Managing Fertility Medication Side Effects

Side effects are common and temporary. Here’s how to cope with each one and when to seek help.

Common Side Effects and Relief Strategies

Bloating and Abdominal Discomfort

Why it happens:

• Ovaries enlarging (up to size of oranges or grapefruits)
• Multiple follicles developing
• Fluid retention
• Hormonal changes

What helps:

• Hydration is key: Drink 8-10 glasses water daily, more if very bloated
• Protein: Eat protein-rich meals (helps fluid balance)
• Small frequent meals: Instead of large meals
• Avoid salty foods: Worsens fluid retention
• Loose comfortable clothing: Don’t compress abdomen
• Heating pad: Gentle warmth can help
• Rest: Lying down relieves pressure
• Gentle walking: Light activity, don’t overdo

Duration:

• Increases throughout stimulation
• Peaks around retrieval
• Improves few days after
• If pregnant, may continue 1-2 weeks

Normal bloating:

• Uncomfortable but tolerable
• Gradual increase
• Able to eat and drink
• Able to urinate normally

Hot Flashes

Why it happens:

• Estrogen fluctuations
• GnRH agonists especially
• Clomid commonly causes them
• Body thinks it’s menopausal temporarily

What helps:

• Dress in layers: Easy to remove
• Cool environment: Lower thermostat, use fan
• Cold drinks: Keep water bottle handy
• Avoid triggers: Spicy foods, caffeine, alcohol, hot beverages
• Breathe slowly: During episode
• Cool shower: Before bed
• Light bedding: Cotton sheets, fewer blankets

Duration:

• While on medication
• Resolve when medication stopped
• Temporary menopause symptoms

Expect them – extremely common, not dangerous.

Mood Swings and Irritability

Why it happens:

• Hormonal roller coaster
• Estrogen and progesterone fluctuations
• Stress of treatment
• Sleep disruption
• Worry and anxiety

What helps:

• Acknowledge it: “I’m hormonal and that’s okay”
• Warn loved ones: “I may be moody, please be patient”
• Self-compassion: Don’t beat yourself up
• Time out: Step away when overwhelmed
• Exercise: Releases mood-boosting endorphins (gentle only during stims)
• Sunlight: Natural mood lifter
• Connect: Talk to others going through it
• Counseling: If severe

What doesn’t help:

• Trying to “control” emotions
• Feeling guilty about mood
• Isolating yourself

Tell partner: “I may cry over weird things, snap at you, or be all over the place emotionally. It’s the hormones, not you. Please be patient with me.”

Duration:

• Throughout treatment
• May continue if pregnant (pregnancy hormones)
• Improves when meds stopped

This is temporary. You’re not losing your mind.

Headaches

Why it happens:

• Hormonal fluctuations
• Estrogen especially
• Stress and tension
• Dehydration

What helps:

• Hydration: Drink plenty of water
• Tylenol (acetaminophen): Safe, ask about dosing
• Avoid NSAIDs: Ibuprofen/aspirin usually avoided during treatment
• Rest in dark quiet room
• Cold compress on forehead or back of neck
• Massage: Neck and shoulder tension
• Caffeine: Small amount may help (but limit overall intake)
• Regular meals: Low blood sugar triggers headaches

When to call doctor:

• Severe sudden headache
• Headache with vision changes
• Headache with severe nausea
• Not relieved by Tylenol

Duration:

• Variable
• Often improve after few days
• May recur

Breast Tenderness

Why it happens:

• Elevated estrogen
• Progesterone
• Breast tissue responding to hormones
• Similar to period or early pregnancy

What helps:

• Supportive bra: Good quality, wear day and night if needed
• Sports bra: For comfort
• Avoid underwire: Can be uncomfortable
• Cold or warm compress: Whatever feels better
• Avoid caffeine: May worsen tenderness
• Gentle support: Crossing arms when moving

Duration:

• Throughout stimulation
• Worsens with progesterone
• If pregnant, continues
• If not pregnant, resolves with period

Very common and harmless.

Fatigue and Low Energy

Why it happens:

• Hormones (progesterone especially sedating)
• Disrupted sleep
• Emotional exhaustion
• Body working hard
• Frequent early morning appointments

What helps:

• Listen to your body: Rest when tired
• Nap: If possible
• Early bedtime: Prioritize sleep
• Reduce commitments: Say no
• Ask for help: Delegate tasks
• Caffeine (limited): One cup coffee okay usually
• Light exercise: Can boost energy paradoxically
• Good nutrition: Stable blood sugar helps

Don’t push through:

• Your body needs rest
• This is temporary
• Not the time to be superwoman

Duration:

• Throughout treatment
• Especially during progesterone phase
• If pregnant, continues first trimester
• If not, improves quickly

Nausea

Why it happens:

• Estrogen levels
• Progesterone
• Medications (especially taken on empty stomach)
• Anxiety

What helps:

• Take meds with food: Unless instructed otherwise
• Small frequent meals: Prevents empty stomach
• Bland foods: Crackers, toast, rice
• Ginger: Tea, candy, capsules
• Peppermint: Tea or candy
• Avoid triggers: Greasy, spicy, strong smells
• Fresh air: Open window, walk outside
• Vitamin B6: Ask doctor about supplement

When to call doctor:

• Severe persistent nausea
• Vomiting (unable to keep anything down)
• Combined with severe bloating and rapid weight gain

Duration:

• Usually temporary
• May worsen if pregnant (morning sickness)

Constipation

Why it happens:

• Progesterone slows digestion
• Decreased activity
• Abdominal discomfort leading to less movement

What helps:

• Hydration: Essential for bowel function
• Fiber: Fruits, vegetables, whole grains
• Prunes or prune juice: Natural laxative
• Walking: Stimulates bowel movement
• Stool softener: Colace safe, ask doctor
• Avoid straining: Can be uncomfortable with enlarged ovaries

Don’t use:

• Harsh laxatives
• Enemas
• Anything aggressive

Duration:

• Especially during progesterone phase
• If pregnant, may continue

Injection Site Reactions

Why it happens:

• Needle insertions
• Medication irritating
• Repeated injections in same area
• Individual sensitivity

What helps:

• Ice before: Numbs area
• Let alcohol dry: Wet alcohol stings
• Room temperature meds: Not cold from fridge
• Rotate sites: Never same spot twice in row
• Massage after: Helps medication absorb
• Arnica gel or cream: Reduces bruising
• Heat after injection: Improves absorption
• Gentle pressure: Not hard rubbing

Expected:

• Redness
• Small bruises
• Tenderness
• Little bumps

Not expected (call if occurs):

• Large painful lumps
• Spreading redness
• Hot to touch
• Fever
• Pus or drainage

Duration:

• Daily with injections
• Heals within days
• Bruises may linger

Vaginal Discharge or Irritation (Progesterone Suppositories)

Why it happens:

• Suppository base material (waxy)
• Doesn’t fully absorb
• Melts and leaks out
• Local irritation

What helps:

• Panty liners: Essential (will ruin underwear otherwise)
• Insert at bedtime: Less leakage
• Lie down 20 minutes after: Improves absorption
• Wear old underwear: May stain
• Hygiene: Gentle cleaning, no douching

Normal:

• White or yellowish discharge
• Waxy texture
• Unscented or mild odor
• No itching or burning (or minimal)

Call if:

• Itching or burning (yeast infection possible)
• Foul odor (infection)
• Blood

Duration:

• Throughout progesterone use
• Weeks if pregnant

Annoying but harmless.

Serious Side Effects: Ovarian Hyperstimulation Syndrome (OHSS)

What Is OHSS?

Over-response to fertility medications:

• Too many follicles stimulated
• Ovaries very enlarged
• Fluid leaks from blood vessels into abdomen/chest
• Can be mild, moderate, or severe

Risk factors:

• PCOS
• Young age
• Low body weight
• High number of follicles
• Previous OHSS
• Becoming pregnant (hCG maintains it)

Prevention:

• Lower medication doses if high risk
• Close monitoring
• “Coasting” (pausing meds if estrogen too high)
• Triggering with GnRH agonist instead of hCG (IVF only)
• Canceling cycle if too many follicles
• Freeze all embryos (avoid fresh transfer)

Mild OHSS (Common)

Symptoms:

• Abdominal bloating and discomfort
• Mild nausea
• Diarrhea
• Ovaries enlarged

Management:

• Drink lots of fluids
• High protein diet
• Rest
• Monitor at home
• Usually resolves in 7-10 days

Affects 10-20% of IVF cycles – usually manageable at home.

Moderate to Severe OHSS (Rare)

Symptoms – Call Doctor Immediately:

• Severe abdominal pain and bloating
• Rapid weight gain (more than 2 pounds per day)
• Nausea and vomiting (can’t keep fluids down)
• Decreased urination (dark, concentrated urine)
• Shortness of breath
• Tight or enlarged abdomen
• Dizziness or lightheadedness

Can be serious:

• Requires medical monitoring
• May need hospitalization
• IV fluids
• Drainage of fluid (rarely)
• Blood clot risk

Emergency Contact: 026965055

Peaks 3-7 days after hCG trigger (egg retrieval).

Worse if you get pregnant (hCG keeps ovaries stimulated).

Prevention is key – clinic monitoring prevents most severe cases.

When OHSS Resolves

If not pregnant:

• Improves with menstruation
• Ovaries return to normal
• Usually within 1-2 weeks

If pregnant:

• May worsen initially
• Lasts longer (weeks)
• Requires monitoring
• Eventually resolves

Severe OHSS is rare (1-2% of cycles) with modern protocols.

Emotional and Psychological Side Effects

Anxiety

Common throughout treatment:

• Worry about outcomes
• Fear of failure
• Financial stress
• Time pressure
• Medical procedures

What helps:

• Acknowledge fears (valid)
• Focus on what you can control
• One step at a time
• Counseling or therapy
• Support groups
• Stress reduction techniques
• Limit Google searches (seriously)

Depression

Treatment is emotionally draining:

• Hormones contribute
• Grief and loss
• Repeated disappointment
• Isolation

When to seek help:

• Persistent sadness
• Loss of interest in activities
• Sleep changes
• Appetite changes
• Hopelessness
• Suicidal thoughts (call 988 immediately)

Don’t wait – depression is treatable.

Stress and Relationships

Treatment strains relationships:

• Different coping styles
• Sexual intimacy affected
• Financial pressure
• Scheduling challenges

Protect your relationship:

• Communicate openly
• Schedule non-treatment time together
• Be patient with each other
• Couples counseling if needed

When to Call Your Doctor

Urgent – Call Immediately

Severe OHSS symptoms:

• Severe abdominal pain
• Rapid weight gain
• Difficulty breathing
• Decreased urination

Other emergencies:

• Heavy vaginal bleeding
• Severe headache with vision changes
• Chest pain
• Fever over 101°F

Emergency Contact: 026965055

Call During Business Hours

Moderate concerns:

• Persistent moderate pain
• Vomiting (not keeping meds down)
• Moderate bleeding
• Severe injection site reaction
• Persistent headaches
• Severe mood changes
• Side effects preventing daily function

Questions about:

• Medication dosing
• Side effects management
• When symptoms are normal vs concerning

Don’t hesitate to call. Clinics expect questions and concerns.

Self-Care During Treatment

Physical Self-Care

Hydration:

• 8-10 glasses water daily
• More if bloated
• Helps everything

Nutrition:

• Balanced meals
• Protein important (especially if OHSS risk)
• Avoid extremes
• Prenatal vitamins daily

Rest:

• Sleep 7-9 hours
• Nap if tired
• Your body is working hard

Gentle movement:

• Walking fine
• Gentle yoga
• Avoid intense exercise during stimulation
• No high-impact after retrieval

Emotional Self-Care

Be gentle with yourself:

• This is hard
• Hormones affect mood
• You’re allowed to struggle
• Ask for help

Stress management:

• Whatever works for you
• Meditation, yoga, walks, baths, reading
• Connection with others
• Professional support

Set boundaries:

• Say no to draining obligations
• Limit social media
• Protect your energy
• Put yourself first

Remember

Side effects are temporary. They end when treatment ends.

Most are manageable with simple strategies.

Millions of women have gone through this. You can too.

Focus on the goal: bringing home your baby.

Every injection, every side effect, every hard day is one step closer.

You are stronger than you know.

This phase will pass. The reward lasts forever.