A lot of patients ask for advice when trying to coordinate fertility treatments and vacation or business travel. In general, I ask them to consider a couple of factors when trying to decide what to do. First of all, if hoping on a plane were all you needed to do to prevent pregnancy then flight attendants would never experience unintended pregnancies! However, there are reasons to be careful about leaving town following fertility treatments (or during early pregnancy).
Clinical vignette A:
MS was a 34 year old patient who had never been pregnant. She was given 4 months of clomid by her Ob Gyn and told to just keep trying. No other testing had been performed. No sonogram, no sperm analysis, no HSG. During her 3rd Clomid cycle she was at a professional conference in Chicago when she experienced severe abdominal pains and was taken to the local ER. She spent the next day and a half in the hospital with bilaterally enlarged ovaries with large (6 cm) cysts that may have been either endometriomas (endometriosis cysts or chocolate cysts) or just Clomid induced cysts.
Finally, she felt well enough to travel and returned to DC. She came to see me and on ultrasound had bilateral cysts which were hard to distinguish between clomid cysts and endometriomas. We waited a few cycles an they failed to resolve so she had a laparoscopy that demonstrated severe endometriosis.
Lesson learned: Don’t give clomid to patients that may already have a significant ovarian problem. This can easily be avoided by making the transvaginal sonogram part of the routine fertility evaluation. This week a couple was thinking about taking Clomid just before going to Europe for a fantastic vacation…I told them to have fun, get pregnant and wait on the Clomid until after they return!
Clinical vignette B:
TD was a 29 year old with unexplained infertility. She came in on a Friday afternoon for confirmation of pregnancy because she had tested positive on a home pregnancy test. However, her period had come that month or so she thought and was a bit concerned. The beta level was available on Saturday morning at 11:30 AM and it was over 1500 IU/L but not as high as it should have been given her usually regular periods and the fact that she was sure when she had conceived.
I called her and told her the news and suggested an ultrasound to evaluate whether this was an abnormal pregnancy in the uterus or even an ectopic pregnancy. When she answered her cell phone she was in line at the United baggage check to check her bags as she and her husband were on their way to France! I explained that an ectopic was possible and could rupture even in mid-flight on their way to France. On the other hand, it could be just an abnormal pregnancy destined to miscarry…My advice was to cancel the trip and come right on over to the office. They debated and called me back a couple of minutes later. They were going to France anyway. We discussed the risk of travel and the need for prompt assessment. They called me back an hour later. They canceled their trip.
On Sunday AM I performed an ultrasound that showed a 3 cm ectopic pregnancy. She underwent laparoscopy and was very grateful that she had not taken that flight.
Lessons learned: All pregnancies are potential ectopics. Sometimes you need to rain on someone’s parade in order to give them the best medical care.