Anatomy of an Egg Donor Cycle

This is a post that has been kicking around in my head for months, and I am so glad that I can finally set it free. I want to thank everyone who has been incredibly supportive and kind in the past week and say that I have really enjoyed getting to know new bloggers through NIAW! I am slowly slogging through all of the "Join the Movement" posts (read them here) and am just amazed at all of the incredible voices out there. It makes me feel so special to be a part of this group of strong women (and men) battling infertility.

I'd like to take you through what a donor egg IVF (DE IVF) cycle looks like--at least what it looks like for me. Like all IVF cycles, there are variants in medications. Unlike all IVF cycles, there are differences in how you match up with a donor. Other clinics have databases where you make the decision, where you see photographs, where you get a lot of information. Other clinics have you work with an agency, which can often be very expensive. Costs for DE IVF vary just as costs for "regular" IVF vary--my IVF cycles have cost around $8600 plus medication, so with help on the meds front and occasional financial boosts no one IVF cycle has cost more than $10,000, and often it has cost less. Other clinics in other areas of the state and country can charge upwards of $20,000 for a "regular," "fresh" IVF cycle. Cost is relative, and we are lucky to live in an area where, while this treatment doesn't exactly fall into what normal people consider affordable, relatively speaking it is less expensive than many other places. The cost for a donor cycle is quite a bit more, but again, for us it is still less than $20,000 (although hovering around double our normal payout), when it can be $30k or more elsewhere. All of these variants can make your head spin, so I'm going to focus on what this process looks like for us, Bryce and Jess, in Rochester, NY.

Decision Time
First we had our consult appointment, in September 2012, following our devastating early pregnancy loss from our last frozen transfer. After being given our options, we pretty much felt it was a no-brainer to go with a change in plans rather than to keep beating our heads against the wall, searching for the mythical Golden Egg. It may still be lurking in the crusty recesses of my polycystic ovaries, but I just don't have the wherewithal to keep on the quest when it has caused us so much pain to gather the evidence that my eggs are probably not chromosomally normal. (Again, a bitter pill to swallow, because we are still in the "probably" camp, with no concrete evidence that this is definitely the case, but a lot of anecdotal evidence which is good enough for me. But still, that question mark exists. Grrr.) We wanted to take a break, have a Fertility-Free Holiday Season, and then start up in January. We were told a basic overview of what would happen, and then were mailed home some forms.

Step 1: Donor Forms
The forms that arrived in the mail were the most intimidating things ever. In order to eventually be matched with a donor, we had to provide information about ourselves and then what we would like to see in a donor. Which seemed interesting at first, until you realize that you are needing to prioritize what pieces to the genetic pie mean the most to you. Which opens a Pandora's Box of questions...what comes from the egg??? What is genetic, versus something you pass on through the environment of your home? Would I still have been a violinist if I was not genetically linked to my very musical parents, but had still been brought up in a highly musical home? (In my mind, the answer is yes.) If we had been able to use my eggs and had my genetics in the Punnett Square Soup, is there any guarantee that I would have a baby with curly hair? With dark hair? With dark blue eyes like mine? Whenever I visualized our FutureBaby during meditations or daydreams of a time when this is all a distant nightmare, the baby (sometimes boy, sometimes girl, usually two years old for some reason) had curly towheaded hair. Bryce was a towhead, and that's pretty dominant. My hair is naturally curly, but my mom's is not. My dad's is wavy, but my cousins run the gamut of straight, wavy, and curly. See how much time I spent just on hair? Now imagine filling out a form where you are deciding if eye color is important, hair color and texture, height, weight, skin tone, ethnic background, and then the very difficult short answer portion at the bottom that asks about personality factors. It was overwhelming. It felt weird. It felt like after mailing this in, I should receive an American Girl doll in the mail that looks just like me, but not really. It caused a lot of angst. It lived on the coffee table for months (because what was the rush, really, if we didn't have to make this decision until January or so?). I cried every time I tried to fill it out. We had conversations about what was important. Can you really concretely make a decision on what are the genetic traits that you would like someone else to give to your child? How the hell did I get to this point? It could have felt like picking out positives, like the wish book catalogs that JC Penney used to mail out before Christmas. But it felt a little more like "What am I willing to give up so that I can have a donor with proven fertility? What do I need to sacrifice?" The one thing that was non-negotiable was that the donor needed to have proven fertility, specifically previous cycles that resulted in babies.  I would give up just about anything for a chance at success. It was so hard, especially since we made the decision so quickly after our loss that I don't think I had fully mourned both the loss of my last fully genetic babyling AND the loss of any future fully genetic babylings. But, in January, the paperwork got mailed.

Step 2: Psychological Evaluation
Yup, we had to do a psychological evaluation. A two-and-a-half hour process involving 350+ questions that needed bubbling in of circles labeled "Always, Often, Sometimes, Never" and were things like, "I think of death daily," "My favorite hobbies are archery and stamp collecting," "I feel that my thoughts are being transmitted to the world," and "I am destined for something special." Which I thought was unfair, because thinking you're destined for something special in itself shouldn't be a red flag (I am destined to be an awesome mom! That's pretty special... but then again if I think I will be Queen of the Universe and rule everyone from my sky castle, well then that might be a problem). It was apparently patterns within the psychotically voluminous battery of questions that raised the flags. We could not take it seriously. I mean, we answered the questions seriously, but laughed a lot and tried to guess what psychological disorders each question was trying to ferret out. They only contact you if there's a problem, so thank goodness we weren't coded, but then that begged the question...are you not approved for parenthood if you have mental illness? That seemed not quite right either. After the battery of multiple choice, we then had what was basically a couples' therapy session where we outlined our family lives, previous relationships/marriages, our relationship, and then our story of trying to conceive. That was exhausting. Then we had to discuss the intricacies of DE IVF from an emotional standpoint, and whether we were prepared for failure. Cheery, no? I totally understand wanting couples to be ready emotionally and well-thought-out in their decision to proceed with third-party reproduction. They require this of the donors, so they began requiring it of the recipients as well. But I'll be honest--I kind of felt like I was undergoing an approval process--were we decent enough, well-adjusted enough people to be parents? NO ONE ELSE HAS TO DO THIS type of invasive exploration of all things you unless you are engaging in third-party reproduction or adoption. It seems the more you want a baby, the more difficult it is for you to accomplish that, then the more hoops you have to jump through to get to that final step. So not fair when no one asks the meth addicts if they're adjusted enough for parenthood, but Step Two it was.

Step Three: Mock Cycle
Before you can be matched with a donor, you need to do a mock cycle where all the special lining-thickening meds can be adjusted when the stakes aren't so high. Again, not all clinics do this but most do. I called in January with my first day of my cycle, and was shocked that it would be weeks before I went onto Lupron. That's right, my nemesis Lupron is again a part of this protocol. God I hate Lupron. I was on Lupron for a couple of weeks before starting estrogen patches in February to build up my lining and get my estrogen levels up. A donor cycle is like a frozen cycle--the goods aren't being made in your body but you have to be ready to receive. The drugs are different because you have to be able to have some flexibility since you are dependent on someone else's stimming. So, after Lupron shots every morning that make you crazy and menopausal, you start the dizzying process of the estrogen patches. They stick on your belly, but have to be numbered with a ballpoint pen because after the first couple days of "on a few days, off and put a new one on" it becomes a crazy "Who's On First" tracking of which patches come off when and sooner or later you have 6 or so patches on at once and your tummy looks like a bar code. It is so bizarre. The patches alone didn't work for me (again, good to know before I am getting ready to receive actual embryos), so I also had to take Estrace pills. Little, blue, oval pills. And not orally. I had to take a teensy little blue pill and shove it where the sun don't shine, which is exceedingly difficult since it is not meant for that type of administration. Tiny pills with no delivery device make you feel like you are going to lose the thing, and hurt your ego by making your lady parts seem unimaginably huge in comparison. And then there's the bizarre side effect... what goes in must come out, and I did mention these pills are blue, right? I'll just let you figure out what happens a day or two later. So disturbing. Anyway, you go in for an ultrasound to check your lining and if all looks good, you are cleared for matching!

Step Four: Matching
This is where that scary and emotionally conflicting doll order form comes into play. After a successful mock cycle, the doctors and the nurses in charge of the donor program look at what you have deemed most important, and look at their pool of donors, and make a decision on what profiles will be considered good matches. I guess typically you are presented with 1-2 profiles, and you either approve or deny them. If you deny, they look again and see what they can do and the process may take longer. In my case we put all our trust in our medical team, and were presented with one profile which we approved because it was perfect. A profile contains the most basic of basic information and NO photo--age, height, weight, eye color, hair color, skin tone, ethnic background, career choice if applicable, and interests (again, do interests come from an egg? Does a love of hiking come from the fact that my donor and I have this in common, or that we strap our darling baby into a carrier from the get-go and get deep into the woods on a regular basis?). The staff at our clinic know the donors pretty well, and attested that they are all fabulous people who are largely doing this philanthropically. Lest you think we are "buying" eggs from some strapped young lady paying for college, this is a terrible way to make money. This donor will be shooting herself up with all the lovely follicle-stimulating drugs I did (although less of them, since she is actually a normal fertile lady and won't need the complex cocktail I did), go through the pain of very sore ovaries and multiple internal vaginal ultrasounds with Mr. Wand, go through the surgery of egg retrieval, and need time off of work for both the surgical procedure/recovery and any bloodwork/ultrasound monitoring appointments. For all of that she will receive several thousand dollars. Not exactly a cash cow given the time commitment and pain of needle sticks and an aspiration needle going through your vaginal wall to retrieve those golden eggs. This also isn't an adoption of sorts. Eggs are an ingredient, not an entity. Any semblance of "parental rights" that could exist are relinquished, as those eggs are nothing until they are embryos and implant into my nourishing uterine environment. All of that said, at this point in the process we are matched and thrilled with the match. Due to the intricacies of getting two lady cycles on the same page and some preexisting travel plans on the part of our donor, we are looking at the summertime for the curtain to rise on the actual cycle. And so now...we wait. Which apparently we are expert at.

Step Five: Actual Cycle!!!
We aren't here yet, but one day in the late spring we will receive a call that our donor has received her period. Very strange that I log so many cell minutes on discussions regarding my period and/or someone else's period, but we have to be all synced up for this to work. Which is why I've been on the Pill for some time (always cracks me up that I need birth control to feasibly get to the point where I can actually GET pregnant). Then I will go on Lupron (and so will she), and then I will start the hoopla of the estrogen patches as she stims. Her job is to make fabulous follicles and my job is to make a plush home for the fertilized embryos to snuggle into. When she has her egg retrieval, Bryce will come in and make his contribution (always awkward), and I WILL BE THERE TOO. I will be a monkey's uncle if I am not in the same building when all the pieces are being put together to make those beautiful embryos. It is so weird that I don't even have to be in the same zip code for the embryos to be made. After the donor's eggs are fertilized with our sperm, they will call us a day later to let us know how many fertilized and made it to Day 1. And then the game looks pretty much like a "normal" cycle from there on out. They will decide if we will do a Day Three (8-celled) or Day Five (blastocyst) transfer. They will only transfer two of them--they won't do three like I've done on multiple occasions (with limited success and no multiples). This is because we are far more likely to end up with twins with two embryos than ever before, because these will be SuperEmbryos. I will welcome those sweet little ridiculously robust embabies to the Mother Ship. It will be back to the regular scenario--me in the stirrups, Bryce holding my hand, and both of us watching our potential future children come home to my uterus. Except now we will both also be thinking of that incredibly special person, that amazingly selfless woman who is giving us our best chance of finally actually experiencing the miracle of pregnancy. We will be excited as we've never been before, and so, so grateful that this whole shebang exists and that there are people out there willing to give us this very special gift. We will be more hopeful than ever that this process that takes longer than we thought and is more involved than we thought and more emotionally challenging than we thought will bring us more joy than we thought possible, and bring us that much closer to meeting FutureBaby.