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A Cautionary Tale


a blog by Ellen S. Glazer, LICSW, July 22, 2010

I have a client who is pregnant after a long struggle with infertility. That’s the good news. The almost very, very bad news is that she nearly died this week. This is what happened…

My client, whom I will call Lucky Lady, went through an IVF cycle, had two embryos transferred, and two weeks later, got the good news that she was pregnant. An ultrasound confirmed that one embryo had implanted. Or so it seemed…

When my client was six weeks along, she developed severe “cramps.” She says they were awful — so bad that when she contemplated going to the emergency room, she couldn’t imagine how she would get out of bed. Fearful of miscarriage, she assumed that was what the “cramps’ signified. Lucky Lady endured the pain for the weekend and on Monday, feeling better, she got up to go to work. Convinced that she had miscarried, she called the nurse at her fertility center to tell her what had happened and to ask what to do next.

“But your numbers have been so high.” The nurse said. “I really don’t think you miscarried.”

“I did. I know I did,” replied Lucky Lady.

“Well come in tomorrow and we’ll take a look.” Then the nurse paused and said, “No, come in now so you won’t worry. I really think everything will be OK.” And these were the words that saved Lucky Lady’s life.

A heteroectopic pregnancy. That is what it is called when one embryo implants in the uterus and another in a tube. Lucky Lady had read about ectopic pregnancy and agrees that her symptoms were “right on the mark,” but she did not know that an ectopic pregnancy could occur after IVF and she certainly didn’t know it could occur at the same time as a uterine pregnancy. Anyway, she went to the hospital for reassurance and ended up with surgery that saved her life.

My client arrived at the hospital, had an ultrasound and was relieved to know that there was still a strong heartbeat and a growing fetus. However, when the doctors explored further, they discovered why she had been in so much pain over the weekend and why the pain had subsided: A second fetus growing in a tube had ruptured the tube, which resulted in extensive internal bleeding. LL’s pain had subsided following the rupture but the extensive bleeding had her hours — at most — from going into shock. Had she been at home alone, she might well have died. Emergency surgery saved her, and she is now out and about, looking well and back to being anxiously making her way through her first trimester.

So why a cautionary tale on this blog? I think that infertility patients sometimes get so “good” at accepting pain and of being “good patients” that you may lose perspective on when it is time to ask for help. Infertility patients take pride in being self-sufficient, figuring things out on your own and avoiding being “the girl who cried wolf.” It seems that after months, even years, of giving yourself injections, dealing with discomfort and not wanting to be seen as a “pest” to your fertility center, you may come to forget that there are times when it is important to call the doctor. At the risk of sounding overly dramatic, it may save your life.

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