Your GoodRx Guide to IVF Medications: How They Work, When They’re Used, and Ways to Save

In vitro fertilization (IVF) is a form of assisted reproductive technology that can help you become pregnant. An IVF cycle requires several different treatment steps, and each step requires a different medication — sometimes more than one at the same time.

IVF can feel overwhelming, and it’s easy to lose track of each medication and what it’s for. But GoodRx has you covered, with a guide to the most common fertility medications used in IVF.

What are the steps of an IVF cycle?

There are several different types of IVF cycles. But in general, they include the following steps:

1. Stimulating ovarian follicles to develop mature eggs

2. Preventing the ovaries from releasing the eggs too soon

3. Triggering the ovary to release the egg(s)

4. Egg retrieval

5. Egg fertilization

6. Embryo transfer into the uterus (this can happen within days of the retrieval, known as a “fresh” transfer, or at least a month after the retrieval, known as a “frozen” transfer)

Some IVF cycles include an additional step before stimulation happens. These types of cycles are often referred to as “long agonist” or “microdose flare” protocols. We’ll go into more detail on this later.

In some cases, you’ll take medication such as birth control or estrogen pills before your IVF cycle starts. This is known as “priming,” and it helps regulate the timing of your cycle.

Now that we’ve covered the basic steps of an IVF cycle, let’s get into the medications used for each step.

Good to know: The type of IVF cycle that’s best for you depends on several factors, such as your age, previous fertility treatments, and how many follicles you have. Your fertility provider will help determine the best IVF cycle for your specific situation.

Step 1. Medications that stimulate the ovaries to produce mature eggs: Gonal-F, Follistim AQ, and Menopur

Your body makes a hormone called follicle stimulating hormone (FSH) that tells your ovaries to develop a follicle each month. In an IVF cycle, you’ll administer injections of FSH to do the same thing, but with one major difference.

In a typical menstrual cycle, once a mature follicle develops, FSH levels drop to ensure that only one follicle develops at a time. In an IVF cycle, the goal is usually to develop as many follicles as possible. So you’ll continue to administer FSH until your fertility provider tells you to stop.

The medications typically used to stimulate follicles include:

• Gonal-F (follitropin alfa)

• Follistim AQ (follitropin beta)

• Menopur (menotropins)

Gonal-F and Follistim both contain a lab-made form of FSH. Menopur is slightly different in that it contains two hormones: FSH and luteinizing hormone (LH). It’s also not a synthetic medication the way Gonal-F and Follistim AQ are. Instead, Menopur is made from the purified urine of postmenopausal women. You can use Menopur on its own, or sometimes it’s combined with either Gonal-F or Follistim AQ. But you won’t use Gonal-F and Follistim AQ at the same time.

All of these medications require injections, usually once a day. And you should give the injection at the same time every day for best results. Overall, these medications seem to be similarly effective. A fertility clinic may prescribe one over other based on availability, the prescriber’s preference, or pricing agreements with the manufacturer.

Common side effects of stimulation include headache, abdominal pain, and injection site reactions. The main risk of these medications is overstimulation, which can cause a condition called ovarian hyperstimulation syndrome (OHSS). You’ll see your fertility provider frequently during the stimulation process to make sure the medications are working and keep an eye out for early signs of OHSS.

Step 2. Preventing the ovaries from releasing the eggs too soon: Cetrotide, Ganirelix, and leuprolide

Your body is designed to release an egg from the ovary as soon as the follicle is mature. But in an IVF cycle, this has to be planned in advance so your fertility team knows when to retrieve the eggs.

In order to prevent your body from releasing the eggs and to prevent overstimulation, you’ll use medications that block a hormone called gonadotropin releasing hormone (GnRH). These are typically known as suppression medications, and there are two types: GnRH antagonists or a GnRH agonist.

GnRh antagonists work quickly, so they’re typically started about 4 to 6 days after the stimulation medication. They include:

• Cetrotide (cetrorelix)

• Ganirelix (Fyremadel)

Leuprolide (Lupron) is a GnRH agonist that’s used off-label in some IVF cycles instead of the medications listed above. If you’re using leuprolide, you’ll start injecting it a week or so before you start your stimulation medication. That’s because at first, leuprolide increases FSH and LH levels. But with continued use, it has the opposite effect and helps prevent the mature egg from being released.

These medications seem to be similarly effective, but leuprolide may be preferred if you have a low number of follicles or have had unsuccessful IVF cycles in the past.

Common side effects of suppression medications include hot flashes and mood swings. They’re all injectable medications, so injection-site reactions are also possible.

Step 3. Trigger medications: Novarel, Pregnyl, and leuprolide

Once your follicles are developed, your fertility provider will let you know that it’s time for your trigger injection. This is the final step of the egg development process, and it needs to be specifically timed along with your egg retrieval. So it’s crucial to give yourself the injection exactly when your fertility specialist tells you to.

There are three main medications used to trigger egg release:

• Novarel, Pregnyl (human chorionic gonadotropin, or HCG)

• Ovidrel (choriogonadotropin alfa)

• Leuprolide

If you use leuprolide earlier in your IVF cycle, it won’t be effective as a trigger medication. So you’ll need to use one of the other options.

You may have mild stomach pain or nausea after your trigger shot. Injection site reactions are also possible. After you administer your trigger shot, your fertility provider will perform your egg retrieval and fertilize the eggs (steps 4 and 5). You typically won’t need specific medications for these steps. Once a healthy embryo develops, embryo transfer can occur.

Good to know: Trigger shots (and other fertility medications) can cause a false positive on over-the-counter (OTC) pregnancy tests. That’s because these medications raise your HCG levels, and OTC tests measure HCG levels to determine if you’re pregnant. So if you receive a fresh embryo transfer, you’ll need to wait at least 7 days (1 week) for an accurate pregnancy test result.

Step 6. Embryo transfer medications: Progesterone, Estrogen, and more

As mentioned, there are two types of embryo transfers: fresh and frozen. The medications you take may differ depending on what type of transfer you’re receiving.

Fresh embryo transfer

If you’re receiving an embryo transfer immediately after retrieval and fertilization occur, it’s considered a fresh transfer. In most cases, you’ll start treatment with progesterone a few days before your transfer is scheduled. This helps ensure that your uterine lining is ready to accept the embryo and maintain a pregnancy.

There are several different forms of progesterone that can be used in this step:

• Crinone (vaginal gel)

• Endometrin (vaginal tablets)

• Milprosa (vaginal ring)

• Progesterone in oil (injection into a muscle)

• Progesterone capsules (Prometrium), typically inserted vaginally (not taken orally)

• Progesterone vaginal suppositories (these may require a compounding pharmacy)

Vaginal and injectable progesterone seem to be similarly effective for fresh embryo transfers. Some people prefer vaginal progesterone, since progesterone injections can be painful. But vaginal progesterone can cause vaginal irritation and leakage, which can be unpleasant.

Frozen embryo transfer

If you’re receiving a frozen embryo transfer, you’ll likely need additional medication to help prepare your uterus for the transfer. This may include:

• Birth control pills, to regulate your cycle and ensure the transfer happens at the right time

• Leuprolide, to suppress your natural hormonal cycle so no additional follicles develop

• Estrogen (estradiol) tablets, patches, or injections, to help thicken and prepare the uterine lining

You’ll also start progesterone a few days before your transfer, as described above.

In some cases, a “natural” frozen embryo transfer is also an option. Instead of using medication to control the timing of the transfer, your fertility provider will monitor your natural menstrual cycle and schedule the transfer during your most fertile days.

Miscellaneous fertility medications

There are many types of IVF cycles, and the medications you use are typically tailored to your  unique situation. So there are a number of medications that aren’t part of a “routine” cycle, but may be included in certain cases. Several of these medications are compounded, which means they aren’t commercially available, so they need to be specially made.

Medications that may be part of a specific IVF cycle include:

• Clomid (clomiphene) or Femara (letrozole): These are both tablets that help stimulate follicle development. They’re typically prescribed to increase the chance of pregnancy with natural conception or intrauterine insemination (IUI). But they’re sometimes used as part of an IVF cycle, too.

• HCG dilution: This is a compounded form of HCG that’s a much lower dose than what’s used for a trigger shot. It’s sometimes added at the beginning of an IVF cycle to help stimulate follicles.

• Leuprolide dilution: This is a compounded form of leuprolide that’s a lower dose than typically prescribed. It’s sometimes added before an IVF cycle to suppress your natural hormone release and increase the effectiveness of the other medications once the IVF cycle is started.

• Sildenafil vaginal suppositories: These are another compounded medication used to increase blood flow to the uterus and increase the chance of successful implantation in some people.

How to save on the cost of IVF medications

IVF medications are notoriously expensive, since many commercial insurance plans don’t cover them. But there are still ways to save on the cost of your medications.

• Shop around. Most IVF medications require you to use a specialty pharmacy. That’s because many of them are refrigerated and require special shipping. Each specialty pharmacy typically has cost-savings available based on the type of medications you’re prescribed. And some offer better savings than others. In most cases, your fertility clinic will know where you can get the best prices. But it doesn’t hurt to call around and see if you can find better savings elsewhere.

• Use GoodRx. Check the savings available on your IVF medications using a free GoodRx coupon. They helped one family save almost $7,000 on their IVF medications.

• Ask questions. If cost is an issue for you, be sure to let your fertility care team and the pharmacy you’re working with know. They may have additional savings programs available. Or they may be able to change your treatment regimen to accommodate your budget. So be sure to ask about all of the savings options available to you.

• Contact your insurance. In some cases, your insurance may cover certain medications used in an IVF cycle. Estradiol tablets or patches, trigger shots, and injectable or vaginal progesterone are more likely to be covered than other IVF medications. So be sure to check with your insurance first before you pay out of pocket for a medication.

• Use your health savings account. In many cases, you can use your health savings account (HSA) or flexible spending account (FSA) funds on IVF medications.

• Research grants and scholarships. A wide variety of nonprofit organizations offer financial assistance for IVF medications. Take advantage of these programs if you’re eligible to help save on the cost of treatment. The manufacturers of some fertility medications also offer financial assistance.

It’s just as important to know what not to do when you’re trying to save on the cost of your IVF medications. Use caution when purchasing medications online. Counterfeit products are common and could derail an entire IVF cycle, not to mention put you in harm’s way. Websites like legitscript.com can help you verify an online pharmacy website to make sure it’s legit.

It’s also best to avoid purchasing medication from another individual who has some “leftover” from their IVF experience. These medications have very strict storage requirements, and may not work if they’re expired or aren’t stored properly. That being said, some fertility clinics have a take-back program where people can donate unused medication that’s held for emergencies or people in need. Ask your fertility clinic if they participate in something similar.

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Written by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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