Why are fertility medications necessary?

In a typical in vitro fertilization (IVF) cycle, "fertility medications," sometimes referred to as "hormonal medications," are used to foster egg production in the ovaries.

During the course, of a natural menstrual cycle, your brain produces hormones that stimulate one of your two ovaries to release a single egg each month. During an IVF stimulation cycle, you are prescribed these same hormones to mimic the body's natural menstrual cycle. These drugs are known as fertility medications. The goal of fertility medications is to simultaneously stimulate both ovaries to mature numerous eggs. If more eggs are matured, more can be retrieved, and ultimately more can be used to create embryos, resulting in higher chances for a successful pregnancy today or in the future.

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Types of Fertility Medications

Infertility is a medical condition that often requires treatment using hormonal medication(s). At NYULFC, we believe there is no “one size fits all” approach to fertility treatment. If your physician determines that fertility medications need to be part of your treatment plan, you will be prescribed an individualized medication protocol that meets your needs and family building goals. The medication list below outlines common medications that may be prescribed during a fertility treatment cycle at NYULFC.

Clomiphene (Clomid)

Clomid is an oral medication started at a specific time of the menstrual cycle, typically between days 3 to 5 after the start of a menstrual bleed. This drug is used to recruit and develop the production of ovarian follicles that will produce an egg. Clomid is often prescribed to women who experience irregular ovulation or do not ovulate. This medication can be prescribed by either an OB/GYN or by a fertility specialist. Clomid should be taken at approximately at the same time each day, and the usual treatment course is five days in total.

This popular treatment plan, if deemed medically appropriate, is viewed as the first step in treating infertility. Ovulation Induction (OI) cycles are cost effective and less invasive than other types of fertility treatment cycles. Common side effects may include heightened symptoms of the menstrual cycle such as nausea, bloating, and mood changes. There is also a higher risk of a multiple pregnancy (roughly a 7% chance of twins), and therefore Clomid is not recommended for women who are unwilling or unable to carry a twin pregnancy.

Fertility Injections

The medications listed below are commonly used during an ovarian stimulation cycle for IVF or egg freezing. Like all medications, there is a risk of side effects ranging from bruising or a reaction at the injection site to nausea and abdominal bloating. While each patient reacts to medications differently, many describe side effects as mild or manageable.

  • Gonadotropins (FSH, HMG) are used to stimulate the ovaries to mature multiple follicles simultaneously. FSH is administered via a “pen needle” while HMG is administered using a traditional syringe with needle. Both FSH and HMG are given through the subcutaneous route (under the skin with a small needle).

  • GnRH Antagonists are used to suppress the release of luteinizing hormone (LH) which helps to prevent premature ovulation. GnRH Antagonists are administered via the subcutaneous injection route.

  • GnRH Agonists are used to suppress the natural hormones released during the cycle to also prevent premature ovulation. GnRH Agonists are administered via the subcutaneous injection route.

  • “The Trigger Shot” for Ovulation is given to help mimic the natural surge of luteinizing (LH) in the body. These drugs finalize the maturation process of the stimulated eggs and prepare your body for the oocyte retrieval procedure. The determination of which trigger medications will be used and in what dosages is unique to each patient, with the goal of attaining the best possible outcome for the number and quality of eggs retrieved. An example of a frequently used trigger protocol at NYULFC is a “combination trigger.” This treatment plan includes a medication called Ovidrel or a similar type drug, such as, Human Chorionic Gonadotropin (HCG), Pregnyl or Novarel, and two injections of Leuprolide Acetate, often taken 12 hours apart. These final hormonal medications in your retrieval cycle are timed with ovulation and are usually taken in the nighttime hours. Once you take the first trigger injection, ovulation occurs within approximately 35 to 36 hours. Because of the correlation between your trigger time and your assigned oocyte retrieval procedure, you MUST take these medications at the specified time instructed by the NYULFC clinical staff, within a strict 10-minute window to avoid premature ovulation. Trigger medications are administered via subcutaneous injection.

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Fertility Medications: Frequently Asked Questions

What are some other medications commonly used in fertility treatment cycles?

Progesterone (sometimes referred to as luteal support) enhances the uterine lining’s ability to promote embryo implantation and sustain pregnancy. Progesterone is needed in both fresh and frozen embryo transfer cycles. Progesterone in Oil is administered via intramuscular injections and/or used every other day in combination with progesterone vaginal suppositories such as Endometrin or Crinone daily.

How much do injectable fertility drugs cost?

The self-pay fee for medications used during an IVF cycle ranges from $2,000 to $8,000 depending on the length of the cycle, the types of medication needed, and pharmacy used to procure the medication(s). Most patients undergoing IVF can expect their fertility medications to cost between $4,000-$5,000. Prior to your first visit at NYU Langone Fertility Center (NYULFC), please reach out to your insurance company to discuss coverage for fertility medications and services.

How many injections are needed for IVF?

The number of injections needed for an IVF cycle will vary depending on the length of your cycle. In an “average” or standard cycle, a patient will be prescribed two injections per day for the first five to seven days, and three injections per day for an additional three to five days. The trigger shot involves two to three injections 12 hours apart. This would total approximately 30 injections per cycle, but this estimate may vary significantly based on each patient’s unique medication protocol.

How do you inject fertility drugs?

Before your cycle, you will attend an orientation class with our NYULFC health educator, during which you will receive detailed instructions for injecting fertility medications. Remember, it’s normal to feel anxious. You may refer to the below training videos for guidance at any point before or during your cycle.