Medications

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Medications

The following table of medications are those commonly used in our office and will specify which cycle they are used in. Please pay special attention as several medications are used in multiple types of cycles. Please ensure that before you begin a cycle or by your first monitor day, you have all necessary medications for that cycle.

MedicationActionCommon DosageSide EffectsCycle Type
Clomid (clomiphene citrate)This medication helps to block the E2 receptor in the pituitary gland to help produce endogenous (self-made) FSH and LH to mature the follicle. This medication has also been shown to prevent premature ovulation.25mg (1/2 tablet) or 50mg (1 tablet), by mouth, daily. Typically starts on CD3-CD5.

Most common- headaches, breast tenderness, slight spotting and thin endometrial lining.

Rare due to low dosage- Ovarian Hyperstimulation Syndrome (OHSS), swelling, weight gain, nausea, vomiting, abdominal pain.,/
MS-IVF
Nolvadex (tamoxifen citrate)This medication helps to block E2 receptors throughout the body including the endometrial lining and breast tissue to help increase natural FSH and LH. Also shown to help prevent premature ovulation.

20mg (1 tablet, once daily) or 40mg( 1 tablet, twice daily) by mouth.

Can start on CD3 (MS) or CD6 (NC)

Most common- headache, spotting, and irregular period.

Rare due to short term use- sudden weakness, confusion, nausea, abdominal pain, depression, chest pain.
  • MS-IVF
  • NC-IVF
  • HR-FET
  • NC-FET
Femara (letrozole)This medication blocks the conversion of estrogen into its biologically active form. It is a non-steroidal aromatase inhibitor and stimulates FSH production.

2.5mg (1 tablet) Can be given once daily or twice daily, by mouth.

Typically starts on CD3, and only given for 3 days.

Most common- fatigue, headache, dizziness, and night sweats/ hot flashes.

Rare due to short term use- bone pain, weight gain, numbness, pain in arm/hand/ wrist, joint pain, weakness.
  • MS-IVF
  • HR-FET
Estrace (estradiol)This medication is the biologically active form of estrogen in the body. It helps to inhibit FSH production, support reproductive tissue and boost endometrial lining. It also helps to promote pregnancy.

2mg (1 tablet) Can be given once, twice or three times daily.

Can be used both by mouth and transvaginally.

Can start on CD3 or post ovulation for follicle priming.

Most common- headaches (sometimes severe), nausea, vaginal itching or discharge, and spotting.

Rarely reported in our office- difficulty breathing, chest pain, dizziness, swelling, weight gain, vomiting, confusion, darkening of facial skin.
  • MS-IVF
  • NC-IVF
  • HR-FET
  • NC-FET

OR

After ovulation in any cycle.
Provera (medroxy-progesterone acetate)This medication is the biologically active form of progesterone. It helps to promote uterine lining growth and maintenance. It can be used to help induce period after ovulation/egg retrieval.

10mg (1 tablet) Once daily by mouth.

Can be given on CD6-CD8 or 2 days after egg retrieval.

Most common- Spotting, headache, nausea, acne.

Rare- stomach cramping, breast pain, vomiting.
  • MS-IVF
  • NC-IVF
Prometrium (progesterone)This medication is the biologically active form of progesterone. It helps to promote uterine lining growth and maintenance. Promotes the development of fetus and attachment to uterine wall after transfer.

200mg (1 capsule/tablet) Once daily, by mouth at bedtime.

Typically started two days after ovulation induction, to prepare the endometrial lining for transfer.

Most common- Spotting, headache, drowsiness/fatigue, nausea, acne.

Rare- stomach cramping, breast pain, vomiting, swelling, cough.
  • NC-FET
  • HR-FET
Vaginal Progesterone (endometrin or crinone 8%)This medication is the biologically active form of progesterone. It helps to promote uterine lining growth and maintenance. Promotes the development of fetus and attachment to uterine wall after transfer. Increases progesterone levels locally by absorbing through the vaginal wall.

Endometrin- 100mg (1 vaginal suppository) insert one, three times daily.

Crinone 8% gel- apply once daily; may result in vaginal discharge or leaking.

Typically started two days after ovulation induction, to prepare the endometrial lining for transfer.

Most common- Spotting, vaginal infection/ itching or discharge, drowsiness/fatigue.

Rare- headache, acne, vomiting, swelling, cough.
  • NC-FET
  • HR-FET
Progesterone in Sesame oilThis medication is the biologically active form of progesterone. It helps to promote uterine lining growth and maintenance. Promotes the development of fetus and attachment to uterine wall after transfer. Most effectively absorbed into system.

50mg/ 1mL or 25mg/ 0.5mL- intramuscular injection, into buttocks, once daily.

Typically started two days after ovulation induction, to prepare the endometrial lining for transfer. Can be added after 1st P4 check if level is low.
Most common- Lump at injection site, Pain/ tenderness at injection site, spotting, drowsiness/fatigue.

Note: If you have any warmth, redness or discharge at the site of injection, please contact the office immediately.

Rare- headache, acne, vomiting, swelling, cough
  • NC-FET
  • HR-FET
Gonal-F (follitropin alpha)This medication is recombinant human FSH that can be used to help stimulate follicle growth, egg production and egg maturity. Do not use if you have high baseline FSH levels.

75iu or 150iu, subcutaneous injection, into your lower abdomen every other day.

Typically administered on CD6, 8, 10 and 12, as needed.

Most common- breast tenderness, headache.

Rare due to low dosage- abdominal pain, chest pain, dizziness/ weakness
MS-IVF (can be used instead of Follistim AQ)
Follistim AQ (recombinant FSH)This medication is recombinant human FSH that can be used to help stimulate follicle growth, egg production and egg maturity. Do not use if you have high baseline FSH levels.

75iu or 150iu, subcutaneous injection, into your lower abdomen every other day.

Typically administered on CD6, 8, 10 and 12, as needed.

Most common- breast tenderness, headache.

Rare due to low dosage- abdominal pain, chest pain, dizziness/ weakness, nausea, vomiting, weight gain or swelling.
MS-IVF (can be used instead of Gonal-F)
Menopur (menotropins)This medication contains synthetic FSH and LH to help stimulate follicle growth, egg production, maturation and ovulation. Do not use if you have high baseline FSH or LH levels.

75iu or 150iu, subcutaneous injection, into your lower abdomen every other day.

Typically administered on CD6, 8, 10 and 12, as needed.

Most common- headache, pain at injection site

Rare due to low dosage- fever, chills, weakness, ovarian enlargement with abdominal or pelvic pain
MS-IVF (Can be used with Follistim or Gonal-F)
Lupron (leuprolide acetate)This medication briefly stimulates the pituitary gland to create a burst in production of LH and FSH to induce ovulation. Often referred to a "trigger" shot to produce ovulation in 34-37 hours.

0.75mg/15 units, subcutaneous injection, into your lower abdomen when the follicle has reached maturation.

Might be used together with Ibuprofen.

Most common- pain or burning sensation at injection site, temporary increase in blood sugar, nausea.

Rare due to low dosage- bone pain, sudden chest pain, urinary problems, dizziness, vomiting, depression.
Required for every cycle
Pregnyl (human chorionic gonadotropin, HCG)This medication is similar in chemical structure to LH and can be used to help induce ovulation in combination with Lupron (usually a higher dosage). Also helps to maintain high progesterone levels and help promote the success of pregnancy.

5,000iu (for IVF) subcutaneous injection, into your lower abdomen when the follicle has reached maturation. (Risk of OHSS)

1,000iu (for FET) subcutaneous injection, into your lower abdomen when the follicle has reached maturation.

Most common- headache, felling restless, pain or burning at injection site.

Rare due to low dosage- severe pelvic pain, swelling, abdominal pain, weight gain, diarrhea, depression.
  • MS-IVF
  • NC-IVF
  • NC-FET
  • HR-FET
Loloestrin (norethindrone acetate and ethinyl estradiol)This medication is a form of birth control often used after egg retrieval to help prime the follicles for the following cycle by suppressing the production of FSH, preventing dominant or leading follicle formation.

Norethindrone 1mg, and ethinyl estradiol 10mcg (1 tablet) Once daily by mouth.

Typically started 2 days after egg retrieval.

Most common- headache, nausea, breast tenderness.

Rare due to short term use- spotting, weight gain, acne, abdominal pain, anxiety and depression.
  • MS-IVF
  • NC-IVF
Ethinyl EstradiolThis medication is a form of birth control often used after egg retrieval to help prime the follicles for the following cycle by suppressing the production of FSH, preventing dominant or leading follicle formation.

0.02mg (1 tablet) Take once or twice daily, by mouth.

Typically started 2 days after egg retrieval. Can be used during cycle instead of Estrace.

Most common- headache, nausea, breast tenderness.

Rare due to short term use- spotting, weight gain, acne, abdominal pain, anxiety and depression.
  • MS-IVF
  • NC-IVF
Necon (Norethindrone and Ethinyl Estradiol)This medication is a form of birth control often used after egg retrieval to help prime the follicles for the following cycle by suppressing the production of FSH, preventing dominant or leading follicle formation.

Norethindrone 1mg, and ethinyl estradiol 35mcg (1 tablet) Once daily by mouth.

Typically started 2 days after egg retrieval.

Most common- headache, nausea, breast tenderness.

Rare due to short term use- spotting, weight gain, acne, abdominal pain, anxiety and depression.
  • MS-IVF
  • NC-IVF

Abbreviations: MS= minimal stimulation, NC= natural cycle, HR= hormone replacement, IVF= egg retrieval cycle, FET= frozen embryo transfer

*NOTE: If you experience rash, hives, or any rare symptoms; contact the office to report your reaction immediately. If you experience shortness of breath, difficulty breathing or swallowing, swelling or mouth, tongue or throat, seek IMMEDIATE medical attention.

Once your follicle has fully matured, your treatment plan will instruct you to prepare for your ovulation induction.