How to Navigate Common IVF Side Effects

Nov 23, 2022


Alto Pharmacy

In vitro fertilization (IVF) can be challenging both physically and emotionally, and fertility medications can cause various side effects.

To help you prepare for your cycle, we're sharing more information about common side effects and the best ways to manage them.

Common side effects of fertility medications

The fertility medications your doctor will prescribe fall into several main categories.

Stimulation medications

The first phase of IVF focuses on stimulating egg growth. These are some of the medications you may take during this stage:

  • Clomid/Letrozole (Femara®)

  • Gonal-f® or Follistim®

  • Menopur®

These medications are typically taken as nightly injections, with the exception of Clomid/Letrozole, which is an oral medication.

Known side effects of these medications include:

  • Injection site reaction (soreness, redness, or mild bruising)

  • Bloating

  • Cramping

  • Headaches

  • Nausea

  • Mood swings including heightened sensitivity, irritability, euphoria, or depression - individual responses vary

  • Breast tenderness (less common)

These medications also bring the risk of ovarian hyperstimulation syndrome (OHSS). This condition is characterized by swelling and pain in the ovaries as the result of over stimulation or an excessive hormonal response to fertility medications. Many mild cases don’t require treatment, but doctors often recommend the following medications for moderate to severe symptoms. (These medications may also be prescribed to prevent OHSS.)

  • Cabergoline is an oral medication, sometimes used vaginally, that can reduce OHSS symptoms

  • Gonadotropin-releasing hormone (Gn-RH) antagonists or letrozole suppress ovarian activity

In some cases, your doctor may recommend canceling treatment and starting a new cycle in the future after OHSS symptoms have resolved.

Ovulation suppression medications

Ovulation suppression medications prevent premature ovulation — the body’s natural release of eggs from the ovaries — so that your doctor can retrieve as many eggs as possible for fertilization. These are some of the medications you may take at this stage:

  • Cetrotide/ganirelix

  • Leuprolide

Known side effects of these medications include:

  • Injection site reaction (soreness, redness, or mild bruising)

  • Hot flashes

  • Headaches

  • Mood swings

  • Vaginal dryness

Trigger medications

Once your eggs have sufficiently developed, your doctor will schedule 1-3 trigger shots to give your eggs a final growth spurt and trigger release.

  • Novarel/Pregnyl®

  • Ovidrel®

  • Leuprolide

At this point in your cycle you may feel very full in your abdomen as the ovaries are enlarged from growing follicles.

Known side effects of these medications include:

  • Injection site reaction (soreness, redness, or mild bruising)

  • Bloating

  • Cramping

  • Headaches

  • Nausea

  • Mood swings

  • Breast tenderness (less common)

Transfer medications

The final phase of IVF is the transfer of a fertilized egg into your uterus. Progesterone or estrogen supplements are often prescribed at this stage to support successful implantation of an embryo and sustain a healthy pregnancy.

Progesterone is taken as an intramuscular injection or vaginally in the form of suppositories and capsules. Known side effects include:

  • Soreness or swelling at the site of injection, if taking progesterone injections

  • Vaginal itching or burning and yeast infection, if taking vaginally

  • Dizziness or fatigue

  • Mood swings

  • Bloating

  • Nausea

  • Cramps

Estrogen is typically taken as a topical patch but can also be taken orally, vaginally, or as an injection. Known side effects include:

  • Headaches

  • Breast pain or tenderness

  • Nausea

  • Redness or irritation in the skin covered by the patch, if taking topically

  • Increased vaginal discharge, if taking vaginally

  • Constipation, bloating, or stomach cramps  

  • Changes in mood

  • Back, neck, or muscle pain

  • Fluid retention 

Everyone has a different threshold for pain or discomfort. You know your body best. If anything feels unusual, it’s always worth speaking with your doctor.

The best ways to manage side effects

Below are effective and safe ways to treat common side effects during IVF. Many over-the-counter products can be added to the delivery of your fertility medications through Essentials From Alto.

Injection site reaction

This is one of the most common side effects during IVF, and you should expect to experience some soreness, redness, or bruising at the site of injection. You don’t need to do anything to treat the reaction; it will typically resolve itself within a few days.

Icing your skin beforehand can help keep this side effect to a minimum for intramuscular injections — the deeper of the two injection techniques used during IVF. Be sure to massage your skin afterwards, both to help the medication spread and to prevent soreness in your muscles.

Icing isn’t necessary for subcutaneous injections, the other injection technique.

Topical patch reaction

If you are prescribed estrogen as a topical patch during the final phase of IVF, rotating the location of your patch can help prevent skin irritation.

The patch should be applied to an area of your skin free of powder, lotions, hair, and cuts or other irritations. The most common application sites are the lower abdomen or buttocks.

It's important to let application sites heal as much as possible before reapplying a patch. Aim for at least one week between patch applications.

Back, neck, or muscle pain and headaches

Acetaminophen (Tylenol®) is the best way to treat pain during IVF. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®, Advil®) during IVF. Their anti-inflammatory properties prevent the ovaries from expanding and growing, essentially canceling out treatment.

Shop acetaminophen through Essentials From Alto.


Eating smaller meals can help reduce bloating. Some individuals also take simethicone (Gas-X®). If you develop acid reflux from bloating, Tums® is safe to take.

Order digestive health products through Essentials From Alto.


Stool softeners like Colace® and the fiber supplement Metamucil® are often used to alleviate constipation. In addition, stay hydrated — drinking more water helps stool softeners work better — and opt for fiber-rich foods.


Heating pads and acetaminophen (Tylenol) are commonly used to alleviate abdominal cramping during IVF. NSAIDs should be avoided.

Increased vaginal discharge

Pantiliners can help absorb additional vaginal discharge caused by vaginal preparations of estrogen.


Over-the-counter nausea relief options include ginger chews, peppermints, and nausea bracelets. You can also speak with your doctor about your options for prescription nausea medication if symptoms persist.

Mood swings

Some IVF side effects like mood swings and hot flashes occur as the result of hormonal changes, making them harder to treat.

However, if you find that mood changes are interfering with daily activities, speak with your doctor about medication. Many medications for mood disorders are safe to take during IVF. 

Vaginal itching or burning and yeast infection

Some OTC antifungals like Monistat® are helpful for vaginal itching or burning and yeast infections. However, always check with your doctor before using these medications to make sure they’re appropriate for you. You can also ask your doctor about prescription medication options like fluconazole (Diflucan®).

Reducing medication side effects

Most people experience some degree of side effects during an IVF cycle, and not all are avoidable, but there are ways to prevent them or reduce their severity.

Stay hydrated

You can become more easily dehydrated during IVF so be sure to consume plenty of water throughout the whole process.

Exercise in moderation

You may need to modify your workout routine during IVF. High-impact exercises such as running and interval training can increase the risk of ovarian torsion, a rare but serious complication in which an ovary twists around supporting ligaments.

Focus on low-impact exercises that place minimal stress on the body, like walking, yoga, and swimming. Always consult with your doctor about exercise precautions.

Consult your doctor about the best way to take medication

Always ask your doctor about when and how to take your medications, and follow their guidance. Many side effects of IVF medications are more manageable if medications are taken at night or with food.

Ask if it’s possible to begin at a low dose

Side effects are typically less common or less intense when you’re taking the lowest effective dose of a medication. In general, it’s ideal to start at a lower dose and increase it if you’re not experiencing the benefits or results as intended.

With fertility treatment, it can be tempting to take an aggressive approach from the start and go with the strongest treatments possible, but it’s better for your health and wellness to stay grounded in the bigger picture. As you research your options for fertility clinics, ask questions about their care approach.

Read Top Questions to Ask Your Fertility Clinic

Seek guidance from pharmacists

Consulting fertility-trained pharmacists who are experienced in IVF can make a big difference during treatment. At Alto, our pharmacists can answer any questions you may have about potential side effects and clarify the best ways to take medication.

You are less likely to experience discomfort from injections if you know the best way to administer them. Our pharmacists are happy to walk you through the injection process in real time over the phone. We also have a library of injection guide videos for the most commonly used medications.

Choose a flexible and reliable pharmacy partner

Fertility treatment can be challenging, but we’ll be with you every step of the way. To ensure that your treatment plan is followed correctly, we offer fast, reliable delivery of your medications and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

Interested in learning more about how Alto can support your fertility treatment? Request a price quote online or reach out through secure in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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