Letrozole Ultrasound: Will I Not Ovulate This Cycle Too?

[worldbandy]

Hi! I’m on my first medicated cycle:
1. Provera - to induce period after 70+ days without one (bless, it worked!)
2. Letrozole 2.5mg starting on day 3 - for ovulation induction)

Having preovulation symptoms (e.g. transition from creamy to very watery CM) and with today being day 5 after finishing my last dose of letrozole, I went in this afternoon for a transvaginal ultrasound to see if the letrozole worked. Some of the key findings of the ultrasound included:
- Many cysts in ovaries (doctor thinks likely due to letrozole and nothing to be concerned about; also ruled out PCOS)
- Left ovary: 5 follicles with 1 bigger than rest (1.02cm)
- Right ovary: 8 follicles with 1 bigger than rest (1.33cm)

However, she mentioned that follicles need to be closer to 2cm to be considered the dominant follicle.

As my doctor didnt provide any conclusive advice besides “We’ll do a CD21 blood test and see”, I still have 2 main concerns/questions:
1. Given that today is CD12 (and with the letrozole-induced ovulation typically occurring b/w CD12-16), I’m concerned that I won’t be able to ovulate this cycle too. How realistic is it that my follicles will be able to grow quickly to ~2cm in the next 4+ days?
2. Given that I have a lot of cysts this cycle, can I can do Letrozole next cycle too or is it recommended to skip a cycle?

Any advice would be much appreciated!

EDIT: As this is my first cycle trying with medications / under guidance, we have not yet planned for trigger shots nor IUI/IVF. Medications are the only thing planned for this cycle.

 

[godsplan]

@worldbandy It sounds like you are not close to ovulating yet so your doctor will do a blood draw on CD 21 to see if you ovulated or are close to ovulating. I’m working with a fertility doctor right now on letrozole also, I was told that the follicles can get really large on letrozole before ovulating, like mid 20mm. (I’m definitely no expert but here’s what I’ve heard from my doctor)
1. Follicles grow about 1-2mm per day, so you might ovulate a bit later if your largest follicle is only 13mm. Are you doing a trigger shot? Start testing with ovulation tests in the next few days.
2. As long as you don’t have bad side effects or signs of letrozole thinning your uterine lining, it’s ok to do back to back cycles. They’ll also check for cysts at your baseline ultrasound after your period starts. I’ve been on letrozole 7.5 since November with one month break. I respond really well but side effects are starting to catch up with me though so I’ll probably take another break next month.
Hope this helps!

 

[worldbandy]

@godsplan Ahh this was so helpful and exactly the insight I was looking for - thank you so much!!! No trigger shot planned for this cycle (honestly, my doctor hasn’t informed me about that as an option either this is the first time I’m hearing about this as well for non-IUI/IVF!) Assuming you have been doing trigger shots, may I ask when/what made your doctor recommend proceeding with it? I’ve been hearing that it’s mostly for IUI and IVF, so wanted to see if this may be a good option for me.

Also, my doctor did say my uterus lining looked good. Regarding the cysts on Letrozole - do the ones that are likely induced by Letrozole “reset” or go away by the time of the next menstrual cycle? Since we didn’t do an ultrasound during my provera-induced period, I’m wondering if 1) I should plan for an ultrasound to review the cysts during my next period, hope that the letrozole-induced cysts “reset”, and I can continue Letrozole for the subsequent cycle or b) if I’ve missed my chance since I’ve already started Letrozole this cycle and now the cysts will likely remain.

Apologies about so many questions!!!

 

[godsplan]

@worldbandy No worries! I had so many questions when we went down this road too! We are taking a high dose of letrozole every month to try and attempt IUI with trigger shot but it’s been tricky because I only have one fallopian tube. So the high dose is to help make sure the ovary with the tube makes at least one egg each cycle but unfortunately we keep getting the opposite ovary of course! We’ve done one IUI with the trigger shot so far, but no luck yet. You could ask about adding a trigger shot with timed intercourse, I know thats an option, but some doctors like to start with the least intervention at first and move on from there. But yes the follicles that don’t ovulate will shrink and go away, my clinic always does an ultrasound during your period to make sure you’re all set to start a new round of letrozole, I always call my office on day one of my period to schedule. I’m not sure if that’s required for a low dose though!

 

[hintofasian]

@worldbandy The advantage of using a trigger shot is mostly for timing, which is most important in an IUI or IVF cycle. Some people also do it with TI, but there is also nothing wrong with just using your body's natural LH surge if you are comfortable tracking that on your own. If you typically do not ovulate on your own, it might be a good idea to add the trigger shot to ensure that ovulation does occur when it's supposed to (but this also requires monitoring of the follicle size to know when to trigger).

I don't think anyone here can tell you if the cysts will resolve on their own, it can vary depending on the person and how big the cysts are. It's pretty common to get a baseline ultrasound on Day 2 or Day 3 of your cycle starting, so they can check for cysts on your next cycle.

 

[woodznutz]

@worldbandy Sounds like something you need to ask your doctor…. Can you call the office and ask to speak with your doc?

 

[worldbandy]

@woodznutz Yes I asked the doctor the same questions on the spot when she was doing my ultrasound; unfortunately, she didn’t provide much insight except for let’s wait until CD21 i thought I’d check here first so that I can possibly plan the next couple of days accordingly for ovulation