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Fertility Medications 101

Fertility medications

There are many paths to parenthood. For some, the journey includes fertility treatments like egg freezing or in vitro fertilization (IVF), which help millions of individuals preserve their fertility options or conceive. And while these procedures can help you start the family you’ve always dreamt of, the process can sometimes feel like an overload of information and new things to learn.

Fertility medications are often one of the more overwhelming parts of the journey as they are prescribed on a tightly-timed schedule with specific doses based on hormone levels. Your doctor may decide to change your prescriptions throughout the process based on ultrasounds and bloodwork.

Managing your medications, which are often taken as nightly injections, can be stressful and may take some getting used to. However, learning more about the purposes and side effects of your fertility medications can help with peace of mind. Let’s take a closer look at the main types of fertility medications used for egg freezing and IVF.

Ovarian Stimulation Medication 

The main goal of egg freezing is to retrieve as many mature eggs as possible from your ovaries: the more eggs you have, the higher your chances are of fertilizing one or more eggs and becoming pregnant as a result of IVF. This process involves ovary stimulation to induce follicle growth and egg production.

Stimulation medications used in egg freezing contain three important hormones that cause the ovaries to mature and release eggs: follicle stimulation hormone (FSH), luteinizing hormone (LH), and human chorionic gonadotropin (hCG). Your doctor may prescribe some of the following commonly used stimulation medications:

Clomid/Letrozole 

These oral medications are mainly used during ovulation induction (OI) or intrauterine insemination (IUI) treatments to induce the ovary to produce and release eggs. Both Clomid and Letrozole work by reducing estrogen levels, which then signals the body to generate more FSH.  

Gonal-f® or Follistim®

Created in a lab, these medications are biosimilar to natural hormones and mimic FSH in your body. They are taken at the beginning of an egg freezing or IVF cycle to help your body produce many follicles, which are fluid-filled sacs in your ovaries that potentially contain an egg.

Menopur®

This medication contains LH and FSH. Like Gonal-f or Follistim, it is introduced early on in an egg freezing or IVF cycle to stimulate follicle production.

Novarel/Pregnyl®

Novarel/Pregnyl are both a urinary extracted form of hCG (compared to Ovidrel which is a recombinant, or created in the lab). These hCG medications stimulate the body’s natural LH surge, inducing the final maturation of your eggs and triggering ovulation within 36 hours. They are usually the last injection of your IVF treatment.

Ovidrel®

This medication also contains hCG but in a recombinant, or lab-made, form. Similar to Novarel/Pregnyl, it is used to promote the eggs' final growth spurt and trigger ovulation.

If you have a decreased ovarian reserve, or if your body doesn’t respond well to the stimulation medications listed above, your doctor may also prescribe omnitrope, a growth hormone whose main purpose is to improve the quality of your eggs. 

Stimulation medications are usually taken as nightly injections. If you have questions about how to self-administer, Alto’s pharmacists are available to walk you through the process via in-app messaging or over the phone. You can also view our step-by-step guides on fertility injections.

When taking stimulation medications, you may experience some of the following known side effects:

  • Soreness, redness, or mild bruising at the site of injection
  • Bloating
  • Cramping
  • Headaches
  • Nausea
  • Mood swings
  • Breast tenderness

Consult with your doctor or pharmacist if you have any concerns about your side effects.

Ovulation Suppression

Once eggs are released from the ovaries — known as ovulation — they cannot be retrieved by your doctor and used for the fertilization process, so ovulation suppression medications are critical to completing an IVF cycle. If your fertility journey involves an egg donor or gestational carrier, this type of medication may also be used to coordinate cycles.

Cetrotide/Ganirelix

These fertility medications work against a hormone called GnRH — which helps produce the ovary-stimulating hormones LH and FSH — to help prevent premature ovulation. Some of the common side effects are abdominal discomfort, headaches, and soreness at the site of injection.

Leuprolide

This fertility medication stimulates an initial surge in LH and FSH but ultimately causes the body to stop production of these hormones during a process called downregulation. Common side effects include hot flashes, headaches, mood swings, and vaginal dryness.

Once ovulation suppression medications are added to the schedule on top of the stimulators, some people develop ovarian hyperstimulation syndrome (OSH). In this condition, overproduction of follicles causes extreme swelling or pain in the ovaries. Your doctor may recommend taking medication to help control symptoms or canceling treatment until a future cycle.

IVF Transfer Medications

In IVF, after your doctor has completed the egg retrieval, the eggs are fertilized and then transferred to your uterus through a quick, non-surgical procedure. In this stage of the process, your doctor may prescribe progesterone and/or estrogen supplements.

Progesterone is a natural hormone produced by your ovaries after ovulation. It supports the lining of the uterus, making it easier for an embryo to become implanted. You might take vaginal, oral, or injectable progesterone, or a combination of different forms. These are some common progesterone medications:

  • Progesterone injection
  • Endometrin 100mg
  • Crinone 8%
  • Progesterone capsules, suppositories, lozenges

Watch out for the following common progesterone side effects:

  • Soreness or swelling at the site of injection, if taking progesterone injections
  • Vaginal itching or burning and yeast infection, if taking suppositories
  • Dizziness or fatigue
  • Mood swings
  • Bloating
  • Nausea
  • Cramps

Progesterone injections may also cause hard welts at the site of injection, though this is a less common side effect.

Estrogen is also a natural hormone that thickens the uterine lining. In IVF, estrogen is used to help the body prepare for implantation, often in the form of estradiol topical patches. The following side effects may occur. Consult with your doctor if you have any concerns.

  • Headache
  • Breast pain or tenderness
  • Nausea
  • Redness or irritation in the skin covered by the patch
  • Constipation, bloating, or stomach cramps  
  • Changes in mood
  • Back, neck, or muscle pain
  • Fluid retention 
  • Cold symptoms (stuffy nose, sinus pain, or sore throat) 

The IVF medication schedule is precisely timed. To learn more about how these medications will be used in the context of your cycle, read our blog on the sequence of fertility medications in the IVF process: IVF Medications: Schedule and Side Effects Explained

Prenatal vitamins can help put your mind at ease even before pregnancy

Taking simple prenatal vitamins is one of the most effective ways to ensure that you have the nutrients you need to nourish your baby throughout your pregnancy. It’s never too early to start taking them, and by beginning early, you can ensure that your body has the key vitamins and minerals needed during the earliest stages of fetal development. 

Read What to Look for in a Prenatal Vitamin to learn more.

We’re with you at every step of your fertility journey

Starting fertility medications may feel stressful, but you’re never alone in your journey. Alto’s dedicated fertility team will work with your physician to ensure your treatment plan is followed properly. And our fertility pharmacists are always available to answer any questions or walk you through your first injections. To learn more, visit us at alto.com/fertility or reach out via phone, text or the app.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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