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PNAS 2018] SUMMARY OF PAIN MEDICATION USE There is ample evidence that long-term narcotic use is detrimental to sperm quality, though short-term use of these medications for an acute event (such as recovery after a surgical procedure) likely has no significant impact

8 weeks: ~3 vials 12 weeks: ~4 vials 16 weeks: ~6 vials Insulin Syringes (U-100, 1 mL) Per week (once daily): 7 syringes 8 weeks: 56 syringes 12 weeks: 84 syringes 16 weeks: 112 syringes Bacteriostatic Water (10 mL bottles) Use ~3.0 mL per 10 mg vial for reconstitution

Minimizing side effects Several strategies reduce the likelihood and severity of side effects: Start low and titrate up

Clinicians will typically try standard prenatal vitamins or oral supplementation first, resorting to IM/IV B-complex therapy if those are inadequate or not feasible