IVF medications explained
Gonadotropins — the stimulation injections
These drive multiple follicles to develop. Conventional dosing is 150–225 IU daily.
ESHRE (2026) finds the main options broadly equivalent:
- Recombinant FSH and hMG — equally recommended
- Follitropin delta and follitropin alfa/beta — equally recommended
- Long-acting and daily recombinant FSH — equally recommended in antagonist cycles for normal responders
So if you are told one brand is superior, ask on what basis.
On adding LH activity: r-hFSH with r-hLH and r-hFSH alone are probably equally recommended — in the general population, in low responders, and in women aged 35 and over. Describing LH supplementation as necessary in older women is not supportable.
Combining r-hFSH with hMG is probably not recommended over either alone. Adding low-dose hCG to FSH is probably not recommended.
Suppression — stopping premature ovulation
GnRH antagonist (cetrorelix, ganirelix) — recommended over agonist protocols in the general population, given comparable efficacy and better safety. Started partway through stimulation. The fixed antagonist protocol is probably preferred over flexible.
GnRH agonist (leuprolide, buserelin) — where used, the long protocol is recommended over short or ultrashort.
Progestin — probably equally recommended to GnRH analogues where a freeze-all is planned.
Trigger
hCG — recombinant and urinary hCG are equally recommended. In agonist protocols, 5000 IU is probably preferred over 10,000 IU.
GnRH agonist trigger — recommended with freeze-all where OHSS risk is high, to minimise severe OHSS. Strong recommendation. Triptorelin 0.1–0.4 mg.
Recombinant LH is not recommended for triggering.
Dual trigger (agonist plus hCG) is probably not recommended — in normal, low or high responders.
Luteal support
Progesterone is recommended. Dydrogesterone is probably recommended — but ESHRE records published reports of an association with congenital malformations, causality not established. Worth discussing.
Adding oestradiol is probably not recommended. hCG 1500 IU for luteal support is not recommended.
Medications recommended against
Growth hormone, DHEA, testosterone pre-treatment, myo-inositol, aspirin, sildenafil, adding letrozole or clomiphene to gonadotropins, routine metformin with the antagonist protocol in PCOS.
Almost every adjuvant reviewed in the 2026 guideline received a recommendation against.
OHSS prevention
Dopamine agonists are recommended to reduce early OHSS risk, particularly where hCG is used for trigger. Strong, and new in the 2026 update.
Practical
Injections are subcutaneous, usually in the abdomen or thigh, self-administered. Most people find them far less difficult than expected.
Bruising, bloating, mood changes and headaches are common. Ask your clinic which effects warrant a call and which are expected.
Frequently Asked Questions
Are IVF injections painful?▾
Most patients describe IVF injections as mildly uncomfortable rather than painful — similar to a small pinch. Pre-filled pens (Gonal-F, Puregon, Orgalutran) are easiest to use and most comfortable. Letting the medication reach room temperature before injecting and rotating injection sites reduces discomfort. Most patients find the injections manageable within the first few days.
What is the trigger shot in IVF?▾
The trigger injection (typically Ovitrelle — recombinant hCG) is given when the lead follicles reach 17–20mm. It triggers the final maturation of the eggs, and retrieval is timed precisely 34–36 hours later. The trigger must be given at the exact prescribed time. For women at high risk of OHSS (PCOS, high AMH), a GnRH agonist trigger is used instead — it is equally effective but dramatically reduces OHSS risk.
How long do you take progesterone after IVF?▾
Progesterone support typically begins on the day of trigger injection (or day of transfer in a frozen cycle) and continues until at least 10–12 weeks of pregnancy if the transfer is successful. If the transfer fails, progesterone is stopped and a period follows within a week. Do not stop progesterone without your doctor's specific advice — sudden withdrawal can disrupt an early pregnancy.