Letrozole and follicle size
Letrozole for Ovulation Induction: How It Works, Why We Use It
While IUI may seem less intensive than treatments like IVFit is more intensive than alternatives like oral medications on their own or timed intercourse. The steps involved in an IUI cycle, and the timeline of that cycle, are largely determined by two decisions: which if any drugs to use, and whether or not monitoring is done. A natural IUI cycle is when the woman takes no drugs -- she will grow a follicle and ovulate naturally. Here, the goal of IUI is simply to get sperm to the right place at the right time. This ultrasound sets the schedule for the cycle. This medication is an injection with a small needle in the abdomen. The IUI is scheduled 36 hours after the trigger medication is injected. Awaiting Natural Ovulation: Blood work or urine-based ovulation predictor kits OPKs can predict when a woman will naturally ovulate. In this case, the IUI occurs either later that day or the next morning. Anovulatory Patients: Can start medication at any time. In this case, a 7 to 10 day course of progesterone like provera or aygestin can be given to cause the onset of a period and clomid or letrozole would be started thereafter. Unexplained Patients: Can start medication on day 3 or 5 of the cycle. If the patient is having her treatment cycle monitored, she will come in on day 3 for bloodwork and an ultrasound. On ultrasound, the doctor will be checking to make sure that no follicles have already started the process of growing because once one follicle is already growing, it is unlikely that others will also start growing in response to clomid or letrozole. The doctor will also look at estrogen levels through blood work to confirm this. Once the patient has started taking clomid or letrozole, they continue for 5 days, and 4 days thereafter the woman may return to the office for monitoring and blood work. Increase dosing if no follicles are growing or switch to gonadotropins if no follicles are growing and the patient has reached the maximum dose for clomid mg or letrozole 7. Continue waiting if the cycle looks promising. Patients may return the next day for insemination if the follicles are large 18mm or in 2 - 3 days if follicle growth is slower. The patient comes in on day 3 of her cycle for blood work and ultrasound to make sure that all of the follicles are resting none have started down the developmental path toward ovulation and that the lining of the uterus is thin which means the lining is ready to start growing in preparation for a possible pregnancy. She will begin the injectable medications later that night. She will continue the same dose of medication for 4 nights and then come back to the office for an ultrasound and bloodwork to monitor her progress. Specifically, the doctor is looking for the rate of estrogen growth to inform what to do. In this case, the doctor has three choices:. Increase the dose: Estrogen levels are not climbing and follicles are not growing. Decrease the dose: Estrogen levels are rising too fast e. The response will also dictate when the next visit will be. A patient with no response can safely return in 2 to 3 days. A patient with a vigorous response will probably be back every day. The ultimate goal is to have 2 or 3 follicles reach approximately 18mm in diameter. This is because smaller, immature follicles are still growing and if there is a delay in natural surge, they may catch-up in size to the larger, mature follicles. Upon release, the woman may now have 4-or-more eggs available for fertilization, which can dangerously increase her risk of a high-order multiple pregnancy. Most patients tolerate the insemination itself well and consider it far less painful than their experience with an HSG or saline sonogram. Spotting is also common and not an indication that something has gone awry. This occurs because the cervix is especially sensitive. The degree to which an IUI cycle is demanding depends on the decision of which if any drugs are taken and whether the cycle is accompanied by monitoring. For cycles using clomid or letrozole, patients start medication depending upon whether they are able to ovulate. If a woman does have a regular cycle, she can start medications on either day 3 or day 5 following the start of bleeding.
The Logistics of IUI
We strive to provide you with a high quality community experience. If you feel a message or content violates these standards and would like to request its removal please submit the following information and our moderating team will respond shortly. This is my second round of femara 5mg cd Had an ultrasound on cd12 and had a large follicle on each side, one measuring 29mm and the other 32mm. My nurse said that was great but I'm worried they are too big to be viable. Anyone get pregnant with similar measurements? My last cycle on femara, I had 3 follicles on cd 12 that were 27mm, 25mm and 25mm. We triggered that day. I googled myself to the point of insanity worrying they were too big but after I finally asked my nurse, she said there was no concern until they were closer to 40 mm. That being said, all 3 were on my left ovary. I did not get pregnant but I've had many issues with my left side. I also had a ruptured cyst at my last check which was most likely one of those follicles. But she also said my body most likely recognized it as a bad egg. So while I did not get pregnant that cycle, I do not think it was due to follicle size. Hope that gives you a little peace of mind. Just wanted to update - i ended up getting a bfp this month so the follicle size wasn't an issue! I had a scan today and I'm measuring 6w2d and we heard the heartbeat!! FX for a healthy bean!! Don't write off this cycle yet!! But definitely have a plan for the next if it doesn't work out!!! I bet my follicles were similar around cd8 as well - I wish I had been monitored a day or two earlier because I think that would have made a big difference. At least I know to do that next cycle if it comes to it. My lining was around 7mm which I've read is decent. FX for us both! The ultrasound tech at me RE's office was going on vacation this month so they checked me on CD 8! I was shocked to find out I had 2 16mm follicles on my right side and she went ahead and had me trigger the next day! I can always tell them which side my follicles are on before they even look! I think if you were doing retrieval, that size follicle would be too big because they're looking for specific stages. Otherwise, it's not nearly as important! Another thing to consider is how your lining is looking. This time, she said it was "ready"! So I feel like that can really play a factor as well! Thanks so much for responding. Google is so dangerous and I know I need to stop torturing myself!! Hopefully this is our month but if it's not, I am going to ask to be monitored much earlier next cycle!
What's the Average Size of a Mature Follicle on Day 10?
Letrozole, an aromatase inhibitor, has been demonstrated to be effective as an ovulation induction and controlled ovarian hyperstimulation agent. However, dose administration has generally been limited to 5 days at 2. We undertook a retrospective review of over treatment cycles using letrozole in doses as high as Results indicate that such doses do indeed offer benefit to patients; in that there is increased follicular growth and a higher number of predicted ovulations with higher doses of the drug. However, increasing doses does not produce a detrimental effect upon endometrial thickness. High-dose letrozole may be of value in women who fail to respond adequately to lower doses. Furthermore, randomized trials are needed to determine whether high-dose letrozole might actually be optimal as a starting dose for certain treatment groups. In women undergoing ovulation induction for the treatment of oligoanovulation, clomiphene citrate has long been the initial drug of choice for first-line therapy [ 1 ]. The drug works primarily by competitively inhibiting the binding of estradiol to its receptor in the hypothalamus, thereby releasing the hypothalamus from negative inhibition and allowing increased release of follicle stimulating hormone FSH from the pituitary gland. This increase in FSH release enhances follicular growth, increasing the chances of ovulation. The drug has also proven useful for producing multiple ovulation in couples with unexplained infertility, male factor infertility, and other disorders where controlled ovarian hyperstimulation has been deemed of value. While approved for use in the United States for more than 40 years, clomiphene has some significant limitations. Furthermore, side effects of the drug can be psychologically difficult to endure hot flashes and mood swings and detrimental to fertility impaired endometrial development and abnormal cervical secretions. The drug has a lengthy half-life, and adverse effects may be cumulative over time [ 2 ]. A class of drugs known as aromatase inhibitors also has the potential to enhance FSH release, not by the inhibiting estradiol-receptor interaction, but rather by inhibition of estradiol synthesis. One such inhibitor, letrozole, was approved for use in for the treatment of breast cancer. Byit had been used in anovulatory women with great success, and at present the drug is extremely popular among physicians and patients in the treatment of both ovulation dysfunction and for controlled ovarian hyperstimulation: the drug has a half-life of only 45 hours, and side effects, while similar to those of clomiphene, are far milder and less frequent [ 3 ]. The original choice of dosing with letrozole was extrapolated from several studies performed on postmenopausal women being treated for breast cancer [ 45 ]. Data derived from these patients suggested substantial inhibition of estradiol formation with doses of 2. However, the application of these data to short-term use of the drug in reproductive age women is highly questionable. Nevertheless, clinical investigation of the drug in infertile women has been generally limited to 5 days of treatment at doses of 2. For several years, we have, in women felt to be suboptimally responding to established doses of letrozole, administered doses of the drug up to This manuscript was designed to examine the following questions: 1 is there a role for the use of high doses greater than 7. This study is a retrospective cohort analysis with data extracted from our electronic medical record eIVF, Practice Highway, Dallas. Ages ranged from 23 to 47 years. All patients were administered 5 days of a fixed dose of letrozole beginning day 3 of their cycle; if the patient was anovulatory, medroxyprogesterone was administered to induce menses. Ultrasonography was performed on cycle day 11, and follicular number, follicular size, and endometrial thickness and pattern were determined; follicles were measured in two perpendicular dimensions and the mean value recorded, while endometrial thickness was measured at the point of greatest thickness. Predicted ovulation number was calculated based upon the size of follicles on day 11, with a 1. Each extrapolated follicle size was then assigned a probability of ovulation taken from previously published data [ 7 ]. Summation of these probabilities yielded a single predicted ovulation number per cycle. Descriptive statistics were calculated for all variables in an univariate manner. Multivariate linear and logistic regression analysis were performed to determine the relative importance of each predictor variable and its covariates. Eigen-value diagnostics were performed to identify potential problems with multicollinearity. One-way analysis of variance was performed as needed. A total of treatment cycles utilizing a five-day fixed dose of letrozole were identified in the two-year period.
The Use of High Dose Letrozole in Ovulation Induction and Controlled Ovarian Hyperstimulation
We strive to provide you with a high quality community experience. If you feel a message or content violates these standards and would like to request its removal please submit the following information and our moderating team will respond shortly. I had my day 11 ultrasound today. I'm on Im using donor sperm and IUI. I have PCOS. Have never ovulated on my own ever. Today my Dr was NOT happy with my follicle size at all. Said it was bc I'm so big that the mess are not working. Yes I'm overweight yes I'm trying to lose weight. With ones less than 10mm. I feel so hopeless and bummed. Am I wasting my time on this cycle? The Dr ordered another 5 more days of taking I've never had this many follicles ever so something had to have worked, right? What is normal size for this day? I go back the 13th for another scan. Praying something grows. Your follies aren't big enough to release. They should be minimum The extra meds should help. Don't give up. Just relax and give them more time to grow. You may ovulate late with good sized follies by then. Good luck. I also have PCOS. You may also have follicles that need a little extra coaxing, which isn't a bad thing. It's a PCOS thing. Whenever I'd get frustrated about not having large follicles early on, my nurse would remind me that I have PCOS and that it was simply how my body responded. That said, since you're using donor sperm, I think you may miss ovulation if you wait another five days. I'm not in the medical field, but I have a lot of experience with when follicles take off growing. Follicles hit the active growth stage at 12mm. You had 3 maybe 4 right there. Once follicles are in active growth, they can grow mm per day. You could quite possibly ovulate before your next appointment it happened to me. I know you don't ovulate on your own and I don't either, but with medication, sometimes my body will do an LH surge on its own without use of trigger. I would hate to see you go through this and miss your opportunity this cycle.