Questions When Choosing a Reproductive Endocrinologist (RE)
by Cara

The best type of patient is a prepared patient! I was both excited and anxious for my first appointment with my RE. I find I function best when I know what to expect and I stay calm if I am organized. In order to help you through this potentially nerve-wracking first experience, I have prepared a list of tips, questions and expectations for your first appointment with your RE. If you are not satisfied with the answers from the first RE and clinic that you visit, I urge you to keep looking for one that is a better fit.

Tips for your first appointment:

• Bring your list of questions with you
• If possible, have someone accompany you to the appointment–2 sets of ears are better than one
• Take notes during the consultation
• Bring relevant medical records: surgeries, recent pap test, list of medications
• Bring copies of any fertility work up you or your partner have had completed with the OB
• Bring list of concerns/observations about your cycle. If you have a month or two before your first appointment, try charting your basal body temperature
• Do not leave your appointment until all your questions are answered to your satisfaction!

Questions, Questions and more Questions!

About the Clinic

• How long has this clinic been in business?
• What are your office hours?
• What procedures are performed on the weekend?
• Are the Clinic and Lab open 365 days a year?
• How much work should I expect to miss?
• Do you provide pre-natal care? If not when will I be released to an OB?

About Communication

• Who is the case manager?
• Who is available if I call with questions?
• Can I leave a message for my RE? Can I email my RE directly?
• How long will I wait to receive a return call/email?
• Is there a number for off-hours problems?

About the Reproductive Endocrinologist (RE)

• Where did you earn you degree?
• What is your training in infertility? Are you board certified as a reproductive endocrinologist?
• What hospital are you affiliated with?
• Will I always get to see you?
• If not, how many REs are part of the group?
• Will I always see the same nurse?
• Will all my treatment and procedures be performed by you?
• How often will I get to meet with you face to face?
• How open are you to discussing information that I have learned about from other sources?
• Do you recommend counseling?
• Do you have a counselor on staff? If not, can you refer me to one?
• What books do you recommend reading?
• What is your view on alternative treatments (acupuncture, TCM, vitamins)?

About Initial Evaluation

• What tests do you perform to evaluate me/us?
• How long will it take to diagnose my/our problem?
• What specific tests would you recommend to diagnose my infertility?
• How long will you wait from the time of diagnosis to starting treatment?
• What do you see as our first step in treatment?
• If that fails to produce a positive, where do you see us moving next?

About Treatment and Procedures

• Will my treatment be individualized or will you follow set protocols?
• What procedures do you perform at your clinic?
• Which do you perform on-site? Which in a hospital?
• How will you proceed if we have unexplained infertility?
• Do you monitor while on Clomid?
• What kind of monitoring should I expect for other types of medicated cycles?
• During a treatment cycle, how often will I have to come into the clinic?
• What are your office hours for different procedures (ie: Blood tests, ultrasounds)
• If we go to IUI or IVF, can I bring in sperm sample or does it have to be produced in the clinic?
• How long do you stick with a particular treatment before moving forward?

About the Lab

• Do you have a Donor Egg and Donor Sperm programme?
• Do you do Blastocyst transfers?
• Do you do Assisted Hatching?
• Do you do Intracytoplasmic Sperm Injections (ICSI)?
• Do you do Pre-implantation Genetic Diagnosis (PGD)?
• How long do blood tests and other results take to receive? What is the procedure for getting the results?

About Expenses

• Do you have a price list? Can you run through it with me?
• Do your fees include the medications? Injection Instruction?
• Is it possible to set up payment plans?
• Will my insurance pay for the testing and/or treatments?
• Will your clinic help me determine what my insurance will cover?

About Success

• May I contact any of your patients who have had similar treatments?
• What are your statistics for couples with our diagnosis?
• What are your live birth statistics for different procedures?
• How do your statistics stack up against national averages?
• What would account for these differences?

What you might expect from your first RE appointment:
You can expect your first appointment to last from an hour to two hours. You will meet with the RE and your primary care nurse. The RE will ask you about your medical history as well as your sexual history. Check your embarrassment at the door! The more honest you are with your doctor, the quicker he may be able to arrive at a diagnosis and treatment plan. Whenever I feel myself getting embarrassed about something, I think: no matter how weird/abnormal this seems to me, the doctor has certainly seen worse!

At your first appointment your RE will probably order blood tests to check for the following diseases: Rubella (female only), Chlamydia (female only), HIV antibody, Hepatitis B surface antigen, Hepatitis C antibody, RPR (syphilis).

Depending on where a woman is in her cycle, your RE may also take blood to check the following: Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Estradiol, Progesterone, Prolactin, Free T3, Free Thyroxine (T4), Total Testosterone, DHEAS, Androstenedione.

For women, the RE may also wish to perform a vaginal ultrasound to look for any abnormalities, measure ovarian volume and look at antral follicles. The RE will probably order a Hysterosalpingogram (HSG) to be done between days 7 and 10 of the next cycle.

Men may also do a semen analysis, even if they have done one or two before. Be prepared: abstain from sex 3-5 days before your appointment! If the man has had previous semen analyses with abnormal results, the RE may refer him to a urologist. The urologist will order blood work to look at hormone levels, and he may recommend a testicular ultrasound.

IVF (FET or Frozen Embryo Transfer)
by Bea

Why Would You Be Having An FET?

1. Because you had extra embryos left after your fresh transfer cycle. There is a limit to how many embryos can or should be transferred at one time. This limit will vary from patient to patient, for both personal and medical reasons, and also according to the laws and guidelines in your region of the globe. Extra embryos of good enough quality can be frozen for later use. This cuts down the amount of drugs and treatment you need to have to achieve a pregnancy.

2. Because, although you made nice embryos, your fresh transfer was cancelled. This may be the case if you are at risk for ovarian hyperstimulation syndrome.

3. Because you are using donor embryos (which will usually be frozen).

What Can You Expect?

1. First, your specialist will decide on a protocol. In some cases, there is a clear reason for choosing one protocol over another – a post-menopausal woman, for example, will most certainly be prescribed a HRT protocol (see below). Other cases rely on a review of many factors, including cause of infertility, clinician and patient preference, and response to previous protocols. In other words, it’s very complicated and frankly, half the time it’s either hard to know what is best in advance, or it will make little difference to your chances of success either way.

At the basic end, you have the natural FET. You are monitored for ovulation and lining thickness, and embryo transfer is scheduled for several days after ovulation. The exact timing will depend on the age of the embryos at transfer. If you have frozen the embryos at day two, transfer will happen two days after ovulation. If you have frozen the embryos at day five, transfer will happen five days after ovulation, and so on. The idea is to mimic the natural process as closely as possible. As in the natural situation, the timing doesn’t have to be ultra-precise, with studies showing there is up to twenty-four hours leeway.

A natural cycle may be used with or without some form of luteal phase support. Commonly you will be given two or three hCG injections and/or progesterone supplements (pessary-style or injections). Again, protocols for luteal phase support vary wildly, sometimes starting before transfer, sometimes the day of transfer, some continuing until beta (and perhaps beyond if your test is positive), and others continuing only for a set number of days, no matter what.

If you don’t ovulate reliably on your own, your specialist may use an ovulation induction (OI) protocol, in which ovulation of a single follicle is induced (usually using FSH injections). You will either be monitored for a natural LH surge, or triggered with an hCG injection. Transfer and luteal phase support happens as per a natural protocol.

Hormone replacement therapy (HRT) protocols are favoured by some specialists, and for some patients. These use hormone tablets, patches, pessaries or injections to mimic the natural cycle, plus or minus a GnRH agonist/antagonist to shut off your body’s natural control. The simplest and most common protocol seems to be oestrogen tablets until the lining is thick and ready, followed by progesterone supplements, with transfer happening near the beginning of the “luteal” (progesterone) phase.

2. Prior to transfer, your embryo will be thawed out. Fifty to eighty percent of embryos survive the thaw. By thawing the day before transfer, the lab ensures plenty of time to thaw extra embryos if need be. It also gives a chance to see if the embryo will resume growth after thawing – those that don’t are very unlikely to survive inside the uterus.

It’s also possible to thaw a batch of embryos and grow them for a few days prior to transfer–for example, if you have decided to grow day two embryos to blast. An embryo can be thawed, grown, and re-thawed providing it remains of good enough quality.

3. The transfer itself is exactly like a fresh transfer. The procedure is similar to an IUI (which feels a bit like a pap smear) except it is performed in the hospital for easy access to the laboratory where embryos are kept and thawed, instead of in the doctor’s rooms. You are usually given a short period of rest, and your doctor will let you know if there are any other instructions. Some doctors prefer you to rest for a day or more, just on the off-chance this helps, although numerous studies show no benefit to restricting your normal activities for more than twenty minutes after the transfer is done.

Problems That May Arise And Ways To Trouble Shoot

1. Problems with giving medication. Please see trouble-shooting suggestions under subcutaneous injections, intramuscular injections or progesterone.

2. Cysts and other nasties. If a cyst is discovered at the beginning of your cycle, your doctor may want to treat it before going ahead with transfer.

3. Ovulation is not happening or the lining is not thickening. Most of the time, your specialist will simply prescribe extra drugs and continue monitoring. If the problem is severe, your cycle may be cancelled and a new protocol put in place for next time.

4. It’s a natural cycle and ovulation is missed. Your cycle will be cancelled and you will be monitored more closely next time, or placed onto a medicated cycle for greater control.

5. Embryos do not survive the thaw. From personal experience, it is possible to thaw four embryos, one by one, in the twenty-four hours prior to transfer, and almost certainly more, depending on how quickly each succumbs. This is, of course, wrenching in its own way, but as long as there are embryos left, you will not need to worry about your cycle being cancelled.

If none of your embryos survive the thaw, it’s possible to start a full cycle straight away. For example, if you usually start sniffing or around day 21 or so of the cycle prior to EPU, you can start your drugs within a week of your cancelled transfer day.

6. Unusual spotting in the middle of your cyle. If it’s happening in your luteal phase, your specialist may prescribe extra drugs to support the lining. If it happens prior to transfer, your cycle may be cancelled pending investigation – depending on the opinion of your specialist. Unusual spotting is very common, not always explanable or treatable, and can happen even in successful cycles. Having said that, please report it to your doctor immediately.

Personal Tips

A frozen embryo transfer is easier, physically and emotionally, than a full cycle. As you can see, problems do sometimes arise, but most people find things go fairly smoothly until beta day – so please try not to let the above list panic you! There is often some trial and error involved in finding the best protocol for your body. Good luck – and yes, FETs do work for many people!

IVF (fresh cycle)
by Serenity

Why would you be doing In-Vitro Fertilization (IVF)?

IVF essentially means “fertilization outside the body.” People undergoing IVF can have the following diagnoses:

Blocked, damaged, or inoperable Fallopian tubes
Male factor infertility (low count, abnormal morphology, etc)
Women with endometriosis
Unexplained infertility
Immunological issues

In general, an IVF cycle consists of a phase where you will suppress your body’s tendency to ovulate with a GnRh agonist subcutaneous medication such as Lupron, then use a follicle-stimulating medication such as Follitism or Repronex to super-stimulate your ovaries into producing a number of eggs. When you have a number of mature follicles, you’ll “trigger” with a shot of HcG, and exactly 36 hours from that shot, your doctor will extract them in a retrieval which is usually done under general anesthesia. From there, embryologists will take the mature eggs and fertilize them with sperm. Transfers of the resulting embryos (6-8 cells) or blastocysts (multiple cells) take place either three (embryos) or five (blastocysts) days after the retrieval. Any excess embryos or blastocysts from the procedure can be cryo-preserved (frozen) for future frozen embryo transfers (FET).

What you can expect

In general, an IVF cycle involves a lot of needles – depending on your protocol, the agonist repression, follicle-stimulation, and trigger medications are delivered via subcutaneous injections. There are some agonists that can be delivered in an inhaler form – you “sniff” the agonist once or twice a day. But generally you will be required to give yourself daily injections.

When you begin your follicle-stimulating medications, too, you can expect ultrasounds and blood draws every other day and/or every day leading up to the retrieval. Additionally, as you get closer to the retrieval, you might become a little bloated and uncomfortable from the extra eggs that are developing in your ovaries.

For the retrieval, like any other procedure under general anesthesia you will be advised not to eat or drink after midnight. When the procedure is over you may feel some pain from the egg extraction and/or nausea from the anesthesia.

And because a doctor is surgically removing the egg from your follicles, there is no corpus luteum to generate progesterone. So after the transfer, you might also be required to have someone give you daily progesterone-in-oil (PIO) intramuscular injections, depending on your protocol (if you’re lucky like I was, you’ll just get the prometrium suppositories instead).

There are a host of potential side effects of the medications you’ll take during IVF cycle. During the repression phase, you may be prescribed birth control pills, which might cause headaches and PMS-type symptoms. In the stimulation phase, you might feel physically uncomfortable and have headaches (I had massive migraines with my Gonal-F until they reduced my dosage). After the retrieval, expect to stay home from work for a few days – you will be bloated and at least a little sore.

Problems that might arise

The biggest issue that might arise is Ovarian Hyper-Stimulation Syndrome (OHSS), where the follicles after the retrieval fill with fluid and leak into the abdominal cavity and into the chest. Symptoms of OHSS include rapid weight gain (2lbs or more per day), inability to urinate, fullness/bloating in your abdomen, and/or a shortness of breath. Mild OHSS will resolve itself in a few days, though if you get pregnant it might take longer. But moderate and severe OHSS can be life-threatening, though fairly rare – less than 1% of patients end up with OHSS this severe.
However, your doctor will monitor your estradiol levels (E2) via bloodwork just before the retrieval. Levels over 5000 are generally not recommended – if this is the case your doctor may have you “coast” (i.e. skip your injections) for a day to decrease your levels.

Personal tips

Take things a day at a time. I was totally overwhelmed with the number of needles and medication I needed for our IVF cycle at first, so I just focused on what I needed to do that day. Before I knew it my medicines were almost gone.

If you can’t do the injections yourself, have your husband do them. I have no issue with needles and did my own injections. However, most women seem to prefer it if their husbands do their injections, and it’s a nice way to keep him involved.

If you do your injection slowly, chances are you won’t bruise. I found that when I rushed my injections I ended up giving myself a bruise. Slower is better.

Drink plenty of Gatorade after the retrieval to replenish your electrolytes. The more fluid you drink, the better chance you’ll have at healing more quickly.

It takes longer than you’d expect to recover from the retrieval. Granted, my E2 was at 5178 when I triggered, so I had a moderate case of OHSS, complete with a burst follicle. But I couldn’t walk far at all for about 5 days after the retrieval, so I stayed home pretty much for an entire week. Just be prepared that you’re going to be uncomfortable and might need to stay home and rest up.

IM injections
by Lisa

Why would you be doing an IM injection?

While most of the stimulant drugs are administered via sub-cue injection, some injections, including progesterone in oil (PIO) and some “trigger” shots (Human Chorionic Gonadotropin, or HCG) are given by intra-muscular (IM) injection.

What to expect

For those of us scared of needles (even despite administering hundreds, if not thousands, of sub-cue injections), the prospect of an IM injection can be utterly horrifying. The needle is 1 ½ inches long and often 22 or 25 gauge (remember that the lower the number, the thicker the needle so an 18 gauge is much thicker than a 25 gauge needle.) But take it from a recovering needle-phobe, these injections are actually much less painful than the size and gauge of the needle would indicate.

As with any injection, get everything ready beforehand: extra needles, gauze pads, and, for IM injections, plug in a heating pad for post-injection. I always iced the area for 5-10 minutes (sometimes 15 when I was particularly nervous!) beforehand. I know people who didn’t ice the area beforehand—they are much braver than I, but it just goes to show you that it is possible to do without icing. Do what makes you feel most comfortable.

Often, you will draw up the medication with a larger (18 or 22 gauge) needle, and will then switch to a smaller (22 or 25 gauge) needle for administration. Since it is extremely thick, PIO typically needs to be drawn up and administered with a thicker needle. You can administer it with the thinner (25 gauge) needle, but it will take a little longer to inject the oil and I personally never felt any difference between the 22 and 25 gauge needles, so if you want the needle out of you as fast as possible, go with the thicker (22 gauge) needle for administration.

A couple of things to remember: first of all, switch needles after drawing up the medication and before administering it, even if you are using the same size needle to draw and administer. The needle can get just a little bit dull after it is placed into the vial of medication, and you want as sharp a needle as possible for administration—dull needles hurt a lot more than extra sharp ones! Also, remember to tap all air bubbles to the top of the syringe and depress the plunger a small amount to get the bubbles out (I usually pushed the plunger until a tiny bead of the medication came out of the tip of the needle, which indicated to me that the air was out.)

Now, for the dreaded injection. IM injections must be done in the large muscle of the buttock. To locate the correct area, imagine the buttock is divided into four areas (like an x/y axis). The injection should be given in the upper, outer portions. Another easy way of locating the correct area was demonstrated by my nurse: place your hands on your hipbone, with your thumb pointing toward your butt crack and your other fingers on the front of your hip, with the area in between the thumb and forefinger flat against your hip bone (like you’re putting your hands on your hips). The injection can be given below the thumb, but not past the tip of the thumb—that area gets close to your sciatica nerve and you want to avoid that area.

The easiest way to administer the injection is to have someone do it for you. However, it is possible to do it by yourself—I traveled on business during the 2ww and had to do it myself two nights in a row unless I wanted to as a business associate to help me (granted, she is also a good friend and knew about our IF treatments, so she even volunteered to help if necessary but I just couldn’t bring myself to have her injecting me in the butt.)

If you have someone to do it for you, the easiest position is to lean against a counter and put all of your weight on the leg opposite the side of the injection (you should alternate sides each night from left to right to avoid over-irritating one side). Don’t look back. The person administering the injection should hold the skin taut with his/her thumb and forefinger of the hand not holding the syringe, and should be holding the syringe in the other hand like a dart. Have the other person count to three if you’d like, and then go in at a 90 degree angle as quickly as possible­— you will feel a slow injection more than a quick one, so make sure they go quickly.

If you are doing the injection yourself, find a comfortable position where you can hold the needle steady and still keep all weight off of the side you are injecting. I leaned against the counter similar to when my husband did the injection, but you can also try sitting in a chair and leaning to one side. Twist yourself around so that the hand not holding the needle holds the skin taut between your forefinger and thumb. With the other hand holding the syringe like a dart, inject as quickly as possible at a 90 degree angle.

Once the needle is in (make sure all 1 ½ inches are in the skin/muscle), pull back the plunger just a small amount to make sure there is no blood, which would mean the needle is in the incorrect position. IF you see blood, DO NOT PANIC. Simply pull the needle out slowly, attach a new needle, and inject again in a different location. You do not need to discard the medication because of the blood. The blood is your own and can be re-injected (with a clean needle) along with the medication. I have a friend who wasted a lot of PIO because she thought she had to throw it away if she drew blood.

If there is no blood in the syringe, slowly depress the plunger to inject the medication. When done, quickly pull the needle out in a straight line. Do not panic if you have a little (or even a lot) of blood coming out of the injection site—just put pressure on with a gauze pad for a minute or so and the bleeding will stop. You can put a band-aid on the area if necessary.

Massage the injection area to help spread the medication (especially PIO) around. I always put a heating pad on the injection area for 10-15 minutes after the injection, especially with PIO because the heat can dissipate the oil so that it does not harden in an uncomfortable lump. I also made sure to walk around a bit to avoid any muscle soreness and, for PIO, to further spread the oil around. The few times I did not use a heating pad and/or walk around after the injection, I felt more soreness the next day.

Some problems that might arise (and ways to troubleshoot)

As mentioned above, there is always the chance that you will hit a blood vessel and draw blood when you draw back the syringe. Do not panic—just withdraw the needle, make sure to change the needle, and re-inject in a different spot.

You may also experience soreness—some people experience more soreness than others. The best ways I found to eliminate, or at least reduce, soreness was to consistently use a heating pad after the injection, massage the injection area, and walk around a bit. Soreness is more likely with PIO because the oil has a tendency to coagulate in the muscle and cause an uncomfortable lump. Massage, heat, and moving around can help the oil spread out and prevent these lumps.

Finally, there is a chance that you could hit a nerve when administering the injection. If you are careful, this will not happen (it never happened to me). To avoid this possibility, make sure you are giving the injection closer to the hip than to the middle of the buttocks. Remember the “thumb” rule mentioned above—put your hands on your hips with your thumbs pointed towards the back, and do the injection below the thumb and not past the tip.

My personal tips

I covered my personal tips above, but one additional tip would be to have a nurse do your first IM in
jection, if possible, with your significant other (or whoever will be administering your injections) present. We did this for our first IM injection and we both felt better knowing that a professional had gone over the procedure before we tried it ourselves. Remember, I was needle-phobic before this whole IF journey, and I found the IM injections very easy. I almost preferred them to the sub-cue injections because they were actually less painful (stung less than the stim drugs). So take a deep breath and just do it. You’ll realize that it isn’t as bad as you are probably imagining!

Ovarian Hyperstimulation Syndrome (OHSS)
by Bronwyn

Why would you be dealing with Ovarian Hyperstimulation Syndrome (OHSS)?

Because you have undergone controlled ovarian hyperstimulation – either for IVF or IUI. Every time you undergo controlled ovarian hyperstimulation there is a small degree of risk. However, your symptoms are likely to be very mild, involving only a minor degree of swelling or discomfort. OHSS usually starts a couple of days after an egg retrieval – although, like everything, this can vary and your symptoms may start earlier or later.

Factors Which Increase Your Risk

1. Lots of follicles and high estrogen levels. This is the biggest risk factor, and one of the reasons why more isn’t necessarily better. You may be “coasted” to reduce the number of follicles/estrogen levels.
2. hCG seems to trigger, prolong, and increase the severity of OHSS. If you are at very high risk, your retrieval may be cancelled because the hCG trigger injection will be deemed too dangerous. If you are at slightly lower risk, you will be asked to trigger and undergo retrieval, but your transfer will be cancelled to avoid pregnancy in that cycle and the embryos frozen for later use.
3. Low body mass index. For some reason skinny women are slightly more at risk. No-one knows why.

What You Can Expect

Symptoms: Pain or swelling of the belly. Decreased urine output and pain when urinating. Nausea and vomiting. Thirst. Shortness of breath. Sudden increases in weight.

The average case lasts seven to ten days. Unfortunately, there is no way to make the OHSS go away. Instead, you need to support your body until the hormones settle down. Most of the time, adequate monitoring and treatment can be given at home – this is discussed in more detail under “troubleshooting”. If your symptoms become too severe for at-home treatment, you will be admitted to the hospital. Although the principles of supportive care and monitoring remain the same, both will be more aggressive for in-hospital patients.

Treating OHSS

1. Keep up the fluids. You will be losing fluids into your abdominal cavity. If you can’t keep up with this loss by drinking fluids, you will be put on an IV drip.
2. Keep up the proteins. You will also be losing proteins into your abdominal cavity. If eating protein-rich foods and drinking protein shakes isn’t enough, you can be given albumin via a drip. 3. Control pain. The type of painkiller you need will depend on your level of pain.
4. Control nausea. Anti-nausea medications may be used.
5. Control shortness of breath. Mild shortness of breath can be treated with rest. In more severe cases, intranasal oxygen may be used.
6. Maintain organ function and treat specific complications. If the pressure in your abdomen is too great, an in-dwelling tube can be placed under local anaesthetic to drain some of the fluid away. As the proteins in this fluid are lost to the body forever, and cannot be resorbed, this will only be done if the benefits are thought to outweigh the risks. If you are having trouble emptying your bladder due to the enormous swelling of your ovaries, you may need an in-dwelling urinary catheter placed. Other specific complications are treated as they arise.
7. Maintain circulation. You may find that fluid collects around your lower body. Flight socks can be used to prevent swelling around the calves. Heparin injections and aspirin may be prescribed to lower the risk of clotting and thromboembolism.

Monitoring OHSS

1. Daily weight checks.
2. Measurement of urine output and fluid intake.
3. Daily blood tests for in-hospital patients.
4. Monitoring vital signs for in-hospital patients (heart rate, respiratory rate, oxygenation, temperature).
5. X-rays and ultrasounds may be used for some in-hospital patients, depending on symptoms.

After OHSS

Most clinics advise taking a cycle off to allow your reproductive system to get back to normal. Opinions do vary, though – some specialists are willing to do an FET the very next cycle, and others advise a longer wait of several cycles. Most patients find their next cycle is longer than usual. It’s common to be anything from two to four weeks late in the cycle following OHSS. The cycle after that may also be prolonged.

Ways to Troubleshoot

You should report any and all symptoms to your specialist. This is important! Simple treatment for mild cases: 1. Drink plenty of fluids. Electrolye drinks (sports drinks) and protein shakes (eg sustagen) are especially good. This is because your body is losing fluid, electrolytes and proteins into your abdominal cavity. High-protein foods, such as chicken, are also recommended. 2. Take pain killers. Doctors usually prescribe paracetamol/acetominophen plus or minus codeine for mild pain. If these don’t work, consult your specialist. 3. Rest up. I promise this will make you feel better. 4. Monitor your symptoms. Check your weight on the bathroom scales each morning. Report any sudden increases in weight. Measure your waistline. If you are putting on inches each day, talk to your clinic. Take note of your urine volume. If it’s decreasing, or if you find you are going to the toilet very frequently without passing much each time, contact your clinic. If any other symptoms arise – nausea, vomiting, shortness of breath etc – contact your clinic.

Personal Tips

1. Don’t be afraid to talk to your clinic about your symptoms. If your symptoms are changing and progressing – talk to them again. Better safe than sorry.
2. OHSS is tough mentally and emotionally. There are an awful lot of hormones involved, and you are genuinely sick, which is frightening. The fact no-one can tell you how long it will last is frustrating – will it be a few days or will you be that rare patient whose symptoms go on for over a month? Supportive treatments, especially IV albumin, can make you feel better temporarily and lead you to think it’s all over – until they wear off. This is very different from illnessess or injuries you may have had in the past, where each day you can feel yourself getting a little bit better. With OHSS, you may be getting worse each day, or feeling up and then down again, with no clear ending in sight. Please remember almost everyone gets better in seven to ten days. During my ten days in the hospital, a couple of things were said to me which I clung to. A nurse said, “You will get through this – hour by hour, day by day, moment by moment.” And another said, “You’ll never stop putting yourself through these things for your kids.”