I arrived at the clinic at 7.30 am yesterday for egg retrieval, shaven like a porn star and pretty nervous, as I’ve never been sedated before.
I took the advantage of being alone in the waiting room to change the TV from the usual Discovery Channel to Sky News. Who decided that a menu of survivalist, bounty hunter and other boring macho programmes was suitable fare for a fertility clinic audience? “How Do They Do It?” – no one cares, people.
The very capable Nurse K swept me down to the dungeons and talked me through the post-procedure meds: progesterone vaginal suppository nightly until Friday, when it will change to morning and night; Bymycin antibiotic twice a day from Tuesday to Friday and three Estrofem (hormone replacement therapy) tablets every evening starting from after the procedure. I handed over the Flagyl suppository and confirmed I’d taken my two Solpadol on arrival. These were already making me feel slightly spaced out – I can see how people get addicted to codeine.
I asked about the possibility of ovarian hyperstimulation syndrome and Nurse K confirmed it was a risk for me based on Friday’s estradiol reading but explained that some people will get it and some won’t and it’s hard to call. She said they might ask me to come in on Wednesday for a scan to see how things are looking but that the doctor would decide.
Enter Dr J, whom I’d never seen before. After confirming I’d taken my 5,000 Pregnyl on Saturday night, he got me to sign the consent forms. One of them was about what would happen with any embryos if I “got run over by a bus” (his words, not the form’s, that would be weird). The two options are: 1) destroy them; and 2) donate them to other fertility patients. I went for the second but didn’t have the wherewithal to ask if the embryos would be identifiable in that case ie would any future child be able to track down my family (me being dead and all). I would like the embryos to be identifiable, obviously, but hopefully this is all academic.
I was pretty surprised that I also had to decide on the spot whether they should implant one or two embryos when it comes to transfer later on. The only time this has been mentioned was when Dr O was talking me through the IVF process on the phone back in March, when he said they would probably implant two embryos, with a 20% chance of twins at my age and fertility. It would have been useful if they had warned me about this last week so I could hash it out in my head. Dr J’s stance was, “Would twins be an absolutely disastrous outcome?” It wouldn’t, though not ideal, so I said we should go for two embryos. He seemed to agree, explaining that despite my healthy fertility, my eggs are still 40 years old after all.
Dr J confirmed that OHSS was a risk and told me I’d need to come in on Wednesday. What I wanted to ask him but chickened out of raising was whether they might have missed a trick on scans #2 and #3 by not taking hormonal bloods, which presumably would have highlighted my rising estradiol. Although my treatment plan called both of these appointments “ultrasounds/hormonal bloods,” we only did an ultrasound each time. Indeed, on my last scan on Friday, I had actually said goodbye to Nurse Mute and gone to the toilet before heading home when she tracked me down to have bloods taken, as if she had forgotten. Were they supposed to take bloods at each scan? No point worrying about that now, I guess.
After the paperwork and meds chats, I headed into the theatre for the egg retrieval all gowned up, settled into the chair and was strapped into the stirrups. Nurse L confirmed that I had taken my trigger and pain relief tablets and went through a checklist of any other meds. The hatch opened and J cross-checked with the embryologist, confirming it was donor sperm (they didn’t ask me this time to confirm it was the right donor and I should have asked but never mind) and that I would be implanting two embryos on transfer. As far as I understand, during retrieval the embryologist hangs about at the hatch and is given the contents of each follicle as it’s aspirated.
I was hoping to be able to report back on how at least some of the procedure went but once Dr J attached the IV drip, I remember nothing except the room whirling slightly, him saying I would now fall asleep and then me waking up in the recovery area some unspecified time later attached to a heart monitor and a saline drip. I guess it went a little something like this.
The great news was that Nurse K told me they managed to retrieve all 19 eggs, so we’re off to a good start on that front. Whether they implant anything on Saturday will depend on how any embryos develop after fertilisation and whether it looks like OHSS is happening.
There were two awkward moments as I left the theatre area to meet my poor brother, who had been waiting for two hours to drive me home (maybe just awkward in my head though). The first was meeting Nurse L in the hall – she was smiling broadly and I wonder if I was talking complete rubbish to her under sedation after the procedure. It’s horrible looking at someone and not having the slightest idea of what just happened between you. Like the horrors of a very bad hangover. The second was that, as Nurse K accompanied me upstairs from the dungeons, we shared the lift with a couple who had also just had their retrieval done. “Make sure you look after her well today,” she said to the husband, and there was a split second’s silence as she then looked at me. Or maybe that was sedation-induced, single mother by choice-wannabe paranoia.
Having talked to the doctor, Nurse K went through my OHSS plan after the retrieval. She gave me a prescription for Dostinex – half a tablet every two days for two weeks. This has me a little confused and alarmed, as judging by the patient information leaflet, it doesn’t mix well with pregnancy. Dostinex is a “dopamine antagonist” that mimics the action of dopamine to reduce the production of prolactin in the blood, eg to suppress breast milk production or to treat conditions caused by hormonal disturbance that can result in high levels of prolactin. You’re not supposed to take it if pregnant. Among the many side effects are nausea (I threw up at 10 o’clock last night, though that could have been the sedation/food combo, see below), hallucinations and sudden sleep onset and, bizarrely, “strong impulse to gamble despite serious personal or family consequences” and “aggression… and increased sexual drive… which is of significant concern to the individual or others.”
Maybe if all is okay and egg retrieval can go ahead on Saturday, they’ll ask me to stop taking the Dostinex before then. Not too happy at all to be on this drug, though if it saves me from OHSS I shouldn’t complain.
Nurse K told me to book in the scan for Wednesday and to give the clinic a call on Tuesday to let them know how things are looking. I’m to drink at least 4 litres of fluid a day, including 1 litre of milk if possible. Flat isotonic drinks, cranberry juice etc are best – not all water. I need to call them if: 1) I pass less than half a litre of urine in a day (they mention a measuring jug but, really, how is this supposed to work in practice? – good luck trying this at work, ladies); 2) my stomach girth at the belly button increases by more than a few centimetres a day; or 3) I become breathless. From the little I’ve read, OHSS is sneaky, as it can take a week after egg retrieval to occur. It must be a right bugger if it happens in pregnancy.
I slept for much of Monday. Nurse K recommended eating only very lightly all day. She warned that a lot of people think they are okay, eat a big meal and then are sick. I had toast for lunch and for tea and then risked a handful of yoghurt-covered peanuts in the evening, which might have contributed to my throwing up several hours later. I’ll listen to Nurse K next time.
Postscript: Call from the embryologist. Seventeen of the 19 eggs fertilised. Pending results of my scan and how things progress this week, an embryologist will call me with further results on Friday after 4.30pm if we’re going ahead with fresh embryo transfer on Saturday. They’ll call me on Sunday instead if we have to freeze because of OHSS.
So, great work follicles. Now, please don’t muck it up by going all crazy batshit on me and giving me OHSS. Pretty please.