Infertility
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Two rounds of Femara in one cycle?

Hey everyone. I have tried three rounds of Clomid, all of which completely failed (no ovulation). I am also on 1500mg Metformin and have been for about 8 months. I went to an RE and was prescribed 5 mg of Femara and a trigger. Well, today was my ultrasound and unfortunately I did not have any mature follicles (I didn't get the exact size, the tech said they were itty bitty). I was so devastated because I just want to much to move forward with this cycle.  

Anyway, they prescribed 7.5 mg of Femara for the next five days and I go back next Thursday for another ultrasound. I'm not feeling very optimistic....has anyone had experience with this? Thank you! I have PCOS and never ovulate on my own. 

Re: Two rounds of Femara in one cycle?

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    Hello @brandiwiggins91! I don't have any experience with Femara but I was on two rounds of clomid in one cycle. Started at 50mg which wasn't producing any mature follicles and then increased to 100mg.
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    @brandiwiggins91
    Hey gal!  I've been through the exact same thing myself.  I have PCOS and don't ovulate on my own.  I never responded to Clomid at all.  The blood tests indicated that I didn't ovulate even while on the Clomid.  So they switched me to Femara.  When I first started taking it they did several ultrasounds to monitor my follicles.  They were typically not ever big enough the first time so they would send me home to take more Femara for a few days then back for another u/s to measure the follies.  It stinks that they didn't give you a head's up that you might have to take additional medications and come back again if they weren't big enough.  At least you could have prepared yourself mentally for a potential delay.

    My experience was that I responded really well to Femara and they grew pretty rapidly and I was able to trigger within about 3-5 days (usually just 3).  I'm on the max dose now and not responding like I used to, so I've been "upgraded" to Gonal-f when the Femara doesn't do the job.  But don't worry, they'll get those follicles to grow (they just have to find the right med and does for you) and you'll be triggering before you know it!  Hang in there!
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    I have not experienced this yet, but this is the exact protocol my RE said she would do if my follies aren't mature at my mid cycle US. I have a feeling we might need to do this just because I didn't respond to the Clomid like at all. I know Femara is a completely different drug and that's what I'm on now, so you just never know. It's all trial and error with these meds. It's their job to find the right fit for each individual. Good luck! 
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    I did a piggyback cycle of clomid that resulted in one large follicle. If possible next cycle ask for the extended protocol off the bat, about 5 days at 5mg then 2-3 extra days at 7.5mg all at once. I have read the extended protocol works better than the piggyback one. 
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    I haven't been responding to femara at all so am now on femara and menopur. Day 10 and no response so they increased my dose and I go back in a few days. I kind of think I'll get canceled. I hope you have luck with your next ultrasound!
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    This happened to me with clomid -- I have PCOS too, and was on metformin for over a year.

     I didn't respond to my first dose of clomid, so they immediately tried a higher dose of clomid starting the day of my unimpressive ultrasound. I didn't respond to that either, and immediately switched to femara.  That caused me to ovulate (with a trigger), but I didn't get pregnant.  However, I got pregnant the very next month with just the femara + trigger.  I noticed less side effects with the femara, and piggy-backing with multiple rounds of drugs in one cycle caused me to get pregnant much faster than I would have otherwise. 

    Good luck! 
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    @brandiwiggins91 Well, my thoughts were correct. The same exact thing happened to me today, as it did to you. 5mg of Femara and my biggest was only at an 8 today. So now 7.5mg for the next 5 days and back next Thursday. It's nice to hear that most of these ladies have had similar experiences and had good luck. How did your U/S go yesterday? Did the second dosing of Femara work for you? 
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    Hi I am new to all of this as well. This is my first and extremely long cycle. Started with 2.5 Femera no follicles on u/s so they up the dose to 5mg first week we still see no mature follicles
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    @akashal What did they say the next step is since you still aren't showing mature follies? 
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    During my first cycle, they started me on the lowest dose of Femara and I didn't respond, so they upped the dose and had me come back for a second ultrasound. Still nothing, so they increased the dose one more time, and scrapped the cycle when I still didn't respond. This cycle, they started me on the low dose of Clomid and at my ultrasound last week I still didn't have any mature follicles, so they increased my dose to 150 and I'm due back on Thursday to check progress.

    Wish me luck, because if this doesn't work, she's switching me to injectables and IVF.
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    I have done the back to back and sadly didn't end up having any mature follies but the next cycle I had the biggest follie I have ever had. :) 
    Me: 37 DH: 32 TTGP Since 2014 INFERTILITY INFO (Medicated, IUI's, IVF/FET) IN SPOILER
    October 2014-April 2015: Without Medication or Doctor Guidance No Periods/No O BFN 
    Medicated April-December 2015: Clomid (didn't work) and so we tried Femera/Letrozole. Progesterone Met 1000 Not diagnosed PCOS but treating the same. Anovulatory. TI No US No O BFN 

    - TW - 
    IUI"S 
    January 2016-October 2016: Letrozole 2.5mg-7.5 mg, Pregyl or Ovideral Trigger Shot.
    9 cycles of IUI
    (7 Cancelled due to no mature follicles) (2 attempted IUI's with mature follicles)  

    IUI # 2 June 2016 and July 2016:  Met 1000, Estrogen (21 days), Progesterone (5 days) Femera 5m 6/28/16 Ultrasound CD14 = 25 follie. Pregnyl Trigger CD14 IUI 7/13 1stBeta (DPO 15): 7.6 (Surprise BFP...but Low #'s) 2ndBeta (DPO 17): 18 3rdBeta (DPO 19) 52.8 Progesterone Prescribed (spotting) 4thBeta (DPO 26) 6.9 Chemical Pregnancy BFN

    IVF and FET (diagnosed with PCOS) 204 pounds at start of IVF
    IVF # 1 October and November 2016: CCRM - Minneapolis 10/14 Consult and CD 3 testing, 10/14 started (OCP Antagonist - BCP) BCP, 10/21 1 day work up, Doxycycline 100mg 10 days, 10/24 stop bcp, Bloodwork US 10/29, 10/30-11/8 Stims 2 vials of Menopur, Dexamethasone, 225 of Gonal-F daily (dropped to 120). CCRM Vitamin Cocktail (like 20 of them), Monitoring (11/2, 11/4, 11/5, 11/6, 11/7, 11/8), Retrieval 11/10 (38 eggs, 30 mature, 16 fertilized ICSI), 11/16 8 Blasts 11/30 CCS testing results 3 Normal 5aa's (2 boys and 1 girl) 1 Unknown 4 Abnormal (All girls) 


    Fet #1 January 2017: CCRM - Minneapolis bcp/lupron/suppository/p4 in oil QOD AF 12/7, 12/8 start meds. 1/3 lining and blood work check 14/15 mm, BW check 1/6. 1/9 transfer with acupuncture 1 CCS/PGS Normal 5aa hatching Progesterone around 26ish? Lower estrogen level 207 (wanted above 300 but over 200 was acceptable), started 1 estrace, progesterone in oil every other day, vivelle dot patches 4 every other day, 3x estrodiol daily, vitamin cocktail. POAS: - 4dp5dt and 5dp5dt, 6dp5dt frer very very very faint line. 7dp5dt and 8dp5dt + on Accuclear. 8dp5dt pregnant on a clear blue easy digital. 214 pounds at FET
    1/18 #1 Beta 91.1
    1/20 #2 Beta 215.9
    2/3 6 week US 2 sacs? Twins? but only 1 heartbeat/pole good heartbeat Stopped taking baby asprin Added in DHEA Veg Vitamin (also got the report that they transferred a girl 5aa eggo) 
    2/10 7 week US 2 sacs (likely vanishing twin) only 1 heartbeat/pole etc good heartbeat 137
    2/24 9 week US 1 eggo sac good heart beat 182 1 very small fluid sac (shrinking) 
    2/24 9 week 2 days start weening. Graduated from RE (CCRM is now starting weening as soon as 8.5 weeks)
    3/7 10 Weeks 5 days  weened completely of FET meds A1C 5.3% (Normal)
    3/9 11 Weeks 1 day my progesterone level was 15 and my estrogen level was 881 (I freaked out!)
    3/16 12 Weeks 1 day baby heard on doppler 164 HB
    4/14 16 week 2 days Ultrasound baby is looking good with all good numbers sized 17 weeks. Also got to hear her on the doppler for a few mins too. 

    5/5 19 Weeks 2 days going in for "20" week anatomy ultrasound got measurements but need to come back as wasn't able to get all the measurements
    MEASUREMENTS BPD 4.6 cm 19 weeks 6 days* (78%) HC 17.0 cm 19 weeks 4 days* (70%) AC 14.5 cm 19 weeks 4 days* (69%) Femur 3.1 cm 19 weeks 6 days* (63%) Humerus 3.1 cm 20 weeks 2 days (84%) Cerebellum 2.0 cm 19 weeks 5 days
    CisternaMagna 6.2 mm Nuchal Fold 4.5 mm
    HC/AC 1.17 FL/AC 0.22 FL/BPD 0.68 EFW (Ac/Fl/Hc) 309 grams - 0 lbs 11 oz
    THE AVERAGE GESTATIONAL AGE is 19 weeks 5 days +/- 10 days.

    6/9 24 Weeks 2 days Glucose Test 1 hour (Failed) 190
    6/16 25 Weeks 2 days Ultrasound and 1st Baby Shower 
    6/20 25 Weeks 6 days Glucose Test 3 Hours (Failed) 95 (95), 183 (180), 213 (155), 198 (140) etc
    6/21 26 Weeks Recommended to a perintologist
    6/22 26 Weeks 1 day start monitoring blood sugar levels 
    6/30 27 Weeks 2 day A1 (blood sugar test ordered)

    7/5 28 Weeks Echo and 3d Ultrasound
    AMNIOTIC FLUID Q1: 2.6 Q2: 3.2 Q3: 4.8 Q4: 5.6 AFI Total = 16.3 cm Amniotic Fluid: Normal 
    MEASUREMENTS BPD 7.2 cm 28 weeks 5 days* (60%) HC 26.4 cm 28 weeks 4 days* (48%) AC 23.3 cm 27 weeks 4 days* (36%) Femur 5.2 cm 28 weeks 0 days* (36%) Humerus 4.8 cm 28 weeks 0 days (49%)
    HC/AC 1.13 FL/AC 0.23 FL/BPD 0.73 Ceph Index 0.77 EFW (Ac/Fl/Hc) 1142 grams - 2 lbs 8 oz (37%)
    THE AVERAGE GESTATIONAL AGE is 28 weeks 1 day +/- 14 days.

    7/10 28 Weeks 5 days Dietitian Appt and Lactatcian Consultant and A1 blood draw 5.4% (normal) 218.5 pounds
    7/20 30 Weeks GD consult. 6 Lantus at 7pm daily. Novolog 1 unit for every 15 gm carbohydrate if consumed more than 30 gm at brkfst or 60 gm at lunch or supper 215.6 pounds
    7/20 30 Weeks Transferred care to OB due to high risk. 216 pounds

    8/2 32 Weeks Ultrasound (not cooperative and still breech) and then weekly NST's
    MEASUREMENTS BPD 8.0 cm 32 weeks 2 days* (44%) HC 29.2 cm 31 weeks 6 days* (22%) AC 26.9 cm 31 weeks 0 days* (24%)  Femur 6.3 cm 32 weeks 2 days* (57%) Humerus 5.7 cm 32 weeks 6 days (71%)
    HC/AC 1.08 FL/AC 0.23 FL/BPD 0.78 Ceph Index 0.78 EFW (Ac/Fl/Hc) 1808 grams - 3 lbs 15 oz (29%)
    THE AVERAGE GESTATIONAL AGE is 31 weeks 6 days +/- 18 days.
    AMNIOTIC FLUID Q1: 3.4 Q2: 2.9 Q3: 2.9 Q4: 4.4 AFI Total = 13.6 cm Amniotic Fluid: Normal

    8/8 32w6d upped to 1:10 for dinner 
    8/11 Baby Shower
    8/13 Baby Shower
    8/16 34 weeks NST good reading Upped to 8 at bed for fasting and 1:7 for dinner 
    8/18 Dr Appt

    8/24 35 weeks 1 day (was suppose to be scheduled for 36 weeks) Weeks Ultrasound/GD Dr Appt/OB Appt 
    Frank Breech
    MEASUREMENTS BPD 8.9 cm 35 weeks 6 days* (67%) HC 31.7 cm 35 weeks 1 day * (35%) AC 30.2 cm 34 weeks 2 days* (33%) Femur 6.9 cm 34 weeks 6 days* (57%) Humerus 6.0 cm 34 weeks 6 days (64%)
    HC/AC 1.05 FL/AC 0.23 FL/BPD 0.78 Ceph Index 0.80 EFW (Ac/Fl/Hc) 2494 grams - 5 lbs 8 oz (39%)
    THE AVERAGE GESTATIONAL AGE is 35 weeks 1 day +/- 21 days.
    AMNIOTIC FLUID Q1: 3.3 Q2: 3.8 Q3: 2.4 Q4: 3.8 AFI Total = 13.4 cm Amniotic Fluid: Normal

    8/31 36 Weeks
    9/7 37 Weeks
    9/10 Water broke...I got it tested at the emergency room it it showed it was negative. More water breaking and didn't go to the dr.
    9/11 37 weeks 4 days Called the Dr and got retested for water breaking...
    10:30pmish Baby Girl Born via Emergency C Section (Frank Breech Baby) 6lbs 3oz  -
    9/13 Dropped to 5 pounds 10oz and had jaundice 
    9/13 38 weeks

    9/22 39 Weeks 2 days C Section Scheduled for 10am (arrive at 8am) Equinox/Solstice
    EDD 9/27
  • Options
    Toby102008Toby102008 member
    edited July 2016
    @becauselove What did they do for the following cycle that resulted in the mature follie? Did you stay on orals or move to injectables? 

    Edited for spelling error. 
  • Options
    As my Dr. just said again this last visit to me...I respond non uniformly to the medication. So sometimes its hot and sometimes its cold. 

    The 2nd dose I took in the same "cycle" of Femera/Letrozole was a higher dose. And they kept me on that higher dose (5 instead of 2.5) for the future one. And it seemed to work. 

    She asked me what I had been doing differently and the things that were different during one of the "bad" cycles was not going to acupuncture and not taking my metformin. But likely those didn't have a ton of impact as just this cycle I have been taking a super low dose of metformin (and not with regularity...been lazy) and haven't been going to accuputure and I had a great follie this cycle. So its all hit or miss with me. 

    My Dr. won't go with injectables with me at this point based on that when it does work it works perfectly fine. She is worried about over simulating things. 

    It for sure makes things a roller coaster and can be super frustrating when I am doing everything right and don't get a mature follie.

    So I still currently do femera/letrozole at 5mg keep my fingers crossed. A trigger shot if everything goes well...and then a IUI. :) Its all just crap shoot for me...and sometimes lots of crappy luck. :) 


    Me: 37 DH: 32 TTGP Since 2014 INFERTILITY INFO (Medicated, IUI's, IVF/FET) IN SPOILER
    October 2014-April 2015: Without Medication or Doctor Guidance No Periods/No O BFN 
    Medicated April-December 2015: Clomid (didn't work) and so we tried Femera/Letrozole. Progesterone Met 1000 Not diagnosed PCOS but treating the same. Anovulatory. TI No US No O BFN 

    - TW - 
    IUI"S 
    January 2016-October 2016: Letrozole 2.5mg-7.5 mg, Pregyl or Ovideral Trigger Shot.
    9 cycles of IUI
    (7 Cancelled due to no mature follicles) (2 attempted IUI's with mature follicles)  

    IUI # 2 June 2016 and July 2016:  Met 1000, Estrogen (21 days), Progesterone (5 days) Femera 5m 6/28/16 Ultrasound CD14 = 25 follie. Pregnyl Trigger CD14 IUI 7/13 1stBeta (DPO 15): 7.6 (Surprise BFP...but Low #'s) 2ndBeta (DPO 17): 18 3rdBeta (DPO 19) 52.8 Progesterone Prescribed (spotting) 4thBeta (DPO 26) 6.9 Chemical Pregnancy BFN

    IVF and FET (diagnosed with PCOS) 204 pounds at start of IVF
    IVF # 1 October and November 2016: CCRM - Minneapolis 10/14 Consult and CD 3 testing, 10/14 started (OCP Antagonist - BCP) BCP, 10/21 1 day work up, Doxycycline 100mg 10 days, 10/24 stop bcp, Bloodwork US 10/29, 10/30-11/8 Stims 2 vials of Menopur, Dexamethasone, 225 of Gonal-F daily (dropped to 120). CCRM Vitamin Cocktail (like 20 of them), Monitoring (11/2, 11/4, 11/5, 11/6, 11/7, 11/8), Retrieval 11/10 (38 eggs, 30 mature, 16 fertilized ICSI), 11/16 8 Blasts 11/30 CCS testing results 3 Normal 5aa's (2 boys and 1 girl) 1 Unknown 4 Abnormal (All girls) 


    Fet #1 January 2017: CCRM - Minneapolis bcp/lupron/suppository/p4 in oil QOD AF 12/7, 12/8 start meds. 1/3 lining and blood work check 14/15 mm, BW check 1/6. 1/9 transfer with acupuncture 1 CCS/PGS Normal 5aa hatching Progesterone around 26ish? Lower estrogen level 207 (wanted above 300 but over 200 was acceptable), started 1 estrace, progesterone in oil every other day, vivelle dot patches 4 every other day, 3x estrodiol daily, vitamin cocktail. POAS: - 4dp5dt and 5dp5dt, 6dp5dt frer very very very faint line. 7dp5dt and 8dp5dt + on Accuclear. 8dp5dt pregnant on a clear blue easy digital. 214 pounds at FET
    1/18 #1 Beta 91.1
    1/20 #2 Beta 215.9
    2/3 6 week US 2 sacs? Twins? but only 1 heartbeat/pole good heartbeat Stopped taking baby asprin Added in DHEA Veg Vitamin (also got the report that they transferred a girl 5aa eggo) 
    2/10 7 week US 2 sacs (likely vanishing twin) only 1 heartbeat/pole etc good heartbeat 137
    2/24 9 week US 1 eggo sac good heart beat 182 1 very small fluid sac (shrinking) 
    2/24 9 week 2 days start weening. Graduated from RE (CCRM is now starting weening as soon as 8.5 weeks)
    3/7 10 Weeks 5 days  weened completely of FET meds A1C 5.3% (Normal)
    3/9 11 Weeks 1 day my progesterone level was 15 and my estrogen level was 881 (I freaked out!)
    3/16 12 Weeks 1 day baby heard on doppler 164 HB
    4/14 16 week 2 days Ultrasound baby is looking good with all good numbers sized 17 weeks. Also got to hear her on the doppler for a few mins too. 

    5/5 19 Weeks 2 days going in for "20" week anatomy ultrasound got measurements but need to come back as wasn't able to get all the measurements
    MEASUREMENTS BPD 4.6 cm 19 weeks 6 days* (78%) HC 17.0 cm 19 weeks 4 days* (70%) AC 14.5 cm 19 weeks 4 days* (69%) Femur 3.1 cm 19 weeks 6 days* (63%) Humerus 3.1 cm 20 weeks 2 days (84%) Cerebellum 2.0 cm 19 weeks 5 days
    CisternaMagna 6.2 mm Nuchal Fold 4.5 mm
    HC/AC 1.17 FL/AC 0.22 FL/BPD 0.68 EFW (Ac/Fl/Hc) 309 grams - 0 lbs 11 oz
    THE AVERAGE GESTATIONAL AGE is 19 weeks 5 days +/- 10 days.

    6/9 24 Weeks 2 days Glucose Test 1 hour (Failed) 190
    6/16 25 Weeks 2 days Ultrasound and 1st Baby Shower 
    6/20 25 Weeks 6 days Glucose Test 3 Hours (Failed) 95 (95), 183 (180), 213 (155), 198 (140) etc
    6/21 26 Weeks Recommended to a perintologist
    6/22 26 Weeks 1 day start monitoring blood sugar levels 
    6/30 27 Weeks 2 day A1 (blood sugar test ordered)

    7/5 28 Weeks Echo and 3d Ultrasound
    AMNIOTIC FLUID Q1: 2.6 Q2: 3.2 Q3: 4.8 Q4: 5.6 AFI Total = 16.3 cm Amniotic Fluid: Normal 
    MEASUREMENTS BPD 7.2 cm 28 weeks 5 days* (60%) HC 26.4 cm 28 weeks 4 days* (48%) AC 23.3 cm 27 weeks 4 days* (36%) Femur 5.2 cm 28 weeks 0 days* (36%) Humerus 4.8 cm 28 weeks 0 days (49%)
    HC/AC 1.13 FL/AC 0.23 FL/BPD 0.73 Ceph Index 0.77 EFW (Ac/Fl/Hc) 1142 grams - 2 lbs 8 oz (37%)
    THE AVERAGE GESTATIONAL AGE is 28 weeks 1 day +/- 14 days.

    7/10 28 Weeks 5 days Dietitian Appt and Lactatcian Consultant and A1 blood draw 5.4% (normal) 218.5 pounds
    7/20 30 Weeks GD consult. 6 Lantus at 7pm daily. Novolog 1 unit for every 15 gm carbohydrate if consumed more than 30 gm at brkfst or 60 gm at lunch or supper 215.6 pounds
    7/20 30 Weeks Transferred care to OB due to high risk. 216 pounds

    8/2 32 Weeks Ultrasound (not cooperative and still breech) and then weekly NST's
    MEASUREMENTS BPD 8.0 cm 32 weeks 2 days* (44%) HC 29.2 cm 31 weeks 6 days* (22%) AC 26.9 cm 31 weeks 0 days* (24%)  Femur 6.3 cm 32 weeks 2 days* (57%) Humerus 5.7 cm 32 weeks 6 days (71%)
    HC/AC 1.08 FL/AC 0.23 FL/BPD 0.78 Ceph Index 0.78 EFW (Ac/Fl/Hc) 1808 grams - 3 lbs 15 oz (29%)
    THE AVERAGE GESTATIONAL AGE is 31 weeks 6 days +/- 18 days.
    AMNIOTIC FLUID Q1: 3.4 Q2: 2.9 Q3: 2.9 Q4: 4.4 AFI Total = 13.6 cm Amniotic Fluid: Normal

    8/8 32w6d upped to 1:10 for dinner 
    8/11 Baby Shower
    8/13 Baby Shower
    8/16 34 weeks NST good reading Upped to 8 at bed for fasting and 1:7 for dinner 
    8/18 Dr Appt

    8/24 35 weeks 1 day (was suppose to be scheduled for 36 weeks) Weeks Ultrasound/GD Dr Appt/OB Appt 
    Frank Breech
    MEASUREMENTS BPD 8.9 cm 35 weeks 6 days* (67%) HC 31.7 cm 35 weeks 1 day * (35%) AC 30.2 cm 34 weeks 2 days* (33%) Femur 6.9 cm 34 weeks 6 days* (57%) Humerus 6.0 cm 34 weeks 6 days (64%)
    HC/AC 1.05 FL/AC 0.23 FL/BPD 0.78 Ceph Index 0.80 EFW (Ac/Fl/Hc) 2494 grams - 5 lbs 8 oz (39%)
    THE AVERAGE GESTATIONAL AGE is 35 weeks 1 day +/- 21 days.
    AMNIOTIC FLUID Q1: 3.3 Q2: 3.8 Q3: 2.4 Q4: 3.8 AFI Total = 13.4 cm Amniotic Fluid: Normal

    8/31 36 Weeks
    9/7 37 Weeks
    9/10 Water broke...I got it tested at the emergency room it it showed it was negative. More water breaking and didn't go to the dr.
    9/11 37 weeks 4 days Called the Dr and got retested for water breaking...
    10:30pmish Baby Girl Born via Emergency C Section (Frank Breech Baby) 6lbs 3oz  -
    9/13 Dropped to 5 pounds 10oz and had jaundice 
    9/13 38 weeks

    9/22 39 Weeks 2 days C Section Scheduled for 10am (arrive at 8am) Equinox/Solstice
    EDD 9/27
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    @becauselove I'm sorry it's been a rollercoaster. I know exactly how you feel. :( I'm curious if this doesn't work for me if she'll want to keep me on orals and just increase the dosage to 7.5 and maybe do more than 5 days or if she'll just want to switch to injectables. She seemed hesitant too on injectables because of overstimulating just because I have so many follies and something about me being tiny. (Not sure what that has to do with anything)  They just don't want to grow either. Darn our stubborn bodies! 
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