Infertility Emergencies

Some nights you just have to roll with life's little surprises. Last night we had a delivery at 9 pm and the delivery man accidentally rolled his handcart over my dog's front leg. Poor Indy ran off yelping at the top of her lungs and when I finally found her she was huddled up against the kitchen sliding door. As I am not a veterinarian I bundled her off to the Animal Emergency Clinic in Rockville where we spent the next couple of hours. Ultimately, the xray showed the leg was not broken and they dosed her up with doggie morphine and doggie super-Motrin. This morning she was pathetic but putting a little weight on the leg. The damage to my Visa card was almost $300. Oh well.

Last week the resident physician from Georgetown who rotates through our practice asked what constituted a RE emergency. Sometimes it is hard to know what is an emergency and what isn't as a fertility patient.

There is an old Ob Gyn joke that goes like this....

It is 3 am and the emergency pager for the Ob Gyn doctor wakes him up from a deep sleep. He calls the number and the patient is so appreciative that he has called her back.

"Doctor," she says, "I have a terrible sore throat and think that I may have a sinus infection."

"Gee," he replies, "that sounds bad but why are you calling me....I am your Ob Gyn and I don't recall that you are pregnant or have any current Ob Gyn issues?"

"You're right but as it's 3 am I figured that my family doctor is asleep, but I assumed that you were awake delivering a baby or something."

The doctor prescribes an antibiotic but doesn't address her logic in calling him.

3 nights later he is on call delivering a baby at 4 am and calls the patient. "Hi Mary, it's Dr Jones. Since I was awake delivering a baby I thought that I would give you a call to see how you were making out with that sinus infection!"

Mary got the message.

Now, I am not advocating that patients suffer in silence but some phone call can wait and some cannot.

So here is the Question of the Day, but it is NOT in the book 100 Questions & Answers about Infertility. It is a never before seen question that has leapt from my mind to the computer...

101. What is an infertility emergency?

Clearly there are certain clincial conditions that are an emergency and need to be addressed right away.

1) Bleeding in pregnancy. Spotting is probably OK to wait to call until the morning but heavy bleeding may need to evaluated in the emergency room or first thing in the AM. Unfortunately, about 50% of fertility patients can have some bleeding so this is a frequent call.

2) Significant pain after egg collection. It is usual to be somewhat uncomfortable after egg collection but severe pain or nausea and vomiting needs to be addressed. Same with a fever after egg collection although infection is a rare complication. The first sign of OHSS is often pain but sometimes the pain quickly resolves within a day or two of egg collection.

3) No medication instructions. I tell my patients that if you were in for monitoring and did not get a call-back then that IS an emergency. Don't wait until midnight to think about checking in with the nurse or RE! Get your instructions before dinner so everyone is happy. We are all human and sometimes a patient may just not get a call for various reasons: wrong phone number, answering machine glitches, nurses didn't drink enough Starbucks...who knows. But the point is that you, the patient, need to be your own advocate and make sure that you understand your instructions.

4) A family emergency arises and you need to leave town but you are in the middle of a cycle. This information is crucial for your treatment to work. Sometimes we can stop and restart stimulation later or arrange for monitoring out of town. In any case, this is an emergency for us.

5) Your DH cannot do his "thing." If we don't have sperm then this is a big problem. Egg freezing doesn't work that well compared with embryo freezing. If there is any concern that he may have performance issues or travel problems then cryo sperm ahead of time.

6) You run out of meds. Years ago in Long Island one of my patients went to take her HCG for IVF only to realize that the box in her medication stash was empty as it was from the previous cycle! She freaked out (as expected) and called me at 11:45 pm which is 3 hours after my bedtime. I jumped in the car and met her at the office where we kept some extra meds. She was very thankful and the cycle was a success but they still didn't name the kid after me... So don't run out of meds unless you want to see DrG in his PJs. If you do run out, then don't suffer in silence.

These are not the only RE emergencies but they cover probably 90% of the issues that patients face when undergoing treatment. Feel free to add your thoughts.