Fertility Medications

Understanding Fertility Medications at NYU Langone Reproductive Specialists of New York

Your Guide to Fertility Medications

In a typical ovarian stimulation cycle, fertility medications, sometimes referred to as hormonal medications, are used to stimulate egg production in the ovaries. This process is an integral part of fertility treatment cycles like in vitro fertilization (IVF) and egg freezing.

During the course of a natural menstrual cycle, the brain produces hormones that direct one of the two ovaries to release a single egg each month. During an ovarian stimulation cycle, we prescribe those same hormones (fertility medications) to mimic the body’s natural menstrual cycle but simultaneously stimulate both ovaries to mature multiple eggs. The more eggs are matured, the more can be retrieved and ultimately used to create embryos, resulting in greater chances for a successful pregnancy when the patient is ready.

Types of Fertility Medications

At NYU Langone RSNY, we believe there is no “one size fits all” approach to fertility care. Infertility is a medical condition that may require treatment involving hormonal medication(s). Should your care team determine fertility medications are a necessary part of your treatment plan, you will be prescribed an individualized medication protocol aligned with your needs and family building goals. Outlined below are some common medications that may be prescribed when receiving care at NYU Langone RSNY.

Clomiphene (Clomid)

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

Clomid, when deemed medically appropriate, is a popular treatment plan and often seen as the first step in treating infertility as ovulation induction (OI) cycles are less expensive and less invasive than other types of fertility treatment cycles. However, there is a higher risk of a multiple pregnancy (roughly a 7% chance of twins), and Clomid is not recommended for women who are unable or unwilling to carry a twin pregnancy. Common side effects often include heightened symptoms of the menstrual cycle such as nausea, bloating and mood changes.

Fertility Injections

During an ovarian stimulation cycle for IVF or egg freezing, injectable medications are used. 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. Each patient reacts to medications differently, but most 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. 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 RSNY 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 RSNY clinical staff, within a strict 10-minute window to avoid premature ovulation. Trigger medications are administered via subcutaneous injection.

Frequently Asked Questions

  • 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.

  • 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 Reproductive Specialists of New York (RSNY), please reach out to your insurance company to discuss coverage for fertility medications and services.

  • 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.

  • Before your cycle, you will attend an orientation class with our RSNY 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.

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