u/Separate_Exam9947

Hello all ! Just looking for some guidance.
I had my follow up with my RE this morning.
After 3 failed 5mg Letrozole, Ovidrel, and 600mg progesterone supp cycles they are recommending I move to IUI. The medications/doses/protocol will remain the same for all 3 IUI cycles. They also added me to the IVF list. My RE stated that if I fail 3 cycles of the IUI they recommend I move to IVF.

Background 35, high AMH, lean PCOS and anovulation.
Clear saline HSG, clear SA. Regular monthly bleed despite anovulation. Normal BMI.

Have began naturally ovulating again as of last cycle according to mira tracking, blood work, and BBT.

Ac1 in 2025 was 5.5 now in 2026 it’s 5.8 RE said to try changing my diet. That’s it.. no mention of metformin or anything else?

So I guess I’m wondering does it make sense to go straight to IVF after 6 failed cycles? (3 timed sex + 3 IUI).

I am responding well, 1 dom follicle on the 5mg of letrozole but Cycles 1-3 my lining had been getting thinner each cycle, but they don’t seem to be concerned about that right now?

I guess I’m wondering if I should be asking about other options or anything else rather than just doing the same protocol and moving to Ivf if things fail again.

In general I do like my RE and don’t necessarily feel like she’s just trying to push me to IVF asap but i guess the lack of suggestions or trying anything else like metformin has me questioning things.

Any advice is appreciated. Thanks! 😊

Hello all! Background 35 with lean PCOS + anovulation. At diagnosis; Vit D and Iron deficiency, Ac1 5.5, healthy BMI, clear saline HSG, and High AMH.

My third cycle failed of medicated monitored TI but I’ve been responding well to treatment - 1 dominate follicle by cd 10-14 and little to no medication side effects.

Current protocol:
•Letrozole 5mg (cd 3-7)
•Ovidrel 250mcg (usually trigger cd 12)
•Prometrium 600mg - vaginal. (Starts 2/3dpo)

Consistently taking:
•Prenatal’s
•Vit D
•Iron
•CoQ10
•Probiotic

Recently added:
•Vit B12
•Myo & D-Chiro Inositol
•Raspberry Leaf Tea - will start next cycle.

I have a follow up pending with my RE later this month so we will be skipping cycle 4 and I will not be on any prescribed medications.

My lining has been decreasing each cycle - 8.5mm, 6.4mm, 5.2mm. - I know letrozole can cause this.

My Ac1 in 2025 was 5.5, this year it is now 5.8.
At the time I was not diagnosed with insulin resistance, but now I’m questioning it given the elevation. BMI unchanged.

My Vit D is now back in normal range, iron is improving and I naturally surged and ovulated cycle 3. First time in many years.

My questions are:
Should I speak to my RE about starting metformin, estrogen patches, or possibly just changing meds all together ?

Is there anything else I should ask or bring up during my follow up?

Anything else recommend that I can do to improve things while I wait?

Any advice is appreciated, thank you!