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Monitored vs. unmonitored medicated cycle (losses mentioned)

jilligan14jilligan14 member
edited October 2015 in Infertility
Hi all,

I've been hanging out at the "TTC>35" page for the past year and heard this is a cool place as well. So I thought I'd say hi!

I'm almost 36 and have been TTC #1 for awhile now (stopped preventing in 11/12 and started really trying around 8/14). I got pregnant twice in 2014 by natural means, but both resulted in early miscarriages. I went to an RE in Dec, 2013 and was diagnosed with PCOS. My DH has excellent sperm count, mobility, etc. I've been seeing an acupuncturist for a couple months and she put me on a strict no carbs/sweets/fruits diet and encouraged me to increase my protein/meat intake. I'm also taking a billion vitamins and some nasty herbal concoction. I've noticed some positive effects - such as actually ovulating (this doesn't always happen) and having some nice high temps during the luteal phase.

I also just started seeing a new RE and did some more testing. It now looks like I have high-ish prolactin levels, which is most likely caused by my PCOS. I just started taking cabergoline to bring the levels down. The RE wants me to take Letrozole next cycle and said it's up to me if I want to do the ultrasound monitoring (with trigger shot) or not. Not sure how much it would cost with our insurance to be monitored so I'm looking into that. Although it does seem way easier and cheaper to do it unmonitored...

Feeling sad at the thought of giving up on an all natural conception but also anxious and a little panicked that I'm about to be turning another year older. So H and I figure we'll move forward with the Letrozole next cycle, unless I get super lucky this cycle!

Looking forward to connecting with all of you. Good luck to everyone!
ME: 36 (PCOS), DH: excellent SA
NTNP since 11/12, actively trying since 8/14
m/c @ 7w (4/22/14), m/c @ 6w (11/19/14)
11/15: Letrozole, Ovidrel, TI = BFP!!!
Beta #1(14dpo)=349, Beta #2(18dpo)=2,805
12/17/15: Got to see the heartbeat (105bpm)!
1/25/16: NT scan = normal (HB=163bpm)
EDD: 8/10/16 
8/8/16: Baby boy born @ 12:25am, 8lbs, 20.5 inches
5/18/17: BFP!!! (11dpo)
Beta #1(12dpo)=176.4, Beta #2(15dpo)=607.1
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Re: Monitored vs. unmonitored medicated cycle (losses mentioned)

  • HBamama2BHBamama2B member
    Letrozol even isn't bad, but I definitely recommend the monitoring (and most other ladies on this board will to). Letrozol has less side effects than clomid and can be more effective than clomid for us PCOS ladies so that's a definite plus! It's hard to give up the idea of natural conception, but you replace it with higher odds of holding a bundle of joy. :) are you doing IUI?? welcome and good luck on your journey!!
    Report Reply
  • jilligan14jilligan14 member
    @HBamama2B - thanks for responding. I've definitely heard that you should really do the monitoring with Clomid but it sounds like it's not as necessary for Letrozole (but I'm getting contradictory info here). In your opinion, what are the risks of NOT doing the monitoring? I'm going to write to my RE today and see if I can talk to the financial counselor just so I have all the information. We aren't doing IUI yet because H has really good sperm but we'll consider it if the first medicated cycle doesn't take. There's just so much info to take in and so many decisions to make...
    ME: 36 (PCOS), DH: excellent SA
    NTNP since 11/12, actively trying since 8/14
    m/c @ 7w (4/22/14), m/c @ 6w (11/19/14)
    11/15: Letrozole, Ovidrel, TI = BFP!!!
    Beta #1(14dpo)=349, Beta #2(18dpo)=2,805
    12/17/15: Got to see the heartbeat (105bpm)!
    1/25/16: NT scan = normal (HB=163bpm)
    EDD: 8/10/16 
    8/8/16: Baby boy born @ 12:25am, 8lbs, 20.5 inches
    5/18/17: BFP!!! (11dpo)
    Beta #1(12dpo)=176.4, Beta #2(15dpo)=607.1
    Report Reply
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  • riveridgionalriveridgional member
    I believe the risks of not monitoring with Letrozole are: (1) you could have a cyst prior to beginning treatment, which would make stimulation dangerous; (2) you won't know if it is working for you; (3) you won't know if it is working too well for you (you may have too many follicles, resulting in a real risk for high order multiples); (4) you won't be able to time IC as well to make sure you catch the egg(s) and to know when any progesterone supplements should start; and (5) no monitoring after O when not automatically taking progesterone supplements will not ensure you don't have a progesterone deficiency.

    It's a cost-benefit analysis you will have to go through if you aren't sure you want to spend money on monitoring.
    Married to DH 10/6/12
    TTC since 5/14
    Unexplained with (controlled) hypothyroidism and suspected ovulatory dysfunction (but, I do ovulate on my own)
    Clomid 50 mg 3/15 (unmonitored) - BFN
    Clomid 50 mg + metformin 4/15 (unmonitored) - BFN 
    First RE appt. 5/15; Natural cycle 5/15 monitored with 2 mature follicles and Pregnyl Trigger (full dose) + prometrium - BFN
    6/15 HSG - clear tubes & normal uterus; great PCT test results
    TI - 100 mg Clomid + prometrium (AM & PM) + vaginal estrace (AM & PM) 6-7/15 (monitored) --> no additional response and thinned lining - BFN
    TI - Injectables (follistim + Gonal-F, Ganirelix, & 1/2 dose Pregnyl) + prometrium (AM & PM) 9/15 --> 3-7 mature follicles (3 definites and 4+ that could have matured due to trigger) @ O -->BFN + 5 large cysts
    BC for 2 weeks due to cysts
    TI - Injectables (Gonal-F, Ganirelix & full dose Pregnyl) + prometrium (AM & PM) 10/15 --> 1 mature follicle --> BFN 
    TI - Last attempt at injectables (Gonal-F, Ganirelix & 1/2 dose Pregnyl) + crinone (AM only) + vaginal estrace (AM & PM) 11/15 --> 3-4 mature follicles --> BFP!! 11/27/15 @ 13dpo (shockingly, actually waited until then to test)

    Beta #1 @ 16dpo (11/30/15) = 1,075
    Beta #2 @ 19dpo (12/3/15) = 3,150
    One baby: Saw heartbeat @ 5w5d (114 bpm; baby measuring 2.3mm)

    "Great Things are Happening"
    Report Reply
  • riveridgionalriveridgional member
    Also, over 99% of people who take the trigger shot will ovulate, and it allows you to time IC better.

    I'd lean towards monitoring, but, of course, I don't know your story and financial circumstances. So, you just need to make the best choice for you! Good luck with your decision!
    Married to DH 10/6/12
    TTC since 5/14
    Unexplained with (controlled) hypothyroidism and suspected ovulatory dysfunction (but, I do ovulate on my own)
    Clomid 50 mg 3/15 (unmonitored) - BFN
    Clomid 50 mg + metformin 4/15 (unmonitored) - BFN 
    First RE appt. 5/15; Natural cycle 5/15 monitored with 2 mature follicles and Pregnyl Trigger (full dose) + prometrium - BFN
    6/15 HSG - clear tubes & normal uterus; great PCT test results
    TI - 100 mg Clomid + prometrium (AM & PM) + vaginal estrace (AM & PM) 6-7/15 (monitored) --> no additional response and thinned lining - BFN
    TI - Injectables (follistim + Gonal-F, Ganirelix, & 1/2 dose Pregnyl) + prometrium (AM & PM) 9/15 --> 3-7 mature follicles (3 definites and 4+ that could have matured due to trigger) @ O -->BFN + 5 large cysts
    BC for 2 weeks due to cysts
    TI - Injectables (Gonal-F, Ganirelix & full dose Pregnyl) + prometrium (AM & PM) 10/15 --> 1 mature follicle --> BFN 
    TI - Last attempt at injectables (Gonal-F, Ganirelix & 1/2 dose Pregnyl) + crinone (AM only) + vaginal estrace (AM & PM) 11/15 --> 3-4 mature follicles --> BFP!! 11/27/15 @ 13dpo (shockingly, actually waited until then to test)

    Beta #1 @ 16dpo (11/30/15) = 1,075
    Beta #2 @ 19dpo (12/3/15) = 3,150
    One baby: Saw heartbeat @ 5w5d (114 bpm; baby measuring 2.3mm)

    "Great Things are Happening"
    Report Reply
  • jilligan14jilligan14 member
    @riveridgional - thanks for all the info! I wonder why the RE seems so casual about doing it unmonitored if there's all these risks? I'm definitely looking into it more to see what the overall costs will be and will do it if it's possible/feasible for us. Also, in regards to the cysts...I have PCOS, which means I have cysts all the time. The RE knows this and didn't seem concerned. So when the first monitored ultrasound checks for cysts, are they just checking for a certain amount or a certain size? Because I know I already have some.

    I still have a bit of time to sort all this out because my next AF isn't due until early November (unless a miracle happens and I have a natural BFP before then!). but boy, it's a lot to think about...
    ME: 36 (PCOS), DH: excellent SA
    NTNP since 11/12, actively trying since 8/14
    m/c @ 7w (4/22/14), m/c @ 6w (11/19/14)
    11/15: Letrozole, Ovidrel, TI = BFP!!!
    Beta #1(14dpo)=349, Beta #2(18dpo)=2,805
    12/17/15: Got to see the heartbeat (105bpm)!
    1/25/16: NT scan = normal (HB=163bpm)
    EDD: 8/10/16 
    8/8/16: Baby boy born @ 12:25am, 8lbs, 20.5 inches
    5/18/17: BFP!!! (11dpo)
    Beta #1(12dpo)=176.4, Beta #2(15dpo)=607.1
    Report Reply
  • HBamama2BHBamama2B member
    edited October 2015
    @jilligan14 I developed a cyst while on letrozol. It wasn't an issue and they continued the cycle but with PCOS it should be watched. I also had 2-4 mature follicles on just letrozol and HCG trigger which can cause multiples.

    PCOS patients can over respond to fertility meds so it's good to watch for at least the first cycle I would think. Also, keep in mind that letrozol is finite. If it doesn't work the first 3 times you have to move on or up statistically to achieve success. And the reason they do IUI with letrozol is that ithe med prevents the production of fertile CM which in turn prevents the sperm from effectively navigating through the cervix and reaching the egg. If you don't notice copious amounts of CM with your letrozol cycle, TI isn't likely to work. All of the info offered by ppl above is on point! GL!
    Report Reply
  • jilligan14jilligan14 member
    Thanks @HBamama2B! I'm definitely going to talk to the clinic on Monday about the costs involved with monitoring. Is there something to help with the CM if I get all dried up on my Letrozole cycle? I've heard some things about preseed but not sure how well it works. Anyway, it's good to connect with you all on this board! Good luck to you all!
    ME: 36 (PCOS), DH: excellent SA
    NTNP since 11/12, actively trying since 8/14
    m/c @ 7w (4/22/14), m/c @ 6w (11/19/14)
    11/15: Letrozole, Ovidrel, TI = BFP!!!
    Beta #1(14dpo)=349, Beta #2(18dpo)=2,805
    12/17/15: Got to see the heartbeat (105bpm)!
    1/25/16: NT scan = normal (HB=163bpm)
    EDD: 8/10/16 
    8/8/16: Baby boy born @ 12:25am, 8lbs, 20.5 inches
    5/18/17: BFP!!! (11dpo)
    Beta #1(12dpo)=176.4, Beta #2(15dpo)=607.1
    Report Reply
  • HBamama2BHBamama2B member
    My RE recommended preseed. Not sure how much it helps but may be better than nothing!
    Report Reply
  • HBamama2BHBamama2B member
    edited October 2015
    If you google, there are also things diet wise you can do to try to up your cm production! GL!!!
    Report Reply
  • emsmama15emsmama15 member
    @jilligan14 - I used pre-seed for all my medicated cycles.  A little goes a LONG way!!  When I was doing injectables, my CM was better, but Letrozole definitely dried it up!!  
    *** Child & current pregnancy mentioned ***
    Me - 41 (PCOS), Hubby - 43 (healthy)
    7/2013 - Sweet baby girl born (Clomid + TI)
    3/2014 - TTC #2, return to RE 7/2014
    12/2015: IVF #1 transferred two great looking embryos - BFP!
    First ultrasound: TWO beautiful little heartbeats!!
    Harmony: negative; level 2: babies look great and are boy/girl! :) 
    Report Reply
  • jilligan14jilligan14 member
    **UPDATE**

    I just talked to the financial department at my RE's office and it looks like the monitoring IS covered by my insurance! So I'll definitely be playing it safe and going that route. Thanks all for the input, suggestions and advice! It's great to have such a wonderful support network.
    ME: 36 (PCOS), DH: excellent SA
    NTNP since 11/12, actively trying since 8/14
    m/c @ 7w (4/22/14), m/c @ 6w (11/19/14)
    11/15: Letrozole, Ovidrel, TI = BFP!!!
    Beta #1(14dpo)=349, Beta #2(18dpo)=2,805
    12/17/15: Got to see the heartbeat (105bpm)!
    1/25/16: NT scan = normal (HB=163bpm)
    EDD: 8/10/16 
    8/8/16: Baby boy born @ 12:25am, 8lbs, 20.5 inches
    5/18/17: BFP!!! (11dpo)
    Beta #1(12dpo)=176.4, Beta #2(15dpo)=607.1
    Report Reply
  • HBamama2BHBamama2B member
    Wonderful! GL & I Hope you get your BFP this round!
    Report Reply
  • pmnf26pmnf26 member
    That's great that it is covered for you! Good luck and hoping you get your BFP this round !
    Report Reply
  • jilligan14jilligan14 member
    Thanks everyone! I still have some waiting time since I'm only on CD17 of this current cycle. Hoping I can start the medicated cycle early November.

    Good luck to everyone!
    ME: 36 (PCOS), DH: excellent SA
    NTNP since 11/12, actively trying since 8/14
    m/c @ 7w (4/22/14), m/c @ 6w (11/19/14)
    11/15: Letrozole, Ovidrel, TI = BFP!!!
    Beta #1(14dpo)=349, Beta #2(18dpo)=2,805
    12/17/15: Got to see the heartbeat (105bpm)!
    1/25/16: NT scan = normal (HB=163bpm)
    EDD: 8/10/16 
    8/8/16: Baby boy born @ 12:25am, 8lbs, 20.5 inches
    5/18/17: BFP!!! (11dpo)
    Beta #1(12dpo)=176.4, Beta #2(15dpo)=607.1
    Report Reply
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