You've been told you need IVF. Your doctor mentions Gonal-F, Cetrotide, Ovitrelle, Crinone. You go home with a prescription and a bag full of vials, needles, and instructions you half-understood in the clinic.

This is stressful. Here's what you can control: understanding what each medication does, why you're taking it, and what to watch for.

This guide covers every medication used in a standard IVF cycle in India — what it is, what it costs, when you take it, and how it fits into the larger process.

Why IVF Requires So Many Medications

A natural menstrual cycle produces one egg. IVF requires multiple eggs — ideally 8–15 — to maximise the chances that at least one embryo will be healthy and implant successfully.

To get multiple eggs, your ovaries need to be stimulated beyond what they do naturally. Then that stimulation needs to be carefully controlled so the eggs don't release prematurely. Then retrieval needs to be timed precisely. Then your uterus needs support to accept the embryo.

Each group of medications addresses one of these goals:

Phase: Stimulation · Goal: Grow multiple follicles · Medications Used: Gonadotropins (FSH ± LH)

Phase: Prevention · Goal: Stop premature ovulation · Medications Used: GnRH antagonists (or agonist in long protocol)

Phase: Trigger · Goal: Final egg maturation · Medications Used: hCG or GnRH agonist trigger

Phase: Luteal support · Goal: Prepare uterus for implantation · Medications Used: Progesterone, estradiol

Phase 1: Stimulation Medications (Gonadotropins)

What are gonadotropins?

Gonadotropins are injectable hormones that stimulate your ovaries to produce multiple follicles simultaneously. They are the backbone of IVF stimulation — no gonadotropins, no eggs.

There are two main types:

  • FSH (Follicle-Stimulating Hormone): Directly stimulates follicle growth. Used in almost every IVF cycle.
  • LH (Luteinising Hormone): Works alongside FSH. Some protocols combine FSH + LH, particularly for women with low LH or poor responders.

Gonadotropin brands used in India

Brand Name: Gonal-F · Type: Recombinant FSH · Manufacturer: Merck · Approximate Cost (India): ₹1,500–₹2,500 per 75 IU vial

Brand Name: Puregon · Type: Recombinant FSH · Manufacturer: Organon · Approximate Cost (India): ₹1,400–₹2,200 per 75 IU vial

Brand Name: Fostimon · Type: Urinary FSH · Manufacturer: IBSA · Approximate Cost (India): ₹700–₹1,200 per 75 IU vial

Brand Name: Meriofert · Type: HMG (FSH + LH) · Manufacturer: Merck · Approximate Cost (India): ₹700–₹1,100 per 75 IU vial

Brand Name: Menopur · Type: HMG (FSH + LH) · Manufacturer: Ferring · Approximate Cost (India): ₹900–₹1,500 per 75 IU vial

Brand Name: Recagon · Type: Recombinant FSH · Manufacturer: Organon · Approximate Cost (India): ₹1,200–₹1,800 per 75 IU vial

Recombinant vs. urinary: Recombinant gonadotropins (Gonal-F, Puregon) are manufactured in the lab and are more expensive. Urinary gonadotropins (Fostimon, Meriofert) are derived from the urine of post-menopausal women and are more affordable. Both are clinically effective — your doctor's choice depends on your protocol and budget.

How much do gonadotropins cost for a full cycle?

Your total gonadotropin cost depends on your dose and how long you stimulate. Typical doses range from 150 IU/day to 300 IU/day. Most stimulation runs 10–12 days.

Stimulation Profile: Normal responder (standard) · Daily Dose: 150–225 IU/day · Total Dose (10–12 days): 1,500–2,700 IU · Estimated Cost: ₹25,000–₹50,000

Stimulation Profile: High responder (PCOS, low doses) · Daily Dose: 100–150 IU/day · Total Dose (10–12 days): 1,000–1,800 IU · Estimated Cost: ₹15,000–₹35,000

Stimulation Profile: Poor responder / low AMH · Daily Dose: 300–450 IU/day · Total Dose (10–12 days): 3,000–5,400 IU · Estimated Cost: ₹55,000–₹1,00,000+

Stimulation Profile: Branded (Gonal-F/Puregon) standard · Daily Dose: 150–225 IU/day · Total Dose (10–12 days): Same · Estimated Cost: ₹40,000–₹90,000+

Note: No clinic can accurately predict your medication cost before monitoring begins. Your dose may be adjusted based on your follicle response. Be wary of fixed upfront estimates.

How to take gonadotropins

  • Route: Subcutaneous injection (just under the skin), lower abdomen
  • Frequency: Once daily, at the same time each day (±30 minutes)
  • Duration: Days 2/3 of your cycle until your trigger shot — typically 10–14 days
  • Storage: Refrigerate at 2–8°C. Do not freeze.

The needles are small (typically 27–30 gauge). Most women are surprised by how manageable they are. Your clinic nurse will teach you or your partner to inject before you start.

Phase 2: Prevention of Premature Ovulation

GnRH Antagonists (Antagonist Protocol)

The most common protocol in Indian fertility clinics today is the antagonist protocol, which uses GnRH antagonists to prevent your body from releasing eggs prematurely during stimulation.

Without this medication, the LH surge (the signal that triggers natural ovulation) could cause your follicles to release before egg retrieval — the eggs would be lost.

Medications:

Brand Name: Cetrotide 0.25mg · Generic: Cetrorelix · How Given: Subcutaneous injection · Timing: Daily, from Day 5–6 of stimulation until trigger

Brand Name: Ganirelix (Orgalutran) · Generic: Ganirelix · How Given: Subcutaneous injection · Timing: Daily, from Day 5–6 until trigger

Cost in India: ₹1,500–₹2,500 per 0.25mg injection. Over a 5–7 day course: ₹7,500–₹17,500.

You'll be giving yourself two injections per day once the antagonist is added — both are subcutaneous and take about 60 seconds combined.

GnRH Agonists (Long Protocol)

Some clinics and some patients use the older long protocol, which uses a GnRH agonist to suppress the ovaries before stimulation begins. This approach is less common today but is still used for certain complex cases.

Medications:

Brand Name: Lupride (Leupride) · Generic: Leuprolide acetate · Route: Subcutaneous injection · When Used: 14–21 days before stimulation starts (mid-luteal phase of previous cycle)

Brand Name: Buserelin · Generic: Buserelin · Route: Nasal spray or injection · When Used: Same suppression purpose

The long protocol adds 2–3 weeks to your total cycle timeline and has fallen out of favour in most Indian clinics for standard cases. Ask your doctor specifically which protocol you're on and why.

Phase 3: The Trigger Shot

The trigger shot is the most time-critical medication in your entire IVF cycle.

After stimulation, when your lead follicles reach 17–20mm, your doctor will instruct you to take the trigger shot at a precisely specified time — often something like "tonight at 10:30 PM exactly." This triggers the final maturation of your eggs and prepares them for retrieval 34–36 hours later.

Missing or mistiming the trigger shot can mean eggs release prematurely into the abdomen — and are lost. Set an alarm. Don't be late.

Types of trigger shots used in India

Medication: Ovitrelle (choriogonadotropin alfa) · Type: Recombinant hCG · When Used: Standard patients · Key Consideration: Most common; single-dose prefilled syringe

Medication: Pregnyl (hCG) · Type: Urinary hCG · When Used: Standard patients · Key Consideration: More affordable option; requires mixing

Medication: Leupride (leuprolide acetate) · Type: GnRH agonist trigger · When Used: High OHSS risk patients (PCOS, high AFC) · Key Consideration: Significantly reduces OHSS risk; cannot be used if you are on a long protocol with a GnRH agonist for suppression. Note: Leupride (leuprolide) is used at very different doses for suppression vs. trigger — your doctor will specify the dose for each use.

Medication: Dual trigger (hCG + GnRH agonist) · Type: Combination · When Used: Poor responders or at-risk patients · Key Consideration: Used at select Indian centres

Cost:

  • Ovitrelle (250 mcg): ₹2,000–₹3,500
  • Pregnyl (10,000 IU): ₹800–₹1,500
  • Leupride (1mg): ₹300–₹600

What happens after the trigger shot

  • You take the trigger at the exact specified time
  • You go in for egg retrieval 34–36 hours later
  • You fast for 6 hours before retrieval (no food or water)
  • The retrieval is done under IV sedation — you feel nothing during

Phase 4: Progesterone Luteal Phase Support

After embryo transfer, your uterus needs progesterone to maintain the right environment for implantation. Your ovaries' natural progesterone production is suppressed during IVF, so you supplement it.

This medication is non-negotiable. Stopping progesterone early — even if you feel fine — can cause a miscarriage. Always follow your doctor's specific instructions — never stop or reduce without consulting them.

Progesterone medications in India

Brand Name: Crinone 8% · Form: Vaginal gel · Route: Vaginal · Typical Dose: Once daily

Brand Name: Endogest 200mg · Form: Soft gel capsule · Route: Vaginal (inserted) · Typical Dose: 2–3 times daily

Brand Name: Susten 200mg/400mg · Form: Soft gel capsule · Route: Vaginal · Typical Dose: 2–3 times daily

Brand Name: Gestofit 200mg · Form: Soft gel capsule · Route: Vaginal · Typical Dose: 2–3 times daily

Brand Name: Progesterone injection · Form: Oily injection · Route: Intramuscular · Typical Dose: Daily or every 2–3 days

Vaginal route vs. injection: Vaginal progesterone is the standard in most Indian clinics today. It achieves good uterine levels with fewer systemic side effects. IM injections are used in some protocols or when vaginal administration is not preferred.

Cost: Vaginal progesterone — ₹5,000–₹12,000 for the post-transfer period (10–14 days to beta-hCG, then continues 10–12 weeks if pregnant). IM progesterone is slightly cheaper.

Side effects of vaginal progesterone:

  • Bloating and breast tenderness (identical to early pregnancy symptoms)
  • Vaginal discharge (normal with suppositories)
  • Mild cramping

These side effects make the two-week wait particularly confusing — you can't use symptoms to guess whether the cycle worked.

Additional Medications You May Be Given

Depending on your specific diagnosis, your doctor may add:

Estradiol (for frozen embryo transfer cycles)

If you're doing a frozen embryo transfer (FET), estradiol builds the uterine lining before embryo transfer.

  • Brands: Progynova (oral), Estradot (patch), Estrogel (gel)
  • Route: Oral tablets, skin patch, or topical gel
  • Cost: ₹300–₹1,500 for a 2–3 week course

Low-dose Aspirin

Some clinics prescribe 75–100mg aspirin daily during stimulation to improve uterine blood flow. Evidence is mixed, but it is widely used in India.

  • Cost: Negligible (₹50–₹100/month)

Prednisolone / Dexamethasone

Used in some protocols, particularly for patients with high AMH or inflammatory markers. Some clinics use corticosteroids to reduce the immune response during implantation.

  • Cost: ₹100–₹500 for a course

Metformin (for PCOS patients)

Women with PCOS may be pre-treated with metformin to improve insulin sensitivity and reduce OHSS risk.

  • Cost: ₹200–₹500/month

Vitamins and Supplements

Your doctor may recommend (though evidence varies):

  • Folic acid (5mg): Standard pre-conception supplement
  • CoQ10 (200–600mg): Antioxidant support for egg quality, often recommended for women over 35 or poor responders
  • DHEA: For diminished ovarian reserve — requires specialist supervision
  • Vitamin D: Often deficient in Indian women; low levels linked to IVF outcomes

Ovarian Hyperstimulation Syndrome (OHSS): The Risk to Know

OHSS is the most serious medication-related complication in IVF. It occurs when the ovaries over-respond to stimulation — producing too many follicles and releasing fluid into the abdomen.

Who is at risk:

  • Women with PCOS
  • Women with high AFC (many antral follicles)
  • Young women with high AMH

Mild OHSS (bloating, mild discomfort, nausea): Very common. Managed at home with rest, fluids, and monitoring.

Severe OHSS (rapid weight gain >2kg in 24 hours, severe abdominal distension, difficulty breathing, reduced urination): Rare but serious. Requires hospitalisation.

Prevention: If you are high-risk, your doctor should use:

  1. 1Lower stimulation doses
  2. 2GnRH agonist trigger (instead of hCG) — this dramatically reduces OHSS risk
  3. 3A "freeze-all" strategy — freezing all embryos and doing a frozen transfer later, which eliminates the progesterone surge that worsens OHSS

Call your clinic immediately if you experience: difficulty breathing, inability to urinate, severe abdominal pain, or rapid weight gain.

How to Organise Your Medications

IVF medication schedules can be overwhelming. Here's what helps:

Create a daily medication chart. Write down every medication, the dose, the time, and the route. Tick it off each day.

Day: Day 2 · Time: 9:00 PM · Medication: Gonal-F · Dose: 225 IU · Route: SC injection · Done?: ☐

Day: Day 6 · Time: 9:00 PM · Medication: Gonal-F · Dose: 225 IU · Route: SC injection · Done?: ☐

Day: Day 6 · Time: 9:00 PM · Medication: Cetrotide · Dose: 0.25mg · Route: SC injection · Done?: ☐

Day: Trigger night · Time: 10:30 PM · Medication: Ovitrelle · Dose: 250 mcg · Route: SC injection · Done?: ☐

Storage matters:

  • Gonadotropins: Refrigerate at 2–8°C. Never freeze.
  • Opened vials: Use within 28 days (most recombinant FSH); check your specific brand's instructions.
  • Progesterone suppositories: Room temperature is usually fine; check label.

Buy medications in advance. Some clinics dispense from their pharmacy; others ask you to purchase externally. Confirm availability before starting — certain brands like Gonal-F can be in short supply at some chemists.

Medication Cost Summary (India, 2026)

Medication Category: Gonadotropins (FSH/LH) · Cost Range: ₹25,000–₹1,00,000 · Notes: Biggest variable — depends on your dose and brand

Medication Category: GnRH antagonist (Cetrotide/Ganirelix) · Cost Range: ₹7,500–₹17,500 · Notes: 5–7 injections

Medication Category: Trigger shot · Cost Range: ₹500–₹3,500 · Notes: Leupride is cheapest; Ovitrelle most expensive

Medication Category: Progesterone luteal support · Cost Range: ₹5,000–₹12,000 · Notes: Until beta-hCG; continues weeks if pregnant

Medication Category: Estradiol (FET cycles only) · Cost Range: ₹300–₹1,500 · Notes: Not used in fresh cycles

Medication Category: Supplements (optional) · Cost Range: ₹1,000–₹5,000 · Notes: Variable; discussed with your doctor

Medication Category: Total medication cost (fresh cycle) · Cost Range: ₹40,000–₹1,35,000 · Notes: Most couples: ₹50,000–₹80,000

Questions to Ask Your Doctor About Your Medications

- Which protocol am I on (antagonist or long)? Why this one for my case? - What gonadotropin brand are you prescribing? Is there a more affordable equivalent that's equally effective? - What is the estimated medication cost for someone with my AMH and AFC? - Am I at high risk for OHSS? What precautions are built into my protocol? - At what exact time do I take the trigger shot? Write it down for me. - Which progesterone preparation are you recommending? Vaginal or IM? - When do I stop progesterone — and what if I miss a dose? - Are there any supplements you specifically recommend for my case?

The Bottom Line

IVF medications are intensive but manageable. Understanding what each one does removes a lot of the anxiety. You're not just taking drugs — you're carefully orchestrating the conditions under which your eggs can be retrieved, your embryos can develop, and your uterus can accept them.

The medication phase is where IVF gets real: daily injections, monitoring appointments, dose adjustments, and the constant awareness that every day is moving toward retrieval. Most couples who've done it say the medications were less physically painful than they expected — and that having a clear daily schedule helped them feel in control during a time when much is out of their hands.

The cost is real too. Medications are typically the second-largest expense in IVF after the procedure itself. Get a detailed medication estimate from your clinic before starting, understand that it's approximate, and build a buffer into your budget.

This article is for informational purposes only and does not constitute medical advice. All medication decisions must be made by your treating fertility specialist based on your individual test results and history. Do not adjust or stop any medication without consulting your doctor.

Sources consulted: ESHRE (European Society of Human Reproduction and Embryology) guidelines, FOGSI (Federation of Obstetric and Gynaecological Societies of India) protocols, Indian Fertility Society recommendations, and published cost data from Indian fertility pharmacies (2025–2026).