QuestionHi! I was diagnosed with PCOS in 2006. I conceived my first daughter with the use of glucophage and clomid. My husband and I have been trying to conceive our second child and we have used only clomid for two cycles and with both cycles I didn't produce any follicles. My dr. now has me taking Femara 2.5 on days 3 through 7 of my cycle. I have read a lot of mixed reviews about Femara. I guess my question to you is Femara successful in infertility. I have been on the south beach diet to lower my sugar and also exercising. I was just wondering if I would have a good chance of producing follicles. My dr. seems optimistic and I am hoping he is right. Any help would be greatly appreciated. Thanks
Answer
Dr. R
Hello Cherisse from the U.S.,
Either Clomid or Femara would work. They both work by similar mechanisms of action. Femara has indeed been shown to induce ovulation in PCOS patients. However, not all PCOS patients will respond, just as not all respond to Clomid. Also, the dosage is variable, so that patient has to be checked for response. Clomid has a dosage range of 50-250 mg (1-5 tablets) for five days. Femara has a dosage range of 2.5-7.5 mg (1-3 tablets) per day for five days. Your doctor's task is to try each dosage level until he finds the appropriate dosage, then keep you at that dosage for several cycles so that you can try to get pregnant. Because of the estrogen receptor blockage from Clomid, it is NOT recommended to take Clomid each month. For that reason, I alternative between Clomid and Femara.
About 80% of PCOD patients will not respond to this regimen. In that case, then can move to a combination regimen, adding Follistim, for 3-5 days in addition to the Clomid or Femara, or go to pure FSH (Follisitm, Gonal-f) from the beginning. I will usually go to the combination first.
You have already shown that you can become pregnant. It is just a matter of time before you get pregnant again, depending on how good your doctor is at treating you.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com and twitter with me at @montereybayivf.
