AW: First Medicated Cycle

LindseyM2012 · November 2014

I'm sorry to do an AW post, but I'm on my first medicated cycle and still have some questions about what to expect. I've picked some things up from you ladies, but I'm still a little anxious - probably because I've waited so long for this.

I took 2.5mg Letrozole CD4-8 and am going for my mid-cycle ultrasound and bloodwork tomorrow morning. I'm excited and scared at the same time. I haven't had any side effects from the Letrozole (other than headaches, but those are normal for me even without meds) so it makes me anxious that I am not responding. I know the amount of side effects do not correlate to what my ovaries are or are not doing, but I was kind of expecting to feel something. If I don't respond, is it normal to get another dose of Letrozole in the same cycle (I think I read previously some ladies here did that) or would I just scrap this cycle and wait until CD35 to start Provera (I don't get CD1 on my own)? I'm hoping I'm responding well and depending on what tomorrow's u/s shows, I'll give myself a shot of Ovidrel and get busy with "homework".

So my questions: I believe follicles are considered mature and ready for trigger at 16-25mm, correct? If none are that large, will my RE have me wait a day or two to trigger or should I insist on another u/s in a couple days? I'm trying to plan out possible appointments just in case because I'm trying to give work as much notice as possible if I need to tweak my schedule (without having to tell my boss about IF). I'm also nervous about giving myself a shot. The needle on the training video I watched didn't look that big, but the shot also hasn't arrived yet so I don't know for sure. It is no big deal, right?

LindseyM2012 · November 2014

@Buttmonkey34 - Thanks for the reassurance on the shot. I don't really have a fear of needles, but I don't exactly like them either. It'll be weird to have to look when the needle goes in (I normally look away when somebody else sticks me).

@nariadreaming - Thanks! If it does come to scrapping my cycle, I'll ask about not waiting until CD35. I didn't even know that was an option to start Provera right away. That makes me feel better.

LindseyM2012 · November 2014

@firstarabesque - Thanks! Feeling no side effects is definitely throwing me off. Glad to know you've had good sized follicles without many side effects.

redandblue · November 2014

I agree with PP. I have done two rounds with the Ferama and haven't had any side effects and both time developed 2 beauty follies. So try to be patient. The US and BW will give you the most accurate information. The nurse also gave me the ovidrel shot, so I didn't have to worry about that. My RE is pretty efficient and when I have never had an appointment longer than 30 minutes. Even my last IUI I was in and out in about 15 minutes. So strange really. FX crossed for you. The first cycle I believe is the worst for waiting.

LindseyM2012 · November 2014

@BlueFairy5 – Thanks. I’m definitely trying not to be anxious. Very difficult J

@amymckenzie555 – My RE is pretty great with keeping appointments only as long as necessary. My baseline u/s and b/w appointment was less than 30 mins!

@Rumbera28 – That is really good to know about the E2 levels! I didn’t know that, so thanks so much! I appreciate being armed with as much information as possible so I can understand the RE’s decisions.

BandM14 · November 2014

I had barely any side effects last month on Femara (headaches, which I get anyway, and a couple very brief hot flashes) and I still wound up with 3 follies! I didn't do a trigger shot, so no advice on that, but I will be doing my first one this month if I have follies on the left-- so we can take the plunge together!

I actually have my mid cycle tomorrow morning too, to see if I'm responding well this month and if we can do the IUI. Good luck to you, I hope we both get good results!

BunnyBerry · November 2014

One follie is almost always the norm on Femara, so it wouldn't be weird not to feel anything happening ovary-wise.

I'm never able to pinpoint ahead of time the day of trigger/IUI or even when exactly they'll have me in for repeat ultrasounds - we were all set for Saturday AM IUI and it ended up turning into Tuesday AM because my follie was a slow grower. That's actually the #1 reason why I am so ready to be done with IUIs - it's so stressful and kind of embarrassing to make last-minute plans to miss work.

I've given myself the Ovidrel shot twice and kind of enjoyed it, because I felt tough and empowered!

deelopi9 · November 2014

My RE likes to see them above 18mm. Your follicles on average grow around 1mm a day.

firstarabesque my old RE didn't do mid-cycle bloodwork, only at the first medicated natural cycle, after that they never checked.

typo31 · November 2014

If you are anxious, would you consider having another person give you the trigger shot? Needles make me shaky as hell, so I make my husband do mine. If I ice the area and put my earbuds in with some loud music cranking I kid you not - he has to shake me to tell me it's done!

LindseyM2012 · November 2014

@BandM14 – AW!!! We’re cycle buddies this month! Good luck with your appointment tomorrow morning! Are you giving yourself the trigger or is the nurse?

@BunnyBerry – I’ll be happy with one follicle. I’ve discussed this with my husband and he is against selective reduction so I’ll scrap a cycle if there is more than two since we’re doing trigger shots. I’m glad to hear you’ve had a good experience with the trigger shots. I hope I feel as tough as you! J

@rainbowbridge14 – Your point will be important to keep in mind. I’m a creature of habit and like when things are predictable, so I’ll just have to prepare myself for the possibility of things changing up at the last minute.

@typo31 – I’m such a control freak that I don’t want my husband to do the shot. I also don’t exactly want him to know when it will be so our “homework” won’t be so forced for him. He’s never had a performance problem, but I don’t want to take the chance. I want to make this as fun as possible.

I just want to say how sweet and lovely all you ladies are!!!!!!

coaster102516 · November 2014

No advice to add because I am in the same boat as you. I have done Clomid once and Femara twice before. I am currently on my third Femara cycle and this time we are doing the trigger shot. I go in Monday for my mid-cycle ultrasound.

I have crazy side effects with Femara but had zero side effects while taking Clomid. Switched to Femara because Clomid left me with a nasty cyst and thinned out my lining. Everyone is reacts different, doesn't mean you aren't responding though.

This will be my first trigger shot and can't decide if I am going to do it or have my husband. I am a control freak but don't necessarily want to stick myself with a shot...

dancerspose · November 2014

I have no advice since I have yet to get to a medicated cycle, but I just wanted to say good luck!

LindseyM2012 · November 2014

@CaitOst21 – Good luck with the trigger. I’m sure it will be just fine…we’re probably psyching ourselves up for nothing.

@hrushka – Thanks lady!! I was wondering what would happen if someone didn’t want to take Provera right away. I guess that’ll be a decision you’d make when the time comes.

@shafwilson – Thanks so much! You’re so sweet. J

DharmaChick · November 2014

Congrats on being off the bench!!

I don't have much to add to what has already been mentioned here, but I'll mention my experience:
I've had pretty much no symptoms/side effects on Letrozole, though I did have some unpleasant side effects on Clomid. The most recent cycle was the only one where I felt some discomfort, and this was likely due to two follies that were very close together. I have only seen one mature follie on each Letrozole cycle. If you don't 'feel' anything happening, don't worry.

I always have a bit of a slow response (and my RE is a bit conservative with dosage in order to avoid cancelling a cycle) so I generally need to go in for more than one ultrasound. As others have mentioned, they look for a follie that is at least 18mm and they also check E2 levels to help determine how close you are to ovulation. If they don't see any progress, particularly in E2 levels, your RE may prescribe a second round of Letrozole.
While I needed to "stair-step" when I was on Clomid (do a second round of meds within the same cycle, at a higher dosage), I've only had one cycle on Letrozole when I needed a second round, and it was at the same dose (5mg) as my RE will not go above 5mg.

As for the trigger shot, the most difficult part is the mental step of getting any past issues with the idea of giving yourself an injection. Or, for me, it was the worry that I would somehow do it wrong. Honestly, the process is super easy, and it doesn't really hurt. The needle for Ovidrel is tiny, and simple to use.

Good luck!!

mshandlebar · November 2014

Other PP have pretty much covered things. I am glad you are off the bench!

I also had to go back a few days later when my follies weren't big enough. The first cycle was definitely the most stressful, and I had a hard time planning it all out. While I hope you only have to do this once, you will have a much better idea about scheduling next time.

Also, don't sweat the shot it is seriously next to nothing. It's a thin little needle and I can barely feel it go in. I do get paranoid about the placement (I obsess about the 1 inch from belly button 'cus I've gotta obsess about something). I usually draw a little bullseye on my belly

Good luck!

lebradford · November 2014

You're off the bench!! Yay! Good luck, lady!

BandM14 · November 2014

@LindseyM2012 Thanks!! It went really well, so we will be doing IUI #1!!! I'm going again Sunday to check follie size, and the nurse said she thinks I'll definitely be ready because I already have 1 that is mature and 3 that are close (2 of the close ones are on the blocked side so we don't have to worry about the potential for quads haha). I'm going to do the trigger myself Sunday night if all goes well Sunday morning! MH and I actually have a party to go to Sunday, so I may be doing it in my cocktail dress in the bathroom lol. I hope your appointment went awesome today!!! Keep me updated

LindseyM2012 · November 2014

@BandM14 - YAY for mature follies! I'm so glad to hear that for you! You paint a funny picture with the cocktail dress and trigger shot.

My appointment went just fine. Good news: I'm responding to the Letrozole. Not so good news (but not bad): My follies are still cooking. I have one 14mm on the right and one 10.9mm on the left. I'm waiting for my E2 results to see when I'm going back for another u/s. It'll probably be Monday.

Everyone here really helped me adjust my expectations about the timeline. If you all hadn't told me your experiences, I'd probably be much more disappointed about not being ready to trigger.

BandM14 · November 2014

@LindseyM2012 That's great that you are responding!! Hopefully you are ready to go with 2 mature follies on Monday-- the nurse told me today that they can grow 2mm per day, so that would both of yours in range in a few days

. I'll let you know how my first trigger shot goes on Sunday, but I feel much better after reading all of the responses you got on here, so thanks for posting this!

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