[TakingChances]

Hello All! Hoping you can help!!

As you can see below, I tried for a September IVF, but was overstimulated and cancelled. Now I'm trying again in November and praying that they get my meds right! Last time I was on Follistim and Menopur. I received my meds calendar in the mail and it looks like they are keeping everything the same except adding Femara. I'm guessing that is to keep my estrogen under control? If anyone has any experience with Femara, I'd love to hear about it! Right now I'm (ignorantly) feeling frustrated that dosage is the same since I stimmed too quickly, but unsure if Femara is a viable solution to the problems I had last cycle??

Thanks in advance. These forums are an absolute lifesaver!

to all of you!

[babydoll00]

My last cycle of IVF failed. My re thinks that I may have low integrin. She said integrin is what helps the embryo stick. She's going to do a biopsy on me as soon as I get my pd. She said that if my integrin was low she would give me letrozole. Femera, I think is the same as letrozole. I could be wrong but I believe it is. I don't know if this is why you were put on the femera but it is used for this purpose. Also I have read on the internet that IVF done with letrozole may be used to prevent overstimulation. Since you overstimulated last month, that may be the reason. I have been on femera before and it was much better for me then the clomid. I had horrible cysts with clomid but not letrozole. I did have hot flashes some but the side effects on femera were no where near as bad as the injections. God bless my husband for putting up with my moods during this last cycle. It will all be worth it I know. Another way of preventing overstimulation is to reduce the injection dosage. This is what my re did for me after my first overstimulated cycle. Wishing you the best of luck.

[Ghost]

Originally Posted by TakingChances

Hello All! Hoping you can help!!

As you can see below, I tried for a September IVF, but was overstimulated and cancelled. Now I'm trying again in November and praying that they get my meds right! Last time I was on Follistim and Menopur. I received my meds calendar in the mail and it looks like they are keeping everything the same except adding Femara. I'm guessing that is to keep my estrogen under control? If anyone has any experience with Femara, I'd love to hear about it! Right now I'm (ignorantly) feeling frustrated that dosage is the same since I stimmed too quickly, but unsure if Femara is a viable solution to the problems I had last cycle??

Thanks in advance. These forums are an absolute lifesaver!

to all of you!

I suspect your clinic probably intends a more mild stimulation. I suspect they will give you less FSH than before, in combination with a little help from the Femara, which would be expected to develop fewer follicles than a full stim with FSH, and therefore reduce your OHSS risk. That would make more sense than using Femara to reduce the estradiol. It will definitely reduce estradiol, but the problem with that approach is that estradiol is just an indicator, not a cause. Need to treat the cause, not the indicator.

If your FSH (Follistim and Menopur) dosing is reduced from before, then that would make sense.

[LGB]

I took it but am not sure why it was part of my protocol-maybe to give my eggs a boost bc I was a moderate responder. It does keep your estrogen suppressed until you're off of it bc I was on it for the first 4 days of stims and was E2 level was low but then when they took me off it, it started to rise nicely.

[TakingChances]

Originally Posted by babydoll00

My last cycle of IVF failed. My re thinks that I may have low integrin. She said integrin is what helps the embryo stick. She's going to do a biopsy on me as soon as I get my pd. She said that if my integrin was low she would give me letrozole. Femera, I think is the same as letrozole. I could be wrong but I believe it is. I don't know if this is why you were put on the femera but it is used for this purpose. Also I have read on the internet that IVF done with letrozole may be used to prevent overstimulation. Since you overstimulated last month, that may be the reason. I have been on femera before and it was much better for me then the clomid. I had horrible cysts with clomid but not letrozole. I did have hot flashes some but the side effects on femera were no where near as bad as the injections. God bless my husband for putting up with my moods during this last cycle. It will all be worth it I know. Another way of preventing overstimulation is to reduce the injection dosage. This is what my re did for me after my first overstimulated cycle. Wishing you the best of luck.

babydoll - thank you so much for sharing your experience! I had not even heard of integrin, but I will inquire at my next appt. Also happy to hear that the side effects are bearable - that's always a bonus! I'm hoping that your biopsy provides the insight that they need to help you get a next cycle!

[TakingChances]

Originally Posted by Ghost

I suspect your clinic probably intends a more mild stimulation. I suspect they will give you less FSH than before, in combination with a little help from the Femara, which would be expected to develop fewer follicles than a full stim with FSH, and therefore reduce your OHSS risk. That would make more sense than using Femara to reduce the estradiol. It will definitely reduce estradiol, but the problem with that approach is that estradiol is just an indicator, not a cause. Need to treat the cause, not the indicator.

If your FSH (Follistim and Menopur) dosing is reduced from before, then that would make sense.

Ghost - thank you for replying!! I need all the feedback I can get! My frustration is that they are NOT giving me less FSH. I'm no doctor, but logic is telling me that doesn't make sense. Here's last cycle's protocol/results:

Day 1: 2 Menopur, 150 Follistim
Day 2: 2 Menopur, 150 Follistim
Day 3: 2 Menopur, 150 Follistim
Day 4: morning b/w = 452 estrogen, and follies already 11-15mm; 2 Menopur, 75 Follistim
Day 5: 2 Menopur, 75 Follistim, 1 Ganirelix
Day 6: morning u/s shows that at least 5 follies on left are already 18-20mm

Based on follie size, they said I needed to trigger evening of Day 6, but that if they proceded with ER, I would likely only have 6 eggs and they may not be mature. They thought they could get much better results out of me, and advised not to do ER. So...now I'm confused why we're leaving med dosages the same and just adding Femara. It sounds like I'm going to need to question them on this approach - it's just hard when you feel that you're at the mercy of their medical opinions.

Thanks for the insight!!!!

[TakingChances]

Originally Posted by LGB

I took it but am not sure why it was part of my protocol-maybe to give my eggs a boost bc I was a moderate responder. It does keep your estrogen suppressed until you're off of it bc I was on it for the first 4 days of stims and was E2 level was low but then when they took me off it, it started to rise nicely.

LGB - Thanks for sharing your experience! I just checked, and it looks like they're starting me on Femara one day before Follistim/Menopur, and keeping me on it for 5 days. So hopefully I'll see the same estrogen rise you did for the last days of stims (provided I make it that far!) Thanks for your help!!!

[Ghost]

Originally Posted by TakingChances

Ghost - thank you for replying!! I need all the feedback I can get! My frustration is that they are NOT giving me less FSH. I'm no doctor, but logic is telling me that doesn't make sense. Here's last cycle's protocol/results:

Day 1: 2 Menopur, 150 Follistim
Day 2: 2 Menopur, 150 Follistim
Day 3: 2 Menopur, 150 Follistim
Day 4: morning b/w = 452 estrogen, and follies already 11-15mm; 2 Menopur, 75 Follistim
Day 5: 2 Menopur, 75 Follistim, 1 Ganirelix
Day 6: morning u/s shows that at least 5 follies on left are already 18-20mm

Based on follie size, they said I needed to trigger evening of Day 6, but that if they proceded with ER, I would likely only have 6 eggs and they may not be mature. They thought they could get much better results out of me, and advised not to do ER. So...now I'm confused why we're leaving med dosages the same and just adding Femara. It sounds like I'm going to need to question them on this approach - it's just hard when you feel that you're at the mercy of their medical opinions.

Thanks for the insight!!!!

Short answer: Time to find a new clinic.

Long answer: You are correct, it makes no sense. They are treating the indicator by using Femara. Femara will reduce estradiol levels, but this approach will not reduce OHSS risk. It will merely alter the indicator of risk to make it appear safer.

Follicles produce estradiol. More follicles = more estradiol, so estradiol is a good indicator of follicle development. After trigger, in the presence of hCG, follicles produce (among other things) VEGF, and it's too much VEGF that causes OHSS. So the number of follicles indicates OHSS risk, and estradiol correlates with the number of follicles. Femara will block estradiol production, bringing down the estradiol levels. But it will not reduce the number of follicles, nor will it impair VEGF production, so it will not reduce OHSS risk. It will only make the risk appear lower by tampering with the indicator (estradiol). It's like trying to slow your car by pushing the speedometer needle toward zero with your finger. It's just an indicator!

Triggering on day 6 can be predicted to yield a lousy cohort of eggs.

A far better approach is to stimulate until you have a good cohort of follicles, then trigger with Lupron instead of hCG. Lupron will immediately cause and LH surge. LH is the same hormone that matures the eggs in natural cycles. But LH is short-lived while hCG takes a long time to clear. hCG keeps stimulating those spent follicles so they keep making VEGF for a long time, and OHSS can develop. With a Lupron trigger, the LH is gone by the time the eggs are retrieved. So OHSS is virtually impossible, and there's no need to compromise the egg cohort.

The University of Connecticut published this in 2006 and again in 2008. It works well but the luteal support must be intense. The vanishing LH means there will be no corpus luteum activity to help sustain the pregnancy.

[TakingChances]

Originally Posted by Ghost

Short answer: Time to find a new clinic.

Long answer: You are correct, it makes no sense. They are treating the indicator by using Femara. Femara will reduce estradiol levels, but this approach will not reduce OHSS risk. It will merely alter the indicator of risk to make it appear safer.

Follicles produce estradiol. More follicles = more estradiol, so estradiol is a good indicator of follicle development. After trigger, in the presence of hCG, follicles produce (among other things) VEGF, and it's too much VEGF that causes OHSS. So the number of follicles indicates OHSS risk, and estradiol correlates with the number of follicles. Femara will block estradiol production, bringing down the estradiol levels. But it will not reduce the number of follicles, nor will it impair VEGF production, so it will not reduce OHSS risk. It will only make the risk appear lower by tampering with the indicator (estradiol). It's like trying to slow your car by pushing the speedometer needle toward zero with your finger. It's just an indicator!

Triggering on day 6 can be predicted to yield a lousy cohort of eggs.

A far better approach is to stimulate until you have a good cohort of follicles, then trigger with Lupron instead of hCG. Lupron will immediately cause and LH surge. LH is the same hormone that matures the eggs in natural cycles. But LH is short-lived while hCG takes a long time to clear. hCG keeps stimulating those spent follicles so they keep making VEGF for a long time, and OHSS can develop. With a Lupron trigger, the LH is gone by the time the eggs are retrieved. So OHSS is virtually impossible, and there's no need to compromise the egg cohort.

The University of Connecticut published this in 2006 and again in 2008. It works well but the luteal support must be intense. The vanishing LH means there will be no corpus luteum activity to help sustain the pregnancy.

Ghost - thanks for your help. I truly appreciate it. l'll call for another appt with my current clinic, and then also try for a consult with another clinic. I'm going to go out on a limb and guess you're a doctor. If that's the case, and you come on these forums solely to help those of us that are, say, more MBA-minded rather than PhD-minded, bless you. Your insight is much needed and greatly appreciated. I'm touched by your concern for others and willingness to share your expertise. I sincerely thank you.

[Ghost]

Originally Posted by TakingChances

Ghost - thanks for your help. I truly appreciate it. l'll call for another appt with my current clinic, and then also try for a consult with another clinic. I'm going to go out on a limb and guess you're a doctor. If that's the case, and you come on these forums solely to help those of us that are, say, more MBA-minded rather than PhD-minded, bless you. Your insight is much needed and greatly appreciated. I'm touched by your concern for others and willingness to share your expertise. I sincerely thank you.

Thanks for the kind words.

I am not an MD. I hope the information I share helps you and others.