I called the clinic Friday afternoon and asked to speak to one of the nurses about my symptoms - mainly the discomfort that was getting to be a problem. She said I should probably come in for an ultrasound just in case. Like me, she didn't think I fit all the criteria for OHSS, but said it would be best to have it checked out. I was fine with that, even though it meant getting up before the crack of dawn to drive downtown on a Saturday morning for a 7:00 a.m. appointment. She also said I should not have anything to eat or drink after midnight in preparation for the
unlikely event that they would need to do a pelvic tap. But she really didn't sound concerned about it and as we were wrapping up the conversation, she casually mentioned that it probably meant I was pregnant.
PREGNANT! No one had used that word yet, even in theory, and it caught me off guard. Unfortunately (or fortunately, depending on how you look at it) I was in enough discomfort that I wasn't able to obsess over it much. I drove home after work (pants unbuttoned
and unzipped - classy!) and promptly changed into sweatpants. We had a BBQ to go to at B's house that night. I didn't really want to go, especially since I knew I'd be tempted to eat too much. But we went anyway and made it an early night.
Saturday morning, we headed into the city bright and early. A radiology tech (one I hadn't seen before) took us back for the ultrasound. I described my symptoms to her: slight shortness of breath with even light exertion, difficulty taking a deep breath, feeling painfully full after only a small meal, and of course, the tightness and bloating that were making me very uncomfortable. I mentioned that I was mainly concerned because it had been better and then got worse again, and that it seemed like the bloating was higher up than before - more abdominal than pelvic. The tech nodded and said it was likely that I had some fluid in there, especially since they had seen a little during my stimulation period and they had retrieved a LOT of eggs, which raises the risk. She explained that in most cases, after the stimulation period is over, the ovaries shrink back down (over the course of several days) to their normal size. But in rare cases (6-8%), they don't shrink and may even get bigger. When that happens, they become leaky and fluid starts to seep into the surrounding body cavities. The fluid can build up and put pressure on other organs and tissues, as well as cause bloating, etc. And then she said the P word. She said that most of the time, when symptoms worsen after embryo transfer, it is because pregnancy exacerbates the situation.
She had me lay back on the table and pull up my shirt. Apparently it was another external exam. The ultrasound took a while. She slid the probe all over the place and took a lot of measurements. While examining around my rib cage and lungs, she told me when to take a deeper breath, hold it, or breathe normally. After about 10 minutes, she gave us the verdict. I had fluid. A lot of it. Definitely not the most she'd ever seen, but enough to explain my symptoms. She said we basically had two options: 1) she could take me over to the procedure area and they could do a tap to drain as much of it off as possible, or 2) we could wait and see. She explained that even if they did the tap, a lot of my fluid was higher up in my abdomen (as I'd suspected!) and they would be relying on gravity to pull it down to the pelvic area to be drained, so they might not get as much. And because my ovaries were still huge, the fluid would come back and pretty quickly. In other words, I could be coming in almost every day for a tap. Basically, there is no "cure" for OHSS and the tap is only meant to give temporary relief in extreme situations. Alternatively, we could wait and see whether or not it got worse. If it did, I could change my mind and come back for a tap another day. If not, I could just tough it out and wait for my body to figure out what to do with the fluid (i.e. absorb it back into my bloodstream to be sent to the kidneys). The bottom line was that if I
was pregnant, the giant ovaries were there to stay, at least for most of the first trimester. She then said that while she couldn't tell for certain, if she were a betting woman, she would be that I was pregnant.
I glanced over at Paul and he raised his eyebrows at me. Part of me really wanted to be excited by her statement, but part of me also wanted to scream at everyone to stop saying that I was
probably pregnant and that
in most cases OHSS this late in the game is actually a good sign. I was already in the minority of women who can't get pregnant the old fashioned way. And now I was in the minority of those undergoing IVF who develop OHSS. Who was to say I wouldn't
also be in the minority of IVF patients who develop late-onset OHSS and turn out to be
not pregnant? As they would say in
The Hunger Games, the odds were
not really in my favor. At least that was how I felt.
Meanwhile, we had a decision to make about the tap: to have it or not. The tech had also mentioned that many of her patients find relief from OHSS through acupuncture. Since I already had an appointment set up with my acupuncturist on Monday, part of me wanted to go ahead and get the tap so I could feel better until then. But she cautioned me that it was unlikely the relief would last that long. At the same time, she had pointed out that I was actually doing pretty well given the amount of fluid that was already in there. Patients with severe OHSS, she said, come in looking like ghosts, barely able to walk and unable to carry a conversation. By comparison, I looked fine, walked fine, and talked fine. In my condition, I could probably make it to my acupuncture session by just sucking it up on my own. And if things got worse, I could always change my mind and come back.
After some debate, we finally decided to wait on the tap. The on-call doctor for that weekend (Dr. S who had done my retrieval) came in to listen to my lungs and heart and discuss our decision. He echoed everything the tech had said and assured us he was just a phone call away if things worsened. He then sent me over to the lab to get weighed and have my vitals checked before we left. The ride home was particularly unpleasant. It felt like every bump in the road sent the fluid sloshing around, which made my stomach hurt. In addition, I had a MAJOR hot flash, which made me shaky and nauseous. I ended up laying in the passenger seat at a 45 degree angle with all of the air vents blasting icy cold air conditioning on me while I sobbed uncontrollably for about 15 minutes. I wasn't even sure why I was crying at the time. Looking back, it was probably a combination of feeling like crap, wondering if we'd made the right decision about not doing the tap, and being torn between excitement that it might be a positive sign and fear that my upcoming beta would be negative. Now that I think about it, I'm not surprised I had a meltdown. I was overdue for one anyway.
By the time we got back out to the suburbs, I had pulled myself together enough to realize I was starving. We stopped at a Dunkin Donuts and I got a breakfast sandwich and my allotted cup of coffee. Back home finally, I crawled back into bed for a nap while Paul headed over to the fire station. He's part-time/paid volunteer at our local department and was supposed to be on shift all day. I slept the better part of the afternoon, although it wasn't a particularly restful sleep. It was hard to find a position that was comfortable to lay. If I laid on one side for too long, the fluid would collect on that side via gravity and start to get painful, so I'd wake up and have to readjust. At the same time, rolling over to shift positions was becoming increasingly difficult - it was like my core abdominal muscles just stopped working. Eventually, I gave up on napping and dragged myself to the store to pick up stuff to take to the fire station for dinner. It was Cinco de Mayo so I got stuff for quesadillas. I was able to eat two, very slowly over the course of a couple of hours. I told Paul I felt like I was getting worse. My trip to the grocery store had left me pretty winded, and I was starting to notice some shortness of breath when talking. He'd noticed as well.
That night I slept terribly. I was restless and uncomfortable, and the few times I actually
was asleep, I woke up needing to pee. The fluid was pressing on my bladder, making me feel like I had to pee all the time. I got up rather early Sunday morning, seeing as sleep wasn't happening anyway, and staggered out to the couch. I could tell right away things had gotten worse. It hurt to stand up all the way - my torso felt swollen and tight. I got short of breath just walking out to the living room. My head was throbbing and my back hurt from laying in whatever odd positions had allowed me to get an hour of sleep here and there. I planted myself on the couch and watched
Friends reruns on TBS for a couple of hours. I tried to call my mom to give her an update and had a hard time stringing together more than a sentence at a time without stopping to catch my breath. Paul called to check on me around noon and could tell right away that I was worse. He was on shift at his full time job that day. An hour or so later, he texted me to say he was on his way home. He'd talked to the officer on shift and they let him take emergency personal leave to come take care of me. Once he was home, about mid-afternoon, I called the clinic's answering service to ask them to page the nurse on-call. She called back to discuss my condition, which had definitely deteriorated from the previous morning. In addition to all my symptoms worsening in severity, I'd been weighing myself almost hourly and, to my alarm, had gained almost 7 pounds since my weigh-in at the clinic the day before.
The on-call nurse said to plan on coming in first thing the next morning for a tap. She said they would prefer I not go to the ER before then, unless I absolutely had to, since most ERs aren't staffed with fertility doctors and don't regularly handle OHSS cases. She also gave me the same spiel about limiting my intake of fluids (particularly plain water) while staying hydrated with electrolyte-containing drinks and eating salty foods. I'd been doing all that since my retrieval, but promised to keep it up. By that evening, I was short of breath even sitting and not talking, and had to have help getting up from a sitting position. B came by to hang out for a bit and was kind of horrified by my condition. Sunday night was rough. I didn't think I could handle laying flat in bed, so my wonderful husband made up the recliner in the basement for me and the couch for himself. I dozed off and on without ever really falling asleep and was mostly relieved when the alarm went off at 4:45 the next morning. Since it was a Monday and there would be rush hour traffic, we left the house by 5:30. It felt like the longest ride
ever. I was so miserable and exhausted that I almost didn't remember it was May 7 - the day I was supposed to have my first beta test.
