Oocyte Retrieval: "In very rare cases..."

Thursday morning I woke up with plenty of time to get dressed and send out a quick email for work, but made sure not to leave too much time that I would want to eat something. Considering how full I felt from the follicles and large ovaries, I wasn't really hungry anyways. They took me and C pretty quickly into the back room where my medical history was reviewed. My mom is a nurse anesthetist and one of her good friends and former colleagues now works at the center where my procedure was and agreed to give my anesthesia. It was very nice to have a friendly face with me in the OR and the last thing I remember is talking about how her children are doing now, as I used to babysit them when I was in high school.

The next thing I remember is some voices and then eventually opened my eyes to look at the clock on the wall, almost exactly an hour from when I went into the OR. C was there and his calm presence was comforting. I can't remember who I heard from, but they pretty quickly informed me that 23 eggs were retrieved! I was floored, as the largest count I was ever given in the monitoring appointments was 20. They weren't able to tell me how many of these were mature so I just assumed that half of them won't be mature enough and not all of those will fertilize. I was am still focusing on having low expectations to hopefully curb the disappointment, which clearly had worked for me up to this point.

I felt really sore in my shoulders and abdomen, as if spent all time under anesthesia doing crunches and should raises. The shoulder pain was what surprised me, but the nurses told me that this was pretty normal and weren't concerned. They were a little concerned that I couldn't urinate. I tried at least three times before I was able to produce anything, each time sitting calmly and relaxing on the toilet and running the water in sink to hopefully stimulate things. Despite feeling totally relaxed, the urge to urinate was completely absent. They told me that my bladder was likely descended from all the fluids I was given and the longer I went without urinating the harder it would be. Finally I was able to produce enough to fill one of those urine cups (I estimated) and we all agreed that this was enough to let me leave. They went over all the discharge papers with C and they instructed us to call if there were any concerning signs, but that some pain and discomfort was to be expected.

C drove me home and put me into bed. The only way I could be comfortable was with all the pillows in the house propping me upright to a nearly fully sitting position, which was not so comfortable for sleeping. He had to run to campus for a few hours and I felt OK as long as I didn't move. My dad was home and he came to check on me in the afternoon. I couldn't get up without extreme pain shooting from my shoulders down through my pelvis. It felt like this whole part of body was having a Charlie Horse, or extreme muscle cramping, and then would then completely lock up so that I couldn't move. As long as I didn't move, I felt OK, but I still couldn't take full breaths without having pain near my diaphragm. My dad helped me to the bathroom again and then he had to go out to run some errands. I figured that I would just stay put and be fine. Discomfort was to be expected, although I was beginning to be concerned about how I was supposed to get to the work the next day. I remember jokingly asking my mom if she could steal some heavier narcotics from work because the medication they gave me wasn't doing anything.

C arrived home and I was doing OK in my upright position and taking slightly shallow breathes. Until around 6:30 in the evening when, completely out of the blue, my whole body cramped up and pain shot from my shoulder through my pelvis and wouldn't let up. I wasn't able to breath in regular breaths without excruciating pain and it felt like I wasn't getting enough air. Imagine the worst leg cramp you've felt, but in your chest and abdomen. My dad had just arrived home and they decided to call the ambulance because I couldn't move enough to get into a car. The paramedics were able to get me out from my bed with a combination of carrying and walking. In the ambulance they determined that my heart rate was normal but very elevated and that my oxygen was a little low so I got some O2.  They weren't able to get in an IV because of my tiny veins, dehydration, and the fact that I'd been stuck so many times this past week that most of the "good" veins had scar tissue.

Getting in an IV was also an issue once we got to the ER and it took over two hours for them to get me any pain medications. Luckily, the spasming had subsided and I was back to my normal amount of pain as long as I didn't move an inch. Unfortunately, this wasn't conducive for them to move from the gurney to the hospital bed, examine me, take a chest x-ray, or especially attempt to do an ultrasound. Each of these activities reactivated the spasms and the medications they were giving me were not even touching the pain. Within the first six hours of the ER and ultimately hospital stay, I had been given IV doses of Percocet, Oxycodone, Morphine, and Dilaudid and felt no effect from any of it.

Testing came back to indicate that I was having internal bleeding from my right ovary. The blood and fluids were causing increased pressure in my abdomen, which was causing the pain. Apparently there is some nerve that travels from your shoulder to your abdomen, which is how the shoulder got involved. Luckily, blood work came back relatively normal so they were hopeful that the bleeding would get reabsorbed on its own and would not need an additional surgery. I ended up being admitted at the main hospital (requiring another bumpy ambulance ride) for monitoring and pain management.

The pain management finally seemed to arrive around 9am the next morning, a full 15 hours after the most severe pain began. They explained that all the drugs needed time to catch up to severe pain, which is why the first several doses of their most serious stuff weren't doing anything. Eventually I did notice some relief with the Dilaudid and Morphine and they even sent me home with oral Dilaudid, which I've heard is some pretty serious stuff. By the late afternoon, my vitals and blood work had all stabilized without the need for any additional intervention or surgery, and I was cleared for discharge.

Two of the RE physicians came by, along with the RE Fellow and an OB resident, so I felt very well cared for once being admitted (the ER was another story and is a lovely testament to how little even medical professionals know about IVF). They explained to me that this is a complication from IVF seen in approximately 1 of 800 cases, and was further complicated by the fact that I have PCOS and large ovaries. They were all very confident that this shouldn't affect my transfer, which is something I probably asked at least six times to anyone I thought might know the answer.

The story, as far along as we are into it, does have a happy ending. While in the hospital, the lab called and left message. Of the 23 eggs retrieved, 13 were mature. They injected (ICSI) the thirteen mature eggs and then allowed the others to be inseminated. The grand total of eggs that were fertilized by the next day: 15!

I'm at home resting now. I called off work for both Monday and Tuesday to give myself more time to recover. I am still very sore and not walking normally, but generally feel much more human than before. Hopefully this is the most excitement I get until of the pregnancy test.