Stimulation Medications (the Main Event)

These daily injections ask your ovaries to recruit multiple follicles at once, rather than the single egg a natural cycle would produce.

FSH Medications: Gonal-F and Follistim

Both deliver recombinant follicle-stimulating hormone (rFSH) and work the same way. Your clinic will likely choose based on what your pharmacy prices and which pen device feels easier to handle. Doses typically fall between 150 and 450 IU per day, injected subcutaneously in the abdomen.

Side effects: Bloating, mild abdominal discomfort, headache, mood swings. As follicles swell, you may notice a sense of fullness or pressure low in the pelvis.

Menopur (menotropins)

This one carries both FSH and LH activity, sourced from purified urine of postmenopausal women. Clinics often add Menopur to Gonal-F or Follistim when a patient runs low on LH or when a long lupron protocol calls for extra LH support. It arrives as a powder you mix with diluent right before each shot.

Side effects: Similar to the FSH pens. The injection itself tends to sting a bit more, which is normal.

Ovulation Prevention Medications

Cetrotide and Ganirelix (GnRH Antagonists)

These stop your body from releasing eggs too early. In an antagonist protocol, you begin one of these around stimulation day 5 to 7 and keep going until the trigger shot. One subcutaneous injection per day, usually in the morning.

Side effects: Injection site redness or itching (common with Cetrotide), headache, nausea.

Lupron (leuprolide Acetate, GnRH Agonist)

In a long lupron protocol, you start daily Lupron injections during the luteal phase of the cycle before stimulation even begins. This quiets your pituitary gland so the fertility team has tighter control over follicle growth. Lupron can also serve as a trigger shot at a higher dose, replacing hCG for patients at risk of ovarian hyperstimulation.

Side effects: Hot flashes, headache, mood changes, fatigue. All temporary, all a result of the hormone suppression.

The Trigger Shot

Given precisely 36 hours before egg retrieval to push the eggs inside the follicles to maturity.

hCG Trigger: Ovidrel, Pregnyl, or Novarel

Ovidrel comes as a prefilled subcutaneous injection. Pregnyl and Novarel are intramuscular shots that require mixing first. All three replicate the natural LH surge that tells your body it is time to ovulate.

Lupron Trigger

A high-dose Lupron injection, used instead of hCG when ovarian hyperstimulation syndrome (OHSS) is a concern. It prompts a natural LH surge from your own pituitary. When a Lupron trigger is used, fresh transfer is typically off the table; all embryos get frozen for a later FET.

After Retrieval: Progesterone Support

Once retrieval is done, your body needs progesterone to get the uterine lining ready for implantation and keep it in place.

Progesterone in Oil (PIO)

Intramuscular injection into the upper outer quadrant of the buttock. Thick oil, a large needle, given daily or every other day. Most patients name this the hardest injection on the list. A few tips that help: warm the vial in your hands or under warm water for 60 seconds before drawing up, use a heating pad after the shot, alternate sides each time, and ice the area beforehand if the cold needle stings.

Endometrin or Crinone (vaginal Progesterone)

Vaginal suppositories or gel, used two to three times a day. Less painful than PIO, though you may notice discharge and some irritation. Some clinics rely on vaginal progesterone alone; others pair it with PIO.

Other Medications You May Encounter

  • Doxycycline: A short antibiotic course around retrieval to guard against infection.
  • Methylprednisolone (Medrol): A brief steroid course around transfer to dial down inflammation.
  • Baby aspirin (81mg): Sometimes prescribed to improve blood flow to the uterus. Usually started before transfer and continued through the first trimester if pregnancy takes hold.
  • Estrace (estradiol): Used in FET cycles to build the uterine lining before transfer.
  • Valium (diazepam): A single dose before transfer to relax the uterus and ease cramping.

Injection Tips From People Who Have Done This

  • Ice the injection site for 30 seconds before subcutaneous shots.
  • Pinch the skin and inject at a 45 to 90 degree angle. Your nurse will walk you through it.
  • Inject at the same time each day so it becomes routine.
  • PIO: let the oil warm to room temperature first. A warm compress afterward aids absorption.
  • Rotate injection sites to avoid tissue buildup.
  • Watch your clinic's injection tutorial videos. Most have them posted.

Find a fertility specialist in the Baaby provider directory to discuss which protocol fits your situation.