Question about Letrozole in IVF protocol (Ghost, are you out there?)


#1

Hi all,

I am starting my 6th fresh round of IVF the end of June/beginning of July. I have been diagnosed with high FSH (highest recorded was 20 when I was 27), low AMH (1.56), DOR. Basically, I have crappy eggs. I have stimmed well in the past. My last cycle I had 19 eggs retrieved. However, only 11 were mature and only 5 fertilized. In past cycles, I have had as many as 24 eggs retrived and as little as 11 eggs. We always use ICSI and they usually fertilize well. Not sure what happened last time. I was taking DHEA for 3 months prior to my last cycle hoping to improve egg quality…maybe it made it worse. I have since stopped taking it and have continued my other supplements (Super B complex, baby asprin, coq10, vitamin c, pycnogenol, myo-inositol, probiotic, wheatgrass, red raspberry leaf, vitamin d, fish oil, l-arginine, prenatal)

I conceived a healthy baby girl born in 2010 after the Microdose Lupron Flare protocol. I had a 3dt transfer of 2 6 cell, 1 5 cell and 1 4 cell embie. She was one of those. I have been pregnant twice since using the antagonist protocol…300 Bravelle, 300 Menopur, and Centrotide. Both resulted in miscarriage. I have had plently of negative cycles as well.

After regrouping from our last failure in March, my RE decided to switch things up completely. We have tried recreating the protocol that made my daughter, without success. I seem to get more eggs from antagonist protocols, but still have poor embie quality and have never had an embie go to day 5. I have always had 3 day transfers. So onto a new plan.

My RE now wants to do Estrogen Priming with an Antagonist Protocol. I will start Estrace in the luetal phase of my period as soon as :af: arrives. Then once :af: arrives again, I will start stimming. I will be on Follistim 375 units, Low Dose HCG 10 units, Ganeriellix…and Letrozole in the beginning of my stim phase. I have never used any of these meds and am especially worried about the letrozole. What is its purpose? What are they hoping to acheive by adding it to my protocol? Can it help improve egg quality? I did ask them and they said that they wanted to “change the environment” in hopes for better quality eggs. They are afraid they are “frying” my eggs with too much menopur/bravelle. I know Letrozole can be used to prevent OHSS because it keeps E2 levels low…but I have never been at risk for OHSS…my E2 levels are usually around 2400 after 11 days of stim.

Needless to say, we are rapidly reaching the end of our financial and emotional rope. Does anyone have any experience using this type of protocol with Letrozole? I know I tagged Ghost in my Thread title…but anyone with experience would be helpful.

Thanks, ladies and :bsv: to all of you.


#2

I should also mention that I have tried mini-IVF with low dose stims (75 menopur, 225 bravelle) and did get pregnant with that protocol, but that resulted in one of my miscarriages…blighted ovum at 9 weeks.

Basically…I’ve tried a lot of protocols.

If the definition of insanity is doing the same thing over and over hoping for different results…I’m starting to worry that I’m insane:nerd: .

What we will do to make our dreams come true…


#3

:cross: that someone has had this protocol. Anyone???


#4

I think I’m on almost the same protocol. Our first IVF in march failed (that one was follistim, menopur, ganarilex). We got 5 eggs, 4 were mature, 3 fertilized w/ICSI and two made it to 3-day transfer.

I started coq10 and dhea and this time I did testosterone priming (androderm patch) for 6 days, then when I started stims (150 menopur, 450 follistim) I had to add the letrozole and dexamethazone (sp?). I trigger tonight for retrieval Thursday. Doc told me today he is much happier with my progress this month. But the proof is in the pudding I guess, need a good, high quality egg to implant.


#5

Peanut21 you have been through it all!!! Wow… not sure how much help I can be. I was asking some questions about Letrozole too…

I’m going to be starting a mini-IVF with letrozole soon.
My protocol has me starting letrozole and HGH, then adding 2 vials of menopur on the second day…
I’m taking DHEA- I think the DHEA and the HGH really helped my last cycle.
I have lead follicle issues- no matter what kind of protocol or cycle they have tried this past year- 2 follicles take off and nothing ever catches them… so we finally decided to continue on our last cycle despite those lead follicles- I had only a few eggs to retrieve since the others were too small- but I’ll take quality over quantity any time.
4 years ago I had 14 fertilized but only 1 made it to day 5. Last month with DHEA and HGH I had 2 fertilized and both made it to day 5… and so far my surrogate is preggers… very very early, waiting for ultrasound next week.:cross::cross::pray::pray:
Now I am trying to bank some embryos for later use…

I’m wondering how Letrozole works and did it have any side effects?

Good luck to you both, let me know how it all goes!!! I hope this letrozole is the winning ticket!!
:babydust::babydust:


#6

Letrozole is an aromatase inhibitor. These reduce estradiol production. This in turn cause the hypothalamus to release more GnRH so the pituitary will release more FSH to stimulate your follicles. This should work as long as you are not taking an agonist or antagonist at the same time.

Ganirelix is a GnRH antagonist. That means it interferes with GnRH by blocking the GnRH receptors in the pituitary. It is very similar to the Cetrotide you had before (another GnRH antagonist). By blocking the GnRH receptors, they prevent the pituitary from releasing a premature LH surge. But they also prevent the pituitary from releasing FSH, so your Re will probably have you stop the Letrozole once you start the Ganirelix.

Letrozole is an inexpensive way to boost your FSH level during stimulation. I don’t know of it improving egg quality relative to stimulation with FSH meds.

You have had the equivalent low dose hCG before, when you took Menopur. Menopur contains a little hCG. It works much like LH. Opinions vary on how much benefit there is from low-dose hCG in the follicular phase.

I did ask them and they said that they wanted to “change the environment” in hopes for better quality eggs. They are afraid they are “frying” my eggs with too much menopur/bravelle. I know Letrozole can be used to prevent OHSS because it keeps E2 levels low…but I have never been at risk for OHSS…my E2 levels are usually around 2400 after 11 days of stim.

No, Letrozole will not reduce OHSS risk. Yes, it will reduce E2 levels, but E2 does not cause OHSS, so reducing E2 levels this way will not reduce OHSS risk.

But you are correct that they are not giving you Letrozole to reduce OHSS risk.

Needless to say, we are rapidly reaching the end of our financial and emotional rope. Does anyone have any experience using this type of protocol with Letrozole? I know I tagged Ghost in my Thread title…but anyone with experience would be helpful.

Thanks, ladies and :bsv: to all of you.

It’s a fairly common protocol, esepcially in low responders or in cancer patients who want to preserve fertility before chemotherapy (some cancers are sensitive to E2). The letrozole is less expensive than FSH meds, so it saves a little money. But it won’t work in a patient taking an agonist (like Lupron) or antagonist (like Ganirelix).


#7

littleitalian…thanks so much for your reply. I hope you have your good, high quality egg this cycle. It sounds like we are on similar protocols. What is the purpose of your testotesterone priming? That sounds interesting and is something I haven’t heard of before.

wannabe…Congrats on your pregnancy!!! I pray that your surro has amazing u/s results next week. Did you use letrozole during the protocol she got preggers? I hope that you find that it works for you with mini ivf. Thank you for your reply.

Ghost…thanks so much for your reply. I’m a little concerned because it sounds like I’ve bascially done this protocol before, since cetrotide is similar to ganeriellix and low dose HcG is similar to Menopur. I guess the Follistim is new…but is that similar to Bravelle? The only thing different would be the letrozole. And I guess the amount of hormones they are giving me. Is 10 units of low dose HcG equalivlent to 300 of Menopur? I am just trying to figure out if they are giving me basicallly the same protocol as before but hiding it in different brands of medication.

Thank you all for your replies!


#8

I am not sure about protocols. My first Ivf I did the long Lupron (with 450 follistim) and my egg quality was not that great. Out of 7 fert, only 3 made it to day 3 for transfer. The rest had already arrested.

Second Ivf they did the antagonist (375 follistim, 150 menopur) and I did take letrozole the first 5 days. That cycle I have 2 fert and both made it to transfer at day 3. The problem with that cycle was I had a bunch of empty follis, the dr thinks they had already lutenized.

My 3rd I went back to the long Lupron with 375 follistim and 75 menopur and letrozole. I had 9 fert and 5 made it to day 5! So for me it really improved my egg quality (at least as far as them making it farther in the process) and my re said they have seen a huge jump in egg quality across the board and they are giving to many patients who are in the low amh bucket like me. I did get preg my first cycle but miscarried at 9 weeks. Second I had some uterine cramping and a terrible transfer which is what I think resulted in my bfn. I am in the 2ww from my 3rd but transfered two beautiful blasts, so we shall see! I figure Any med that can help me increase my chance. Ad costs me 10 (it’s not coded as a fertility drug soy insurance covers it but even so I think it’s less than 20 for the 5 days I was on it) is worth a shot!

Best of luck to you!


#9

[QUOTE=Peanut21]
Ghost…thanks so much for your reply. I’m a little concerned because it sounds like I’ve bascially done this protocol before, since cetrotide is similar to ganeriellix and low dose HcG is similar to Menopur. I guess the Follistim is new…but is that similar to Bravelle? The only thing different would be the letrozole. And I guess the amount of hormones they are giving me. Is 10 units of low dose HcG equalivlent to 300 of Menopur? I am just trying to figure out if they are giving me basicallly the same protocol as before but hiding it in different brands of medication.

Thank you all for your replies![/QUOTE]

Sorry I was not clear. Menopur is an FSH product, as are Bravelle, Follistim, and Gonal F. Menopur and Bravelle are derived from human urine (purified from the urine of post-menopausal nuns). They therefore contain a little “LH activity” along with the FSH. In the case of Menopur, that “LH activity” comes mainly from hCG, so each 75 IU of FSH is accompanied by about 10 IU of hCG, if I recall correctly. If you take 300 IU of Menopur per day, then that’s 300 IU of FSH and 40 IU of hCG.

Follistim and Gonal F are recombinant FSH products, so they are derived from cultures of genetically modified CHO cells (Chinese Hamster ovary cells).


#10

jennjack…congrats on your transfer. I hope your beautiful blasts are snuggling in. How many days past transfer are you? Are you going to POAS? Just so I’m sure…these blasts were the result of a protocol that had letrozole in it, right? If so, that gives me a LOT of hope for my next cycle.

Ghost…thanks again for the information. It sounds like I will be getting less LH this time around then since I will not be on menopur, but instead the recombinant FSH products which do not appear to contain that little bit of LH. I have read reports from Dr. Sher that he does not believe that patients with my diagnosis (DOR, High FSH) should have too much Lh…something to do with testosterone, I think. Maybe taking some of that LH out of the protocol will help my eggs be of a better quality.

I really appreciate everyones response. I’m hoping for good news come July:clap:


#11

[QUOTE=Peanut21]jennjack…congrats on your transfer. I hope your beautiful blasts are snuggling in. How many days past transfer are you? Are you going to POAS? Just so I’m sure…these blasts were the result of a protocol that had letrozole in it, right? If so, that gives me a LOT of hope for my next cycle.

everyones response. I’m hoping for good news come July:clap:[/QUOTE]
Yes, my blasts were from a cycle where I used letrozole. I am 3dp5dt. And yes, I’m a PoAs addict and will be doing it sometime this weekend as Monday is beta day. Best of luck come July!


#12

We did only injectables- long lupron protocol with my last IVF but I have these lead follicles that take off no matter what protocol we use…so we only get a couple of eggs. My RE thought that we could get the same results for a lot less money doing this mini IVF…
[COLOR=“Red”]Peanut-I’m very curious to see how we all do on letrozole.
so keep us posted on how this goes for you.
Thank you [COLOR=“red”]Ghost for all your info! you are like an encyclopedia!
[COLOR=“red”]JennJack- good luck! I hope they are getting snuggly in there!!! :cross: :cross: for a great beta!!
[COLOR=“Red”]littleitalian- good luck with your retrieval! I’ll be thinking about you! :pray: :pray: :pray:


#13

[QUOTE=wannabehopeful]Peanut21 you have been through it all!!! Wow… not sure how much help I can be. I was asking some questions about Letrozole too…

I’m going to be starting a mini-IVF with letrozole soon.
My protocol has me starting letrozole and HGH, then adding 2 vials of menopur on the second day…
I’m taking DHEA- I think the DHEA and the HGH really helped my last cycle.
I have lead follicle issues- no matter what kind of protocol or cycle they have tried this past year- 2 follicles take off and nothing ever catches them… so we finally decided to continue on our last cycle despite those lead follicles- I had only a few eggs to retrieve since the others were too small- but I’ll take quality over quantity any time.
4 years ago I had 14 fertilized but only 1 made it to day 5. Last month with DHEA and HGH I had 2 fertilized and both made it to day 5… and so far my surrogate is preggers… very very early, waiting for ultrasound next week.:cross::cross::pray::pray:
Now I am trying to bank some embryos for later use…

I’m wondering how Letrozole works and did it have any side effects?

Good luck to you both, let me know how it all goes!!! I hope this letrozole is the winning ticket!!
:babydust::babydust:[/QUOTE]

I ha d no side effects from it at least that I’ve noticed both cycles. I was shocked at the difference in egg quality though. :clap:


#14

[QUOTE=wannabehopeful]We did only injectables- long lupron protocol with my last IVF but I have these lead follicles that take off no matter what protocol we use…so we only get a couple of eggs. My RE thought that we could get the same results for a lot less money doing this mini IVF…
[COLOR=“Red”]Peanut-I’m very curious to see how we all do on letrozole.
so keep us posted on how this goes for you.
Thank you [COLOR=“red”]Ghost for all your info! you are like an encyclopedia!
[COLOR=“red”]JennJack- good luck! I hope they are getting snuggly in there!!! :cross: :cross: for a great beta!!
[COLOR=“Red”]littleitalian- good luck with your retrieval! I’ll be thinking about you! :pray: :pray: :pray:[/QUOTE]

Thanks. I’m feeling really hopeful about this cycle. It’s just been picture perfect and I’ve been so relaxed the whole time. :pray: :pray: :pray: it’s my hthb cycle!


#15

wannabe…I will certainly keep you updated. I start stimming the end of June so I’ll update around then. Good luck with mini ivf. :cross: that those dominint follices stay away. I did a cycle of mini ivf…much less expensive, which my wallet loved!

Jennjack…Good luck with POAS! I’m so excited for your outcome. Can you come back and post your results?? You have given me something to hope for…snuggle in little embies!!!


#16

[quote=Peanut21]wannabe…I will certainly keep you updated. I start stimming the end of June so I’ll update around then. Good luck with mini ivf. :cross: that those dominint follices stay away. I did a cycle of mini ivf…much less expensive, which my wallet loved!

Jennjack…Good luck with POAS! I’m so excited for your outcome. Can you come back and post your results?? You have given me something to hope for…snuggle in little embies!!![/quote]

I sure will! I am getting nervous about POAS, I am so positive about this cycle and scared to death at the same time! I want a baby and will continue if its not, but I am so tired of living the IF life! :grouphug:


#17

I know what you mean about being tired if IF. HOping this is it for you…good luck with POAS!!! I’m thinking double lines for you!


#18

Can you detail your letrozole protocol for us?

JenJack11, can you give me the protocol that you used where you used Lupron/Gonal-f/menopur/Letrozole. What were the doses and did you take lupron throughout the stims or right before you started the stims. I have never heard of this type of protocol.

My RE is suggesting I use Letrozole as well and I’m AMA and high FSH. I would like to recommend your protocol to my doctor to see what he thinks.

Thanks for the sharing and I wish you the best of luck on your transfer!

Linda


#19

[QUOTE=LindaL]JenJack11, can you give me the protocol that you used where you used Lupron/Gonal-f/menopur/Letrozole. What were the doses and did you take lupron throughout the stims or right before you started the stims. I have never heard of this type of protocol.

My RE is suggesting I use Letrozole as well and I’m AMA and high FSH. I would like to recommend your protocol to my doctor to see what he thinks.

Thanks for the sharing and I wish you the best of luck on your transfer!

Linda[/QUOTE]

Yes I was on Lupron basically starting a week before stims until ER. I started letrozole the first day of stims and took that in the am 2 a day. Then at night I did 75 iu of menopur along with 375 of fsh. I had some gonal that was given to me and then my follistim so I basically used one cartridge of one for a few days (900iu) then would switch to the other. It was basically a long Lupron protocol with menopur and femara. I was thrilled with the results as I got 2x more than I had before on my other cycles.

My re is pretty conservative and likes to stick with the long Lupron. First time I get 7 eggs and quality was pretty poor so I asked to change to antogonist and it was a disaster. So when he wanted to go back to the long Lupron with the femara and menopur to help quality I was ok with it as the 7 was much better than the 2 I got the next time. So when I ended up with 14 retrieved and 9 mature I was thrilled! Had my transfer last Sunday (mothers day) with two high quality blasts I was so happy as I had never made it to day 5 before. I had one that made it to expanded blast after but it was missing the inner cell mass so they had to destroy it. Oh well, if I get prego this cycle and get my healthy take home baby we are done so I’m not really upset about no frosties, then I don’t have to worry about what to do with them.

Best of luck!


#20

Congratulations!

I am wishing you :bfp: soon! That’s exciting. :cheer:

I have never heard of a Lupron long protocol with Letrozole. Lupron usually shuts down your pituitary gland’s ability to produce Estrogen, LH and FSH - it suppresses you. That’s why you have to take lots of Gonal-F or Follistim and Menopur to make up for the loss that your body is not producing naturally while on Lupron. Letrozole works by coaxing your pituitary gland/ovaries into producing more FSH and LH by not allowing estrogen to be produced, but if your pituitary gland/ovaries are shut down, I don’t know how Letrozole could work properly.

This is puzzling to me. Does anyone know how Letrozole can work while taking Lupron? How is this protocol able to produce more follicles?