The following is meant to provide answers to frequently asked questions during the preconceptual period. This information may be useful to you as you undergo fertility treatment. We welcome you to discuss the following issues or any other fertility-related concerns with us. Lifestyle and environment: Certain lifestyle choices and environmental factors have been shown to influence fertility. Prior to and during fertility treatment, we recommend the following:
Avoid cigarette smoking (male and female partners)
Limit alcohol consumption to 4 or fewer drinks per week
Limit caffeine intake to less than 2 cups a day
Avoid use of marijuana or any other recreational drugs
Avoid direct exposure to perchlorethylene (dry cleaning industry), toluene (printing business), ethylene oxide, herbicides, fungicides, pesticides
Exercise: If exercise is part of your daily or weekly routine, you may continue to do so as long as it is comfortable. However, there are times during fertility treatment and perhaps during early pregnancy that your doctor will recommend that you refrain from or limit exercise. Specifically, if you are undergoing in vitro fertilization and/or embryo transfer, exercise should be avoided on the day of egg aspiration and through pregnancy test. In addition, if your ovaries are stimulated to make multiple eggs, you may feel uncomfortable with some forms of exercise and should limit it to such exercise as walking, stationary biking, swimming and yoga. We ask that you refrain from inverting your body during stimulation (i.e. upside-down yoga positions, trapeze, gymnastics or any sport that would have your feet higher than your head. Medications: Many over-the-counter and prescription medications may be taken during fertility treatment. If we prescribe it to you, we believe that it is safe. In addition, the following may be taken during fertility treatment according to the directions on the bottle (unless you are known to be allergic):
Tylenol, regular or extra strength, Tylenol with codeine, Vicodin
Sudafed, Afrin nose spray, TheraFlu, Tylenol Cold, Benadryl, Claritin, Zyrtec
Cough Medicine: Robitussin DM, Vicks Formula 44 Antacids:
Penicillin, Ampicillin, Keflex, Macrobid, Flagyl, Doxycycline
Yeast infections: Monistat, Gyne-Lotrimin, Diflucan Aspirin:
Baby Aspirin (if specifically prescribed)
The following medications generally should not be used during fertility treatment, unless specifically approved or recommended by your doctor:
Motrin, Advil, Aleve, full-strength aspirin, non-steroidal anti-inflammatory drugs
Hormonally–active herbs, Black Cohosh, Feverfew, Garlic, Ginseng, St. John’s Wort, Goldenseal
Recommendations for pre-conceptual counseling for birth defects and genetic disorders: Birth defects are abnormalities which are present at the time of a baby’s birth. They occur in approximately 3% of pregnancies. It is possible that you may be at increased risk for certain types of birth defects and therefore may want to consider special counseling and/or testing prior to achieving pregnancy.
1) Structural birth defects: When some part of the baby’s body did not form correctly or completely,
this is a structural birth defect. For example, neural tube defects (e.g. spina bifida, anencephaly) result when the coverings over the spinal cord or brain do not close properly. The folic acid in your prenatal vitamins can help prevent neural tube defects, but must be taken before pregnancy (that is, while you are attempting to conceive) and in early pregnancy to be effective. There is no single cause of structural defects, but certain medical conditions such as diabetes can be associated with a higher risk.
2) Intracytoplasmic sperm injection (ICSI): For men who have very low sperm counts and require
ICSI, we recommend that further genetic testing be done, including a test to count the number of chromosomes (karyotype), and a specific test to look at the male chromosome (Y chromosome deletion). There have been reports of infertility in male children born after ICSI using sperm of men with severely decreased sperm counts.
3) Birth defects due to infection: If certain infections are acquired by the mother during pregnancy,
they can cause abnormalities in the baby. Rubella (German measles) and varicella (chickenpox) are two examples. If you have not already had these diseases or been vaccinated, you should be vaccinated at least one month before becoming pregnant.
4) Prenatal Screening for Genetic Disorders: It is possible that you are unknowingly a carrier of a
genetic disorder that could be passed on to your offspring. Some inheritable diseases are more common among individuals of certain ethnicities. For example:
• African-American: Sickle cell • Caucasian: Cystic Fibrosis • Ashkenazi Jewish: Tay-Sachs, Cystic Fibrosis, Familial Dysautonomia, Fanconi • Asian: Thalassemia
Blood tests can be performed either before conception (pre-conceptual) or early in pregnancy to find out whether either parent is a carrier of certain genetic defects that could affect the health of the baby. If you fall into one of the above ethnic categories, you may want to consider pre-conceptual testing.
I, ______________________________________, have read and understand the above information. ___________________________________________
Date November 10, 2011 (FINAL) Authors Karen E. Jacobson – NEMSIS Director Keith R. Davis – NEMSIS Data Architect N. Clay Mann – NEMSIS P.I. dConfiguration.04 - Medications Permitted by the State The code list associated with dConfiguration.04 (Medications Permitted by the State) is represented by a selected group of values found in RxNorm. RxNorm is a standardized nomenclatu
BLADDER TUMORS IN DOGS Background Bladder tumors are uncommon in dogs and cats. Like most tumors in animals and people, we do not know why they occur. Tumors typically arise from the lining of the bladder or urethra, and can also involve the prostate in male dogs. Clinical Signs The most common presenting complaints for animals with bladder tumors are increased frequency an