Our egg donor’s egg retrieval

On Friday morning, my husband and I rolled up at the hospital in Belgium with our awesome egg donor Marie for her egg retrieval surgery. I’ve been trying to write a post about it ever since, but the past week was such a blur of ultrasounds and international road trips that we’re all pretty exhausted. So instead, allow me to present a brief highlights reel.

The ‘puncture’

The finale of Marie’s past two weeks of hormone injections was the egg retrieval surgery. Marie was never particularly thrilled about this part of the process, but she was even less thrilled when she learned that it’s referred to in Dutch as ‘the puncture’. This makes sense, as it’s performed by sticking a very large needle into the vagina, through the vaginal wall, and into each ovary. A fun way to spend a Friday morning!

Here in Belgium (& the Netherlands), this procedure is done while you’re awake. Our clinic uses a local (internal) anesthetic and a morphine IV to help minimize the pain. Ironically, Marie found the IV (which was placed in her hand) to be the most painful part of the whole procedure. I tried my best to distract her while we waited to be taken back with entertaining anecdotes from my husband’s experience one floor below.

The ‘sample’

At roughly the same time as Marie was being called in for her puncture, my husband had a finale of his own….so to speak. For our first two IVF cycles in Holland, the ‘sample’ (as it’s called) could be ‘produced’ at home and biked over in his jacket pocket. (Can you imagine what would happen if he had gotten into a bike accident??)

Here in Ghent, the ‘sample’ is instead produced in a small room with a tasteful silhouette of a naked lady on the wall and a collection of decidedly less-tasteful magazines. For maximum quality, the ‘sample’ should have ‘accumulated’ for 2-3 days. I’ll leave the rest to your imagination.

The number of eggs retrieved was…

Back in the operating room upstairs, Marie and I were 3rd in line (out of four ladies that morning) for her puncture. We were called back around 10am — almost exactly 36 hours after her trigger shot — and the actual procedure got underway. Marie was pretty out-of-it from the morphine at that point, but I got to watch the ultrasound monitor as the fluid was rapidly drained from each follicle and into a tray of waiting test tubes. Marie had WAY more follicles (17!) than I had ever produced, so she filled up test tube after test tube. No wonder she had been feeling bloated!

Marie’s large number of follicles also meant the fluid couldn’t be processed immediately to find the eggs like mine was (think panning for gold), since the procedure was all done in only about 30 minutes. But shortly after the procedure was over and Marie was back resting in her bed, the nurse came in to give us the great news: 16 eggs had been retrieved!!

If you recall my previous post about the odds of this cycle working, you may also recall that ~15 eggs is the optimal number as far as maximizing the odds of pregnancy. So basically, Marie and her overachieving ways freaking #killedit.

A slight hiccup

There is a downside to Marie producing so many eggs: it puts her at a higher risk for developing ovarian hyper-stimulation syndrome (OHSS), where the ovaries become painful and swollen. In order to mitigate the risk, our clinic puts anyone who produces more than 15 eggs on Cetrotide injections. So although we thought Marie had had her last encounter with a needle, she’s now being treated to 7 more days of daily stomach injections.

How many eggs fertilized?

On Saturday morning, back in Holland, I got the call that 15 out of 16 eggs had fertilized. This is a fantastic fertilization rate, and hopefully it increases our odds even further. When I relayed the information to my husband over the phone, I like to imagine his hands were clasped over his head in a victory gesture.

Now we are waiting to see how many of the 15 embryos continue to divide and develop into 5-day-old blastocytes, when we will hopefully transfer one to my waiting uterus and freeze any remaining for later attempts. Today is already day 3, which means my husband and I will make the drive back to Belgium tomorrow night for a Wednesday morning embryo transfer. Unfortunately, the necessary timing of the transfer also means we will miss the departure of Marie and her family! They all fly back to the U.S. early that same morning, wrapping up what must be one of the most eventful family vacations ever.

By the way, if you’ve ever wondered how you’d react if one of your friends traveled internationally to have elective surgery and potentially give you the gift of life, it may be something like this:

Decked out in surgical scrubs and #thankful

Egg donor’s retrieval scheduled

We’re currently in the thick of our fourth IVF cycle, and our first attempt using donor eggs. Yesterday morning our egg donor, Marie, and I made the ~8 min drive from the hotel where we’ve been staying in Ghent (Belgium) to the hospital there for her 3rd check-up. Marie is now a seasoned vet at the transvaginal ultrasounds that are needed to count and measure the follicles growing in her ovaries. So let’s get down to it.

This latest ultrasound showed she’s still growing around 17 follicles in total — same as the last check. The follicles are growing at different rates, which is totally normal, but it means that only some of them are expected to be the right size to contain a mature egg. In particular, in order to maximize the total number of eggs retrieved, sometimes the clinic decides to sacrifice the largest follicle in order to wait for a larger number of smaller ones to catch up. Even then, there are usually also some follicles that are still too small to contain a viable egg.

Marie now has one follicle that is probably too large (25 mm), but 9 that are the right size (18-22mm). In addition, she has around 5 more slightly smaller ones (15-17mm), some of which may (hopefully) be large enough by the retrieval. Then there are two that are definitely too small (12-13mm). These results are shown in the (embarrassingly poor-quality) screenshot below, which Marie and I shamelessly snapped from the ultrasound technician’s computer. If all of those follicles yield an egg (which is not guaranteed), then we will hopefully retrieve 9-15 eggs in total…a great result, and way more than they retrieved from me in all three of my previous IVF cycles combined(!)

Poor-quality screenshot showing size of follicles in millimeters (y-axis) versus date of exam (x-axis). Marie’s ultrasound yesterday morning (far right column) showed 9 follicles in the correct range (18-22mm), one at 25mm (probably too large), and 5 more (15-17mm) that may also be large enough to contain a mature egg by the egg retrieval. (The 12-13mm guys are sadly too small.)

When will the retrieval be?

After her ultrasound, Marie had a blood test to check her hormone levels. We got a call yesterday afternoon that the results came back in-range, which means that we are good to move on to the next step. So last night at exactly 10:30pm, we gave Marie her final hormone injection: a trigger shot in the stomach (#hardcore). This final shot helps the eggs mature so that they’ll be ready exactly 36 hours later for the egg retrieval, scheduled for tomorrow morning.

Does 9-15 follicles mean 9-15 embryos?

We’re super happy that Marie is responding so well to the medication and that we’ve made it this far. But before everyone gets overly excited, I just want to clarify that 9-15 follicles does NOT mean 9-15 embryos. If it did, our chance of a live birth from this cycle would probably be way more than the predicted ~25%.

To start with, we can’t be sure that all of the follicles (even the big ones) will yield eggs…

Then, of the eggs retrieved, only some of them will be mature…

Of the mature eggs, only some (maybe 70% on average) will fertilize…

Of the fertilized eggs, only some will divide normally into embryos…

And finally, only some of those embryos will make it all the way until the fifth day, when we will hopefully have at least one that can be transferred to me (and stick).

In other words, even with 17 follicles, it’s perfectly possible that we could end up with only one or two 5-day embryos. Of course, that would still be way further than we got with our last 5-day transfer (which was cancelled due to having 0 embryos)! So cross your fingers (or hold your thumbs) that we make it that far. And keep Marie in your thoughts tomorrow for the egg retrieval, which she was less-than-thrilled to learn is referred to in Dutch as the ‘puncture’.

Egg donor’s 2nd follicle check

In my post from Friday, I discussed how our egg donor, Marie, had her first transvaginal ultrasound to check on the growth of her follicles. We saw 17 quickly-growing follicles — a great response — prompting our clinic in Belgium to request another ultrasound on Monday. For this one, we had to come to Belgium, as they also needed a blood test that we’d been unable to get locally in Holland. Additionally, the last ultrasound before the retrieval must be done at their clinic, and they thought she might almost be ready.

We thought it would be nicer to arrive the night before rather than get up at the crack of dawn, and we’d already booked a room near the hospital for the whole week just in case. Fortunately, Marie’s husband also arrived from the US on Friday to help care for their two kids while we’re busy with all this. So Sunday night, Marie and I borrowed a friend’s little red car and made the 2+ hour trip to Belgium.

Joint Ultrasounds

Marie and I both needed ultrasounds, which were scheduled back-to-back. Marie’s was needed to check her follicular growth, and mine was needed to check my uterine lining. You know how some friends hang out by going to the movies, or getting their nails done together? Well we hang out by going to a foreign country and having wands shoved up our hoo-has.

Marie went first, and we were thrilled to see that the 17 follicles were all still there and growing. The largest are already 2cm in diameter, so they’re starting to look quite crowded. Here you see two different views of Marie’s left ovary.

Two different views of Marie’s left ovary, which is growing ~11-12 follicles.

My ultrasound was much quicker, as the technician didn’t need to search for and measure any follicles. She just checked that my uterine lining had the right thickness and structure. It’s currently measuring at ~11mm, which means the estrogen pills I’m taking are working.

We then had to go down to the lab to get a blood test for Marie. It showed that the follicles aren’t quite ready yet. This means we need to go back for another ultrasound and blood test tomorrow.

How is Marie feeling?

Several friends/family members were curious about how Marie is feeling while taking the hormone injections, and the answer is: completely normal. It doesn’t seem to be affecting her mood at all, and until recently, she didn’t have any physical side effects either. Only in the last couple of days has she started to feel a ‘fullness’ in her abdomen, or a slight twinge if she leans over to one side to grab her phone. This makes sense, as each follicle is the size of a large grape — and there are 17 of them in total — so she essentially has a bunch of grapes in each ovary. In her words: “I knew generally where my ovaries were before, but now I can tell you they are [pointing] here and here.”

Our egg donor’s first follicle scan

I’m writing this the night before our egg donor, Marie’s, first follicle scan, with plans to fill in the details later. Since I don’t actually know how it’s going to go yet, I guess I’ll have to write it kind of like a choose-your-own-adventure novel, with alternate endings depending on how it goes. I will write one version that’s excited and hopeful for if we see a lot of follicles growing, and I will write another that’s disappointed-yet-putting-on-a-brave-face for if we don’t see much response.

I do already know how the logistics of the appointment will go from my three non-donor-egg IVF attempts, so I can write about that first. Although our fertility clinic is in Belgium, and although you are required to do the first and last ultrasound checks there, I’ve previously used a local clinic here in Holland to do the intermediate scans. This is much more convenient than driving to Belgium every few days, and they only charge 75€ per scan. Right before my recent test cycle, they actually stopped offering this service for people who aren’t their own patients, but since I’d already been coming there, they (thankfully) agreed to keep doing mine. Fortunately, they also agreed to do Marie’s, since she’s only there as my donor.

Unfortunately, they weren’t able (or willing?) to do the blood tests that are required along with the ultrasounds. For my own checks, I was able to convince the local hospital where I had done my first two non-donor-egg IVF cycles to do those for me during my Belgian attempt. This meant biking 20 minutes across town to do the ultrasound, then biking 30 minutes in the other direction to get blood drawn. This usually also meant arriving to work super late and sweaty, but it was all still better than a 2+ hour drive to Belgium.

However, when I asked the hospital if they could also do Marie’s blood tests, they refused on the grounds that she doesn’t have Dutch insurance. After multiple phone calls to my ‘huisarts’ (GP) and various labs, we never actually found a solution. As a result, we will only be getting an ultrasound tomorrow, and we will have to hope that provides enough information on its own. If not, we may be making a last-minute trip to Belgium.

What happens at the ultrasound?

Like Marie’s initial scan before she started the injections, this will be a transvaginal ultrasound. At this point, I should note that the Dutch doctors don’t give you those flimsy ‘privacy sheets’ (or gowns) that Americans are used to. I’ve gotten quite used to stripping down and walking pantsless across the room to the waiting stirrups, but Marie is fresh-off-the-boat, so her American aversion to nudity is still firmly intact. I’ve advised her to wear a long shirt or dress, effectively creating her own privacy gown.

They will then use the ultrasound wand to have a peek around inside. For non-donor-egg IVF, they would start by checking the thickness and structure of the uterine lining. Since Marie is only donating the eggs — not acting as my surrogate — they will instead head straight to her ovaries. Once they’ve located them, they will look for the dark round spots that indicate growing follicles. They will use the computer cursor to measure the diameter of the follicles, and they will officially count all those greater than 10mm in size.

And the results are…

Marie’s first scan is now over, and the results look promising, with 17 follicles in total. Marie’s left ovary shows 5 follicles greater than 10 millimeters and 7 that are <10 mm, and her right ovary shows 2 that are >10 mm (with 3 more <10 mm). It’s only the first scan, so we will see how many of those little guys can catch up between now and the next ultrasound. Follicles grow 1-2 mm a day, and at the point of the egg retrieval, we can expect to find a mature egg in those that are ~15 mm or larger. We have our fingers crossed for ultimately retrieving at least six (mature) eggs in total — and ideally 12-15 for the best odds. Now we will email Marie’s results to the Belgian clinic, and wait for them to tell us whether we need to make a spontaneous trip to Belgium for bloodwork!

The results from Marie’s first follicle check. Way better than my typical result of a single follicle. Keep growing guys!!

The skinny on IVF medication

Time is really flying these days. Our egg donor, Marie, arrived from the US eleven days ago now, and after an initial ultrasound to check her ovaries, she has already had injections for six days. She’s on the same medication I was on for my last (non-donor-egg) IVF cycle, but the hope is that she will have a much better response than I did. And seeing as I basically had no response at all due to my premature ovarian failure, this is pretty much guaranteed!

Many people are curious about the daily injections she’s taking on our behalf, so let me break it down for you here. As I mentioned in my last post, there are two basic components to IVF treatment:

  1. Inhibiting spontaneous ovulation. Women’s ovaries contain hundreds of thousands of ovarian follicles, each of which contain an (immature) egg. During a normal menstrual cycle, one of these follicles becomes dominant, matures, and naturally releases its egg about halfway through the cycle. In IVF, the eggs (note the plural, see #2) are retrieved from the ovaries surgically, so medication must be used to inhibit this spontaneous ovulation.
  2. Stimulating follicular growth. Normally, the non-dominant follicles die off before ovulation as hormone levels drop, resulting in just one dominant follicle with one mature egg. However, given all of the steps involved to go from egg to baby, I personally think it’s a freaking miracle our species has survived. The IVF process keeps the level of follicular stimulating hormone high, fooling the woman’s body into producing multiple follicles (and thus eggs) in one go, and thus helping the odds.

How does the medication accomplish this?

Of course, the exact medication (and dosages) depend on the country, clinic, and patient, but the medication that Marie is taking for the first part (inhibiting ovulation) is Decapeptyl 0.1mg. This medication turns off the body’s natural hormone regulation, thereby temporarily stopping ovulation. Even though the medication has to be mixed every day — including breaking a small glass vial with your hands — and even though it has to be administered as an injection, I actually prefer this medication to the nasal spray I took during my first two IVF cycles, which gave me a continuous sore throat.

Decapeptyl, a daily injection to inhibit ovulation.

For the second part (stimulating follicular growth), Marie is using 300 units of Menopur, which is actually the maximum dosage allowed in Belgium. This dosage was determined based on her age and AMH level (which, you may recall, is still over an order of magnitude better than mine). Menopur stimulates the growth of follicles in the ovaries using human menopausal gonadotropins that (fun fact) are extracted from the urine of postmenopausal women, who have naturally high levelsSo I’ll just let that sink in for a minute.

How are the injections done?

Both of these injections are subcutaneous, which means they only need to go under the skin and not specifically in a muscle (like the recent injection I had to get). For my last three cycles, I always did my injections myself one-at-a-time in the side of the thigh. Marie isn’t a huge fan of needles, so she asked that my husband and I give her both shots simultaneously to get it over with quicker. This means there’s usually a contest to see whose shot hurt more, which I (administering the Menopur) won tonight.

My husband and I administering Marie’s daily injections. This is how we make a baby… #romantic (Marie wants me to add #NoThighGap)

How much does it hurt?

The needles used to administer both these medications are tiny, so unless you are very unlucky with the placement (like my husband was last night), they usually slip in without much pain at all. What can hurt is the injection of the liquid itself, particularly if it’s cold, or if there are air bubbles in the medication. For this reason, we make sure to get the menopur out of the fridge ahead of time, or hold it in our hands for a few minutes to warm it up to body temperature. We’re also pros at flicking syringes* to get the air bubbles to float to the top — something that I like to imagine makes us look like hardcore drug addicts to the police station directly across the canal.

In my past cycles, I usually found that the menopur burns a little even with these precautions, and I think Marie agrees. You can also bleed a little at the injection sites and develop some gnarly bruises after the fact. But as someone who has dealt with pretty bad chronic back pain, these issues are really only temporary — and thus minor — inconveniences. And as Marie has discovered, it’s nothing a little chocolate can’t help.

*Sidenote: “Flicking Syringes” is going to be the name of my punk band.

And so begins egg donation IVF cycle #1

The last couple weeks have been a whirlwind of activity. First I was traveling abroad for work, then I was sick at home with a souvenir cold, then we had some last-minute German visitors who have been driving around Europe with their 6-month old in a VW bus (I feel cool just knowing them), and then my husband had the stomach flu. With everything going on, we had hardly any time to prepare for the arrival of our egg donor, Marie, and her two kids (ages 3 and 5), who flew in last Saturday from the US.

Two days after they arrived, we all piled into a borrowed car and drove 2+ hours to Belgium for our first appointment. There, Marie had what we in the infertility community refer to as “a date with Wanda” — i.e., a vaginal ultrasound with an ultrasound wand. The point of this first ultrasound is to check that her ovaries are quiet (no activity) before she starts the heavy-duty hormones. Her two girls were particularly curious about the procedure, with the 5-year old asking loudly at one point “IS THAT THING GOING IN YOUR BUTT?!”

Once Marie’s ovaries had been given the all-clear, we had an appointment with the egg donation nurse to go over the tentative egg donation IVF timeline. Then the kids had a quick break in a conveniently located hospital playground while I picked up our €1000+ of medication, delivered in a freezer bag for the long ride home. This was fortunate, as the normally ~2-2.5 hour drive ended up taking 3.5 hours with traffic. The kids were champs and were rewarded with a ride in the bakfiets (wheelbarrow bike) to get happy meals at McDonalds. They happily declared “This has been a GREAT day!”, which, after 6 hours in the car and 2 hours of doctor’s appointments, shows just how terrible kids’ memories are.

Our egg donor’s kids love riding in our bakfiets, which is essentially the Dutch version of a minivan.

Bring on the meds

Marie and I have both been on birth control for the last month to sync up our periods, but we took our last pills this past weekend. I started my period on Tuesday, which means I’ve now started taking the estrogen pills to build back up my uterine lining for the actual donation cycle. This is the same medication I did the test cycle for last month, so luckily we already know I respond to it well.

On Thursday, Marie started her first medication: daily decapeptyl injections to delay her ovulation until the right moment. Marie had me give her the injection, which she found painful and I — even after giving myself 3 IVF rounds worth of injections — found terrifying. It’s one thing to inflict pain on yourself, but it’s another thing entirely to inflict pain on someone else who is just trying to help.

What happens next?

Tonight, Marie will begin the second type of daily injections: “stims” (Menopur) to stimulate the growth of follicles in her ovaries. This means things are really starting to happen! It also means I have to give her two injections a night instead of one…oh joy. This will continue until her follicles have grown large enough in size to have the egg retrieval surgery, which should be around 12-14 days from now.

So what happens in the meantime? Well Marie will have another ultrasound and a blood test this coming Friday to check how her follicles are developing. Depending on how this looks, we will probably have to go back again a few days later. Once the follicles reach a certain size, we will drive back to Belgium for what should be the final ultrasound. Then she will take an injection to trigger ovulation, and exactly 36 hours later, we will cross our fingers that all this Dutch cheese we’ve been feeding her will result in the retrieval of multiple high-quality eggs.