Medication Info

Since I haven't had much to report, well actually I am just being stingy with my info, I googled some info on the meds and things that I have been using. It will give you more insite on the monthly process I go through! I have an appointment today at 1:00 to check out my follicles. I am hoping to have more than one mature one this time around! I tested positive on my Ovulation Test today, so we are crossing our fingers.

Letrozole for Infertility Treatment: Background information

Letrozole is being used commonly as an infertility treatment. Letrozole is the most recent addition to the drugs being used for fertility treatment. Fertility drugs are used often in infertility treatments. There are two situations in which fertility drugs may be useful. First, these drugs can be used to induce an egg to develop and be released in women who are not ovulating on their own. This is known as ovulation induction. Fertility drugs can also be used to increase the chances of pregnancy in women who are already ovulating. This is known as superovulation . In many fertility centers, clomiphene citrate (Clomid, Serophene) has been the drug of first choice for either ovulation induction or superovulation for many years. In general, it has been a relatively effective medication. However, clomiphene citrate lasts for a long time in the body and may therefore have an adverse effect on the cervical mucus and uterine lining. Some groups of patients, such as women with PCOS – polycystic ovary syndrome, do not respond well to clomiphene citrate. Another group of fertility drugs which are administered as injections are called gonadotropins (Gonal F, Follistim). The gonadotropins are very efficient at inducing ovulation and have higher pregnancy rates than clomiphene citrate. However, gonadotropins are much more expensive than clomiphene citrate and the injectable route is uncomfortable for patients to administer and inconvenient. The risk for multiple pregnancies is also much higher with gonadotropins.

Letrozole is a medication that has been widely used in women with breast cancer. It is sold under the trade name Femara. Letrozole belongs to a class of medications known as aromatase inhibitors.

Recently, the manufacturer of Letrozole sent a notice to doctors warning that there are reported cases of birth defects that arose in the children of women who received Letrozole while pregnant. Novartis, the manufacturer of letrozole, reviewed their safety database and found 13 reports of pregnant women receiving the drug worldwide. Of those 13 women, two had children with birth defects. In the United States, the labeling of letrozole already warns that it has been associated with birth defects. Novartis has never sought FDA approval to market letrozole as a fertility medication and is clearly concerned about their liability if given in pregnancy.

However, there are no reports of letrozole being associated with birth defects when given prior to pregnancy. It is important to make the distinction that when used as a fertility medication, letrozole is given before the establishment of pregnancy. Letrozole is a medication that is metabolized rapidly in the body. It is not thought to have significant levels in the blood or tissues for a prolonged period of time.

At least one major pharmaceutical company, Serono, is conducting studies with a similar medication called anastrozole in the hopes of obtaining FDA approval to market it specifically as a fertility medication.

Aromatase is an enzyme that is responsible for the production of estrogen in the body. Letrozole works by inhibiting aromatase thereby suppressing estrogen production. Clomiphene citrate, on the other hand, blocks estrogen receptors. In both cases, the result is that the pituitary gland produces more of the hormones needed to stimulate the ovaries. These hormones, FSH and LH, can cause the development of ovulation in women who are anovulatory or increase the number of eggs developing in the ovaries of women who already ovulate. As a result, several studies have now been published using letrozole as a fertility drug.

One of the earliest studies using letrozole as a fertility drug looked at 12 women with inadequate response to clomiphene citrate. Ovulation on letrozole occurred in 9 of 12 cycles and 3 patients conceived. A later study by the same investigators compared the effects of letrozole to those of clomiphene citrate. This time 19 women were studied. Ten women received clomiphene citrate and nine women received letrozole. This study was unable to demonstrate any difference in the number of women who ovulated, the number of eggs that developed in each woman, or the thickness of the uterine lining during treatment. However, a more recent study by a different group of investigators found that compared with clomiphene citrate, letrozole is associated with a thicker uterine lining and a lower miscarriage rate.

Nobody has yet identified the optimal dose for letrozole. Three dose regimens have been tested: 2.5 mg, 5 mg and 7.5 mg. Different studies comparing these dose regimens have occasionally found favor with one dose or another but there is no conclusive data that one dose is better than another. The usual length of treatment is for five days.

Some early studies suggested that the pregnancy rates with letrozole far exceeded those with clomiphene citrate and were possibly even higher than gonadotropins. Further data has determined that this is not the case. Pregnancy rates with letrozole are similar to those seen with clomiphene citrate and are lower than the pregnancy rates seen with gonadotropins. Older patients have a lower chance of success than younger patients.

Treatment with letrozole may still be successful even if other treatments have failed. For example, some data shows that in women who did not ovulate with clomiphene citrate, they still may ovulate with letrozole.

Letrozole side effects

Letrozole works based on its ability reduce estrogen levels. Low estrogen levels of any cause can cause a woman to have symptoms. The data on side effects comes from women who have been using letrozole for an extended period of time in order to treat breast cancer. The treatment duration for letrozole is only five days. In our experience, we have seen side effects that are similar to those seen with clomiphene citrate:

Hot flashes

Headaches

Breast tenderness

Letrozole and pregnancy

Studies conducted so far have shown either no increased risk of miscarriage or a decrease in miscarriage risk. Letrozole is considered pregnancy Category D. Letrozole should not be given to women who are already pregnant. Studies in rats and mice have shown that letrozole increases the risk of fetal death and malformations. Since there are no studies in human beings, it should be assumed that a similar effect is possible.

Letrozole Fertility Treatment Protocols

Monitoring with ovulation predictor kits and having intercourse only.

1. Call the office on Day 1 of your period.
2. Day 2 or 3 - Office visit- Blood test and ultrasound.
3. Take the letrozole 2.5 mg tablet on days 5,6,7,8, and 9.
4. Start testing urine on the morning of day 10 or 11.
5. Look for the first definite color change. Do not continue to test after the color change.
6. Have intercourse the same day you see the color change and the next day.
7. Call the office when you see the color change. Schedule an appointment approximately one week later for a blood test to verify ovulation

Happy and not so Happy Valentine's Day....

Saturday afternoon Josh and I headed to Apalachicola to the Coombs Inn Bed & Breakfast. The drive was beautiful and it took us less than two hours to get there. The room we got, The Hemingway, was amazing and included a 2 person jacuzzi tub and a separate sitting room.


We explored the town for a while and looked around at all the unique shops. We had a snack at That Place Off 98 that included shrimp cocktail and soup...yes I know weird combo, but it was delicious! We had dinner at another restaurant, can't think of the name. I had Ahi Tuna and Josh had some yummy shrimp! We also enjoyed a wine tasting at the Bed & Breakfast!
Apparently we didn't get the memo that you aren't supposed to put bubbles in a jacuzzi tub and ended up having more bubbles than water in the tub. Needless to say that makes your bath time less than enjoyable!! lol


Sunday morning we had a great breakfast at the B & B that included a bacon and spinach quiche and some fruit. They also had bagels, muffins, cereal and many other things to choose from. After breakfast we went on a bike ride. It was pretty nice except Josh could not seem to connect with his bikes because both of them broke!! Haha!! It was pretty fun and we had some really great laughs. We did a little more exploring and then picked up our picnic basket and headed to the beach! St. George Island was only about 15 minutes away. We drove to the state park and found a private spot on the beach. The weather was perfect and we enjoyed sandwiches, chips, fruit etc.


We had a crazy seagull not too far from us that would "yell" at every bird that came near it. It was like our own little body guard! We also saw some dolphins. There were about 7 or 8 that we spotted. After we finished at the beach we parked the car back at the room and went for some homemade gelato. It was excellent, I got mint chocolate chip and Josh got coffee!


After relaxing in the room for a while it was time to get ready for a nice dinner. We had dinner at The Verandas. It was amazing!! We had Lobster and Crab Bisque Soup, Salad and a yummy bottle of Riesling. Josh ordered out side of the box and ordered Duck! It was soooo good!! I ordered a Filet Mignon with mushrooms and some roasted red potatoes and vegetables. It was definitely one of the best meals I've ever had! After dinner we relaxed in the jacuzzi tub, minus the bubbles, and watched the Grammys and talked and such ;)

It was a really amazing weekend to just be together alone and talk and spend some really great time together!!


This morning we had another yummy breakfast at the B & B and packed our things to head out. The drive home was going really well and we were to get home around 11:30. We noticed though that every time we were completely stopped the car would start shaking. When we would go, we would hear a big water swooshing noise. So Josh took the car to Joel to look at. He told him that he thinks it's the radiator and that a gasket blew. This really stinks because as some of you know, about this same time last year our engine blew up. This vehicle has been causing us nothing but problems so I may be looking for a way to get rid of it. Only problem is that I'm not really into the whole using 1 car thing.


I'm trying to stay positive and just think about my next doc appointment on Wednesday. I really hope that my body will have made some progress! I have been taking my pills two a night for a couple nights now and I am hoping it works! If all goes well I will be getting my HCG trigger shot this time next week!!

1 Week Later....

So it has now been a week since my let down of not being pregnant. I have gotten over the disappointment pretty quick thanks to some really amazing friends and family. I just thank God every day for how blessed I am to have these people in our lives.

I had an appointment yesterday (Thursday) and we discussed our next plan of action. I decided that I wanted to just jump right back into it and not waste time trying! So I will be doing the pills again, but double the dosage, and then I will get the HCG trigger shot again. I am looking forward to this round of treatment and pray it will be a success!!

With the double dosage, as with any fertility treatment, there is a higher chance to have twins. That does not scare me at all knowing the amazing support we have around us.

I went to visit a friend and her new baby boy this week. He was born on Josh's birthday, January 27th, and he is soooo beautiful. I got to hold him and touch his soft blond hair. It is such an amazing feeling hold a newborn that little and just watching them sleep. I haven't been able to stop thinking about him since. He has been on my mind all week. I just can't wait until it's my turn to have that feeling and it last a lifetime.

Excited for a Valentine's Day adventure with the hubby this weekend...we will be back Monday and I will tell you all about it! =)

Those Two Evil Words

All of you out there that have had the pleasure of trying and trying to conceive know exactly the two words...NOT PREGNANT. Those are the two most evil words you can see or hear together during this kind of journey. Those are the two words I heard today.


I was kind of preparing myself for this outcome, but it was really hard to hear the confirmation. I shed a few tears which stunk because I am at work and now feel like a hot mess. I know though that I have a ton of people that encourage me daily. I know it will happen for us but the waiting and all the treatment wears on you.


My next plan of action is not set in stone yet and I will probably have a more definite plan next week, but they may just double up my medication that produces Follicles so that I will have a better chance of conceiving the next try. I will then get the HCG trigger shot like this last time to stimulate ovulation.


This treatment plan is not very expensive at all since I have insurance that covers the Meds and so on, but the $25 co-pay sometimes three times a week adds up pretty quickly. I am thankful though right now that I have this treatment option. We are not doing IUI's yet, but I am thinking that will probably be the next option if this doesn't work next time.


Again, thank you to everyone for the amazing support you have provided for me and Josh we couldn't do it without you! =)