Welcome to this episode of Fertility Docs Uncensored, where your hosts Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Abby Eblen from Nashville Fertility Center, and Dr. Susan Hudson from Texas Fertility Center explore an important topic: managing the possible pain and discomfort that can arise during the fertility treatment process.

From injections and blood draws to procedures like egg retrievals and embryo transfers, certain aspects of the journey can be physically challenging. In this episode, we’ll discuss common sources of pain or discomfort and share practical strategies and tips to help reduce them. Our goal is to provide you with the tools and knowledge to make your fertility journey as comfortable as possible.

Join us for a compassionate and informative discussion focused on making your path to parenthood a little bit easier. Let’s dive in!

Episode Transcript:

Susan Hudson (00:01)

You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.

Susan Hudson (00:23)

Hello everyone, this is Dr. Susan Henson from Texas Fertility Center with another episode of Fertility Docs Uncensored. We are here today with my boisterous and beautiful co-host Dr. Carrie Bedient from Fertility Center of Las Vegas and Dr. Abby Eblen from Nashville Fertility Center.

Carrie Bedient MD (00:37)

Hello

Abby Eblen MD (00:42)

Hey everybody.

Carrie Bedient MD (00:43)

I feel like I’m probably the boisterous in that in Abby’s the Beautiful.

Susan Hudson (00:43)

How are y’all doing?

Abby Eblen MD (00:47)

I can be boisterous too, Carrie.

Carrie Bedient MD (00:52)

I don’t know, you’re pretty much a southern belle

Abby Eblen MD (00:53)

Okay. 

I am kind of a rule follower though, that’s a running joke between my husband and I. He’s not the rule follower and I’m always a rule follower. If you tell me to do something, that’s what I do.

Susan Hudson (01:03)

You are definitely the most rule follower amongst the three of us.

Abby Eblen MD (01:08)

Guilty!

Carrie Bedient MD (01:09)

Yeah.

Susan Hudson (01:12)

All good. Along that, in following the line, we were just talking about our favorite pens. And as nerdy as that sounds, we’re all very opinionated about this.

Carrie Bedient MD (01:24)

So, Abby, you are the artist among the group and so we will automatically defer to you as the pen expert in all of this. What is your favorite type of pen? If you get to choose, what’s the style you like the best?

Abby Eblen MD (01:41)

So Faber Castell is my favorite pen style. And the reason I like it is because it has India ink and so it stains the paper so you can actually do watercolors over it. So you can do like pen and ink and then you can add watercolor to it. far as actually writing, I don’t really have a favorite pen type. I just kind of steal whatever is laying there, whatever pen I’ve gotten from somebody. very guilty of doing that and I always feel bad, but I and return the pen if I realize it’s not mine.

I don’t really have a favorite pen style when I write notes or anything.

Susan Hudson (02:13)

Carrie, do you have a favorite pen?

Carrie Bedient MD (02:15)

There’s two answers to that. The first one is our office has the Fertility Center of Las Vegas labeled ballpoint pens. And those are my default when I’m in the office, because I like those better than the Bics and the other random ones that I find around. I am also incredibly guilty of stealing pens, but I’ve gotten much better at returning them immediately, because what I have found is that if I return them immediately, then they are there for me to steal the next time.

Abby Eblen MD (02:40)

If you steal the one pin that’s there, then it’s not there the next time you want to steal it.

Carrie Bedient MD (02:46)

Actually, this is of most use in the embryology lab because they do not have a surplus of pens and the pens that they do have are all Sharpies and I can’t use those to sign my notes. And so I have to be very good about returning the pen that I have stolen so that it’s there for me to steal the next time. When we’re talking about just notes on sticky notes or when I’m taking notes in a meeting, things like that, I like the black.

It’s not quite felt, but it’s also not ballpoint. It’s got a really pretty dark black ink and it’s not, it’s not that ballpoint where you have to push into it where I feel like it’s, you create an almost a reversed embossed situation because you’re having to push so hard. I think, I think those are the prettiest, but they’re also the ones that I have to take the most time to write with because otherwise I get sloppy and it just goes everywhere and it’s hard to read. And yeah, what about your Susan?

Susan Hudson (03:41)

I’m very opinionated. actually do not tend to steal pens because I’m such, I’m so obsessed with like having a pen that I like writing with. I usually have one with me and so I tend not to steal unless it is a very desperate moment. I love 0.7 gel pens. I typically use the Tul one and they just have, they’re nice and smooth. They don’t skip, they’re dark.

Always black, always black, which is funny because my husband used to be in the real estate industry where everything you would sign is blue, but it was drummed into me as a medical student, you only use black. And so unless I’m signing a legal document having to do with real estate, it is always, always in black. And it’s nice and smooth. It doesn’t make my hand cramp. It’s beautiful.

Carrie Bedient MD (04:35)

We all have such random preferences on things. I bet if you went to all the docs in our respective offices that everybody would have an opinion.

Abby Eblen MD (04:38)

Hahaha!

Susan Hudson (04:46)

It’s funny. It definitely is. All right, let’s do a question and we’ll hop into our subject today. Okay, our question for today is, my Ovidrel trigger shot did not work. I ovulated about a week after IUI trigger. He has switched me to a Pregnyl trigger shot this round. Is the Pregnyl shot more likely to work, i.e. to cause ovulation within 24 to 36 hours compared to Ovidrel? We’re moving to IVF in January if this doesn’t work.

Will I have any issues with the Lupron trigger shot used in IVF?

Abby Eblen MD (05:18)

Ovidrel is a subcutaneous, Underneath the skin, little tiny needle underneath the skin. injections like Pregnyl probably are absorbed a little bit better. It’d be really unusual though for you to ovulate a week after that injection. That’s the one thing that doesn’t entirely make sense to me because I could get that maybe it didn’t make you ovulate right on the spot the way you wanted to, but it’d be really unusual if you had an egg that was almost ready to go that waited a week to ovulate. So that’s the part I don’t understand.

Carrie Bedient MD (05:45)

That makes me think more that maybe the Ovidrel shot wasn’t the first place. Well, or that it had been left in a hot car or exposed to something or was expired, whatever it was. Now, granted, I don’t particularly care for Ovidrel. I default to Pregnyl and Novarel even in my IUI cycles, because I just, I don’t like it. But I would think that when you’re working with either IUI or IVF using one of the other types of HCG or Lupron, you should be fine. Maybe worth talking to your clinic and just making sure you’ve got a quick injection teaching. There are a lot of really good videos online through especially the pharmacy companies, the companies that produce these meds. They are all very, very invested in people giving them correctly. So there’s a lot of good resource videos out there that we use, but you should be fine.

Susan Hudson (06:26)

Things that I think about are what are things that may have contributed to something not being quite as effective. So as we mentioned, maybe there was something wrong with the Ovidrel as well, manufacturing wise, or if it was left out in the heat. Other things to think about, rarely you might have a receptor issue that you need to have a bigger dose, whereas Pregnyl, you can give higher dosages than your pre-filled Ovidrel syringe. The other thing to think about is BMI. So how much weight someone has can sometimes affect the volume of distribution of those types of medications. So there’s a number of things falling into it. Also just because it didn’t work one time doesn’t necessarily mean it won’t work another time. Very few people use Ovidrel when it comes to an IVF cycle.

And really that inability to respond to that specific medication should have no bearing on a Lupron trigger because that’s all depending on how your brain responds, not tricking your body into thinking that you had a LH trigger. All right. All right. So our topic for today

Carrie Bedient MD (07:49)

Exactly.

Susan Hudson (07:56)

is intended to help bring down anxiety. So we are going to talk about things within the fertility treatment process that oftentimes may create some pain or discomfort and address ways that we can help reduce that pain and discomfort to make your fertility journey better. Let’s start at the very beginning and you’re coming in for your new patient appointment. Most of us are going to ask to do a vaginal ultrasound. Let’s talk about the realities of a vaginal ultrasound to start.

Abby Eblen MD (08:33)

Vaginal Ultrasound is just what Susan said. It’s an ultrasound probe. about the caliber of, I’m trying to think, a candlestick maybe, about the caliber of a candlestick. And it’s a little bit at the end.

Carrie Bedient MD (08:46)

All the candlesticks that are in my house are three-wick candlesticks that have probably a six inch diameter. That is not the type of candle that we are talking.

Abby Eblen MD (08:54)

No, no, no, no, no, no. We’re talking about the tapered candlestick that you have over your Thanksgiving dinner. Maybe I shouldn’t have said that. But, the only part that goes in you is a few inches long. It’s a little bit wider at the end. patients will have discomfort, most commonly right when it’s inserted because it’s a little bit thicker there. it’s really…

I mean, it’s basically made to fit the full size of your vagina. So if you’re sexually active, I mean, it shouldn’t be all that painful. It’s a lot like a speculum exam if you’ve ever had a pap smear done before. so the wand, we call it, is inserted in the vagina. And then the procedure for the vaginal ultrasound is maybe 10 minutes long. you feel some pressure as it’s being done. But for most patients, it’s not particularly uncomfortable. And it’s just the best way that we can see your uterus and your ovaries.

If we look abdominally, which is what most people think of with an ultrasound, and we’d certainly do that once you get pregnant and you’re further along in your pregnancy, we can see what we need to see at that time with an abdominal probe. But if you’re not pregnant, we can’t really see your uterus and your ovaries very well unless that’s the type of probe that we use. But I would say the comfort, maybe we should rank these on a scale of one to 10. The discomfort would be maybe a two on a scale of one to 10, or maybe even a one. It’s not very uncomfortable at all, I would say.

Carrie Bedient MD (10:06)

I think probably the biggest tip for either vaginal ultrasounds or speculum exams would be pretend that your bottom is melting into the table because the instinct that many people have is to tighten the muscles, close their legs.

One, the other or both and raise their bottom off the table just a little bit. That tightens all those muscles. That makes it more uncomfortable than it needs to be. And even so, even when you do that, you maybe take it from a one to two to a two to three. So we’re not talking bad. It is more the idea of it that tends to be problematic for people. But what I would say is if you can imagine your bottom just melting into the table and keeping it low and those muscles relaxed, it will be even less annoying than it is already, I think annoying is probably the best way to describe it because it’s not really hurt. It’s just, you wouldn’t choose to do it for fun on a Saturday night.

Abby Eblen MD (10:59)

Yeah.

Susan Hudson (11:04)

And while we’re talking about these things, we do want to include the caveat that we understand that some people are going to have different pain thresholds and some people are going to have potentially different medical conditions that could exacerbate or make less different pain situations. So when we’re talking about these ranges of what we’re expecting, know that there is going to be some variability. Now, whenever you’re having a pelvic exam, especially if you have any history of abuse in the past, and you know that this might be a less than great venture for you, talk to your REI and make sure that they are aware of that situation for you, because there are other things that we can do to help you relax and be comfortable and making this situation that’s unfortunately necessary better than what it potentially could be.

Carrie Bedient MD (12:08)

Definitely agree with that.

Susan Hudson (12:11)

All right, well let’s talk a little bit about two things together, saline ultrasounds and HSGs. So let’s talk about the difference of what they are as tests and then kind of what different patient experiences may be.

Abby Eblen MD (12:27)

The two different tests, one is an ultrasound test, one’s done in the office and it’s much like what we just described using a vaginal probe ultrasound. So we have to use a vaginal probe ultrasound. This is called a saline sonogram. It’s where fluid or saline is put up inside the cavity. It’s almost blowing air into a balloon. It opens the cavity up and we’re able to see inside the cavity in a much better way than we would with just a regular ultrasound. With that, sometimes we can even put air bubbles through the fallopian tube or some type of foam through the fallopian tube to be able to make sure that the tubes are open and that the cavity doesn’t have polyps or fibroids. So that’s a procedure typically done in our office. The other procedure, hysterosalpingogram, is an x-ray test. That’s done by a radiologist. type procedure in the sense that a speculum is placed in the vagina, you’re awake for it for both procedures. The radiologist will put a little metal catheter up inside the uterine cavity or sometimes plastic catheter with a little balloon on it. They’ll inject radio opaque, not radioactive, but radio opaque fluid up inside the cavity. And it really the same thing. It opens the cavity up. way we can see if there’s polyps, fibroids, any growths within the cavity. We can also see that radio opaque dye going through the fallopian tubes. During that process, the radiologist will usually take to five pictures as the dye goes through, just a document that spill occurred and then everything looked normal.

There’s varying degrees of discomfort from those saline sonograms. Just anecdotally, think patients tend to have less discomfort than they do with an HSG. HSG, sometimes the dye can be really uncomfortable as it gets into the body cavity. the distension of the uterus with either procedure though can be uncomfortable as well. either one, it’s reasonable to take something like Tylenol or ibuprofen ahead of time just to help with the minimal discomfort that you have.

And with both of those procedures, usually you can drive yourself there and you can drive yourself home. Carrie may want to speak to the actual level of discomfort for both of them, but for me personally, I had an HSG and to me it felt like really bad menstrual cramps for maybe five to 10 minutes and then it went away.

Carrie Bedient MD (14:28)

The HyCoSy is another tubal test that fits in here. I would say it’s somewhere between the saline ultrasound and the HSG because they are pushing the fluid a little bit harder, a little bit further in order to get it to pass through the tubes. But I think it’s more along the lines of a saline ultrasound rather than HSG. And it’s something that many of the procedures we’re talking about today, part of the reason why they hurt so bad is the anxiety going into them makes them worse.

That’s not to discount or diminish the fact that they are not particularly fun tests, particularly that HSG. However, when someone walks into something with the anticipation of this is gonna be the worst pain ever, sometimes that amplifies the pain that you’re feeling. It’s something to consider as you are going through it of consider, is there a meditation app you can put on your phone and stick in your earbuds while you’re going through it?

Can you take the ibuprofen an hour ahead of time? Can you have a heat pack ready with one of those little disposable ones that you can get from the drugstore that you can have ready to go to help quiet down those muscles? Can you practice your breathing exercises to go through it? All of these things are just helpful tips in general for tough situations in life, but they apply very specifically here because they can help you get through what’s an uncomfortable situation.

Abby Eblen MD (15:49)

Well, it’s also to even having a supportive partner on hand can be helpful too. If somebody’s in the room with you, sometimes that comforts people and helps diminish the discomfort that you would have with the procedure.

Susan Hudson (15:59)

I’d like to say that the HSG is the one thing that in anyone’s fertility journey is potentially the worst thing except for actually delivering your baby. And so realize even if you have bad cramps from that, that is like one bad cramp. It may last a little while, but it will fade and it will get better relatively soon. so having some perspective of this is kind of a means to an end.

Abby Eblen MD (16:08)

Yes.

Susan Hudson (16:27)

This was getting a very, very important piece of information. And also this is one of those stay off the internet things. No one who has had a good HSG experience is sitting out there blogging about their good HSG experience. It’s only the people who had cramping. And so you need to take those types of things with a grain of salt. Yes, you may have some cramping, but in the grand scheme of what we’re trying to accomplish, it’s a means to an end. It’s getting us where we need to be. And again, using some of these measures to make things easier. Also, if you can go in with a somewhat full bladder, that can straighten up the angle of the uterus and make it a little bit easier for either your REI or the radiologist to place the little catheter.

Let’s talk about those blood draws. are some things that when you have to go in for blood work, either in your diagnostic phase or in your treatment phase, that can make those less… Owie.

Carrie Bedient MD (17:35)

Stay well hydrated going in. Even if you’ve got to be NPO, meaning nothing to eat or drink after or before a certain amount of time, if you are really well hydrated going into them, it makes it much easier for our phlebotomists, the ladies who draw the blood, to find your veins. And there’s almost always a couple of veins that are accessible, whether they’re in your elbow crease, on your hand, in the space in your forearm between them.

These people are very, very good at finding your veins. My husband, whenever we are out on a date and holding hands, he is always running his thumb over my hand veins, because those happen to be the best ones on my body. And don’t, I don’t know what you’re doing, Markey. I know exactly what you are doing. You are feeling my veins because I have good veins.

Trying to avoid the super high salts things that may make you pee all the time, what not, caffeine that constricts your veins, those things may be helpful but usually hydration is the big one that I go for.

Abby Eblen MD (18:35)

I was just gonna add too that if you think you’re somebody, some people get really nervous and they’re afraid they’re gonna pass out. Well, anytime you’re in a situation like that, we want you just to let us know, because we’re gonna lay you down and we’ll put you in a really quiet room. would make you feel better and make you feel more relaxed when we draw blood, we can certainly do that. The other suggestion I have is a couple of things. One would be to ice that area to make it a little bit more numb. There’s also some cream, and if you ask your doctor, they can…get it for you. And I think there’s actually some that one of the pharmacies has that you don’t get by prescription, but essentially you can put numbing cream on your arm and that can help. And If it’s really the needle prick that really makes you anxious and upset, those are things, some side things that you can do that may be beneficial.

Susan Hudson (19:18)

As someone who is a terrible stick and I hate hate hate going in get my blood drawn and whenever I do get my blood drawn the phlebotomists are not happy to see me. One thing that is somewhat helpful is try to stay warm before you’re going in to get your blood drawn. So have a jacket in your car, don’t have the air conditioner on full blast and literally have those veins as warm as you possibly can get them and that can improve the situation. So while we’re talking about needles, and I think Abby was alluding to a little bit, let’s talk about needles for injections. So a little bit different because we’re either giving those to ourselves or potentially friends or family member are administering those. So let’s talk a little bit about the two types of injections we typically do, either subcutaneous or intramuscular, and how those can be different.

Abby Eblen MD (20:15)

Subcutaneous are just underneath the skin. They’re small little needles. If you’ve ever had a TB skin test or something like that, they’re pretty tiny little needles. They’re really almost like the caliber of a pen. They’re really tiny. And generally those don’t cause quite as much discomfort. The other type of injection that Susan’s alluding to is an intramuscular injection. And that is a bigger needle. It’s a longer needle. It has to go in the muscle. A lot of times we have you do it in your hip because it’s less uncomfortable than other places that it can be injected.

And those are the ones where you might want to get some sort of Emla creme or some type of cream that numbs that area to make that shot more tolerable because there are some situations where you have to be on those shots for an extended period of time.

Carrie Bedient MD (20:54)

When you are giving the subcutaneous shots, if you can pinch the area, usually on your stomach, that you’re going into, sometimes the pinch is actually more painful than the needle going in because you pinch hard, you put the needle in, you don’t notice the needle going in, putting the fluid in doesn’t hurt. And then you take everything out and you’re fine. And so that experience is actually not terribly painful from a physical perspective.

When you’re giving the intramuscular shots, people oftentimes freak out about the length of a needle. And that’s not actually the thing to freak out about. If you are going to freak out about a needle, you freak out about the width of the needle, because that’s a wider needle, you feel a lot more as opposed to a very thin needle. And most of the time, we are giving you pretty small gauge needles. And when I say small gauge, I actually mean the higher numbers.

So a 24 gauge is actually much tinier than a 14 gauge, for example. And most of the time when we’re giving you these needles, we’re looking at 18, 22, 24, those types of gauges. And so you can have a needle that’s six inches long. That’s actually probably not going to hurt nearly as much as a needle that is disproportionately wide. And we know that, and we try and give you the thinner needles so that when they go in, they’re not as obnoxious.

Susan Hudson (21:50)

One thing that I recommend doing is icing either one subcutaneous or intramuscular injections And then afterwards, you can use heat and massage to help distribute your medications. As Carrie was talking about, pay attention to your gauges of needles. So in our office, we often for the progesterone and oil injections, we’ll get two different gauges of needles.

So we’ll give 18 gauge needles and we’ll give 24 gauge needles. And this is for a very specific reason. And please don’t mix these two up. So the 18 is a bigger needle. It’s a wider needle that is meant to draw up the progesterone in oil from the bottle. Then you take off that 18 gauge needle, attach your 24 gauge needle, and that’s the one that goes into your booty. Okay? Yes, it may take a little bit longer for it get injected in because it’s not as big, but it will be more comfortable than having an 18 gauge needle going into your hip.

Carrie Bedient MD (23:26)

Yes, agree.

Susan Hudson (23:26)

All right, okay. Let’s talk a little bit about things like IUI. Is IUI uncomfortable? What’s involved in that particular procedure?

Abby Eblen MD (23:39)

So an IUI is a process, also called intrauterine insemination. And basically it’s a process where we’re able to put sperm up inside the uterine cavity and really just to get a more concentrated amount of sperm closer to the egg. And so sometimes we even do that in situations where the count is normal, but it’s just a way to get it closer to where it needs to be. So in that process, a speculum is placed in the vagina, we put a little catheter up through the cervical canal into the uterine cavity, and sperm is injected up into the cavity. In that process, when the catheter goes through the actual cervix, that can stretch the cervix just a little bit. In fact, stretching of the cervix to a much more major degree with a baby is what really causes a significant amount of pain with labor. With putting this little catheter through, the catheter is so tiny, a lot of times we don’t have to do anything to, it just goes right in, we don’t have to dilate your cervix in any way.

But some people will experience a mild amount of cramping just because we’re irritating your cervix a little bit. Ultimately, you may have a tiny bit of cramping, but much, much less than the HSG. And so a lot of people are worried like, gosh, I had significant cramping with HSG, is this gonna really hurt? And for most people, it’s really no big deal. After it’s over with, you’re able to go back home, back to work, you can drive yourself. It’s not a significant level of discomfort afterwards.

Carrie Bedient MD (24:56)

I think one sharp cramp is a good way to describe it. Although many people do not feel anything and we pull everything out and start to clean up our space and they’re like, wait a minute, is this, are you done? And I always offer, if they want me, I will pinch them really hard if they feel like they’ve missed out on something. No one has yet to take me up on that offer, but really the IUIs are fairly user friendly. Some people will feel some cramping the night before they come in for the IUI, and that is pretty normal. There’s a variation. Some people will feel it the night they give the trigger shot. Some people will feel it the night before the IUI. Some people will feel it more during the IUI. There’s a variation of normal. All three of those things are normal to feel one or multiple, and don’t worry about it.

Susan Hudson (25:46)

How would you compare IUI to embryo transfer? They’re very similar procedures from our standpoint.

Abby Eblen MD (25:53)

I usually tell patients that basically it’s the same procedure, but we just do it in a different room. We make a much bigger deal out of it. With an embryo transfer, most of the time we have your bladder full, and I think that’s really what causes the most discomfort. I personally don’t like my patients to have very full bladders. I do my best to try and get them, come in with a very full bladder to basically urinate and get rid of as much of it as they can so I can still see, but so that they’re not extremely uncomfortable.

But generally the procedure itself is the same as an IUI. It’s just a bigger deal. We’re transferring an embryo, which gives you a much better chance than putting sperm in. But what we do is very similar with the exception of a full bladder that can cause some discomfort.

Carrie Bedient MD (26:33)

I think the embryo transfers from the perspective of the catheter that we’re putting in are actually easier and less likely to cause distress because we tend to have a little bit more direction and ultrasound guidance when we’re doing the embryo transfer. And I think it’s much less likely that I’m going to hit the sides of the uterine wall because I’m able to see much more clearly. And the type of catheter that we use, at least the one that I use, has a little bit more stiffness to it. So it’s a little bit more directable.

The biggest problem is almost always that your bladder is full and being the sweetness and light that we are, we’re pushing on it from the inside with the speculum and from the outside with our ultrasonographer. And that’s what causes the most annoyance rather than anything. God forbid you should pee during that procedure. Know that we have all been peed upon before and we don’t care.

Abby Eblen MD (27:22)

One other thing though I would say about the embryo transfer, we have mentioned before that anxiety can magnify discomfort sometimes. And I think there’s no question if you weren’t anxious when you’re about to have an embryo transfer, we’d be surprised because there’s a lot riding on it. And so I think that’s the bigger issue is just the worry about how’s it gonna go? Am I gonna get pregnant? And I think sometimes that will magnify the discomfort with the procedure, but the procedure itself is pretty much the same as an IUI.

Susan Hudson (27:49)

And when we’re looking at bumping things up a notch and we’re going towards IVF, what kind of, let’s start, let’s deal with the stimulation first. What type of discomfort do people experience from their ovaries getting bigger? And then we’ll hop into the actual egg retrieval.

Carrie Bedient MD (28:10)

One thing that people don’t necessarily count on, especially if they’ve done injectable medications before, is actually one of the injections that we do within an IVF cycle, which is Menopur. That one has a bad rap for being very uncomfortable going in, burning sensation. Sadly, that’s pretty typical. We do hear that from a large group of patients. Menopur is a great medication. So when we’re using it, it’s with the knowledge of We’re sorry this will cause a little bit more discomfort in a burning sensation, but there’s a trade off and we’re getting something very distinct from it. So as you’re giving the medications, that’s actually probably the most obnoxious one in the retrieval process meds-wise. With the ovarian growth, normally your ovaries are starting out as the size of small little limes, and they have the potential to get as big as large grapefruits. And that is a stretch, discomfort situation. It’s not pain, really, but it is significant discomfort and the two have some overlap. Part of the reason I’m making that distinction is because imagine you’ve just eaten three Thanksgiving dinners and you have not yet gone to the bathroom and you just feel full and you feel stretched and you’re wondering, why the hell did I do this? Why did I have that eighth helping of mashed potatoes or stuffing or whatever? And

And you know that if you just allow time to pass, you will feel better, but there’s just not a dang thing you can do in the meantime. That’s what an egg retrieval feels like as you are a stimulation feels like as you are getting closer to the egg retrieval, because your ovaries are much larger. There is only so much real estate within your belly and it’s getting taken up a disproportionate amount by the ovaries and everybody else is throwing elbows and annoyed at it, but it’s just living through it and knowing this is going to be uncomfortable. It’s not truly pain. It’s just I don’t feel great.

You guys have both gone through it, what do you think?

Abby Eblen MD (30:14)

Actually, Carrie, I was going for somebody that hadn’t gone through this, that’s a great description, because I was going back in time in my mind, and it wasn’t that my stomach hurt, it’s just you do, you just feel like, like just bloated. I mean, it’s just that it just feels like a lot of bloating, but it didn’t hurt. As far as how I actually felt with the medicines themselves, the actual experience, because I think a lot of people get really nervous that they’re gonna turn into a completely different person when they’re on the medicines.

I think actually most people feel pretty good when their estrogen level is really high. It’s just the discomfort from the fullness of your ovaries that’s kind of uncomfortable. But I mean, I didn’t feel crazy. I mean, I was able to work just fine. It goes back more to the anxiety of what’s this all gonna culminate in? Am I gonna actually get pregnant or not? And that’s really where most of the the fear comes from. But the actual experience of taking the injections and feeling full, wasn’t that big of a deal for me anyway. How about you, Susan?

Susan Hudson (31:05)

Yeah, I would say that the anxiety of everything that’s hanging on the IVF cycle is way, way worse than any physical experience that I had. The injections weren’t fun, but they were, again, a means to an end. And I did them and I was like, okay, I’m going to power through this. And when it came to the stimulation, yes, you felt full, you didn’t want to move quickly and it…just wasn’t as comfortable as you would normally be. I mean, honestly, think you kind of feel like you do if you have a lot of gas or constipation. It’s like things aren’t exactly where they need to be. And it’s intentional. And we’ve created that situation. On that note, when you are going through your IVF stimulation or when you’re going through taking medications, especially any type of progesterone, realize that progesterone is a smooth muscle relaxant. And so things that may move normally for you may start to not move normally for you. And so if you’re noticing that your bowel movements are not the same, you’re having some constipation, increase your hydration, increase your fiber, really try to do all those things you know to keep yourself regular because it is going to make you feel worse. So kind of…Keep on keepin’ on when it comes to that.

Carrie Bedient MD (32:29)

It is much easier to keep yourself out of a hole than it is to try and dig yourself out of that hole once you’re in it. So the second you notice anything slowing down, stool softeners, the various medications that you can dissolve in water like Miralax. I have a friend in GI who swears by warm, it has to be warm prune juice to help get things going. But stay on top of that because sometimes that is the worst thing that people go through and do not underestimate how much being FOS, full of shit, can make you comfortable and just jump on it right away because it’s something that we can avoid and is helpful to.

Susan Hudson (33:11)

Okay, egg retrieval.

Carrie Bedient MD (33:13)

Alright, I’m going to defer straight to you guys to answer this one.

Abby Eblen MD (33:15)

So egg retrieval. So you’re asleep for the egg retrieval. That’s the good news. And like Susan said, I was a little bit anxious before the egg retrieval, but I’d already done quite a few before I ever had my own egg retrieval. So I knew what was going to happen. And so wasn’t afraid of the procedure. I knew the doctor that was doing my egg retrieval was more than competent. And I knew that she would do a good job. It’s more the fear of how many eggs am I going to get and that sort of thing.

As far as actual discomfort, for the first 24 hours after the egg retrieval, my abdomen felt really sore, kind of like I had done a lot of sit-ups. It just felt sore. And so it was really helpful to take Tylenol and ibuprofen. That knocked out the pain. Generally takes you about two weeks to get your ovaries to the point where they’re the appropriate size and ready for retrieval. It takes about two weeks for your ovaries to get back down to normal again.

You need to be kind to your body and listen to your body. And we don’t want you doing a lot of exercise because ovaries are like grapes hanging down on like a little vine. And so if your ovaries are really big and full and you do a lot of movement, a lot of activity, it can twist and torse those ovaries. so generally the discomfort though, after the egg retrieval goes away after about 24 hours. And then I would say I felt pretty much back to normal by my next menstrual cycle.

Susan Hudson (34:29)

I would say that a lot of how I would expect someone to feel depends on how many follicles they have. Quite frankly, if you have five, six, ten follicles that we’re going into, that’s a whole different ball game than somebody who has 30 or 40 follicles.

And so this is definitely one of those kind of knowing where you are in your fertility journey and knowing what your ovaries have produced. Because if you have a few follicles, you’re probably not going to have the same amount of discomfort as somebody who had 40 eggs retrieved. It just isn’t going to be the same. With that being said, if you are home post retrieval and things are not gradually getting better or you’re having severe pain, that is definitely something that you would need to call your doctor about. Okay. And everyone who’s listening, if you’re seeing an REI and you’re post retrieval, there is somebody on call, call the office. There’ll be a medical exchange of some sort, and you will be able to get in touch with the physician who’s covering emergencies and they’ll help be able to walk you through. Is this something that we need to check out right away? Or is this on the realm of normal?

Carrie Bedient MD (35:47)

I am going to make mention of one particular patient population who may feel all of this a little bit differently than the others. And these are the endometriosis patients. And with endometriosis, the medications we are giving you are oftentimes stimulating the endometriosis. And so this is the one patient population where…We tell them, your stim’s gonna be fine and the retrieval will be uncomfortable, but it’ll ultimately be okay, blah, blah, blah. And particularly, especially when we don’t know they have endometriosis and this is something that we’re figuring out in the midst of it, they come in and they’re having really intense pain or more pain than anticipated. And they’re freaking out going, my God, what is going on? Is something wrong with me? Is there something bad happening? Because of course that’s what we all do with pain.

It is a signal that something is happening differently within the body. And endometriosis patients do oftentimes feel much more acutely what they are going through in a retrieval. Typically, it actually is not signifying anything bad is happening within you, but it can be very frightening, especially when we tell you the things that you normally want to do to make yourself feel better, like take an ibuprofen NSAID type medication that you can’t do. You got to stick with Tylenol and maybe some very short applications of heat and stretching and things like that. They’re not great solutions for dealing with the pain. But many times people feel much better once they know, this is part of the experience. This is what’s gonna happen. This is part of the reason why I have to do this in the first place. And so that’s just a forewarning, advanced notice for some of our patients with endo. The good news is when you hit the transfer in pregnancy, you tend to feel great because all the progesterone exposure makes you feel so much better. And I have some of my endopatiens who will say, sign up for pregnancy. I can do this all day, every day, because they really do feel pretty good during pregnancy, which given that that’s nine months, that’s totally a win.

Abby Eblen MD (37:49)

Mm-hmm.

One other thing I would add to that, Carrie, when you said it’s special group of patients, the other group, I recently had somebody who did IVF and has a history of migraine headaches, and I see a lot of people with migraine headaches, and I would say for 90 % of people with migraine headaches, it doesn’t bother them at all. But some people who have really severe bad migraine headaches, and particularly if it’s responsive to fluctuations in estrogen, either absolute numbers, high estrogen levels, or just the fluctuation either up or down.

I would just have a plan in place before you get started with your doctor, just in case you’re one of those people who, as your estrogen level goes up, you start to have more headaches. Have a plan in place for what you’re gonna do, what medicines you’re gonna use, because again, like Carrie said, there’s a lot of things we don’t want you to use when you’re stimulating, so just make sure you have a plan in place.

Susan Hudson (38:37)

All right, else you think we need to touch on today?

Carrie Bedient MD (38:42)

Let’s talk about progesterone shots real quick. That’s the one part of the transfer that we haven’t quite hit on. These are, for the most part, injections that go in your backside. They’re literally a pain in the butt. It is typically not the first couple that cause a problem. It’s when you’ve been doing it because you are pregnant and you’re six, seven, eight weeks into it where your butt is just annoyed because we have to give this in oil.

That’s the way that progesterone dissolves. This is not because we love torturing you. It is because that is the best way to deliver that medication via injection and doing things like ice beforehand to numb the area, heat afterwards and massage to help the oil kind of spread out. It’s not the progesterone. It is the oil that it’s causing that annoyance. Rolling your butt around on a tennis ball to kind of break things up and move them around. All of those are some of the tips that we give patients to help to deal with those injections or sorry they hurt. They do a really good job of what we need them to do, which is why we go for them.

Susan Hudson (39:35)

One thing I would like to mention, typically nowadays, progesterone oil comes in one of two different types of oils. There’s lots of oils that can come in, but the most common nowadays is sesame oil or ethyl oleate. And if you have progesterone and sesame oil, and it’s causing quite a bit of discomfort, sometimes switching to the ethyl oleate will be more comfortable, but know that if your insurance is paying for it, they often will not pay for the ethyl oleate. So it’s a little bit more of an expense, but sometimes it’s worth literally the pain in the butt.

Carrie Bedient MD (40:20)

Definitely.

Susan Hudson (40:20)

All right, so to our audience, thank you so much for listening and subscribe to Apple Podcasts to have next Tuesday’s episode pop up automatically for you. Also be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Abby Eblen MD (40:35)

Visit us on fertilitydocsuncensensored.com to submit specific questions you have and sign up for our email list. We’d love to hear from you.

Carrie Bedient MD (40:43)

As always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we will talk to you soon. Bye!

Abby Eblen MD (40:53)

Bye.

Susan Hudson (40:53)

Bye.