Ask Dr. Marc: Is Letrazole Safe?

Dear Dr. Marc,
I’ve been experiencing secondary infertility for 16 months now trying for a 3rd baby. It’s been determined as unexplained. I ovulate, no blockages, husband is fine, etc. we tried one round of Clomid and IUI last month which was unsuccessful and I can’t take anymore Clomid because it caused my vision to be blurry. My reproductive endocrinologist has recommended letrozole as a next step.
But I am nervous because I don’t know anyone who has taken it, am leery of fertility drugs in the 1st place, and read online that the chance for multiples is lower but can be linked to birth defects. What are your thoughts?
Thank you.
Hi can’t take clomid,
It is quite common for people to be leery of fertility medication. Such fears are exacerbated if the medication has ever had a “black box” warning placed upon it, such as letrazole.  With that being said, there is ample evidence that letrazole is very safe and quite effective.  I would encourage you to consider it.
Let me give you some background on Letrazole.  Letrazole belongs to a class of drugs called aromatase inhibitors.  Aromatase is the enzyme which converts testosterone to estrogen.  Aromatase inhibitors block that conversion effectively blocking production of estrogen.  They are often used in situations where exposure to estrogen is undesired, breast cancer for example.  In the world of fertility, these drugs make the brain think that the ovaries are not producing estrogen.  Consequently, the brain sends a stronger signal to the ovaries to get them to make estrogen by making one egg (in women who do not normally ovulate), or multiple eggs (in women who ovulate normally).
The controversy with letrazole came from a small study presented in 2005 which showed a slightly higher rate of birth defects in 150 women who took letrazole as compared to the general population.  Despite that fact that since that time, many other larger studies have been conducted which did NOT find a higher rate of birth defects, the manufacturer of the medication placed a specific warning on the medication against the use for fertility.
Most current fertility specialists see this warning as politically motivated and not based on science.  This is unfortunate because it is an excellent medication which may be better than other alternatives such as clomid.
In short, I understand your fears, but there is reason to believe that letrazole is safe, effective and a reasonable alternative to clomid.  If my wife and I were going through fertility treatment, I would not hesitate to use it.
Good luck,
Dr. Marc

Ask Dr. Marc: Timing Ovulation

Hi Dr. Marc.


I’m taking fertility drugs such as gonal f and/or clomid, I’m 37, I ovulate on my own, I’ve run the gamut of testing and everything on both my end and DH’s end is great. So I’m wondering if I will ovulate all eggs without a trigger shot – or will my surge only allow me to ovulate 1.


Thanks for your time.





Your natural surge is sufficient for all mature follicles to ovulate.  This is true whether you have 1 or many mature follicles.

Despite this, your doctor may recommend using a “trigger shot” to induce ovulation.  There are a couple reasons a doctor may choose the trigger shot.  First, in order to coordinate an insemination, we need some advanced notice to prepare the sperm and get you in for an appointment etc.  The trigger shot allows the timing of ovulation to be amenable to normal working hours when an insemination can be done.

Second, ovulation predictor kits tend to be less accurate when a patient is using injectable medication.  Thus, they cannot be relied upon to schedule an insemination.

Hope this helps TTCT, good luck!



Dr. Marc

Share Your Story: Just Stop Trying and It Will Happen

Today I want to introduce you to Tracy.  Tracy has been on the infertility roller coaster for quite some time.  Her ability to keep her spirits up and cheer for others along the way is truly inspiring.  She began blogging as a form of catharsis, but quickly realized that if we all stick together we can help each other along the way.  Did I mention that she’s also funny?  With the tagline, “Barren and blogging.  Don’t be jealous”, you know you’ll find some humor along the way!  You can find her over at Just Stop Trying and It Will Happen.  Please show her some love and support here today as she shares her story with all of you.

My infertility story began about three and a half years ago.  The husband and I were newly married, and eager to start a family.  We let things go for a couple of months, not really trying to try.  When nothing happened after about six months, and my two closest friends who had been married within a few months of me were expecting their first babies, I started to get frustrated.

I escalated to ovulation predictor kits, and learned a lot more about my body.  After a few unsuccessful months of that, I escalated again to taking my basal body temperature every morning.

Every month brought disappointment, frustration, and jealousy over others’ ability to produce children at will.  I peed on more things than I can count, and that has yet to end.

After we had been actively trying for about 18 months, I went to my new ob-gyn and asked for advice.  She asked me to show her on a calendar how often the husband and I were having sex, told me that was not adequate, and told me to have sex every other day.  If nothing happened within a year, I was to report back to her for further treatment.

At this point, I was 29.  My clock had been ticking for a while… I was ready.  Not in a year.  Now.

I made an appointment with a new ob-gyn that day, and saw her the next week.  She ordered a whole barrage of blood work for me, a a semen analysis for the husband, and sent me for an HSG to be sure my fallopian tubes were not blocked.

After everything came back normal, I was officially diagnosed with unexplained infertility.  I like to call it Invisible Infertility.  Ugh.

I started a two month stint on the entry-level dosage of Clomid, and found that despite the side effects, the meds helped me to see a more clear ovulation occurring on my BBT chart and with the OPKs.  Since I was prescribed the meds through my ob-gyn, I was not able to be monitored aside from a blood test at the beginning and end of each month.

When the second month of Clomid was unsuccessful, the very kind ob-gyn advised that I see a reproductive endocrinologist.  I made the appointment, and waited the three excruciating months for the consultation.

The meeting was brief.  We talked about my testing, medical history, and knowledge of the conception process.  In the end, my insurance would not cover much of anything, and we opted to try more medicated cycles.  I started what would be a six month Femara and Ovidrel diet, along with monitoring ultrasounds and blood work.

When the November 2011 cycle came to an unfortunate, but not unexpected conclusion, the husband and I decided to take the holidays off to enjoy being unmedicated for a bit.

In January 2012, I heard a radio advertisement offering a clinical study for women with unexplained infertility.  I figured I’d call and check it out… I mean, what could it hurt, right?  So I called.

After a series of questions over the phone, I was invited up for some preliminary blood work and to fill out some paperwork.  I found out about a week after the call that I’d been accepted into the study, and would receive four fully-funded IUI cycles, complete with medication and monitoring for my participation in the study.

I was randomized for medication at the beginning of February, and of the three options (Clomid, Femara, and Menopur), I was chosen for the pills.  I’m still not quite sure which pills, and I won’t officially know until after the study concludes.  I have a sneaking suspicion that it’s Clomid, however, based entirely on the horrendous hot flashes and night sweats.  I also get an HCG trigger 36 hours before my IUI, and I follow the IUI with Prometrium.

Last cycle was tough.  We not only got news of a very close family member who is expecting their first child, but we also suffered a chemical pregnancy after what was the most promising cycle I’ve ever had.  It was a very hard time for us, but I didn’t want to lose momentum and opted to continue onto the next cycle.

I am currently waiting to start monitoring for my thrid IUI cycle, and expect the procedure itself to take place early next week.

Come ooooooooon, lucky number three!!

So that’s my story so far.  I started blogging for catharsis, and through that process have met some of the most amazing, caring, supportive people in my life.  I hope to inspire others to share their stories as well, and to ask questions about the treatment process, the emotional toll, and how we cope with the stress month after month.

Above all else though, I hope to be a mother.  One of these days, it’s bound to happen, right?  :)

Thank you, Tracy.  Sending you lots of support and pregnant thoughts!

Share Your Story: One LoCo Mommy

This week on Share Your Story, meet Diane.  Known on Twitter as One LoCo Mommy, Diane blogs over at One LoCo Mommy.  There was nothing easy about her journey to parenthood, including a substantial amount of pain.  After months of trying without any luck, Diane finally saw a specialist.  It was then that she learned that she really only had a 1-2% chance of conceiving each month.  And so she started infertility treatments.  Today she shares her story with us.  “It’s So Hard When It Doesn’t Come Easy” originally appeared on The Invisible Disability on April 26, 2012.

It’s So Hard When It Doesn’t Come Easy

Byline:  One LoCo Mommy

This morning, after putting Mayita back down in her crib from yet another waking, I stumbled back to bed. Unfortunately I couldn’t get back to sleep. Thoughts kept rolling through my mind (like, preparing for her birthday party, why is my credit card bill so damn high, etc.) when I suddenly realized that I missed a BIG anniversary.

Five years ago, on April 23rd, 2007, I walked into an nondescript office building. It was a day we were waiting for a long time. It was the day of my Intrauterine Insemination procedure, otherwise known as an IUI.

It was a long, frustrating and painful lead-up to that day. We were trying for a year and a half.  We were doing all the “right” things. I had bought “Taking Charge of Your Fertility”. I measured my basal body temp every single morning and charted. I even had a subscription to an online site that would take my temps and pretty much told me the right time to…well…try.

I exercised, limited my caffeine and alcohol intake, and definitely tried to negotiate with “the big man upstairs”. I bought  books and then more books. I scoured the Internet for resources. I went to online sites and found other women like me trying to learn some magic trick to getting pregnant.

And, every month, like clockwork, there was the disappointment. The crying. And, because I havedysmenorrhea, I was in extreme pain (because the Pill actually helps regulate that). I was not a pleasant person during these times.

Inevitably, we would buck up and look forward to the next month with optimism. That maybe “this” was THE month.

But it was never THE month. And so it went on. We had to dodge questions from family and friends. We always had a smile and joked that our dog was, “our child” but yet it still hurt. When family members and friends announced their upcoming joys we were crushed. We would hold the babies in our arms, devastated that we hadn’t been the “lucky” ones.

I finally saw my OB again, and other tests were run. We discovered what we had suspected all along – that we were dealing with infertility. Most likely, we were looking at IVF for a shot of becoming pregnant. Even now, I remember how far my heart fell when I heard all those words. But yet, it was strangely reassuring because now there was something new to explore. We knew what was going on now.

We got our referral to a Reproductive Endocrinologist (RE). After reviewing our initial results, the doctor explained that we had about…oh…1-2% chance of getting pregnant every month. Well, with those odds, no wonder we were failing miserably. The doctor continued by telling us that maybe an IVF wasn’t the avenue we should pursue. Instead, we should try an IUI, with Clomid and injectibles. As he put it, “create as many targets as possible for the little buggers.”

So we went through more tests and blood work. I had to get an hysterosalpingogram (HSG). And while the majority of women only have slight pain or cramping, I was not one of those. The poor techs were not sure what to do with my sharp breathing and yelps. Happily they were able to report that my reproductive system was clear as a bell.  I’ll take that as a compliment.

We had to go to a class to learn how to use the injectibles. Rather, Husband had to learn and I had to make sure that I wasn’t going to freak out about the thought of Husband giving me shots.

When we finally straightened out the insurance (and let me just say, we were extremely lucky my insurance covered this) we were able to “officially” start Round 1. That meant more blood work, and then I got to experience the transvaginal ultrasound. This is what I commonly joked to as the “dildo cam”. I took the Clomid on cue every day and then, on the designated days, Husband did his duty and poked me with the injectibles. He did very well and I was proud of him.

I had to have another ultrasound to monitor my follicle development and when the time was right, we scheduled the IUI. I had many viable follicles that were ripe for insemination. Woot. The actual procedure itself did not take long at all, was nowhere near as painful as the HSG (thank GOD) and I was able to go right back to work. With a little secret, of course.

And, so we waited anxiously. For two whole weeks. I obeyed my RE doctor and nurse who said not to test early. I didn’t want to have a false negative (or positive). In order to get an accurate result, a Beta Pregnancy Test was best. Which meant more blood work.

I never told y’all that I hate getting my blood drawn, right? I mean I actually will pass out. I was actually advised to not donate blood because I couldn’t last two minutes. But I put on my big girl panties for the chance to become a mom. I had to.

Putting on the big girl panties worked. My Beta levels were high. I was pregnant. Round 2 of the Beta test, then the ultrasound proved it. There was a tiny heartbeat going strong. Mere months later, Mayor Bee entered our lives. And we won the Battle of Infertility.

And for all the frustration, sadness, and worthlessness I felt during that long journey, holding that little precious baby made it all melt away. It was all worth it.

Thank you, Diane, for your words, your strength, and for sharing your happy ending.  A little bit of hope goes a very long way.  Now head on over and pay Diane a visit.
One LoCo Mommy