Femara after Clomid?

erinms

So we have done 4 months of Clomid with TI (three 50 mg rounds and one 100 mg round), each time producing 1 very large (27-32 mm) follicle and BFNs each time.

They are recommending that we move on, which makes sense, but we need to decide whether to try Femara or just go on to injectibles.

Anyone have experience with Letrazole/Femara after Clomid? 

We are unexplained IF- DH had a good SA and all my labs have been normal.  I have a short luteal phase, but managed to get KTFU with DS 4 years ago without medication despite that.   

TripMomma

Are you being triggered? Why are they letting the follies get that large? I was triggered around 20 on Clomid. I think you may have been working with over mature eggs. JMO.

erinms

TripMomma:

Are you being triggered? Why are they letting the follies get that large? I was triggered around 20 on Clomid. I think you may have been working with over mature eggs. JMO.

I don't have a good explanation.  They triggered me at CD 12-14 each time, moving up the u/s each time, until the last time they triggered a 30mm follicle at CD 12.  Every time I asked they said that the follicles can get very large on Clomid, and that they do see success with larger follicles, but that they were on the upper edge of size.

Honestly, I am unhappy with the way things went, but we're moving on.  I do think they were probably all over mature, so I'm hoping we have better luck with Femara.  If not, it's onto injectibles and many, many more ultrasounds for monitoring on injectibles.

TripMomma

 I think moving on is a good idea. I don't have any experience with Femara, but do as much research as you can...make yourself an expert then don't be afraid to advocate for yourself with your RE. Sounds like your follies get ready to ovulate early...so maybe you need more ultrasounds to make sure they trigger you at a good size. I wouldn't want to go over 22mm on pretty much any med. Good luck!

erinms

TripMomma:

 I think moving on is a good idea. I don't have any experience with Femara, but do as much research as you can...make yourself an expert then don't be afraid to advocate for yourself with your RE. Sounds like your follies get ready to ovulate early...so maybe you need more ultrasounds to make sure they trigger you at a good size. I wouldn't want to go over 22mm on pretty much any med. Good luck!

Do you know if there are a minimum number of days needed for the egg to mature?  Should you not trigger before a certain day, or once the follicles are at least 18-20mm you should trigger, even if it is very early in the cycle?  I mean, my follicles must have been 20 mm at CD 7 or 8.  Would I have triggered then? 

TripMomma

I have never heard of a follie between 20-24mm not being mature no matter what day of your cycle it is...UNLESS, it may be a left over follie/cyst from the previous month that never ruptured.

I think the key with you may be a day 3 ultrasound...just to make sure you are not holding on to any left overs, then I would want a day 6 ultrasound...and then every day/other day until the follies are 22mm ish. I know the ultrasounds are not cheap...I am OOP too, but they really take a lot of the guess work out, and give you much higher odds for a good outcome.

ttcmbbaby

I have done Femara after Clomid but only because I did not respond to Clomid. My follies never got big or mature and never more than one. On Femara I know I trigger later than I ever did because my follies mature later. I would think that your dose is too high also. Why did they increase your dose if you are producing mature follies? I think doing more monitoring would be helpful for you and trying Femara cannot hurt prior to moving to injectables but usually you only move on because you are not having mature follies... I don't know if this is even helpful but I hope so... I've done all three and stick with Femara because it's the only thing I have good mature follies without having too many (like I did on injectables).

kandmrod

My RE doesnt like follies to get over 25 because the quality isnt as good because they are overmature.  We triggered early CD10 (earlier than normal for me) because I had 2 follies one at 20 and one at 17-18.  I was on injectibles which made a huge difference for me.  I never tried Femara but I was a late responder on Clomid.  I would give Femara a try but see if you can add another ultrasound in the mix to make sure your follies arent overmaturing.  Good luck!