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

A small (17mm) victory

The last couple of weeks didn’t exactly go to plan. I’ve been prepping for a frozen embryo transfer (FET), where they will carefully defrost one of the extra embryos that resulted from our recent donor egg IVF cycle, then place it in my uterus with what is essentially a high-tech turkey baster. To prepare my body, I stopped taking my birth control pills and started taking estrogen (Progynova) in order to grow a nice thick endometrial lining. And to prepare my mind, I timed all this to occur while I was sipping piña coladas on a Greek island.

Unfortunately, I managed to come down with a nasty little case of laryngitis on the last ~5 days of our trip, which instead saw me pitifully sipping chamomile tea in bed. My clinic assured me that the cocktail of pain killers and antibiotics I was taking wouldn’t negatively impact the upcoming transfer, but I was still bummed that I wouldn’t be as healthy and rested as I wanted.

Lining check

Fast forward to my first day back from holiday, where I started my workday nice and early with a date with Wanda*. The point of this 12-day scan is to ensure that the ovaries are quiet and the uterine lining is sufficiently thick to allow for implantation.

The ideal lining is at least 7 or 8mm thick and displays a distinctive ‘triple-line’ structure that indicates good ‘estrogenization’ and healthy growth of the endometrium. I’ve never had any trouble in this area, but growing a sufficiently thick lining is one of the hardest parts for many women facing infertility.

After confirming my ovaries were dormant (I could have told her that!), the doc headed over to my uterus (it’s like Mrs. Frizzle and the Magic School Bus over here). Immediately her eyes bulged, and she pointed at the screen like ‘Get a load of this’. She asked me to repeat what medication I was taking, and when I answered Progynova, 2mg, three times a day, she said “Well it’s working.”

Since I don’t have nearly as much experience as she does staring at fuzzy ultrasound screens, I still didn’t really know what she was talking about…until I saw her measure the endometrium thickness: 16.93mm.

My 17mm triple-lined endometrium in all its glory.

Since I posted this image on Thursday, Instagram has been losing its collective mind. And with good reason — studies show that pregnancy rates correlate with lining thickness. Many women struggle to grow a lining even half this thick, which probably explains the plethora of heart-eye emojis in the photo’s comments. From all the oohing and aahing, you’d think I posted a photo of a puppy in a mailbox rather than an ultrasound of my uterine tissue.

How did I grow a 17mm lining?

In addition to the heaps of admiration, one commenter asked the question everyone really wanted answered: “Holy hell. 16.93???? How?!”

At first I didn’t think anything of it. I’ve always grown a fairly thick lining (~11-12mm), so I thought maybe it was just a natural gift (& the world’s lamest superpower?) Still, it’s almost 50% thicker than usual, which seems like quite a large deviation. Maybe it’s a weird side effect of the antibiotics I’ve been on? Or maybe that wondrous week I spent spread-eagle in the sun somehow did the trick?

Then I had a realization so obvious that I’m embarrassed it took me as long as it did: I was taking an iron supplement this cycle. I didn’t think of it earlier because I was taking it for a totally unrelated reason. Namely, I’ve been feeling particularly tired lately, and a friend mentioned that low iron levels could be the culprit. I happened to have some sitting around in the medicine cabinet, so I popped it in my pill case without a second thought. I only took it for about 10 days due to unpleasant side effects**, so by the time my ultrasound rolled around, it was totally off my radar.

I can’t be sure it was the iron, of course. There are too many other variables, and I don’t have a control group. But it makes a lot of sense, since iron plays a vital role in the creation of healthy red blood cells. So if you’re looking for ways to thicken your uterine lining, you might consider some combination of taking a Greek holiday, developing severe laryngitis, and talking to your doctor about an iron supplement.

xx

* Wanda is the trans-vaginal ultrasound wand used to check one’s uterus and ovaries. We’ve been having a torrid affair for over a year (don’t breath a word to my husband).

** This is my polite way of saying severe abdominal bloating and constipation. At one point, there had to be at least five Greek salads in there.

Frozen embryo update!

In the words of children’s author Judith Viorst, this past Wednesday (the day of our embryo transfer) was a terrible, horrible, no good, very bad day. After things seemed to be going so ridiculously well in this IVF cycle — our egg donor Marie produced 15 mature eggs, 100% of which then fertilized and were looking strong in the days that followed — we learned on Wednesday that only a single embryo had developed into a viable day-5 blastocyte. Two others had also become blastocytes, but they were too poor-quality to be frozen. When I tried to ask if there were any other embryos still in-the-running, the doctor was — excuse my language — a ginormous dick. He sounded so pessimistic — admitting it was a below-average response, and even hiding his chart so I’d stop asking questions(!) — and I left feeling completely despondent.

I sobbed the entire 2+ hour drive home from Belgium. Once back at our house, I transitioned onto the couch for further sobbing. I had made a deal with my husband earlier in the day that he had to do whatever I said all day so that I’d feel happy and relaxed after the embryo transfer. Before the bad news, this had come in the form of sassy decries (e.g., “I decry that you escort me around on your arm all day”; “I decry that you stop sending me stupid Reddit videos”). After the news, and back at home, I decried that he leave me be so I could mourn the unfairness of the Universe in solitude.

A sudden turn of events

After such a miserable day, you can image my surprise when I received an email the next morning saying that 5 embryos had been successfully frozen. FIVE! Not trusting my Dutch reading skills, I copy-and-pasted the email into google translate just to be sure. It still said the same thing…FIVE EMBRYOS COULD BE FROZEN!!!

IVF is such an insane emotional roller coaster.

So why the sudden turn of events? Well, my husband and I are still complete newbies when it comes to blastocyte development, since we never made it this far with my own eggs (or lack thereof). Apparently, in addition to freezing any good-quality blastocytes on day 5, they let the remaining embryos continue to develop overnight, allowing the stragglers to catch up. These slower-growing day-6 embryos may still turn into blastocytes which can result in a healthy pregnancy, and they will freeze any good-quality ones as well. I had no idea that there could be such a big change from day 5 to day 6, and it would have been nice if the dick — Sorry, I meant doctor — told us that there was still some hope.

What does this news mean?

Obviously we hope that the embryo I currently have on-board will decide to stay put. However, based on its quality, it only has a 17% chance of resulting in a live birth (though a ~30% chance of pregnancy…fun implications there). If it decides not to stick around, then we can try what’s called a ‘frozen embryo transfer’ (FET) without having to go through the whole egg retrieval process again. Most of the embryos should theoretically survive the thaw, so that would hopefully give us another few chances.

In the meantime, I’m oscillating between cautious optimism and (more statistically realistic) extreme pessimism with the current embryo on board. It’s far more likely that it won’t stick….but there’s still a non-zero chance that it will. I seem to be growing (unwisely) more optimistic each day, which is probably the emotional equivalent of that slow upward climb on a roller coaster before the huge stomach-lurching drop. In that sense, the (potentially poorly translated?) advice that our favorite Belgian egg donation nurse gave me might actually make more sense: “Keep your head on.”

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’.

What does donor egg IVF entail?

I’ve been busily blogging these last few weeks about our current donor egg in-vitro fertilization (IVF) attempt, just naively assuming that everyone else already knows what that means. Then last week, two friends (and avid blog readers) asked me who will carry the baby if we get to that stage. Great question! And one I should have addressed earlier. Sometimes I forget that other people don’t also spend their every waking hour reading about, preparing for, or talking about IVF. With three failed ‘normal’ attempts under my belt, as well as our latest foray into donor egg IVF, I’m basically an expert. So please allow me to explain what donor egg IVF is, and how it differs from regular IVF.*

So in a regular IVF cycle, you only need two people: a man and a woman. It begins with the woman taking medication to stimulate follicle growth (‘stims’ if you want to be hip with the IVF lingo). This comes in the form of a liquid that is injected into the thigh or (if you’re super hardcore) the stomach. The woman also takes a medication to suppress ovulation, so that it can be triggered at exactly the right time. This may be a nose spray which makes one feel like one has continuous post-nasal drip, or it may be another injection which needs to be mixed first by breaking a glass vial, because obviously that’s very safe and I’ve definitely never cut myself doing that.**

The woman does these ‘stimming’ injections every day for around two weeks, depending on the specific protocol. After the first ~5 days, she needs to have a blood test and a vaginal ultrasound every couple days. The ultrasound technician will check how the uterine lining is developing, as well as how many follicles are growing in each ovary, if there are any. (Normally only one follicle will develop to maturity in a non-IVF cycle, but the idea of the ‘stims’ is to increase the odds by growing multiple follicles.) The technician will record the number of follicles in each ovary and, if any are larger than 10mm, they will record the size. Or, if you’re like me and don’t grow (m)any follicles, this may turn into a game of ‘find the ovary’.

Once the biggest (‘lead’) follicle reaches a size of around ~20mm, the doctor will have the woman ‘trigger’ ovulation by taking another medication. This is also an injection, again administered in the thigh or stomach (because the woman probably hasn’t had enough needles poked into her recently). This must be taken exactly 36 hours before the egg retrieval surgery, so that the follicles will be nice and mature, but not yet bursting.

The man’s big moment to shine comes the next morning, when he deposits a sperm sample at the hospital. Then, exactly 36 hours after the trigger injection, the woman has the egg retrieval surgery. This is a relatively minor surgery (though it does involve more needles), and I will describe it in more detail in another post.

How does donor egg IVF differ?

In the case of donor egg IVF, you need an additional woman: the egg donor. The main difference is that almost all of the steps I’ve described so far then apply to the woman who is donating eggs, rather than the hopeful mother. The other difference is that the hopeful mother also takes medication (but in this case, to inhibit follicle growth) and has regular ultrasounds to check her uterine lining, since it is she who will (hopefully) carry the baby — not the donor. That means that after the egg retrieval, the donor’s part is done.

All of the subsequent steps (waiting to hear how many eggs are mature, waiting to hear how many eggs fertilize, waiting to hear how many embryos develop, and more waiting to hear if there are any to be placed back in and any extras to be frozen) are the same for both normal and donor egg IVF. If an embryo makes it to transfer, then it is placed in the hopeful mother with what is essentially a high-tech turkey baster. That kicks off the final stage of waiting: waiting to see if the embryo sticks and develops into a baby.

*Note that I’m only referring to actual in-vitro fertilization (IVF) here, not intra-uterine insemination (IUI), a less invasive procedure which is often tried before resorting to IVF.

**I’ve definitely cut myself twice breaking the glass vial. I can’t imagine this is legal in the US…