As a fertility nurse, I know that we often receive emails from the front desk asking us to call a patient about a particular question or problem.
Although fertility treatments, and the challenges inherent in them, can be incredibly stressful (and this is not meant to minimize that) you might get a laugh from some of these. Whether you are a nurse or patient, I’m sure you can identify with many of these scenarios.
The following is a list of some recent (and real) email subject headings as well as a description of the situation and outcome.
- 1) “Patient’s husband can’t leave a sample because there was a bat in the house and he’s very stressed out.”
We often joke about the male partner’s role in fertility treatments. The female has to do the bulk of the ‘work’: mix and administer injections, undergo blood draws and vaginal ultrasounds…etc.
All the man has to do is to provide the sperm sample. Well, we need to remember that the ‘act of providing’ the sample is somewhat dependent on the male being relaxed and in the mindset to ‘produce.’ Having any kind of added stress can be deleterious to the production process, to say the least. So in this particular situation, after chasing a bat around the house in the early morning hours, the last thing this poor guy wants to think about is producing into a cup. This can happen in even less eventful situations, like having an important work meeting or just feeling the stress of a positive ovulation predictor kit month after month.
If you think this might be an issue for your partner or your patient, have a back-up plan. Consider a frozen sample, or renting a local hotel room (seriously, sometimes the proximity to the office or escaping an office-like atmosphere can help). Although we often focus most of our care and attention on our female patients, this serves as a reminder not to forget about the men.
- 2) “Please call patient, she has a meeting and can’t have her egg retrieval today.”
There are many variations of this: husband unable to bring in his sample due to traffic, unable to come in for a blood test or ultrasound due to bad weather … etc. Yes, there are many components of a fertility treatment cycle that are precisely timed, but there are some that can be modified.
Usually, the most flexibility occurs earlier on in a treatment cycle, so if you have to miss or reschedule an appointment, it can often be done then. If you have ‘blackout dates,’ or those days that you are unable to come into the office due to vacations or work conflicts, we can often plan around them, if we know in advance. There are some procedures, though, that are specifically timed and can’t be rescheduled, such as having an insemination or retrieval after your trigger shot. It’s still worth calling the office if you have a change in your schedule to see what can be rearranged and what can’t, but just know that some timing is beyond our control and rescheduling might be detrimental to your cycle. Regarding the semen sample timing, most centers are comfortable with the sample arriving within 45 -60 minutes of production (check with yours to see their policy). The sample should be kept close to body temperature, not frozen, for example, we had one male partner put his in a cooler with frozen veggies as he thought he would run errands on his way home from the grocery store.
- 3) “Patient sneezed and her embryo fell out. She saved it, though, and can bring it in.”
So…this one, or some version of this, has come up almost every year since I’ve working in REI. Even though a blastocyst (an embryo at its implantation stage) is only the size of a period on a keyboard, infertility patients will obviously do anything to protect it and facilitate implantation.
We can only be so proactive to help implantation take place. Even when we do IVF, where we transfer the embryo directly in the uterus, it still floats around and finds a comfortable spot on its own, which can take a day or so. No amount of pressure (such as sneezing and going to the bathroom) will expel the embryo. Likely, what is being seen or felt is residue from vaginal medications, mucus or (yup) urine. So don’t worry if you sneeze or cough or yell. Your blastocyst is safely ensconced and is looking for (or found) its cozy spot.
- 4) “Patient sent a picture of her butt and wants to know if she gave injection in the correct spot.”
Well, I have seen many butts, stomachs, and thighs over the years, and even seen some remotely (and abruptly) over FaceTime or Skype. Patients are taught how important it is to give the proper amount of medications, in the proper spot, and avoid big veins and the sciatic nerve. It’s no wonder they are so careful about where to give the injection. Even though we are happy to draw circles on their butts, when it is time to actually give the injection, it is still scary and nerve-wracking to give yourself or your partner an injection.
One of my patients asked her grandmother to help, because she is diabetic and used to giving injections. However, she didn’t take into account her grandmother’s poor eyesight issue, which generated an interesting injection site and caused some pain for the next few days. Also, sometimes, no matter how careful someone can be, there will be a little bleeding at the injection site, even moderate bleeding, because there are superficial blood vessels that can’t be avoided. Hitting these is ok, it just might cause a little bruise. We know that you’re nervous, so we are happy to draw circles, help with injections or look at your butt whenever necessary.
- 5) “Patient’s dog ate her estrogen and she is wondering what to do.”
Fertility patients are very protective of their medications and with good reason. They are expensive, not easily obtained, very time-consuming and dose-specific. It can be overwhelming to receive the big box that is shipped and wonder, “what goes in the fridge?” or, “what needle do I use with what medication?” …etc.
I usually suggest separating and batching the medications and syringes, that is, putting stuff next to each other (or rubber banding it) that goes together. So, progesterone with progesterone needles, leuprolide with leuprolide needles…etc. As for the pills, many of them are not used until later, so they can be put away until you’re told to use them, in an effort to avoid any confusion and stay organized. It is helpful to keep the medications in a safe, climate-controlled area (unless they need to be refrigerated) away from kids, pets and nosy mother-in-laws who might snoop. Maybe in the master bathroom or in your bedroom, but out of reach. We have had cats knocking over and playing with medication vials, birds flying off with syringes, and dogs eating pills. By the way, the dog was ok, just a little breast tenderness.
Many of my colleagues and I really enjoy our roles as fertility nurses. We love taking care of our patients and helping them through the process, and absolutely understand that questions arise along the way. Hope that this answers a few of them and in the future, we will pick on the men a little more.