Part 37: OHSS Follow-up, More Needles, and Beta #2

I was scheduled for acupuncture and the chiropractor that afternoon.  Since I was feeling so fantastic post-tap, I decided to go to both.  Technically speaking, my acupuncturist and chiropractor were the first to hear the "news."  But when it came time to disclose it to them, I realized I was nowhere near ready to say the "P" word.  Not only was I still trying to wrap my head around the BFP, but I was hyper-aware of the fact that it was only one test and that it was still super early.  So instead, I simply told them the facts and let them draw their own conclusions:

1. I had undergone a retrieval followed by a day 5 transfer of a single embryo.
2. I had developed OHSS in the week following my transfer.
3. I had undergone a pelvic tap that morning, during which they drained 1400 mL of fluid.
4. My first beta HCG test had been that morning as well, and it was positive.

Both appointments gave me much-needed added relief - the chiro adjustments helped ease some of the back and neck tension that had built up from poor sleep and the acupuncture treatment left me feeling calmer and more relaxed.  That evening, I was able to eat an actual entire meal and enjoy it!  Then we had some planning to do...  Cookie said they wanted to see me first thing the next morning for a follow-up.  Specifically, they wanted me to see Dr. B, who was going to be at another location.  Since there was a chance that the fluid would return and I would need another tap, I had to have someone else drive me to/from the appointment.  Unfortunately, Paul was scheduled for a shift that he couldn't get out of and my MIL had injured her knee over the weekend and was in no shape to drive me there and back.  So in the end, it was decided that my FIL would take me. 

The appointment was at 6:30 in the morning, and the other location was pretty far away, which meant we had to leave super early to allow for rush hour traffic and finding the place.  I was a little worried that it might be awkward - I wasn't sure how much my FIL knew about the situation (aside from that we were doing IVF) and at that point we weren't ready to tell our parents about the BFP.  But it ended up being fine. Since we'd left so early, we arrived with plenty of time to spare and found the clinic easily.  They took me back to do the ultrasound first (my FIL stayed in the waiting room).  The tech asked how I was feeling as he examined my pelvis and abdomen on the screen.  He said that it looked like the fluid was coming back to some degree - it was already at about a third of the level it had been the previous morning pre-tap.  As a result, he thought it was possible I would need another tap in the next day or so, but said that Dr. B would review the results with me.

I headed back out to the waiting area to update my FIL and wait for Dr. B.  She called me back about 15 minutes later and we sat down in a small office to chat and go over results.  She said I'd had about 7 cm worth of fluid in each of 4 quadrants on the previous morning's ultrasound.  As of that morning, I was at 7 cm in one lower quadrant and 4 cm in the other, with some additional fluid around my left lung.  She didn't think I needed another tap yet, but she predicted I would need one sometime that week.  As a result, she wanted me to set up repeat ultrasound appointments every morning and come prepared to do a tap (i.e. no food/drink after midnight, etc).  I mentioned that I might have issues finding someone to drive me every day since my options were limited, so we worked out a compromise.  I could make my ultrasound appointments at the clinic closest to my house (which does not handle procedures); they could then call in my report to the main clinic and if needed, I would find a ride there to do the tap.  On the other hand, if I woke up and was feeling really crappy again, I was to come straight downtown to the main clinic and call on my way to let them know I was coming.  It was going to be a lot of hassle, but if that was what needed to be done, then we would make it work.  Besides, what part of IVF treatment isn't a hassle?  Fortunately, I'd already told my boss I would be working from home most of that week.

She also wanted me to start a blood thinner (Lovenox).  She explained that all the added hormones from the drugs, the OHSS, and now the pregnancy could thicken my blood and raise the risk for things like clots.  It would be a short-term intervention, but she thought it was best to start right away and said that one of the nurses could call it in for me before I left.  Then, she sent me for blood work, which involved several tubes for everything from a chemistry panel and CBC (complete blood count) to hormones (including beta #2) to an assessment of blood clotting times.  After that, I was free to go.  I met my FIL back in the waiting area and told him I'd been examined, given a new prescription, and stabbed with another needle, but that I didn't have to have a tap that day.  And then we went to Dunkin Donuts to get some breakfast before heading home.

I picked up my Lovenox later that morning.  The Walgreens pharmacist seemed concerned since it was an injectable (sub-Q) and asked whether or not I'd had proper training from my doctor on administering it.  I stared at her thinking, "Lady, if you only knew...".  Instead I responded that yes, I knew what I was doing, having just been through a full IVF cycle, and no, I didn't have any questions.  As I drove away with my bag of pre-filled syringes, I pondered that for most people, being stabbed with one (or more) needles on a daily basis is not normal.  Interesting how quickly it had become normal for me...  I did my first Lovenox injection as soon as I got home.  Dr. B said I should do them once a day, preferably late-morning (by which time each day we'd know if I was going to need a tap or not).  It had been a while since my last belly shot, and it definitely stung!  Sometime after lunch, Brownie called to give me the results of beta #2.  It was still positive and on the rise!  She asked if I had any questions about the Lovenox and we confirmed the plan for my follow-up ultrasounds.

By later that afternoon, I could feel the fluid building up again.  This time it was lower, concentrated more in the pelvic region.  I was careful to pace myself with eating since I didn't want to end up with that painfully overstuffed feeling.  Paul's shift was only during the day, and then he had a training meeting afterwards.  By the time he got home that evening, I was getting a bit short of breath again.  I told him we would see how I felt in the morning, but it was very possible I'd need to go in for another tap.  We talked it over and he decided to go ahead and call in to let them know he would not be at work the next day.  While it had been fine having my FIL take me to and from my appointment that morning, I really wanted Paul with me if/when I had to have another tap.  We went to bed early that night and I slept fitfully.  The discomfort wasn't the same as before since the fluid was lower.  But there was an achy, heavy feeling in my pelvis and I had to get up to pee several times from all the pressure on my bladder.  By about 6:00 the next morning, I was wide awake and feeling pretty certain that we needed to go straight downtown.  I woke Paul up and called the main clinic while he got ready.  By 6:45 we were on the road.