Ever wonder what happens when you get diagnosed with an ectopic?
Well that night, I had the residency over for a wellness Thanksgiving dinner. I couldn’t cancel it – I was hosting. It was for my residents. I was supposed to be the example of wellness, which apparently meant negating my own wellness and the wellness of my husband, who was clearly not in the mood for 30 people at our house. Then after dinner, I went in for my overnight shift. A colleague met me at the hospital and ultrasounded me once more to confirm. Yup the ectopic was still there. No heterotopic to be found. The next day, a friend administered my methotrexate injection- my husband, understandably, couldn’t bring himself to do it. And off I went to work another overnight shift. I have never felt so ill on shift – EVER. I could barely get out of my chair. At one point, I told the chief resident working with me my blood type, just as a precaution. I survived the overnight shift, but by 5 am, I had to apologize to my residents – I could barely get out of my seat.
So that was it. We had survived this struggle. Or so I thought. A few days later I was at home, alone, when I had intense pain- truly 10 out of 10. I couldn’t move off the floor. I couldn’t get to my phone. I panicked. The Emergency Medicine doc in me was no longer composed – mine brain was racing with worst possible scenarios. I was certain my ectopic ruptured. I was going to die on the floor of my bedroom in my underwear. It was certain. Eventually the pain subsided. I put on my scrubs (I was on the schedule… again) and drove myself to the ER. My friend ultrasounded me and we saw free fluid- a lot of it. I checked in the ER. MY ER. My husband left the fire station and rushed to the hospital to be with me. A colleague had to cover my shift. I put on a patient gown. I waited behind closed doors for my OBGYN consultant. Waited longer. I got wheeled through the hospital corridors to radiology, in a patient gown, past residents, past firefighters, past a lot of puzzled faces. I waited in radiology for my formal ultrasound. I waited for someone to push me back downstairs to the safety and security of my ED. One of my own Emergency Medicine interns was on her ultrasound block, and she found me waiting in the hallway for transportation. She kindly wheeled me back downstairs to safety. I did not have a ruptured ectopic. I was just “lucky” enough to develop 2 very large cysts on my left ovary, in addition to my left-sided ectopic. When I got back to the safety of my hospital room, behind the closed door, I cried. A lot.
For the first time, my personal life and my professional life had truly collided. My work world was interrupted by this process of trying to make a baby. And finally, after being forced to take off my next shift, I was forced to take time to grieve.
My story didn’t end at round 1. A few months later (Februrary) I started injections for Round 2. We retrieved 7 eggs. Three of those fertilized, and we ended up with one embryo. My pregnancy test was negative. (I will tell you a secret. I took three home pregnancy tests, all in the middle of the night while my husband was at the fire station so I could wallow in private. The test was still negative when he got home in the morning. And when we went for my blood test. I was decidedly NOT pregnant.) Again, I had no embryos leftover. In May, I underwent the surgery they had suggested on my initial visit over a year prior. As a physician, and more specifically as an Emergency Medicine physician, commonly diagnosing small bowel obstructions and other post-operative complications, the idea of having an abdominal surgery was a HUGE deal to me. I didn’t want anyone mucking around in my abdomen. The amount of desperation that I had to even consider this surgery was significant. So I had it, begrudgingly. And I woke up with vague answers from my husband about what my doctor had said. I didn’t even know if the surgery was successful. I wanted to have the world’s WORST case of endometriosis, so I was sure to have a more successful round 3. My surgeon – an awesome female doc – sent me home with a video of the surgery, which I happily watched while still on drugs immediately post-operatively. She called me and told me that I had stage 2 endo. The diagnosis was confirmed. It was all scraped out and I was good to go for my next round.
Or so I thought. I went back for my post-op appointment weeks later. She walked in and gave me the look that has become so common to me now. The one that means – you are always a puzzle, always the unexpected – I knew it wasn’t good news. My biopsy results did NOT confirm endometriosis. There was no endometrial tissue at all. But I did have some abnormal cells – cells typically seen with tuberculosis. They had tested me for multiple other diagnoses, including TB, all of which were negative. Basically, we had no clue what was wrong with me, but fingers crossed that the surgery would make it better. At this point, my IVF Hurricane was category 5. I NEVER wanted this surgery and now I put myself at risk for NOTHING. I was tired of being the patient and more tired of being the patient in which NOTHING went right. The patient where the unexpected was expected. I was tired of being the 1%.
In August, we started injections for round 3. At this point, I had been following a keto diet for almost 9 months, cheating only once. I had been going to acupuncture for a similar amount of time. I had basically stopped all forms of working out, only letting my max heart rate get to 120. I was meditating and practicing mindfulness for relaxation. I was doing EVERYTHING. I went in for my first ultrasound, and we found that my body was doing its own thing, not following the schedule for IVF. We had to cancel my cycle. We rescheduled for September, but added in cetrotide to suppress my body from creating its own novel follicles. In September, at my first ultrasound, same thing. My body had been making follicles that were maturing at a rate much different than the ones induced by my injections. I had to cancel AGAIN.
I just finished undergoing round 4 this month. Praying for my miracle embryo. But I’m sharing this story, because I am NOT alone.
As women in medicine, we have an INCREASED RISK of infertility.
Studies have found that our risk for infertility is 24.1% (compared to the national average of 12.1%). For women in medicine, ONE IN FOUR of us will struggle with infertility. Many will say it is because we attempt conception at an older age, and yes that is part of it. But it is NOT the whole story. A study in Hungary looked at over 3000 female physicians and compared them to an age adjusted control group of professional women, other women who delayed child-birthing for their education and careers. The study found that women in medicine STILL had a statistically significant increase in infertility rates. We have to start having a conversation about physician infertility. We need data to find out WHY our career puts us at risk. And we need to raise awareness – we need to #SayTheFWord.
An adaptation of this will be published on www.sheMD.org.