Fertility Medications: A Complete Guide to What You Will Take and Why

When you start fertility treatment, you will likely be prescribed medications you have never heard of before. Names like letrozole, menopur, and cetrotide suddenly become part of your daily vocabulary. You might find yourself injecting hormones into your stomach, timing doses to the minute, and wondering what all of these drugs are actually doing inside your body.

It can feel overwhelming, especially when the list of medications keeps growing. The pharmacy bill alone can be shocking. And the side effects, while usually manageable, add another layer of complexity to an already stressful time.

Understanding your medications helps you feel more in control. When you know why you are taking something and what it does, the process feels less like something happening to you and more like something you are actively participating in. Knowledge reduces anxiety.

This guide walks you through the most common fertility medications, explaining what each one does, how it is taken, what side effects to expect, and how it fits into your overall treatment. Whether you are just starting with oral medications or preparing for a full IVF protocol, this information will help you navigate your medication journey with more confidence.

For a complete overview of all fertility treatment options, see our comprehensive Treatments guide.

How Fertility Medications Work

Before diving into specific drugs, it helps to understand the basic categories of fertility medications and what they are designed to do.

Ovulation Induction

Some women do not ovulate regularly or at all. Ovulation induction medications stimulate the ovaries to develop and release eggs. These are often the first-line treatment for women with ovulation disorders like polycystic ovary syndrome (PCOS).

Ovarian Stimulation

In IVF, the goal is to retrieve multiple eggs rather than the single egg that naturally matures each cycle. Ovarian stimulation medications encourage multiple follicles to develop simultaneously, maximising the number of eggs available for retrieval.

Ovulation Triggering

Once follicles have matured to the appropriate size, a trigger medication causes the final maturation and release of eggs. In IVF, this is precisely timed so eggs can be retrieved before natural ovulation occurs.

Preventing Premature Ovulation

During IVF stimulation, it is critical that you do not ovulate before egg retrieval. Certain medications suppress your natural ovulation signals, keeping the eggs in your ovaries until they are ready to be retrieved.

Supporting Implantation

After ovulation or embryo transfer, progesterone supports the uterine lining and helps maintain early pregnancy. Progesterone supplementation is standard in most fertility treatment cycles.

Oral Medications for Ovulation

These medications are typically the starting point for women who are not ovulating regularly or for mild fertility treatment approaches.

Letrozole (Femara)

Letrozole has become the preferred first-line medication for ovulation induction in many clinics.

What It Does

Letrozole is an aromatase inhibitor, originally developed to treat breast cancer. It works by temporarily lowering estrogen levels, which signals your pituitary gland to produce more follicle-stimulating hormone (FSH). This increased FSH stimulates your ovaries to develop follicles.

How It Is Taken

Letrozole is taken orally, typically for five days early in your cycle (often days 3 through 7 or days 5 through 9). The standard starting dose is 2.5 milligrams daily, though your doctor may increase this if you do not respond.

Common Side Effects

Side effects are usually mild and may include hot flashes, headaches, fatigue, and occasionally joint pain. Most women tolerate letrozole well.

Why It Is Often Preferred

Letrozole has a lower risk of multiple pregnancy compared to clomiphene because it typically results in the development of one or two follicles rather than several. It also clears from your system quickly and does not have the anti-estrogenic effects on the uterine lining that can occur with clomiphene.

Clomiphene Citrate (Clomid, Serophene)

Clomiphene was the standard ovulation induction medication for decades and is still widely used.

What It Does

Clomiphene is a selective estrogen receptor modulator (SERM). It blocks estrogen receptors in the brain, which tricks your body into thinking estrogen levels are low. This triggers increased production of FSH and LH, stimulating follicle development.

How It Is Taken

Like letrozole, clomiphene is taken orally for five days early in your cycle. The starting dose is typically 50 milligrams daily, with potential increases up to 150 milligrams if needed.

Common Side Effects

Side effects may include hot flashes, mood swings, headaches, breast tenderness, and visual disturbances (rare but should be reported immediately). Clomiphene can also thin the uterine lining and affect cervical mucus quality in some women.

Multiple Pregnancy Risk

Clomiphene carries a higher risk of twins (about 8 to 10 percent) compared to letrozole. Higher-order multiples are possible but less common.

Metformin

Metformin is not a fertility drug per se, but it is commonly prescribed alongside other fertility medications for women with PCOS.

What It Does

Metformin is a diabetes medication that improves insulin sensitivity. In women with PCOS, who often have insulin resistance, metformin can help restore regular ovulation and improve response to other fertility medications.

How It Is Taken

Metformin is taken orally, usually once or twice daily with meals. It is often continued throughout fertility treatment and sometimes into early pregnancy.

Common Side Effects

Gastrointestinal side effects are common, including nausea, diarrhoea, and stomach upset. Starting with a low dose and taking it with food helps minimise these effects. Extended-release formulations are often better tolerated.

Injectable Gonadotropins

For IVF and more intensive fertility treatments, injectable medications containing FSH and sometimes LH are used to stimulate the ovaries more aggressively.

FSH Medications (Gonal-F, Follistim, Puregon)

These medications contain follicle-stimulating hormone, the same hormone your pituitary gland naturally produces to stimulate follicle development.

What They Do

FSH medications directly stimulate your ovaries to develop multiple follicles simultaneously. Unlike oral medications that work through your brain, these act directly on the ovaries, allowing for more controlled and potent stimulation.

How They Are Taken

FSH medications are injected subcutaneously (under the skin), typically into the lower abdomen. Most women inject themselves at home after instruction from their clinic. Injections are given daily, usually in the evening, for 8 to 14 days depending on your response.

Dosing

Doses are highly individualised based on factors like your age, AMH level, antral follicle count, and previous response to stimulation. Doses typically range from 150 to 450 IU daily. Your doctor adjusts your dose based on monitoring appointments.

Common Side Effects

Side effects include injection site reactions (redness, bruising, mild pain), bloating, breast tenderness, mood swings, and headaches. As your ovaries enlarge, you may feel abdominal pressure and discomfort.

LH-Containing Medications (Menopur, Pergoveris)

Some medications contain both FSH and luteinizing hormone (LH).

What They Do

LH works alongside FSH in follicle development. Some women, particularly those over 35 or those with certain conditions, benefit from having both hormones in their stimulation protocol.

How They Are Taken

Like FSH-only medications, these are injected subcutaneously, following the same general approach and timing.

When They Are Used

Your doctor may prescribe an LH-containing medication from the start of stimulation, or may add it partway through your cycle based on how your follicles are developing.

Choosing Between Medications

The specific gonadotropin your doctor prescribes depends on your individual situation, your clinic's protocols, and sometimes on cost and availability. In most cases, the different brands of FSH medications work similarly, and the choice is less important than getting the right dose for your body.

Medications to Prevent Premature Ovulation

During IVF stimulation, you need to prevent your body from ovulating on its own before egg retrieval. Two types of medications accomplish this.

GnRH Antagonists (Cetrotide, Orgalutran, Ganirelix)

What They Do

GnRH antagonists block the signal from your brain that would normally trigger ovulation. They work quickly and are added partway through your stimulation cycle.

How They Are Taken

These are subcutaneous injections, typically started around day 5 or 6 of stimulation (or when your lead follicles reach a certain size) and continued until your trigger shot.

Common Side Effects

Injection site reactions are the most common side effect. Some women experience headaches or nausea.

Why They Are Often Preferred

Antagonist protocols are simpler and shorter than agonist protocols. They also carry a lower risk of ovarian hyperstimulation syndrome (OHSS).

GnRH Agonists (Lupron, Synarel, Buserelin)

What They Do

GnRH agonists initially stimulate the release of FSH and LH (a "flare" effect) but then suppress these hormones with continued use. This suppression prevents premature ovulation.

How They Are Taken

In a long protocol, GnRH agonists are started before your stimulation medications, sometimes in the cycle before your IVF cycle. In a short or flare protocol, they are started at the beginning of stimulation to take advantage of the initial hormone release.

Common Side Effects

Side effects can include hot flashes, headaches, mood swings, and vaginal dryness, similar to menopausal symptoms. These result from the hormone suppression.

When They Are Used

Long agonist protocols were once standard but are now less common. They may still be used for women with certain conditions or those who did not respond well to antagonist protocols.

Trigger Medications

The trigger shot causes final egg maturation and prepares eggs for retrieval. Timing is critical: retrieval is scheduled 34 to 36 hours after the trigger.

hCG Triggers (Ovidrel, Pregnyl, Novarel)

What They Do

Human chorionic gonadotropin (hCG) mimics the natural LH surge that triggers ovulation. It causes the final maturation of eggs within their follicles.

How They Are Taken

hCG triggers are usually a single injection, either subcutaneous or intramuscular, given at a very specific time determined by your clinic.

Important Considerations

hCG triggers are very effective but carry a higher risk of OHSS in women who are hyperstimulated. If you have developed many follicles, your doctor may choose a different trigger approach.

GnRH Agonist Triggers (Lupron)

What They Do

In women using an antagonist protocol, a GnRH agonist can be used as a trigger. It causes your body to release its own LH surge, which triggers egg maturation.

When They Are Used

Agonist triggers are often chosen for women at high risk of OHSS because they result in lower hCG levels and reduce OHSS risk. They may also be preferred in egg freezing or donor cycles.

Considerations

Agonist triggers may result in slightly lower progesterone production in the luteal phase, so additional progesterone support may be needed. They cannot be used if you have been on a long agonist protocol (your pituitary would already be suppressed).

Dual Triggers

Some protocols use both an hCG trigger and an agonist trigger together. This approach may improve egg maturation while still reducing OHSS risk compared to hCG alone.

Progesterone and Luteal Support

After ovulation or embryo transfer, progesterone is essential for preparing and maintaining the uterine lining.

Why Progesterone Is Needed

In natural cycles, the corpus luteum (the structure left after ovulation) produces progesterone. In IVF and some other fertility treatments, normal corpus luteum function may be disrupted, making supplementation necessary.

Forms of Progesterone

Vaginal Progesterone (Crinone, Endometrin, Cyclogest)

Vaginal gels, suppositories, or inserts are the most common form of progesterone supplementation. They deliver progesterone directly to the uterus and are generally well tolerated.

Side effects may include vaginal discharge, irritation, and applicator discomfort. The gel residue can be messy but is harmless.

Intramuscular Progesterone (Progesterone in Oil)

Intramuscular injections deliver progesterone into the muscle, typically the buttock. These injections use an oil base and require a longer needle.

Injection site soreness and occasional lumps are common. Some women find these injections difficult to self-administer and need help from a partner.

Oral Progesterone (Utrogestan, Prometrium)

Oral progesterone is sometimes used but is generally less effective for luteal support than vaginal or intramuscular forms because of how it is metabolised. It may be prescribed as an adjunct to other forms.

How Long Progesterone Is Taken

Progesterone supplementation typically continues until your pregnancy test. If the test is positive, you will continue progesterone until around 8 to 12 weeks of pregnancy, when the placenta takes over progesterone production.

Other Medications You May Encounter

Estrogen (Estrace, Progynova)

Estrogen may be prescribed to help build your uterine lining before a frozen embryo transfer. It is taken orally, vaginally, or via patches.

Low-Dose Aspirin

Some doctors prescribe low-dose aspirin to improve blood flow to the uterus. This is particularly common in women with implantation issues or certain clotting disorders.

Antibiotics

A short course of antibiotics may be prescribed around the time of egg retrieval or embryo transfer to prevent infection.

Steroids (Prednisone, Dexamethasone)

Low-dose steroids may be used to suppress immune responses in women with certain conditions or to support adrenal function in women with elevated androgens.

Managing Medication Costs in UAE

Fertility medications represent a significant portion of treatment costs. For a complete breakdown of what to expect financially, see our IVF cost guide for the UAE. Here are some considerations for managing medication expenses specifically.

Clinic Pharmacies vs External Pharmacies

Some clinics have in-house pharmacies; others require you to purchase medications externally. Compare prices, as there can be variations.

Insurance Coverage

If you have Thiqa insurance (for Abu Dhabi Emiratis) or certain private insurance plans, some fertility medications may be covered. Check with your insurance provider about your specific coverage.

Avoiding Waste

Only order medications as needed rather than your entire cycle's supply upfront. Your protocol may change based on your response, and unused medications cannot be returned.

Generic Options

Some medications have generic versions available at lower cost. Discuss with your doctor whether generics are appropriate for your treatment.

Tips for Managing Your Medications

Organisation

Keep a medication calendar or use an app to track what you need to take and when. Set alarms for time-sensitive doses.

Storage

Many fertility medications require refrigeration. Check storage requirements for each medication and ensure you have appropriate space.

Injection Technique

Your clinic will teach you how to administer injections. Practice with the materials they provide. Most women find injections easier than expected after the first few times.

Side Effect Management

Track your side effects so you can discuss them with your doctor. Most are manageable, but your doctor should know if you are experiencing significant discomfort.

Medical Disclaimer

This guide provides general information about common fertility medications. Your specific protocol may differ based on your individual circumstances. Always follow the instructions provided by your medical team and contact them with any questions or concerns about your medications.