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letrozole side effects infertility

letrozole side effects infertility

Letrozole

Letrozole is used frequently as an infertility treatment. It is a recent addition to the drugs that are currently used for fertility treatment. This medication is a helpful aid to induce an egg to develop and be released in women who are not ovulating naturally; this is known as ovulation induction. Fertility drugs can also be utilized to increase the probability of pregnancy in women who are already ovulating.

Clomiphene Citrate or Serophene  has been the drug of first choice for both ovulation induction or superovulation for several years. By and large,  letrozole-300x135it has been a relatively effective medication. Clomid is known to last longer in the body and so may have an adverse effect on the cervical mucus and uterine lining.

Pregnancy rates with letrozole are similar to those seen with clomiphene citrate and are lower than the pregnancy rates seen with gonadotropins. Older patients will have a reduced chance of success than younger patients.

Treatment with letrozole may still be successful even if other treatments have failed. Some data has shown that in women who did not ovulate with clomiphene citrate, may ovulate with letrozole.

Who should try letrozole?

Before prescribing letrozole, your doctor should do a consultation and testing, explains Librach. The specific tests vary from case to case, but they can include sperm testing, blood hormone level testing and checking for blockages in your fallopian tubes.

If you’re diagnosed with an ovulatory disorder like PCOS and your doctor decides that letrozole is a good fit for you, they will likely have you try it for up to six months, says Bob Casper, a reproductive endocrinologist and senior scientist at the Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital who led the team that worked out the drug’s use for ovulatory disorders.

Letrozole as a Fertility Treatment

Letrozole is a medication that has been widely used in women with breast cancer. It is sold under the trade name Femara. Letrozole belongs to a class of medications known as aromatase inhibitors. Aromatase is an enzyme that is responsible for the production of estrogen in the body. Letrozole works by inhibiting aromatase thereby suppressing estrogen production. Clomiphene citrate, on the other hand, blocks estrogen receptors. In both cases, the result is that the pituitary gland produces more of the hormones needed to stimulate the ovaries. These hormones, FSH and LH, can cause the development of ovulation in women who are anovulatory or increase the number of eggs developing in the ovaries of women who already ovulate. As a result, several studies have now been published using letrozole as a fertility drug.

One of the earliest studies using letrozole as a fertility drug looked at 12 women with inadequate response to clomiphene citrate. Ovulation on letrozole occurred in 9 of 12 cycles and 3 patients conceived. A later study by the same investigators compared the effects of letrozole to those of clomiphene citrate. This time 19 women were studied. Ten women received clomiphene citrate and nine women received letrozole. This study was unable to demonstrate any difference in the number of women who ovulated, the number of eggs that developed in each woman, or the thickness of the uterine lining during treatment. However, a more recent study by a different group of investigators found that compared with clomiphene citrate, letrozole is associated with a thicker uterine lining and a lower miscarriage rate.

Dosing

Letrozole comes in 2.5mg tablets and is taken once a day for 5 days, usually beginning on day three or day five of your menstrual cycle. You may need monitoring through blood tests and/or ultrasounds to determine when you are approaching ovulation.

Side Effects

Letrozole works by reducing estrogen levels in order to stimulate ovulation. Low estrogen levels of any sort can cause a woman to have symptoms. Those most commonly seen with Femara use include:

  • Fatigue
  • Dizziness
  • Headache
  • Bloating
  • Hot flashes
  • Night Sweats
  • Blurred vision
  • Upset stomach
  • Breast pain
  • Difficulty sleeping

What are the side effects of Letrozole?

The most common side effects are sweating, hot flashes, joint pain and fatigue, nausea and diarrhea.

Why is Letrozole not used routinely?

It is not approved for ovulation induction by the FDA. It is therefore used "off-label" in specific circumstances only.

Clomiphene citrate has now been used clinically for more than 40 years and remains the most common drug used for ovulation induction.

There is a controversy concerning birth defects with the use of Letrozole. The drug maker (Novartis) has sent a letter to physicians discouraging the use of Letrozole for ovulation induction. Recent data suggest that these fears are unfounded. This will be discussed in detail in my next blog.

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