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Tag Archive for: Letrozole

Posts

Getting Pregnant with Clomid or Letrozole

Blog, Fertility, Pregnancy

There is a lot to know about getting pregnant with Clomid or Letrozole. It is estimated that 10% of women in the United States face infertility and have trouble getting pregnant. This condition can pose many challenges and doesn’t always have a clear cause. But it’s important to understand there are possible solutions. Let’s discuss two types of medications that are commonly used to treat infertility by acting on your body’s ability to ovulate (release an egg): Clomid and Femara.

Typically, women produce and release one egg each month, but some women do not ovulate regularly. For women who do ovulate each month, these medications are used to increase the follicles produced each month, which is called controlled ovarian hyperstimulation. For women who don’t ovulate regularly, these medications are used to induce ovulation.

Learning more about your options may help you and your OBGYN create a path forward as you navigate the complexities of your condition before you visit a fertility clinic.

What is Clomid (aka clomiphene citrate)?

Clomid, also known generically as clomiphene citrate, is an oral medication used to treat infertility in women. It is often a 50-milligram pill taken on days 3-7 or 5-9 of your menstrual cycle. Your OBGYN will typically start you on a low dose, and then increase it incrementally each month until it is clear you are ovulating.

How does Clomid work?

Clomid tricks the body into thinking that your estrogen levels are lower, which makes the pituitary gland increase follicle-stimulating hormones (FSH). Ultimately, this helps stimulate the ovary to produce eggs that can be released during ovulation. It essentially stimulates the ovarian follicles (tiny fluid sacs in the ovaries), which hold an immature egg. Encouraging this growth can help those immature eggs turn into mature eggs, be released, and meet with sperm in hopes of becoming fertilized.

Clomid can be taken as part of fertility treatment before intrauterine insemination (IUI), or in combination with IUI.

Is Clomid right for you?

Clomid is typically best for those who have been unable to get pregnant for about a year, or who have unexplained infertility. If you have irregular periods, talk to your doctor right away. They may suggest Clomid sooner (don’t wait a year). If you have polycystic ovarian syndrome (PCOS), a different medication called Femara (Letrozole) may work better for you than Clomid (more on that later).

If you have been diagnosed with hypothalamic amenorrhea, premature ovarian insufficiency or breast cancer, Clomid may not be a good fit for you.

Clomid side effects

Clomid’s side effects include hot flashes, mood swings, and pelvic pain. Other potential side effects include nausea, breast discomfort, blurred vision, headaches, and spotting. If you experience vision changes while taking Clomid, contact your OBGYN immediately.

In our experience at Madison Women’s Health, most women don’t complain of many side effects from this medication as they are only taking it for five days each cycle.

It’s worth noting that those who take Clomid have an increased risk of carrying multiple babies, like twins or more.

What is Femara (aka letrozole)?

Femara, also known generically as letrozole, is an oral medication commonly used for estrogen-sensitive breast cancer in postmenopausal women. In 2004, it became an off-label treatment for fertility, as it can help trigger ovulation in some women, especially women with PCOS. While it is not yet FDA-approved for fertility treatment, it is considered by many physicians to be a better choice than Clomid for anovulatory women.

To induce ovulation, letrozole is typically taken once a day for five days, beginning on days 3-7 or 5-9 of your menstrual cycle.

How does letrozole work?

Letrozole blocks a protein called aromatase, which helps make estrogen. Letrozole decreases the amount of estrogen in the body. Regarding fertility, lowering estrogen levels can help the body release other hormones and chemicals that can help immature eggs (known as follicles) grow and mature, increasing the likelihood of pregnancy.

Is letrozole right for you?

When deciding whether to prescribe Clomid or letrozole, your OBGYN will take into consideration why your ovaries may not be releasing eggs. If the cause is PCOS, then your OBGYN will likely recommend you take letrozole instead of Clomid.

If a different issue is affecting ovulation, such as hypothalamic amenorrhea or premature ovarian insufficiency, letrozole may not be beneficial. Ovarian insufficiency can occur when the ovaries are not functioning normally and don’t produce the typical amount of estrogen or don’t release eggs regularly. It can be confused with premature menopause.

If you have a history of breast cancer, letrozole would also be the medication of choice to help induce ovulation. Expect to have close monitoring by your oncologist.

Letrozole side effects

Common side effects of letrozole can include hot flashes, joint pain, exhaustion, headaches, nausea, spotting, cysts, and dizziness. (Women who are taking letrozole for breast cancer will have more side effects because they are taking much higher doses of the medication.)

Tracking ovulation

Before beginning infertility treatments, your OBGYN will want to determine if you’re ovulating regularly. This is important when it comes to conception because it is when the mature egg leaves the ovaries and travels down the fallopian tube, where it can be fertilized. Ovulation occurs approximately two weeks before the start of the next period or menstrual cycle, but this can vary based on your cycle.

If you have a regular menstrual cycle, there’s a good chance that you’re ovulating. However, some women may not experience a normal 28-day cycle or may have a condition that makes cycles less predictable.

Signs that you’re ovulating can include:

  • Cervical mucus secretions that are clear, wet, and elastic (like egg whites).
  • A positive result using an ovulation predictor kit (OPK). Ovulation predictor kits measure luteinizing hormone (LH) levels in your urine. Your OBGYN provider may recommend you begin measuring your LH levels around cycle day 10. You can purchase an OPK at most retail pharmacies.

Progesterone levels in the second half of our cycle are another way to help your OBGYN determine if you are ovulating. Or, if you are using ovulation predictor kits, your OBGYN provider may recommend you have your progesterone levels checked about seven to eight days after a positive OPK result (or peak LH).

We often recommend our patients use an app that collects all of this data in one place and helps to visualize what is happening. A popular app our patients enjoy using is FLO.

Effectiveness of fertility drugs

The effectiveness of the medications you’re prescribed varies on many things, including any other diagnoses you may have. For instance, if you have PCOS, your physician will likely begin at a lower dose of fertility medication and increase it if results are not seen within about three months. If ovulation is absent, the beginning step would be to address ovulation first. In 2019, the Clomid success rate was 21.4%. Letrozole has a similar success rate but has shown higher success rates with those diagnosed with PCOS.

How long does it take to get pregnant on Clomid or Letrozole?

This is a common question we are asked, but it has a complex answer. If you are ovulating already, these medications can speed up the process to become pregnant. If you’re not ovulating, then you could become pregnant within 6-12 months of taking these medications.

We start our patients on the lowest dose for these medications and typically increase the dose until they ovulate. There is no limit to the number of cycles you can take these medications, but if you have not achieved pregnancy after 9 cycles, you should be evaluated for other possible causes of infertility. Expect some additional bloodwork and an ultrasound to look at your fallopian tubes and uterine anatomy.

You can also read more about common infertility causes and treatments here.

Which fertility drug should you choose?

While these medications act similarly, the first step in any treatment should be to speak with your provider or fertility specialist. They’ll review a detailed history including other results, lab work, or medications you may be taking that can help determine the best choice for your body. It’s important to keep in mind that other diagnoses, like PCOS or potential side effects, can also impact your decision. Determining if you’re ovulating is a good initial step.

Speak with your OBGYN provider to get more information about fertility treatments and what may be the best option for you. We’re dedicated to helping you achieve your health and family goals and will do what we can before referring you to a reproductive specialist or fertility clinic.

Vicki Slager-Neary - Nurse Practitioner at OBGYN clinicVicki Slager-Neary, OBGYN, WHNP, A.P.N.P, has been serving women in the Madison area as board-certified Women’s Health Nurse Practitioner since 2016. She has provided patient care for over 17 years as a nurse in the Emergency Department, Labor and Delivery, Fertility, and OBGYN. Vicki has extensive experience working in Reproductive Endocrinology and Infertility for the past 10 years. Her areas of special interest include preconception counseling and treatment, contraception, and pregnancy. Vicki has a wide variety of experience managing infertility conditions including PCOS, amenorrhea, recurrent pregnancy loss and unexplained infertility.

 

 

September 25, 2022/by Vicki Slager- Neary
https://madisonwomenshealth.com/wp-content/uploads/2022/09/AdobeStock_210623618-2.jpg 668 1000 Vicki Slager- Neary https://madisonwomenshealth.com/wp-content/uploads/2017/09/mwh_logo-300x177.png Vicki Slager- Neary2022-09-25 14:02:282023-01-13 15:04:10Getting Pregnant with Clomid or Letrozole

Getting Pregnant: Fertility Tips for Problems Conceiving

Blog, Fertility, Pregnancy

Thinking about getting pregnant and starting a family can be an exciting time. But when it takes longer than you expect to get that positive pregnancy test, you may start to wonder “Why am I not getting pregnant?”

As a Madison OBGYN, I meet with many women who are wondering what they can do to get pregnant faster. I enjoy supporting women in their “trying to conceive” journeys and want to answer the most common questions I’m asked as well as address misinformation that can be confusing and even hurtful.

Chances of Getting Pregnant by Age

Your age plays a role in your fertility. Women are born with a fixed number of eggs and your total number of eggs declines with age. The term “ovarian reserve” refers to your egg supply.

Women in their 20s have peak fertility. Their fertility starts a slow decline around age 32, with a more rapid decline around age 37.

  • A healthy woman in her 20s has a 25% chance of conceiving naturally each month.
  • A healthy woman in her 30s has a 20% chance of conceiving naturally each month.
  • A healthy woman in her 40s has a 5% chance of conceiving naturally each month.

When You Should See a Doctor About Getting Pregnant

About 80% of couples conceive in the first 6 months of trying. That number increases to 85% after 12 months. If you have regular menstrual cycles and have been trying to conceive for a year, then it’s a good idea to talk to your OBGYN about it. We will evaluate to see if there are other issues that make it harder for you and your partner to conceive.

If you’re over 35 years old, have this conversation with your doctor sooner—after you’ve been trying to conceive for 6 months. If you are in your 40s and want to have a baby, it’s better to speak with your OBGYN right away because often fertility treatments can be started right away.

No matter your age, if you know you have irregular periods (consistent cycles less than 25 days or greater than 35 days apart), get evaluated sooner. If you have other health problems, make a preconception visit to make sure these conditions are optimized prior to conceiving.

Before you are referred to a fertility clinic, your OBGYN can rule out and/or treat common issues. Sometimes we can recommend small changes that can help you get pregnant.

Madison Women’s Health OBGYN clinic refers patients to fertility clinics when:

  • you are 40+;
  • there is concern about early menopause;
  • after 3-6 months of using Clomid or Letrozole to induce ovulation (or a little longer if we can prove you are ovulating on these medications);
  • there are abnormal semen parameters that require intervention;
  • or there is any other reason to expedite your chances of conception.

Problems Conceiving? How to Prepare for Your First OBGYN Visit

  • Track your menstrual cycle. Cycle length and regularity are important for fertility. Tracking your menstrual cycle will help your doctor know if you are ovulating each month. Use a calendar or a tracking app to mark the first day your period begins (first day of red bleeding). Most apps have other parameters you can input, but your period is most important. Bring your calendar or app!
  • Know your medical history and family history of genetic conditions. If you are visiting Madison Women’s Health for the first time, be sure to bring your health records and any testing or blood work you might have done previously.

Best Apps for Tracking Your Fertile Window

When it comes to tracking your menstrual cycle and your “fertile window” (the days when you are most likely to get pregnant) you can go as high-tech or low-tech as you want. Whether you want a basic calendar or an app that syncs with all your devices, choose something you know you can use consistently.

There are hundreds of apps to help identify your fertile window, but only about 20 that research has considered to be reliable and easy to use. It’s important to choose an app that is based on accurate scientific data. The app that I recommend to my patients is the Glow App. It’s available on the iTunes App Store and on the Google Play Store. There are both free and paid versions. You can even join online communities with people who are trying to conceive (just be careful about following advice from people who aren’t medical professionals).

Getting Pregnant with Irregular Periods

If you have irregular periods, it’s important to discover what is causing them. Too-short or too-long of cycles can be caused by anovulation (not ovulating), thyroid conditions (hyperthyroidism, hypothyroidism), being underweight or overweight, extreme stress, and being near puberty or menopause. We have blood tests to help us find the cause.

Common Tests for Fertility

In addition to checking blood work, your OBGYN will also evaluate your uterus to make sure there isn’t anything about your uterine anatomy that makes it difficult to get pregnant.

At Madison Women’s Health, we can do a Saline Infusion Sonohysterogram, often called an SIS. After injecting saline fluid in the uterus, we use ultrasound equipment to evaluate the uterine cavity.

It’s also important to know if your fallopian tubes are open so a sperm and egg can meet. The hysterosalpingogram, or HSP, is like an SIS but uses an x-ray machine to view your uterus and test if your fallopian tubes are patent (open).

Testing Male Factor

Because male factor infertility is very prevalent (in approximately 10% of infertility cases, a male factor is the only identifiable cause), a semen analysis is an important step in the process. His tests are less costly and much less invasive. While we don’t evaluate male factor infertility at Madison Women’s Health, we can place the order for your partner to have a semen analysis done in Madison. Abnormal semen parameters warrant referral to a specialist for infertility.

Prescriptions to Induce Ovulation

If your test results show that you aren’t ovulating, your doctor may prescribe a medication to give your ovaries a boost. Clomid and Letrozole work by making the body think your estrogen is low. This makes the ovaries ramp up production of follicles that lead to ovulation.

Clomid has been used for many years without known adverse long-term effects. Common short-term side effects are hot flashes, nausea, bloating, mood swings, and headaches.

Letrozole is a newer medication used to induce ovulation. It is not FDA approved for this, but has been documented as safe and effective. We often recommend this instead of Clomid. Your OBGYN will work with you to prescribe the best medication for your situation.

Read more about getting pregnant with Clomid or Letrozole.

Natural Ways to Increase Your Fertility

Not everyone needs or wants medical intervention to get pregnant. There are natural things you can do to increase your chances of getting pregnant each month.

  1. Timed intercourse during your fertile window. If you’re tracking your cycle each month, you’ll know approximately when you’re ovulating. Have sex every 1-2 days during your fertile window, which is about 5-6 days before you ovulate. (For example, if you have a 28 day cycle, with day 1 being the first day of your period, you can estimate your fertile window to be days 9-14 of your cycle.)
  2. Avoid using lubrication. Most over-the-counter lubricants inhibit sperm. If you need lubrication during intercourse, use a lubricant specifically made for couples who are trying to conceive, like Pre-Seed. You can also use canola oil or mineral oil.
  3. Healthy weight. If you are underweight or overweight, you may not ovulate or have a regular menstrual cycle. If you are overweight with frequently missed periods, decreasing your weight by as little as 5% can increase your chances of having regular periods and conceiving.
  4. Limit alcohol to 2 drinks per day. Cut alcohol completely out when you are actively trying to get pregnant.
  5. Reduce caffeine. At typical levels of caffeine intake, there does not appear to be an association between caffeine consumption and inability to conceive. Some studies suggest that going overboard may not be helpful, however, so try to limit to no more than two 8oz cups of coffee per day.

Common Misconceptions About Increasing Your Fertility

When people find out you are trying to conceive or are having problems getting pregnant, you may get a lot of advice. People have good intentions but may have limited medical knowledge. It can get confusing sorting through all the health blogs, fertility forums, and more. It can also be painful when people think they have an easy solution to something that is so private and personal. Here are some common myths about getting pregnant and increasing fertility:

  1. “Herbs, vitamins, teas and supplements will increase your fertility.” This is not necessarily true. Eat a healthy diet, take a prenatal vitamin, and exercise. Healthy women are more likely to have healthy pregnancies.
  2. “This super food will increase your fertility.” There are many so-called fertility diets. If there was a super food that increased a woman’s chance of getting pregnant, everyone would use it! If a website endorses a specific food for fertility (like yams and pineapples), they are based on small, poorly done studies. They are full of antioxidants, however, which are great for overall health!
  3. “Don’t worry, it’ll happen when you quit trying so hard.” First of all, I am sorry if anyone has said this to you. This statement simply adds guilt to the stress that infertility is already creating. At the most, the stress related to fertility troubles may slightly lengthen the amount of time it takes to get pregnant. Stress only affects your fertility if it prevents you from having intercourse or is affecting your menstrual cycle.
  4. “Get in the right position.” Certain positions during sex, elevating your hips, lying flat for twenty minutes afterward do not increase the likelihood of conceiving.

If you come across any other advice that promises to be “the answer to all your fertility troubles,” be wary. Will it help you eat healthier? Does it encourage you to be active? Fertility is complex and there isn’t a right answer for everyone. Be sure the advice encourages healthy habits and listen to your doctor’s recommendations.

Focus on Your Health

One of the best things you can do to improve your chance of getting pregnant and have a healthy pregnancy is to optimize your own health. No matter what age you are, it is important to be cognizant of your weight. Eat a diet rich in vegetables, lean protein, whole grains, and healthy fats. Reduce your alcohol and caffeine consumption. Get regular exercise. Begin taking a prenatal vitamin right away. The healthier your body is when you are trying to conceive, the better your chances of having a healthy pregnancy.

The key point in all the fertility advice you may receive is this: be healthy, let us know if your menstrual cycle is abnormal, have timed intercourse, and see a doctor for a preconception visit if you have questions about your health before trying to conceive.

At Madison Women’s Health, we are here for you in your journey to pregnancy. We’re excited to be your partners as you grow your family!  To make an appointment with one of our providers, call (608) 729-6300.

Dr. Ashley Durward, MD of Madison Women's HealthDr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.

March 21, 2020/by Dr. Ashley Durward
https://madisonwomenshealth.com/wp-content/uploads/2020/03/getting-pregnant-fertility-tips-problems-conceiving.jpg 667 1000 Dr. Ashley Durward https://madisonwomenshealth.com/wp-content/uploads/2017/09/mwh_logo-300x177.png Dr. Ashley Durward2020-03-21 11:45:152022-09-27 12:37:32Getting Pregnant: Fertility Tips for Problems Conceiving

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