Back in the saddle: Restarting IVF

Well, kids, here we are. The year is 2021 — nearly 2022 — and somehow I have a 2(!) year old.

And slowly but surely, a number of the insta-friends who had their donor-egg IVF (DEIVF) miracle babies around the same time as we did have started trying for (and in some cases already having) miracle #2. I feel bad for even admitting this, but it’s been making me a bit envious, if I’m honest.* And yet, despite being in the extremely fortunate position of having three more donor-egg embryos in the freezer, we haven’t quite managed to get back in the saddle ourselves for a number of reasons that I’ll get into now.

First off, it turns out that babies are incredibly poor sleepers. Apparently there are some people who can function on 4-6 non-consecutive hours of sleep a night, but I’m not one of them. I’ve been barely able to spell my own name, much less find the time/energy to consider adding another infant to the mix. Especially when this involves coordinating the logistics of an international embryo transfer.

Because despite having tackled one of the biggest obstacles to pregnancy (namely, having viable embryos) thanks to our egg donor, Marie, the practical details of another transfer are still non-trivial. Our embryos are at our clinic in Belgium, while we live several hours away in the Netherlands. For our first three DEIVF embryo transfers, I managed to convince a local Dutch clinic to do the monitoring (ultrasounds and blood tests) during the early part of the cycle so that we only had to drive to Belgium for the actual transfer. Unfortunately, the Dutch clinic we used before has said they will no longer help. This means I will either need to find another local clinic to do the necessary monitoring (no luck so far) or resign myself to making multiple long drives back and forth across the border.

Additionally, there’s the fact that I’m still breastfeeding MB. It’s only a little bit (and only before bed). Nevertheless, the official advice is that you must stop breastfeeding before a cycle since the prescribed hormones are transmitted through breast milk. I haven’t wanted to rush the weaning process, however, since — as a mom via donor eggs — the chance to breastfeed has been so extra special.

Small steps

Since we didn’t know what other steps would be needed prior to a new transfer attempt (eg. rejoining the waitlist, protocol changes due to my current use of hormone replacement therapy (HRT), etc), we made an appointment at our clinic a few months ago to ‘start the process’. In our horse analogy, this isn’t getting back in the saddle, exactly, but it is taking time to figure out where the heck you put the saddle last time you used it.

At the appointment, we learned I needed to redo my bloodwork for thyroid monitoring and a number of standard checks. We also filled out a metric ton of paperwork — approximately the same amount I imagine you’d need to fill out if you were acquiring a small nation state.

Excitingly, we got the great news that our remaining frozen embryos are good quality. (There was so much going on during our first few transfers that we couldn’t quite remember.) We have a 4BB and two 3BBs. These are all better grades than MB, who grew from a scrappy 3BC. That doesn’t guarantee any of them will work, of course, but the doctor seemed quite optimistic that we at least have a shot.

Page 2 of our embryo report, where you can see two of the three remaining frozen embryos (both 3BB) as well as the embryo that became MB!

Lastly, we learned that there’s no waitlist to start, so it’s up to us (ie, whenever I’m ready to stop breastfeeding MB and sleep even less again). They sent us home with the prescriptions for the hormones, and instructions that I could simply start them as soon as I stop the HRT and start my period. Easy peasy.

Spoiler: It was not easy peasy

Reader, I had a gut feeling it would not be so simple. You see, I’ve been bleeding almost continuously on the HRT, which is an annoying but apparently not-unheard-of side effect. Between that and my post-menopausal ovaries, I was quite skeptical that I’d get my period after stopping the HRT (despite the doctor’s assurance it would come ‘within three days’). So after worrying uselessly about it for a few weeks, I staged my own test run by stopping the HRT and waiting to see what happened.

I waited one day. Two days. One week. Two weeks… Still no period. At that point, I was starting to feel the (very unpleasant) effects of stopping the HRT, so I gave up and started again, figuring I’d simply ask the doctor to clarify the protocol in such a circumstance. It may seem like a minor point, but I didn’t want to submit myself to the physical and emotional stress of strong fertility hormones and international trip logistics if the timing wasn’t right to start a cycle in the first place.

I emailed the clinic to clarify. I won’t bore you with the details of everything that followed, but the short version is that I spoke with three different other doctors/nurses at the clinic and got three different answers to this very basic question. As I was getting increasingly frustrated, I finally demanded that our doctor — who I had yet to hear from, and who I like and trust more than anyone else there — call me.

That’s when it came out that our doctor is not currently ‘there’…. As in, she’s missing in action. As in, they don’t know ‘if or when she’ll be back’. And when we said we hoped she was ok, they replied, ‘We do too.’

So to beat a dead (horse) analogy: we’ve found the saddle, we’ve dusted it off, but now the dang horse has gone missing.

xx

* This feeling of envy is itself difficult to reconcile with the deep-rooted notion that I should be grateful for what I already have. This is probably some form of post-infertility-trauma survivor’s guilt…but more on this incredibly cheery topic in another post!

Follow me on Instagram: @thebunlessoven

‘Staying positive’ during IVF

A few months ago, I did an Instagram takeover of DefiningMum’s account, run by the wonderful human & fellow donor egg (i.e., DEIVF) mama Becky (blog: DefiningMum.com). If you’re elderly (in spirit) like I am and don’t know what a ‘takeover’ is, basically Becky gave me her trust (i.e., Instagram password) for a day and allowed me to post on her stories.*

There, I recapped our long journey to parenthood and answered related questions submitted by followers, including: Did I ever question our decision to use donor eggs? Did I bond well with baby? What’s my relationship like with our egg donor?** For anyone who wants to check it out, my answers are saved as a story in DefiningMum’s Instagram Highlights reel.

One of the first questions I got is something that multiple other women have also asked me in private: How did I stay positive from one cycle to the next during our grueling, multi-year IVF & DEIVF journey? I answered as best as I could in a single story, but since this is a topic that so many people are clearly interested in, I want to expand on my answer a little more here.

How did I stay positive during IVF?

To jump straight to the punchline: I didn’t.

Seriously — I was never optimistic about any given cycle working, except maybe the very first one. That was the cycle I only grew a single follicle, but it miraculously fertilized and managed to grow into a ‘perfect’ (according to our doctor) 8-cell embryo by day 3. As my microscopic miracle continued to pass each hurdle with flying colors, I started to become more and more hopeful. Maybe we would be one of those rare IVF success stories that beat the odds. Maybe, just maybe… <cue romantic orchestral overture> …this one precious egg was meant to be our baby!

Of course, anyone who follows this blog knows that first cycle ultimately failed. Unfortunately, so did the one after that, and the one after that… and etc, etc. With each new failure, I developed the cynicism that’s pretty standard amongst long-time infertility veterans. Our dream of a baby was slipping further and further away, and even within the larger IVF community — the very people who should most relate to my struggles — I felt increasingly alone. Not only could I not get pregnant without IVF, but it seemed I couldn’t get pregnant with it either.

I’ll be honest — that was quite a dark time. I’ll spare you the painful details, but there was a good amount of ugly-crying with a fair share of social media blocking and a sizable dose of self pity. I definitely wouldn’t characterize my mental state during that time as ‘positive’ or ‘optimistic’, nor do I think that’s necessarily the right goal to strive for in the first place. When your infertility journey is full of so much loss, it’s important to let yourself grieve in whatever way you need to.

What kept me going?

If I wasn’t feeling positive from one cycle to the next, then how (and why??) did I keep going? Was it sheer willpower? Masochism?

It’s true that I was never particularly optimistic about any given cycle, but Mr. Bunless and I were both determined that — somehow, someway — we would end up with a kid to love eventually. One thing that helped with this was to always have the plan mapped out at least 1-2 steps ahead of where we currently were.

At the beginning, we decided that if IVF with my own eggs didn’t work, we would move on to egg donation. Later, we decided that if our known egg donor didn’t work out, we would try an anonymous egg donor in a country with an egg bank. In case none of that worked, we had already started researching adoption laws in various countries. Of course I recognize that we were very fortunate to be able to afford these options, which is not something everyone can say. (Or at least we thought we could probably figure something out once we got to that point, which is still a privilege.)

I also spent a lot or time — like, a LOT — visualizing what our announcement would say when something finally worked. Each time we’d embark on a new IVF cycle, I’d update the text in my head to reflect our new statistics (‘After 5 embryo transfers’ -> ‘After 6 embryo transfers…’). Each time, I’d imagine adding new needles to the picture, and how exactly I wanted it to look. I knew that each hurdle we had to overcome would just make our story that much more amazing, and I’d imagine how proud I’d be sharing it with everyone.

Announcement
The announcement photo I visualized during our IVF/DEIVF attempts.

And speaking of sharing, we also got a lot of support once we started sharing our story with family and friends. Starting this blog, in fact, was one of the best things I ever did.*** In addition to gaining our own cheering squad, I discovered two additional benefits: 1) It allowed me to share the details of our story with family and friends in a way that felt open and yet simultaneously private (I could write it out alone in my room), and 2) It allowed me to own our story, taking back some control over a process which is littered with uncertainty. (One doesn’t have to start a blog to do this, of course, but for me it was the best vehicle.)

In short, I admire those people who can stay positive even while facing the soul-crushing despair of infertility, but I am not one of them. For me, it was less ‘I know this will work!’ and more ‘Let’s just get this over with so we can move on to the next thing.’

xx

* Becky must have a lot more trust in people than I do. Thankfully, I turned out not to be a crazy internet weirdo.

** Clearly not everyone is an avid blog reader or they would know that our egg donor, Marie, is a close friend from high school.

*** Technically, the best decision I ever made was marrying Mr. Bunless, followed closely by switching to the flute from the glockenspiel in the 5th grade. But this blog is definitely in the top three.

The genetics of my donor egg baby

Accepting that we had to use donor eggs during our IVF struggles was extremely difficult, to say the least. I’ve written previously about the grieving process that necessarily goes along with this ultimate admission of one’s infertility — how it feels like a part of you has died, and the post-traumatic stress that can accompany it. And even though I’m extremely grateful to modern science that there was still a way for me to get pregnant, fully accepting that you’re a genetic dead-end is a long, emotionally complex process which I’m still working my way through.

To give one example: when our egg donor, Marie, was here a year ago for her egg retrieval, she was explaining to her 5-year-old how she was helping put a baby in my belly. “One day you, too, will grow a baby in your belly!”, she explained to her daughter.

“Hang on a sec”, I wanted to interject — feeling compelled to add a caveat that it’s not necessarily a given so as not to set unrealistic expectations for the little girl. But then I realized that she was right — the odds are that Marie’s daughter will have no trouble conceiving a child naturally, should she eventually choose to. That then led me to an uncomfortable truth: I was jealous. Of a 5-year-old.

Why it still stings

Even though I’m now very happily 39(!) weeks pregnant thanks to one of Marie’s donated eggs, the lack of a genetic connection between me and our future child is something that I’m still coming to terms with. I think there are two main reasons for this.

The first reason has to do with my husband. We’ve been together over 15 years now, and he’s basically the best man I know. When you are in a (heterosexual) relationship like ours, it’s natural to dream of one day creating a family together — making a kid that is half you and half your partner. It’s like the ultimate expression of unity and an awesome science experiment at the same time. You never dream of creating a child with a third person, as lovely as that person may be.*

The second reason is a bit more selfish. I’m no Mozart or Giselle B, but most of the time I like to think that I’m sort of a cool person. This is also totally natural — everyday insecurities aside, I think most people are partial to their own genetics. It’s therefore become a running joke over the course of this pregnancy that whenever I’m feeling particularly pleased about some totally unimportant aspect of myself, like my exceedingly low blood pressure, or my yogic lung capacity, my husband and I will turn to each other with sorrowful eyes (mine serious, his teasing) and say “What a waste!”

Finding acceptance

Fully accepting the lack of a genetic connection with a donor egg baby is not something that happens overnight, and I think the most important thing is to allow yourself time. As I’ve experienced my own feelings about it evolve, I also wanted to share some thoughts that have helped me find acceptance.

The first and most obvious point is that genetics don’t make a family — love does. (This is also true for sperm donation, embryo donation, and adoption.) I’ve heard again and again from parents of non-traditional families that once you hold the baby in your arms, nothing else matters. You certainly won’t love the kid any less. From the very beginning of this journey — when we first made the leap to egg donation — this thought has comforted me.

Then there is the whole nature-vs-nurture point, where there is increasing evidence that nurture plays a huge role in many aspects of development. For egg donor babies carried in the prospective mother’s own uterus, the latest research in the exciting field of epigenetics even suggests that these environmental effects start in the womb. This means that although the baby’s basic genetic blueprint didn’t come from me, my diet, lifestyle habits, and even genes (via MicroRNAs) do influence which traits in the baby actually ‘turn on’.**

(Yes, I know I just got done saying that genes don’t matter, but this is still pretty cool.)

Another thing that has helped me is something I’ve mentioned before in the context of deciding to use donor eggs in the first place. In particular, I used to worry that I would get sad if our baby looked just like Marie (as beautiful as she is) because it would remind me that we weren’t actually related. However, my husband (smart man) made me realize that I needed to change my perspective. Instead of seeing the lack of a physical resemblance as a painful reminder of my infertility, I should instead see it as a reminder of the amazing gift we’ve been given. This slight change in perspective has helped me immensely.

Last but not least, finding the humor in the situation never fails to help. Just as I sometimes feel particularly pleased about some aspect of myself, there are other traits that I’m decidedly less enthusiastic about, like my terrible eyesight, or my somewhat unfortunate tendency to occasionally drool on myself in broad daylight. Whenever one of these unpleasant traits come up, my husband and I will turn to each other, half smiles on our faces, and say “Thank goodness those genes aren’t being passed on!”

xx

* And luckily for us, Marie is extremely lovely, both inside and out.

** So, unfortunately, that drooling gene may not be quite out of the picture yet.

Should I use a known or anonymous egg donor?

For those brave infertiles who have gone through the necessary grieving process and decided to make the leap to egg donation, choosing between known and anonymous donation is usually the next big decision that needs to be made. I’ll say up front that in our case, the decision was essentially made for us. This is because we were told that an anonymous egg bank wasn’t really a thing in the Netherlands, and we found out that while our Dutch insurance still covered us in Belgium, we weren’t allowed to use the egg bank that does exist there. This was crushing, to say the least.

There were a few reasons we had hoped to at least have the option of anonymous donation. For one thing, I was mildly concerned that if the kid turned out to look exactly like someone we knew, this would be a constant painful reminder of my infertility (as well as fuel for gossip among those who didn’t already know). There was also the concern that it would negatively affect our relationship with the donor. Would I be jealous of their genetic connection? Would they become overly attached to the child? What if they, or their family, became overly involved?

But the biggest reason we initially hoped to use an anonymous donor was that we didn’t think a known donor was even an option for us. Nobody we knew had offered to donate, and it seemed WAY too big a thing to ask (“How has the weather there been? Would you mind having surgery to give us your genes?”) Very few of our friends met the criteria set out by the clinic, and we doubted that those that did would be willing or able to put their lives on hold to fly to Europe, where we had recently relocated from the US.

Taking all of these factors into consideration, anonymous donation seemed like our best (and only) bet.

Will my egg donor baby look like me?

I was never very worried about finding a donor who looked like me, but this can be another benefit of anonymous donation for many women. In particular, some clinics will offer egg donor matching based on physical characteristics. If you aren’t lucky enough to have a sister or close relative who’s willing to donate, this can be the best way for your baby to have a chance of resembling you.

Just to play devil’s advocate for a minute, I actually had the opposite concern — that if the baby looked too much like me, people would be constantly commenting on the likeness. Wouldn’t comments like that be an unwelcome reminder that I have raisins for ovaries? Worse yet, since I’m such a stubborn advocate of infertility awareness, would I feel the need to launch into a diatribe at every innocent ‘She has your eyes’ remark? I could see that getting annoying (for both them and me) real quick.

Benefits of known donation

While my husband and I were initially planning on using an anonymous donor, we could also see the possible benefits of known donation. For one thing, the kid would never have to wonder where they came from, because the donor would already be in our lives (assuming they were happy to be identified). Even with an anonymous donor, the increasing popularity of DNA testing from companies like 23andMe or Ancestry.com means they may not be anonymous forever. What if the child wanted to reach out to learn more about their heritage, and they were rejected?

Another potential benefit of known donation is that you have more information about the donor. If you’re worried about the child inheriting specific qualities, knowing the donor may give you peace of mind. (Although I think any woman who donates eggs has a heart of gold, which is arguably the most important quality.)

Our experience with known donation

In the end, our hopes of using an anonymous donor were dashed when we learned that a known donor was our only option — at least if we wanted to have the procedure partially covered by our insurance. Fortunately, we were extremely lucky that my childhood friend, Marie, volunteered. Marie and I actually share quite a few characteristics (physical and otherwise), which is just icing on the cake. We were even luckier that we managed to work out the ridiculously difficult logistics that accompanied a donor traveling from overseas. (This was, in no small part, thanks to the help of our awesome Belgian egg donation nurse.)

There’s no doubt that if an anonymous egg bank had been available to us, I’d be singing the praises of anonymous donation. Since known donation was our only option without breaking the bank, I’m so grateful to be here singing Marie’s praises instead. When all was said and done, I think the emotional support we felt from Marie’s offer was probably the biggest advantage of having a known donor. And as my husband wisely pointed out, if our kid turns out looking exactly like a miniature Marie-clone, it will be a beautiful reminder that someone in our lives cared enough to literally give us a child.

xx

How we made the decision to use donor eggs

Now that I’m nearly 27 weeks pregnant(!), I’ve gotten a few private messages lately from women in the infertility trenches asking me things like how we made the decision to use donor eggs, how we decided between anonymous and known donation, and how the process compared to non-donor-egg IVF. I actually love getting these questions, because if I can help other people by sharing our experience, it honestly makes it all worth it. (Well… almost worth it… I’m no masochist.)

So for those who are currently considering donor eggs themselves, or those who are just curious, I thought I’d write a series of posts attempting to answer these questions. I’ll start by sharing how the decision process went for our particular case, with the acknowledgement that each case is different, and therefore our case may not mirror yours.

How did we make the leap to donor eggs?

I’m one of those people who researches the hell out of everything, so as soon as we learned that I had premature ovarian failure, I basically already knew that we would end up using donor eggs. To be clear, our OB-GYN here in Holland didn’t actually use the phrase ‘premature ovarian failure’… However, she told us that I had the hormone levels of a menopausal woman despite being 34 at the time, and then once we confirmed how my ovaries were responding to IVF (i.e., they weren’t), I put two-and-two together.

Of course, we still tried my eggs three times, which took quite a bit of effort — we had to talk the infertility clinic we’d been referred to into even doing a second IVF attempt after only getting a single egg the first time. This may be surprising to some people (‘Isn’t helping people get pregnant sort of the whole point of infertility clinics…?’), but the way they explained it is that with such a poor response, the risks of IVF start to outweigh any potential benefits.

That second attempt, we got three (poor-quality) eggs and transferred two — neither of which stuck.

Then we had to switch clinics (and countries) to get to a third try. The new clinic had me on different medication (both for the hormone therapy and for sub-clinical hypo-thyroidism), and I had also drastically altered my diet, so I was kind of hopeful that we’d get a better outcome. With that said, we went into it knowing it was likely our last shot, and the clinic suggested that we do a 5-day embryo transfer instead of 3-day like my other attempts, with part of the reasoning being that this might help us get ‘closure’. Indeed, when the single egg that fertilized (of a measly two retrieved) didn’t even survive to transfer day, that did help us close that chapter.

Was that an easy decision?

No — obviously that was still devastating. Just like normal, fertile people (lucky bastards…) can’t truly understand what it’s like to go through infertility/IVF, I think that those doing ‘regular’ (non-donor-egg) IVF can’t understand what it’s like to ‘give up’ on your eggs. (The same holds for the use of donor sperm, donor embryos, surrogacy, and etc.) For my husband and I, making the leap to donor eggs was a far bigger leap than ‘just’ doing IVF in the first place.

If undergoing ‘regular’ IVF was the equivalent of a Bachelor’s degree, accepting that we needed donor egg IVF was the equivalent of writing a doctoral dissertation.

With that said, I knew that I just really wanted to experience being pregnant, and if it took donor eggs to get me there, I was willing to make that leap. Luckily, my husband felt the same way.

Considering the whole spectrum of cases, I can imagine that making the decision to use donor eggs or not would be harder for those whose ovaries aren’t as geriatric as mine apparently are. When you’re only getting a tiny handful for poor-quality eggs each cycle, like we did, the decision basically makes itself for you. If you’re getting a larger number of eggs, or the reason behind the failed implantation is less obvious, the decision is much less clear-cut, of course. If this applies to you, then my advice would be to talk to your clinic and decide ahead-of-time if a non-donor-egg cycle will be your last one. That way, you can grieve appropriately during the cycle.

How are we feeling about it all now?

So now that we are finally pregnant through donor egg IVF (i.e. DEIVF), how are we feeling about our decision? The short answer is that we feel super excited and ridiculously grateful. Before it worked for us, I used to worry that any eventual DE pregnancy would be bitter-sweet, with each exciting milestone marked by an equal amount of grief for the lost opportunities. (I’m clearly not at all dramatic/prone to melancholy.)

Now that we have made it to the other side and things appear to be going well, I’m happy to report that I am just thrilled to be pregnant, and I don’t even care that it took donor eggs to get us here. Obviously, it being a donor egg pregnancy does raise unique issues — which I will continue to explore in this blog — but the important thing is that my husband and I are 100% happy with our decision. If anything, it just makes us both even prouder of what we’ve endured to get here.

xx

The contents of my uterus

You know those people who talk about the baby like it’s a person before it’s even born? As in, ‘Bradley just loves when I eat ice cream’. Or, ‘Bradley’s nursery will be complete as soon as I hand-stencil the Desiderata on the wall’?

Well I’ve always found this behavior sort of odd, which is part of the reason I didn’t want to tell anybody the name before the birth.

That’s right — we have a name. Some people are surprised we have one ‘already’, but they really shouldn’t be. We’ve had YEARS to figure this out, guys. And actually, we had the name before we even started trying, and well before all this infertility nonsense started. My husband and I both distinctly recall discussing the name as a given already 10(!) years ago*, which means we’ve had it for at least that long.

The only thing we weren’t sure of was whether the gender would fit, because for some reason, we only had a female name. But at our 20-week scan we found out that it will…because, as luck would have it, it’s a girl.

To tell or not tell?

Everyone keeps asking if we were hoping for a girl or boy, and honestly — after years of infertility, failed IVF attempts, and ultimately egg donation — we’re still just over-the-moon that we’re pregnant at all. Our main excitement over learning it was a girl was realizing that we could finally use the name we’ve talked about for so long.**

My husband was so excited he wanted to immediately tell everyone the name, whereas I wasn’t even sure about revealing the gender at first. I admit the initial excitement almost swayed me. But in addition to finding it weird when people refer to an unborn child by a name, I’m also suddenly feeling a little…private?…about it all.

Saying that may seem at odds with the fact that I’m doing so on a public blog — raise your hand if you’ve heard me talk about my uterine lining! — but it’s actually pretty logical. I still believe strongly in raising awareness about infertility and egg donation, but that doesn’t mean I’m not a naturally private person. Infertility steals so much from you — my husband and I couldn’t conceive without getting literally dozens of people involved — and now that we are finally pregnant, I’d like to keep something back for just the two of us.

It’s an…it

In the meantime, my husband and I continue to refer to the baby not by name, or even by gendered pronoun, but as an ‘it’ — including in private. Maybe this will change as the pregnancy progresses further, but for now we’d like to ask our friends and family to do the same.

In addition to my newfound (& somewhat surprising) desire to keep the contents of my uterus private, I think part of it, for me, is that it seems somehow presumptuous/overly familiar to refer so intimately to a person we’ve never met. Another part of it may have to do with the fact that it’s a girl, and I’d like to delay society’s expectations (why is everything so PINK?!) for as long as possible. But I’m also no dummy, and it’s likely that a major part of it has to do with the trauma we went through to get here, and a natural tendency to shield oneself in the event of a loss.

So until this baby makes its grand debut, we will continue to refer to it as an ‘it’, and we hope you won’t mind following along.

xx

*We know this conversation took place exactly 10 years ago because we were trying to adopt a deaf corgi with the same name after we’d already decided we liked it for a kid. When that adoption fell through (and we wound up with our current neurotic fluff-ball instead), the silver lining was knowing we wouldn’t have to choose between finding a new kid’s name, or naming a kid after our dog.

**Ironically, the name we chose over a decade ago on the US is quite popular here in Holland. I can’t say I’m not a little disappointed, but least it will be easy for people here to pronounce…