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I Would Like To Ask Please About Letrozole And Its Risks
Question: Dear gynacologist/obstetrician:
I would like to ask please about letrozole and its risks.
I am 38.5 years old and recently got married. I am trying to conceive as soon as possible due to travel issues and my husband needing to travel. I tried for one month so far but because I have limited time and I have irregular cycles (28-35 days), no cysts in the ovaries, I would like to try taking letrozole when trying to conceive next cycle.
Can you please tell me about your experience with letrozole when to take it and the best dose?
How to monitor when to have intercourse and any paradoxic risks of letrozole on fertility?
Thank you
I would like to ask please about letrozole and its risks.
I am 38.5 years old and recently got married. I am trying to conceive as soon as possible due to travel issues and my husband needing to travel. I tried for one month so far but because I have limited time and I have irregular cycles (28-35 days), no cysts in the ovaries, I would like to try taking letrozole when trying to conceive next cycle.
Can you please tell me about your experience with letrozole when to take it and the best dose?
How to monitor when to have intercourse and any paradoxic risks of letrozole on fertility?
Thank you
Brief Answer:
infertility
Detailed Answer:
Hello,
thanks for the query,
Firstly at 38.5 years of age, you are in elderly age group where planning a conception is not free from risks to the foetus for aneuploidies. however , at age above 35,The follicular reserve also depreciates and moreover with your Irregular cycles, the chances of predicting natural ovulation by natural methods is difficult ( like basal body temperature or following teh mucous vaginal discharge).
You should have attached your hormonal profile and your last ultrasound pelvis and follicular monitoring report for an opinion over option for USING OVULATORY DRUG like LETROZOLE.
It is offered for women who have PCOD or having low antral follicular count with no hypoestrogenism as the most common side effect of letrozole is hypoestrogenism and this can often prevent adequate growth of follicle.
Ideally in suitable cases, it is to be started from day 3 of cycle for 5 days ( dose of 2.5mg) and then follicular monitoring is done to check for maturity of eggs and further ovulation . A constant vigil has to be maintained under a gynaecologist during this whole treatment.
Though the chances of OVARIAN HYPERSTIMULATION SYNDROME OR OHSS is less with letrozole as compared to Clomiphene citrate but cases have been seen which forms an emergency.
So , you should be under a local gynaecologist's care before starting any ovulatory drug.
Wishing you good health,
Regards
infertility
Detailed Answer:
Hello,
thanks for the query,
Firstly at 38.5 years of age, you are in elderly age group where planning a conception is not free from risks to the foetus for aneuploidies. however , at age above 35,The follicular reserve also depreciates and moreover with your Irregular cycles, the chances of predicting natural ovulation by natural methods is difficult ( like basal body temperature or following teh mucous vaginal discharge).
You should have attached your hormonal profile and your last ultrasound pelvis and follicular monitoring report for an opinion over option for USING OVULATORY DRUG like LETROZOLE.
It is offered for women who have PCOD or having low antral follicular count with no hypoestrogenism as the most common side effect of letrozole is hypoestrogenism and this can often prevent adequate growth of follicle.
Ideally in suitable cases, it is to be started from day 3 of cycle for 5 days ( dose of 2.5mg) and then follicular monitoring is done to check for maturity of eggs and further ovulation . A constant vigil has to be maintained under a gynaecologist during this whole treatment.
Though the chances of OVARIAN HYPERSTIMULATION SYNDROME OR OHSS is less with letrozole as compared to Clomiphene citrate but cases have been seen which forms an emergency.
So , you should be under a local gynaecologist's care before starting any ovulatory drug.
Wishing you good health,
Regards
Above answer was peer-reviewed by :
Dr. Kampana
Thanks very much for your reply.
Further information (reports attached here)
Some lab results:
AMH 30.8 in August 2020
Antral follicle count on external ultrasound:15 in August 2020
Hormonal panel done on day 24 of my 31 day cycle (attached). Progesterone was 33.1nmol/L
Pelvic ultrasound done cycle day 8 is attached (basically unremarkable)
Yes because of my age I wanted to get some assistance early and learnt letrozole is better than clomid. Regarding the OHSS, do you know how often it happens or who is more likely to get it? What happens to the patient if this OHSS occurs? Do they need surgery or can they get a trigger shot?
Is the 2.5mg leteozole taken once a day or twice a day?
Thanks for your help
Further information (reports attached here)
Some lab results:
AMH 30.8 in August 2020
Antral follicle count on external ultrasound:15 in August 2020
Hormonal panel done on day 24 of my 31 day cycle (attached). Progesterone was 33.1nmol/L
Pelvic ultrasound done cycle day 8 is attached (basically unremarkable)
Yes because of my age I wanted to get some assistance early and learnt letrozole is better than clomid. Regarding the OHSS, do you know how often it happens or who is more likely to get it? What happens to the patient if this OHSS occurs? Do they need surgery or can they get a trigger shot?
Is the 2.5mg leteozole taken once a day or twice a day?
Thanks for your help
Brief Answer:
follow up
Detailed Answer:
Hello,
Firstly i do not see any reports attached.
bUt keeping in view, AMH of 30 and AFC OF 15 - both are very high and indicate a possible POLYCYSTIC OVARIAN SYNDROME.
In such cases ovulation induction with clomiphene or letrozole is not recommended without any gynaecologist or infertility specialist supervision. You would need a day 2 ultrasound for astral follicular count and amh before starting the same else the chances of OHSS would be very high.
OHSS is the most dreaded complication of ovulation induction where teh follicles may reach even to teh size of 30-35mm each and ovarian volume increases. This can lead to dyselectrolytemia and often if not controlled can cause multi-organ failure.
In your case it would be best to opt for an IVF rather than trying to conceive naturally. Also trigger shot is contraindicated in OHSS.
I would recommend against the use of letrozole.
Regards
follow up
Detailed Answer:
Hello,
Firstly i do not see any reports attached.
bUt keeping in view, AMH of 30 and AFC OF 15 - both are very high and indicate a possible POLYCYSTIC OVARIAN SYNDROME.
In such cases ovulation induction with clomiphene or letrozole is not recommended without any gynaecologist or infertility specialist supervision. You would need a day 2 ultrasound for astral follicular count and amh before starting the same else the chances of OHSS would be very high.
OHSS is the most dreaded complication of ovulation induction where teh follicles may reach even to teh size of 30-35mm each and ovarian volume increases. This can lead to dyselectrolytemia and often if not controlled can cause multi-organ failure.
In your case it would be best to opt for an IVF rather than trying to conceive naturally. Also trigger shot is contraindicated in OHSS.
I would recommend against the use of letrozole.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
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