Clomid or Letrozole. Odds are that if you've been trying for any length of time and you've spoken
to your OBGYN or your IVF doctor about how best to get pregnant, odds are that you've been prescribed
one or maybe even both of these medications to help you ovulate and conceive. Well, if you have,
then this Fertility TV episode is for you, because I'm going to talk about both of them,
the dos and the don'ts, and potentially which one is best for you. Keep watching to learn more.
Hi, I'm Dr. Marc Sklar, also known as the fertility expert. Welcome to Fertility TV,
your YouTube channel dedicated to helping you get pregnant. I've been working with couples for
over 18 years through my online programs and right here in San Diego at both of my clinics, and this
conversation about Clomid versus Letrozole is one we've had on a regular basis. Today,
we're going to dive deeper into that so that you can learn more about both of these medications.
I'm going to start with Clomid because it's been around since 1967, and a fun fact is that it is
the most widely used medication for fertility in history. That's right. If it's been around
for so long, it must be a good medication. Well, the reality is, is that no medication is perfect,
and yes, it is good in certain circumstances, which we'll dive in to. But the other reason
why it's been used so much and is the most widely used medication is because it's inexpensive. It's
cheap and it's an easy place to start for so many OBGYNs to see if you respond to that, to see if
that helps you get pregnant before they send you to the next physician to help you along the way.
So it is an easy start on your fertility journey, so to speak, which is why it's the most used.
That doesn't mean that it's all perfect. Clomid does have some negatives and some side effects,
again, which I'll get into in just a moment. But first we have to talk about how Clomid
works. Clomid works by blocking the estrogen receptors in the hypothalamus and pituitary.
When this happens, the body senses that estrogen is too low and it wants to fix that,
so the best way to do that is to increase FSH production so that it sends a signal back
down to the ovaries to either increase follicular development or growth, which in turn increases
estrogen levels. That's exactly how Clomid works. But that's also why Clomid has some side effects.
In its attempt to do this, it can cause thin endometrial lining, especially with repeated use,
and can cause a lot of side effects and symptomology like premenstrual symptoms,
irritability, emotional instability, and so forth. These are things that we want to steer
away. One way to bypass that is to either take a lower dose of Clomid or not take it regularly or
from cycle to cycle so that you can minimize and mitigate those potential longterm side effects.
Oh, and one of the other things that I do feel like I need to mention is that because of its
anti-estrogen effects, it can also reduce the amount of cervical mucus that you're producing.
Any of these things are not ideal side effects, but they can be managed, they can be mitigated,
they can be controlled, hopefully, and so it still is a viable option in terms of medication
if we are trying to increase our follicle growth or the amount of follicles that we're producing,
or especially if you're having a hard time ovulating and you want to make sure
that you ovulate on any given cycle. As compared to Letrozole, Clomid actually
has a much higher multiples rate, meaning twins, so we do tend to be more careful
in the fertility space about having multiples because multiples can cause more complications.
To some of you, twins might sound attractive, but to all of us on the medical side of things,
we prefer to mitigate or reduce the chance of twins, and Clomid does increase your chance,
especially in relationship to Letrozole. The chance of having multiples or twins in this
case with Clomid is about eight percent. Now let's talk about Letrozole, or Femara,
used interchangeably. Okay? Those two are the same thing. It's a relatively new medication,
especially in comparison to Clomid, because it's been used in the fertility space since about 2001.
Letrozole is different from Clomid in terms of how it functions in the body because it
is in aromatase enzyme inhibitor, and what it does is block the androgens, like testosterone,
from converting into estrogen, both E1 and E2. It is similar to Clomid in that once the brain
senses that estrogen is reduced, then it wants to create more estrogen, so it stimulates the
follicular growth to create more estrogen. They both work in slightly different ways,
but in the end, their goal is to have the same impact, is to have an increase in follicular
growth, so for all of you out there, follicles can mean eggs and so more eggs on any given cycle
and hopefully better sizes of them. Now, the difference between those two is
that it's more common to have more eggs I've seen with Clomid than you would with Letrozole. Now,
that may or may not be a good thing depending on where you stand and what you're trying to achieve.
Letrozole does not work on the hypothalamus and pituitary like Clomid does, but more so
in the ovaries. The other difference is that it is more expensive, so if cost is an issue,
that might be something to consider in the bigger picture. The other thing that we do
have to consider is your underlying diagnosis. What condition do you have that might influence
the type of medication that you are given? Because we just talked about Letrozole in
the sense of its reduction of androgens, if your diagnosis is polycystic ovarian syndrome, or PCOS,
where inherently your androgen levels typically are higher, Letrozole may be an ideal choice and a
more ideal choice as a medication to use than Clomid. There actually was
a research study that did show that exact thing, that Letrozole showed to support women with PCOS
and allow them to ovulate better and have a higher chance of conception when it comes to
its comparison to Clomid. Now, on the flip side, Clomid,
there was a research that showed that Clomid was better for those with unexplained infertility,
but that doesn't encompass all of you out there. Right? If you have a different diagnosis,
then we have to start to look deeper at your hormones and your history to determine which
medication might be better suited for you and which path you might go down.
Now, for all of you watching, I want to encourage you, please have a conversation with your
physician, with your doctors about what might be the best choice. Talk to your IVF doctor, talk to
your OBGYN. Which one is a better choice to start with to get you to your goals? They know your
situation better than this video does and we need to consult with them to get you the best results.
If you ask me overall in just a general sense, then my preference typically tends to be leaning
towards Letrozole over Clomid because there's much less side effects and we can control the amount
of follicles growing a little bit easier with Letrozole than you could with Clomid.
But I also want to remind you all that neither one of them might be the ideal choice for you.
You might actually need to go to injectables when it comes to stimulation medication to get
better results, and that might mean that the cost is more expensive, and that might mean that
you might need to look towards IVF. Those are things that need to be discussed in the bigger
picture of your overall history or the path that you're going down and your overall goals.
Now I want to hear from all of you. Have you taken Clomid or Letrozole before?
Have you tried injectables? If so, comment below and let me know. More importantly,
what was your experience? How did you feel on them?
What results did you get? In the end, did they work for you? Comment below and let me know.
I also want to remind you all that if you need more support, if you need more guidance,
if you need a customized plan on your fertility journey to hopefully get you the
results that you're looking for and hopefully without having to use Clomid or Letrozole,
then my HOPE fertility coaching program is open for enrollment. If you want to apply to
see if you qualify and to work with me and my team to get you pregnant and have the results
that you deserve, then I want to invite you to apply using the link in the description below.
If you like this video, give me a thumbs up. If you are not already a subscriber
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notified when I put out a new video for all of you. Until the next video, stay fertile.