First Egg Freezing Cycle: Egg Retrieval

I usually sleep in on Saturdays, but not Saturday, November 23, 2013--that was my egg retrieval day and I had to be at the clinic by 7:30. As instructed, I didn’t have anything to eat or drink, not even water, after midnight the previous night. The clinic had responded to my email about messing up the trigger shot timing (see previous post) and they said not to worry about it. Phew! I hadn’t ruined everything.

My mom drove me to the clinic. You are required to have an adult pick you up after the procedure; they won’t let you go until someone is there to collect you. You are not even allowed to take a taxi.

I was starting to feel pretty nervous. I had never been under any kind of anesthesia before. My big fear was that the anesthesia wouldn’t work properly, and I would be one of those people you sometimes read about who feel pain during the procedure but cannot alert the doctors. Never mind that for egg retrieval I was not even going under general anaesthesia; I still had this fear.

A really nice nurse I had never seen before called me back and started going over the procedure with me. We sat in a little room while she explained what would happen, the risks, etc. and there was another consent form for me to sign. While she was talking, I started to feel woozy. A little dizzy, sweaty, then the room started to go black. “I’m not feeling so good,” I said and she said something like, “I was wondering about that, you were starting to look a little pale.” I told her I would like to lie down. She called for another medical assistant and the two of them walked me over to the pre-op area so I could lie down. I started feeling better almost right away. I couldn’t believe it--nothing had even happened yet and I was so nervous that I had managed to almost faint!

I was asked to change into a gown; I could keep my bra and socks on. The nurse put an IV into my arm. This was the first time I’d ever had an IV, and it didn’t hurt as much going in as I had thought it might. Then the anesthesiologist came to talk to me. He asked if I had had this procedure before (I hadn’t), asked if I’d had anesthesia before (I hadn’t), asked if I was on benzodiazepines (I wasn’t) and if I drank a lot (I don’t). Then he explained that he would be giving me Versed and Propofol, the “Michael Jackson drug.” He assured me that unlike in the case of Michael Jackson, I would be carefully monitored the entire time.

Next a fellow came to see me and ask if I had any questions. I didn’t. Another medical assistant came to see me, and she recognized me from years before and asked if we had gone to high school together. I didn’t recognize her face but I remembered her name and realized that we had actually gone to middle school together. I could tell from her rings that she was married. I didn’t ask about kids. Crazily, I felt a little jealous that she was married and therefore wouldn’t be needing to undergo egg freezing like me.

Soon I was moved from the pre-op area to procedure room. The stirrups setup was a little different than at a normal gynecologists exam; the medical assistant from my middle school had me drape my thighs over some sort of metal support. Then she placed warm, wet towels over my legs. The anaesthesiologist gave me some Versed through the IV and asked if I was feeling it. I didn’t notice anything and asked him what I should be looking for. He said it should feel like I just had a margarita. I definitely wasn’t feeling anything like that, so he said he would give me some more, and that is the last thing I remember until waking up back in the pre-op area.

When I woke up, I didn’t feel woozy and I wasn’t in any pain. I never saw the doctor--I was asleep before she had come into the operating area, and she was gone before I woke up. For all I know she had never been there at all. The nurse gave me some apple juice and graham crackers. I was very happy to have the liquid since I hadn’t been allowed to drink since midnight the night before (normally I drink a ton of water.) It wasn’t long before the nurse told me I could get dressed and gave me a post-procedure instruction sheet with the number of eggs retrieved written on it: 13. I thought that was not bad; I had been hoping for 15 but 13 would do. I changed out of my gown and went to meet my mom in the waiting room.

First Egg Freezing Cycle: The Trigger Shot

My trigger shot was to be at exactly 9:30 PM on Thursday, November 21, 2013. Earlier that day, I gave myself the last Ganirelix shot.

I had now been on hormones for well over a week. How was I feeling? As it turned out, I was feeling surprisingly normal. I had been concerned that the hormones would affect my mood and that I might experience strange crying jags or temper flares, but that did not happen. Physically I was also feeling pretty good. I was not particularly bloated, and though I thought I could feel my ovaries, I was never quite sure if it was just a figment of my imagination brought on by the suggestion that I should be feeling heaviness in the ovaries. I was however moving differently than usual, in an effort to heed the nurse’s cautions about the risk of ovarian torsion from certain movements. I was supposed to avoid anything that caused bouncing, so I walked more slowly than normal. I had also started taking the elevator up instead of the stairs up to the clinic. I tried to be careful to avoid twisting movements, though I always toss and turn a lot during my sleep so I’m sure I wasn’t able to completely eliminate twisting motions.

The nurse had suggested that I start mixing up my HCG (the trigger shot) at 9:20 PM, to be sure it was ready for 9:30 PM. When I picked up the box, I noticed it said “For intramuscular use only.” I have picked up from other egg freezing blogs and forums that some clinics have their patients do intramuscular shots for the HCG, but at Stanford we are supposed to do a subcutaneous shot. I certainly didn’t have either the training or the needle necessary for an intramuscular shot. I was concerned that I had ended up with the wrong variety of medication. I didn’t know what to do, so I paged the on-call fellow to ask.

When the fellow called back, it was apparent that she hadn’t heard of this exact problem before. I would have loved her to say, “Yes, I know it says “for intramuscular use only” on the box, but it is fine to do the subcutaneous injection.” Instead, she asked me to read her what it said regarding what kind of medicine was in the box, she told me that it sounded like the correct medication, and told me it should be fine to do a subcutaneous injection with it. An answer, but not quite as confidently reassuring as I had hoped for.

Anyway, I set about mixing up the medication and transferring it out of the vial into the injection syringe. I was able to get around two-thirds or three-quarters of the medication into the injection syringe, but I absolutely couldn’t get the last bits out. I remembered the nurse had taught me how to do it after my last ultrasound, but I couldn’t remember what exactly the secret was. I was running way behind now, between paging the on-call fellow and trying to get more medication into the syringe, it was well past 9:30. I finally decided to inject what I could before it got any later. After injecting myself with most of the medication, I set about getting out the last one-quarter to one-third of the medication which was stubbornly stuck in the vial. I held the vial and the syringe at various different angles, desperately trying to get all the medication out. I finally managed to get most of the remainder and gave myself a second injection (thank goodness the clinic had prescribed extra needles, as you need a new needle for each injection). By this time it was well past 10:00. That’s right, I had managed to screw up the timing of this most-important, absolutely-had-to-be-at-9:30 shot.

I emailed the clinic to explain what had happened and then got ready for bed--I would have to leave for my retrieval appointment around 7:00 AM the next day.