IVF medication side effects: what you may notice and when to get help

IVF medicines are hormones, and most of their side effects are things like bruising where you inject, bloating, headaches, sore breasts and mood swings. A few signs mean you need help right away. They are listed under when to get help, with the ones that need 911 first.

What you notice depends on the medicines your clinic prescribes. Each box has a leaflet that lists the side effects for that exact product, so read it and ask your nurse what to expect from your plan.

What might I notice?

Common side effects of the stimulation medicines include:

• Nausea and vomiting.
• Hot flashes.
• Headaches.
• Enlarged ovaries.
• Belly pain.
• Bruising from the shots.

IVF can also be hard on your feelings. Many people going through it struggle with depression and anxiety. Telling your care team how you feel lets them offer support.

A side effect list on a label is a list of problems people reported while using the medicine. Some of them can come from other parts of IVF, such as egg retrieval, so a symptom on the list is not proof that the medicine caused it.

Side effects by medicine type

Your clinic picks your medicines, and your plan may not use all of these.

Shots that help eggs grow (gonadotropins)

These shots contain a hormone called FSH (follicle stimulating hormone), sometimes with LH (luteinizing hormone). They help several eggs grow at once, as our guide to IVF stimulation explains. Side effects can include:

• Skin irritation or bruising where you inject.
• Sore breasts, headaches or mood swings.
• Belly pain, bloating, gas and nausea.

The GONAL-f RFF Redi-ject label says these shots can make the ovaries grow too large. Signs of that are bloating or pain low in your belly.

Shots that stop early ovulation

These shots keep your body from releasing the eggs too soon. For Cetrotide, one of them, the leaflet lists mild, short-lasting redness, itching and swelling where you inject, plus nausea and headache. Its label also reports allergic reactions, including serious ones with the first dose.

The trigger

The trigger helps your eggs finish maturing before egg retrieval. Your clinic gives you a trigger medicine plan and an exact time to take it. One trigger medicine is the hormone hCG. In most cases, OHSS (see below) develops because hCG stimulates the ovaries.

Progesterone

Progesterone helps the lining of the uterus get ready for an embryo. In IVF it is given as a shot into a muscle or placed in the vagina as a suppository, gel or tablet. A progesterone pill taken by mouth does not work well for this, because the stomach does not absorb enough.

Each form has its own label. For one vaginal insert, ENDOMETRIN, the label lists:

• Belly pain, bloating and cramping.
• Nausea, vomiting and constipation.
• Feeling tired or sleepy.
• Headaches and sore breasts.
• Mood swings and feeling irritable.
• Vaginal bleeding.

The same label says to call your provider right away for irregular vaginal bleeding. If you use progesterone shots or another vaginal form, read the leaflet that came with it, because the forms are not the same product.

Estrogen

Estrogen helps build up the lining of the uterus. Many people take it before and after a transfer, and in a frozen embryo transfer it may come as a pill, a shot or a skin patch.

Sore breasts from high estrogen are common after a transfer. A general MedlinePlus page on estrogen, written mainly for other uses, also lists belly pain, upset stomach, gas, weight changes, dizziness and vaginal discharge. It says to tell your doctor if any of these are severe or don't go away. The serious signs it lists, such as sudden swelling or pain in an arm or leg, are in the warning lists below.

After embryo transfer

Common side effects after a transfer are bloating, cramping, sore breasts, spotting and constipation. Your ovaries may still be enlarged, so some discomfort can happen. Our guide to life after embryo transfer covers the days of waiting.

Bloating, belly pain and OHSS

OHSS (ovarian hyperstimulation syndrome) happens when the ovaries swell and leak fluid into the belly. It can follow fertility medicines that stimulate the ovaries. Most cases are mild and cause short-lived discomfort. Severe cases are rare but can be life-threatening.

Symptoms often start within a week after the stimulation medicines, though they can take two weeks to show up. Milder signs are belly pain, bloating, nausea and some weight gain. Call your clinic right away about any OHSS signs, even mild ones, so your team can decide what to do. The serious signs are in the lists below.

If you have just had your eggs collected, our guide to egg retrieval recovery explains what bloating to expect.

When to get help

Call your clinic right away, day or night, if you have:

• A fever of 100.4°F (38°C) or higher.
• Heavy bleeding: soaking a full-size pad with bright red blood in less than an hour, or bleeding heavier than a period. Before a transfer, call for bleeding your clinic did not tell you to expect or a brown, watery discharge. After one, call for any bleeding.
• Belly or pelvic pain that is severe, gets worse, or isn't eased by the pain relief your clinic recommended.
• Pain and bloating in your belly, or bloating that is getting worse.
• Nausea and vomiting, nausea that won't go away, or you can't keep fluids down.
• Peeing less than usual, even if you are not thirsty.
• Fast weight gain. Your clinic will tell you its number, but do not wait to reach a weight threshold if you feel unwell.
• Before a transfer: sudden belly pain, dizziness, lightheadedness, or feeling faint.
• Pain, redness or warmth in an arm or leg.
• Blood in your urine, or pain when you pee or poop.
• Discharge from your vagina that smells bad, after a retrieval.

If the office is closed, use the after-hours line rather than waiting for the morning.

Tell your clinic at your next contact about other milder symptoms that are new, don't go away or slowly get worse. That includes a side effect that bothers you, and feeling sad, anxious or overwhelmed.

A symptom log you can copy

A short log helps you tell the nurse exactly what changed and when. You don't need to note every small thing. Focus on symptoms that are new, that last, or that get worse. A log is not a way to get help: for any sign in the lists above, act first and write it down later.

Date and time	Medicine taken	Symptom	How bad (1 to 10)	Weight	Peeing less?	Notes

Weight and peeing are in the log because fast weight gain and peeing less are both OHSS signs.

Tips for managing side effects

• Save your clinic's after-hours number in your phone.
• Ask your nurse which side effects to expect from your exact plan.
• Read the leaflet in each medicine box.
• Never stop or change a medicine on your own unless the label or your clinic tells you to.

Key takeaway

Bruising, bloating, headaches, sore breasts and mood swings are listed side effects of IVF medicines. Call your clinic right away, day or night, about any OHSS signs or the clinic warning signs, and call 911 for the emergency signs.