Femara & Intro

[samski]

Hi! I was originally going to post this on you know where but then I started reading and ended up here! 

I'm Sam. I'm 25 & DH is 27. We've been ttc since late 2009. After a few years, we finally decided this obviously wasn't gonna happen the old fashioned way. We turned to the gyno for an answer and after tons of blood work and an awkward u/s, I got the dx of PCOS. I started my 1st round of Clomid..no luck. Did a 2nd round..no luck. At that point, we were so frustrated that we just didn't even bother calling the gyno back asking for another round. Well lately I decided to put my big girl panties back on and try again. Went back to gyno and he felt it was best to not do another round of Clomid if both rounds failed and referred me to the RE with the thoughts that he was immediately going to put me on injectables. Whoa scary even hearing the words come out of his mouth! Well we went to the RE & he felt there was no need to jump to injections yet (partly because they're crazy expensive & because he wanted to exhaust all other options). Had to get more blood work done and another u/s (I was more prepared for this one  ). He finally came to the conclusion that we were going to get a sperm analysis done but in the mean time, start me on Femara 2.5mg 3x day. If it doesn't work this cycle, we will go again but add Metformin to the mix. After that, then we would move onto doing the hsg and injections. Phew..felt like I just typed a novel!

Anyway, my question for you ladies is... everywhere I've looked online, anyone that is taking Femara is taking either just 2.5mg 1x day or 5mg 1x day. Since I'm taking 2.5mg 3x day, I'm at 7.5mg daily. Is anyone else here doing that or has done this? If you've done it, any success? Any info appreciated!!!

[rainbowbridge14]

Welcome. I am so glad you got a referral to an RE, but I did want to mention that it does seem concerning that they are not having you get the HSG and having your husband get an SA before starting treatment. I would be hesitant to do treatment without that testing as it could be useless to do femara and timed intercourse if you have MFI or blocked tubes. I have PCOS too and sadly we also are dealing with MFI, and unfortunately that is fairly common as about 1/3 of couples dealing with IF have both male and female factor infertility.

In regards to your question on femara. The dosing usually starts at 2.5mg which is equivalent to 50mg clomid and the normal starting dose. When I did femara I started at 7.5 mg (I just took all three at once) because I hadn't responded to the clomid and they wanted me to start at the highest dose. I have seen other ladies REs prescribe up to 10mg, but mine says 7.5mg is their max dosage.

[samski]

rainbowbridge14 Thanks for the welcome! When I asked about doing the HSG before the Femara he said he felt pretty confident that it wasn't a blockage but we would have it done if the Femara wasn't working. I'm supposed to go back 2 weeks after last pill for blood work to check levels & u/s (3 weeks from now). Then I'm assuming we'll even know if the Femara worked. We actually have the SA scheduled for early next week and they do same day lab results so we should have a little time inbetween to get something started with DH if needed. The Dr. didn't seem to worried about it so at the time I wasn't either. But now I'm thinking maybe I should have asked a little more along the lines of your reasoning. Maybe I was just so excited that I just sat there like a deer in the headlights and went along

[BunnyBerry]

Welcome! Fellow TTCer-since-2009 here.
Glad you've gotten to an RE! We were so relieved after taking that step last year.

But I've got to say...how the heck would he know, confidently or otherwise, whether you have anything blocking the ute or fallopian tubes, unless you have an HSG? That's a red flag for me, unfortunately. Please insist on an HSG. It's a few minutes of discomfort/straight-up pain for a lot of peace of mind. And get going on that SA! Starting a treatment cycle before knowing SA results is heard of, but it makes you wonder why he's in such a rush without it.

I'm guessing he's starting you on the higher dose Femara because you did not respond to Clomid (if your OB monitored you mid-cycle to confirm whether you got mature folli(es)), or because your bloodwork indicated very high numbers early in your cycle that would interfere with the Femara doing its thing.

Another reason that I would be more wary of assuming the PCOS dx is all that needs to be treated is because you have been trying for so long without a lucky BFP - PCOS is not a death sentence for natural BFPs, so there's somewhat of an indication that another factor may be involved (perhaps tubal or MFI).

[remylove1011]

Welcome! Glad you found your way over here.

I'm currently taking Femera and will be having my HSG during this treatment cycle. It may be worth it to ask if this is an option for you. Also I'm glad to hear that you are in fact getting the SA done soon. We're dealing with MFI so doing timed intercourse would have been a complete waste of a cycle for us. My RE moved us straight to IUI for this. The other thing is that two weeks after last pill seems like a long time to wait for monitoring. I take my last pill on Sunday and then go back in on Friday. That gives the RE a chance to change/add something if your not responding and also we're doing a trigger shot.

[bluefairy5]

Welcome. A couple things:

1) Glad you found us!
2) Was your OB testing your progesterone level 7 days past presumed ovulation (or were you temping) throughout your Clomid cycles? Because if not, it's entirely possible you were developing follicles on Clomid and simply not releasing them without a trigger shot. I know this is possible because [say in superserious after-school-special PSA voice] it happened to me. I unwittingly did a Clomid round with my OB and from what we can figure based on side effects, follies yes, O no. This kind of extra ovulatory dysfunction (and variance in response to oral meds) is verrrrry common with PCOS.
3) My OB also assumed the RE would shoot me straight to injects, which just goes to show you how little OBs know. They don't seem very aware of Femara at all, and she certainly didn't seem to think about how injects and PCOS can be a very unpredictable combination.
4) The SA is crucial because if it comes back with anything way out in left field, you need to know not to waste your time with TI cycles, and move to something like IUI right away.
5) Others might flame me for this but I will go ahead and admit it: My RE didn't order my HSG immediately either (my OB never ordered it at all). I believe he did this because there was 0 reason to suspect endo (which can block tubes), I'd never had abdominal or pelvic surger (which scar tissue can block tubes), and I'd never had an infection history that would risk blocked tubes. My HSG ended up being just fine. However, here's the thing.  You can have endo and not know it.  You can acquire an infection and your body clears it before your next annual and not know it.  I never KNEW either of those things until between the time he ordered my HSG and I had the test.  I really wish I had stood up for myself and had him order it before I did a single Clomid cycle with him, for peace of mind. Once I learned everything was all good, a weight was lifted off my shoulders, but I also felt so stupid for not lifting that weight for myself as early as possible. And that is my flame-worthy confession.

Good luck!

[dancerspose]

Welcome and good luck!

I'm going to put my two cents in about the HSG...my RE strongly suggests one before treatment along with SHG, and I'm incredibly glad I went along with that plan, even though it did greatly delay me getting to treatment. I had absolutely no signs of endo, no pelvic pain or painful periods, but it turns out I did have a blocked tube. In my case, it isn't endo, but another blockage. My SHG also showed a uterus full of polyps, which would have impacted my ability to conceive too. Could treatment have worked with one open tube and the polyps, sure, but we're out of pocket for all treatment, but diagnosis (and surgery) were covered so we figured lets get all the information up front to make an informed decision about how to best use our limited resources. So, long way of saying, in my opinion, I'd want a full picture of my reproductive health before starting treatment.

Regarding the fermara. I didn't respond to one cycle of clomid and I'm doing my next cycle on 5mg of fermara. Since you were seeing an OB do you even know if you resonded to the clomid? Not knowing if you responded, it seems a bit high to start you on 7.5mg, but I'm no expert.

Good luck!

[mrspotatohead91]

I also did to respond to 50 and 100 mg of Clomid. My RE started me on 2.5 mg of Letrazole last cycle but didn't get a great response so he added in 5 mg to speed things along. This cycle he started me on 5 mg. I am sitting in the office now waiting for The ultrasound and bloodwork. Hopefully this progressed faster this cycle!

I definitely think you need to get an HSG done ASAP. There is no way your RE could know that your tubes are open. Hoping everything goes smoothly for you!! I personally wanted all of the testing out of the way because I didn't want to spend money on treatment without knowing that everything is working properly!!

[sumbeach]

Hello and Welcome! I ditto what everyone else has said. SA & HSG before you subject your body and you sanity with meds. Don't be afraid to ask/require proper care

[rachaeleigh]

Welcome!
PPs brought up a lot of good points. I'll just reiterate that I'd ask about the HSG, asap. :-)

[hrushka]

Welcome! PPs offered lots of good advice, especially about getting an HSG/SA sooner rather than later.

I'm also a little surprised you're on such a high dose right off the bat. Did I read right that you're not having an ultrasound until something like CD21? For your first time on the med and at such a high dose I would think you'd O somewhere closer to CD14, so your first u/s could be a week after O? That seems very odd to me.

[deelopi9]

Hi and welcome! Fellow PCOSer here. You've got some great suggestions and recommendations from the ladies. What type of PCOS did they diagnose you with?

[fightersince83]

Not to be a broken record, but push for the SA and HSG before more medicated cycles. If your tubes aren't open it's wasted time & money. Or, if the SA results are poor, that would change your options too. GL

[remylove1011]

Jan 23, 2015 8:42:04 GMT -5 hrushka said:

Welcome! PPs offered lots of good advice, especially about getting an HSG/SA sooner rather than later.

I'm also a little surprised you're on such a high dose right off the bat. Did I read right that you're not having an ultrasound until something like CD21? For your first time on the med and at such a high dose I would think you'd O somewhere closer to CD14, so your first u/s could be a week after O? That seems very odd to me.

All of this. I'm on Femera now. I take my last pill on Sunday (CD 7) and then go in for ultrasound on CD 12. It's surprising to me that they are doing no monitoring of the meds and not looking to see if she needs to trigger.

[mrsrodgersaz]

Hi! I agree with PPs about the SA and HSG. I would also ask why they are having you come in for monitoring so late. I did 3 rounds of Femara (5mg) and always went back in for monitoring between CD 10-13. The main reason they are monitoring is to make sure you don't have too many follicles. Since you've never taken Femara before, and you're on a high dose, I'd be worried about producing too many follicles and then running the risk of HOM.

[lillee]

Hi, you've gotten a lot of great advice so far so I just want to say welcome.

[tiffmich08]

Welcome and ditto what everyone else is saying! HSG is the FIRST thing my RE did! Also, on Femera (I was on Letrozole, same thing) I always go in for an US between CD11-CD14, I think if you go any later, it's possible you'll miss your O window.

[cateyes]

I agree with what others have said. I wouldn't take any more meds until all testing is done. If there is something going n in the male department or you have blocked tubes, then no matter what med you take, it won't work. Test first and then move onto meds.

As for meds. My RE started me out this month (first month) with 5mg once a day. If you didn't respond to clomid, that might be why you have a higher dose of letrozole.

[madamewaffles]

Hi there! I too am on 7.5mg Femara. This is my first cycle taking it - I took Clomid for a few cycles with mixed responses; some months were good, others no response at all. I asked to switch and they decided to start me off at a higher dosage because of the Clomid reponses. PPs have given great advice and wishing you the best of luck!

[rainbowbridge14]

Jan 23, 2015 2:05:22 GMT -5 samski said:

rainbowbridge14 Thanks for the welcome! When I asked about doing the HSG before the Femara he said he felt pretty confident that it wasn't a blockage but we would have it done if the Femara wasn't working. I'm supposed to go back 2 weeks after last pill for blood work to check levels & u/s (3 weeks from now). Then I'm assuming we'll even know if the Femara worked. We actually have the SA scheduled for early next week and they do same day lab results so we should have a little time inbetween to get something started with DH if needed. The Dr. didn't seem to worried about it so at the time I wasn't either. But now I'm thinking maybe I should have asked a little more along the lines of your reasoning. Maybe I was just so excited that I just sat there like a deer in the headlights and went along

All the other ladies gave the advice I would have gave about pushing for the HSG, but I did just want to add in that sadly not all REs are created equal. My first RE told me it was fine to do TI with 18% motility and 3% morphology which thankfully I later learned was not a good use of our time or money. He also wanted to do minimal monitoring and have me time my cycle with OPKs and not a trigger shot. I say that because if you push to have an HSG sooner and to get more monitoring (because you really need to be seen earlier than 2 weeks from the last pill) and your RE isn't responsive, sometimes stitching can be the best thing. It sucks that we have to advocate for ourselves so much in this process, I know we all want to trust our doctors, but if there is one thing I have learned from this board it is that you need to push for proper care if you are not getting it. 

[samski]

Thanks everyone for your awesome advice! Im definitely going to have to call them and see what's up! We definitely do want to put tons of faith into these doctors and I guess I never even thought to question it since this was like the first major step we've really done. To answer someones question about being monitored on the Clomid, yes the OB actually did monitor me and there was nothing happening. Thanks again everyone!

[bellefontaine]

Welcome! You've gotten some excellent advice! I have PCOS as well. I know it probably feels weird to second guess your Dr. They are supposed to be the experts right? Everyone else has said it better so I won't repeat. But it is super important to have answers from those tests before you put powerful drugs into your body. This is a great place to learn about what's right for you and what questions you should ask. I wish you lots of luck!

[daydreamsam]

Everyone else covered it so I just wanted to say welcome! I'm glad you found us and am glad to hear you are going to call them and pursue the HSG and SA. Good luck!

[tngirl89]

Welcome! I agree with the need for a SA and HSG, Good luck to you!

[Deleted]

I'd say everything was pretty well covered by the PPs. I hope it all worked out for you, welcome and good luck!

[Bombonny]

Welcome! I also have PCOS, though I have never taken that dose of femara/letrozole. I have had a great experience with metformin, but it can take up to a few weeks to months for people to start seeing the impact.. so I would recommend you talk to him about taking it sooner rather than later as well. I noticed it having an impact after about 3 weeks, but not everyone will respond similarly. My new RE wanted me to be on it for 4 weeks before starting treatment in order to make sure I got the full benefit. If you have any questions about it, feel free to ask or shoot me a PM!

Good luck advocating for yourself with your RE and hopefully you get all your new questions answered! Don't hesitate to get a second opinion if you feel like he's not giving you good responses. I am with a new doctor after almost a year of treatment, and it is absolutely the best thing I've done so far - I can't say enough good things about her so far; she is a million times better than my first doctor!