Ovulation Medication Q&A with Dr. Gleaton

Every month, Dr. Gleaton answers all your questions about fertility, pregnancy, birth and more. Follow us on Instagram to ask your questions!

By OBGYN Dr. Gleaton

I’m eleven months postpartum and still breastfeeding. I needed ovulation medication to conceive - how do I go about baby #2? 

Secondary infertility, the inability to get pregnant or carry a pregnancy after previously delivering a child is not uncommon. The good news is that the chance of success with baby number two is higher after a prior successful pregnancy. Depending on your specific medical history, it may be necessary to again start medications to assist ovulation. Speak with your provider to discuss if and when starting medications may be right for you. Also focus on optimizing nutrition, exercising often, and taking a high quality prenatal vitamin.  

Taking femara...how does it work? 

Femara, the brand name for letrozole, belongs to a  class of drugs called aromatase inhibitors. Aromotase inhibitors cause a decrease in estrogen levels, which in turn causes your brain to release more follicle stimulating hormone (fsh) which stimulates your ovaries to release an egg (or eggs). Thus, femara helps to correct irregular ovulation or induce ovulation if you're not ovulating at all.

FSH - is it possible to lower your number by following a fertility diet and eliminating parabens? 

This is a bit complicated. FSH gives a snapshot of your ovarian reserve. It is released by the brain and indicates how hard your brain is working to cause your ovaries to ovulate. So a really high FSH level means the brain is working harder to cause your ovaries to respond and ovulate.  And while certain dietary practices or medications can help lower FSH, that lowered value doesn’t correct the underlying problem nor does it correlate with improved fertility or response to fertility medications. However, FSH is only one component of your fertility portfolio. Ask your provider if other lab tests such as AMH may offer a more accurate picture of your fertility status. 

Best diet to follow during fertility treatments?

While the best diet depends on who you ask, most studies suggest a diet low in trans fat and processed sugar, and high in vegetables and slow carbs are your best bet. Plant-based foods, including whole fruits and vegetables, seafood rich in omega-3 fatty acids such as salmon, mackerel, and lake trout. In addition, whole grains, raw nuts, legumes (beans, lentils, etc.), and extra virgin olive oil (monounsaturated fat) are excellent ways to naturally support fertility and allow food to be your medicine.

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What do you tell your patients going through IVF the chance of a successful pregnancy is? 

Success rates for IVF are generally difficult to predict because of the many variables that affect outcomes. These include age of couple, underlying cause for infertility, and the IVF center performing the treatment. With that being said, as a general rule, a patient under 35 can expect an IVF success rate of 40% while women over 40 typically see a rate closer to 12%.

I’ve been trying to conceive for three years, and on clomid/femara for that long. Am I at a higher risk for cancer? 

Multiple studies have been conducted to answer this very question. In fact, a 2019 Cochrane review concluded that there is "no definitive relationship between the use of fertility drugs and cancer" However, most experts agree that there is little utility in continuing clomid or femara beyond six months because fertility outcomes are not improved after that point.

How do you know when to seek a second opinion when it comes to fertility treatments? 

This decision is highly personal. However, second opinions should not be considered taboo. When our cars or appliances need repair, we often get three quotes with corresponding plans. When partnering with a fertility provider, it's important to invest that same attention and research your options! 

Clomid or letrozole while still breastfeeding. Why or why not? 

Neither clomid or letrozole are contraindicated in breastfeeding. However, both can decrease milk supply and small amounts can be excreted in breastmilk. Typically, I recommend weaning prior to initiating these medications.

Do fertility medications that induce ovulation also increase progesterone?

Yes, if fertility medications are successful in causing ovulation, your progesterone should increase at 7 days post-ovulation.

What are success rates of clomid with timed intercourse vs. clomid with IUI?

Clomid success rates are typically determined by various inherent factors including age, and prior fertility testing. But studies suggest that IUI increased pregnancy rates over timed intercourse (11% vs 48%).

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