CANINE COGNITIVE DYSFUNCTION Dr. Jill Cline Research Nutritionist Nestle Purina PetCare More and more dogs seen in practice are of the older, more mature variety than ever before. Mirroring the human population, the average age of dogs in developed countries has increased- over 25% of dogs in Europe are considered senior. Also mirroring the human population, increased age in dog
sydneyrx2014.com Available ED Pharmacy is an 1st. pharmacy providing a individual service to the community in Australia. Over 80,000 extremely satisfied customers! We're your medication drug store kamagra australia and have provided trusted service to families in Australia for over 15 years.
Women’s health specialistsFamily Fertility Program
Clinic Hours: Monday – Friday 7:00 AM – 12 NOON Weekends and Holidays for procedures only by 10:00 AM 1818 N. Meade Street, Appleton, WI 54911 Direct Phone: 920-738-6242 | Fax: 920-831-1851 www.FoxValleyOBGYN.com
Ernesto Acosta MD | Jeffery Cherney MD | Jil Honkamp MD | James O’Leary MD ElinaPfaf enbach MD | Tina Ramsey MD | Stephen Savage MD | Amy Schmidt MD Angie Lipschutz APNP | Connie Masak APNP | Wanda VanderWyst PA-C Consultant in Reproductive Endocrinology/Infertility – Mark Severino, MD 2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 Family Fertility Program
1818 N. Meade Street, Appleton, WI 54911
Direct Phone: 920-738-6242 Fax: 920-831-1851
WELCOME! The following information gives answers to some questions we routinely get about our program and
office. We hope it proves helpful now, and in the future, as a reference.
The inability to conceive a child can be a trying experience. The Women’s Health Specialist Family Fertility Program
offer compassionate, personalized care to assist those who wish to become parents.
We are dedicated to providing the highest quality medical care and treatment for persons experiencing varying
degrees of infertility. Our program, along with your gynecologist, has advanced skills in helping couples achieve their
dream of having a natural child and in other areas of gynecology such as treatment of endometriosis, uterine fibroids
and problems associated with hormonal variations.
We work with you every step of the way, ensuring that you have the knowledge and support to make decisions in
your care. Our team is committed to finding the cause of your fertility and working together to select the best option to
At Women’s Health Specialists Family Fertility Program, we can also provide you with the latest in Assisted
Reproductive Technology (ART) to diagnose and treat infertile or sub fertile couples. We also have a special interest
male infertility and can offer a range of services within the area for testing. We work closely with the UW-Madison
Reproductive Endocrinology Department who provides the additional staffing and equipment required for the
advanced technology associated with ART. (IVF or IVF/ICSI)
We understand that no two medical problems or patients are alike, and treatment is individualized to every patient’s
We set up our practice to offer most diagnostic tests and services within our office.
Artificial Insemination Husband or Donor 7 days a week Ovulation Induction with injectable agents Evaluation and treatment of recurrent miscarriages In Vitro Fertilization (IVF) monitoring of labs and ultrasounds The following services are located on the same campus and include: 2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 What is Infertility?
Infertility is defined as a couple's inability to become pregnant after 1 year of sex without using birth control. However, "normal fertility" is defined as the ability to naturally conceive within 2 years' time. A woman's fertility gradually declines from her mid-30s into her 40s, due in great part to the natural aging of the egg supply. can lead to scarring of the fallopian tubes Use of tobacco products is harmful to the Reproductive organ surgery for cervical dysplasia can make 2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 SCHEDULING INFO
Telephone Calls for Scheduling During Clinic Hours
During the regular work week, routine appointments may be scheduled as follows : Women’s Health Specialists in Appleton by calling the Family Fertility line at 920-738-6242, Andrology appointments can be scheduled at 920-738-6460 Appointments for all locations are scheduled within their working hours as follows : Monday –Friday 0700-1200 and Wknds/Hoidays on call for procedures only from 0700-1000 TELEPHONE CALLS FOR NURSING STAFF DURING CLINIC HOURS
Staff are available from 7:00 AM- 12 Noon to return phone calls relating to specific medical questions and processing of requests for medication refills. Please call 920-738-6242, if we are on another line or with a patient, our phone will go to voicemail. Please leave a message stating your name, message, or pharmacy information. Please note that while our goal is to try to return all patient calls the same day, this may not always be feasible. TELEPHONE CALLS AFTER CLINIC HOURS, WEEKENDS & HOLIDAYS
For life threatening emergencies, dial 9-1-1, otherwise please leave a voicemail message , messages are always picked up by 10 AM the following day SCHEDULING AN INTRAUTERINE INSEMINATION (IUI) WITH HUSBAND SEMEN
• General Information Inseminations are performed the day after you surge. The Andrology Laboratory and Women’s Health Specialists Family Fertility Program are open Monday-Friday, and open for limited service (Inseminations) on Saturday and Sunday mornings by previous appointment only. Please call Family Fertility by 10:00 AM for scheduling Holidays We are available for all holidays, except all services from December 24th thru January 1st. Family Fertility Fee schedule is available upon request. Fees are payable at time of service. If you have any questions, call our financial counselor at 920-749-4000, or one of the nurses with Family Fertility at 920-738-624 2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112
What is a Reproductive Endocrinologist (RE)?
A reproductive endocrinologist (RE) is an obstetrician/gynecologist (OB/GYN) with advanced education, research and
professional skills in reproductive endocrinology and infertility. REs complete at least two additional years of
specialized training in reproductive endocrinology and infertility at an approved fellowship program, following their
training in obstetrics and gynecology. This specialization is important in the constantly evolving field of infertility,
physicians must be aware of new tests, drugs and procedures. REs can treat both men and women and some REs
have subspecialties, such as in reproductive surgery (for fibroids or endometriosis). Your RE will provide you with a
range of treatment options, cutting-edge therapies and direct access to services through his/her office or center that
needed throughout treatment.
What to Ask Your Fertility Specialist on Your First Visit
This is your first important step toward diagnosing and treating your infertility, so it’s best to go prepared. These
questions will help you get the answers you are looking for regarding treatment. Print these questions out and use
them as a guide during your first appointment with a fertility specialist.
1. What percentage of your patients are my age?
2. What tests will my partner and I have to go through prior to treatment?
3. Why are you doing these tests?
4. Do I have to have these tests at your office or can I go to my OB/Gyn for some of them?
APPOINTMENT SCHEDULING FOR REPRODUCTIVE ENDOCRINOLOGY
Call 920-738-6242 to schedule your appointment with Dr. Mark Severino, Reproductive Endocrinologist from Aurora
Bay Care in Green Bay. The doctor sees patients in our clinic, typically once a month. Our staff will conduct a
preliminary telephone interview to assure that we are adequately prepared for your appointment.
Once the appointment is scheduled, our staff will send a Welcome packet. The packet will include authorization for
release of medical information, and a new patient history questionnaire for both partners to complete and those forms
and bring with you to your appointment.
Infertility evaluations require us to obtain copies of your partner’s semen analysis or urology workup. A separate
authorization consent (if you are not currently working with Family Fertility), will be mailed along with your Welcome
packet, please mail back to our offices so we may obtain records prior to your office visit
For a comprehensive fertility assessment, both partners should be present at the appointment. This evaluation
usually requires about an hour.
Every attempt is made to keep the clinic operating on schedule, therefore please plan to arrive 10- 15 minutes prior to
your scheduled appointment. If you arrive late, you may be asked to re-schedule or if you’re late for an insemination
appointment, you will be asked to wait in Andrology until we can see you in the Women’s Health Specialists- Family
Fertility Program suite.
2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 Confidentiality
We work hard to protect our patients’ privacy. We do not release medical records or portions of them without written
authorization from the patient
PATIENT RIGHTS & RESPONSIBILIITES
The patient has the right…
• To anticipate and receive efficient, quality health care conducted in a respectful and compassionate manner
• To receive all medically necessary services (Please be aware that each insurance plan utilizes its own definition of
• To be fully informed and active in all aspects of their treatment plan
• To expect the complete confidentiality of their medical records
• To receive a prompt and fair review of any complaints or concerns they may have regarding clinic services
The patient has the responsibility…
• To fully understand their health insurance benefits, with regard to covered and non-covered services
• To treat Women’s Health Specialists- Family Fertility Program staff with courtesy, respect, and patience throughout
the duration of their treatment plan
• To arrive for scheduled appointments on time, or provide the required advanced notification for cancellation
• To prepare for those appointments requiring the signing of consent forms by thoroughly
reading in advance those forms to be signed
• To allow Women’s Health Specialists- Family Fertility Program to propose or provide the appropriate treatment,
even if it differs from the treatment, which they may have received at another clinic
• To provide a complete and current health history for the purposes of accurate diagnosis and clinical treatment
• To notify Women’s Health Specialists- Family Fertility Program in advance of any reasons why they cannot or will
not follow the recommended treatment plan
• To pay co-payments, deductibles, co-insurance, or charges for non-covered services upon notice
The staff of Women’s Health Specialists - Family Fertility Program has the responsibility…
• To provide quality patient health care in a safe and compassionate environment, catering to your physical and
• To include you in the formation and subsequent development of your personalized treatment plan
• To answer questions regarding any potential risks or benefits of treatment
• To return your telephone calls in a timely and amicable manner
2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 Women’s Health Specialists Family Fertility Program
Patient Test Requirement
Upon calling Women’s Health Specialists Family Fertility Program the nurses will take an in-depth look at your health history. You may have already seen a primary care physician or obstetrician/gynecologist with your fertility concerns. If so, having information from those visits will be beneficial to their evaluation. Upon evaluation of your past infertility history, the appropriate lab work, X-ray testing, and in some cases surgical procedures will be ordered for you. Given that the miracle of conception involves numerous factors, every patient’s testing will be different. Which testing might be necessary for you will be discussed after our history review. The testing may include, Blood tests for hormone levels and genetic conditions, Semen Analysis, Hysteroscopy, to view inside the uterus, Laparoscopy, to view inside the abdomen, Hysterosalpingogram an X-ray study of your fallopian or Sonohysterogram a vaginal ultrasound to view the inside of your uterus Semen Analysis
Semen analysis is usually one of the first tests done to help determine whether a man has a problem fathering a child (infertility). A problem with the semen or sperm affects more than one-third of the couples who are unable to have children (infertile). Tests that may be done during a semen analysis include: • Volume. This is a measure of how much semen is present in one ejaculation.
• Liquefaction time. Semen is a thick gel at the time of ejaculation and normally becomes liquid within 20
minutes after ejaculation. Liquefaction time is a measure of the time it takes for the semen to liquefy. • Sperm count. This is a count of the number of sperm present per milliliter (mL) of semen in one ejaculation.
• Sperm morphology. This is a measure of the percentage of sperm that have a normal shape. Sperm
morphology refers to the size and shape of the sperm.
• Sperm motility. This is a measure of the percentage of sperm that can move forward normally. The number
of sperm that show normal forward movement in a certain amount of semen can also be measured (motile • pH. This is a measure of the acidity (low pH) or alkalinity (high pH) of the semen.
• White blood cell count. White blood cells are not normally present in semen.
How To Prepare
You may be asked to avoid any sexual activity that results in ejaculation for 2 to 5 days before a semen analysis. This
helps ensure that your sperm count will be at its highest, and it improves the reliability of the test. If possible, do not
avoid sexual activity for more than 1 to 2 weeks before this test, because a long period of sexual inactivity can result
in less active sperm.
Be sure to tell your health professional about any medications or herbal supplements you are taking. 2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 How It Is Done
You will need to produce a semen sample, usually by ejaculating into a clean sample cup. You can do this in a private room or in a bathroom at your health professional's office or clinic. If you live close to your health professional's office or clinic, you may be able to collect the semen sample at home and then transport it to the office or clinic for testing. • The most common way to collect semen is by masturbation, directing the semen into a clean sample cup. • You can also collect a semen sample during sex by using a special condom. You cannot use a regular condom as it that might kill sperm. You may use a special condom that does not contain any substance that kills sperm. After you have ejaculated, carefully remove the condom from your penis. Tie a knot in the open end of the condom and place it in a container that can be sealed in case the condom leaks or breaks. If you collect the semen sample at home, the sample must be received at the laboratory or clinic within a 1/2 hour. Keep the sample out of direct sunlight and do not allow it to get cold or hot. If it is a cold day, carry the semen sample container against your body to keep it as close to body temperature as possible. Do not refrigerate the semen sample. Since semen samples may vary from day to day, 2 or 3 different samples may be evaluated within a 3-month period for accurate testing. What you should know
• A semen sample collected at home must be received at the laboratory or clinic within 30 minutes of collection. Keep the sample out of direct sunlight and do not allow it to get cold or hot. If it is a cold day, carry the semen sample container against your body to keep it as close to body temperature as possible. Do • A man whose mother took the medication diethylstilbestrol (DES) during her pregnancy with him has a greater-than-normal risk of being unable to father a child (infertile). • Additional tests may include measuring hormone levels, such as testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), or prolactin. • Other fertility testing, including sperm penetration, the presence of antisperm antibodies, or analysis after sexual intercourse (postcoital), may be recommended for infertility problems. What effects the test?
Look at how many days of abstinence there was prior to the semen analysis, if longer than 5 days, the sperm will be less active and not able to swim out of the semen. It will also give less volume. Medications, such as Tagamet, male and female hormones (testosterone, estrogen), sulfasalazine, nitrofurantoin, and some chemotherapy medications. Caffeine, alcohol, cocaine, marijuana and smoking tobacco can effect testing Herbal medications such as St. John’s Wort and high doses of echinacea Biking or jogging (heats scrotal area and kills off the sperm) Sitting in a car or truck all day (heats scrotal area) have him direct cooler air or ice packs In a hot tub just casually or all the time Working construction (summer months), in prolonged heat exposure situations Working with chemicals (chlorine, ammonia, pesticides or spermicides Intercourse and lubricants
It has been known for quite some time that many lubricants used to facilitate intercourse or as an aid in masturbation
for sperm collection may actually be toxic to sperm. A study presented at the American Society for Reproductive
Medicine conference confirmed this through a more rigorous study analyzing sperm motility and DNA damage after
exposure to four brands: FemGlide, Replens, Astroglide and Pre-Seed.
2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 Besides the brands tested, it is also thought that KY Jelly, Vaseline, and even saliva can have a negative impact on sperm. (One of the least toxic substances is pure mineral oil but it is generally not advised that women use lipid-based products in the vagina. Mineral oil remains an excellent choice for lubrication for masturbation.) Ovulation Predictor Kits
The marketplace offers a dizzying selection of devices to help women predict ovulation to increase their odds
of conceiving. Collectively, these products are called ovulation predictor kits (OPKs) or fertility monitoring devices.
They are broadly grouped into two main types: those that gauge a woman's Luteinizing hormone (LH) surge and those that monitor one's estrogen level. The LH surge is tracked with urine testing strips, which are then discarded. Estrogen can be tracked with longer-use fertility monitoring devices that check saliva or other bodily fluids. When under-going intrauterine insemination (IUI), women need a very precise measurement of ovulation. Single-use OPKs that require urine testing first thing in the morning or after 2-4 hours of "holding it" are ideal for this. They react when a woman's pituitary gland sends out an LH surge, directing the egg to leave the ovary in 24-36 hours, like clockwork. The egg then spends the next 6-12 hours sliding down the fallopian tube where it must be fertilized before implanting into the uterus. This critical window requires sperm to be on the spot, ready to fertilize. For LH testing, Women’s Health Specialists- Family Fertility Program recommends ClearPlan/ClearBlue Easy
because, in our experience, they tend to give the most unambiguous results. The kits that are not as highly
recommended are Answer, First Response and generics; they appear to be more prone to false negative results.
For couples timing pregnancy to the LH surge, natural intercourse is recommended both on the day that the kit changes, and the next day. If a couple is going through IUI with fresh sperm, the insemination will be timed the day after the kit shows ovulation. If frozen sperm is being used, many times two inseminations take place: one on the day of change and another the following day. The longer-use ovulation monitors that use saliva to measure estrogen levels typically identify a 72 hour peak
"zone" of fertility. Tracking estrogen levels can be a fascinating process, although patients may need additional time
to train their eye to spot the critical pattern that appears in saliva with elevated estrogen. Curiously, the salt content in
body fluids increases with a rise in estrogen. Once dried in a magnified setting, the saliva reveals a distinct
crystallization, or "ferning" from the salt level (see illustration on left), similar to ice patterns on a frosty window.
Some name brands include Fertile Focus, the Donna and Lady-Q. These devices are useful if couples can have frequent intercourse during their 3-6 day zone of fertility. Since Women’s Health Specialists- Family Fertility Program has not reviewed the estrogen-monitoring products and their efficacy, patients are strongly advised to do their own research. 2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 Infertility Medications and Information
Critical Information Regarding Your Medications Whenever you receive a quantity of medication and injections supplies it is extremely important that you double check
for accuracy. You will want to ensure that you have not only received the correct medication(s), but also the
appropriate quantity of vials/ampules/cartridges/tablets/syringes, etc., that the prescription or refill indicates.
Checking for accuracy is especially critical around the weekends and holidays. It is often difficult to locate pharmacies
(especially in smaller communities) that routinely stock infertility medications. Therefore, it is your responsibility on
Fridays to ensure that you have enough medication and supplies to carry you through the following Tuesday. If a
holiday falls during your treatment cycle, you will want to ensure that you have enough medication and supplies to
carry you through the next business day following the holiday. Lastly, you will also need to take into account any
dosage increases, if applicable.
After Hours: Please remember that we are always available during our regular business hours to assist you with
acquiring your medications and supplies, refill ongoing prescriptions, and/or answer any questions you may have. If it
is after 12 Noon during the week, if you have an emergency situation, call your MD office or service, if they are not
available, go to your local emergency room or wait until morning.
Just as no two people are identical, no two infertility treatment protocols are either. At some point during your
treatment cycle, you will receive an individualized medication protocol designed specifically for you, the details of
which will be reviewed with you several times throughout the course of your cycle. The overall design of the protocol
will depend on your selected type of treatment. (ie. timed intercourse, insemination, IVF, etc.) Although protocols are
quite similar, the type and quantity of medications, number of injections, and administration times will vary greatly
from patient to patient. The information provided below is designed to familiarize you with the basic types of infertility
medications, their functions and side effects.
Low dose aspirin treatment has been shown to enhance blood flow to the uterus and ovaries. As a result of
this improved responsiveness to gonadotropins, increased implantation and pregnancy rates have been
Aspirin can cause indigestion and should be used with caution, if at all, in somebody prone to heartburn or
indigestion. It is best to use aspirin after food. Skin rashes occur in some people and sometimes there is
dramatic swelling of the face and mouth to include difficulty breathing (anaphylactic reaction).
Clomiphene (Clomid, Serophene®)
FDA: FDA-approved for ovulation induction in anovulatory women, but widely used for unexplained infertility
in women who do ovulate regularly on their own.
Most common side effects: Hot flashes, night sweats, dizziness, mood swings
Adverse reactions: ovarian hyperstimulation, abdominal pain or bloating, temporary visual disturbances.
Long term effects: Possible increased incidence of noninvasive (“borderline”) ovarian tumors – not proven
to be causative. Most recent studies find no link with invasive ovarian cancer. Because more than one
follicle may develop (potentially releasing more than one egg during ovulation), multiple pregnancy (4-6%
chance ) is a possible complication. Additional side effects may include increased frequency of headaches,
visual changes, mood swings, ovarian cysts, or hot flashes.
Oral estrogen used in frozen embryo transfer or donor recipient embryo transfer protocols for the purpose of
helping build the endometrial lining. Estrace is also used for patients undergoing a Clomid or Letrozole cycle
or fresh IVF retrieval cycle to supplement the body’s natural estrogen production.
Migraines, nausea, abdominal cramps, bloating, mood swings
GnRH agonists (Lupron, Synarel)
FDA: Although Lupron and Synarel are not FDA-approved for IVF use, they are widely used in the U.S. to
prevent premature ovulation in IVF cycles.
Most common side effects: Mild headache
2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 Adverse reactions: Patients with unrecognized pituitary tumors can experience a type of pituitary “stroke”
when on Lupron. This is very rare but potentially serious.
Long term effects: bone loss in long-term users, not significant for the short courses used for IVF.
Gonadotropins (Follistim, Gonal-f, Repronex, Menopur)
FDA: FDA-approved for super-ovulation and in IVF to recruit multiple eggs.
Most common side effects: Tiredness, local injection site skin reactions such as pain and redness
(especially Repronex), abdominal fullness, bloating. Contrary to popular belief, we rarely hear our patients
complaining of mood swings on gonadotropins.
Adverse reactions: Ovarian hyperstimulation, multiple pregnancies (twins or more).
Long term effects: Some concern was raised in the early 1990’s about whether these drugs could increase
a woman’s risk of ovarian cancer. Most recent studies are reassuring that there is not an increased risk.
These studies are ongoing because this class of drugs has only been in wide use for about 25 years.
Because all of these medications act directly on the ovary and induce development of more than one follicle,
multiple pregnancy is a possible complication. However, with careful monitoring and low-dose medication,
the frequency of multiples is decreased. As previously indicated, these medications result in the
development of multiple follicles. While large follicles can be expected to ovulate, the smaller follicles that do
not will continue to grow in response to the HCG injection. This activity may result in ovarian
hyperstimulation syndrome. Other adverse effects may include dizziness, nausea, abdominal discomfort,
ovarian cysts, and breast tenderness. You may experience pain, redness and itching at the injection site.
Generally, patients experience less discomfort if it is administered subcutaneously in the abdomen.
GnRH Antagonists (Ganirelix, Cetrotide)
FDA: FDA-approved for use in IVF to prevent premature ovulation.
Most common side effects: None that we have seen.
Adverse reactions: Earlier (pre-FDA approval) versions of these medications were sometimes associated
with severe allergic reactions but we have not seen any yet in our practice.
Long term effects: bone loss in long-term users, not significant for the short courses used for IVF.
hCG (Novarel, Pregnyl)
FDA: FDA-approved for ovulation induction. Commonly used in clomiphene, gonadotropin and IVF cycles to
time insemination or egg retrieval.
Most common side effects:
Some increased discomfort, rarely outright pain, at the time of ovulation.
If a patient has multiple follicles on gonadotropins, hCG can be the final kick to the ovaries to tip someone
over into hyperstimulation syndrome. This is not seen in natural cycles or in most patients on clomiphene.
Long term effects:
When given by itself, there are few adverse effects associated with HCG. When given in conjunction with
either clomid or gonadotropins, however, HCG can contribute to ovarian hyperstimulation syndrome
(OHSS). Some patients also experience the following generalized side effects: headache, nausea, breast
It is the most recent addition to the drugs being used for fertility treatment. It has been widely used in women
with breast cancer. It is an aromatase inhibitor, an enzyme that is responsible for the production of estrogen
in the body.
This medication is used for treatment of infertility. It is especially effective on patients with PCOS or patients
who do not respond to Clomid.
Hot flashes, headaches, breast tenderness
Ovidrel® is the only recombinant chorionic gonadotropin (r-hCG) approved in the U.S. Ovidrel® is
administered subcutaneously (just under the skin) with a small needle. Other available hCG products are
urine-derived and need to be given intramuscularly with a much larger needle.
Ovidrel® is indicated to help egg follicles mature and to trigger the release of mature eggs in women
following the follicular phase of fertility treatment. Ovidrel® should not be taken if there are signs or
symptoms that ovarian hyperstimulation syndrome (OHSS) or over-stimulation of follicles may occur.
2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112 Side effects
As with other hCG preparations, side effects can occur with the use of Ovidrel®: discomfort at the injection
site, stomach pain, nausea and vomiting have been reported. As with all medications, it is important to report
any physical changes and all symptoms to your health care provider. Contact your doctor immediately if you
experience severe pain or bloating in the stomach or pelvic area, severe upset stomach, vomiting, or weight
gain. These may be symptoms of a rare but serious condition called ovarian hyperstimulation syndrome
(OHSS). Severe OHSS occurred in less than 1% of patients during clinical trials.
Progesterone (Prometrium, Endometrin, Progesterone suppositories,
Progesterone in oil)
FDA: Only Prometrium is FDA approved and it is approved for use in menopause in conjunction with
estrogen hormone replacement. It is pure oral micronized progesterone. Progesterone suppositories and
Progesterone in oil are usually compounded by individual specialty pharmacies (pharmacies that specialize
in distributing fertility drugs). Most progesterone packaging advises not to use in pregnancy but these drugs
are the exact same progesterone produced by the human ovary in the luteal phase and in early pregnancy
so are widely used in fertility treatment.
Most common side effects: Mostly very minor things like breast tenderness or mild bloating. For patients
on progesterone in oil, local pain and redness at injection sites is common.
Adverse effects: Local vaginal reactions such as irritation or itching from suppositories. Severe local skin
reactions to progesterone in oil are fairly rare.
Long term effects: Questions have been raised as to whether high doses of progesterone in early
pregnancy may be associated with urinary tract abnormalities in the fetuses of the mothers taking
progesterone. There has never been any such association proven. Mood swings, weight gain, breast
tenderness, insomnia, local irritation at injection site (it is normal to have some redness or irritation at site
due to loculation of oil; massaging the area, applying hot packs to the area before and after injection to help
relieve these symptoms). If taking progesterone in oil notify the clinic immediately if hives or rash develops.
Do not use if allergic to peanut or sesame oil.
Cold and Flu Guidelines
The best prevention against cold and flu viruses is adequate rest, a good diet, and frequent hand washing. A head
cold may last 7-10 days.
If necessary while trying to conceive or questionable pregnancy, plain Tylenol may be sued for aches, pains and
fever. Over the counter Sudafed, Actifed or Tavist tablets may be used as directed for nasal congestion. Afrin nasal
spray may also be sued for no more than 3 days. Prolonged use may worsen nasal congestion. Plain Robitussin may
be used for cough. Throat Lozenges or cough drops are safe to use as directed.
For stomach upset or heartburn, you may use Tums, Maalox, or Mylanta as directed.
When you have a cold, drink fluids and get extra rest. A vaporizer at night and extra pillows to elevate your head may
also be helpful. If your cold symptoms seem more severe than usual, or if you have a severe sore throat, please call
For flu symptoms, a clear liquid diet for 24 hours may prove helpful. Clear liquids include tea, Kool-aid, strained
lemonade, stained fruit juice (orange, grape, cranberry, apple, cran-apple) fruit-flavored beverage, fat-free broth,
bouillon, gelatin, hard candy, popsicles, fruit and ice.
2012 Women's Health Specialists, S.C. ● Family Fertility Program ● REV. 080112
Medien-Box Drogen und Sucht Stadtbücherei Soest Das Angebot von thematisch zusammengestellten Medien-Boxen, die von der Bücherei über einen längeren Zeitraum an Kindergartengruppen bzw. einzelne Schulklassen ausgeliehen werden, stellt eine Form der Zusammenarbeit mit dem Kindergarten bzw. der Schule dar, von der beide Seiten in großem Maße profitieren. Das Ausleihen eine