Josie’s Story: Getting Pregnant With Ovulation Induction
I want to talk to you about Josie who by the way is pregnant and well now after her fertility treatment, but she did develop two known problems as a consequence of her fertility treatment.
Josie is a 29 year old university student with PCOS who had been trying to conceive for 18 months before I saw her in my clinic. We tried to help her to conceive through the fertility treatment of ovulation induction with the hormone tablet Clomiphene Citrate (Clomid), but no ovulation occurred despite increasing the tablet dose up to 150 mg of Clomid.
In fertility talk we call this having “Clomid resistance”.
She then started the next level of fertility treatment for PCOS called FSH ovulation induction with the hormone injection Follicle stimulating hormone – FSH. See the ovulation induction article in the fertility treatment section of this website for more detail.
Josie’s ovaries responded well. She ovulated and conceived, but two weeks after ovulation, Josie rang saying she had increasing abdominal pain and some shortness of breath.
What she had developed is a condition called Ovarian Hyper-stimulation Syndrome also known as OHSS, which only develops as a consequence of fertility treatment.
Josie was admitted to hospital for a week, needing observation, intra-venous fluids, and pain relief until it resolved.
In OHSS, the ovaries can become large and plasma fluid can leak into the abdominal cavity – see the article OHSS in the Clinical notes section of the website.
Later on… Josie’s first obstetric ultrasound revealed two pregnancies in the uterus… indicating a twin pregnancy. This was a great surprise for everyone especially Josie who was over the moon with this finding. The twin pregnancy would of course have been due to her ovulating not one but two eggs that fertilised during her ovulation induction treatment.
There can be some mild side effects with ovulation induction fertility treatment such as bloatedness, mood changes – perhaps headaches…
…but the more serious side effects are OHSS and multiple pregnancy such as twins, triplets, quadruplets and MORE. (See article on OHSS in clinical notes).
A multiple pregnancy does have risk for both the mother and the babies:
For the babies there are;
- the risks of intra-uterine growth retardation,
- and very premature delivery
- with the associated risk of cerebral palsy
- or some disability.
To the mother there is the increased risk of;
- obstetric health problems like high blood pressure in pregnancy,
- gestational diabetes and
- the risk of caesarean section
- and bleeding after delivery.
For Josie and other women, many twin pregnancies do well, but there is the need to be cared for in a tertiary hospital by an Obstetrician with ‘twin’ experience.
I enjoy sharing these stories with you and will have another PCOS Story posted soon.