I am on cycle day one and will be starting Estrace in twenty more days ! YAY ! I got my detailed medication protocol this morning and got some awesome documents from my doctor which explains the various medications, their purpose and possible side effects.

► Clomiphene Citrate: (Clomid) This medication increases the amount of FSH the pituitary gland will secrete. This is often used to stimulate ovulation in women who have absent
periods, infrequent periods or long cycles, or unexplained infertility.
The dosage is usually started at 100mg a day and taken for 5 days. Dosage may be increased if ovulation still does not occur. Potential side effects from Clomid include:
Increased incidence of multiple birth, Hot flashes, nausea, and breast tenderness, Headaches or blurred vision
Depression and mood swings, Ovarian cysts and pelvic discomfort from over stimulation of the ovaries

► Follicle Stimulation Hormone (FSH): (Gonal-f, Follistim, Bravelle) This is an injection given just below the skin (subcutaneous injection) that bypasses the hypothalamus and pituitary glands to directly stimulate follicle growth in the ovaries.

Potential side effects include:
Increased incidence of multiple birth, Breast tenderness, swelling, rash at injection site, Mood swings, fatigue and depression, Ovarian hyper-stimulation syndrome which includes enlarged ovaries, abdominal pain and bloating

► Human Menopausal Gonadatropins (hMG): (Menopur, Repronex) An injection that contains equal parts of FSH and LH (Luteinizing hormone), given to stimulate the ovaries to produce multiple eggs during one cycle. Menopur is the most common hMG used. Potential side
effects are the same as noted for the FSH.

► GnRH Antagonists: (Cetrotide, Ganirelix) This is an injection given just below the skin (subcutaneous injection) that helps prevent premature ovulation by decreasing the amount of LH released from the pituitary. It is started when the follicles are of a certain size.

Potential side effects are:
Tenderness, rash or swelling at injection site, Headaches and nausea

► GnRH Agonist: Lupron (or the generic form leuprolide acetate) is an injection given below the skin (subcutaneous injection) designed to prevent mid-cycle LH surge which can result in premature ovulation.

Potential side effects include:
Hot flashes
Headache
Mood swings
Vaginal dryness
Decreased breast size
Painful intercourse

►Human Chorionic Gonadatropin (HCG): (Ovidrel, Novaryl, Pregnyl, generic HCG) HCG is intended to induce ovulation. In the case of IVF, HCG is administered 36 hours prior to egg retrieval to provide final maturity to the developing egg.

Potential side effects include:
Nausea, Tenderness, rash or swelling at injection site

► Estrace: (Estradiol) This is a medication that comes in pill form that will be taken at a designated time in your cycle. You may be instructed to take this medication vaginally, orally, or both. If you are instructed to take this medication vaginally you will insert the pill as high into
the vagina as possible.

Potential side effects include:
Breast tenderness
Mild nausea
Bloating
Vaginal itching or discharge

► Progesterone Support: (Crinone, Endometrin, progesterone in oil) is a medication that will be taken at a designated time in your cycle to support the endometrial lining.

Potential side effects include:
Breast tenderness
Menstrual like cramping
Nausea
Mood swings and depression

Risks and Side Effects

Ovarian Hyperstimulation:

Hyperstimulation of the ovaries is potential risk when taking ovulation induction medications. Ovarian Hyperstimulation occurs when the ovaries become enlarged. In mild to moderate cases of ovarian hyperstimulation, a person may experience abdominal bloating and/or abdominal pain. Approximately 20% of people will experience mild hyperstimulation. Symptoms usually resolve with the onset of menses, however with a pregnancy may continue for several weeks.

In severe hyperstimulation, you may also experience a significant accumulation of fluid in the abdomen, nausea, vomiting, weight gain, dehydration and a decrease in urine output. Clients who experience severe hyperstimulation may require hospitalization.

Mild to moderate uncomplicated ovarian hyperstimulation, which may be accompanied by abdominal distention and /or abdominal pain, occurs in approximately 20% of clients treated with Gonadatropins an hCG. It generally resolves without treatment within a few weeks, or with menses. However, if pregnancy occurs, it may persist several weeks into the pregnancy. Clients experiencing mild to moderate ovarian enlargement usually report pelvic fullness and some abdominal pain and discomfort, usually about 2 to 6 days after administration of hCG. The degree of ovarian hyperstimulation is related to both the estradiol level and the number of follicles.
Multiple Pregnancy:

The administration of fertility medications increase the probability that more oocytes are developed in the ovaries. With the production of more oocytes the risk of multiple pregnancy increases. Multiple pregnancies are associated with an increase risk of complications and premature delivery. Multiple pregnancies can result in the need to reduce the number of fetuses. This procedure is called selective reduction.