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Home > Learn > Fertility Treatments > >Nausea and Fertility Medications

Nausea and Fertility Medications

Apr 25, 23 11 min

By Halle Tecco, MBA, MPH

If you are undergoing infertility treatment – ovulation induction medication, IUI, or IVF – you may experience nausea as one of the side effects. Sometimes, nausea is from the medications (we’ll go through many of them in this article). Other times, nausea can be from anxiety and nerves. The good news is, there are ways to manage nausea. Let’s dive in.

Nausea and hormones

Hormones are chemical messengers that play an important role in regulating various bodily functions, including digestion, metabolism, and mood. [1] When hormone levels fall outside of normal ranges, they can disrupt the delicate balance of these functions and lead to unpleasant symptoms like nausea.

During pregnancy, the body undergoes massive hormonal changes, including an increase in estrogen and progesterone levels. [2] These changes can lead to a variety of symptoms, including what we call morning sickness. While the exact cause of morning sickness is not fully understood, it is thought to be related to the elevated levels of hormones in the body.

There are other conditions that can cause hormonal fluctuations, including your menstrual cycle, thyroid disease, or PCOS. In some cases, medications used to treat abnormal hormone levels or infertility can also cause nausea as a side effect.

Which fertility medications cause nausea?

There are dozens of possible medications you may be prescribed during fertility treatment. Below I’ve outlined some of the most common medications, why they are used, and the percent of people who experienced nausea during clinical trials. Note that some of these clinical trials specify if the group is undergoing IVF, while others are more general. 

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Medication

Purpose 

Brand name

Chances of nausea

Clomiphene citrate

Helps grow and release a mature egg for fertilization; often used to treat infertility due to anovulation.

Clomid®

2.2% [3]

Letrozole

Official use is for treating breast cancer, but is sometimes prescribed for off-label use for ovulation induction. 

Femara®

7.4% [4] 

Follicle stimulating hormone (FSH)

Used during IVF to stimulate the ovaries to produce more than one egg at a time.

Gonal-F®

5.9% for those using it for ovulation induction, 7.1% for those undergoing IVF [5]

Follistim®

3.9% of those undergoing IVF [6]

Menotropins (FSH,LH)

Menopur®

7.9% for those using it for ovulation induction, 12% for those undergoing IVF [7]

Human chorionic gonadotropin (hCG)

Used to stimulate the final development and release of mature eggs at the time of ovulation during IUI and IVF.

Ovidrel®



<2% for those using it for ovulation induction, 3.4% for those undergoing IVF [8]

Pregnyl®

up to 14.6% [9]

Novarel®

<2% for those using it for ovulation induction, 3.4% for those undergoing IVF [8]

Gonadotropin releasing hormone (GnRH) antagonist



Used to prevent premature ovulation during the ovarian stimulation process.



Cetrotide® 

1.3% [10]

Ganirelix®

1.1% [11]

Lupron®

13% [12]

Recombinant human growth hormone (HGH)

Sometimes prescribed to improve egg quality during IVF.

Omnitrope®

<2% [13]

Doxycycline (Antibiotics)

Sometimes prescribed to control bacteria that may affect implantation during IVF.

Adoxa TT®,

Doryx®,

Monodox®,

Oracea®,

Periostat®

depends on dosage, ranges from 4–33% [14]

Progesterone

Supports the uterine lining and helps an embryo implant and grow.

Milprosatm®, Endometrin®,

Prontogest ®, Prometrium® 

4% to 8% of those undergoing IVF [15-16]

Prenatal vitamins and nausea

If you are undergoing fertility treatments in hopes of getting pregnant, you are probably already on a prenatal vitamin. In and of themselves, prenatal vitamins can cause some degree of nausea. [24] More often than not, the culprit is iron. If your prenatal vitamin consistently makes you feel nauseated, check the label—the recommended amount of iron per the American College of Obstetricians and Gynecologists (ACOG) and the National Institutes of Health (NIH) is 27 mg per day. [17] If your prenatal has more than that, ask your healthcare provider about switching to one with a lower dose (as long as you weren’t placed on the higher dose because of anemia). If that still doesn’t help, ask your provider whether you can switch to a prenatal vitamin without iron during your first trimester and get iron from food sources instead.

Another reason your prenatal vitamin could make you feel more nauseated is if you’re taking it on an empty stomach. [24] With few exceptions, taking any kind of vitamin or pill on an empty stomach can make you feel sick. Even something as small as a smoothie, yogurt, or soup and crackers can make vitamins kinder on your stomach. 

Fertility supplements and nausea

Supplements like CoQ10, inositol, vitamin D and folate are generally well tolerated, but like any supplement can sometimes cause nausea. [25] Taking supplements on an empty stomach causes some people nausea and even vomiting. So if you’re experiencing any of those symptoms, you can try eating your supplements with a meal or snack to reduce the stress on your stomach.

Another reason for nausea: anxiety

Nausea can also be the result of anxiety. [18] When you’re feeling anxious, your brain releases chemical messengers called neurotransmitters to help protect you against the threat. [19] You have probably heard of the “fight or flight” response. The neurotransmitters can cause a bunch of symptoms– sweaty palms, high blood pressure, and yup, you guessed it: nausea. [20] 

Having anxiety about fertility treatments – worry about if it will work and how you will pay for it– is totally normal. But if your anxiety is causing unbearable nausea or other symptoms, it’s time to address it. 

The first and most important step in addressing anxiety is to seek professional help. A mental health professional, such as a therapist or counselor, can work with you to develop a personalized treatment plan that may include talk therapy, medication, or a combination of both. You can ask about relaxation techniques such as deep breathing, progressive muscle relaxation, and visualization to help calm the body and reduce feelings of anxiety.

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Treating nausea during fertility treatment

Nausea doesn't have to be a part of fertility treatments. If you are suffering from nausea, the first thing to do is talk to your healthcare provider about your options. Here are some other things to consider.

Take your supplements with food

Taking supplements on an empty stomach causes some people gastrointestinal distress, including nausea or vomiting. [24-25] So if you’re experiencing any of those symptoms, try eating your supplements with a meal to reduce the stress on your stomach.

Avoid caffeine

Caffeine can increase anxiety. [21] Limiting coffee intake during TTC may also improve your outcomes. In one meta-analysis, 26 studies were reviewed and the conclusion was that high caffeine intake did lead to an increased risk of pregnancy loss in a dose-dependent fashion (the more caffeine you consume, the higher your risk). [22]

Try ginger

Ginger has been found to be very effective in reducing nausea and vomiting. It is thought to help improve symptoms of nausea by stimulating your digestive tract motility and the flow of saliva, bile, and gastric secretions. [26] Overall, ginger has been recognized as safe for use (even during pregnancy) and effective in alleviating nausea. [26] However, it is important to note that the maximum safe dose of ginger, as well as ginger and other herb interactions, are unknown. Thus, you should avoid consuming it in high doses or in combination with certain herbs and should ideally stick to ginger tea or other forms of ginger that provide small amounts of it. Discuss taking ginger (in any form or amount) with your healthcare provider prior to altering your medication or supplement routine. One low-dose way to supplement with ginger is Natalist's Nausea Relief Tea.

Make sure you’re getting enough B6

Vitamin B6 has been shown to be effective in alleviating nausea and may even be as effective in treating nausea as ginger. [27] Make sure that you get enough of the vitamin in your diet (1.9 milligrams per day), and if you’re concerned that you’re not getting the required amount, or if you want to try it as a nausea-alleviating agent, talk to your healthcare provider about adding a vitamin B6 supplement (our Prenatal Daily Packs have the recommended 2mg!). 

Consider trying our ginger and vitamin B6 gummies for nausea, providing a convenient and effective option to ease your pregnancy-related discomfort.

Get enough sleep 

Some research shows that getting a healthy amount of sleep (at least eight hours a night) can help relieve anxiety. [23]

If none of that works, ask your provider about prescription nausea medication that is safe for fertility treatments and pregnancy.  

Summing it up

Nausea can be a challenge for those undergoing fertility treatment. Not only is it a miserable feeling, but it can make routine tasks like going to work or cooking a meal unbearable. The risk of nausea due to fertility medications or fertility supplements is low, but it does happen. More often than not, nausea during fertility treatments is due to nerves and anxiety about the entire experience. There are ways to combat nausea, and you should talk to your provider if it becomes a problem. Wishing you all the best!

 

References:

  1. “Hormones and Endocrine Function.” Endocrine Society. URL. Accessed April 2023.
  2. Kumar P, Magon N. Hormones in pregnancy. Niger Med J. 2012;53(4):179-183. doi:10.4103/0300-1652.107549
  3. CLOMID® (clomiphene citrate tablets USP). U.S. Food & Drug Administration. Reference ID: 3206435. URL.
  4. Femara (letrozole) tablets. U.S. Food & Drug Administration. Reference ID: 4244756. URL
  5. GONAL-F® (follitropin alfa for injection). U.S. Food & Drug Administration. Reference ID: 4724779. URL
  6. FOLLISTIM® AQ Cartridge (follitropin beta injection). U.S. Food & Drug Administration. Reference ID: 3003856. URL
  7. MENOPUR® (MENOTROPINS FOR INJECTION, USP). U.S. Food & Drug Administration. NDA 21-663. URL
  8. Ovidrel®. U.S. Food & Drug Administration. Reference ID: 44087-1150-1. URL
  9. Pregnyl Side Effects. Drugs.com. URL. Accessed April 2023.
  10.  Cetrotide™ (cetrorelix acetate for injection). U.S. Food & Drug Administration. Published 08/11/2000. URL.
  11. Ganirelix Acetate Injection. U.S. Food & Drug Administration. Reference ID: 3675716. URL.
  12. LUPRON DEPOT. U.S. Food & Drug Administration. Reference ID: 4585491. URL.
  13. OMNITROPE®. U.S. Food & Drug Administration. Initial U.S. Approval: 1987. URL.
  14. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Committee to Review Long-Term Health Effects of Antimalarial Drugs; Board on Population Health and Public Health Practice, Styka AN, Savitz DA, eds. Assessment of Long-Term Health Effects of Antimalarial Drugs When Used for Prophylaxis. Washington (DC): National Academies Press (US); February 25, 2020. 
  15. MILPROSATM (progesterone) vaginal system. U.S. Food & Drug Administration. Reference ID: 4600230. URL
  16. Endometrin® (progesterone) Vaginal Insert. U.S. Food & Drug Administration. Initial U.S. Approval: 1974. URL
  17. Nutrition During Pregnancy. ACOG. Accessed April 2023. URL
  18. Singh P, Yoon SS, Kuo B. Nausea: a review of pathophysiology and therapeutics. Therap Adv Gastroenterol. 2016;9(1):98-112. doi:10.1177/1756283X15618131
  19. Mittal R, Debs LH, Patel AP, et al. Neurotransmitters: The Critical Modulators Regulating Gut-Brain Axis. J Cell Physiol. 2017;232(9):2359-2372. doi:10.1002/jcp.25518
  20. Zhong W, Shahbaz O, Teskey G, et al. Mechanisms of Nausea and Vomiting: Current Knowledge and Recent Advances in Intracellular Emetic Signaling Systems. Int J Mol Sci. 2021;22(11):5797. Published 2021 May 28. doi:10.3390/ijms22115797
  21. Klevebrant L, Frick A. Effects of caffeine on anxiety and panic attacks in patients with panic disorder: A systematic review and meta-analysis. Gen Hosp Psychiatry. 2022;74:22-31. doi:10.1016/j.genhosppsych.2021.11.005
  22. Li J, Zhao H, Song JM, Zhang J, Tang YL, Xin CM. A meta-analysis of risk of pregnancy loss and caffeine and coffee consumption during pregnancy. Int J Gynaecol Obstet. 2015;130(2):116-122. doi:10.1016/j.ijgo.2015.03.033
  23. Ben Simon, E., Rossi, A., Harvey, A.G. et al. Overanxious and underslept. Nat Hum Behav 4, 100–110 (2020). https://doi.org/10.1038/s41562-019-0754-8
  24. Einarson A, Maltepe C, Boskovic R, Koren G. Treatment of nausea and vomiting in pregnancy: an updated algorithm [published correction appears in Can Fam Physician. 2019 Jan;65(1):8]. Can Fam Physician. 2007;53(12):2109-2111.
  25. Taking Medicines With Food. NHS. URL
  26. Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Sci Nutr. 2018;7(1):96-108. Published 2018 Nov 5. doi:10.1002/fsn3.807
  27. Firouzbakht M, Nikpour M, Jamali B, Omidvar S. Comparison of ginger with vitamin B6 in relieving nausea and vomiting during pregnancy. Ayu. 2014;35(3):289-293. doi:10.4103/0974-8520.153746
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