The Medication Bill: What to Expect
IVF medications typically cost $3,000–$7,000 per cycle—roughly 20–30% of your total treatment cost. The biggest variable is your dosage: younger patients with good ovarian reserve generally need less medication (and pay less), while older patients or poor responders may need higher doses. Your protocol also matters—mini-IVF uses significantly less medication by design.
| Medication Category | Typical Cost | Phase |
|---|---|---|
| Gonadotropins (Gonal-F, Follistim, Menopur) | $3,000–$6,000 | Stimulation |
| GnRH Antagonists (Cetrotide, Ganirelix) | $200–$500 | Stimulation (prevents early ovulation) |
| Trigger Shot (Ovidrel, Pregnyl, Lupron) | $100–$300 | Trigger (single dose) |
| Progesterone (PIO, Endometrin, Crinone) | $200–$800 | Post-transfer support |
| Antibiotics, steroids, estrogen | $50–$200 | Various support |
| Total Medication Cost | $3,000–$7,000 | — |
Stimulation Medications: The Heavy Lifters
These are the drugs that make IVF possible. They override your body's natural single-egg-per-month system and push your ovaries to develop multiple mature follicles simultaneously.
Recombinant FSH (follicle-stimulating hormone). The most commonly prescribed gonadotropin worldwide. The pen format eliminates mixing and is the most user-friendly option for self-injection. Dosage typically ranges from 150–450 IU daily depending on your age and ovarian reserve.
Functionally equivalent to Gonal-F—same active ingredient class, comparable results. Your RE may prefer one over the other based on experience or pricing. Uses a reusable pen with replaceable cartridges. Some patients find the pen mechanism slightly different from Gonal-F, so watch the manufacturer's training video for your specific device.
Contains both FSH and LH (luteinizing hormone). Often combined with Gonal-F or Follistim rather than used alone. The mixing process involves reconstituting powder with a diluent—it sounds complex but becomes routine quickly. Menopur is known for stinging slightly during injection; injecting slowly and warming the medication helps.
Suppression Medications: Preventing Premature Ovulation
These prevent your body from releasing the developing eggs prematurely (before retrieval). Typically started around stimulation Day 5–7 when follicles reach a certain size. Added to your daily injection routine—so you'll do two shots a day from this point. Pre-filled and straightforward. Minimal side effects beyond what stimulation medications already cause.
Trigger Medications: The Precision Shot
The trigger shot initiates the final maturation of your eggs. Timing is non-negotiable—take it at the exact time your clinic specifies. Ovidrel is a pre-filled subcutaneous injection (easy). Pregnyl requires mixing and is given intramuscularly (larger needle, upper buttock). Some protocols use a Lupron trigger instead, which carries lower risk of ovarian hyperstimulation syndrome (OHSS).
Support Medications: After Retrieval & Transfer
This is the medication patients talk about most—and not fondly. PIO is an intramuscular injection using a longer needle (1–1.5 inch) into the upper buttock/hip area. Most patients need a partner to help administer it. Tips from veteran IVF patients: warm the oil (hold the syringe in your hands or use a heating pad), inject slowly, massage the site afterward, and alternate sides daily. Soreness and lumps at the injection site are common.
A needle-free alternative to PIO. Some clinics use vaginal progesterone exclusively; others use it in combination with PIO. Endometrin suppositories are inserted 2–3 times daily. Crinone is a gel applied once or twice daily. Both are effective. Main side effects: discharge and messiness (panty liners are essential). Many patients prefer vaginal progesterone over the PIO injections, and research shows comparable outcomes for most patients.
Side Effects: What's Normal vs. What's Not
| Symptom | Normal? | When to Call Your Clinic |
|---|---|---|
| Bloating & abdominal fullness | Yes, very common | If severe, with rapid weight gain (3+ lbs/day) |
| Mood swings & irritability | Yes, from elevated estrogen | If persistent depression or anxiety |
| Breast tenderness | Yes | Usually not concerning |
| Headaches | Yes, common | If severe or with visual changes |
| Injection site bruising | Yes, especially with PIO | If signs of infection (redness, warmth, pus) |
| Mild pelvic discomfort | Yes, ovaries are enlarged | If sharp, severe pain |
| Nausea | Mild is common | If persistent vomiting |
| Significant swelling / rapid weight gain | May indicate OHSS | Call immediately |
| Difficulty breathing / chest pain | May indicate OHSS | Call immediately |
| Decreased urination | May indicate OHSS | Call immediately |
OHSS occurs in 1–5% of IVF cycles (mild forms) and less than 1% in severe forms. It happens when the ovaries over-respond to stimulation, causing fluid leakage from blood vessels into the abdomen. Risk factors include young age, low BMI, PCOS, high antral follicle count, and very high estradiol levels. Modern protocols (including Lupron triggers instead of hCG) have significantly reduced severe OHSS. Your clinic monitors for this throughout stimulation.
5 Ways to Save on IVF Medications
- Manufacturer compassionate care programs. EMD Serono (Gonal-F) and Ferring (Menopur) both offer discount programs for qualifying patients. Ask your clinic or apply directly through the manufacturer websites.
- Specialty pharmacy shopping. Don't just fill your prescription at the first pharmacy your clinic suggests. Get quotes from at least 3 specialty pharmacies—prices can vary by $1,000+ for the same medications. MDR Pharmacy, Freedom Fertility, and Alto Pharmacy are well-regarded options.
- Compounding pharmacies. Some medications (particularly progesterone) can be compounded at significantly lower cost. Ask your RE if compounded versions are acceptable for your protocol.
- Donated/leftover medications. IVF patients frequently have leftover medications after their cycles. Communities like FertilityFriends and r/IVF have medication exchange threads. Your clinic may also have a medication sharing program. Ensure medications are unexpired and properly stored.
- Clinic bulk pricing. Some clinics negotiate bulk medication pricing and pass savings to patients. Ask if your clinic offers an in-house pharmacy or bundled medication packages.