cateyes]

My RE does monitoring with all med cycles including femera. You are not over reacting and especially with a history of cysts, it seems common sense. Push to be monitored!

[annaclaire256]

I would definitely say, with your history, you did NOT overact. My RE doesn't require me do baselines anymore because I've done so many cycles without issue, but she makes it my choice. She did say if I moved to injects it would be required. Glad you stuck up for yourself! Sorry about your BFN....enjoy your wine!

[lilyharper]

Yeah as someone who had a ruptured hemmoraghic cyst on Clomid I wouldn't want to screw around either...it would also make me question the quality of the RE tbh. Especially since he didn't immediately offer monitoring after actually Reading your file.

[lovegrilledcheese]

I don't you overreacted ketchup and with your history I would be even more cautious. My RE won't give a prescription for a medicated cycle until you have had a baseline ultrasound CD 3-5. If you can't make it to the ultrasound then you don't get the script.

[bluefairy5]

a) You didn't overreact. With your history? Are you shitting me? Some REs (including mine) don't consider baselines crucial when everything went stellar the previous cycle, but in your shoes I cannot imagine not getting a baseline each and every time, for peace of mind if nothing else. Especially if you're not totally OOP.
b) Very sorry to hear about AF showing her jerk face. Alex Skarsgard wants to take you out for some wine:

[lilyharper]

bluefairy5 any gif with Alex Skarsgard is a good one.

[cateyes]

Jan 17, 2015 14:46:01 GMT -5 lovegrilledcheese said:

I don't you overreacted ketchup and with your history I would be even more cautious. My RE won't give a prescription for a medicated cycle until you have had a baseline ultrasound CD 3-5. If you can't make it to the ultrasound then you don't get the script.

Smart office. If you don't have time for the appointment then you don't have time to properly use the medication! 

[bandm14]

I'm gonna give what may be a flame-worthy confession, but I have never done a CD 3 monitoring appointment on Femara. My first RE just never mentioned it, and when I called on CD 1 for my first medicated cycle I asked the nurse about it and she said they don't do them for this medication. I thought maybe this was just RE #1, but when I met with my new RE this week and told him that I hadn't been doing baselines he said that that was totally normal for a Femara cycle, since the risk of cysts is extremely low with it... and I trust this guy, because he has a pretty amazing medical background and seems awesome. He did say that I would absolutely have to do a CD 3 u/s every time for injects cycles (which are up next for me if this one doesn't work out), and told me that there is a higher risk of cysts and over-stimming so they increase monitoring on the injectable meds.

All that being said, given your history @ketchup, I think you were totally right to push for a baseline. I don't think there is such a thing as being "too pushy" in this process--- you have to do what you feel most comfortable with. I don't like any doctor that takes a "one size fits all" approach-- so what if they "don't normally" do baselines for Femara cycles? You want one, you are the patient, and your medical history suggests that monitoring is very important for you. So I'm glad that you advocated for yourself and will be able to get the treatment you want! Also, I'm sorry for CD 1. I hope you have lots of wine tonight.

[murrt]

Definitely did not overreact. My RE doesn't always monitor mid-cycle, but she always does a baseline for safety. How comfortable are you with this new RE in terms of everything else he's said to you?

[sammae]

Not an over-reaction at ALL! ESPECIALLY since you BTDT.
Our clinic does baselines for all monitored cycles and you meet with the RE, nurse AND pharmacy afterwards to make sure everyone's on board.
Kudos for kicking your RE's ass! You pay them enough GD money to do their job and monitor you properly!
WINE for you! **runs upstairs to refill her own glass**

[bluefairy5]

Jan 17, 2015 16:28:43 GMT -5 bandm14 said:

I'm gonna give what may be a flame-worthy confession, but I have never done a CD 3 monitoring appointment on Femara. 

I'll be your flame target buddy! I did Clomid, not Femara, but I skipped quite a few baselines as well, because my RE didn't think they were necessary. (To his credit, my body doesn't seem very cyst-prone [PCO "cysts" being something else entirely, that is]). Kinda glad I'm not the only one.

[SweetieShellie]

i had baselines done for all 4 of my femera IUIs, so you had every right to ask for one!

[bandm14]

Jan 17, 2015 17:02:00 GMT -5 bluefairy5 said:

Jan 17, 2015 16:28:43 GMT -5 bandm14 said:

I'm gonna give what may be a flame-worthy confession, but I have never done a CD 3 monitoring appointment on Femara. 

I'll be your flame target buddy! I did Clomid, not Femara, but I skipped quite a few baselines as well, because my RE didn't think they were necessary. (To his credit, my body doesn't seem very cyst-prone [PCO "cysts" being something else entirely, that is]). Kinda glad I'm not the only one.

Haha thanks for 'fessing up with me bluefairy5, I'm glad I'm not the only one too! I sort of figured that if there was a big risk of cysts with the Femara, that the clinic would push for baselines to a) cover their asses by making sure nobody had one rupture and b) because why not? It's more money for them the more visits they make people do. Like I said though, if I had had any history of cysts or knew that I was at risk for them, I would have asked for a baseline (although I would have hoped that I wouldn't need to and that the RE would be on top of knowing my history and individualizing his approach!)

[cinzink]

WTF? I am so sick and tired of patients having to be more educated than their doctors in order to receive proper and safe care. I'm in a bad mood as is today but seriously. It took me 3 years to get dx with lupus and fibromyalgia ten years ago. I was told by a reputable dr, "you just need to learn to handle every day pain." Always told the same thing about periods, "pain is normal, you just have to handle it."
One of the reasons I love this community is the knowledge you and others provide as well as the support. We're supposed to trust our drs but it makes it hard when there are shady ones willing to take risks with your body. I'm so sorry @ketchup.
I give you my TP from next week.

[NariaDreaming]

No, you didn't overreact.

Granted, I didn't have a baseline this IVF cycle, but that's because I had a mid-luteal ultraound 2.5 weeks prior and I was on suppression drugs.

[nikiswimr]

I already said this but you definitely didn't overreact. Especially with your history! I'm going to pull some @ketchup tactics to get a CD3 ultrasound if one is not offered. Interestingly same RE did a CD3 ultrasound for me this cycle (probably because my CD12 ultrasound for IUI # 1 showed a cyst?). But no cysts with this last cycle on mid-cycle monitoring so I'm guessing I'm going to get the same spiel.

All the wine for you today!

[fightersince83]

I ALWAYS get a baseline u/s with bw plus additional monitoring appts (u/s & bw) while cycling (approx every 2-3 days). It's standard procedure @ my RE to make sure my E2 is cooperating and that I'm responding appropriately. This was true for my IUI (Clomid + injects) and IVF cycles. You were right to push for it. Especially with your hx. Supposedly there is less risk of over responding with Femara, but how will they know how you're responding if they have no baseline for E2 and follies? Go Ketchup!

[lindseyp2012]

You did not over react. Especially your history with a ruptured cyst (who cares if that was Clomid and not Femara), I'd be a tad paranoid/cautious too! Personal anecdote: my 2nd round of Femara I had 5 mature follicles and decided to trigger. Due to the large amount of follicles, they brought me in for a post-trigger u/s to make sure everything looked ok. Only 3 of the 5 follicles ovulated and 2 were left to either shrink away or keep growing into a cyst. Went in for baseline on next cycle and they did shrink away. Moral of the story: un-ovulated follicles do happen on Femara and you are right to always ask for proper treatment.

Correct me if I'm wrong, but I think this is your first cycle off the bench so there's little chance that you'll have leftover follicles/cysts but still...always better safe than sorry!!! As long as you don't curse out the RE, I think you're fine.

[lemonliz]

I don't think you overreacted. At all.

By chance did they happen to run baseline blood work though, to check E2? Sometimes that gives them an idea of whether or not you might have a cyst.

[lg2793]

I don't think you overreacted at all! My RE does baseline u/s and bloodwork every cycle before I can take femara. The only exception was my very first cycle of femara...they did bloodwork before, but no vag cam.

Good for you, standing up for your body's health!

[hrushka]

I don't think you overreacted at all. Especially given your history. I've done seven Femara cycles, never had issues with cysts or more than one fully mature follicle and I always HAD to have baseline and multiple mid cycle ultrasounds.

That being said, I was surprised to learn that many PPs didn't have as much monitoring on Femara. Now I kinda feel like after so many of the same cycles I probably had more ultrasounds than I really needed <$$$flush$$$>. I'm sure it's just my clinic's protocol, and better safe than sorry and all, but ugh.

And sorry for the BFN, @ketchup. I hope the Femara is nice to you.

[deelopi9]

Hell no you didn't over-react. In any work environment you take different approaches with different types of people. You are an educated woman who has experience to back up your knowledge. I've always had baseline appointments w/ all of my cycles natural & medicated. Sorry for the BFN cycle buddy.

[ldubhawksfan]

I don't think you over reacted, especially given your history. Good for you for advocating for yourself. That pisses me off that you got so much attitude and resistance from your new dr.

[BunnyBerry]

I'm with bandm14 (we go to the same place and have discussed this before) - I only got a CD3 u/s on Letrozole when I didn't just come off another treatment cycle. They said that if you had normal ovaries at mid-cyle, with confirmed O, then there was no worry about cysts on this med. I took them up on it. Although one month I insisted on one because I thought I'd felt a rupturing cyst. I think it's good that he allowed you to get one. And, I've had large (5- and 6-cm) cysts in the last couple years, but that didn't worry them.

ETA: Just saw your update. I always got bloodwork for hCG - I was told it was a requirement since Femara is contraindicated with pregnancy.