Ovulation Induction
- Jan 3, 2025
- 5 min read
My NHS experience with Letrozole.
I know when we were starting our treatment I searched for information on other people’s experiences with letrozole so I thought it would be helpful to talk through our experience in our local NHS fertility clinic.
Looking back on our fertility journey so far and we’ve been lucky in lots of ways.
After my GP referred us to the NHS fertility clinic in October 2021 we only had to wait 4 months for our first appointment. They offered me the option of having a HyCoSy - Hystero Contrast Sonography - to check the patency of the fallopian tubes and I felt it was a no-brainer. In my mind there was no point spending all this time on fertility meds if my tubes were blocked.
Prior to the HyCoSy I did what everyone does and googled it. Most women said it was uncomfortable but bearable, a few cramps, a bit of spotting but nothing to worry about. I wish I could say my experience was similar but it wasn’t. I went on my own, in hindsight this was a mistake and if you’re having this procedure done I would encourage you to take someone with you. I’ve dealt with painful periods my whole adult life, I can deal with a bit of discomfort, this would be a walk in the park I thought.
Putting it bluntly, it was agony. They insert dye through a small catheter in your cervix and I thought I was going to pass out from the pain. They managed to confirm that one of my tubes was patent but the other appeared to be blocked. They wanted to use more dye to try to flush it out but I couldn’t stand the pain any longer and they abandoned the procedure. Afterwards the nurse did say that they find women who experience painful periods experience more pain during a HyCoSy - would have been helpful to know this beforehand…
The team were lovely and reassured me that you only need one patent tube to get pregnant and we continued on with our first cycle on letrozole.
So what is letrozole?
Letrozole was orginally used in the treatment of breast cancer in post-menopausal women but was then found to induce ovulation by inhibiting oestrogen production. The reduction in oestrogen causes the body to produce more FSH which stimulates ovulation. Studies have shown that letrozole appears to be more effective in ovulation induction for women with PCOS compared to clomid and is now commonly offered as first-line treatment.
I started on 5mg letrozole and took if from day 2 to 5 of my cycle. I went for my first ultrasound at day 12 and unfortunately I didn’t seem to be responding. I went back for another ultrasound 2 days later and the clinic confirmed I had not responded, the dose needed to be increased next cycle.
Cycle 2 and on 7.5mg this time. The ultrasound confirmed I had a large follicle but my lining was thin and I remember the nurse saying she didn’t think it would sustain implantation. She went on to talk about the possibility of adding in oestrogen and progesterone in my next cycle if it continued to be an issue. I was deflated. It felt like we were hitting issue after issue. Remarkably, 2 weeks later my period had still not arrived so I took a test and it was positive. I couldn’t believe it! This was it, we’d done it. But a week later I started bleeding and by the time I was seen in EPU it was all over, I’d miscarried.
We carried on for a few more cycles after the miscarriage but eventually decided to take a break for few months.
We restarted letrozole in December 2023. I called the clinic and asked if I could continue despite not using it for several months and they were fine with it. I restarted on 7.5mg and went for my first scan just before Christmas. This time I’d over-responded, and with Christmas in the way, the clinic had no way to rescan me to monitor the follicles so they told us to abandon the cycle. I briefly thought about ignoring them and trying anyway but the risk of 4 follicles maturing was too high, and knowing our luck we’d end up with an incredibly high-risk multiple pregnancy which we didn’t want.
3 cycles later and we had another positive test. We were more cautious this time, we’d experienced loss and knew it was still high risk. But as the weeks went past we became more hopeful, I had a scan in the fertility clinic at 6+5 weeks and we saw the tiny heartbeat fluttering away. I’d had some spotting since I had the positive test and was nervous this was a bad sign but the nurse reassured me that it was old blood and nothing to worry about. A week after the scan I started getting cramps and more bleeding, we went for another scan and they confirmed there was no heartbeat, our baby had died.
What followed was weeks of waiting; waiting for symptoms to stop, waiting for test results to come back, waiting 3 months for repeat blood tests, waiting for those results to come back. Eventually, we were given the ok to restart letrozole in August 2024, 5 months after the miscarriage.
We continued the medication, the cycle tracking, the scans and the testing but we’ve had no more positive tests. Our fertility clinic had said we could have 6-9 cycles of letrozole following the miscarriage and if that didn’t work the next step would be IVF, but because of the miscarriage we’d have to wait until March 2026 if we wanted it on the NHS. Yes, it’s sh*t, and I’m grateful that we’re in a position to be able to pay for private IVF.
Letrozole did work for us, it made me ovulate and we did get pregnant but there is clearly other issues for us. My clinic did eventually give me progesterone pessaries to use after ovulation but this was only after the 2nd miscarriage and I can’t help but think it was too late, could it have helped to prevent the 2nd miscarriage?
Everyone tells me that thinking about the ‘what ifs’ isn’t helpful but it doesn’t stop you thinking about them. It could have helped and we’ll never know. What I have learned is that we have to advocate for ourselves, I suspected I had a luteal phase defect over a year ago but when I mentioned it and the nurse brushed me off I didn’t say anymore. I wish I’d pushed harder and I wish I’d spoken up.
Women navigating infertility deal with the sadness and grief in different ways. For me, most of the time, I try to cling on to some positives. Our journey with ovulation induction has ended and we’re now moving on to IVF. I’m hopeful this will work for us, that a different approach is what we need, and that a bit more luck will come our way. Keep your fingers crossed for us.
Ask questions, share your thoughts, share your stories.
L x
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