the one with the ovulation med Battle Royale
If you need some ~ovulation magic~, you’re gonna get pointed towards one of two drugs as your gateway infertility interventions of choice: clomiphene and letrozole. Let’s talk about what those are, how each works, and what the differences are so you (if you’re so inclined) can work to make your best choice!
What is Clomid, anyway?
Clomid’s the v v v v V typical gateway drug for infertility. Often, doctors will prescribe Clomid as a first level of intervention without doing much digging - which, hey, like, that one-size-fits-all approach *does* works a lot of the time and saves a lot of emotional+financial angst, so, you do you.
Quick overview of its method:
- Clomiphene tricks your body into thinking you don’t have as much estrogen as you do.
- Estrogen would normally work to help your body make more fertility hormones, including key players called FSH and LH.
- Without estrogen to do that in a normal way, your body freaks out and makes way more FSH and LH to compensate. (The power of homeostasis: We can make your body do stuff because your body always wants to be in balance.)
- FSH (follicle stimulating hormone) and LH (luteinizing hormone) play key roles in egg maturation and ovulation stimulation. More hormones, more eggs, is the idea.
- Boom, ovulation, is the idea.
Common side effects may include:
- Vaginal dryness
- Bloating
- Sore breasts
- Upset stomach
- Hot flashes
- Moodiness (ahem)
- Dizziness
What is Femara?
Femara’s main use is to treat breast cancer (fun thought to introduce into infertility diagnosis!), but it’s being seen as a more common alternative to Clomid particularly for women with PCOS.
Quick summary of how Femara works its magic:
- Letrozole (the ‘drug’ name; Femara is the ‘brand’ name, just another way that the Pharma world is crazy confusing) works on your body’s androgens - or the hormones that are generally considered ‘male’ ones (like testosterone, etc).
- Letrozole stops androgens from turning into estrogen.
- Once your bod senses the lack of normal amounts of estrogen, it reacts by making more of the hormones that estrogen would normally trigger - FSH/LH. (Similar to Clomid, yep.)
- Increased FSH/LH = boom, ovulation, is the idea.
Common side effects may include:
- Weight gain
- Fatigue
- Headache
- Bone or muscle pain
- Hot flashes
The eagle-eyed among you will note that these two ovulation drugs work in a pretty similar way - at least towards the end. Is there a difference?
Here’s what the research has to say.
What’s the difference between Femara and Clomid?
One of my fave PCOS awareness media feeds, Healthy PCOS, makes a crucial point: One of the meds works in your brain, the other works in your ovaries. GO FOLLOW THAT ACCOUNT - but I’m going to borrow/cite two of his images here to paint a picture:
As you can see - and as we documented above - they get very similar jobs done. They take a couple of different specific triggers/ways to do that job, though.
The MAJOR thing to remember is that EVERY SINGLE WOMAN’S body is crazy different. These are two different drugs, and how *your body* (if you’re in need of an ovulation trigger) will respond to either drug may differ. The best med for you will depend on you, so, keep that in mind.
That said, here’s some efficacy data:
One 2014 study showed that when women with PCOS suffering from infertility took Femara to stimulate ovulation / try and get pregnant for up to five cycles / attempts, this happened:
- 27.5% - a little over one quarter - went on to have a successful birth (as compared to 19.5% on Clomid)
- 61.7% ovulated on Femara (as compared to 48.3% on Clomid)
- Fewer multiple pregnancies were observed with Femara as compared to Clomid
- Similar miscarriage rates were observed.
SO, interpretation: Femara seems to be better at helping women ovulate, with resultant increased pregnancy success.
The realist in me wants to note that a quarter of women having successful pregnancies in five months still isn’t great. Multiplying the odds out seems to indicate that you’d have to try for 20 months on Femara to get, like, that 100% chance - which is a long time - and that’s not even how that probability works.
Still, seemingly better than Clomid - at least when it comes to those all-important odds.
So. Why would you choose Clomid, when Femara’s in the picture?
Basically, it's a SUPER personal decision, and women going through infertility tend to test both (with the aid of a physician) to see which works better for them. That's what we did. SMASH CUT TO
Our experience with both.
I’ve written about the p intense hormonal tornado that was Clomid before 😂 Suffice it to say that I (normally, a relatively even-keeled person) was a wreck. Crying, shouting, crying some more, not understanding why I was feeling angry or sad or frustrated even though my brain objectively understood why, if that makes any sense. It probably doesn’t. Our experience on Clomid was rough.
That’s subjective, though. Let’s look at what happened on a cycle level in two months, one on Clomid and the other on Femara:
SO. Disregarding that fun Clomid peak (which you better believe I thought was a surefire sign of pregnancy - such fun!), Femara seems to get my temps (on avg) a little higher. My luteal phase was a little longer on Clomid, but my temps were way more stable...but, but, my mucus pattern was involved.
And the unchart-able emotional roller coaster that accompanied Clomid was enough to make us shy away from trying it again. We’re pretty grateful that research and our NaPro both seem to point towards Femara being our better option.
What about Femara’s unchart-able effects?
Of the two ovulation medications, this has had by far a better overall effect. We’ve done a few months on it and noticed some recurring patterns/symptoms:
- For reference, I take my entire dose of Femara on day 2 of my cycle, as directed by my NaPro. (Definitely work with a medical professional to determine your own best strategy.)
- 1-3 days after that megadose, I get crazy hot flashes. This kid had best appear before summer, because that isn’t gonna be fun come July.
- We’ve noticed some mood swings early in the cycle.
- My insomniac response gets a lot stronger 2-3 days after the dose. (To be fair, my body’s first response to any stressor is insomnia.)
- And that’s it.
With Clomid, we didn’t notice any symptoms up-front (around when I took the med, in the first third of my cycle), but midway through my cycle (around ovulation) I turned into a crazy person. Very confusing, very upsetting - and, to have all of those mood swings come into play right when we’re supposed to be *actually making the kid* is UM shall we say INCONVENIENT.
With Femara, it’s a weird few days up front, but then relatively smooth sailing for the rest of the cycle. (For me. Experiences differ for everyone.)
Something cool that’s happened recently
SO, um, I’m not pregnant yet, and that’s okay.
BUT. To borrow a concept from the Whole 30 community, I’m noticing quite a few non-scale victories….quite literally, as the scale hasn’t budged AT ALL; I continue to be in the 69 kilos plateau of plateaus, which is also okay.
I do want to note, though, that something seems to be working. I have more energy during the day; I’m sleeping better at night. I’ve started returning to habits that have given me joy in the past - reading not-for-work stuff, doing like five minutes of makeup in the morning, actually making our bed everyday, sticking to a minimal workout routine…TINY stuff, but stuff (I kid you not) that has seemed for the past few YEARS to have IMPOSSIBLY HIGH activation energy thresholds.
I know that I’m on an increasingly fun cocktail of meds and interventions at the moment. But! It’s fun to see that something’s clicking.
As one of the aims of NaPro is to treat the underlying cause of infertility as well as, like, help a woman have a kid, that’s been really great to see. (This is also how NaPro is working for *us*. I talk here about our reticence to get involved initially, and why I completely get other people’s skepticism.)
Real honesty for a second? Things are on the up-and-up so weirdly dramatically (after years of kinda being grey, pastel colors are seeping in? Like, seriously, enter: a bunch of cheesy analogies, that’s all I got) that this month I found myself TERRIFIED that I’d actually be pregnant and all the good-feeling-hormones were because baby.
Which would have been awesome. Obvi.
But I kinda want to feel better…in general, all the time, and not *only* because I’m pregnant, you know? More honesty: I’m also TERRIFIED that I’m gonna get pregnant and suddenly feel like crap again. I’m starting to feel like a real human girl, for the first time in a long time, and I don’t want that taken away from me. (Flip side, I also cry at random commercials and get pissed super easy, so, it’s not all sunshine and rainbows…I want to admit that before Ted edits this HI LOOK AT ME I’M BEING HONEST).
Behind the scenes, Ted and I are putting together a pregnancy/adoption pro/con list, which is cute, because we’re trying as hard as we can to get pregnant without luck…so it’s not as if we’ll be using this list to make a decision between the two routes, per se. It’s a justification document, and we know that.
BUT. True story: Going on the ‘very real experience of making a very real human in my very real body’ pregnancy side of the pro/con list is our growing appreciation of exactly how hard my body’s working - and what pregnancy could do to my body, for better or for worse. I know a lot of women come through birth with an appreciation of how badass their bodies are. I also know a lot of woman sustain permanent pain and chronic conditions after birth. And…I guess…our infertility process thus far has really helped us see, up front, some shade of what that might mean for us.
No changes to our battle plan. Growing a Corgan kiddo au naturel (that’s def not what that means, leaving it in anyway) is still #1 on our to-do list.
We’re just learning. Being a woman is fun!
Thanks for tuning in. We'll be back soon; in the meantime, have a great week, and stay safe!