Many women struggling with infertility turn to in vitro fertilization (IVF), but are hit with sticker shock when they pick up their meds and receive their medical bill. Not only does IVF have a high price tag, but the cost of treatment and the associated medications are often not covered by insurance. According to a GoodRx analysis, IVF drug list prices have gone up 50% since 2014, and much of this increase is due to the lack of affordable generic alternatives for fertility medications.
So, as prices continue to rise, what should you expect to pay for IVF medications? And are there ways to save if you don’t have insurance coverage? Let’s find out.
This process comes with a whole host of tests, medications, and doctor visits. According to FertilityIQ, one IVF cycle can cost $23,474 on average, and you will typically need more than 1 cycle for a successful pregnancy.
The type, duration, and order of medications differ from patient to patient. But in general, drugs are an important part of the egg retrieval portion of the IVF process. Your provider will prescribe certain medications for you depending on your specific needs during the egg retrieval process. They may also prescribe medications to be used after the embryo is implanted to support pregnancy.
We’ll walk through the medications used in egg retrieval, then review drugs typically used in the embryo implant phase.
The egg retrieval process can be broken down into 3 phases: suppression, stimulation, and the triggering of egg release. Depending on the protocol your provider selects, either the suppression or stimulation phase comes first. The triggering of egg release phase is always last.
One of the first steps in IVF is to suppress ovulation (the natural cycle of when a mature egg is released from the ovary for fertilization). This is necessary to allow for multiple eggs to develop at the same time for retrieval.
To achieve this, you are prescribed medications that block ovulation. These medications are known as gonadotropin-releasing hormone (GnRH) agonists or antagonists. What you’re prescribed depends on the IVF protocol that your provider chooses for you.
Below are the typical medications used for suppression and their prices.
Ganirelix and Cetrotide
Ganirelix and Cetrotide are GnRH antagonists. In short, they work to suppress the release of hormones that trigger ovulation. Ganirelix has an average cash price of around $258 per syringe, and Cetrotide has a cash price of around $279 per vial. Both medications usually contain 1 to 2 doses depending on the protocol, so you will likely need to purchase multiple syringes or vials per cycle.
Both Cetrotide and Ganirelix require you to self-inject. However, Ganirelix comes packaged as a pre-filled syringe, while Cetrotide requires you to dissolve the powder and mix the solution before injecting.
Luckily, if you are struggling to afford Cetrotide, you have some options. If you don’t have insurance or your insurance does not cover Cetrotide, the manufacturer has a program that offers savings or rebates.
Leuprolide is a GnRH agonist. It works by initially increasing the production of hormones that trigger ovulation. Over time, your body adapts to this stimulation by stopping the production of these hormones, leading to a delay in ovulation.
Leuprolide comes in a vial with multiple doses. The average cash price this past year for a multi-dose vial of leuprolide was $2,338. While a single vial of leuprolide is priced higher than Ganirelix and Cetrotide, leuprolide contains multiple doses per vial compared to only 1 to 2 doses per vial of Ganirelix or Cetrotide. You will need to measure your dose with a syringe for self-injection.
In addition to suppressing ovulation, it is crucial to mature multiple eggs for retrieval because eggs can be lost in the process of IVF. In order to do so, FSH (follicle-stimulating hormone) and/or human menopausal gonadotropins (hMG) are used to cause a higher number of follicles (sacs in the ovary containing the immature eggs) to mature.
The stimulation phase can happen either before or after the suppression phase depending on the protocol. By far, this stage has some of the most expensive drugs.
Gonal-F and Gonal-F RFF
Both Gonal-F and Gonal-F RFF are copies of the natural FSH hormone responsible for egg stimulation. What differs is how they are packaged. Gonal-F RFF is available in a pen form for ease of administration. One 450 iU Gonal-F vial is $1,337, and one 450 iU Gonal-F RFF pen is $1,331. They are similarly priced, and both require self-injection. However, the vial form involves dissolving the powder and mixing the solution prior to injecting.
If you don’t have insurance or your insurance does not cover Gonal-F or Gonal-f RFF, the manufacturer has a program that offers savings or rebates.
Follistim AQ is also a copy of FSH, which again is the hormone responsible for egg stimulation. It comes in pre-filled cartridges and needles to be used with the Follistim AQ pen for injection. While there are differing amounts of Follistim AQ sold, 1 cartridge of 300 iU costs $884. The price for the medication will ultimately depend on the number of doses and the dose needed.
If you have commercial insurance, the manufacturer of Follistim AQ offers savings on out-of-pocket costs.
Human menopausal gonadotropins (hMG) is another type of medication that can also be used to stimulate egg growth. hMG differs from the other stimulation drugs because it contains both FSH and luteinizing hormone (LH). A low amount of LH is needed to support egg maturation. Menopur is currently the only version of hMG on the market.
The price per vial is $237; however, you may need multiple vials per injection depending on your dose. Therefore, while a Menopur vial costs less than the other FSH vials, your may need to purchase multiple Menopur vials per injection.
Menopur vials contain a powder that needs to be mixed before self-injection.
The final step in the egg collection process is the triggering phase. Medications containing the hormone human chorionic gonadotropin (hCG) trigger the eggs to go through the final phase of growth and trigger the ovaries to release mature eggs after about 36 hours. Then, the eggs are retrieved by the fertility doctor.
You typically need only one dose of hCG, but only brand-name hCG medications are currently available on the market. Their prices are listed below.
Novarel and Pregnyl
A vial of Novarel with 10,000 units has a cash price of $306, while a vial of Pregnyl with 10,000 units has cash price of $134. Novarel is also available as a vial with 5,000 units with cash price of $172.
There is only one form of Ovidrel, and it comes as a pre-filled syringe of hCG for self-injection, making it much easier to administer. One 250 mcg syringe is $203.
If you don’t have insurance or your insurance does not cover Ovidrel, the manufacturer has a program that offers savings or rebates.
After the eggs are retrieved and fertilized with sperm in the lab, the final step is to implant the embryo in the uterus.
To further support the embryo transfer, your provider may prescribe progesterone supplementation up until the end of the first trimester of pregnancy. Why is this necessary? Because IVF medications for egg retrieval can actually decrease progesterone levels in your body, and progesterone is a hormone that prepares the lining of the uterus to allow for the implantation of the embryo.
The costs of progesterone drugs are listed below.
Progesterone and Prometrium
Both progesterone and Prometrium come in a capsule form of either 100 mg or 200 mg. However, progesterone is the generic and much cheaper version of Prometrium. For example, one 100 mg capsule of Progesterone is $2, while one 100 mg capsule of Prometrium is $13. Progesterone also comes in a vial for self-injection, which contains multiple doses.
Crinone and Endometrin
Crinone and Endometrin contain progesterone and are inserted vaginally. Crinone is available as an applicator with gel at one end for ease of administration. It is available at a 4% and an 8% concentration, costing $47 and $29 per applicator, respectively. Endometrin is available as a vaginal insert (tablet) that you put on the end of an applicator for administration. It is priced per insert at $14.
For either Crinone or Endometrin, you must pay per applicator or insert, and you usually need multiple doses. And while Endometrin is cheaper per dose, you usually need to take it 2 to 3 times a day, whereas you usually take Crinone only once a day.
If Crinone is too expensive, you can consider using Endometrin because the manufacturer has a patient savings program available for commercially insured or non-insured patients.
Overall, fertility medications and the entire IVF process are no small expense. All in all, it is important to educate yourself on the process and the associated costs so you can save. Our tips are below.
Shop around. Prescription drug prices can vary from one pharmacy to the next, so it pays to shop around before you buy. Make sure you check for GoodRx coupons to get a discount off the retail price.
Use manufacturer coupons. Check out the links in this article to manufacturer savings on fertility medications.
Start a conversation with your doctor, nurse, or pharmacist. If you’re having trouble affording your prescription, let your healthcare provider know. They can help you work through insurance coverage issues and/or find affordable alternative medications for you. In addition, some medications used for the stimulation phase (Gonal-F, Gonal-F RFF, Follistim AQ) are overfilled, so they actually contain more medication than what’s listed on the label. You may be able to get an extra partial or full dose depending on how much you need per injection. Talk to your doctor or nurse to see if you can use the extra medication to get an extra dose.
Doctor’s samples. Ask your doctor for any samples of medication that are part of your IVF protocol. You may be able to get extra doses of medication.
Use insurance. If you have insurance, you can check with your insurance company to see if a fertility drug is covered and how much it will be.
Here are some other great resources to learn about IVF:
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Co-contributor: Jennifer Tran, PharmD
This GoodRx analysis is based on a representative sample of U.S. prescription fills (not GoodRx fills) and comes from several sources, including pharmacies and insurers. The reported prices in this article are based on average cash prices, the so-called “usual and customary” prices or retail prices at the pharmacy (not including insurance copays or coinsurance). All prices listed on this article are based on data from October 1, 2018 to September 30, 2019. The prices presented are based on the smallest unit of the drug that can be filled.
A note about IVF drug use: The total price of prescription drugs for IVF will vary because the dosing and the course of drugs will differ based on a provider’s recommendation to a patient. We base our IVF process information on several sources including FertilityIQ and multiple published reviews in the medical literature. 1, 2, 3, 4, 5