Womens Health

Off Label Drug Use and Infertility

The Daring Type?

If Clomid hasn't worked for you, you might be exploring alternative treatment protocols. If you're the daring type, Femara just might be right for you. You'd need to be daring because the use of the drug for inducing ovulation is considered an off label use—one that does not have the approval of the Food and Drug Administration (FDA).

Fewer Side Effects

Femara (letrozole), a drug created to fight hormonally-responsive breast cancer, has been used to induce ovulation for the treatment of fertility since 2001. Doctors believe that the drug may perform better than the more standard treatment for ovulatory dysfunction known as Clomid or clomiphene citrate. Some physicians report that they're seeing fewer side effects with Femara and that there seems to be a smaller risk of multiple gestations.

A Canadian study presented in 2005 at a conference of the American Society of Reproductive Medicine showed that Femara increases the risk of birth defects, but this risk is attendant on all of the drugs used to induce ovulation, including Clomid. For this reason, doctors are careful to monitor a patient's status so as to discontinue treatment should a pregnancy occur. The aim is to induce ovulation. Once ovulation occurs, there is no reason to continue treatment. A strict protocol should spot ovulation before there is any reason to be concerned about a subsequent pregnancy.

Even so, and perhaps fearing the possibility of legal action, the manufacturer of Femara, Novartis, sent out statements to physicians all over North America warning them that the use of the drug for ovulation induction remains unapproved and is unsafe for pregnant women as well as for women who might become pregnant.

Femara Uses

Doctors have also used Femara to treat endometriosis, a condition that is affected by the production of estrogen and which can cause infertility and pain.

Femara has been shown to reduce the body's total estrogen level by 98%. While the drug lowers estrogen, it raises testosterone, leading some athletes to use it as an adjunct to steroid bodybuilding drugs. Men find that the drug keeps water retention to a minimum and prevents them from forming breast tissue, both common side effects of certain anabolic steroids.

Another use of Femara is for treatment of adolescents on a regimen of growth hormones due to short stature. Letrozole works to delay the fusing of an adolescent's growth plate, giving the growth hormones a chance to work their magic.

In general, while Femara does not have FDA approval for use as a fertility drug, its use has been accepted by most physicians in the fertility field with doctors in both the United States and Europe using the drug to good effect. Femara seems to avoid common problems seen with Clomid, such as thinning of the uterine lining, and vaginal dryness.

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