Had RE consult to ttc#3, now I'm confused

queenbone · May 2012

Last week we met with the RE to discuss our plan to ttc#3. Last time I did 75 iu of Follistim, ovidrel trigger, and TI. I triggered with a 18 and 18.5. Our first cycle worked.

He had reviewed our file and said that we could have had triplets because I also had a 14 and he counts everything over 12. He however was on vacation when I triggered and another RE there was monitoring/advising me. No one mentioned that to us last time. Now DH is totally freaked out about doing Follistim again.

The RE said that the lowest dose now for Follistim is 50iu so if we wanted to do Follistim again we could try that. He also suggested I could try Letrozole. That would certainly be a lot less expensive, but I have two concerns:

1) I HATED clomid. I was like a crazy, evil person on it and I worry that I could have a similar reaction on letrozole (I had no s/e from follistim.)

2) I worry that I'm working backwards here going from inj to oral meds. I had 3 unsuccessful rounds ttc#1 and 4 unsuccessful ttc#2. I'm 36 so I'm not getting any more fertile, and I wasn't very fertile to start with! I feel like I have less time to mess around with options that could work and would rather stick what I know worked in the past.

Since it has been 2 yrs since I was ttc, he wants me to do a clomid challenge test which I'm less than thrilled about, but figure I should probably do it.

The other controversial thing we talked about was Family Balancing. Do we want a daughter? Yes. We were hoping to see about doing the sperm spinning for sex selection. The RE however doesn't do it and doesn't have any faith in it. He said we could do IVF for family balancing, but I feel like that is a really dumb idea when we are at the end of our family building journey. I don't want extra embryos, etc. Having a daughter is very important to me, but I don't think it is that important. Plus I don't think we could afford it anyway.

So, if I can't do sperm spinning for sex selection I don't want to do an IUI and would rather stick with follistim, trigger, TI.

I think DH is leaning towards trying the letrozole because the RE freaked him out. He really only wants one more, not 2. He is ambivalent about IUI because he is not Catholic and doesn't have all my hang ups.

So I'm overwhelmed now and don't feel confident about how I want to proceed. Thoughts?

P.S. Any successful letrozole stories are welcome.:)

jenber77 · May 2012

I've definitely heard that the side effects from letrazole are not nearly as bad as those from clomid. And I know that sometimes people respond to letrazole when they don't respond to clomid, so I don't think you can expect the same results. It might be worth a shot for a couple of cycles, but I think if I'd want to move on pretty quickly. The low dose of follistim sounds like a decent plan.

Sunshine05 · May 2012

I had absolutely zero side effects from Femara/Letrozole and had success with it on my 3rd round!

queenbone · May 2012

Sunshine05:
I had absolutely zero side effects from Femara/Letrozole and had success with it on my 3rd round!

Was that with an IUI?

Cajunladybug22 · May 2012

I had success with Metformin/Letrozole/IUI on our 2nd round to get pg with DD. It's also what we'll be doing again next cycle to try for #2. I already ovulate on my own, so the Letrozole was for timing purposes mostly, but I have several PCOS friends who have WAY better success with Letrozole than they did with Clomid, and tons less side effects. They can also go up from 2.5 to 5.0 and 7.5, so if you don't ovulate on the first dose, there are options.

I had one, big beautiful follie each time. Good luck!

kgs0505 · May 2012

What is the point of doing a Clomid Challenge? What kind of information will that give you? I'd be reticent to ever have clomid in my body again too, as I had similar issues with the stuff. Neither of the two RE's I've been to have suggested that test.

Sarafuss · May 2012

Sunshine05:
I had absolutely zero side effects from Femara/Letrozole and had success with it on my 3rd round!

Same here. We did IUI. If it were me I would go with what has worked in the past. If you have more follicles than you are comfortable with you could cancel the cycle.

Sunshine05 · May 2012

queenbone:
Sunshine05:
I had absolutely zero side effects from Femara/Letrozole and had success with it on my 3rd round!

Was that with an IUI?

I had done IUI but my successful cycle was with TI. It was a place holder cycle while waiting to start injects. I only ever had 1-2 follies, which is a great thing about letrozole... fewer follies.

LnR70707 · May 2012

I thought 6 cycles was the maximum lifetime recommended limit for clomid? Wouldn't a clomid challenge put you even farther than that? With 7 failed oral med cycles, I'd go for the lower dose of injectables.

betheveh · May 2012

Femara baby here on our first IUi with it. That was after 2 failed IVFs and 2 failed Iuis with Clomid. And I also was nuts on Clomid but had no side effects with Femara. I'm a big fan

dusk42 · May 2012

I have had a headache twice with letrozole (out of 7 cycles over the last few years), and that is the extent of the side effects. It doesn't have the same side effects as clomid because clomid blocks estrogen receptors everywhere and letrozole just temporarily inhibits estrogen production and is cleared quickly.

I have read that lots of REs now use letrozole plus injectables because it lowers the cost a lot (I only did 3-4 days of menopur (days 7-10 or 7-11)). I think it is worth a shot if it will lower your number of follicles.

DD was conceived with just Femara + TI (no trigger), and I have always had 1-2 follicles per cycle with either Femara alone (trigger + TI) or +menopur/trigger/IUI (once I had 2 mature and one smaller, but BFN). My RE added the menopur because my lining is on the thinner side with just Femara (6-7). This is my third cycle with Femara/menopur, so after this we will reassess if it doesn't work. But I am a big fan of letrozole (and so is my RE - he doesn't generally use clomid and prefers letrozole).

Good luck!

BigHairQueen · May 2012

I had success with Femara! No s/e at all!!! I tried 4 rounds of Clomid, 1 fresh IVF, and 2 FETs (see siggy) and I got pg with twins the first time I tried Femara (and TI to boot, how does that happen?!?).

mmttc1b · May 2012

I thnk I'd look for a lab that offeres sperm spinning.

A friend of mind did several cycles with clomid and the clomid did nothing for her. She then tried one cycle win Letrezol and now has 3 year old triplets. I'm sure this information would really freak our your husband, although I understand multiples on Letrezol (sp?) are rare.

crystalgirl · May 2012

kgs0505:

What is the point of doing a Clomid Challenge? What kind of information will that give you? I'd be reticent to ever have clomid in my body again too, as I had similar issues with the stuff. Neither of the two RE's I've been to have suggested that test.

A new antral count to reassess ovarian reserve...

I don't have any advice, really, as I've always had to go straight to IVF+ICSI from the get go. I'm sorry you have so much to sort out. GL with everything!

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