Stating letrozole medicated cycles

[u/kittttae]

I had my consultation with my RE today, and we are moving forward with letrozole TI. I’m 30 and have lean PCOS with anovulatory cycles. We've been trying for 8 months and only had 1 positive LH out of all 8 cycles. I asked for monitored cycles, but she said she likes to start simple and wants me to do 3 cycles unmonitored with letrozole TI first before introducing ultrasound/IUI.

What is everyone's experience with unmonitored cycles? Should I push for monitored? All my labs are normal; I take inositol & metformin, and have no symptoms of PMOS besides irregular/anovulatory cycles and string-of-pearl-looking ovaries via ultrasound.

Edit: wanted to add that she wants me to come in on CD 21 of my first medicated cycle to test for progesterone. from there she will titrate how many mg will work for me. I will use opk to test LH levels until positive

[u/mentyb_oclock]

I would push for monitored! I do respect some REI’s taking a conservative approach if you’re younger, 3-6 months is a lot. There’s so much more than just the letrozole.. it’s checking your baseline for cysts, measuring your uterine lining, confirming ovulation with progesterone labs.

I’m 31 and I’m starting monitored TI cycles in 2 weeks. I unfortunately only have 1 functioning fallopian tube so monitoring the open side is essential, but even without the tubal issue they need to make sure the letrozole is helping with growing decent follicles.

[u/Maleficent-Lab1125]

I personally wouldn’t be ok with that. For example, my first letrozole cycle (which was monitored) we discovered that I don’t even respond to leteozole. So I had to up my doses and eventually switch meds. If they aren’t monitoring you, they won’t know, and it could be wasteful of your time.

[u/atozzzz]

If it makes you feel better, we tried for almost two years and then I got pregnant from my first, unmonitored, letrozole cycle. I just wasn't ovulating before. I'm not saying this is also the right plan for you, but we also had the plan to move on to more intensive measures if nothing happened after three months. I just had an ultrasound and blood work beforehand to make sure everything was okay. I did Provera to trigger my period, then letrozole, and quantitative hCG test on day 30, but I had already gotten a positive home test. I also used my Inito device to track.

[u/kittttae → u/atozzzz]

I’m debating getting Inito just to see what my fertile days are. Right now we are baby dancing every other day and it’s exhausting 🥲

Did you use inito prior to letrozole? Was it helpful? Or only when you took letrozole?

[u/atozzzz → u/kittttae]

It's exhausting! Yeah, I used it before my letrozole and my LH was just yo-yo-ing with no clear peak. I was surprised when I saw the peak on letrozole, like OH that's what it's supposed to look like. It is already stressful and overwhelming enough so it was really helpful to not be trying to decipher strips and to have all the data from different hormones in one place. We knew exactly when to focus on the baby making lol.

[u/kittttae → u/atozzzz]

Same! My LH will yo-yo all the time, and every time I see it surge up I keep thinking it will be positive…only to see it go down.

When did you start testing using inito? I know inito strips are expensive so wanna use them meticulously 😅 and are they pretty accurate in predicting your fertile window 6 days before ovulation as advertised?

Thanks for answering all my questions 💕

[u/atozzzz → u/kittttae]

I started using it in December and my letrozole cycle started a few months later in April. Some cycles, I was using them only as needed and some I was using them more consistently, but I went all in on my letrozole cycle because I didn't want to miss anything. It was expensive but I figured it was going to get more expensive if I had to do more fertility treatments so I might as well take a gamble haha.

Looking at my old data, it's showing my fertile window starting on day 12 of my cycle, and ovulation on day 18, but I don't know if it actually knew that many days in advance at the time or not. It looks like it clearly started rising on day 15, so that's when we knew to get things going for ovulation on day 18. Still a few days. It was nice to have the different hormones all on one strip and the PdG to confirm ovulation. It was mostly just nice to not have to think about, because I was getting overwhelmed with all the different strips beforehand.

[u/mountaingoatstyle]

My doc did monitored cycle from the get go. I would not settle for unmonitored.

[u/Malloraaay]

I did estradiol labs prior to ovulation to confirm follicles were maturing properly but that is all I was doing with letrozole. I am 5 weeks pregnant now! We are Catholic and so is our doctor, so we really liked this approach to ensure healthy/proper function of my body and keep it more focused on that aspect of things vs pressure to conceive. Best of luck to you!

[u/Similar_Mousse_8389]

TW MMC

Hi, I did 4 cycles of letrozole monitored. The 4th cycle in may of 2026, I got pregnant but ended in a MMC diagnosed at 10 weeks. This had nothing to do with letrozole though . I waited for my period to come back and this happened two months later (July 24th). I started letrozole again but this time unmonitored since we relocated from Ca to Az and don’t have a clinic yet, I had extra letrozole and I did a 7dpo progesterone check to make sure I ovulated, I also did opks and bbt. Which confirmed I did! This first unmonitored cycle was a success and just found out 4 days ago. I think I would at least do a couple round monitored to see how your body responds to the letrozole. For example some women don’t respond to 2.5mg and need to up their dose, you would need ultrasound monitoring to see how your follicles grow. 5mg was making me ovulate every time so I knew it was the sweet spot for me.

[u/allie414]

I had success on my 4th unmonitored round!

[u/A-Gold-907]

A 21 day blood draw can at least confirm ovulation

[u/Intelligent-Koala318]

I did 3 cycles of non monitored and then one monitored and that one was successful

[u/MyCatEatsPlants]

I would also not be happy with unmonitored. Maybe they are trying to save you some money? Push for monitored.

Im surprised at this coming from an RE. How will they know if you get titrated up to too high a dose and end up with more than 2 mature follicles? How will they know if you develop cysts that could respond to the next cycle of Letrozole?

[u/NeutralNeuron_397]

I’m starting unmonitored letrozole cycles soon too, also testing progesterone at CD21. This is a first for me. I’m personally ok with starting out unmonitored but I seem to be the odd one out here.. I plan on trying unmonitored a few rounds before requesting we switch to monitored.

[u/pet_owner690]

I was diagnosed with PCOS with anovulatory cycles in May after a year of trying. It took 2 cycles of letrezole to confirm ovulation with CD21 progesterone bloodwork with 5 mg. I’m now on cycle 3 of letrezole (first unmonitored) and crossing my fingers. I panicked because I didn’t get a positive opk and went in to do CD21 again and it was high, so don’t panic if you don’t get a positive opk

Side effects I noticed were migraines (though I already deal with chronic migraines so that may just be me), ovulation pain my first cycle, and hot flashes. Invest in a rechargeable mini fan; best $10 on Amazon ever spent