IVF (in vitro fertilization or "test-tube baby" procedure) seemed both exciting and scary all at the same time. For the first time, we were going to be able to see the eggs and determine whether the sperm could fertilize them. We would watch the embryos grow and divide and pick the best ones. This procedure has a significantly better chance of pregnancy than IUI. It also means undergoing a procedure to take the eggs out. For this, anesthesia is usually given, but afterwards you definitely feel sore. The medications would be the injectables again, and here I had another dilemma. At the time, the highly purified medication that I needed was brand new. We weren't as good at controlling it as we were with the older urinary medication. Therefore, the pregnancy rates weren't as good either. (Now we have tons of experience and have figured out the quirks of genetically engineered and highly purified FSH. So this is no longer an issue.) I wanted my best chance, but I knew it would make me sick. After days of agonizing, I decided I would tough out the fevers and use the urinary medication. I was so desperate to have a baby. That turned out to be a big mistake!
After 2 days on the urinary medication, I knew I was in trouble. The fevers were higher, and I felt like I had the worst flu of my life. I could barely move. I changed my mind and went back to the highly purified medication, but the fevers didn't stop. After 2 more days, I couldn't even get out of bed. I confessed to my doctor what I had done. He was, of course, furious. We decided it was best to just forget the IVF cycle and stop the medication until I was feeling better. I didn't get better, though. After another week of being sick, things got even worse. I woke up from a nap, and it felt like my heart was going to jump out of my chest. I was breathing very rapidly, and my hands and lips were all tingly. I tried to call for my husband, but he was outside. I couldn't get off the couch. I laid there for a while until my husband finally came back. He took one look at me and called 9-1-1.
The ambulance came and took me to the hospital--my hospital, the one I had done my residency in and was now working as a fellow. I wasn't sure if that was a good or a bad thing. I recognize the doctor on call immediately upon entering the ER. We had clashed a few times over whether a patient had a GYN or surgical problem. I thought, "Oh, boy, I hope he still likes me!" He asked me a few questions about what was going on and ordered some labs. As they were being drawn, a new doctor appeared and said that it was now his shift. I had never met him before. He was very kind and very worried. My temperature was 106 degrees and my pulse was 220 beats per minute. He also pointed out that, despite my high temp, I was not sweating at all. Despite drinking all the Gatorade I could tolerate, I was severly dehydrated from the weeks of fever. If he didn't bring my temperature down, I could end up with brain damage. They started pouring in fluids through an IV. I started to feel a little better. Then I became very, very cold! They had only given me a thin sheet, and between the airconditioning in the ER, the lovely hospital gown I was dressed in, the room temperature fluids being poured into my body, and my fever; I felt like I was packed in ice. I asked the nurse if I could have a blanket, and he said he would ask the doctor. After about 20 minutes of shivering and waiting for a blanket, I gave up and cajoled a volunteer into getting me one. I guess I wasn't much of a VIP, despite the fact that I worked in the hospital!
About this time, my doctor appeared. It was one in the morning, and I felt terrible for having gotten him out of bed. I apologized profusely, and he looked at me like I was crazy. I was his patient, colleague, and friend; of course he was going to come in and see me! We talked, and he said that he have never seen a reaction go on this long. He wanted me to see an infectious disease specialist in the morning to make sure we weren't missing something. He said he thought I probably just had "sick-as-hell" disease (a play on words with Sickle Cell Disease), and I smiled and remembered why I had chosen him. He has this amazing calm demeanor and ability to make you smile, even when thing were not going well. A quality I have definitely tried to emulate in my own practice!
I saw the infectious disease doctors, who were baffled as well. They said that they would do some research and get back to us. By the time they called back to say that they hadn't found anything, I was starting to feel better anyway. They said that doctors and nurses always get the most rare and horrible complications, and that was certainly true of me. That didn't make me feel any better.
I was finally back to normal, and I wanted to get going again. It was clear, however, that I was not going to be able to use the highly purified medication either. I had reacted to that, and no one wanted to see if it would happen again! The genetically engineered FSH was available in Europe, but not in the US. The FDA has a program, however, that allows non-FDA approved medication to be given to an individual on a compassionate care basis. This is only done if you can prove that there are no FDA-approved medications that the patient can take, and that the medication is necessary. It involves a HUGE amount of paperwork. Both my doctor and I dove in and started the paperwork. The manufacturer of the new medication also wanted a paperwork filled out. It took 2 weeks to get it all done, but we finally did it. Then started the waiting. Months and months went by, and I didn't hear anything. I called the manufacturer and they said it was "in the works". After an entire year of waiting, I finally caught a break. It didn't come form the manufacturer, though, at least not directly.
At that time, there was only one manufacturer of these types of fertility medication. They were in the midst of changing over all their plants from urinary medications to the genetically engineered one, and it caused a shortage of the urinary medication in this country. The shortage was terrible. Patients had to delay or cancel cycles, because we couldn't get them enough medication to complete the cycle. Finally, the FDA stepped in and said that we could import medication from Europe until the crisis was over. This was my chance! I found a reputable pharmacy in London and had them ship me the medication I needed. I was set!
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