Learn About Fertility Preservation X

Fertility Medications and Side Effects

Fertility Medications and Side Effects

September 15, 2005

One of the most common questions from patients about to embark on any fertility treatment plan is “What are the side effects of the fertility medications I will be taking?” This is a most appropriate question to which I'd like to provide an in-depth answer.

When discussing any fertility medication, it is important to keep in mind some concepts when discussing “side effects.” Side effects are really those symptoms, usually minor, most commonly suffered by a significant proportion of patients taking the medication. Typically, this would include nausea or headaches.

There are also “adverse effects.” These are more serious events, usually rare and often unpredictable. Examples would be a stroke or a heart attack. An example of a less severe adverse effect would be ovarian hyperstimulation syndrome. If a drug has been found to have a significant incidence of severe adverse effects, it is not likely to pass FDA approval. If the adverse effect is extremely rare, it may not be discovered until very large numbers of patients have taken the drug and the medication may be pulled from the market after approval (e.g. Bextra).

Separate from side effects and adverse effects, are “long term effects.” These are generally serious adverse effects not discovered until well after the drug therapy is undertaken. An example of this is the effect on the uteri of daughters of mothers who took the drug DES during pregnancy. When patients ask us about the safety of fertility medications, they are usually referring to adverse or long-term effects as much as concerns about side effects.

When reading the FDA-approved package labeling for almost all fertility medications, fertility drugs included, it's important to be aware that any possible adverse effect anyone has ever experienced on the drug will be reported. Unfortunately, this almost renders this information useless because there are virtually no drugs that someone somewhere has taken without something happening at the same time. It is often impossible to prove whether or not that medical event was related to taking the drug or not.

None of the medications that are in use for fertility treatment are known to have such serious adverse effects that the FDA has even considered withdrawing its approval.

Overall, we believe fertility medications to be very safe, usually associated with only very mild side effects, relatively rare and treatable adverse effects (mostly commonly ovarian hyperstimulation) and no known significant long term effects.

Below is a list of some of the most common side effects our patients mention, as well as some of the more common adverse effects. It is by no means an authoritative or exhaustive list.


Clomiphene (Clomid, Serophene®)

• FDA: FDA-approved for ovulation induction in anovulatory women, but widely used for unexplained infertility in women who do ovulate regularly on their own.

• Most common side effects: Hot flashes, night sweats, dizziness, mood swings

• Adverse reactions: ovarian hyperstimulation, abdominal pain or bloating, temporary visual disturbances.

• Long term effects: Possible increased incidence of noninvasive (“borderline”) ovarian tumors – not proven to be causative. Most recent studies find no link with invasive ovarian cancer.


GnRH agonists (Lupron, Synarel)

• FDA: Although Lupron and Synarel are not FDA-approved for IVF use, they are widely used in the U.S. to prevent premature ovulation in IVF cycles.

• Most common side effects: Mild headache

• Adverse reactions: Patients with unrecognized pituitary tumors can experience a type of pituitary “stroke” when on Lupron. This is very rare but potentially serious.

• Long term effects: bone loss in long-term users, not significant for the short courses used for IVF.


Gonadotropins (Follistim, Gonal-f, Repronex, Menopur)

• FDA: FDA-approved for super-ovulation and in IVF to recruit multiple eggs.

• Most common side effects: Tiredness, local injection site skin reactions such as pain and redness (especially Repronex), abdominal fullness, bloating. Contrary to popular belief, we rarely hear our patients complaining of mood swings on gonadotropins.

• Adverse reactions: Ovarian hyperstimulation, multiple pregnancies (twins or more).

• Long term effects: Some concern was raised in the early 1990's about whether these drugs could increase a woman's risk of ovarian cancer. Most recent studies are reassuring that there is not an increased risk. These studies are ongoing because this class of drugs has only been in wide use for about 25 years.


GnRH Antagonists (Ganirelix, Cetrotide)

• FDA: FDA-approved for use in IVF to prevent premature ovulation.

• Most common side effects: None that we have seen.

• Adverse reactions: Earlier (pre-FDA approval) versions of these medications were sometimes associated with severe allergic reactions but we have not seen any yet in our practice.

• Long term effects: bone loss in long-term users, not significant for the short courses used for IVF.


hCG (Novarel, Pregnyl)

• FDA: FDA-approved for ovulation induction. Commonly used in clomiphene, gonadotropin and IVF cycles to time insemination or egg retrieval.

• Most common side effects: Some increased discomfort, rarely outright pain, at the time of ovulation.

• Adverse reactions: If a patient has multiple follicles on gonadotropins, hCG can be the final kick to the ovaries to tip someone over into hyperstimulation syndrome. This is not seen in natural cycles or in most patients on clomiphene.

• Long term effects: None known.


Progesterone (Prometrium, Progesterone suppositories, Progesterone in oil)

• FDA: Only Prometrium is FDA approved and it is approved for use in menopause in conjunction with estrogen hormone replacement. It is pure oral micronized progesterone. Progesterone suppositories and Progesterone in oil are usually compounded by individual specialty pharmacies (pharmacies that specialize in distributing fertility drugs). Most progesterone packaging advises not to use in pregnancy but these drugs are the exact same progesterone produced by the human ovary in the luteal phase and in early pregnancy so are widely used in fertility treatment.

• Most common side effects: Mostly very minor things like breast tenderness or mild bloating. For patients on progesterone in oil, local pain and redness at injection sites is common.

• Adverse effects: Local vaginal reactions such as irritation or itching from suppositories. Severe local skin reactions to progesterone in oil are fairly rare.

• Long term effects: Questions have been raised as to whether high doses of progesterone in early pregnancy may be associated with urinary tract abnormalities in the fetuses of the mothers taking progesterone. There has never been any such association proven.


-- Carolyn Givens, MD


By Cinthia
December 09, 2014
Me and my husband have been trying to conceive for more than 3 years and it has not happend I have irregular periods the most a year is 2-3periods in the whole year I do not have a primary doctor to follow up with about my abnormalities. I was wondering how much is the exams for myself and my husband to see why I cannot conceive and if I need medication how much would it be? Please help me I am 25 years old and my husband is 27.
January 27, 2015
Hi Cinthia, Please call our new patient coordinators at 888-834-3095 to discuss pricing and next steps. Thank you. Best, PFC
By Mrs. Gatsby
October 13, 2016
I had the same issue. Turns out, I had PCOS (polycystic ovarian syndrome). A condition which cause weight gain, difficulty losing weight, infrequent ovulation as well as abnormal facial hair growth. But the great news is that, woman with PCOS can still have kids. Several friends of mine with PCOS has. If traditional conception doesn't happen there is always artificial insemination and IVF. Don't get discouraged. You will be a mommy soon
By Magdalena
April 22, 2015
Me and my husband has a nine year old boy. And need another child its been a long time trying. I've had constant absent periods. Can't understand why i can't have another child
April 23, 2015
Hi Magdalena, Please call our new patient coordinators at 415-834-3095 to discuss your medical history in more detail. Thank you. Best, PFC
By Rachael vellos
November 16, 2015
Hello my name s Rachael Vellos I was wondering about selling my eggs
December 01, 2015
Hi Rachael, Pacific Fertility Center does have an in house egg donor agency available for women interested in donating their eggs. You can learn more and fill out an application on the website: http://www.pfcdonoragency.com/egg-donor/egg-donors Please feel free to call the egg donor agency directly at 415-834-3075 if you have additional questions. Thank you, Pacific Fertility Center
By Stephanie
November 19, 2015
I've had horrible reactions to hormonal birth control (mood swings, hives, depression, yeast infections, you name it), what is the probability that I will have a bad reaction to the IVF medications?
December 01, 2015
Hi Stephanie, It is possible, but unlikely because most hormonal birth control is progesterone based and the medication for IVF is not. Please let us know if you have any further questions. Thank you, Pacific Fertility Center
By anonymous
January 06, 2016
I am 33 and don't have a child, I experienced 5 miscarriages all in my first trimester. The scan showed cyst on my left ovary, can this affect me getting pregnant and if I want to use fertlity med to procduce multiple babies can it be a problem? The doctors seem not to know the possible cause of the recurrent miscarriages
January 11, 2016
Hello and thank you for reaching out to Pacific Fertility Center. We encourage you to contact our New Patient Coordinators to talk more specifically about your particular circumstances. They should be able to answer your particular questions and are able to schedule a telephone consultation with one of our physicians to talk more in depth about your case and your options. You may contact them at 415-834-3095 or toll-free at 888-834-3095. Thank you!
By vanessa
March 04, 2016
I removed my IUD 11 months ago but i dont seem to get pregnant again can i use the fertility drugs aor its still early , i have one son aged 3yrs
March 14, 2016
Hello and thank you for reaching out to Pacific Fertility Center. We encourage you to contact our New Patient Coordinators to talk more specifically about your particular circumstances. They should be able to answer your particular questions. You may contact them at 415-834-3095 or toll-free at 888-834-3095. Thank you!

Post a new comment