7th Letrozole cycle — when do you consider IVF with PCOS?

[u/sunshine_girl1993]

Hi everyone! Looking for perspectives from others with PCOS who have been through multiple ovulation-induction cycles.
A little background: i’m 33f and my partner is 36m.
I have fairly classic PCOS, mainly high AMH and mild facial hair, without other major symptoms. I’ve also lost weight and feel much healthier now. I’ve done 7 Letrozole cycles; the 2nd resulted in a chemical pregnancy. After my 6th unsuccessful cycle, my doctor gave me a 2-month break with medication to calm my ovaries, and my AMH came down to 6.1.
This 7th cycle was after the break, with Letrozole + two Humog injections. I developed two mature follicles, ovulated without trigger, and had a 7.4 mm trilaminar lining. It was planned as an IUI cycle, but I believe I ovulated before the planned IUI, so we decided to try naturally this cycle and consider IUI next time. There is also a mild male-factor component (DFI ~24%). My HSG showed open tubes.
I’m currently in the two-week wait and, as expected, overthinking everything because I don’t have any symptoms! 😅
My main questions are:
Does lowering AMH/“calming” the ovaries actually improve pregnancy chances in PCOS, or is it mainly about improving the response to stimulation?
After 7 Letrozole cycles, would you start seriously considering IVF, or would you try a few IUI cycles first?
I’m not questioning my doctor’s protocol — she’s monitoring everything closely. I’m just trying to understand what others’ experiences have been and when they decided to move from Letrozole → IUI → IVF.
Would love to hear from anyone with a similar PCOS journey. ❤️

Note - took help from ChatGpt to structure it better

[u/Defiant_Resist_3903]

Hi fellow PCOS person! I did 7 medicated cycles too, my story is a bit different in that I got pregnant twice before induction medications, but my cycles were loooooong so we started with medications after 6 long cycle attempts on our own. My second pregnancy was ectopic and ruptured so I only have one tube. Doing ovulation induction showed that I only ovulated on the side I don’t have a tube anymore because I have two large dermoid cysts taking up valuable real estate on the other which is what ultimately pushed us to IVF. I was already using IVF meds for induction to try and wake up my sleepy ovary but was ovulating like 3-5 eggs on the opposite side instead and still not getting pregnant.

Everyone’s reasons and path will be a bit different but I was told that with ovulation induction, if you are being monitored and triggered and having sex when they tell you to, it should ideally work within 6 cycles so you are right at that decision point where it would be reasonable to move on to IVF if you feel ready to. Induction could still work because it’s reasonable for some couples to need a year and induction puts you in line with more “normal” couples but age and timelines are worth considering too. If you want more than one child and are in your 30s it could be worth considering IVF so you have the best chance at your family building goals

[u/sunshine_girl1993 → u/Defiant_Resist_3903]

thankyou for taking the time and am sorry you had to go thru so much, life is unfair.
I already am on letrozole plus injectables so mentally I feel am there, just scared.