Being suddenly handed a medication list can feel overwhelming. Here’s the good news: most fertility protocols use only a handful of drugs, and each one has a specific job. Once you understand the five jobs, the list stops feeling intimidating.
Fertility medications generally do one of the following:
- Encourage the ovaries to grow follicles, either with a pill or an injection
- Prevent ovulation from happening too early, so eggs can be retrieved on schedule
- Trigger final egg maturation, timing ovulation or retrieval precisely
- Prepare and support the uterine lining, so an embryo has the best chance of implanting
- Support the protocol in specific cases, used as add-ons when a cycle needs extra help
This guide is organized by those jobs. Your care team will select from these based on your diagnosis, your hormone levels, and how your body responds. Not everyone takes every medication, and the same drug can be used differently in different protocols.
A note on dosing
This guide explains what each medication does and what patients commonly experience. It does not include doses or timing. Those are individualized and come directly from your care team.
Which medications apply to my cycle?
| Medication group | Timed intercourse or IUI | IVF |
|---|---|---|
| Oral ovulation medications | Very common | Occasionally, in low-stimulation protocols |
| Injectable ovarian stimulation | Sometimes, when pills are not enough | Nearly always |
| Preventing early ovulation | Rarely needed | Nearly always |
| Trigger shot | Yes | Yes |
| Uterine lining preparation and support | Sometimes | Usually, especially with embryo transfer |
| Protocol add-ons | Rarely | Case by case |
1. Medications that encourage ovulation: the oral options
These are pills, usually taken for about five days early in the cycle. They work indirectly by changing the hormone signals the brain sends to the ovaries, which prompts a follicle to grow and ovulation to occur. For a lot of people, this is the first step in treatment, especially if you have PCOS, irregular ovulation, or unexplained infertility.
What most people feel
Side effects from oral medications tend to be mild and temporary, and they usually resolve within a few days of the last pill. Hot flashes, headache, bloating, fatigue, and mood shifts are the most commonly reported.
| Medication | Generic name | What it does | How it is taken |
|---|---|---|---|
| Femara | letrozole | Lowers estrogen briefly, which prompts the brain to send a stronger signal to the ovaries so a follicle can grow and ovulation can happen | Pill |
| Clomid / Serophene | clomiphene citrate | Blocks estrogen receptors in the brain, which encourages the release of more FSH and LH to stimulate ovulation | Pill |
Worth knowing
- Femara and Clomid do similar work through different mechanisms. Many clinics start with Femara for PCOS.
- Clomid has one side effect Femara does not typically share: visual changes such as blurred vision, flashes, or spots. This is uncommon, but tell your care team promptly if it happens.
2. Medications that stimulate the ovaries: the injectables
These are known as gonadotropins, which are essentially lab-made versions of hormones your body already makes to grow eggs. Instead of signaling the brain, they act directly on the ovaries. You usually move to these if oral medications alone aren’t producing enough response, and they are the backbone of nearly every IVF stimulation cycle.
These are given as small injections under the skin, usually in the abdomen or upper thigh. Most patients give them at home after a teaching session with a nurse, and more manageable than it sounds.
What most people feel
Bloating and a feeling of pelvic fullness or pressure are the most common experiences, and they typically build over the course of stimulation as follicles grow. Headache, nausea, and irritation at the injection site are also common.
What to watch for
Because these medications work directly on the ovaries, they carry a higher chance of multiple pregnancy and of ovarian hyperstimulation syndrome (OHSS) than oral medications do. See the safety section below for the symptoms that warrant a call.
| Medication | Generic name | What it does | How it is given |
|---|---|---|---|
| Gonal-F | follitropin alfa | Lab-made FSH that directly stimulates follicle growth | Injection under the skin |
| Follistim AQ | follitropin beta | Another lab-made FSH, used when a stronger ovarian response is needed | Injection under the skin |
| Menopur | menotropins (hMG) | Provides both FSH and LH activity, stimulating the ovaries to grow multiple follicles | Injection under the skin |
Worth knowing
Gonal-F and Follistim are close counterparts. Menopur adds LH activity, which is why some protocols combine it with one of the others rather than choosing between them.
3. Medications that prevent ovulation too early
During IVF, the goal is for many follicles to grow together so eggs can be retrieved on a specific, planned day. If the body ovulates on its own beforehand, those eggs are lost. These medications quiet the brain’s natural ovulation signal so the timing stays under your care team’s control.
What most people feel
Redness, swelling, or itching at the injection site is the most frequent complaint. Headache, mild nausea, and abdominal discomfort are also reported.
| Medication | Generic name | What it does | How it is given |
|---|---|---|---|
| Ganirelix | ganirelix acetate | Blocks the ovulation signal quickly, started partway through stimulation | Injection under the skin |
| Cetrotide | cetrorelix acetate | Works the same way as Ganirelix, preventing premature ovulation so eggs can finish maturing before retrieval | Injection under the skin |
| Lupron | leuprolide acetate | Suppresses hormone signals from the brain so stimulation and ovulation happen on schedule. In some protocols it is used later as a trigger shot instead | Injection under the skin |
| Microdose Lupron | leuprolide acetate (low dose) | A low dose used in flare protocols, which briefly stimulates the ovaries early in the cycle rather than suppressing them | Injection under the skin |
Worth knowing
- Ganirelix and Cetrotide are interchangeable in most protocols and are started mid-stimulation.
- Lupron is the one medication on this list that can do more than one job depending on the protocol: suppression, a brief early boost, or a trigger. If you are taking it, ask which role it is playing in your cycle.
- Lupron used for suppression can cause temporary menopause-like effects including hot flashes, mood changes, and vaginal dryness.
4. The trigger shot: timing the finish
The trigger shot is a single, precisely timed injection. It tells your eggs to complete their last stage of maturing and sets the clock for what happens next: ovulation if you’re doing timed intercourse or IUI, or egg retrieval if you’re doing IVF, typically about 36 hours later.
Timing matters more with this injection than with any other. Your care team will give you an exact hour, so it’s a good idea to set an alarm.
What most people feel
Soreness at the injection site, bloating, pelvic pressure or cramping, breast tenderness, headache, fatigue, and mood changes. Because a trigger comes at the end of stimulation, when the ovaries are at their largest, this is when bloating and fullness usually peak.
| Medication | Generic name | What it does | How it is given |
|---|---|---|---|
| Ovidrel | recombinant hCG | Lab-made hCG that prompts final egg maturation and precise timing | Prefilled injection under the skin |
| Pregnyl | hCG | Prompts final egg maturation and times ovulation or retrieval | Injection under the skin or into the muscle |
| Novarel | hCG | Works the same way as Pregnyl | Injection under the skin or into the muscle |
| Lupron (as trigger) | leuprolide acetate | Used as an alternative trigger in some protocols, often when OHSS risk is a concern | Injection under the skin |
What to watch for
hCG can raise the risk of OHSS, and symptoms most often appear in the days after the trigger. If your care team has flagged you as higher risk, they may use a Lupron trigger or adjust the plan.
5. Medications that prepare and support the uterine lining
Growing eggs is one half of the work. Your uterine lining has to be ready too. These medications build the lining, support it after ovulation or transfer, and in some cases, help schedule the cycle before treatment begins.
What most people feel
Bloating, breast tenderness, fatigue, spotting, and mood changes are common across this group. Progesterone in particular tends to cause tiredness and can mimic early pregnancy symptoms, which many patients find confusing during the wait after transfer.
| Medication | Generic name | What it does | How it is given |
|---|---|---|---|
| Provera | medroxyprogesterone acetate | A progesterone-like medication used to bring on a bleed or regulate the cycle before treatment starts | Pill |
| Estrace | estradiol | Estrogen that builds and thickens the uterine lining in preparation for transfer | Pill or vaginal tablet |
| Progesterone | progesterone | Supports the lining after ovulation or transfer and helps sustain early pregnancy | Vaginal insert or gel, or injection into the muscle |
Worth knowing
Progesterone side effects depend heavily on how it is given. Vaginal forms can cause discharge or irritation. Intramuscular injections can leave soreness, redness, or firm lumps at the site. Warming the site and rotating between sides helps.
6. Protocol add-ons
These are not part of a standard cycle. They are added in specific situations, most often when previous cycles produced fewer eggs than hoped. Studies on add-ons are still developing, and your care team will walk you through their reasoning if it’s recommended for you.
| Medication | Generic name | What it does | How it is given | Common side effects |
|---|---|---|---|---|
| Omnitrope | somatropin | Growth hormone used in some protocols, particularly for poor responders | Injection under the skin | Fluid retention, swelling, joint aches, headache, possible changes in blood sugar or insulin response |
| Sermorelin | sermorelin acetate | A peptide that prompts the body to release its own growth hormone | Injection under the skin | Flushing, headache, dizziness, nausea, injection site reactions. Fertility-specific side effect data are limited |
When to call your care team
Most side effects in this guide are expected and manageable. A smaller set is not. Contact your care team promptly if you experience:
- Rapid weight gain, or bloating that worsens quickly rather than gradually
- Severe abdominal pain, or a belly that feels tight and distended
- Shortness of breath or difficulty breathing
- Nausea and vomiting that keep you from drinking fluids
- Noticeably reduced urination
- Visual changes such as blurred vision, flashes, or spots, especially while taking Clomid
- Signs of an allergic reaction: rash, swelling, or difficulty breathing after an injection
The first five can be signs of OHSS, which is uncommon but treatable and best caught early.
References
Grouped by section. AMA 11th edition format.
Oral ovulation medications
- Franik S, Le QK, Kremer JA, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2022;9(9):CD010287. doi:10.1002/14651858.CD010287.pub4
- Hughes E, Brown J, Collins JJ, Vanderkerchove P. Clomiphene citrate for unexplained subfertility in women. Cochrane Database Syst Rev. 2010;2010(1):CD000057. doi:10.1002/14651858.CD000057.pub2
- Purvin VA. Visual disturbance secondary to clomiphene citrate. Arch Ophthalmol. 1995;113(4):482-484. doi:10.1001/archopht.1995.01100040102034
Ovarian stimulation and gonadotropins
- Allahbadia GN. Intrauterine insemination: fundamentals revisited. J Obstet Gynaecol India. 2017;67(6):385-392. doi:10.1007/s13224-017-1060-x
- Goa KL, Wagstaff AJ. Follitropin alpha in infertility: a review. BioDrugs. 1998;9(3):235-260. doi:10.2165/00063030-199809030-00006
- Kumar P, Sait SF, Sharma A, Kumar M. Ovarian hyperstimulation syndrome. J Hum Reprod Sci. 2011;4(2):70-75. doi:10.4103/0974-1208.86080
- Rizk B, Aboulghar M. Modern management of ovarian hyperstimulation syndrome. Hum Reprod. 1991;6(8):1082-1087. doi:10.1093/oxfordjournals.humrep.a137488
Preventing premature ovulation
- Findeklee S, Diedrich PK. Cetrorelix in reproductive medicine. F S Rep. 2022;4(2 Suppl):62-64. doi:10.1016/j.xfre.2022.11.012
- Peng X, Lv X, Li P, et al. Comparison of pregnancy outcomes and safety between cetrorelix and ganirelix in IVF/ICSI antagonist protocols: a retrospective cohort study. Front Reprod Health. 2025;7:1492441. doi:10.3389/frph.2025.1492441
- Shrestha D, La X, Feng HL. Comparison of different stimulation protocols used in in vitro fertilization: a review. Ann Transl Med. 2015;3(9):137.
- Yang Y, Cui Z, Feng X, Zou F, Wu X. Post-marketing safety profile of ganirelix in women: a 20-year pharmacovigilance analysis of global adverse drug event databases (2004-2024). BMC Pharmacol Toxicol. 2025;26(1):91. doi:10.1186/s40360-025-00920-4
Trigger shots
- Gonadotropins. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. National Institute of Diabetes and Digestive and Kidney Diseases; 2012. Updated March 26, 2018. Accessed August 17, 2026. https://www.ncbi.nlm.nih.gov/books/NBK548856/
Uterine lining preparation and luteal support
- Tournaye H, Sukhikh GT, Kahler E, Griesinger G. A Phase III randomized controlled trial comparing the efficacy, safety and tolerability of oral dydrogesterone versus micronized vaginal progesterone for luteal support in in vitro fertilization. Hum Reprod. 2017;32(5):1019-1027. doi:10.1093/humrep/dex023
Sources still needing verification before publication
The following entries appeared in the original source list as author-year only. Full bibliographic details could not be confirmed, so they are held out rather than published with guessed journal, volume, or page numbers. Each needs a PMID or DOI from the clinical team.
| Original entry | Assigned to | Status |
|---|---|---|
| Yang et al., 2021 | Letrozole | Multiple candidate papers, none confirmed |
| Guo et al., 2023 | Menopur / hMG in IVF | Unconfirmed |
| Palomba et al., 2023 | Recombinant FSH | Unconfirmed. Note that a 2023 Palomba OHSS-prevention systematic review exists and may be the intended source |
| Taheripanah et al., 2017 | hCG trigger | Unconfirmed |
| Feldberg et al., 1989 | Leuprolide | Unconfirmed |
| Garcia et al., 2019 | Growth hormone in IVF | Unconfirmed |
| Zakerinasab et al., 2024 | Growth hormone in IVF | Unconfirmed |
| Curran, 2001 | Estradiol | Unconfirmed |
| Darney, 1997 | Estradiol | Unconfirmed |
| Dianat et al., 2019 | Medroxyprogesterone acetate | Unconfirmed |
| Nelson, 1996 | Medroxyprogesterone acetate | Unconfirmed |
| Dashti et al., 2021 | Progesterone | Unconfirmed |
| Khrouf et al., 2017 | Progesterone | Unconfirmed |
| Walker, 2006 | Sermorelin | Unconfirmed |
| Prakash, 1999 | Sermorelin | Unconfirmed |
This guide is for general education and does not replace medical advice. Your protocol, doses, and timing are determined by your care team based on your individual situation.
