Case of the month Apr '08: Episode #7
Six days after her IUI, we got a phone call from Aimee.
"I think something is wrong", she said. "I feel pretty bad, with a lot of cramping and my stomach is really swollen. Is it normal to feel this way?"
My staff transferred the call back to me. It was possible that Aimee was suffering from Ovarian Hyperstimulation Syndrome (OHSS).
OHSS is a condition that sometimes occurs after stimulation of the ovaries. It can sometimes happen with Clomid and has even been reported in people who are taking no ovulation drugs at all. However, most of the time that it occurs, it’s a reaction to injectable ovulation medication.
ME: Tell me what’s going on, Aimee.
AIMEE: Dr, after the IUI, I felt OK. Very mild cramping only. But the past few days, my stomach has gotten quite large and I feel so bloated.
ME: I see. Tell me this. Are you able to eat OK and drink OK?
AIMEE: So far.
ME: Have you been going to work?
AIMEE: I worked yesterday, but was tempted to clock out early. I didn’t, though.
ME: OK, have you been peeing a lot?
AIMEE: Tons.
ME: That’s good. Do you have any idea what your weight is doing?
AIMEE: Actually, I do. After the IUI, I realized I was at 157# when normally I’m usually around 155#. I think those injections made me gain 2 pounds. Then the past few days, I found myself at 158#, but today, I’m back at 157#.
ME: How do you feel today compared to yesterday? By the way, it’s very smart of you to weigh yourself everyday like that. That information is helpful.
AIMEE: Hmmm. About the same. Maybe a little better.
ME: How are you breathing? Also, do you have any swelling or pain in your calf?
AIMEE: No trouble breathing. No, my calves are fine.
ME: Aimee, I don’t think you have hyperstimulation, but if you don’t feel a lot better by tomorrow, I might have you get some blood tests drawn. I’m possibly going to check your blood to see if it is overly concentrated. I also want to confirm that your kidney function is good. However, I’m reassured that you’re peeing a lot and losing weight from yesterday. It means your body is getting rid of the excess water. If you don’t feel better by tomorrow, come on in and I’ll examine you, but otherwise, you may work. You’re a nurse, right? We’ll see what happens with your pregnancy test next week.
AIMEE: OK, thanks for answering my questions. Yeah, I think I can work. I just feel blah.
ME: Do you want me call your husband and tell him to be extra nice to you?
AIMEE: Haha. No, he’s been good. I guess I’ll survive. I sure hope I don’t have to do this again.
ME: Me neither. Me neither. Let’s hope for some great news next week.
ONE WEEK LATER…
"Aimee is here for her beta today", said my staff member. "I think she cheated, because she looked really really happy."
I had just gotten to work and was passing by the blood-draw station.
"Aww, Aimee, did you cheat?" I smiled.
Aimee’s expression alternated back and forth, at times looking like a kid who snuck a cookie from the cookie jar and at times looking like a new fiancee about to burst with happiness showing off her ring. "You know me. I couldn’t wait! I did a home preg four days ago and was so sad when it was negative. But then I did one yesterday and it was faintly positive and today it was very very positive!"
"That sounds pretty promising. We still have to wait for the blood test"
Aimee was correct. She was pregnant. Her hCG was 46. In two days, it was 84. A few weeks later, she had one sac seen on ultrasound with a fast heartbeat. She graduated at 12 weeks gestation, went on to her OB and eventually delivered little baby Raymond at term!
