Restarting Femara/Letrozole without af first?

[Aayla]

Question for you ladies: my latest background, I was put on provera because we were taking a small break but it made me crazy so I had to go off of it and get a biopsy done (it came back fine). Because I hadn't had a period on my own the provera did induce a bleed. It was lighter than normal (tmi: no clots or anything like that). During the biopsy my doc said my lining was thin, which of course was a good thing.

So, I decided to go back on the provera (CD 9 if we count the bleed as an af). and I was on it for 8 days. I wanted to induce an early bleed so I didn't have to wait for a regular 35 day cycle length. Normally it takes 3 day for a bleed to start and I usually have light pink when I wipe on day 2 after stopping the pill.

I am now on day 3 and no sign yet. today I was googling something else and it came up that if your lining is thin then provera won't induce a cycle as there is nothing there to shed.

So...has anyone ever taken letrozole without af or a withdrawl bleed. I have read about it on other forums and it seems to happen quite a bit.

I am also wondering should I just start my pills? Should I wait to see if a period naturally happens at the end of the month? I don't want to take provera again. even the 8 days was insane.

I know i'm not pregnant as I just bled and had a biopsy and my temp is very low today which tells me I didn't ovulate on my own (I am on "cd19") but I can make sure of that if I go for a progesterone test on Friday.

I have unmonitored cycles so the doc just gives me the pills and we do our own thing. I know the doc will say to wait it out but I really can't go back on provera and I don't have cycles on my own without the letrozole (or being induced by provera). and if I did wait it out and used provera it would be at least 30 days from today before I would see af.

Edit in addition after my comment below: I realized that I forgot a bit of info for this particular thread. I have been taking letrozole since May 2015. Got a bfp 3rd cycle but it ended in mc. Did 3 more cycles and then took a small break. No ovulation occurs on non medicated cycles. Now I am restarting letrozole.

 

[messica]

I would never take hyperovulatory meds without specific instruction to and without proper monitoring.

Any doctor allowing you to proceed that way doesn't belong prescribing them. If I were you I'd find another doctor who was more experienced in how to properly utilize them.

 

[Aayla]

The fertility clinic I am part of has been doing it this way since I started last May. I have had 2 doctors and both did it this way. My current doctor likely doesn't monitor me because I got pregnant on my 3rd cycle of letrozole back in August. Unfortunately that ended in a mc. But since I got pregnant on it with timed intercourse they don't seem to feel it is necessary to do ultrasounds. I'm not sure why they didn't in the first 2 cycles. I only ever get the 7 dpo progesterone test to make sure the pills are making me ovulate.

 

[Aayla]

And now it makes no difference because I had spotting tonight. Lol but of course.

 

[messica]

The fertility clinic I am part of has been doing it this way since I started last May. I have had 2 doctors and both did it this way. My current doctor likely doesn't monitor me because I got pregnant on my 3rd cycle of letrozole back in August. Unfortunately that ended in a mc. But since I got pregnant on it with timed intercourse they don't seem to feel it is necessary to do ultrasounds. I'm not sure why they didn't in the first 2 cycles. I only ever get the 7 dpo progesterone test to make sure the pills are making me ovulate.

Monitoring is most important to make sure you're not producing too many follicles. Checking bloods to make sure you ovulated doesn't tell a doctor how *many,* and if it's even safe to proceed with timed intercourse that cycle.

A lot of regular md's pass out hyperovulatory meds without monitoring, it doesn't mean that's ethical or good practice. Actual fertility specialists and reproductive endocrinologists wouldn't dream of doing such a thing because between pill and pregnancy who knows what's going on that way. If you do some research on those forced into selective reduction because they found out 4+ implanted I'm sure you'll understand a bit better why it's so important.

Mine absolutely refused to prescribe me the meds without monitoring because hyperstimulation is dangerous and selective reduction is heartbreaking. I'd had two pregnancies prior to my struggle with secondary infertility, the ability to get pregnant isn't the root of the concern.

Please proceed with caution and consider getting a second opinion about how best to utilize the meds

 

[Aayla]

Thank you for your concern. but I'm not going through a regular MD. I am going through a fertility clinic. I have been with them for 2 years. I actually asked my regular doc to put me on them but he wasn't comfortable because that wasn't his area, so he referred me to this fertility clinic.

There is no way I can get pregnant on my own. I don't ovulate. Never have is what they suspect. Except maybe when I first started menstruating. But I was diagnosed with PCOS at 18. Maybe that is why they don't monitor. there is so little chance of my producing so many eggs that I would have to selectively abort. Probably less than 0.5%. I only have maybe a 3% chance of twins.

 

[messica]

Taking hyperovulatory meds while also having PCOS puts you at increased risk of many complications so monitoring is especially important. Maybe it's because you're in Canada and things are just different there but if you're a specialist worth a hill of beans in the States you monitor your patients who are on it without question.

Your risk of multiples having PCOS on clomid (or femara) actually falls somewhere between 8 and 13% (which is much higher than someone conceiving naturally without PCOS). Having higher order multiples, not having any idea how you're specifically responding, is definitely a risk your specialists should be aware of and be assessing with you regularly.


I do wish you luck

 

[Aayla]

I'm not on clomid. It didn't work for me on the highest dose. Maybe it is Canada but I did google un-monitored cycles on femara and it's quite common. possibly because femara doesn't have the same likelihood of causing multiples.

Not sure in the end though and I'm not too concerned about it. I'm curious enough to ask my doc the next time I have to call. I've been on letrozole for 6 cycles although not back to back. I did get a bfp on my 3rd cycle but that ended in a mc. Then did 3 more cycles after it and took a break for 2 months. Now we are back to TTC.

In the end I just wanted to know if anyone knew about taking it without having a period first. I can't go back on provera to induce one if it doesn't show up.

 

[danser55]

I went on femara the 1st cycle I met with my RE without a period we just counted the day after an all clear HSG as CD3 to begin b/c w/ PCOS we weren't sure when I would get CD1.
However I was monitored. Blood work and u/s CD12 to check hormone levels and follicle sizes. I also had progesterone blood work 7 DPO. There are risks even with femara of taking it unmonitored. I agree with messica 100%. I only add my comments because I care and I would hate for you to do anything to prolong the path to your rainbow.

 

[Aayla]

Well I have been unmonitered for nearly a year. They only thing they check is to make sure my hyperplasia is still gone. Other than that I am told to take the drug days 3-7 and I have a standing order for the 7dpo progesterone test. At 38 years old and 2 years in I am not starting over with another doctor. This is also the only clinic that works with obese women. The other clinic won't.