Femara vs Clomid for IUI- Second Question Follow-up

LO95 · April 2014

We had our first visit with the RE today. If we can improve DH's morphology he'd like to try IUI this summer. His first comment was Clomid, but I interjected and asked about Femara given that I have Endo and have heard Clomid can sometimes adversely affect the Endo.

He said he was leery to push it because it is a "Class X" but said he prefers it and went ahead wrote the script for Femara. (My SIL is going to the same doctor and, after 6! rounds of Clomid with her OB, is going to do Femara and IUI next month with him.)

I'd love all the feedback I can get.

Edit: I have a second question. Why do the REs prescribe the Femara/ Clomid protocol if there is MFI? Is it just to get more eggs? I guess I'm just curious because my doctors all seem to think there is no issue on my end. Which I guess makes me just want to say, "So why am I putting this stuff in my body then?"

pmpknbride · April 2014

Clomid is the only one that is FDA approved for fertility, but with that said, I've tried both, I was resistant to clomid and it gave me craaaaazy side effects. I responded all 3 cycles with Femara and didn't experience really any side effects, so that would be my preference between the two. BFN on all cycles for me, I've moved forward with injects! Good luck!

malerina · April 2014

Both drugs have a catch.

There is already a substantial research results out there linking Clomid with cancer (after multiple cycles use) and Letrozole (Femara) shows some association with birth defects.

The judge is still out there for Injectibles use because they only did Ames tests ( mutagenesis test on bacteria strains) to show that its safe to use and they are expensive.

So, it's your choice what to take as endo loves hormones either way.

That said, small doses to get ovulation started will be probably fine. Do talk with your RE about your concerns as he probably has a lot of experience.

Good luck with your treatments!

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Cbeanz · April 2014

Hi @LO95 !

Clomid did little for me but induce hot flashes, but it is FDA approved so it was the first try. I responded well to Femara. But like PP said, some women respond to one over the other.

emilykbw · April 2014

I became Clomid resistant and had a lot of side effects - moodiness, night sweats, headaches. I didn't respond well to low doses of Femara, but responded well once I got to 10mg and had zero side effects. Femara is a little more expensive, but with a coupon from GoodRX, it's about the same. Good luck!

Lillovebug79 · April 2014

malerina said:

There is already a substantial research results out there linking Clomid with cancer (after multiple cycles use)

This is absolutely false!!!! There is no actual medical research showing this. There is only research showing that women who suffer from infertility may be at a higher risk of ovarian cancer. There is no medical research linking clomid to cancer!!
Furthermore, one could argue that Clomid has been studied way more extensively than Femara. Femara isn't even FDA approved for use in fertility. Not that I think it's bad, it's just not as well researched and hasn't been around as long as a Clomid. Who knows what people will say about it 20 years from now.
You need to discuss what is best for you with your doctor. I did many, many cycles on clomid and while I hated some of the side effects, I had ideal results from it. I didn't get a BPF but in all fairness, that wasn't because of the drug. We are MFI so no matter how well I respond, it doesn't matter if we don't have good enough sperm! I will say that in time I built up a tolerance and had to increase my dose. And although it *can* have negative effects on lining and cervical mucous, that is not the case the majority of the time.
Good luck with whatever you chose!

Edit for quote fail!

malerina · April 2014

Lillovebug79 said:

malerina said:
There is already a substantial research results out there linking Clomid with cancer (after multiple cycles use)

This is absolutely false!!!! There is no actual medical research showing this. There is only research showing that women who suffer from infertility may be at a higher risk of ovarian cancer. There is no medical research linking clomid to cancer!!

Lillovebug, I assume you mean this study:

https://www.ncbi.nlm.nih.gov/pubmed/24170988

To start off here are some links to the most recent studies:

https://www.ncbi.nlm.nih.gov/pubmed/24700523

https://www.ncbi.nlm.nih.gov/pubmed/24595623

https://www.ncbi.nlm.nih.gov/pubmed/23943232

Since clomid is taken to induce ovulation in subfertile and infertile patients, yes, it makes sense that the only results out there are from patients with infertility. I bet it would be very hard and unethical to find healthy females who are willing to take the drug for scientific research only. But here we have a study on rat ovaries that compares ovary tissue from letrozole, clomid and tamoxifene treated groups and all show ovarian dysplasia.

https://www.ncbi.nlm.nih.gov/pubmed/24728105

I am not trying to scare anybody, I am just giving information that yes there is a risk (well-documented), and yes its dose dependent. I confirmed this with my RE as well before I started the treatments. I wish my OBGYN told me about this when I started clomid.

Lillovebug79 · April 2014

@malerina‌ Your example #1 has to do with infertility, not specifically Clomid, examples #2,3, and 4 also can not say that clomid is specifically linked with cancer. None of the research can point the finger at Clomid causing cancer. It leads more to the general underlying reason for infertility or to women who have never been pregnant.
Your second paragraph speaks exactly to why you can't make that statement and what most research says, when you can't compare the results in infertile women vs those who are not, you can't say for sure that it was the fertility drugs that caused it. Nearly every research article states exactly that.
It shouldn't scare anyone because it's simply not proven.

Lillovebug79 · April 2014

And also @malerina‌, the last study you sited said absolutely nothing about all showing ovarian dysplasia, it said it was higher in treated groups, specifically tamoxifen a and letrozole! You didn't include any of that in your first comment linking clomid to cancer and not Femara. I wouldn't put a lot of faith into a rat study alone, especially when no research on humans can specifically link them. None of the research identified a clear increase in cancer with Clomid as you claimed in your first statement.

malerina · April 2014

@Lillovebug79, as you correctly pointed out no research on humans can prove there is direct link to cancer. I hope there never will be one. I wish you good luck in your treatments.

Lillovebug79 · April 2014

@malerina‌ Good luck to you as well. Please avoid using misleading phrases like "substantial research linking to cancer" which will only frighten people and is not actually supported in the research. I know you didn't have the intention of worrying anyone but statements like that often do.
edited to add quotes.

malerina · April 2014

Ok. It's getting late, and I suggest we all avoid strong statements

.

Cigarette smoking also doesn't "link to cancer". It increases the risk of getting it. Substantially.

We don't know yet how great is the risk with these drugs, but there is some evidence.

You are welcome to disregard it as non substantial. The question of association and causality is open here as in many other cases.

I posted links for people to read and learn about the drugs they get prescribed. I hope they will be helpful for somebody who needs to make a decision and can discuss the risks with their physician.

In the end of the day I will take the drugs all the same, and many other people will.

And let's hope they work

sunlavender · April 2014

I can't speak to the side effects of Endo, but I have been on both Clomid and Femara (Letrozole).

I had similar responses to both (2-3 eggs each cycle) and little physical/emotional side effects. I do prefer the Letrozole over Clomid as it doesn't negatively affect my fertile CM in the same way Clomid did. My O pains tend to me more acute on Letrozole as well (although that probably has nothing to do with anything).

Good luck.

DharmaChick · April 2014

I also can't speak to the side effects of endo (sorry), but I have PCOS and went on several cycles of Clomid and I'm now on Femara.

As others have mentioned, I think that most REs start with Clomid, as it the most common med used. Most doctors won't continue it more than three cycles if it hasn't worked out, and it is not recommended for using longer than six months. It seems to be the most "productive" med, for those who respond to it (not everyone does). Side effects vary a lot, as the women of this board can verify (some have had miserable reactions, others have had none). For me, I definitely noticed some of the side effects, but they were tolerable.

After no BFP on Clomid, my RE recently moved me to Femara. It was slightly more expensive, but with insurance it still wasn't bad. I tend to have some dizzy spells whenever I start any new med. Otherwise, the only side effect I've noticed on Femara is very low energy. I feel like I could nap all day. I can't speak to the results yet, but my fingers are crossed!

Good luck to you!!

LO95 · April 2014

Thank you to all who replied!

I know that this can be a really big debate. My RE hinted that there is a lot of controversy about these medications and that he wanted to build some trust up with me before he started prescribing drugs that weren't on approved lists. I guess I wondered if maybe I jumped the gun by expressing concerns about Clomid with Endo, which then led him to say that he prefers Femara to Clomid in many cases. But of course I second-guessed myself when I got home by thinking, "Well, crap. Should I have just said 'Yes' to the Clomid?"

This fertility stuff is so scary. We are dealing with MFI, as another poster mentioned, and so it has made me question the need for Femara/Clomid with IUI if things are "clear" on my end. Does anyone know why you have to do this protocol if it's MFI?

Thanks for your help!

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Lillovebug79 · April 2014

Exactly what @GrailSeeker14‌ said. We are MFI and I've done many rounds of clomid and a few follistim rounds in the hopes of having more "targets" for sperm to hit. It hasn't helped us but it does sometimes help to have multiple eggs.

tarala · April 2014

@LO95‌ Hi- I am over on the Infertility board but I can try to answer your question from my experience. We are dealing with MFI, as well. It was my choice if we wanted to do the clomid/Femera with an IUI. I tried both.

For my first cycle I used clomid. I seemed to have more side effects- such as night sweats- and my lining wasn't great. I only had one follie. That IUI failed. Next cycle we tried Femera. All I had was minor spotting on it; however my lining was great and I had 3 follies. Again, it failed. (This cycle we are doing IVF).

I also questioned why I was on these drugs when we were dealing with MFI. I always ovulate on my own on almost the same day each cycle. My RE explained that the more eggs I produced the better chance one had to fertilize. That second time I had 2 on one side and one on the other- gave the sperm a chance to get into either tube to potentially fertilize.

Good luck and know that everyone is different!

jaco0207 · April 2014

Hi there, we are dealing with mild mfi and egg quality issues. I believe what someone else said was right on, more targets. I initially did two rounds of clomid, but it thinned my lining, and I was switched to Femera. With both I was monitored with a day 10-12 ultrasound to make sure I responded well. I generally had 4-6 follies per cycle, which is what they wanted with my age and egg quality issues. If it was more they would have likely cancelled the iui. Do you know if they are planning to monitor you while on fertility drugs? I think most ladies on this board would agree that this is an important aspect of being on either clomid or femera. Luckily I did not have any side effects with either. As for cost, clomid was not covered for me, but femera was, either way both were affordable ($25 vs. $5). Good luck!

Femara vs Clomid for IUI- Second Question Follow-up

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