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

A vacation & an injection

You know you were in desperate need of a vacation when, 10 days in, you still haven’t conjured up the energy to do anything besides lie comatose in the sun. When, between sunscreen applications and re-applications, one thing leads to another, and before you know it you find yourself in bed at 9:30pm. And when even then, you need to set your alarm for 9:00am to ensure you don’t miss breakfast.

So yeah, I think I was long overdue for a vacation, and this holiday in Corfu has been amazing — just what I needed. For the first 9 days, we were joined by our favorite British travel companion and partner-in-crime, the lovely Louise, who enjoys making silly jokes as much as I enjoy laughing at them. Highlights included a one-day trip to neighboring Albania via ferry (my 29th country!), and a rainy day car trip to an abandoned village, where we learned the fun and totally unrelated fact that Brits also count seconds in ‘Mississippis’*.

Preparing for a frozen embryo transfer

There’s no real vacation from infertility, of course, which means I’ve also spent this holiday preparing for a frozen embryo transfer (FET) with one of the embryos left over from our recent donor egg IVF cycle. I was trying to time it so it could happen as soon as possible after we get home, meaning I would be nice and relaxed from the long vacation and ready both physically and mentally for embryo transfer attempt #5.

Our first day here, I stopped taking the birth control that’s been necessary to control the timing of my cycles. This was a relief, as I had thought these ~6 weeks on birth control would be a ‘break’ for my body, but I conveniently forgot that the hormones in the heavy-duty birth control my clinic prescribed really do a number on me: nausea, severe mood swings, back pain and cramping — the whole kit and caboodle. If timing isn’t so critical next time, I’m definitely going to skip the pill and risk a natural cycle.

A few days after stopping the birth control, my period arrived as expected, and I started taking the estrogen pills needed to grow my uterine lining. I also cut back my caffeine and replaced beach-side cocktails with beach-side smoothies. My clinic actually said I can have a drink here and there during this stage, but I don’t want to overdo it. One quickly learns that the ‘what-ifs’ afterward are what kill you.

A surprise injection

So where does this injection I mentioned in the title come in? In a surprise twist, it has nothing to do with IVF. Rather, I have a long history of getting very sick on vacations**, and this one has proven no different.

I’ve been feeling like I was coming down with something for over a week, and yesterday I awoke with throat pain so bad that I couldn’t speak, eat, or swallow. My husband managed to find a 24-hour drop-in medical clinic, where I was diagnosed with a low-grade fever and acute laryngitis. The doctor prescribed antibiotics and paracetamol, and he told me to come back in two days.

Unfortunately, the paracetamol did approximately diddly-squat for the pain, nor did any of the five other things I tried in desperation. So this morning, after a brief panic where I felt my airway closing off with mucus because it was literally too painful to swallow, back to the medical clinic we went. This time the doc gave me a pain killer that was injected in my butt.

That’s right: I managed to develop such a bad case of sore throat that I had to have an intramuscular injection. I bet you didn’t know that was even possible!

Will this affect the FET?

I still can’t speak at all, and my breathing still sounds like Darth Vader, but the new meds have taken the edge off and allowed me to eat again. The big question now, of course, is will any of these medications (or infections/viruses/fever) affect the success of a frozen embryo transfer?

I’ve emailed our favorite Belgian egg donation nurse for the clinic’s official advice, but a brief bit of googling implies that it won’t. If the clinic confirms that it’s fine to proceed, then that’s probably what we’ll do. Still, I had hoped this vacation would put me in a very relaxed and healthy state prior to the transfer, and it’s disappointing that that’s not the case. These five frozen donor egg embryos required a massive effort, and we want to feel we’ve given them the best shot.

If there’s any good in all this, it’s that my general state of patheticness has really brought out the natural caretaker in my husband. For instance, this morning I sneezed unexpectedly in the grocery store, and he used his ninja-like reflexes to catch a 4-inch drip of my snot with his bare hands before it fell on my shirt***. So you know, if/when we finally manage to acquire a small human, he’s going to make a really great dad.

xx

*When I expressed surprise to Louise that the British didn’t have their own culturally-appropriate measure of a second, my husband helpfully suggested that they use ‘Yorkshires’, which led to a lot of yelling of ‘ONE YORK-SHIRE! …TWO YORK-SHIRES!’ in our best cockney accents (Louise included).

**On our honeymoon alone, I had the flu so badly that I spent three days straight in our hotel room in Venice, and then, as my grand finale, I broke my tailbone in Sicily and had to go to the ER.

***Sometimes I joke that my husband’s idea of romance is giving me the side of the bed with the outlet, but I have to say: Seeing him holding my snot in the middle of the cereal aisle was pretty darn #romantic.

Post-donor egg IVF cycle wisdom

Three weeks ago we found out that our 4th IVF attempt — and first attempt with donor eggs — had failed. In the week that followed, we had two different international visitors (from Australia and the UK!), which was a fun and well-timed distraction. Sadly, they eventually had to go back to their respective countries, and their departures also coincided with the arrival of a particularly unpleasant menstrual period (no doubt due to all the meds). As I lay on the couch with a hot bean bag on my crotch for the second day in a row, I finally had some time to reflect further on this last cycle.

Multiple people have commented on how quickly I was able to bounce back from this last failed attempt and focus on the the positives. I don’t want to give the false impression that any of this is easy, so I’ll tell you my secret why: it’s because the first three failed cycles were much, much harder. Those were the cycles where it became clear that we would never have children with my eggs…where people would tell me ‘it would happen eventually’, and I had to smile and nod, knowing they were wrong. Let’s all take a minute and be thankful that I wasn’t blogging yet back then, because it would have been one nonstop sob-fest.

That’s not to say that this recent cycle was all sunshine and lollipops. It was obviously hard too…but in a different way. As I was trying to figure out how to explain it, I got a nice message from fellow donor-egg-IVF mama Lauren of The Trying Times, who helped me put my finger on why.

The thing is, making the decision to use donor eggs is already a massive leap — it’s something that no one can really fully understand unless they’ve been through it. It’s a trauma that requires it’s own grieving process. After all, you’re giving up on a lifelong dream — what should have been a given for a heterosexual couple like us — of having kids that are half your partner and half you. When you do finally give up on your own chances and make that leap, you sort of feel like you’ve already paid your dues. Then when it still doesn’t work, it feels doubly unfair. It’s like, not only did you fail IVF with your own eggs, but now you have to go through the whole drawn-out process again with someone else’s.

The silver lining

It’s taken me a long time to find a silver lining in all this, but as I waited for the microwave to finish heating my crotch-warmer™️ for the fourth time in as many hours, it came to me: we can finally go on vacation.

You see, once we started the IVF phase of our 5-year (and counting) ‘journey’, it became a race against the clock to knock me up before my ovaries completely kicked the bucket. Even when we gave up on my own eggs, we jumped right into planning our donor egg cycle due to the timing of our egg donor Marie’s summer vacation. Between all of this and my busy work schedule, it means we haven’t had a ‘proper’ (i.e. >2 week, European-style) vacation in over two years. And of course, juggling all of this along with an uber-competitive career is exactly why I so desperately need a vacation.

Now that we’re using donor eggs, it totally changes the game. In particular, we’re fortunate in that there’s no evidence of any additional problems with my uterus or my husband’s sperm. Obviously I’d rather not wait ’til I’m in dentures to pop out a kid, but now when I close my eyes, I’m no longer terrorized by graphs of egg-quality nose-diving with age. If none of the embryos from Marie’s eggs work, our backup plan is to use an anonymous donor in Spain, where I’m sure we can find some fertile 22-year old who gets pregnant from merely being sneezed on. As a result, I feel a lot less pressure to make every month count, so we’ve decided to sit the next cycle out and finally take a long-overdue vacation.

Specifically, we’ll be heading to the south of France (near Bordeaux), and then Corfu, where I plan on lounging around various exotic beaches for hours on end. I’ll also be doing my best to avoid Facebook, where back-to-school photos are in full swing, and my mind can’t help but play the “Was that kid alive when we started trying” game. We’ll be going with our favorite travel buddy, the lovely Louise, who makes every trip about 10x more fun. I love our vacations with Louise — we’ve been dog-sledding in Norway, bathed elephants in Thailand, and have had countless other adventures in foreign lands that were made even more adventurous thanks to Louise’s unwavering faith in Google Maps (I’m looking at you, Cretan goat trail). I also acknowledge that we wouldn’t have gotten to take half these trips if we’d gotten pregnant when we originally wanted to. So I’m planning on enjoying the hell out of this next adventure, and we’ll wait and see what happens the month after.

And that’s a wrap

I had the stupid announcement already written in my head. It was going to be a play on the numbers: After 5 long years trying to conceive, including 4 cycles of IVF, 3 countries, 2 different fertility clinics, and 1 amazing egg donor, we are finally pregnant.

Except we’re not. I took a home pregnancy test yesterday morning (11 days after our 5-day transfer), and it was a definitive negative. This was confirmed by a blood test this morning.

I knew I shouldn’t have gotten my hopes up at all. I knew the chances were very low, and the embryo didn’t have the best grade. I told myself this over and over again, attempting to lessen the impact of the eventual failure. But this was also the first cycle we’d used donor eggs, and our egg donor Marie had both her kids on the first try. And even though that was a few years ago now, a small part of me was hoping that — somehow — those fertile genes would fight their way through all the necessary stages and help us to finally beat the odds.

The last few days, the progesterone side effects were also playing into the fantasy, with my lower back pain and other potential ‘pregnancy symptoms’ growing progressively worse. A few days ago, I got a weird spam email predicting big news today, and last night, I had a vivid dream that we got a positive pregnancy test. If I had actually been pregnant, it would have been very tempting to conclude the Universe was giving us signs.* Instead, we have to cope with the fact that after 5 long years, 4 cycles of IVF, 3 countries, 2 fertility clinics, and 1 amazing egg donor, it’s still not our turn.

The positives in the negative

I’m not going to pretend that this news didn’t suck big-time, or that I didn’t have a private pity-party after seeing the result. Sure — we can try again — but what if it doesn’t work next time either? Or the time after? What if it never works? When should we resign ourselves to that fact and, like, start breeding rare iguanas, or sail around the world?

The only way I’ve been able to cope with this latest negative result is by focusing on the immediate positives, of which there are several:

POSITIVE #1: I can stop taking these <expletive> hormones and hopefully return to feeling myself again! (If you’re pregnant, you have to continue taking them up to 12 weeks). This has been the silver lining of each of our failed IVF cycles, and you have no idea how excited I am about it.

POSITIVE #2: We have people in our corner. This is the first cycle since we ‘came out‘ about our IVF journey, and having that support has been a huge help. Not just the literal support from Marie and her husband — which has been immense — but the emotional support as well. If you’re going through your own IVF ‘journey’ (such a euphemism…) and haven’t come out yet, I highly encourage you to consider it. Nobody should have to go through this alone. For this latest cycle, it’s gotten us through the well-meaning questions from more distant acquaintances (“You don’t have any kids?”) without poking our eyes out with our plethora of used syringes.

POSITIVE #3: We have 5 more frozen donor-egg embryos thanks to Marie, which means 5 more chances. It’s true that I’m not particularly in the mood to go through everything involved in another embryo transfer at the moment — much less FIVE more — but I do acknowledge that it puts us in a privileged position compared to many other couples. It’s certainly never a luxury we had with my own eggs, and for this we are thankful.

POSITIVE #4: Each failure makes you stronger. This is something that took me a while to realize. I used to feel each failure wearing me down, making me weaker. But looking back, I now realize they have slowly-but-gradually been making me stronger. How many people can say they’ve gone through IVF, or donor-egg IVF? How many people have had four (or more!) failed cycles? If you’re in this camp too, I salute you, because you are next-level badass.

*This just goes to show that confirmation bias is a real thing, and we create our own ‘signs’ where we want to see them, true or not. (Also, how dorky am I that I chose to use an emotional post about infertility & grief to make a point about cognitive bias…)

Pregnancy symptoms during the two-week-wait

I haven’t posted in nearly a week for good reason: I’m tired. Like really tired. So tired that I had to skip the Gay Pride Parade in Amsterdam this past weekend, which I was TOTALLY looking forward to. Why? Because I was so exhausted from being awake for 2 hours that it apparently necessitated a 3.5-hour nap. (This is really not helping my reputation with my husband as ‘the most ridiculous human being ever’.)

If you aren’t familiar with the IVF process, this may sound really hopeful. After all, I’m nine days past my 5-day transfer (9dp5dt if you want to be hip with the lingo), and well past the point where the embryo should have implanted in my uterine lining (if it has decided to grace us with its continued presence). So…maybe the exhaustion is a promising sign…meaning that I’m pregnant!

That would be *awesome* if it were the case. Unfortunately, there’s no way to distinguish real pregnancy symptoms from those caused by the hormone supplementation that is also required at this stage. In particular, in addition to the estrogen pills I’ve been taking three times a day for over a month, progesterone is also necessary in the second half of the cycle to help prepare the uterine lining for implantation and potential pregnancy. It’s started right after the egg retrieval by both ‘regular’ (non-donor-egg) IVF patients as well as by the recipients of egg-donor IVF embryos, and honestly — I think it’s the worst part of the whole damn process (injections & vaginal surgery included). My progesterone comes in the form of vaginal suppositories that must be inserted three times a day*, and which manage to leak out even after the requisite 30-min period lying down. Because women facing infertility treatment clearly don’t have enough to deal with already, so now we also get to have leaky vaginas!**

‘Pregnancy symptoms’ on progesterone

The bigger problem with taking progesterone during the two-week-wait is that it it’s exactly the hormone you would be making naturally if you were, in fact, pregnant. This means that many of the side effects we associate with pregnancy are actually due to progesterone, and that taking additional progesterone during the two-week-wait can be a total mindf@$k. As a result, here is an incomplete list of just some of the ‘pregnancy symptoms’ I’ve experienced during my previous (failed) two-week-waits while on progesterone:

  • Cramping
  • Bloating
  • Nausea
  • Gas
  • Diarrhea
  • Constipation
  • Headache
  • Backache
  • Dizziness
  • Sore boobs
  • Vivid dreams
  • Fatigue/drowsiness
  • Mood swings
  • Loss of appetite
  • Increase in appetite
  • Shortness of breath

As I mentioned, those cycles failed, so these symptoms were definitely side effects of the progesterone (or just fabricated by my anxious brain). But when there’s finally a real chance you might actually be pregnant, and when you are experiencing any/all of these symptoms, it’s really hard to just dismiss them as false alarms.

Is there any way to tell between progesterone side effects and actual pregnancy symptoms?

So is there really no way to tell the difference? No small, previously overlooked symptom (e.g., a twinge in the pelvis!) which might finally and conclusively spell the difference between progesterone side effects and real pregnancy symptoms? (“Siri, are pelvic twinges a side effect of progesterone?!”)

Spoiler alert: basically every possible symptom can be a side effect of the progesterone. Having ZERO symptoms can also still mean you’re pregnant, or not! Different women respond differently to both the medication and actual pregnancy, and women can also respond differently during cycles, even if they have the same outcome. I’ve had sore boobs one cycle and not the next, and they both resulted in Big Fat Negatives (BFNs). There’s literally NO WAY to tell besides a pregnancy test, which for me, at least, is still several days away.

In future cycles (should it come to that), I hope that I will finally take my own advice and give up the symptom-spotting once and for all. For now, I’m going to google “9dp5dt cramping backache success stories”. Because for the next couple days at least, there’s still hope.

xx

*If you ever see a sticky note on my office door that says ‘telecon’, now you know what I’m really doing.

**Leaky Vaginas is going to be the name of my new FemRock band.

Embryo transfer: the good news and the bad news

Today was one of the biggest days in the donor egg IVF cycle (our fourth cycle in total) that we’ve been undergoing this past month. Not only did our egg donor, Marie, fly back to the U.S. (feeling slightly less bloated, finally), but we were also booked for a 9:50am embryo transfer in Belgium. I woke up at our Airbnb full of hope, filled my bladder as instructed, and made my way to the hospital with my husband.

The last we heard, most of our 15 embryos were still doing really well. On day 3, eleven of the embryos were exactly the right size (8 cells), three more were slightly too small (5-6), and one was too large (>8 cells). Even if those last four were out, eleven still seemed like a really good number. It was also exactly 11x better than my three previous IVF cycles combined.

On day 4, we only had a brief call with the egg donation nurse, but she said that most of the embryos were still doing really well. In particular, while they had not yet advanced enough to be rated & ranked, they were starting to ‘compact’ as desired, and were on their way to transforming into day-5 blastocytes. This gave us confidence that we should go ahead and make our way to Belgium the night before, since there should definitely be something to transfer.

The good news

The good news is that there was one blastocyte to transfer: an intermediate 5-day blastocyte rated good/fair. Since we didn’t have any embryos make it to day-5 with our last IVF cycle, and since our first two cycles used 3-day transfers (where it’s harder to tell if the embryos are good quality), this is officially further than we’ve ever made it before.

The doctor triple-checked my name, retrieved the embryo from the lab in what is essentially a high-tech turkey baster, and squirted that sucker in in probably less than 60 seconds flat. This means that I am now (for the third time) what we refer to in the infertility community as ‘PUPO’: pregnant until proven otherwise.

The bad news

In addition to the news that the embryo we transferred today isn’t of the highest quality (with only a 17% chance of sticking it out for the long haul), we were also a bit shocked to learn that it’s currently the only decent blastocyte. This news really came out-of-the-blue, since everything had been going so well (almost too well?) up until this point.

What about all of the other 14 embryos, you’re probably thinking? Well a lot happens on days 4-5, and it’s common for many perfectly good-looking 3-day embryos to not make it to the blastocyte stage. This is partly why clinics do 5-day transfers: so they can wait and see which embryos are really viable. I’ve seen the number 40% bandied about, so it seems like we’re doing below-average. On the other hand, while two of our remaining embryos are definitely already out (having reached the blastocyte stage, but being rated as poor-quality), it is theoretically possible that a couple of the remaining ones could make it to the blastocyte stage tomorrow. If they are good enough quality, they can then be frozen for later attempts.

So is this really that bad? Normally I would be thrilled to even get to this stage. But since we used an egg donor this cycle for the first time, and since her egg quality/quantity was an order of magnitude better than mine, I had let myself get my hopes up (rookie mistake!) that we’d end up with at least a couple high-quality blastocytes. That would make all of this effort (from Marie, in particular) seem more worth it, and it would give us an ‘insurance policy’ in the form of another attempt.

Without the insurance policy of frozen embryos, it means that if this current ’embaby’ doesn’t stick, we have to start all over yet again, most likely with another donor/in another country (not to mention the financial cost). And I’m getting really, really tired of starting over.

What happens now?

We’re still waiting to hear if any of the slower-growing embryos will be high enough quality to freeze. Other than that, it’s a tense two-week wait until my blood test on 13 August.

In the meantime, I’m finding support in the amazing community of fellow #IVFwarriors I’ve discovered on Instagram. And I’m getting wicked pleasure out of reporting all of the maternity-themed targeted ads in my Instagram feed as ‘Inappropriate/offensive’. Because #infertilitysucks.