Femara (Letrozole) for Infertility, Ovulation Problems and PCOS Treatment

What is Femara - Letrozole?

Femara (generic name is letrozole) is an oral drug which can be an effective fer
tility treatment for women with ovulation problems, or for those with unexplaine
d infertility.
This medication is in a class of drug called aromatase inhibitors. Femara has ma
inly been used to treat certain cases of breast cancer.
This page is about the use of Femara for infertility
How are Femara and Letrozole Used as a Fertility Drug?
Femara to Induce Ovulation
When the enzyme aromatase is inhibited by the letrozole medication, estrogen lev
els are suppressed in young women. This results in the brain and pituitary gland
increasing the output of FSH (follicle stimulating hormone).
In women that have polycystic ovary syndrome or anovulation (a problem with ovul
ation) the increase in FSH hormone can result in development of a mature follicl
e in the ovary and ovulation of an egg. Doctors call this process "induction of
ovulation".
Femara to Increase Pregnancy Chances in Ovulating Women
In women that already ovulate on their own, treatment with Femara can result in
development of multiple follicles and multiple eggs releasing.
Release of multiple eggs can increase the chances for pregnancy as compared
to release of a single egg with a natural menstrual cycle
Doctors refer to the process of stimulating ovulation of multiple follicles
and eggs as superovulation, or controlled ovarian hyperstimulation.
Femara to Treat Infertility After Clomid Attempts Fail - Femara vs. Clomid
Clomid (brand name) or clomiphene citrate (generic name) is an oral medication t
hat is often used for stimulating ovulation in women that do not ovulate on thei
r own. Femara has sometimes been used in these women as an alternative to clomip
hene.
Some women will not respond to Clomid at all.
Letrozole can induce ovulation in some of these women.
Women that do ovulate with Clomid still might never get pregnant with it.
Some of these women will conceive with letrozole
There can be unpleasant side effects with Clomid that cause women to stop ta
king it
This can be a reason to use Femara instead of Clomid
Femara and Pregnancy - Success Rates Using Femara and Letrozole
Monthly chances for getting pregnant using letrozole are about the same as with
using Clomid.
Much will depend on the age of the female partner and on the status of the fallo
pian tubes and the male's sperm quality.
Higher Success for Women Not Ovulating on Their Own
With the following conditions, we can expect approximately 15% per month for a c
hance to get pregnant with Femara:
No other fertility issues are present
The female partner is under 35 years old
We achieve ovulation with the letrozole in a woman that was not ovulating
Lower Success for Unexplained Fertility in Ovulating Women
When it is being used for unexplained infertility in a woman who ovulates regula
rly on her own, the expectations for success are significantly lower than that.
Femara and IUI
Whether it is being used in unexplained infertility, or to induce ovulation, add
ing intrauterine insemination (IUI) and Femara together significantly improves c
hances for pregnancy.
IUI success rates
Femara and Letrozole Dosing
The most common dose of Femara is 2.5 mg per day on days five through nine o
f the menstrual cycle
Sometimes it is given in higher doses of 5 mg or 7.5 mg per day
Risks and Side Effects of Femara
Report on Higher Incidence of Birth Defects
Many physicians will not prescribe letrozole because of concerns from a 2005 rep
ort from some Canadian fertility doctors suggesting a possible higher incidence
of birth defects in pregnancies from using letrozole.
This study was from a small group of pregnancies and the study has been seve
rely criticized for having an improper design
Femara is known to have a short half-life in the bloodstream and is given ea
rly in the menstrual cycle - several days before a fertilized embryo is present.
It is believed that the drug has cleared from the system before the egg is f
ertilized. Therefore, it is puzzling as to how the drug could cause birth defect
s.
The manufacturer of letrozole sent a warning to doctors saying there are rep
orted birth defects in children born after mothers took Femara. This may have be
en due to liability concerns (lawyers and financial risks for a drug company) ra
ther than real science.
The manufacturer of the drug has apparently not filed for FDA approval to us
e it for infertility. However, physicians often use medications in an "off label
" way. When the off label use is safe and effective it is perfectly legitimate.
Is Femara Prescribed by Fertility Specialists?
Some fertility specialists or gynecologists will not prescribe Femara
Others will use it - after explaining to the patient that there has been con
cerns raised regarding the potential for increased rates of birth defects