OBGYNs who prescribe letrozole (Femara)

[Anonymous]

Anonymous wrote:Thanks guys. For the people asking why, I already stated the cost is 2 orders of magnitude more.
If OBGYNs are fine administering clomid unmonitored (and we had success with it) I'm not sure what the monitoring on a drug that has a statistically less likely chance of multiples is all about. That's why I'm looking for OBGYNs or not REs who prescribe it.

The good ones absolutely are not okay with doing that, nor should they be. There is a lifetime limit on taking clomid, to prescribe it without monitoring is reckless and stupid

[Anonymous]

Anonymous wrote:

Anonymous wrote:Thanks guys. For the people asking why, I already stated the cost is 2 orders of magnitude more.
If OBGYNs are fine administering clomid unmonitored (and we had success with it) I'm not sure what the monitoring on a drug that has a statistically less likely chance of multiples is all about. That's why I'm looking for OBGYNs or not REs who prescribe it.

The good ones absolutely are not okay with doing that, nor should they be. There is a lifetime limit on taking clomid, to prescribe it without monitoring is reckless and stupid

Actually, there's not a "lifetime limit." It's all about whether or not purely ovulating is your issue. If you ovulate on clomid, you'll most likely always ovulate on clomid. If you don't get pregnant while ovulating on clomid after so many times (anywhere from 3-12 it appears, depending on the study and your doctor), then there are other issues at play outside of ovulation.

Granted, you can't take clomid every month for the rest of your life as there are studies (though poorly executed) that indicate an increased risk of breast or ovarian cancer with continued use of clomid.

[Anonymous]

Anonymous wrote:http://www.cbsnews.com/news/fertility-drug-clomid-success-rate-healthy-births/

"Women in the letrozole treatment group had fewer live births, but four times as many multiple pregnancies as women in the clomiphene group."

This study (http://www.nejm.org/doi/full/10.1056/NEJMoa1414827) focuses on the use of letrozole for unexplained fertility and indeed, clomiphene out performs letrozole in terms of clinical pregnancies (28.3% vs. 22.4%), live births (23.3% vs 18.7%). Multiple gestation rate was 22% with clomiphene and 13% with letrozole. These pregnancies were all twins.

However, if the fertility issue is PCOS, Letrozole works better. Letrozole out performs clomiphene in conception (higher conception rate with letrozole), side effects (fewer side effects with Letrozole), chance of multiples (fewer with Letrozole).

Here are a few links to back up the above re: PCOS:
http://www.nejm.org/doi/full/10.1056/NEJMoa1313517
http://www.mdedge.com/obgmanagement/article/88265/reproductive-endocrinology/letrozole-versus-clomiphene-ovulation
https://www.ncbi.nlm.nih.gov/pubmed/25006718

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Thanks guys. For the people asking why, I already stated the cost is 2 orders of magnitude more.
If OBGYNs are fine administering clomid unmonitored (and we had success with it) I'm not sure what the monitoring on a drug that has a statistically less likely chance of multiples is all about. That's why I'm looking for OBGYNs or not REs who prescribe it.

The good ones absolutely are not okay with doing that, nor should they be. There is a lifetime limit on taking clomid, to prescribe it without monitoring is reckless and stupid

Actually, there's not a "lifetime limit." It's all about whether or not purely ovulating is your issue. If you ovulate on clomid, you'll most likely always ovulate on clomid. If you don't get pregnant while ovulating on clomid after so many times (anywhere from 3-12 it appears, depending on the study and your doctor), then there are other issues at play outside of ovulation.

Granted, you can't take clomid every month for the rest of your life as there are studies (though poorly executed) that indicate an increased risk of breast or ovarian cancer with continued use of clomid.

Yeah actually there is, per pretty much any OB in the know, because of the increased cancer risk.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Thanks guys. For the people asking why, I already stated the cost is 2 orders of magnitude more.
If OBGYNs are fine administering clomid unmonitored (and we had success with it) I'm not sure what the monitoring on a drug that has a statistically less likely chance of multiples is all about. That's why I'm looking for OBGYNs or not REs who prescribe it.

The good ones absolutely are not okay with doing that, nor should they be. There is a lifetime limit on taking clomid, to prescribe it without monitoring is reckless and stupid

Actually, there's not a "lifetime limit." It's all about whether or not purely ovulating is your issue. If you ovulate on clomid, you'll most likely always ovulate on clomid. If you don't get pregnant while ovulating on clomid after so many times (anywhere from 3-12 it appears, depending on the study and your doctor), then there are other issues at play outside of ovulation.

Granted, you can't take clomid every month for the rest of your life as there are studies (though poorly executed) that indicate an increased risk of breast or ovarian cancer with continued use of clomid.

Yeah actually there is, per pretty much any OB in the know, because of the increased cancer risk.

Right...so exactly what I said.