Fertility Treatment Side Effects and How to Cope with ThemDeborah Bohn
Have you ever read the warning label on a bottle of baby aspirin? The list of potential side effects will make your toes curl: dizziness, ringing in the ears, and gastrointestinal bleeding to name a few. Is it any wonder that legions of women considering assisted fertility solutions are cautious when they ponder the idea of injecting bottled hormones into their body in hopes of making a baby?
As a woman who’s been there and injected that, take my advice and chill out, because it’s really not that big a deal. Although I experienced the full gamut of assisted reproduction side effects, everything from weight gain and water retention to pelvic pain and peevishness (which is a polite way to say “pissed offishness”), I can honestly say that the discomfort was temporary, and the result, two gorgeous healthy daughters, was worth every needle prick and extra pound.
It also helps to keep in mind that every body is different and each patient’s drug protocol is unique, so no two women will have the same experience. At one end of the spectrum are those strange and amazing ladies like Robin Taylor of Atlanta who actually feel better once they start taking fertility meds. “When I was on the hormones, I felt more balanced,” she says. “I was a little bloated after my egg retrieval procedure, but that was my only issue.” On the other end are those unfortunate few who are so miserable that they stop treatment before the first pregnancy attempt. Dr. Abby Eblen, a reproductive endocrinologist at Nashville Fertility Center, says, “Maybe three or four times a year a patient says, ‘I can’t do this’ and cancels her cycle.” But according to experts like Dr. Carolyn Givens, reproductive endocrinologist at Pacific Fertility Center in San Francisco, the overwhelming majority of women fall somewhere in between. “I always ask my patients how they’re feeling and most say, ‘I was expecting so much worse,'” she says.
So what’s all the hype about? And what sorts of side effects can a woman expect to experience from her fertility treatments?
Clomid—Moodiness and Multiples
Clomid is an anti-estrogen drug used to stimulate the ovaries to produce mature eggs, and it’s often the first choice for women who don’t ovulate regularly. “Lots of people feel lousy on Clomid. We get a lot of complaints about feeling moody and out of sorts,” says Dr. Arthur Wisot, executive director of Reproductive Partners Medical Group, which has offices throughout Southern California, and author of Conceptions & Misconceptions: The Informed Consumer’s Guide Through the Maze of In Vitro Fertilization and Other Assisted Reproduction Techniques. Most women only take Clomid for a few weeks and weather the emotional storms. But one of Clomid’s most notable side effects is permanent! “The biggest side effect is multiple births,” says Dr. Wisot.
Donna Young of Falls Church, Virginia, didn’t get pregnant with twins or triplets when she took Clomid in 2003, but says she experienced “very strong highs and very strong lows.” She laughs, “You’re in super-PMS mode!” How did Young cope? “Does chocolate ice cream count as a coping mechanism?” she asks. “I pampered myself a bit more.”
According to Dr. Eblen, about 2 percent of patients taking Clomid experience visual disturbances like seeing spots and streaks, a potentially serious problem that requires an immediate call to the doctor.
Lupron is an injected drug used in the early stages of in vitro fertilization cycles to decrease a woman’s production of her own naturally occurring reproductive hormones, which sends her body into a pseudo-menopausal state. And like women in menopause, patients sometimes experience hot flashes, vaginal dryness, insomnia, and headaches. Like Clomid, Lupron rapidly decreases a person’s estrogen levels and can cause the same uber-grouchiness. In my case, Lupron didn’t make me feel sad or weepy, it made me feel like punching everyone who got in my way. “If someone is feeling depressed and angry because they’re infertile, the drug might accentuate those feelings,” says Dr. Givens. Donna Young agrees: “It’s hard to determine if it’s the drugs or the process that’s making you feel grumpy.”
The cure? Understanding that these feelings are normal and temporary. Dr. Christopher Williams, medical director and co-director of the in vitro fertilization program at the Reproductive Medicine and Surgery Center of Virginia in Charlottesville, and author of The Fastest Way To Get Pregnant Naturally, says, “Irritability is a common thing. I tell people to be prepared for it. If you’re insightful, you understand what’s happening.” He recommends extra-strength Tylenol (acetaminophen) to combat the headaches, but cautions patients to avoid Advil or Motrin (ibuprofen). “They can affect implantation and early pregnancy,” he explains.
Follicle Stimulation Hormone—Expanding Ovaries and Waistlines
I like to refer to follicle stimulating hormones (FSH) as henhouse drugs because their sole purpose is to help a woman’s body release as many eggs as possible in a single month. The other reason for this nickname is that once you start injecting FSH, your body begins to resemble a fat brood hen—squat and round.
When I went through IVF, my belly expanded so rapidly that I had to go out and buy larger clothes for work—lots of adjustable wrap skirts and softer, flowing pants with long jackets to hide my new bulge. “Bloating, weight gain, and mood swings are the most common reactions to FSH,” says Dr. Wisot. He attributes the mood swings to the body’s rapid estrogen rise, triggered by the medication. “When you make an egg on your own you’ll have an estrogen level of 200, but on FSH, it will be up in the thousands,” he explains.
Feelings of abdominal heaviness come from temporarily enlarged ovaries. “Ovaries are normally the size of a walnut. But after FSH, they could be the size of plum or even the size of a grapefruit,” explains Dr. Frederick Licciardi, reproductive endocrinologist and founding partner of the New York University Program for In Vitro Fertilization, Reproductive Surgery and Infertility. Dr. Williams advises patients to change positions to take pressure off the ligament attached to the abnormally heavy ovary and try Tylenol for mild discomfort. But he cautions women to contact a doctor if they have nausea, vomiting, or pain that doesn’t subside with positional changes. These symptoms could indicate a twist in the ligament (ovarian torsion), a serious condition that requires immediate medical attention. Ovarian torsion is rare, though, so most women will find relief with a little rest, an understanding partner, and elastic pants!
Hyperstimulation—Too Much of a Good Thing
FSH will very rarely trigger a condition called ovarian hyperstimulation syndrome (OHSS), where excessive fluid leaks into the abdominal cavity causing extreme bloating, nausea, and shortness of breath. As one of the unlucky 1 or 2 percent of women who have experienced it, I can say that although it was uncomfortable, the signs were pretty easy to recognize. I was only two weeks pregnant but looked five months along, and I had a hard time catching my breath. The cure—draining the excess fluid in the doctor’s office under mild sedation (paracentesis)—provided quick relief, and my pregnancy proceeded perfectly.
For mild bloating, women can find relief with soup! “The best home remedy is to keep lots of salt in your body to hold the fluid in your blood stream so it doesn’t leak into your abdomen,” says Dr. Williams. “Drink salty fluids like Campbell’s soup, V8, tomato juice, or Gatorade Endurance.”
Progesterone—Grumpy and Lumpy
Once embryos are created and transferred into a woman’s uterus, she’ll take progesterone for approximately 10 weeks to create a more robust uterine lining for the growing baby. Candace Tan of San Francisco, who conceived her first child via IVF in 2005 and is currently pregnant with her second baby, says, “It became very obvious to me when I was on progesterone and when I wasn’t. It made me moody and edgy. I’d gain three pounds of water weight. I’d get headaches. I was miserable.”
Dr. Williams confirms that progesterone causes intestinal bloating as well as heartburn. He recommends “lots of fluids and fiber to keep things going through” and antacids to keep the burps at bay.
The other major complaint about progesterone? It’s literally a pain in the rear end. That’s because it’s often mixed with oil and delivered as an intramuscular shot that causes lumps under the skin. Dr. Licciardi jokes, “Progesterone is really a ‘sore’ subject.” An alternative is to use progesterone vaginal suppositories. They’re messy, but don’t hurt a bit. Dr. Given’s practice uses suppositories; Dr. Williams says the injections and suppositories have the same success rate. Another option is to ask for a smaller injection needle. According to Robin Taylor, “Progesterone hurts like hell. It hurt to walk.” She says it helped when a nurse swapped her 1.5 inch/22 gauge needles for shorter, thinner 1 inch/23 gauge needles.
The Ultimate Side Effect
If all of this sounds daunting, try to remember that thousands of women undergo fertility treatments each year with no major complaints. “For every patient who tells me she’s at her wits’ end, I have another who says she feels fine,” says Dr. Licciardi. “For every negative extreme, I have an extreme that’s fantastic, and everyone else is in the middle.” And really, all the moods and extra pounds are undoubtedly forgotten when the best side effect of all shows up—a new baby.