The in vitro fertilization (IVF) process can be complex and confusing, full of nuance and a slew of new vocabulary — most of which applies to IVF medications. While IVF medications play a major role in this particular fertility journey, there is a steep learning curve when it comes to learning about the types of IVF medications available, how these medications work, and the risks and side effects to be aware of.
Explore the blog post:
- A guide to IVF medications
- Types of IVF medications
- How IVF medications work
- Known risks
- Common side effects
- Medication administration
A guide to IVF medications
An IVF medication regimen can look different for different people — even if the individuals taking those medications are on the same fertility journey. While some medications are injectable (delivered as shots), others may be administered orally. The IVF medications you may take and the dosages you are prescribed will depend entirely on your specific situation and the plan that your provider determines is best for you and your goals.
No matter what your specific protocol might be, it is important to understand the critical role medications play in the IVF process. A few of the most common types of IVF medications include:
- Medications to stimulate the ovaries in order to cause more than one egg to develop at a time: This may include a medication that contains follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of both. These medications stimulate more than one egg to develop at a time.
- Medications to help the eggs mature: Once the follicles (the fluid-filled sacs in the ovaries that contain eggs) are ready for egg retrieval, a medication containing human chorionic gonadotropin (hCG) or an agonist (Lupron) will help the eggs mature. Every person is different, but it takes about 8–14 days, on average, for eggs to reach maturity during an IVF cycle.
- Medications to prevent ovulation from occurring too early: These medications help prevent the body from releasing the eggs before they are fully mature and ready to be retrieved.
- Medications to prepare the uterine lining: You might also take medications containing progesterone on either the day of your egg retrieval or at the time of your embryo transfer to help prepare your uterine lining for implantation.
Types of IVF medications
All the medications used in IVF are part of a process known as “controlled ovarian hyperstimulation,” which involves administering IVF medications to stimulate the ovaries to produce many follicles (fluid-filled sacs in the ovaries) that each contain an egg. In most cases, the process starts in the early stage of the menstrual cycle, following a blood draw and baseline ultrasound. Stimulation medications are often administered once or twice a day for about 7–14 days (usually by injection but can be delivered in other ways too, depending on the medication protocol). When ovulation occurs on its own, there is typically only one egg that matures; the medications used in IVF work together to help increase the number of eggs that are eventually retrieved. Here are some of the most common types of medications used during the IVF process.
Gonadotropins are two hormones produced in the pituitary gland (LH and FSH) and one that is usually produced by the cells of the placenta during pregnancy (human chorionic gonadotropin or hCG). Gonadotropin medications are used to stimulate the ovaries to produce multiple egg-containing follicles during an IVF cycle. Most gonadotropin medications used during IVF are injected under the skin, and some people using them for IVF may receive preparations that contain FSH only. There are many different protocols for the type, dose, and timing of gonadotropin medication use, but in many cases, the medication will be administered once per evening during the IVF cycle, usually under the skin of the abdomen or thigh. Some of the common gonadotropin medications that are prescribed during IVF include Gonal-f and Follistim (which are both FH), Menopur and Repronex (which are both menotropins, meaning they contain FSH and LH), and Pregnyl, Ovidrel, or Profasi (which are hCG).
GnRH agonists are synthetic forms of gonadotropin-releasing hormone (GnRH), which is naturally produced in the brain’s pituitary gland and stimulates the ovaries. GnRH agonists work by first stimulating the pituitary gland to release any stored gonadotropins (LH and FSH) and then, over the course of about 7–10 days, suppress the production of any new gonadotropins. This can help control the development and maturation of eggs during the IVF cycle and help prevent premature ovulation, which would mean that eggs are released too early from their follicles and are not able to be retrieved and eventually fertilized. GnRH agonists are typically injected during the IVF cycle, and some common forms include Lupron (leuprolide), Synarel, Suprecur, and Zoladex.
Like GnRH agonists, GnRH antagonists are medications that also prevent premature ovulation, but they do not produce the initial surge of LH and FSH that agonists do. GnRH antagonists work by binding to the receptor for GnRH to prevent the natural LH surge and ovulation that occurs during a natural cycle. Preventing premature ovulation during an IVF cycle is important to ensure that the maximum number of eggs can be retrieved. GnRH antagonists are typically injected, and common forms include Antagon, Ganirelix, Orgalutran, and Cetrotide.
During a regular menstrual cycle, the ovaries typically produce progesterone in the middle of the menstrual cycle during ovulation, and the hormone helps prepare the uterine lining for implantation. If pregnancy does not take place during a menstrual cycle, progesterone levels drop, and a period occurs. If an embryo implants in the uterine lining, the ovaries (and eventually the placenta) continue to produce progesterone. Because patients often take medications to prevent premature ovulation during IVF, which can impact the ovaries’ ability to produce progesterone, doctors sometimes prescribe progesterone supplements to help support the uterine lining if a patient is planning embryo implantation. If needed, progesterone supplementation may be prescribed. Common forms include Endometrin suppositories, Crinone gel, Prometrium tablets, or injectable progesterone in oil. This supplementation is usually started the same day as egg retrieval, and may continue through pregnancy if necessary.
In some cases, doctors may prescribe estrogen during the IVF cycle to help stimulate egg growth. In other cases, estrogen may help increase the odds of embryo implantation when used during a frozen embryo transfer to help thicken the uterine lining. Estrogen comes in many forms, including oral pills, vaginal suppositories, and skin patches. In many cases, estrogen may be used in the days leading up to an IVF cycle. Estrace is a common estrogen supplement that contains a form of estrogen known as estradiol.
Androgens are a group of specific sex hormones that are generally found in larger amounts in males but are made in the bodies of all genders. The testicles and the ovaries produce androgens, of which testosterone is the most common. In some cases, doctors may prescribe androgen supplements to IVF patients who have not responded well to ovarian stimulation. Some research indicates that testosterone supplementation may help promote follicle growth in these patients. Testosterone gel is often used in these cases, and a common name for the medication is AstroGel, which contains testosterone.
Other common medications taken during the IVF process
In some cases, providers may use other medications or treatments for any conditions associated with a patient’s specific journey.
- Birth control/estrogen: Before starting the ovarian stimulation portion of IVF, some people will need to take birth control pills or estrogen to help control the timing of the menstrual cycle or stop the development of ovarian cysts. In some cases, doctors may prescribe a combination of birth control pills, which contain estrogen and progesterone.
- Antibiotics: In some cases, doctors may prescribe oral antibiotics, such as doxycycline or Zithromax, during an IVF cycle to help control any bacteria that may negatively affect embryo implantation.
- Parlodel: If infertility is linked to the overproduction of a hormone made in the pituitary gland called prolactin, oral medication known as bromocriptine (Parlodel) may be necessary during an IVF cycle. This oral or vaginal medication can help reduce the amount of prolactin released by the pituitary gland.
- Clomid: Clomid is a medication commonly used to help stimulate follicle and egg development in patients with long menstrual cycles and infrequent periods. By causing the brain’s hypothalamus gland to detect an estrogen deficiency, Clomid prompts the body to secrete more FSH and LH, which can help stimulate follicle and egg growth.
- Dexamethasone: The oral medication dexamethasone may be used with ovulation stimulation drugs during the IVF cycle to help reduce excessive androgens in the body, making the ovaries more receptive to IVF treatment.
How IVF medications work
All the IVF medications prescribed during a cycle help regulate ovulation and ensure that the ovaries produce the highest quantity and quality of eggs possible. While the types and dosages of IVF medications used may vary, all the prescribed medications are intended to help increase the chances of a successful egg retrieval and potential embryo transfer procedure, which may both improve the odds of pregnancy. The IVF process can generally be broken down into five steps.
1. Suppression of ovaries
Some IVF patients are prescribed medication to suppress ovulation prior to starting the ovarian stimulation phase. This might mean taking oral birth control pills or the injectable medication, Lupron, anywhere from 1–4 weeks prior to starting stimulation.
2. Stimulation of ovaries
During the stimulation phase, medications containing FSH, LH, or a combination of both help stimulate the ovaries to produce more than just one egg, which is typically the number produced during a regular menstrual cycle. Ovarian stimulation usually involves self-administered injections under the skin of the abdomen or thigh every day and regular visits to the doctor’s office for transvaginal ultrasounds and blood work, which monitor hormone levels and follicle development. This step lasts an average of 8–12 days and may include medications like Follistim, Menopur, Gonal-F, Bravelle, Repronex, or a combination.
3. Prevention of premature ovulation
Ovarian suppression also typically occurs during the IVF cycle after ovarian stimulation starts. This form of ovarian suppression is achieved with GnRH agonists (like Lupron, Synarel, Suprecur, and Zoladex) and GnRH antagonists (like Antagon, Ganirelix, Orgalutran, and Cetrotide). These medications help prevent the body from prematurely ovulating and releasing developing eggs. The length of this step in the IVF cycle varies depending on a number of factors but typically starts after ovarian stimulation begins and ends when stimulation is done.
4. Triggering ovulation and retrieving follicles
Ovulation is typically triggered after about 8–12 days of ovarian stimulation. By injecting hCG, Lupron, or both, the patient can trigger ovulation once the doctor deems the follicles mature. The timing of this step is very important, because the egg retrieval procedure will need to be performed 36 hours after the medication is administered. During the procedure, doctors will aspirate the follicles from the ovaries and assess the number of eggs that reach maturity.
5. Preparation of the endometrium
If an embryo is ready to be transferred, endometrial preparation or priming is often necessary to increase the chances of successful implantation. This step is often especially important in frozen embryo transfers (FETs) when previously frozen embryos are used. When a fresh embryo transfer occurs, it is typically transferred about 3–5 days after egg retrieval; during an FET, the frozen embryos are thawed and then transferred to the uterus. Fresh transfers are considered part of the same IVF cycle, but FETs require about 3–4 weeks of additional IVF medications to help prepare the uterine lining for implantation. Every case is different, but the endometrial preparation for FETs often includes IVF medications like oral birth control to override the natural menstrual cycle, Lupron injections to control ovulation, and estradiol, as a pill, injection, or patch, to thicken the uterine lining. Finally, a pill, gel, or intramuscular form of progesterone is administered before the transfer, and a steroid pill called Medrol may also be prescribed to help support implantation.
It is important to understand that all medications carry some risk. While IVF medications and the procedures involved in the IVF cycle are considered very safe, it is important to know the warning signs of serious side effects and rare complications.
Ovarian hyperstimulation syndrome
An excess of hormones during the IVF cycle can result in a rare condition called ovarian hyperstimulation syndrome, or OHSS, which occurs when the ovaries swell too much and become painful. The symptoms of OHSS often begin within the first week of using injectable medications but can also appear later in the cycle or even after retrieval. Mild to moderate symptoms of OHSS can range from abdominal pain and bloating to nausea and vomiting, and severe OHSS may include symptoms such as rapid weight gain (more than 2.2 pounds within 24 hours), severe abdominal pain, nausea, vomiting, shortness of breath, and blood clots. The cause of OHSS is not completely understood but may be related to the high level of hCG causing an abnormal accumulation of fluid in the abdomen. If not treated immediately, OHSS can cause ovarian torsion (in which the ovary twists), kidney failure, and, in rare cases, death. To reduce the risk of OHSS, doctors will closely monitor lab results and ultrasounds to adjust medication dosages accordingly.
Multiple pregnancies (twins, triplets, or more during one pregnancy) are more likely to occur with IVF. These types of pregnancies are considered high risk because they may result in preterm labor or delivery, which can cause babies to be more premature, putting them at risk for health issues like intestinal infections and cerebral palsy as well as learning disabilities or behavioral problems. A multiple pregnancy can also put the mother’s health at risk because it increases the chances of cesarean section (C-section), hemorrhage, gestational diabetes, and more. Research has shown that voluntary single embryo transfer (SET) helps reduce the rate of multiples while maximizing success rates, helping to reduce:
- Low birthweight risk by more than 50%
- Neonatal intensive care unit (NICU) admissions by more than 50%
- Hospital length of stay by more than 80%
SET is an important concept in IVF that involves transferring a single embryo into the uterus during an IVF cycle, as opposed to transferring multiple embryos. For more information, check out this fact sheet.
The primary reasons for promoting SET include:
- Reducing multiple pregnancies
- Improving pregnancy success rates
- Minimizing the risk of multiple birth defects
- Reducing the need for selective reduction in order to enhance the chances of a healthier pregnancy
- Cost saving — multiple pregnancies require more prenatal care and extended hospital visits
IVF poses a small risk (about 2–5%) of an ectopic or tubal pregnancy, which means the embryo implants somewhere other than the uterine lining (most often in one of the fallopian tubes). An ectopic pregnancy requires medication to end the pregnancy or surgery to remove it. Several major risk factors that increase the likelihood of ectopic pregnancy include cigarette smoking, maternal age, and previous tubal surgery. The signs of a possible ectopic pregnancy include sharp, stabbing pain, vaginal spotting or bleeding, low back pain, low blood pressure, and dizziness or fainting. If a patient experiences any of these issues, they should call their doctor immediately.
Bleeding and infection
There is a risk of bleeding or infection and damage to the bowel, bladder, or a blood vessel during egg retrieval. This is because aspirating needles are used to collect eggs from follicles. Some mild bleeding or spotting is normal after the egg retrieval procedure, but if the bleeding does not stop or seems excessive, it is important to contact the doctor. There is also a risk of mild to severe pelvic infection following egg retrieval or embryo transfer, but these risks can be minimized by the use of antibiotic medications administered at the time of the egg retrieval procedure. In rare cases, severe infections may require hospitalization.
Allergic reactions to IVF medications are rare but may occur on the skin at the site of injection. The symptoms of allergic reactions usually involve itchiness or redness. If an allergic reaction occurs, it is important to contact the doctor immediately for treatment recommendations.
Common side effects
While serious complications are rare, there are some common side effects to be aware of before beginning an IVF cycle. Individual side effects may vary, but some of the most common may include:
- Mild soreness or bruising at the site of injections (switching the location of the injection with each injection may help minimize this)
- Breast tenderness
- Increased vaginal dryness
- Mood swings
Everyone will have a different preferred method for injecting IVF medications, but there are some rules of thumb that can make the process run smoothly. Clean the injection site with an alcohol swab, and before injecting the medication, aim the needle at the injection site at a 90° angle. It is also advised to squeeze the skin of the injection site before pushing the needle through the skin in one swift motion and injecting all the medication. Before removing the needle, count to five, and breathe deeply. When you are ready to remove the needle, pull out slowly, and gently press on the injection site with gauze in small circular motions. Then, cap, and remove the needle, and place it into a puncture-proof container.
Dosage and timing
IVF medication regimens vary, but generally speaking, gonadotropins are administered in the evening, usually between 5–11 PM for about 8–12 days. The dosing and number of days will vary depending on a number of factors and on doctors’ recommendations, lab results, and ultrasound monitoring. Other medications may need to be administered in the morning, and the trigger shot(s) will need to be administered 36 hours before egg retrieval.
Monitoring response to medications
During the IVF cycle, patients will need to return to the fertility clinic on a regular basis to receive blood work and transvaginal ultrasounds, which help doctors assess the quantity and size of the development follicles. These monitoring appointments can also help prevent OHSS. Monitoring appointments usually start a few days after the initial ultrasound and the start of medications.
Adjusting dosage as needed
Depending on the results of the lab work and ultrasounds, the doctor may adjust the dosages of prescribed IVF medications. Modifying dosage amounts may help the process progress more favorably.
There are a number of reasons why a patient may discontinue IVF medication, including a lack of funding and psychological stress. In some cases, a doctor may advise a patient to discontinue an IVF medication that does not seem to be working so that other options can be explored.
FAQs on IVF medications
How long do patients typically take IVF medications?
The IVF process can take several weeks from start to finish, but patients usually only take IVF medications for an average of 1–2 weeks.
How do I know if IVF medications are working?
The doctor will be able to assess whether the prescribed IVF medications are working by closely monitoring blood work and ultrasound results at regular appointments throughout the cycle.
How much do IVF medications cost?
The cost of IVF medications varies widely depending on a number of factors, including the types of medications required, the pharmacies supplying the medications, and whether the medications are covered by insurance. The total cost of injectable IVF medications for one cycle typically ranges from $3,000–$7,000, but there may be additional medication costs for embryo transfers.