Stress is part of everyday life. In fact, sometimes it's normal and not all bad. It can actually motivate people to prepare or perform. For example, stress may boost performance when you take a test. It can even be life-saving in some situations.

However, stress can negatively affect your health. It can take a toll on your physical and mental well-being. If stress becomes chronic — meaning it lasts for too long — it starts to affect many systems in your body, such as your immune system. People under chronic stress tend to be more vulnerable to illnesses like the flu or common cold.

Over time, continued strain on your body from routine stress may lead to serious health problems, such as heart disease, high blood pressure and diabetes. Because no one’s life is completely stress-free, it is important to know how to manage stress. Read the following tips to learn how to cope with stress.

1) Focus on Positive Thoughts
One way to manage stress is to change your mindset. Try to maintain a positive attitude by replacing negative thoughts with positive ones. For example, instead of thinking, “I can’t do this,” try thinking, “I will do the best I can.” Try to accept that you cannot control everything. Instead, decide what must get done versus what can wait. Although it may be difficult, learn to say no to new tasks, especially if they will make you feel overwhelmed.

2) Learn Your Stress Triggers
Learn what triggers your stress. Try writing in a journal when you are feeling stressed and then looking for a pattern. This can help you avoid stressors in the future. For example, if you have determined that a health problem is stressing you out, speak with your health care provider. He or she can help you better manage your health and, as a result, reduce your stress. By reducing your stress, you are, in turn, helping to prevent the negative toll stress can have on your health — a win-win.

3) Take Care of Your Body
Make sure you are eating well-balanced meals, getting enough sleep and exercising daily. Hunger can worsen stressful situations. Do not skip meals, and always have healthy, energy-boosting snacks on hand. A lack of sleep can also compound stress. Try to get at least seven to eight hours of sleep per night so your body and mind are well-rested. Also, try to limit alcohol and caffeine intake. These substances may aggravate stress or anxiety. Instead, try drinking more water.

4) Relax
Try a relaxing activity like meditation, yoga, tai chi or another gentle exercise. Try to schedule regular times for these activities. When you feel stressed, try taking slow, deep breaths or slowly counting to 10. If this does not help, try taking a quick timeout to meditate or listen to music. Stepping back from problems and performing these relaxation techniques may clear your head.

5) Ask for Help
Stay connected with people you can count on for support. Ask friends and family members for help. Speak with a health care professional like a physician or therapist if you need professional help.

Everyone faces stress occasionally, but it can be managed. For more tips on how to manage stress, speak with your local pharmacist.

Citation:
National Institute of Mental Health, "5 Things You Should Know About Stress"
Anxiety and Depression Association of America, "Tips to Manage Anxiety and Stress"
American Heart Association, "3 Tips to Manage Stress"
Image Courtesy of Juan Moyano | Dreamstime
 

Three Steps to Dealing with Infertility in New York City

New York City is a big place with fast-movers, quick-talkers, and a lot of movement. And when it comes to an issue as personal as infertility, sometimes we need someone to slow the pace and have our hands held ever-so-slightly as we make our way through the process. So, here’s our quick guide to dealing with infertility in a city that moves probably way too fast.

  1. Step one: Research. It may seem like an obvious first step in dealing with infertility, but to many, it’s not. You’ll want to do some of your own research to find out why you’re not able to conceive. Get your computer out, talk to fertility experts, etc.
  2. Step two: Seek advice on where to get the best treatment in New York City. You’d be surprised if you open up about the topic how many friends of friends you may know who have dealt with infertility and can share advice. Having someone you know who is familiar with the New York infertility pharmacies and doctors will help you a lot.
  3. Step three: Prepare yourself. There’s always risks associated with infertility treatment and no matter what happens at the end of the tunnel, you should be ready to embrace the results at the of your fertility journey.
  4. Bonus Step: Fertility problems can be one the most difficult medical challenges on an emotional level. Keeping a positive attitude is helpful in getting through the emotional challenges of infertility. Some some that means stepping outside the city to get some fresh air and a more zen state of mind.

New York has dozens of qualified fertility clinics, with some being the best fertility clinics in the world. That doesn’t mean you’re guaranteed a treatment that works, but there is one thing certain every fertility treatments are a major investment financially and emotionally. Always remember that you can only do so much, so prepare yourself emotionally for any chance of unsuccessful fertility treatments that may be coming your way. For some, that means knowing in advance how much you are willing to invest in your fertility journey, and what kinds of treatments you’re willing to do.

Thanks to advances in science we have created a solution to every family out there who can’t have their own family; there’s meditation, In Vitro, surrogacy, and adoption. Each of those processes could be tedious and require extreme patience. If you chose the IVF route, and you’re lucky if on your first treatment, everything goes perfectly. But for some, there are health risks and even more unsuccessful treatments sorting out to adoption.

Don’t rely solely on fertility treatments — you also have to do your part by keeping a good physical and emotional health. Patients who have generally good health and take care of themselves before and after their treatment are more likely to succeed in the treatment. And, obviously, those who don’t take care of their bodies before and after the treatments can’t expect the same results.

A final tip: Reach out and seek support from fertility support groups like:

  • Women’s Infertility Support Group
    Surviving and Thriving with Infertility
    RESOLVE Fertility/ART support group
    Mind/Body for Infertility

Being a part of these kinds of groups will help you along the way of accepting and understanding and maybe this time start figuring out how to live a healthy life, they are the ones who will pave you the way of understanding that there maybe other good healthy options other than trying out the treatment 27 times. It doesn’t hurt to talk about what you are going through to the people who are also going through the same thing.

How Specialty Pharmacy Services in NY Are Changing

Specialty Pharmacies focus on specialty and rare medications that treat infertility, Chrons disease, HIV, HEP C, and other illnesses. In 2016, pharmacies dispensed about $115 billion in specialty drugs, according to industry expert Adam Fein, PhD, President of Pembroke Consulting, Inc. and CEO of the Drug Channels Institute, a blog that provides analysis of pharmaceutical economics and distribution trends.

And while the specialty pharmacy industry is rising, with some estimates targeted to $240 by the end of 2017, the industry is shrinking, with fewer and fewer specialty pharmacies to chose from outside of the big box chains.

“In New York especially, we’re seeing many specialty pharmacies in NYC disappear,” says owner Ron DelGaudio. “With fewer savings programs from the pharma companies, it’s harder to compete with the big box chains.” In addition, some drug manufacturers are launching specialty drugs with narrow distribution networks, often to fewer than 25 pharmacies. Those pharmacies are usually larger ones, making it increasingly difficult for low-cost pharmacies to compete.

In the past, specialty pharmacies in NY could apply for “loyalty” programs from companies like Merck and Phizer. Now those cost-savings opportunities are also fewer and further between.

Local pharmacies are having to invest more time and money in studying the industry, healthcare trends, pharmaceutical trends, and trends in illnesses, to navigate which medications are most important for to keep on the shelves and reduce operational costs like relocating outside of New York City to the Brooklyn and Bronx areas.

“Over the next years you’ll find fewer fertility pharmacies in NYC,” says DelGaudio. “The box chains will stay, but for special savings, customers will have to look for pharmacies outside of the city.” The other option is mail and central-fill pharmacies, which today account for upwards of 70% of specialty medication fulfillment. That number is increasing yearly. “The difficult thing is that with many of these complex specialty medications, customer care is extremely important — you want to make sure you have a pharmacist who makes sure the drug works alongside your other medications, that you’re storing and handling it correctly, that you’re injecting it correctly — these are services a mail pharmacy will find more difficult to provide,” says Ronda Lopez, a pharmacist at Kings.

Our main focuses are continuing to improve patient care and keep down healthcare costs. Second to that, we’re constantly embracing and re-embracing the shifts in the market. For those of us in the industry we know that specialty drugs are usually all of the three H’s: High Cost, High Complexity, High Touch. We joke that staying afloat in the pharmacy industry requires the same – High Cost, High Complexity, and High Touch.

Kings Pharmacy supports Hemophilia Walk in Riverside Park – June 3, 2017

For years Kings Pharmacy has been a proud supporter of the New York City Hemophilia Walk, one of the largest Hemophilia Walks in the country!

We want to thank the New York City Hemophilia Chapter and the National Hemophilia Foundation for helping people affected by bleeding disorders in the New York City area.

Hemophilia Walk

We’re proud to be a sponsor!

The Kings Pharmacy team at the finish line!

 

Ron DelGaudio

Our owner, Ron DelGaudio proudly walking in NY’s Hemophilia Walk.

Are Male’s Lack of Knowlege Leading to Higher Infertility Rates?

infertility amongst men

Male infertility is on the rise, and doctors may finally have a first step at combatting it. A new study suggests that it’s the men’s lack of information (or, you could call it ignorance) that may be the culprit here. While women are researching the causes of infertiliy from the first signs of infertility, men have taken a back seat to self-education.

It’s widely known that half of infertile couples are due to male infertility, yet most men have little knowledge of the risk factors that contribute to the inability to conceive naturally.

In a study published in the November issue of the journal Human Reproduction, men could identify only about 50% of the potential risks and health conditions that could significantly affect their sperm count and fertility.

The Journal of Human Reproduction’s survey studied more than 700 Canadian men aged 18 to 50 with a range of ethnic backgrounds, income, and education, and asked them to identify factors associated with male infertility. Most of the men were able to identify the more common or well-known infertility risk factors such as cancer, smoking, and steroid use, but very few were able to identify lesser-known causes like obesity, frequent bicycling, and using portable computers on their lap.

According to Dr. Phyllis Zelkowitz, a professor and researcher of psychiatry at McGill University and the Jewish General Hospital, “Men tend to ask fewer questions about their health when they go to the doctor.”

So the solution? Besides the obvious solution of encouraging men to do their own online research, men should look up male education programs, online groups geared towards male infertility, and group meetups that allow men to share their experiences together, and utilize their time with their doctors to inquire about infertility risk factors.

What are good questions to ask during an IVF consult?

For those experiencing infertility for the first time, the initial consult with the doctor can be scary and overwhelming! What do you ask, how many questions should you ask, and how do you even know where to start?! The initial consultation is a great opportunity to learn as much as you can about both infertility in general, and your specific case in a short time, and you’ll want to take advantage of it.

If you are seeing a good doctor (which, hopefully you are as fertility is not something to skimp on), he or she should guide you through the process and be prepared with the answers to the questions you should be asking, without you having to ask them. Sometimes letting the doctor provide a lot of the initial information in a systematic way can be very helpful and make it easier to understand.

If you have reached the point of having an IVF consult, you have likely have eliminated most, if not all, other options of conceiving naturally, so a list of questions might have already started brewing in your mind. When you sit down to discuss this with your IVF doctor, its important that you bring every one of your thoughts, concerns, and questions to the table to ensure that your clinic is the right one for you.

A great place to start before going into your initial fertility consultation appointment, is to check as many online resources as possible to gain as much knowledge on your own as you can. A few trusted fertility resources include: SART, and Resolve.org.

Next, the questions. Here is a list that make a great starting point for your fertility consultation:

Clinic Procedural Questions:

  • Do they offer a shared risk program? (Some clinics offer a flat rate, 3 fresh, 3 frozen cycles package)
  • What is their policy on embryo transfers? 1 or 2? (Some people feel that clinics that are willing to transfer more than 2 are in it more for the positive ratings of pregnancy then the health and wellness of baby and mom. In the 20’s-30’s age bracket 2 transfers is the norm, while in the 40’s age bracket, 3 transfers is acceptable.)
  • What does a cycle look like with their clinic? What type of timeline do they use, from start to finish?
  • Who would you be working with? The nurse or the doctor? (You can also request to meet this nurse or any other person who will be directly supporting you in your fertility journey.)
  • Is the clinic open for retrievals and transfers on weekends?
Clinic Success Questions:
  • Request information about the clinic’s past success rates: ask for the number of cycles they have done and their successes/failures.
  • What is the clinics pregnancy success rate with people in your age bracket with similar infertility issues?
  • How often does the clinic see OHSS cases (hyperstimulation – this typically this happens when the doctor overstimulates – we’re looking for low numbers here).
Personal Success Questions:
  • Based on your medical history, what specific challenges do they foresee?
  • Given your medical history, what percentage of success rate do they foresee for you to get pregnant with one fresh cycle?
  • Clinics have a “base” medical IVF standard they use when starting patients on a med program. One thing you will want to know is based on your medical and fertility history, how will they adjust the medications specifically for you? (For example, if you have low progesterone, your doctor might determine you’d be at an advantage to start you higher than they typically do.)
  • What kinds of fertility medications do they recommend for your particular kind of infertility, which are the cheapest fertility meds, which are the most trusted fertility medications, and which meds have they personally seen the most success with, for similar cases as yours?

 

Ask as many follow-up questions as you need to to feel comfortable, and don’t leave with any left hanging. Make sure you feel comfortable with the answers that you are given. If they start using medical jargon, abbreviations, or fertility medication or procedure terms you’re not familiar with, stop them to ask them what certain medications or abbreviations mean. Your goal is to walk out of this appointment knowing that you understand the journey ahead of you, and have a firm understanding of what that specific fertility clinic or doctor can do for you and your specific case.

With a huge influx of facts and figures thrown at you, you may feel a bit overwhelmed when you leave. It’s okay to take time to decompress. Use your support units, partner, trusted friends or family members. If you still have questions, call the clinic back. And remember that you are a customer, paying them to provide a service, so you have absolutely every right to feel comfortable, satisfied, and safe during the entire fertility process.

Polycystic Ovarian Syndrome (PCOS): The Five Most Important Things to Know

If you’re reading this article you likely already know that Polycystic ovarian syndrome, or PCOS, is when a woman’s estrogen and progesterone hormone levels are out of balance. This results in growth of ovarian cysts (benign masses on the ovaries), which cause problems with a women’s menstrual cycle, fertility, cardiac function, and appearance. Now, for some thing you might not already know about PCOS:

  1. Women with PCOS may experience many things including gaining weight easier, have more hair growth, mood swings, irregular periods, or have difficulty getting pregnant.
  2. Diet and exercise may not be enough to keep you healthy. Speak with your doctor about the necessity of specialty medications to help manage your PCOS.
  3. The cysts in your ovaries may not be actual cysts, but may be eggs that were unable to grow enough to reach ovulation.
  4. There is not 1 test to diagnose PCOS. Usually, your physician will order an ultrasound and/or do blood work to determine if you actually have PCOS. For this reason, it is important to talk to your doctor if you experience any symptoms stated earlier so that you can be diagnosed early.
  5. PCOS is the leading cause of infertility in women, however it can be treated.

Kings Pharmacy located in Brooklyn, NY has the lowest possible prices for infertility medications. We are able to help women in many different states to get their medications quickly and our friendly staff is always available to help answer any of your pharmaceutical questions. Call 1-800-795-4647 today for more information!

What are specialty pharmacies?

 

Specialty pharmacies, like Kings, are pharmacies that cater to special disease states, like Hemophilia, Hepatitis C, and Infertility. There are two kinds of specialty pharmacies: 1. those who carry only specialty medications and 2. those who carry specialty medications and also compound their own.

Although many organizations have different standards for what qualifies a drug as being a "specialty medication", generally, a specialty pharmaceutical drug may have some or all of the following key characteristics:

  • Is used for the treatment of complex, chronic, and/or rare conditions
  • Has a high cost, often exceeding $10,000 annually
  • Not widely available. (ie, only availability through exclusive, restricted, or limited distribution)
  • Requires special storage, handling, and/or administration requirements (some medications may need to be stored at specific temperatures and/or administered through an IV or other injection technique.)
  • May require ongoing monitoring for safety and/or efficacy (specifically drugs like hep c, which require frequent monitoring of the liver)
  • May require special approval to be ordered - not available through a traditional MD. It may also require a “prior authorization,” (a PA) by your insurance company, which means your insurance company needs to review why a drug has been prescribed before agreeing to pay for it. If you don’t get prior authorization, the medication may cost you more, or it may not be covered at all.

 

What are the most common Specialty Medications prescribed for?

At Kings, we carry a variety of specialty medications. Those include, Cardiovascular drugs, Custom Compounded Medications, Medications for Crohn's Disease, Fertility or Infertility meds, Hemophilia, Hepatitis C, HIV/AIDS, IVIG Therapy, Oncology, Rheumatology, Transplant medications, and more.

specialty drugs ny

 

Where do I get specialty drugs?

Depending on which state you live in, your state may have certain requirements about which pharmacies you are able to use. Many pharmacies are able to ship drugs nationwide with same-day or next-day shipping. If you live in a smaller or more rural town, often times you can buy medication from a larger pharmacy and save money on your medications. Our New York based pharmacy, for example, services the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Massachusetts, Minnesota, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, Utah, and Wisconsin.

  • Your doctor can send a prescription electronically to:
    • Kings Pharmacy
      Address: 357 Flatbush Ave., Brooklyn, NY, 11238
      Phone: 718-230-3535
      Fax: 718-230-0596
  • Order through your regular retail pharmacy. Not all pharmacies fill prescriptions for specialty drugs, so check first.
  • Or, you can refill or transfer a prescription here.

Have pharmacy questions?

Send your questions to info@kingsrx.com and we'll answer as best we can!

Endometriosis

endometriosis

According to the Mayo Clinic, Endometriosis “is an often painful disorder in which tissue that normally lines the insides of your uterus—the endometrium—grows outside your uterus.” In a 2009 in-depth report on infertility in women, the New York Times reports that “endometriosis may account for as many as 30 percent of infertility cases.” Infertility, as a result of endometriosis, can be caused by endometrial lining growth in the fallopian tubes, blocking an egg’s path; growth in the ovaries, which can cause complications in the release of an egg.

Columbia University’s Medical Center in New York City works closely with Cornell University in Ithaca, New York, as the NewYork-Presbyterian University Hospital, where they have found that there are “several theories as to the cause of endometriosis, but none has been established with certainty.” New York University Langone’s Medical Center has an Endometriosis Center, where they specialize in the research and treatment of endometriosis. NYU Langone estimates that “six percent to 10 percent of women of childbearing age have endometriosis.” The endometrium in a woman’s uterus swells and thickens during a menstrual cycle in preparation for the possibility of pregnancy. However, if no pregnancy occurs, the endometrium exits the body during menstruation. Due to endometriosis, endometrial cells coagulate outside of the uterus and “attach to other organs in the body, where they grow into nodules called ‘implants,’” according to NYU Langone’s diagnosis information on endometriosis. Most often, endometriosis implants take form on the ovaries, fallopian tubes, cul-de-sac, and outer lining of the uterus. Less commonly, implants can form on the lower regions of the large intestine, bladder, and rectum. NYU Langone identifies possible, though still uncertain risk factors as: first menstruation at age 11 or younger and hereditary factors. They also mention that “not having been pregnant is also linked with a higher risk.” However, once a woman reaches menopause, ending menstruation, endometriosis will improve.

Endometriosis can be diagnosed in a variety of ways. Ultrasounds are the easiest and most comprehensive way for a medical professional to detect any structural abnormalities in a woman’s pelvic region, using a series of high-frequency sound waves that ricochet off of surfaces within the body, creating live images. More likely, however, a doctor will first perform a pelvic exam, where a doctor palpates “areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus,” according to the Mayo Clinic. Pelvic exams are not as reliable in the detection of endometriosis, unless the disease has advanced and formed cysts within the pelvis region. Another method is laparoscopy, which is similar to the laparoscopic surgeries that are used to treat endometriosis. Laparoscopy involves a small incision, usually at the navel, and the insertion of a long, thin tube with a telescopic lens that allows a doctor to visualize the interior of a woman’s pelvis.

Symptoms of endometriosis are expressed primarily during menstruation, or leading up to menstruation. They are shown as pelvic pain “before or during menstruation, with urination or bowel movements” and during sexual intercourse, according to NYU Langone. The severity of endometriosis will not impact the severity of the symptoms. Treatments for endometriosis, as recommended by Langone, begin with birth control pills. A Langone doctor may recommend either oral contraceptives or an injection, such as the synthetic progesterone medication, Depo-Provera®. The synthetic hormone is medroxyprogesterone, meant to treat the pain associated with endometriosis by thinning the uterine lining and shrinking implants. Another medication at Langone is Lupron Depot®, which must be prescribed by and administered at a medical facility every six months. This medication “suppresses hormonal signals from the pituitary gland in the brain to the ovaries, thereby curbing estrogen production and putting the body into temporary menopause,” according to the NYC based medical facility. Lupron Depot® treatments may put endometriosis symptoms in remission for an elongated period of time.
The New York Endometriosis Center (NY EC), based out of New York City and Greenwich, Connecticut, is a leader in the surgical treatments of endometriosis. Among their staff is Dr. Kanayama, a highly awarded specialist in endometriosis treatment and surgery, having been awarded placement on America’s Top Obstetricians and Gynecologists list in 2004, 2005, and 2007 after training and residency at the Mayo Clinic. Another acclaimed NY endometriosis specialist is Dr. Tamer Seckin, who specializes in gynecology and laparoscopic surgery. Dr. Seckin focuses his work on minimally invasive advance laparoscopy. He was granted the Ellis Island Medal of Honor in 2012, having founded the Endometriosis Foundation of America in 2009.

While laparoscopic surgery is a highly advanced method of endometriosis treatment, another avenue of surgical treatment is endometriosis excision surgery. This surgery aims to remove endometriosis implants with the goal of alleviating pain, increasing fertility, and removing the physical cause of inflammation and endometriosis, the implants. Rather than burning the accessible portions of an implant, as with laser surgery, excision surgery digs into the roots of the inflammatory tissue and allowing the surgeon to see the mass in order to effectively remove it and alleviate pressure on organs that the implants have attached themselves to. This also increases the functionality of those organs. Excision surgery has also been used in cancerous cases. However, if endometriosis is advanced enough, “where pelvic architecture is deformed, and organs are fused with various degrees of adhesions, the difficult of the excision surgery can be more complicated than most cancer surgeries,” according to Dr. Seckin’s explanation of excision surgery. In cases such as these, a surgeon must suture any injured organs and reconstruct them where necessary, after removing the lesions.

Laparoscopy is different from excision in that the pelvic cavity is seen through a telescopic lens (the laparoscope), a 5 mm long tube that is inserted after carbon dioxide is “injected into the abdomen. This colorless, odorless gas swells the cavity, lifting and separating the organs to allow the laparoscope to be safely inserted,” according to Seckel’s explanation of laparoscopy. This direct line of sight to the state of the pelvic region allows a surgeon to understand the extent of an endometriosis case, while remaining minimally invasive.

Here are some helpful links on endometriosis:

http://nyulangone.org/conditions/endometriosis/treatments/surgical-treatment-for-endometriosis

http://nyulangone.org/conditions/endometriosis

http://www.drseckin.com/

http://www.drseckin.com/laparoscopic-surgery

http://www.drseckin.com/endometriosis-surgery

http://www.gynecosurgery.com/endometriosis

http://www.mayoclinic.org/symptoms-causes/dxc-20236425

http://www.gynecosurgery.com/meet-dr-kanayama

Infertility and Leading Infertility Medication

infertility-and-leading-infertility-medication

 

The World Health Organization defines infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse,” in their glossary on Assisted Reproductive Terminology. Infertility is not solely a female issue, and the Center for Disease Control reported in 2002 that “7.5 percent of all sexually experienced men younger than 45 reported seeing a fertility doctor during their lifetime—this equals 3.3-4.7 million men. Of men who sought help, 18 percent were diagnosed with a male-related infertility problem.” In women, the Center for Disease Control reported that infertility affects “about 12 percent of women 15-44 years of age in the United States.”

However, there are a number of leading medications that can help couples suffering from infertility raise a family of their own. For example, there are several fertility clinics with a variety of specialties, be they medication or other advanced treatments, based out of just New York City. In the Health Grove directory for successful fertility clinics, over 100 clinics are located in the greater NYC area. These specific clinics help couples in New York, or those from anywhere in the country seeking the expertise found in these clinics, begin their own families with medications that will treat their specific vein of infertility. This is a growing field of study, as scientists are learning more and more about the female body and reproductive system.

The following are some of the medications referenced by the American Pregnancy Association (APA), as well as what they are prescribed for, what they do, and explained potential side effects. Most commonly, leading medications are used to treat and enhance ovarian stimulation and the prevention of premature ovulation.

These pertain specifically to ovarian stimulation, where women suffer from long, missed, or irregular period cycles.

Clomiphene Citrates

The APA notes that there are two medicinal options, by way of Clomiphene Citrates (CC): Clomid ® and Serophene ®. These medications elevate Follicle-Stimulating Hormone secretion in the pituitary glands. These Follicle-Stimulating Hormones (FSH) controls a woman’s menstrual cycle, as well as ovarian egg production. FSH levels are highest in women just before she ovulates. In men, FSH controls sperm production. Contrary to the fluctuations of FSH in women throughout their menstrual cycle, FSH levels in men are generally constant. The APA emphasizes that regulated FSH counts are integral to fertility. It is recommended by the APA and the American Society for Reproductive Medicine that “clomiphene be prescribed for only three to six cycles” because the “chances of side effects increases as the dosage increases.” Possible side effects of Clomid ®, Serophene ® and other clomiphene citrates include increased chances of: multiple birth, where a mother has more than one baby, which has increased by 74% from 1980 to 2000, in a study by the National Center for Health Statistics on twin births; miscarriage, defined by the APA as a “pregnancy ends on its own, within the first 20 weeks of gestation.” Other side effects of clomiphene citrates include headaches, mood swings, depression, nausea, hot flashes, breast tenderness, ovarian cysts and over stimulation of the ovaries, resulting in pelvic pain or discomfort.

Follicle Stimulating Hormones

Due to the importance of FSH in fertility, Follicle Stimulating Hormones have been developed as medication via injection, where it “bypasses the hypothalamus and pituitary glands to directly simulate follicle growth in the ovaries.” The most common FSH medications are Bravelle®, Follistim® and Gonal-F®. Bravelle® is a urofollitropin, “derived from the urine of postmenopausal women” and purified into the injection format, according to the New York Times’ health guide on infertility. Follistim® and Gonal-F® are both synthetic injections of FSH. The New York times also stated that these three common treatments are sometimes combined with a Human Chorionic Gonadotropin medication, which also triggers ovulation. Possible side effects of these treatments are: increased incidence of multiple birth and miscarriage, just as clomiphene citrates. These natural and synthetic urofollitropins also increase a chance of premature delivery, defined as a “birth that takes place more than three weeks before the baby is due,” according to the Mayo Clinic, a nonprofit practice based out of Rochester, Minnesota. Other side effects include swelling or rashes at the injections site, mood swings, depression, breast tenderness, abdominal pain, bloating and Hyper Stimulation Syndrome, which may be caused by enlarged ovaries.

Human Menopausal Gonadotropins

Another leading treatment is Human Menopausal Gonadotropins, which contain an equal balance of FSH and luteinizing hormones (LH), “given to stimulate the ovaries to produce multiple eggs during one cycle,” according to the APA. Luteinizing hormones, produced in tandem with FSH in the pituitary gland, triggers ovulation when there is a significant rise in production of the hormone. Three leading hMGs are Menopur®, Humegon® and Repronex®. Their side effects are in line with those of FSH medications, due to how similarly they function. hMG is derived similarly to FSH, from the urine of menopausal women. It is also delivered similarly, through a series of injections. They are “usually given for 7-12 days,” according to the New York Times.

Human Chorionic Gonadotropin

hCG, as mentioned previously, is closely tied to FSH and LH. hCG triggers the release of an egg in women. Natural drugs are “derived from the urine of pregnant women,” according to the New York Times. Leading, natural hCG medications are Pregnyl®, Novarel ®, Ovidrel® and Profasi®. The APA emphasizes that if taken independently, rather than in tandem with another medication as is recommended for other treatments, there are “no known side effects.”

In order to prevent premature ovulation, there is one medication vein recommended by the APA:

Gonadotropin-Releasing Hormone Analogs and Antagonists

Gonadotropin-Releasing Hormones (GnRH) are produced in the hypothalamus. They stimulate the production of FSH and LH by stimulating the pituitary gland. GnRH medications are synthetic. Analogs are used to “enable the body to produce a higher number of quality eggs, and preventing “the mid-cycle hormonal surge which can result in a cancelled cycle,” according to the APA. Lupron®, Zoladex® and Synarel® are the three leading analogs, the first two being injections and the latter a nasal spray, respectively. Potential side effects include: mood swings, vaginal dryness, pain during sexual intercourse, hot flashes, headache, insomnia, bone density loss, and decreased breast size. Antagonists such as Ganirelix Acetate® and Cetrotide® cause GnRH “to be released to help prevent premature ovulation,” according to the APA. Like analogs, antagonists are injections and have similar side effects.

Here are some helpful links and sources:

http://www.nytimes.com/health/guides/disease/infertility-in-women/medications.html

http://americanpregnancy.org/infertility/infertility-medications/

http://www.who.int/reproductivehealth/publications/infertility/art_terminology2/en/

http://www.cdc.gov/reproductivehealth/infertility/

http://www.cdc.gov/nchs/nsfg/key_statistics/i.htm#infertility