IVF Medications Explained: Your Complete Guide to Fertility Drugs

If you're about to start IVF, you've probably heard of Gonal-F, Menopur, and trigger shots. The medication protocol can feel overwhelming — needles, timing, refrigeration requirements, and costs that seem to climb by the day. This guide breaks down every medication you might encounter, explains how each one works, and helps you understand what to expect throughout your cycle.

Understanding your medications doesn't just reduce anxiety — it makes you a better advocate for your own care. When you know why you're taking each drug and what it's supposed to do, you can ask better questions and spot potential issues earlier.

The Three Phases of IVF Medications

IVF medications fall into three main phases, each with a specific purpose:

Stimulation Medications: Growing Multiple Eggs

The foundation of IVF is stimulating your ovaries to produce multiple mature eggs. This requires injectable gonadotropins — hormones that directly stimulate the ovaries. You'll inject these medications daily, typically for 8-14 days.

Gonal-F (Follitropin Alfa)

Gonal-F comes in prefilled pens that make injection easier. You'll store it in the refrigerator until first use, then it can stay at room temperature for up to 28 days. Most patients inject into the belly fat, rotating sites to prevent bruising.

Common side effects include headache, injection site reactions, bloating, and mood changes. More serious but rare risks include ovarian hyperstimulation syndrome (OHSS) and blood clots.

Follistim (Follitropin Beta)

The main difference between Gonal-F and Follistim is the delivery system. Follistim uses replaceable cartridges with a reusable pen, while Gonal-F comes in prefilled disposable pens. Your clinic may have a preference based on their experience or your insurance coverage.

Menopur (Menotropins)

Your doctor might prescribe Menopur alone or in combination with pure FSH products. The LH component can improve response in women with low ovarian reserve or those who haven't responded well to FSH alone. Some protocols add Menopur partway through stimulation if follicle growth is slower than expected.

Preventing Premature Ovulation: GnRH Antagonists

Once you start growing multiple follicles, your body might try to ovulate before egg retrieval. GnRH antagonists prevent this by blocking the signal from your brain that triggers ovulation.

Cetrotide (Cetrorelix)

Ganirelix

Both antagonists work immediately — unlike older "agonist" protocols that required weeks of suppression before stimulation could begin. This makes antagonist protocols shorter and more convenient for most patients.

Trigger Shots: Timing Final Egg Maturation

The trigger shot is one of the most precisely timed medications in your entire cycle. It causes your eggs to complete their final maturation and prepares them for retrieval exactly 36 hours later.

Ovidrel (Choriogonadotropin Alfa)

After Ovidrel, you'll have detectable hCG in your system for about 10-14 days. This is important to know because early pregnancy tests can show false positives from the trigger shot rather than actual pregnancy.

Lupron (Leuprolide) Trigger

Lupron trigger only works if you're on an antagonist protocol — it won't work if you've been taking Lupron for downregulation. Your clinic may use a "dual trigger" combining low-dose hCG (1,000-1,500 IU) with Lupron for OHSS prevention while still optimizing egg maturation.

Progesterone Support: Preparing for Implantation

After egg retrieval, your body needs progesterone to prepare the uterine lining for embryo implantation. The retrieval process removes the cells that would normally produce progesterone, so supplementation is essential.

Progesterone in Oil (PIO)

Vaginal Progesterone

Research shows Crinone gel appears equivalent to PIO for both fresh and frozen embryo transfers. Some studies suggest Endometrin alone may have slightly lower success rates for frozen transfers, so many clinics combine it with PIO or use it only for fresh transfers.

Understanding Your Protocol

Your medication protocol will be customized based on your age, ovarian reserve, previous response (if applicable), and clinic preferences. Here are the most common protocols:

Antagonist Protocol (Most Common)

You start stimulation medications on day 2-3 of your cycle and add an antagonist (Cetrotide or Ganirelix) around day 5-6 when follicles reach 14mm. This is the most widely used protocol because it's shorter and has lower OHSS risk.

Long Lupron Protocol

You take Lupron starting in the luteal phase of the cycle before IVF to suppress your natural hormones completely, then begin stimulation. This older protocol takes longer but gives clinics more control over timing.

Mini-IVF / Mild Stimulation

Lower doses of medications aim for fewer but potentially higher-quality eggs. This approach is often used for women with diminished ovarian reserve or those who want to minimize medication exposure and OHSS risk.

Medication Costs: US vs. Colombia

IVF medications represent one of the largest variable costs in treatment. US prices are among the highest in the world.

*Most Colombian clinics include medications in their package pricing. Out-of-pocket costs are typically only for take-home progesterone.

Managing Side Effects

IVF medications can cause a range of side effects. Most are manageable, but knowing what to expect helps you prepare.

Common Side Effects

• Bloating and abdominal discomfort: Your ovaries are growing multiple follicles and can expand to several times their normal size. Wear loose clothing and avoid high-impact exercise.
• Mood swings: Rapidly changing hormone levels affect neurotransmitters. This is temporary and usually resolves after retrieval.
• Headaches: Stay well hydrated and talk to your clinic about safe pain relievers.
• Injection site reactions: Rotate injection sites, apply ice before and heat after, and use proper technique.
• Fatigue: Your body is working hard. Rest when you can and don't overcommit during stimulation.

When to Call Your Clinic

These can be signs of ovarian hyperstimulation syndrome (OHSS), which requires medical attention. OHSS occurs when ovaries over-respond to stimulation, and catching it early leads to better outcomes.

Practical Tips for Medication Management

Storage

• Keep stimulation medications refrigerated until first use
• Once opened, most can stay at room temperature for 28 days
• Never freeze any IVF medications
• Keep progesterone in oil at room temperature (cold oil is more painful to inject)
• If traveling, use an insulated bag with ice packs for unopened medications

Organization

• Create a medication calendar with exact times and doses
• Set phone alarms for each medication, especially the trigger shot
• Keep all supplies in one dedicated location
• Prepare injections at the same time each day to build routine
• Track each injection in a log (many apps exist for this)

Injection Technique

• Watch your clinic's instructional videos multiple times
• Practice with saline if your clinic offers training sessions
• Ice the area for 5 minutes before subcutaneous injections
• Insert the needle quickly — slow insertion hurts more
• Don't reuse needles; use a new needle for each injection

Frequently Asked Questions

Can I choose between Gonal-F and Follistim?

These medications are clinically equivalent. Your clinic may have a preference based on experience, or the choice may come down to insurance coverage or pharmacy pricing. Either option will work well.

What if I miss a dose?

Call your clinic immediately. For most medications, taking a dose a few hours late is manageable. Never double up on doses without explicit instructions from your medical team.

Why do some women need higher doses?

Dose requirements depend on ovarian reserve (measured by AMH and AFC), age, body weight, and previous response. Women with lower reserve or older age typically need higher doses to recruit adequate follicles.

Can I travel during stimulation?

Yes, but plan carefully. You'll need to transport medications properly, maintain injection timing across time zones, and be within reach of a clinic for monitoring appointments.

How long will I need progesterone?

If your transfer is successful, you'll typically continue progesterone until 10-12 weeks of pregnancy, when the placenta takes over production. Your clinic will tell you when to stop.

The Bottom Line

IVF medications can feel overwhelming at first, but they follow a logical sequence: stimulate egg growth, prevent premature ovulation, trigger final maturation, and support implantation. Understanding each phase helps you feel more in control of your treatment.

The most important things are following your protocol exactly as prescribed, storing medications properly, timing injections precisely (especially the trigger), and communicating any concerns to your clinic promptly. If side effects become unmanageable or you notice warning signs of OHSS, don't hesitate to call.

And remember — this phase is temporary. The injections end after retrieval, and you'll be one step closer to your goal.

Read more: Preparing Your Body for IVF | Egg Retrieval Guide | IVF Cost Guide