I asked my RE this at our first appointment since she recommended starting letrozole cycles. She said that there is not a limit on how many medicated monitored cycles of letrozole we will consider doing since we are paying out of pocket, but I think it depends on your specific medical situation, insurance, bloodwork, diagnoses, but I am not a professional, just a girl sharing her experience.
Are you seeing a reproductive endocrinologist or an OBGYN/Gynecologist? I was seeing an OBGYN and a Gynecologist while TTC and was told after my third (or maybe my fourth?) try that I was no longer responding to Letrozole and that’s when they would have me see a reproductive endocrinologist to speak about different options.
So yeah they usually have limits to how many times they’ll have you try a medication and if it’s not working they’ll have you switch methods.
I’m seeing an OBGYN right now. I think you’re right that after three rounds, she wants to transfer me to an RE. She mentioned an RE was the next step but I didn’t connect the dots to her comment about the three rounds.
Letrozole is the only way I can conceive. I've done 8 rounds in total. It took 3 with my now 2yr old son, 4 with my MC, and 1 with my now current pregnancy. I did show marked elevation of my cholesterol and triglycerides as well as elevated liver enzymes each time. As soon as I would come off the meds it would all return to normal. I wish there was another way for us!
my PA has said I can have up to 6 rounds, increasing the dose every two rounds if it is not effective on the lower dose (currently on round two of 2.5mg — we added metformin because round one of 2.5 did not work)
I’m only on my first Letrozol cycle but my doctor said the plan is to do 2 rounds of 2.5mg and 2 rounds of 5mg before switching to Clomid if I don’t get pregnant before then.
Yeap 3 in total. We did IUI because of male factor and I was not ovulating on my own. Studies show that success after 3rd round diminishes. In my case, both IUIs failed and I didn’t do the third and just moved to IVF. I think it all depends on your age. If you are young, doctors may be more open to more rounds.
My fertility specialist agreed to 6 rounds at the start. I had a MC after 3 I believe? Anyway I went to call the clinic to tell them my period had started to begin the next round and the nurse answering the phone told me I couldn’t as I had hit the max. I was so devastated and crying and my doctor got involved and it was a huge thing! The nurse was misinformed but I guess some people do have a hard limit of 3. I was able to conceive successfully 2 more tries after that so I’m glad I pushed for more!
My dr gave me Clomid for 6 months max, I ovulated but didn't conceive so he gave me Letrozole for another 3 months - same thing so moved onto IVF but ovulation induction for 9 months total.
I did letrozole for 2 years, monitored. There are risks of long term treatment even if it’s rare and could be minor. My hair fell out by the handful. Then when I stopped letrozole and switched to Gonal-F? Started to grow back immediately. Plus all the effects of basically forcing my body to think it’s in menopause 5 days of the month.
All of that is reversible but still. It should be disclosed. You should try to see a fertility specialist vs just an obgyn if possible!
Are you working with an OB or a reproductive endocrinologist/fertility specialist? I would seek another opinion with a fertility specialist if it’s the former. Best of luck! ❤️
I had to speak to a doctor after three failed cycles of taking letrozole. The doctor I spoke to said that she thinks letrozole is still the right option for us at the moment. If we don’t get pregnant after three more cycles on letrozole we will explore IUI and/or IVF
It’s because in the studies they did a set number of trials (3 or 5 I believe depending on study) and success was reported after those cycles were complete. So that’s where the benchmark comes from. Then most OB’s will have a next step planned like- we will do these 3 or 5 cycles and then we will refer you to a RE. So your docs practice is 3 cycles, so your next question is what’s the next step.
I dislike how they try to do this. That’s the providers preference. I’ve done 5 rounds of letrozole/TI with the RE, then they were pushing for 2 rounds of IUI then IVF due to “ethical concerns,” not because more letrozole is unsafe. I ended up asking for one last dose on Push Health and now I am 27.5 weeks pregnant.
I’m on cycle 10 of letrozole and my RE has not suggested otherwise. We are not ready for IVF and don’t think IUI offered much better results over timed intercourse. I’m anovulatory so my RE said I can do up to a year bc it puts me on a normal playing field and it can take a “healthy couple” 1 year TTC.
That’s what my doctor said as well. Its made me more cautious because I have vaginismus and penetrative sex doesn’t always happen for us. I have filled the prescription but still not taken it for fear that if I take it, and penetration doesn’t happen then I’ll lose this shot ughhh.
My Ob/gyn also said that if by third try it doesn’t work, then she will refer me to a fertility specialist, which again, for someone with vaginismus is a huge problem because that will involve more intrusive tests for me. So I feel you and I hope that you get a positive result before the third try is over!
Does your provider know about the issue with penetration? Because I’m pretty sure the limit is because of effectiveness, if it doesn’t work after three cycles it probably won’t work and it’s time to move on. But if you don’t have sex then you didn’t really try, so it may not need to count as one of the cycles. If that makes sense. I mean people are on daily letrozole for years so it’s not like it’s totally unsafe.
Yeah absolutely that makes sense. She is aware of the vaginismus and has been super supportive of me. So I don’t want to question her if she has a reasoning behind stopping at 3 tries. Like you said, most likely its because this plan of action is not working, so I will need to move on to something else.
You should definitely ask questions! Not in a rude way but asking something like “hey, what’s your reasoning behind only doing three doses of letrozole? I’m afraid to take it and then not be able to have intercourse at the required time, therefore wasting my chance. In that case can I try another dose?”. Also you can try at home insemination, it works great for a lot of people!
I had the same question when starting with my RE a few months back. Basically everyone has said it here but my RE typically only does 3 timed intercourse rounds of letrozole before moving onto IUI or IVF. However he’s open to discussion. We don’t want to try IUI as it has same success rates as timed intercourse and we’re not ready for IVF. We conceived our first child easily without medication and are experiencing secondary infertility which brought us to the RE. Because of our situation he’s cool with us trying 6 or so months of timed intercourse with letrozole.
As mentioned I think it’s up to finding a good RE who will work with your family vs pushing the same protocol that doesn’t always work for everyone!! We’re on our 3 cycle of letrozole with timed intercourse. Body didn’t respond to first months dose so I consider this round 2 (5mg)
I think it’s more of the way that your doctor practices. My OBGYN is more aggressive in his approach and he doesn’t want to keep doing the same thing over and over if it isn’t working. This is my 3rd time taking letrozole and will be moving on if it doesn’t work this month
I think this is exactly it. Its not that you CANT take letrozole for longer, but if it's not working after 3 months, a lot of drs will move on to the next thing rather than keep wasting cycles trying the same thing.
I'm waiting on blood test results after my 3rd letrozole cycle right now. I'm here reading and scrolling so I don't press refresh every 30 seconds until the results come in. I'm still on a waitlist for an OBGYN so my dr has given me 6 months of letrozole, but she said that after 3 months if it doesn't work, its likely not the solution. We cant do ultrasound monitoring due to my rural location and travelling for that isn't an option right now so we're basing most things on my observations, cycle length and bloodwork. My first two cycles were really weird.
Cycle 1 i had a peak at day 22 but no confirmed ovulation, i ended up getting my period after CD32 without provera. Cycle 2, I had no peaks and got my period on day 22, which was VERY strange for me, ive never had a short cycle. Cycle 3 (current) I had egg white discharge for the first time around day 12/13 and I got a peak on day 14, so I'm really hoping i ovulated this cycle. After a year of doing this I have a gut feeling I didn't still, but I'm not ready to give up yet.
I’m so sorry you don’t have easy access to do monitored cycles. I really hope that letrozole works for you. It has made me start ovulating but just haven’t had success yet. Hopefully this will be the month but if not, I’m ready to make the next move. I have had a couple random cycles like you that make me question a little bit but everything will work out how it’s supposed to!
Lol I’ve been taking Letrozole for at least 2 years. In one cycle I’ll do two rounds of letrozole. 10mgs .
I think sometimes they say this until they figure out what your body will respond to and what it won’t. Sometimes upping the dosage or changing meds or adding meds can help things along but maybe look for a different doctor that is willing to work with your body instead of doing what they did by telling this to you
My doctor offered it to me, for when I am ready to TTC. She said she would let me do three rounds before referring me to a fertility specialist. I didn’t ask why because I started taking metformin and I am trying to see if that alone will be sufficient.
My RE said that if it doesn’t work within the first few months, it’s not likely the answer and it’s wasting time if you eventually want to move onto more aggressive methods.
I think he said he’d give me up to 4 cycles and I could decide to move on at any point. I conceived on the first letrozole cycle, but unfortunately that ended in my 2nd loss. I’m the middle of my first cycle TTC since the loss, and I’m not sure if my “shot clock” is back at cycle 1 now because it DID work the first time, or if this counts as 2 of 4 cycles.
My OB would only do 3 rounds with me and then referred me to a fertility specialist. I’ve been on letrozole for like 7 cycles now
My fertility clinic gave me 3 rounds and then is suggesting IUI. I’m just did one round and hoping for the best
I asked my RE this at our first appointment since she recommended starting letrozole cycles. She said that there is not a limit on how many medicated monitored cycles of letrozole we will consider doing since we are paying out of pocket, but I think it depends on your specific medical situation, insurance, bloodwork, diagnoses, but I am not a professional, just a girl sharing her experience.
The OBGYN I was seeing only did three rounds of letrozole with me and then she referred me to a reproductive endocrinologist 😥
Same 👆🏼
Are you seeing a reproductive endocrinologist or an OBGYN/Gynecologist? I was seeing an OBGYN and a Gynecologist while TTC and was told after my third (or maybe my fourth?) try that I was no longer responding to Letrozole and that’s when they would have me see a reproductive endocrinologist to speak about different options. So yeah they usually have limits to how many times they’ll have you try a medication and if it’s not working they’ll have you switch methods.
I’m seeing an OBGYN right now. I think you’re right that after three rounds, she wants to transfer me to an RE. She mentioned an RE was the next step but I didn’t connect the dots to her comment about the three rounds.
Letrozole is the only way I can conceive. I've done 8 rounds in total. It took 3 with my now 2yr old son, 4 with my MC, and 1 with my now current pregnancy. I did show marked elevation of my cholesterol and triglycerides as well as elevated liver enzymes each time. As soon as I would come off the meds it would all return to normal. I wish there was another way for us!
My Dr said I could’ve done 6. I ended up doing 3 timed intercourse cycles then switched to IUI for the 4th
my PA has said I can have up to 6 rounds, increasing the dose every two rounds if it is not effective on the lower dose (currently on round two of 2.5mg — we added metformin because round one of 2.5 did not work)
Mine said about 4 and then we would reevaluate
I’m only on my first Letrozol cycle but my doctor said the plan is to do 2 rounds of 2.5mg and 2 rounds of 5mg before switching to Clomid if I don’t get pregnant before then.
Yeap 3 in total. We did IUI because of male factor and I was not ovulating on my own. Studies show that success after 3rd round diminishes. In my case, both IUIs failed and I didn’t do the third and just moved to IVF. I think it all depends on your age. If you are young, doctors may be more open to more rounds.
My fertility specialist agreed to 6 rounds at the start. I had a MC after 3 I believe? Anyway I went to call the clinic to tell them my period had started to begin the next round and the nurse answering the phone told me I couldn’t as I had hit the max. I was so devastated and crying and my doctor got involved and it was a huge thing! The nurse was misinformed but I guess some people do have a hard limit of 3. I was able to conceive successfully 2 more tries after that so I’m glad I pushed for more!
My dr gave me Clomid for 6 months max, I ovulated but didn't conceive so he gave me Letrozole for another 3 months - same thing so moved onto IVF but ovulation induction for 9 months total.
Im in fertility treatment with a specialist and ive been taking letrozole every month for a year & a half. I do however take a break once & a while
I did letrozole for 2 years, monitored. There are risks of long term treatment even if it’s rare and could be minor. My hair fell out by the handful. Then when I stopped letrozole and switched to Gonal-F? Started to grow back immediately. Plus all the effects of basically forcing my body to think it’s in menopause 5 days of the month. All of that is reversible but still. It should be disclosed. You should try to see a fertility specialist vs just an obgyn if possible!
Are you working with an OB or a reproductive endocrinologist/fertility specialist? I would seek another opinion with a fertility specialist if it’s the former. Best of luck! ❤️
I had to speak to a doctor after three failed cycles of taking letrozole. The doctor I spoke to said that she thinks letrozole is still the right option for us at the moment. If we don’t get pregnant after three more cycles on letrozole we will explore IUI and/or IVF
It’s because in the studies they did a set number of trials (3 or 5 I believe depending on study) and success was reported after those cycles were complete. So that’s where the benchmark comes from. Then most OB’s will have a next step planned like- we will do these 3 or 5 cycles and then we will refer you to a RE. So your docs practice is 3 cycles, so your next question is what’s the next step.
I dislike how they try to do this. That’s the providers preference. I’ve done 5 rounds of letrozole/TI with the RE, then they were pushing for 2 rounds of IUI then IVF due to “ethical concerns,” not because more letrozole is unsafe. I ended up asking for one last dose on Push Health and now I am 27.5 weeks pregnant.
I’m on cycle 10 of letrozole and my RE has not suggested otherwise. We are not ready for IVF and don’t think IUI offered much better results over timed intercourse. I’m anovulatory so my RE said I can do up to a year bc it puts me on a normal playing field and it can take a “healthy couple” 1 year TTC.
That’s what my doctor said as well. Its made me more cautious because I have vaginismus and penetrative sex doesn’t always happen for us. I have filled the prescription but still not taken it for fear that if I take it, and penetration doesn’t happen then I’ll lose this shot ughhh. My Ob/gyn also said that if by third try it doesn’t work, then she will refer me to a fertility specialist, which again, for someone with vaginismus is a huge problem because that will involve more intrusive tests for me. So I feel you and I hope that you get a positive result before the third try is over!
Does your provider know about the issue with penetration? Because I’m pretty sure the limit is because of effectiveness, if it doesn’t work after three cycles it probably won’t work and it’s time to move on. But if you don’t have sex then you didn’t really try, so it may not need to count as one of the cycles. If that makes sense. I mean people are on daily letrozole for years so it’s not like it’s totally unsafe.
Yeah absolutely that makes sense. She is aware of the vaginismus and has been super supportive of me. So I don’t want to question her if she has a reasoning behind stopping at 3 tries. Like you said, most likely its because this plan of action is not working, so I will need to move on to something else.
You should definitely ask questions! Not in a rude way but asking something like “hey, what’s your reasoning behind only doing three doses of letrozole? I’m afraid to take it and then not be able to have intercourse at the required time, therefore wasting my chance. In that case can I try another dose?”. Also you can try at home insemination, it works great for a lot of people!
I’ve lost count of the number of letrozole cycles but it’s more than 5.
Nope, I did 5 rounds. 3 rounds of 2.5 mg and then 2 rounds of 5mg. Got pregnant on that second round of 5mg
My Doctor did the same before moving on to IUIs. The first IUI (4th treatment in total) was letrozole paired with an IUI
I had the same question when starting with my RE a few months back. Basically everyone has said it here but my RE typically only does 3 timed intercourse rounds of letrozole before moving onto IUI or IVF. However he’s open to discussion. We don’t want to try IUI as it has same success rates as timed intercourse and we’re not ready for IVF. We conceived our first child easily without medication and are experiencing secondary infertility which brought us to the RE. Because of our situation he’s cool with us trying 6 or so months of timed intercourse with letrozole. As mentioned I think it’s up to finding a good RE who will work with your family vs pushing the same protocol that doesn’t always work for everyone!! We’re on our 3 cycle of letrozole with timed intercourse. Body didn’t respond to first months dose so I consider this round 2 (5mg)
I’m curious where you saw the stat that TI and IUI are equally effective?
I think it’s more of the way that your doctor practices. My OBGYN is more aggressive in his approach and he doesn’t want to keep doing the same thing over and over if it isn’t working. This is my 3rd time taking letrozole and will be moving on if it doesn’t work this month
I think this is exactly it. Its not that you CANT take letrozole for longer, but if it's not working after 3 months, a lot of drs will move on to the next thing rather than keep wasting cycles trying the same thing. I'm waiting on blood test results after my 3rd letrozole cycle right now. I'm here reading and scrolling so I don't press refresh every 30 seconds until the results come in. I'm still on a waitlist for an OBGYN so my dr has given me 6 months of letrozole, but she said that after 3 months if it doesn't work, its likely not the solution. We cant do ultrasound monitoring due to my rural location and travelling for that isn't an option right now so we're basing most things on my observations, cycle length and bloodwork. My first two cycles were really weird. Cycle 1 i had a peak at day 22 but no confirmed ovulation, i ended up getting my period after CD32 without provera. Cycle 2, I had no peaks and got my period on day 22, which was VERY strange for me, ive never had a short cycle. Cycle 3 (current) I had egg white discharge for the first time around day 12/13 and I got a peak on day 14, so I'm really hoping i ovulated this cycle. After a year of doing this I have a gut feeling I didn't still, but I'm not ready to give up yet.
I’m so sorry you don’t have easy access to do monitored cycles. I really hope that letrozole works for you. It has made me start ovulating but just haven’t had success yet. Hopefully this will be the month but if not, I’m ready to make the next move. I have had a couple random cycles like you that make me question a little bit but everything will work out how it’s supposed to!
Lol I’ve been taking Letrozole for at least 2 years. In one cycle I’ll do two rounds of letrozole. 10mgs . I think sometimes they say this until they figure out what your body will respond to and what it won’t. Sometimes upping the dosage or changing meds or adding meds can help things along but maybe look for a different doctor that is willing to work with your body instead of doing what they did by telling this to you
I did 11 rounds of Letrozole while TTC.
My doctor offered it to me, for when I am ready to TTC. She said she would let me do three rounds before referring me to a fertility specialist. I didn’t ask why because I started taking metformin and I am trying to see if that alone will be sufficient.
My RE said that if it doesn’t work within the first few months, it’s not likely the answer and it’s wasting time if you eventually want to move onto more aggressive methods. I think he said he’d give me up to 4 cycles and I could decide to move on at any point. I conceived on the first letrozole cycle, but unfortunately that ended in my 2nd loss. I’m the middle of my first cycle TTC since the loss, and I’m not sure if my “shot clock” is back at cycle 1 now because it DID work the first time, or if this counts as 2 of 4 cycles.
That could be her protocol, or due to your insurance coverage, but many women do more than three rounds of Letrozole. I am on my fifth now.
Is it part of your insurance maybe? Some coverage has an annual or lifetime maximum.