First egg collection and OHSS – what to expect

Before the procedure
We were instructed to arrive at the hospital at 8.40am to complete some paperwork, finalise surgery fees ($500 for the procedure) and prepare for the egg collection. Daniel sat with me for about 10 minutes before he had to go to the IVF clinic down the road to do his part. It’s strange to think that we were in separate hospitals for this whole process!
I was called in by one of the nurses and sat with her in a waiting room. She took me through a few things and I signed a consent form, put hospital tags and hair net on and changed into a gown and robe. I was visited by the anaesthetist, another nurse and then my FS. It was great to see my FS there. He put my mind at ease but also reminded me that I was at risk of Ovarian Syperstimulation Syndrome (OHSS) due to the large number of follicles I had at my last scan. Due to this risk, I knew that it was highly likely we would not be able to proceed with a fresh egg transfer five days later.

OHSS occurs when there has been an over response of the ovaries to the stimulation medications. Women who have PCOS, are aged under 30 years and have 20+ follicles retrieved at egg collection are at higher risk of overstimulating. Symptoms include abdominal pain and distention, severe bloating, nausea, fluid retention, weight gain, vomiting, shortness of breath, reduced urine output and pain not relieved by Panadeine or Panadol.

The nurse then walked me into the theatre and I got onto the bed. My FS was cracking some jokes while we waited for the anaesthetist to arrive which relaxed me but I couldn’t help but notice how many people were in the room. At least I knew I was in good hands. The last thing I remember was my FS holding my hand, telling me everything would be ok and saying “sweet dreams” while the anaesthetist inserted the drip in my arm to put me to sleep.

During the procedure, an ultrasound probe is inserted through the vagina and a needle is passed through the ovary into the follicles. Fluid from each follicle is drained to retrieve the eggs.  

Waking up in recovery
20 minutes later I was in recovery with a heat pack on my tummy. They gave me pain relief almost immediately. I felt sharp pain low in my abdomen but it soon spread all over. I was desperate to know how many eggs had been collected and the first thing I did was ask the nurse. She handed me a note from my FS which confirmed he had collected 25 eggs and that they would be frozen for a transfer at a later date. They continued to give me pain medication. The more eggs retrieved, the more invasive and painful the procedure is. You should also expect a longer recovery time.

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After a little while I was moved to a recliner chair and given something to eat. I felt quite uncomfortable and it was difficult to move. As time passed I was asked to empty my bladder and get changed when I could. The walk to the bathroom was painful. I’ve always thought I had a pretty good pain threshold, but this pain and bloating was a whole different feeling. Little did I know over the next few days, the pain would get much worse and I would gain 7kg of fluid.

Trip to emergency
The nurses discussed my risk of OHSS with me and said they would be monitoring me closely over the next week with daily calls and weight monitoring. They also told me that if the pain got worse and I developed symptoms of OHSS, to go straight to emergency at the Royal Women’s Hospital as it was the Easter long weekend and the clinic was closed. The following night I ended up at the RWH where they gave me pain medication, took bloods samples, measured how much water I drank and my urine output weighed me and measured my abdominal girth. I spent the night in hospital and Daniel was sent home. I was given a prescription for stronger painkillers and was on bed rest until symptoms started to improve. I was also told the pain and bloating would get worse before it got better and that my weight could continue to increase with fluid.

The following week at home
I lay on my back for the next week, barely able to move. I couldn’t sleep on my side, couldn’t sit up on a chair, couldn’t laugh, cough or sneeze and was in agony when I did. I’m not joking when I say I looked six months pregnant. Each night I cried myself to sleep in pain. I’m not one to take painkillers – I need to have a pretty bad headache to take Panadol. Every four hours on the dot, I was taking the next two pills I could. Each morning I weighed myself and my weight was steadily increasing. 1kg, 1.5kg, 1.3kg, 1.2kg, 1kg…..in total I gained 7kg of fluid. I vomited in the first couple of days and my whole stomach was so tender. At one stage, I had a fluid shift which was pretty scary. The 7kg of fluid in my stomach started moving to my sides and back. Wherever the fluid was, was rock hard to touch. It made it difficult to breathe at times and I would get puffed out just from talking.

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severely bloated, carrying 7kg of fluid in my tummy

Daniel was my saviour during these days. I couldn’t walk up the stairs to our bed, so we slept downstairs in our spare bedroom for the week. I would dread going to bed at night. There would be no TV to distract me, no one to talk to, nothing to keep me busy and all I could think about was the pain I was in. I barely slept for the first few nights and was exhausted during the day. Daniel would heat my heat pack every couple of hours, and cater to my every need. Lucky for him it was a long weekend as he ended up pretty sleep deprived too!

I can assure you that if you face OHSS, it does get better with time, even if you think it will never pass and your ovaries feel like they’re going to explode. I promise you that there is light at the end of the tunnel! Rest and take all the time that you need to recover.

Embryos
The day after your collection, you will receive a call telling you how many eggs fertilised. Out of the 25 collected, 19 were mature and 16 were fertilised. They keep a close eye on them in the lab for the next few days. At day five, we had six embryos to freeze.

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First IVF cycle

I was really relaxed when we commenced our first IVF cycle, probably because I had been through months of injections and we were really eager to get started.

There are four potential outcomes when it comes to your scan
1. Poor response – need to increase medication
2. Over response – monitoring for overstimulation
3. Not ready for trigger
4. Ready for trigger

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A glimpse of the drug lab

Injections started on day 3 of my cycle with the aim of having 10-15 follicles for egg collection. They were different hormones and at a higher dose to ovulation induction. I was on 75iu Luveris and 100iu Bemfola every night beginning Thursday 30th March. On Tuesday 4th April I had my first scan for this cycle showing slow growing follicles that were small in size. My Bemfola dose was increased to 137.5iu, while continuing with Luveris and adding in Orgalutran from then until trigger to prevent ovulation. Orgalutran stops eggs from being released too early and is taken at the exact same time every morning. The syringe is pre-loaded and needs a real push to pierce through the skin. It was a much more controlled injection that had a real sting to it.

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Orgalutran

My next scan was on Friday 7th April and although there were an increased number of follicles growing, they remained small and insignificant. Bemfola was increase to 162.5iu and I continued taking Luveris and Orgalutran as normal. I was scanned again on Monday 10th April and the scan revealed I had 20 follicles putting me at risk of overstimulating. My medication dosage was reduced (Bemfola 100iu, stopped taking Luveris) for the final two days of injections. I had already planned to have this week off work as I had lots of time in lieu which turned out to be great timing.

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Bemfola and Luveris

I knew on Monday I would find out what day egg collection would be. It was scheduled for the Thursday. By this stage my bloating was quite excessive and I could barely fit in water and food during this week. It was recommended I have small frequent snacks instead of meals in the lead up to egg collection. I could no longer wear jeans and I couldn’t go to the gym. I was just too bloated, tired and uncomfortable.

Monday and Tuesday I continued my medications at the lower dose with the addition of the trigger injection Pregnyl 5000 on the Tuesday night. Pregnyl controls the release of eggs from the ovary, causing ovulation. It comes in two glass ampoules of powder and liquid that need to be drawn up in a syringe and mixed together. I received a call from the hospital with instructions on the Tuesday night about my Thursday procedure and timing for the Pregnyl trigger. I was told to administer the trigger at exactly 8.40pm, 36 hours before my egg collection. I was to fast from midnight to 6am with only sips of water allowed. No water was to be consumed from 6am until after the egg collection. The side effects I had from the triggers I had during the course of my treatment were bloating and night sweats. There were a number of nights I’d wake up soaking wet from head to toe – to the point I would have to change my clothes a couple of times during the night. Of course, I complained at the time, but these side effects were nothing compared to what I faced after egg collection.

Ovulation induction with FSH injections

The first step for us was timed intercourse with follicle stimulating hormone (FSH) injections. The aim of the injections is to develop follicle/s, stimulating the ovaries to ovulate and allow fertilisation to occur naturally by timed intercourse. I was under the impression that if I can produce an egg there shouldn’t be any reason why it can’t be fertilised naturally. Well, it sure wasn’t as easy as that and we faced six failed cycles.

The aim of this cycle was to produce one or two dominant follicles. We started at a very low dose of Puregon because with PCOS there’s a higher chance of overstimulating (producing too many follicles) which could result in multiple pregnancy and in two of my cycles ‘octomum’ where we had to cancel the cycle. Due to the low dose medication, most of the stimming continued for over 20 days (one cycle was over 40 days so you can imagine my disbelief when my period arrived after being absent for years). It was all very slow and steady with 20+ days of having internal ultrasounds every three days and frequent blood tests to check hormone levels. Regular ultrasounds are necessary to check the number of follicles and their development. Each appointment cost $100 – $130 in addition to the cost of medication. We were lucky enough that our FS only charged us for the first five appointments per cycle. To this day we have spent thousands and thousands of dollars on tests, scans, appointments, medication, IVF – we have a folder of receipts but we have no idea of what we have spent up until now. We just know that one day it will all be worth it.

We were to have sex every second day during the stimming then at a specific window of time once a trigger injection is given for ovulation. There’s nothing more romantic about being told when to and when not to have sex!

Injections are administered in the stomach through an epipen looking device. I’ve never really been fussed about needles but did get nervous about injecting myself for the first time. Daniel is definitely not a needle person and I knew there was no way he would be able to inject me. We watched YouTube videos about loading the pen and injecting the needle. They made it look so quick and easy. To be honest I couldn’t feel a thing when injecting Puregon. It was definitely the easiest and pain free needle with little side effects. After the first failed cycle my FS prescribed Ovidrel as an extra support to stimulate follicle growth. I was taking Puregon every night plus the Ovidrel injection every second night. My fridge was beginning to look like a drug lab.

 

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Puregon and Ovidrel pens
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mixing the powder and liquid for the trigger

I administered injections at 6pm each night. I knew that at this time I would usually be home from work, and if it was on a weekend I could do it at home before we went out. On one occasion we went to see a show in the city and had dinner at a nice restaurant beforehand. I had taken my meds to work with me and left them in the fridge along with an ice pack in the freezer. We had a 5.30pm dinner booked so we could make the show and I knew I’d need to do the injections in the bathroom. As it got close to 6pm I got up with my freezer bag and went into the bathroom. I went in the toilet and locked the door. There was only one unisex toilet and I was freaked out at the thought of people waiting outside. I was nervous and shaky. I quickly did the Puregon injection but in a panic dropped the needle tip for the Ovidrel injection in the bin. I desperately tried to ruffle through the bin (ewww) but had no luck. I quickly left the bathroom to tell Daniel what had happened. He tried to reassure me in his calmest tone that it would be ok and we could just inject the second needle when we got home. I was distracted for the rest of the evening until we walked through the door at home.

Failed cycles
#1 – poor follicle response
#2 – bleeding
#3 – overstimulation
#4 – BFN (big fat negative)
#5 – bleeding
#6 – overstimulation

Our last failed cycle was in December 2016 and we decided to take a break over Christmas before commencing IVF.

 

Balancing work and IVF

One concern I had when commencing fertility treatment was how I would juggle it all with work. I decided to tell my boss early on during my fertility treatment. I honestly think I would have had a breakdown if I went through the whole process without the support of my employer. I think it would have added to the stress if I chose to keep my treatment private.

As we did ovulation induction with injections prior to IVF for approximately six months, I was having scans every three days and frequent blood tests and although my work is only a 10 minute drive from the clinic, it took time to get there, find parking, have my appointment and pick up any meds. I would end up being out of the office for one or two hours at a time. I’m very lucky that I have a flexible workplace with wonderful colleagues and very supportive and understanding management. If ever there are last minute appointment changes or I’ve had to miss an important meeting at work, it’s never an issue. IVF treatment is time consuming and at times very demanding and my absence was never questioned. I think your choice to disclose your treatment will ultimately come down to your relationship with your employer and how comfortable you feel discussing it with them.

There is no right or wrong about working during fertility treatment and IVF. For me, I worked full time during ovulation induction with injections and dropped a day when I commenced IVF. Do what works for you. I know some people who have worked full time and some who have worked part time. Do what you’re comfortable with and what suits you best.

Initial information and IVF costs

After you have met with your FS and all of the relevant testing is conducted, you and your partner will require police checks, child protection orders and will need to participate in a mandatory counselling session where you are given the chance to ask any questions, raise concerns, discuss and sign consent forms. You will also meet with your nurse who will go through with you a detailed example of your treatment plan and visual slides of what happens during the egg retrieval and transfer. Daniel was not impressed to learn of the invasive details! The session went for about 90 minutes and was information overload. We both walked out a little speechless. Know that you don’t need to remember everything that was said during this appointment. Your nurse and FS are always available for questions or concerns and are with you every step of the way. When you get to your IVF cycle, you’re given a thorough plan of what to do each day and at what time. Here is an example of the cycle plan we were presented with at our initial appointment with our nurse.

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The clinic will also get you in touch with someone from the accounts department who will discuss payment options with you. We were given an initial quote of $10,000 – $12,600 per cycle, yes PER CYCLE, excluding the cost of meds and egg retrieval. What a joke!! We had the option of paying the full amount up front at the beginning of the cycle, 50% at the start and 50% at the end or the full amount to be paid after egg collection. We opted for the last option. You aren’t given any notice as to the exact day payment will be taken so don’t be alarmed when your bank account is down $10,000+.

Dealing with infertility

It was no surprise that once we were married, people didn’t hesitate to ask:
“Are you pregnant yet?”
“When are you starting a family?”
“What are you waiting for? Clock’s ticking!”
“Why aren’t you drinking?”

I took it in my stride for a while, told people not to worry and that we’d let them know when I was pregnant. I’m generally a positive and open person but this is one thing that really annoys me and everyone else who is going through struggles with fertility. You never know the situation people are in – they could be grieving a miscarriage, they may be suffering in silence, in the process of fertility treatment or have faced numerous failed IVF cycles. You may not realise the effect this can have on someone but I can assure you they probably want to punch you in the face and tell you to f$*% off. If this can detract one person from asking this question then this post has achieved its purpose!

When you’re trying to conceive, everyone around you seems to be pregnant or having babies. It starts to get to you when you hear of all the teen pregnancies and people getting pregnant without trying, or hearing of parents who neglect their children or hearing people constantly complaining about their pregnancy and kids. It’s obvious they haven’t faced the challenges of infertility. I urge you to think before you speak. Your seemingly innocent questions and comments may be received with a fake smile that’s hiding a deep pain, frustration and stress beneath. The bottom line is whether you’re a family member, friend or just a nosy person in general, it’s really none of your business and if someone wants to let you in they will do so at their own time.

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History

Medical conditions: Polycystic Ovarian Syndrome (PCOS) and Thalassemia Minor (not related to my infertility). Sperm count on the lower end.

PCOS is a common hormonal disorder affecting 12-18 per cent of women of reproductive age. Women with PCOS may not ovulate (release eggs). There are several symptoms that can be present and you don’t need to have all of them to be diagnosed. These symptoms include:

  • irregular menstruation or amenorrhea (no periods),
  • excess facial and/or body hair,
  • acne
  • hair loss
  • infertility
  • ovarian cysts
  • obesity
  • insulin resistance putting you at risk of developing type 2 diabetes

I had my first period quite late at age 15. I always had irregular cycles that were initially 6 – 12 months long. My GP put me on the pill at the age of 17 which masked my PCOS symptoms while regulating my cycles. I was on a variety of different pills over the course of about seven years before deciding to take a break to see if I could have a natural period. Months and months passed with no sign of my cycle. I had heard it could take a little while for your cycle and hormones to return to normal after stopping the pill but to this day, it hasn’t come without medical intervention.

In the years that followed, I had a laparoscopy to check for endometriosis which thankfully came back all clear. I was referred to an Endocrinologist who put me on Metformin to improve insulin levels in the hope of regulating my cycle, but I had no luck. Four years passed and still no period. My Endo did a whole range of testing and came to the conclusion that when we were ready to start a family she would send me straight to a fertility specialist at Melbourne IVF (MIVF). Since our wedding on 25 April 2015, we decided that it would be worth giving it a shot for a few months to see if we could get pregnant naturally.

Approximately five months after our wedding we went to a MIVF seminar where we heard from a number of Fertility Specialists (FS), dietitians and doctors. This is where we first heard our FS speak. Both of us knew straight away that we wanted him to be my FS. The next day I called MIVF and booked an appointment to see him. He has been so amazing every step of the way from our very first appointment and we couldn’t be in better hands. I want to stress how important it is to feel comfortable with your FS and have that ‘good feeling’ about who you choose to share your journey with. It’s personal and invasive and you never know how long the road will be.

Image: Affinity Magazine 

About

Thanks for visiting my blog Road To Mummy.

My husband Daniel and I have been together for 11.5 years in total and have been married for two of those years. We have been trying to conceive for approximately 18 months now. I always had a thought at the back of my mind that we might need assistance with fertility when the time came (you will read more detail about this in my posts). I naively thought that IVF was almost the easy way out – sure it would be a costly and emotional journey, but I had no idea about all the highs and lows faced by so many women going through fertility treatment and IVF. This blog is about our journey from the beginning and the fertility treatments we have endured since trying to conceive. I’ve found comfort in reading blogs and forums and know that I’m in no way alone in this journey. I hope that by sharing our story, I can give others information about what to expect at each stage of fertility treatment, whilst documenting each step in my Road To Mummy.

When undergoing fertility treatment and IVF, you’re juggling life, work, your partner, family and friends while spending hours going back and forth to appointments at the hospital and pathology, picking up medication, having tests, scans and completing endless paperwork. It seems like a never ending cycle. If you’re lucky enough to find some spare time, you generally don’t have the energy or mental and physical capacity to do much else other than watch Netflix and laze on the couch.

Fertility treatment and the anticipation of waiting for each step can totally consume your life. The road is long and tiring and there are so many unknowns. I hold onto hope that one day we will have our miracle.

Vanessa xx

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