Secondary IF

Femara (Question for ladies with experience)

I have a friend who is experiencing 2IF and I referred her to my OB.  We both did the 3 rounds of clomid, didn't work for either of us. I got referred to an RE (I assume because of my age).  (She got pg w/ her dd on round 4 of clomid the first go round).

She had her "what next" appointment and our OB is putting her on femara for 3 cycles, if it doesn't work, she'll be referred to an RE. Our OB told her with the femara she doesn't have to be monitored. Is this true? Does this sound right? I ask because had we decided to do an IUI, I was going to do femara + injectibles and I was given a 2 page warning on femara and would be required to sign a waiver before I started it.

My friend also asked about an HSG and our doctor told her "she didn't think she needed it" but that would be something to consider if the femara didn't work. Sidenote, she said the same thing to me and I had a blocked right tube and I freaking ovulated on the right 2 out of the 3 clomid rounds. Crying (not saying it would have made a difference, but I certainly didn't have much of a chance).

I know, I added more detail than needed! lol My main question is: is it safe to not monitor on femara? TIA.

My Little

Re: Femara (Question for ladies with experience)

  • Officially, I don't know.  Unofficially... (please no flames)

    My RE monitored me for the first round, just to make sure it was working as desired.  It was - had great follies, 10m lining, etc.

    Second round, I was told I didn't need to come in, since we've established that it did work as desired (O achieved, no complications). The only requirement was that I not call for the prescription until AF had started (CD1), as taking Femara WHILE PREGNANT can have serious consequences (birth defects).  I went ahead unmonitored, as we're out of pocket.  I knew I was taking a chance.

    Third round, I dealt with a new nurse, who refused to call in the prescription unless I scheduled an ultrasound.  I asked her to check with the doctor to verify what he'd already told me - in the meantime, she kept me on the phone and filled my head with horror stories.  She called in the script, but I was so freaked out, I didn't take it. (Was out of town at the time, so I couldn't just go in, though I would have)

    To make my long story longer - I think it depends upon the definition of the word "safe".  If you've taken it before without any complications, there's a good chance that you will continue to be ok.  It's the "what if" that concerns us - we've all ready the horrible things that can happen if not monitored and issues not caught in time.  None of us wants to be in that position, which makes monitoring a great idea.  It can't hurt, YKWIM?

    My advice, sice your friend has never taken it before, is to ask/insist to be monitored at least during the first cycle on the new drug.  As for the HSG - if she thinks it could be an issue, why wait?  Why waste 3 months only to possibly realize they were a waste of time?  Why not go into a cycle with Femara already knowing that the tubes are clear?  Makes sense to me... (I skipped the HSG because of being OOP.  It's the first thing I'll be doing next month when my insurance kicks in)

    I don't know if this book I've just written has been helpful at all... I am curious though - if Clomid worked for your friend for her first DC, why are they going to Femara now?  I love Femara, but it's because Clomid never worked for me... GL!!!

    Doriimage
    "Just keep swimming, just keep swimming..."

    Miracle DD born 12.2005
    TTC #2 since Dec 2008 w/ PCOS
    ***P/SAIF Always Welcome***

    Keep it Natural, Baby!
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  • No flames here. I'll be honest, I was/am a little jealous that I didn't get to try femara before going to an RE. Although it was a blessing in disguise, since the RE did the hsg and we wasted 2 of 3 cycles anyway. So, here I am taking fertilfreakingaid hoping for a miracle. I digress.

    She has cystic ovaries, but my OB is hesitant to diagnose her with PCOS.  She has been on metformin these last 3 cycles and she did do a CD 3 U/S yesterday and told her she could do a 4th round of clomid if she wanted, since that is what worked w/ dd, and then go to femara for 3 cycles if it didn't work, or go to femara. My friend chose femara because she won't have to take the estradiol with it. I am guessing since clomid worked before but isn't now, that is why she is going to femara. I would personally insist on the hsg, I mean that is potentially 6 cycles that were a waste.

     

    My Little
  • When I did Femara for my IUI I was monitored on day 3 to make sure no cysts before I started then again on day 12 to see if it was time to trigger.  I did clomid before that and didn't get monitored so I don't think you HAVE to get monitored but I think most you ask will say that you should.  I would definitely have an HSG before doing 3 rounds of Femara.  I can't understand whay a doctor would move forward without being 100% sure that there are no blockages.
    Trying for baby #2 since May 2010. DX elevated prolactin. Clomid round 1-50mg=BFN. Clomid round 2-100mg = BFN. Began taking Cabergoline and prolactin levels regulated. July IUI#1= BFN. Break cycle for August and BFP on 8/26/11! Baby Birthday Ticker Ticker BabyFruit Ticker
  • I have only done 1 round of Femara, but my experience is that I got a u/s on day 3 to check on my known clomid cyst, as well as a blood hcg to confirm I was not pregnant.  I also got a u/s the day of my IUI to check follicles, but this was optional, but recommended since it was my first time on Femara so it would be a good idea to see if it worked.  

    I know the chances of multiples are much less with Femara and it has less of an effect on your lining so I can see why the midcycle ultrasound wouldn't be needed.  I do think that a day 3 one should be mandatory since you need to make sure there aren't any cysts that would worsen with a drug like Femara.

     

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  • imageMySweetBaboo:

    No flames here. I'll be honest, I was/am a little jealous that I didn't get to try femara before going to an RE. Although it was a blessing in disguise, since the RE did the hsg and we wasted 2 of 3 cycles anyway. So, here I am taking fertilfreakingaid hoping for a miracle. I digress.

    She has cystic ovaries, but my OB is hesitant to diagnose her with PCOS.  She has been on metformin these last 3 cycles and she did do a CD 3 U/S yesterday and told her she could do a 4th round of clomid if she wanted, since that is what worked w/ dd, and then go to femara for 3 cycles if it didn't work, or go to femara. My friend chose femara because she won't have to take the estradiol with it. I am guessing since clomid worked before but isn't now, that is why she is going to femara. I would personally insist on the hsg, I mean that is potentially 6 cycles that were a waste.

     

    I've never done Femara but I completely agree that proceeding without an HSG is silly.  If there is a physical blockage all the medication in the world is not going get her pregnant but in the meantime she's taking fertility meds.  Makes no sense to me.  But I know it's done and I know many OBs allow it.  I think the key is, it's an OB and the best OB in the world on fertility issues is still not at an RE.  I know you didn't ask for this opinion but I think it's great that you've moved on to an RE.  It's their job to get you pregnant, and as you already learned, they don't waste time not doing important diagnostics.

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  • I do not have a lot of experience with Clomid or Femera, but I know when I was discussed the IF issue with my OB, she said the first thing she woudl do is HSG. Since so many of her patients end up PG a month or two after checking and cleaning out the tubes.  Plus she said what is the point if your tube or tubes are blocked nothing can happen.

    She then said if we were serious and would move on past just clomid and TI she suggested have the RE perform all testing and move forward with them. 

    When we were referred with DS in 2007 we did all the blood work testing and SAs and then I was sent for the HSG the month before we were to start treatments.  Ended up getting PG that month on our own to a huge suprise since we have MFI and DH has a huge morph issue.

    Just met with new RE on Tuesday and again month of testing once I get AF this month I will have my HSG and then we will move on with treatement after I get my AF in October so first medicated cycle will begin in October. 

    They will monitor ally cycles not sure if I am doing clomid or femara, depends on what the Dr. decides at our visit in early October. 

    Good Luck!

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  • I am on my 4th round of femara.  I have to take a pregnancy bloodtest every month before they give me a script for it.  I was also given the paperwork about the risks, but the way my RE explained everything, the study that said it caused more of an instance of birth defects was disproven.  I start taking it on CD3-7 and then go in for a follie check on CD10 (well, this cycle is CD11 b/c they always have me come back and do another one before trigger so we are trying to eliminate that). 

    Anyway, follie check, trigger and then IUI.  Of course then the 2ww.  I guess I average about 3 appointments a month between CD3 bloodwork, follie check and IUI.  I don't think they are monitoring the femara so much as they are taking steps to get me PG.

    I like femara way better than clomid.  I took that for 2 months and it was horrible.  SO moody.  Femara has no effect on me with moodiness or lining.

     HTH!

    Jen Mom to Benjamin, born 9/28/06 TTC # 2 since 7/2010 Unexplained IF 1st round of clomid April 2011 BFN 2nd round of clomid May 2011 BFN 1st round of femara June 2011 BFN 2nd round of femara with ovidrel and IUI #1 July 2011 BFN 3rd round of femara with ovidrel and IUI #2 August 2011 BFN 4th round (ahhhhh!!!!) of femara with ovidrel and IUI #3 converted to TI September 2011 ???
  • Not sure what's "safe" but for me being monitored is the way to go.  I never get a +opk (unless triggered) even though I'm ovulating.  I've gone in for a follie check before a planned IUI only to see that I already ovulated because my cycle was thrown off by femara, which has made cycles longer and shorter then normal for me.
  • My OB doesn't monitor with Clomid. He doesn't use Femara that I know of. I wouldnt do Clomid unmonitored so when OB wanted me to try it I asked for the referral. My RE uses Femara instead of Clomid. He always monitors but he did say he prefers it because there is less chance of multiples and less lining issues with it.
    Oct 2008 m/c #1 5 weeks, May 2009 m/c #2 4w5d. BFP 6/23/09 EDD 3/8/10!
    You gain strength, courage and confidence by every experience in which you stop to look fear in the face. -Eleanor Roosevelt
    After 1 year of TTC#2 BFP May 2011 m/c #3 4w2d. Off to RE.

    Round 1: Femara + Ovidrel +TI = BFP! EDD 2/20/12
    Lilypie Third Birthday tickers Lilypie First Birthday tickers
    2IF does not always equal 3IF...Surprise!
    Lilypie Maternity tickers
  • Hey!  My apologies that I'm super late.  My 2 cents:  I would insist on getting an HSG before starting any ovulation-inducing meds, and I would insist on being monitored on Femara.  Yes, it's "safer" than clomid, but it's not effective and totally safe for everybody and I'd rather find out before it's too late.  I wouldn't take any meds without knowing whether they're working for me.  Good luck to both of you!
    Pregnant with #1 with PCOS and LPD, success with mostly naturopathic treatments
    Our Thanksgiving Day baby 11/22/07

    imageimageimage

    Pregnant with #2 with LPD, uterine polyp/hysteroscopy, DOR (AMH = 0.17), 2 c/ps
    Our early Christmas present 12/9/10
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