If you are starting IVF (test tube baby treatment), you will probably have questions about the injections: what each one does, how many there are, how they are given and what they cost. This guide answers them using guidance from UK, European and American health organisations (the NHS, HFEA, RCOG, ESHRE and ASRM), and sets out what the medicines cost at Mother & Child International Hospital (MCI) in Mirpur.
What IVF injections do
IVF aims to collect several mature eggs in one cycle, so the medicines do three jobs:
- Grow several eggs. Daily injections of follicle-stimulating hormone (FSH) make several follicles, the small fluid-filled sacs that hold the eggs, grow at the same time.
- Stop the eggs being released too early. A second medicine keeps your body's own hormone signals quiet, so the eggs stay in the ovaries until the day of collection. It is usually an injection, but some protocols use a nasal spray or tablets.
- Ripen the eggs. When the largest follicles are about 18 to 20 mm across, one final "trigger" injection helps the eggs finish maturing. It is hCG or, for women at risk of ovarian hyperstimulation syndrome (OHSS), a GnRH agonist, and it is given at the exact time your clinic sets, about 36 hours before egg collection.
If an embryo is to be transferred in the same cycle, you take progesterone after egg collection: a hormone that prepares the lining of the womb for the embryo. It is usually a pessary or a gel, some women have it as an injection, and you continue it at least until the pregnancy test, stopping only when your clinic tells you to.
The short protocol and the long protocol
Doctors combine these medicines in one of two main plans, called protocols.
The short (antagonist) protocol. The stimulation injections start first. From about day 6 of stimulation, a second medicine called a GnRH antagonist is added to stop early ovulation. ESHRE, the European fertility society, says this is the most common protocol today: it has a lower risk of OHSS than the long protocol, with similar chances of pregnancy.
The long (agonist) protocol. First you have a daily injection or nasal spray for 2 to 3 weeks to temporarily switch off your natural cycle, and a scan checks that this has worked before the stimulation injections begin. ESHRE describes it as an older method with a slightly higher risk of OHSS, and no longer the first choice.
Some women are offered the contraceptive pill or progestogen tablets first, to help time the start of treatment. Your doctor chooses the protocol after your tests.
How many injections, and for how long
| Medicine | What it does | When |
|---|---|---|
| FSH injections | Grow several follicles | Daily, usually for 10 to 14 days |
| GnRH antagonist (short protocol) | Stops the eggs being released early | Added from about day 6 of stimulation |
| Down-regulation medicine (long protocol) | Temporarily switches off your natural cycle | Daily injection or nasal spray for 2 to 3 weeks, continued until shortly before egg collection |
| Trigger injection | Helps the eggs finish maturing | Once, about 36 hours before egg collection |
| Progesterone | Prepares the womb lining | Starts between the evening of egg collection and 3 days later, and continues at least until the pregnancy test |
So in the short protocol there are usually about two weeks of daily stimulation injections, with a second medicine for the later part of that time, and then the trigger. The NHS puts a whole IVF cycle at around 3 to 6 weeks.
Why the dose is different for each woman
The starting dose of FSH depends on your egg reserve (measured with the AMH blood test or a count of small follicles on ultrasound), your age, your weight and how you responded to any earlier IVF. ESHRE says the usual aim is about 8 to 15 eggs, and that a higher dose does not improve egg quality: it can produce many eggs that are not suitable, and a strong over-response raises the risk of OHSS. This is also why the cost of the medicines varies from one couple to another.
Scans while you take the injections
ESHRE says to expect 2 or 3 ultrasound scans during the two weeks of stimulation, and sometimes blood tests. The scans show how the follicles are growing, so the doctor can choose the right time for the trigger injection. Never stop or change a medicine unless your clinic tells you to: stopping the medicine that prevents early ovulation too soon can let the eggs be released before collection.
How the injections are given
The stimulation injections usually go just under the skin of your tummy or thigh. Many women give themselves the daily injections at home after being shown how, or their partner learns to give them. If you are running low on medicine, tell your clinic in good time so that you do not miss a dose.
In Pakistan, some injections sold in pharmacies have "IVF" in their brand name. Whatever the name, they are fertility hormones. Take them only as your doctor prescribes: the American Society for Reproductive Medicine (ASRM) advises close ultrasound monitoring for anyone using these medicines, to keep their side effects and risks, such as OHSS and multiple pregnancy, as low as possible.
Side effects of IVF injections
Guy's and St Thomas' NHS Foundation Trust, which runs several hospitals in London, lists these possible side effects:
- The medicine that switches off your natural cycle: hot flushes, night sweats, headaches, mood swings and poor concentration. These usually improve once the stimulation injections start.
- The stimulation injections: tender breasts, bloating, feeling sick and feeling more emotional.
ASRM also says some women get irritation of the skin where the needle goes in. A true allergy to these medicines is extremely rare.
Ovarian hyperstimulation syndrome (OHSS)
OHSS is a potentially serious complication of IVF. It happens when the ovaries over-respond to the medicines: they become large and painful, and fluid can leak into the tummy. Mild OHSS is common: the Royal College of Obstetricians and Gynaecologists (RCOG) says it affects as many as 33 in 100 women having IVF, and moderate or severe OHSS just over 1 in 100. ESHRE's 2025 guidance gives a different estimate: severe OHSS in about 1 to 2 in 100 IVF cycles. It is more likely if you have polycystic ovaries, are under 30, have had OHSS before, or become pregnant in the same cycle. Doctors lower the risk by choosing the dose carefully, using the short protocol with a GnRH agonist trigger, or freezing all the embryos to transfer later.
When to get help straight away
Contact your clinic as soon as possible if, during or after the injections, you:
- have pain and bloating in your tummy
- are feeling and being sick
- feel faint
- are coughing up blood
- have vaginal bleeding or a brown, watery discharge
- have pain or discomfort when you pass urine or open your bowels
If you are worried about any other symptom, contact your clinic too. If you cannot reach your clinic, go to the nearest hospital emergency department. In the UK, contact your fertility clinic or NHS 111.
Go to the nearest hospital emergency department straight away if you have difficulty breathing, chest or upper back pain, are very thirsty and passing less urine than usual (dehydration), have swelling anywhere in your body, low tummy pain on one side, or pain in the tip of your shoulder. These can be signs of severe OHSS or of an ectopic pregnancy. Do not drive yourself: ask someone to take you, or call an ambulance. In the UK, call 999 or go to A&E.
What IVF injections cost at MCI
At Mother & Child International Hospital, IVF or ICSI costs Rs 80,000 from the consultation to the embryo transfer. The medicines are separate and usually cost Rs 50,000 to 70,000. Most of that is the hormone injections, and the dose, and so the cost, depends on your tests. These are the prices for patients in Pakistan, including Pakistanis working in the Middle East.
The first consultation, the ultrasound scan and the semen analysis are free, so you can hear what your treatment would involve before you decide. For families who live in the UK, USA, Europe or Hong Kong and come to Mirpur, IVF or ICSI costs £800, including the medicines and embryo freezing. Families on low incomes can ask about reduced fees at their consultation.
See all our prices, read how IVF and ICSI work at MCI, or book a free consultation.