Stimulation medications (the main event)

These are the daily injections that stimulate your ovaries to produce multiple follicles instead of the single egg released in a natural cycle.

FSH medications: Gonal-F and Follistim

Both contain recombinant follicle-stimulating hormone (rFSH). They are functionally interchangeable; the choice usually comes down to pharmacy pricing and pen device preference. Typical doses range from 150 to 450 IU per day, injected subcutaneously in the abdomen.

Side effects: Bloating, mild abdominal discomfort, headache, mood swings. As follicles grow, you may feel fullness and pressure in the pelvis.

Menopur (menotropins)

Contains both FSH and LH activity, derived from purified urine of postmenopausal women. Often used alongside Gonal-F or Follistim to add LH, especially for patients with low LH or in long lupron protocols. It comes as a powder that you mix with diluent before injecting.

Side effects: Similar to FSH medications. The injection itself can sting more than pen-based FSH, which is normal.

Ovulation prevention medications

Cetrotide and Ganirelix (GnRH antagonists)

These prevent your body from releasing eggs prematurely. In an antagonist protocol, you start one of these around stimulation day 5 to 7 and continue until the trigger shot. Daily subcutaneous injection, 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 in the luteal phase of the cycle before stimulation. This suppresses your pituitary gland, giving the fertility team more control over follicle development. Lupron can also be used as a trigger shot (at a higher dose) instead of hCG in patients at risk for ovarian hyperstimulation.

Side effects: Hot flashes, headache, mood changes, fatigue. These are temporary menopausal symptoms from the hormone suppression.

The trigger shot

Given exactly 36 hours before egg retrieval to mature the eggs within the follicles.

hCG trigger: Ovidrel, Pregnyl, or Novarel

Ovidrel is a prefilled subcutaneous injection. Pregnyl and Novarel are intramuscular injections that require mixing. The hCG mimics the natural LH surge that triggers ovulation.

Lupron trigger

A high-dose Lupron injection used instead of hCG for patients at risk of ovarian hyperstimulation syndrome (OHSS). Causes a natural LH surge from the pituitary. When a Lupron trigger is used, fresh transfer is usually not recommended; all embryos are frozen for a later FET.

After retrieval: progesterone support

After retrieval, your body needs progesterone to prepare and maintain the uterine lining for implantation.

Progesterone in oil (PIO)

Intramuscular injection into the upper outer quadrant of the buttock. Thick oil, large needle, given daily or every other day. This is the injection most patients find the most challenging. Tips: warm the vial in your hands or under warm water for 60 seconds, use a heating pad after injection, alternate sides, and ice the area first if needed.

Endometrin or Crinone (vaginal progesterone)

Vaginal suppositories or gel, used two to three times daily. Less painful than PIO but can cause discharge and irritation. Some clinics use vaginal progesterone alone; others combine it with PIO.

Other medications you may encounter

  • Doxycycline: A short course of antibiotics around retrieval to prevent infection.
  • Methylprednisolone (Medrol): A brief steroid course around transfer to reduce 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 is achieved.
  • 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 reduce 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 demonstrate).
  • Inject at the same time each day to build a routine.
  • PIO: let the oil warm to room temperature. A warm compress afterward helps absorption.
  • Rotate injection sites to avoid tissue buildup.
  • Watch your clinic's injection tutorial videos. Most have them.

Find a fertility specialist in the Baaby provider directory to discuss which protocol is right for you.