The Infertility Guidebook
Stage 4: Femara + Injectables
*The cost variance here depends on how much of the FSH you need. Everyone’s body responds differently to it, so a higher dose will obviously cost more. Femara by itself is fairly cheap, though (only $10 or so).
Meds: Femara (letrozole), Gonal F or Follistim, Ovidrel or HCG
The first line of treatment with our fertility doctor (Reproductive Endocrinologist, or RE) was an oral medication called Femara along with FSH injectables – also known as a “combo cycle.”
Many women will just do a round of Femara, the same as you would’ve done Clomid, and respond great to that. I have pretty severe PCOS and “stubborn” ovaries, as my doctor lovingly likes to say, so she thought the combo would work better for us.
I took Femara on days 3-7 of my cycle, then injections of FSH (Gonal-F) on days 7, 9, and 11 of my cycle. The FSH is Follicle Stimulating Hormone–pretty self-explanatory, it’s the hormone that stimulates (or grows) your follicles.
On day 12, I had an ultrasound to see how my follicles were growing and had three that were still an average size. So we did one more injection that night to “boost” them, and then finally a trigger shot, Ovidrel, the next night (day 13). The Ovidrel trigger shot contains HCG, which basically just forces your body to release the eggs and ovulate (don’t ask me how it works; I don’t know).
After that, we did timed intercourse for a few days to ensure we could catch the eggs. A few days later, I started progesterone supplements to make sure my body was ready to support a pregnancy.
And then, of course, the dreaded two-week-wait, and pregnancy blood test.
What to Expect:
- The easiest shots ever – seriously, these do not hurt even a tiny bit. It’s the world’s smallest needle, and you inject it into the fattiest part of your tummy. YOU GOT THIS. 💪🏻
- Cramping – you’re going to feel your ovaries throughout this process.
- Mood swings – hormones, man.
- Bloating – Think of it as pre-pregnancy puff.
- Cysts – After every cycle using injectables, I developed cysts on my ovaries. This means you have to take a cycle off the next month if it didn’t work to let them reabsorb. You can let them resolve naturally, if you have the patience of a saint, or you can take birth control pills to speed up the process and make sure they actually go away. Cysts are assholes (cyst-holes, as I like to call them), and they can all go to hell.
Depending on how you respond, and how ready you are to kick things up a notch, you might continue on this protocol for a few cycles, or you may jump straight to full injectables and IUI, like we did.
Check out Stage 5: IUI for more on that process.