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 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.”

What are the odds of this donor egg IVF cycle working?

Some people we’ve told about our current donor egg IVF attempt automatically assume that this cycle will work — that we will walk away with a baby. While we are certainly way more optimistic about this cycle than our previous three (non-donor-egg) cycles, unfortunately, the odds are still not 100%…not even close. So in the interest of managing everyone’s expectations, what are the odds of this donor egg IVF cycle working?

I won’t leave you in suspense: the answer is 25%.

Yep. 25%. Depressing, right?

Of course, the exact value will depend on the quality and quantity of eggs they get from our egg donor, Marie. But given her age and the number of eggs they aim for, we are going through all of this effort — multiple international flights, daily injections, disrupting four peoples’ work schedules, and spending thousands of euros — for a one-in-four shot. In other words, don’t get out your baby booty knitting pattern just yet.

So how is this value calculated? As I said above, the two main factors are egg quality and egg quantity. Egg quality decreases with age, where the AMH level can give a rough indication. Marie has a fairly normal AMH level for her age (even a bit above average), but she is still 36. So as high-quality as her eggs may be, we can’t expect them to compare with those of an 18-year-old.

By egg quantity, I mean the number of eggs that Marie grows during the stimulation cycle. I had previously read that they aimed for 10-12 eggs in an IVF cycle. However, apparently 15 eggs is already getting into the territory of ovarian hyper-stimulation syndrome (OHSS), which can cause complications for the donor (in addition to decreasing the quality of the resulting eggs). In order to steer clear of those complications (and since it’s not a very exact science), our clinic will aim for 6 eggs in this cycle. Combining this number of eggs with Marie’s age, we arrive at a 25% chance of it working.

All of this is nicely summarized by this chart from my doctor, which I snapped a (poor-quality) picture of at our last appointment. It shows the predicted live birth rate as a function of age and egg number. The important thing to notice is how the live birth rate starts decreasing again above 15 eggs. Even with a younger donor, this would limit our success rate to 30% (for 6 eggs) or 40% in the very best case of exactly 15 eggs.

IVF live birth rate
Chart from our clinic showing predicted live birth rate as a function of number of eggs and donor age. Note that the success rate starts decreasing again for a large number of eggs, where ovarian hyper-stimulation syndrome (OHSS) can cause complications for the donor and affect egg quality.

In summary, not only are the odds not 100%, but it’s actually likely that this cycle won’t result in a baby. We will continue to be cautiously optimistic, but don’t expect me to be googling gender-reveal cake recipes quite yet.

What genetic diseases will our donor be screened for?

In just a few short days, our egg donor Marie and her husband will be flying in from the US for her screening appointments in Belgium. In addition to meeting with our doctor, a psychologist, the coordinating midwives, and etc, a big part of the jam-packed day will be a meeting with a geneticist. This geneticist will be searching for any genetic diseases that may preclude her from donating her eggs to us. But what genetic diseases will they be screening for, specifically?

There are four tests she needs to have, and the only one she’s had so far is the chromosome analysis. As I described in a previous post, Marie found out that this test can be done much more quickly in the US than Belgium, and she even convinced her doctor there to write up a lab order. However, we still weren’t sure if the results would come in before the screening appointments next week. We even had a bet about what would come back first: the results of the chromosome analysis, or her new passport. (I was betting that the passport would be the last to arrive, leaving us biting our nails until the very last minute.)

Well I lost…the passport came back first. But we also got the results of the chromosome analysis! All normal, as expected for that particular test given that she has two healthy kids. That leaves three more tests that she will need to have done when we’re in Belgium next week.

What are the additional tests?

The are three other diseases that they specifically screen for:

  • Fragile-X: A genetic disorder characterized by intellectual disability, behavioral challenges and certain physical traits like a long face. The likelihood of carrying this gene is higher for women, where approximately 1 in 151 are carriers.

  • Spinal Muscular Atrophy: A genetic disorder that affects the control of muscle movement. Approximately 1 in 50 people are carriers.

  • Cystic Fibrosis: A genetic disorder that causes severe damage to the lungs, digestive system, and other organs. Approximately 1 in 23 people are carriers.

We were a little shocked to learn the statistics for these, especially for cystic fibrosis. Even if Marie is totally healthy otherwise, and even though my husband would also have to be a carrier to result in the baby having a 1-in-4 chance of getting CF, they won’t let her donate if she’s a carrier.

Then is that it?

So if Marie passes all of these tests, then does she get the all-clear to donate? No, because as I’ve mentioned before, we’re apparently trying to create a genetically-flawless, award-winning baby.*

The geneticist will therefore also check her family history for a number of other inheritable diseases. They won’t say exactly what they’re looking for — I think partly because they know people would just lie if they knew. But I understand that a few of the ones on the no-fly list are breast cancer and other inheritable cancers, autism, and epilepsy.

If they do find any of those, then Marie’s out of the running, and it’s back to the drawing board for us. That would be extremely frustrating — to say the least — since most people with any number of issues can pop out a baby any time the mood strikes them. It would also be quite a blow since we had such a difficult time finding a donor in the first place. So let’s hope that doesn’t happen, and that we can move on to Stage 2 of creating this genetically-superior wonder-baby.

*(Unless my husband has any diseases, which they don’t care about in the slightest. It’s perfectly legal to pass down your own genetic problems to your baby. You just can’t give them someone else’s!)

A passport & a plan

When my friend, Marie, offered to donate her eggs to us, I knew that the timing would be critical. There’s a strict sequence of events that must be followed for egg donations, starting with the hormone test, then the STD/genetic tests, then the in-person screenings with the geneticist/psychologist/President of the EU (maybe not that last one?…it’s all a bit confusing…), followed by a ‘try-cycle’ to see how my body responds to the new drugs, and finally the actual donation cycle itself. One of the genetics tests (the chromosome analysis) can take up to three months to get back, and the results have to be in before they’ll let me even start the ‘try-cycle’. To make things more complicated, Marie lives across a fairly large ocean, and we’re trying to get this all done over her summer teaching break, which starts soon and ends in August!

I was guessing the chromosome analysis might be something that Marie could get done slightly faster in the US, since privatized healthcare = more expensive = better customer service. Sure enough, after about a zillion phone calls, multiple in-person visits, and an appointment with a very sympathetic doctor, Marie managed to get a lab order for the test to be done there, and she was told it’d only take two weeks(!) This sounds suspiciously short, so we’re still not completely sure this is the right test — due partly to some translation issues with the original (Dutch) order from Belgium, but mostly just to how medical protocols don’t necessarily cross international borders. When Marie asked for the technical reason behind the surprisingly large timescale discrepancy between the US and Belgium, the secretary helpfully responded <cue strong southern accent>: “Well, that’s a different country.”

The next logistical hurdle was scheduling the in-person screenings with the geneticist/psychologist/Dalai Lama. The earliest appointments available weren’t until July, which would delay the donation cycle itself until at least September. Luckily, I happened to be in Belgium at the time for my last ‘natural’ IVF cycle, and the egg donation nurse was kind enough to see me without a pre-scheduled appointment. She took pity on our predicament, and she managed to convince all the various doctors/world leaders to see us on a much shorter timescale (“Her donor is coming from America.”) I left her office with six back-to-back appointments scheduled for this coming 16 May, and a prayer that Marie would actually be available.

Marie was available, luckily, as was her husband, who also has to come for the screenings. (I really wish I could go back and tell my 21-year-old self that it would eventually take four adults, a team of doctors, and multiple international flights to get me pregnant.) Marie checked that their passports weren’t expired, and we bought the round-trip tickets for their whirlwind 2-night trip to Amsterdam. What she didn’t notice until several days later was the name on the passport…her maiden name. What followed were a bunch of frantic texts referencing travel.state.gov and the expedited passport renewal section.

All of this is to say that we currently have a plan, and hopefully in 8-10 working days, we will also have a passport.