I stumbled across one of those anti-ART blogs recently. It was an accident, I swear. Anyway, it was banging on about donor eggs and how it shouldn't be allowed. Mostly because infertility is not a medical condition deserving of the same treatment as other medical conditions and egg donation is akin to giving up your child and therefore against God's will (didn't get around to her views on God's will in adoption, no), but also because there is a medical risk to donors.

I can only imagine this argument referred specifically to women who feel pressured to donate (eg women from poor socioeconomic backgrounds who are under huge financial pressure), because I can't for the life of me see what business it is of the legislators if I, of my own free will, provide informed consent to undergo such a procedure with its attendant risks. So with that in mind, and because she linked to a personal account of OHSS as "proof" of her argument and I have one such account on my blog, which could potentially be used the same way, I'd like to clear up a few things about OHSS and egg donors.

1. You can see it coming. We chose to proceed with egg colllection (EPU) despite knowing I was at risk. I would never have made this choice if it was someone else's body taking the fall - both out of respect and care for the donor who is prepared to give us such a precious thing, and for the selfish reasons that OHSS creates the risk to me of lower quality or immature eggs together with a donor who doesn't want to do any more cycles.

As soon as you are identified as being at risk for OHSS you can choose to mitigate that risk by cancelling the cycle before pick-up. After waiting for things to settle, your doctor will adjust the protocol for the second try.

2. Pregnancy and/or hCG as luteal phase support is a huge risk factor for OHSS. Neither of these risk factors apply to a donor. Therefore, the risk of moderate or severe OHSS in egg donors is not at all comparable to the risk for the general population of women undergoing IVF (which is already very low - around 1-2%).

3. Newer protocols have been/are being developed which reduce or eliminate the risk of OHSS. I believe in the near future this argument will be a moot point. If you're busy constructing a thesis against egg donation as we speak, you'd be wise not to rely on OHSS to back yourself up.


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(Also, point to note, not everyone shares your religious views. See also "separation of church and state", "independence of nations", "mainstream Christianity". Plus, you are wrong about the medical condition thing. And if there's a large body of women in your country who are under real financial pressure to donate eggs, frankly, it's a disgrace to your social welfare system and not a problem with the assisted reproduction industry at all.)


I've got this notion in my head where the 2006 section of this blog won't be complete unless I go back and fill in the blank that was the stim cycle we kicked off in January. I got OHSS. I thought I might tell you about it.

Then I wrote this long piece of self-indulgent drivel describing everything I can remember from the first moment I felt my ovaries twitch until the day of EPU, and it was kind of huge already before I even started on the bulk of the story, plus it was, like, months ago so who would be interested now?

Then it occurred to me that I was interested and it is, after all, my bloody blog, and besides what if someone drops by one day wanting to know something about OHSS and there's nothing here?

In the end I wrote this.

Risk, Reponse, Pain, Morphine,
Eating and Sleeping,
Raving, Relief, Forgetting



Risk
FS decided that, on balance, it would be best to go ahead with EPU and cancel ET, but that's not the only way we could have handled it. Some clinicians would have cancelled altogether, prior to trigger. Others would have been gung-ho enough to go full steam ahead. I remember the sense of relief I felt when I realised I didn't have to agree with his approach. I could set a lower level of risk. Ultimately it was in my hands. After due consideration I concurred, however, based on the high likelihood that whatever happened, I would recover.

Response
When I decided to take the risk, I promised myself I would not hesitate to get attention if needed. On the evening of the second day post EPU - the day I would have had my transfer - I unilaterally decided to go to the emergency ward at the local hospital. This was because I'd started vomiting. I handed FS's after-hours number to the young doctor who came to see me and asked her to call him to discuss my treatment, which she did. I was admitted.

Pain
After EPU I woke up feeling less painful than I had for the past week of stims. Two days later the pain was worse than ever. A week post EPU I was lying in hospital during my morning examination, when the doctor asked me where it hurt. I said, "Everywhere," and he laughed and told me this was not possible. Over the next hour or two I played a little game with myself called, "Does My X Hurt?" I started with obvious things: does my pelvic cavity hurt? Yes, of course. Does my chest hurt? Absolutely. (By this time I was on intranasal oxygen as I was having trouble breathing.) Then I moved outwards: does my right forearm hurt? Pinky finger? Scalp? I made a list of parts that didn't hurt. It was surprisingly short, and excluded many bits which had no logical claim to pain. I wondered if my sensors were simply so overloaded I had lost the ability to distinguish where my pain was coming from. It seemed plausible.

Morphine
At first I took morphine, and at first it worked. But as time wore on it became less effective. At the height of my illness, it took only the merest edge off my pain. But I started refusing doses before then, for this reason: it messed with my sense of time. After a dose I might close my eyes and try to rest. What seemed like an hour would go by and I would open them again to find only a couple of minutes had passed. I found I had to make a choice between enduring only 95% of the pain I would otherwise feel, but for a length of time which was subjectively four to ten times longer, or gritting my teeth and enduring 100% of the pain, but in real time. I kept changing my mind.

Eating and Sleeping
I couldn't. In truth, this started within the first week of stims, but it worsened until about a week post EPU. On my third day in hospital a nurse counselled me to force down a cup of milo - the most substantial thing I'd ingested since my arrival - because I was having a hypoglycaemic meltdown. It was good advice. I learnt that forcing myself to eat when I believed I couldn't was not only possible, but would make me feel better. It also helped me catch forty-five minutes of long-overdue sleep. I slept only about two hours a day, in two or three snatches, for the best part of a week. Mostly this was down to restlessness, pain and discomfort, although a week post EPU a night nurse spent some time pleading with me to get some rest, and I confided that my breathing difficulties were making me afraid to sleep. I was literally afraid I wouldn't wake up again. From this I gained the hope I needed to make it through - it struck me that things weren't so bad I wanted to die.

Raving
I told everyone everything without inhibition or regard. My sister (who visited me faithfully every night) gleefully rung me for several weeks after my discharge asking me if I remembered this part of our conversation, and sniggering and gloating when I admitted I did not. At one point I even showed her - up close and personal - my indwelling urinary catheter. She has reliable witnesses to back her story. This was a fascinating experience. It made me understand, for the first time, that the unforgivable things our mother said to us during her cancer treatment weren't merely the angry outbursts of a woman pushed to her limit. They were actual ravings, mad ramblings of which she genuinely has no recollection, and for which she can't be held responsible. I didn't understand this before.

Relief
A week post EPU they punched a paracentesis tube through my abdominal wall under local anaesthetic and drained off a small proportion of the fluid. The first breath I took afterwards felt so much easier I disintegrated into loud, racking, uncontrollable sobs of relief which brought enquiring hospital staff from nearby rooms and went on for a good ten minutes whilst the radiography nurse hugged me and passed me tissues. Twenty-four hours later I started having the curious sensation that I was deflating, like a balloon, and sure enough next morning's weigh-in confirmed that my weight had finally plateaued. During my hospital stay it had shot up by 25%. Fuck. That's a lot. When Mr Bea came to visit me the day after that, I noticed how much less tired he looked, and so did everyone else.

Forgetting
A few days after discharge I was lying in bed at home, enjoying, for the first time in almost exactly a month, the sensation of being able to lie on my side. Already I could feel myself losing touch with the physical reality of the illness I'd had. This speed of forgetting took my breath away. I told Mr Bea then I would do it again, if necessary. He looked startled, and hugged me tight, muttering platitudes about bridges, and crossing them. The final lesson was this: temporary physical pain is nothing to be afraid of. Only the permanent repercussions of our actions or inactions are important. The other day I looked, but I couldn't find my paracentesis scar.


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P.S. I have a big backlog of blogs to read today. Sheesh - it was only a weekend off! Take care - I'll get through them slowly.


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