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Femara (Letrozole) for Treating Infertility

What is Femara (Letrozole)?

Many women undergoing fertility treatment are prescribed medications early on that are used to help boost their chances of becoming pregnant.

Femara (letrozole) is becoming more commonly used, often in place of long-time fertility medication Clomid. So, what is Femara, and how does it work?

If you’ve been searching for information on Femara, you may have noticed that it’s often used by women who are undergoing treatment for breast cancer.

While considered a newer use for the drug, Femara (letrozole) has been recommended for women who are undergoing fertility treatment since 2001.

The oral pill is called an ovulation induction drug, or a superovulation medication, because it encourages follicles in the ovaries to produce and release an egg.

If you’re wondering, “Can Femara or letrozole boost my fertility to get pregnant,” know that taking this medication can make pregnancy a possibility.

According to a study by the National Institutes of Health, letrozole can be more effective than clomiphene (also known as Clomid) when used by women with polycystic ovary syndrome (PCOS) who are being treated for infertility.

In some cases, it can have fewer intense side effects than Clomid and offer a higher chance of ovulation. For this reason, Femara is considered by some to be the best fertility drug to get pregnant.

How Does Femara (Letrozole) Help with Fertility?

Many women who need help jump-starting ovulation are prescribed Femara. That’s because letrozole works by stimulating the follicles in an effort to increase the odds of ovulation. Here’s how.

Your doctor will have you take the medication for five days. During this time, the androgens in your body will no longer become estrogen.

This is important because a lack of estrogen informs the pituitary gland that it needs to create follicle-stimulating hormone (FSH), an important hormone that helps with egg production.

By blocking estrogen and sending this message, the ovaries are stimulated and produce an egg (in some cases, more than one egg).

With Femara, your fertility doctor will encourage timing of sex close to ovulation to increase your chances of becoming pregnant.

For most women, letrozole ovulation day occurs about four to seven days after completing the round of medication, so timing sex in the days following Femara is important.

Who Should Try Femara (Letrozole)?

Only your doctor will be able to evaluate your case and determine if Femara is the right option for you.

But, there are some women who may have a higher chance of getting pregnant while using Femara instead of Clomid. You may be a candidate for Femara (letrozole) if:

You have difficulty ovulating

Because Femara can encourage the ovary follicles to release eggs (the act of ovulation), this medication can be a first-line treatment for women who have difficulty ovulating.

In some cases, Femara can cause the body to release more than one egg, which can increase the chances of pregnancy.

You have been diagnosed with polycystic ovary syndrome (PCOS)

Research into the benefits of Femara for women with PCOS shows great results. In fact, studies have shown that women with PCOS who take Femara ovulate more frequently than women with PCOS who take Clomid.

You have already tried several rounds of Clomid

Fertility specialists may recommend trying Femara, even if you have taken Clomid and not become pregnant. That’s because Femara (letrozole) may be better at helping some women ovulate, even if several rounds of Clomid did not jump-start ovulation.

Your doctor determines that you have thin uterine lining

Because Clomid is known to thin the uterine lining, women who take the medication for long periods of time can have a harder time getting pregnant.

That’s because fertilized eggs and embryos have a better chance of implanting and embedding in thicker uterine walls.

Femara does not impact the uterine lining, meaning it could increase the chances of pregnancy with fewer side effects.

Femara vs. Clomid

According to research by the National Institutes of Health, Femara often has a higher rate of success than Clomid for women who have polycystic ovary syndrome (PCOS).

A study published in 2014 showed that many common Clomid side effects — including dizziness, hot flashes, and fatigue — were greatly reduced with Femara.

Overall, research has shown that ovulation tends to be higher for women taking letrozole. The NIH study included 750 women with PCOS, with the group split evenly between letrozole and clomiphene prescriptions.

In the study, women in the Femara (letrozole) group ovulated 61.7 percent of the time, compared to 48.3 percent of the time for the Clomid (clomiphene) group.

While differing in ovulation statistics, Clomid and Femara have similar results with pregnancy success.

There was no major difference between the two medications’ lasting impacts when it comes to the chances of twin and multiple pregnancies, the risk of pregnancy loss, or the risk of infant birth defects.

One of the largest differences between Femara and Clomid is how long the medication remains in your body after you stop taking it.

Femara is known to remain in a woman’s body for less time — as little as three weeks.

While Clomid has been a top choice medication in early fertility treatment, doctors know that the drug stays in a woman’s body much longer — on average four to six weeks.

In addition, many fertility specialists worry about impact Clomid can have on a woman’s uterine lining and cervical mucus. Studies show that Clomid can thin the uterine walls, making it harder for eggs and embryos to implant, and thus harder for a woman to get pregnant.

Unlike Clomid, Femara has not been linked to thinking uterine lining, and for that reason, might be a better choice for some women, or women who have used Clomid for long periods of time.

How to Use Femara (Letrozole)

Femara is an oral pill, which can make it less intimidating than other fertility treatments such as injectable hormones.

This also makes Femara less expensive than other fertility drugs, meaning it’s more affordable and can be taken several times if pregnancy doesn’t initially occur.


Your doctor will prescribe Femara to be taken over five days and will explain how to take letrozole for fertility purposes.

Most women are prescribed a dosage between 2.5 and 5 mg, taken once daily, starting on the second or third day of their cycle.

Fertility treatment protocols

Many women wonder about the best time of day to take Femara for infertility.

The medication isn’t any more effective at one time of day over another, though it is important that you take Femara at the same time every day.

After taking Femara, you can try to become pregnant through:

  1. Predicting ovulation and having intercourse
  2. Detecting ovulation with a predictor kit and undergoing intrauterine insemination (IUI)
  3. In combination with human chorionic gonadotropin (hCG) trigger injections and ovulation monitoring from your doctor’s office

Side Effects of Femara (Letrozole)

Femara can have a wide variety of side effects that may cause slight discomfort, and every woman’s body reacts differently to the medication.

For many women, the benefits of Femara outweigh the side effects. Women who are taking Femara may experience:

  • Nausea, dizziness, and headaches
  • Diarrhea or constipation
  • Drowsiness or trouble sleeping
  • Joint and muscle pain, specifically in the arm, wrist, forearm or shoulder
  • Weight gain
  • Hot flashes or warmth in the chest or face
  • Increased sweating, especially during sleep

In most cases, women taking Femara do not have serious side effects, but it is important to know that you should speak with your doctor if these symptoms worsen over time.

While rare, you should contact your doctor immediately if you have more severe side effects, such as:

  • Mood changes like depression or anxiety
  • Nausea or vomiting that won’t go away
  • Swelling in your arms or legs
  • Difficulty breathing
  • Rash or itching

In some cases, women taking Femara may symptoms similar to pregnancy, though they may not be pregnant. False Femara pregnancy symptoms include:

  • Tender breasts and nipples
  • Headaches
  • Cramping
  • Tiredness

Contraindications and Precautions of Femara (Letrozole)

Like all medications, Femara can interact with other drugs and cause unwanted results.

Before starting Femara, you should speak with your doctor about other medications you are taking or will begin taking at the same time.

In addition, Femara can cause complications with pregnancy, so it’s crucial that you stop taking this medication once you become pregnant.


Femara (letrozole) is known to have severe interactions with at least five commonly prescribed medications.

These side effects can make both medications less effective, or cause serious health issues. You should never mix Femara with:

  1. Estrogen
  2. Immunosuppressants
  3. Tamoxifen and estrogen receptor drugs
  4. Medications for multiple sclerosis

It’s also important to tell your doctor about any herbal supplements or vitamins you are taking to ensure they will not interact with or reduce Femara’s chances of success.

Pregnancy and breastfeeding

It’s important to know that Femara (letrozole) is not safe to take during pregnancy. This medication can cause birth defects and serious complications to unborn babies.

If you have taken Femara during pregnancy by accident, you should speak with your doctor immediately to determine the best course of action, and to understand the side effects that could impact your baby’s health.

In addition, it is not safe to take Femara while breastfeeding. Drug manufacturers are unsure if the medication is passed along to infants through breast milk, though research suggesting that Femara can harm unborn babies suggests that it could be detrimental to infants and small children.

If you are planning to use Femara and are currently breastfeeding a child, you should know that the medication could still appear in breastmilk for up to three weeks after the last dose.

Any milk you pump during this time should not be fed to your child, and instead should be discarded.

Femara (Letrozole) Effectiveness and Success Rates

Letrozole effectiveness greatly depends on a variety of factors, including if it’s taken properly, the kind of infertility a woman is being treated for, and if it’s combined with IVF, IUI, other techniques.

In comparing whether letrozole or Clomid is more effective, many studies disagree.

A 2012 study on letrozole pregnancy rates showed that 25% of users went on to become pregnant and give birth, compared to only 16.8% of Clomid users, while a 2015 study suggested that Clomid was more effective with a 23% birth rate compared to letrozole pregnancy rates of 18%.

You should know that Femara can also increase the odds of having twins, triplets, or multiples. A 2015 study showed that Clomid has the fewest twin and multiple births at a rate of 5.7%, while letrozole fertility multiples occurred in 14.3% of pregnancies.

It’s possible to have a positive pregnancy test after letrozole first-time use. Some women find they have Femara success first cycle, though having a period after letrozole doesn’t mean the medication doesn’t work.

As with any fertility treatment, it may take several rounds of medication to become pregnant.

Femara (Letrozole) and IUI

Femara can successfully be used with intrauterine insemination (IUI). If you and your fertility specialist choose this route, you’ll take Femara as prescribed, but will watch closely for signs of ovulation.

In many cases, women use an ovulation predictor kit or visit their doctor’s office to detect ovulation and undergo IUI at the right time.

Femara can increase the chances of a successful IUI procedure. While IUI results in a live birth between 1% and 6% of the time without fertility drugs, Femara can boost the odds to 4% to 9%.

Femara (Letrozole) Cost

The cost of fertility medications can make it tricky to determine what course of action you should take when undergoing fertility treatments.

Fortunately, Femara is a lower-cost fertility treatment option. Depending on how much you are prescribed, and for how long, Femara can range anywhere from $50 to several hundred dollars.

Is Femara covered by insurance? In cases, yes. This can reduce the price, sometimes dropping the cost down less than $100.

You should also know that there are generic versions of letrozole that can make it more affordable. But even if you prefer to use the name-brand version, Femara coupons are often available to help with the cost.

Femara (Letrozole) Reviews

Many women and couples who are considering Femara seek out letrozole success stories online. If you’re interested in learning about the experiences of other women, and reading reviews about Femara, there are many reliable resources.

Beyond women and couples sharing their personal experiences on a variety of message boards and forums (such as popular sites Whattoexpect.com and Babycenter.com), medication rating websites such as Drugs.com can give you an insight as to successful Femara is, and how women felt taking it.

For additional resources, finding an in-person support group, such as a group listed by the National Infertility Association, can help you meet Femara users for real-life feedback.