Tuesday, January 15, 2019

Donor Egg IVF proccess

This is a post I have been meaning to write for a long time & I've had a couple of questions about the process and a couple requests to do a blog post for it so I am finally getting around to sharing what the process is for using a known egg donor.  I'm going to preface this by saying this...every clinic is different and every clinic will have a different process, however, for the most part the physical aspect to the donor egg process is the same.  There are several different donor programs including using a known donor, an anonymous donor, choosing your own, having your clinic do the choosing, and using a frozen egg bank. 

If you're new here to these parts you may not know the background of our story which is that after several years of infertility treatments (6 cycles of IVF with my eggs/9 total embryos transferred & ZERO pregnancies) we decided to go the donor egg route.  Although no testing has ever been able to provide us with a clear diagnosis because everything has come back normal or negative, having a successful pregnancy via donor eggs gives us a clear indication that my egg quality is the culprit to our years of failed cycles.  Choosing the donor egg route was something I was absolutely against in the early days of treatment.  After 3 failed cycles (1 fresh/2 frozen) with our first clinic we switched clinics and had a terrible cycle, it was after that failed cycle that doctor mentioned that my eggs "appeared" to be poor and I should consider donor eggs.  It took me 1 more clinic, 1 more fresh, and one more frozen cycle before I realized he was right and we began the donor egg process.  In hindsight, donor eggs was the best decision we made on our journey to become parents. 

I will start with the beginning of our DE journey right after we decided we waned to use an egg donor.  Before Amy our donor reached out to me I was in the process of looking through profiles of donors through our local clinic.  It was kind of like a dating site, there were pages of photos that you could click on to view more info about each donor such as height, weight, hair color, eye color, ethnicity, schooling, family history, etc. and this is the process for several clinics.  Shortly after I began my search our donor came into our lives.  We had been friends on social media and she had felt a calling to help us.  She messaged me with an offer to be our surrogate.  Ultimately we were not ready for that step and she wound up donating her eggs to us instead.  Amy had all the qualities that I was looking for in a donor; she was only 26 at the time she donated, she had 2 children of her own already, she was a nurse which I thought was amazing, and her husband was supportive of her choice to help us.  On top of that she happened to look somewhat like me which was totally a bonus for us.  Her an I connected very easily which was also really important to me.

During the process of searching for a donor a lot of people want someone who is "proven" meaning that they have donated & a pregnancy has resulted from their eggs, however, all donors are "unproven" at some time and that is just a personal preference as are many of the qualities that a person can look for in their donor.  Someone might want someone very well educated vs. a person who looks like them while another might not care much about education and wants to focus more on looks.  These are all very personal considerations when choosing a donor.  Some clinics will "match" donors and recipients based on the wants of the intended parents.  The other option is looking at frozen eggs which are significantly cheaper since they've already been retrieved you don't have to pay for the stimming & retrieval portion of the process.  Some clinics offer frozen eggs of their own, or you can use a place like Egg Bank to find frozen donor eggs. 

For our DE cycle I knew that it made most sense for us to travel to Georgia from Illinois so that our donor didn't have to be away from her work and her family for an extended period while she went through stims.  We  didn't have any children so it just seemed easier for us to travel to them so I found a clinic in Augusta Georgia called Servy Massey Fertility Institute.  When we went to Georgia for the first time to meet Amy and her family we also met our doctor for the first time and had a consultation & exam with him along with bloodwork.  We needed to get as much done there as we possibly could so Joe also gave his semen sample at that time which they froze until we were ready to begin our cycle. 

Between March and end of May when Amy started her stims we got all of the legal part handled.  In many clinics and donor programs the legal part (including fees) is included in the process, for us, using a known donor outside of our clinics donor program, we were required to find our own attorney and have our own contract made up to provide to the clinic.  I used Sara Clay from Marietta Georgia who happened to be a lawyer who specialized in Reproductive Law.  I basically just Googled "reproductive law" and found her and everything was done via email.  It cost $750 and she wrote up the contract, we signed everything as did Amy and her husband and Amy provided her family and medical history as part of the contract.  The contract is in place to protect both the donor and the recipients, basically stating that I cannot drop Georgia off at Amy's door and run and say she's her responsibility and Amy cannot claim that Georgia is hers and take her away.  It's nothing that either of us would ever do but it is 100% necessary to protect both the donor and the recipient. 

Once all the paperwork was signed & Amy completed & passed all of the necessary blood work we were given the green light to start our cycle.  Amy did 100 units of Gonal F and 75 units of Menopur for about 11 days, stims are typically 10 days but they added on one extra day for her which is also very common.  She was monitored on day 6 and again on day 8.  During monitoring they will count follicles and take blood.  She also incorporated Ganirelix (ovulation prevention) for a few days before retrieval.  Our doctor was very conservative with her meds which I also liked.  We were shooting for quality over quantity so it was important that her meds were kept low so she wasn't overstimulated. 

On the day of retrieval you are put under anesthesia, the process takes about 20-30 minutes and they do ultrasound guided aspiration using a long needle that punctures your ovary and basically sucks the eggs out.  Amy had 10 eggs retrieved.  Once they're retrieved the embryologists go to work, they either use a process called ICSI where they select a single sperm and inject it into the egg or they let the sperm and egg fertilize on their own, sometimes both of these processes will be used, it's really up to your doctor to determine what is best for each case.  Once the retrieval is done, the donor is finished with their part of the process.  The next day you receive your fertilization report.  Out of Amy's 10 eggs retrieved, 8 of them had fertilized which is really good.  The two that didn't get discarded and the 8 that do are left to continue growing in the lab.  On day 3 we got our embryo update, (not all clinics will do this) which was really good.  Out of the 8 that fertilized, we had 6 that were thriving.

While the donor is stimming, the recipient is also taking meds to prep for the incoming embryo.  Estrogen starts typically the same day as your period starts, my doctor also had me start baby aspirin at this time.  Progesterone injections and suppositories also start about 10 days after the recipients period.  These are the only meds typically required for a recipient, similar to prepping for an FET there are no stims, ovulation prevention, or triggers necessary when you are the recipient.  

5 days after the embryo has been fertilized it's time for transfer just like a normal cycle of IVF.  The embryologist will typically pick the top graded embryo or embryos depending on how many are chosen to be transferred.  Not all clinics will grade embryos and embryo grading does not at all indicate that a cycle will be successful.  Poorly graded embryos certainly can still result in a full-term pregnancy and top graded embryos can also fail.  Our embryologist told us we had a 4AA (top grade) embryo and 5 more that were heading to the freezer for future babies.  Once we spoke to the embryologist we were sent back to prepare for the transfer.  Most clinics will make you change into a gown of some type plus a hair net and socks & hubby's will sometimes be provided with scrubs and booties to wear.  The transfer is usually pretty quick and consists of lying on a table with your feet in stirrups, just like you would for a PAP.  A speculum is inserted followed by a catheter which contains the embryo.  Your bladder is usually supposed to be full so that they have a clear view of the area via ultrasound and you can usually see a tiny little dot appear on the screen.  Once the transfer is complete then you typically are required to lay down anywhere from 10-60 minutes depending on the clinic.

This is of course, just the process that I am familiar with for known donors.  There are many programs out there and a lot of the details can vary.  Donors are allowed to donate up to 6 times, sometimes they do back to back cycles which can cause a delay for the recipient.  Another option that many clinics offer is a shared risk program where you split the cost with another recipient to help offset the cost.  The eggs retrieved are also split so each couple gets an equal share of eggs.  There are pros and cons to all of these programs, the biggest being that insurance covers NONE of the donors part so retrieval and meds are 100% out of your own pocket.  Meds typically cost about $3-4,000 and the retrieval is usually between $15-20k.  For us we were blessed with all of our meds being donated from others in the community along with a few from my local clinic who took care of monitoring me for the cycle since I couldn't be in Georgia for my baseline & monitoring appointments.  However we did pay $13k out of pocket for the rest of the cycle along with the $750 legal fees plus travel to Georgia.  Just like most infertility treatment, it's very expensive.

So that is really the technical part of donor eggs.  The bigger part of donor eggs is the emotional part.  There is a TON to consider and there are some scary things to think about, but ultimately your heart and your intuition will guide you (as it did for me) to determine if it's right for you.  We have always been very open about our journey and that did not stop with egg donation, were were open and honest about it from the beginning and we have been lucky that we have had nothing but amazing support from friends and family.  If someone was unsupportive I would do all I could to educate then about how families are built today, but I would never let an unsupportive person stop me from obtaining my dreams.  As long as my partner and I were in agreement then no one else's opinion would take any toll on my decision.  

As far as a donor child's life, it's VERY important to talk to them about it early on in their lives.  There is absolutely nothing from a donor conceived child to be ashamed of about their lives and hiding anything from them is unfair to them.  They deserve to know where they came from,  how they came about, and most importantly HOW MUCH THEY ARE LOVED AND WANTED.  Without the desire a donor recipient has for a child, there would be no child, so make it known to them that they are so loved and so wanted.  I want Georgia to be proud of her roots, I want her to know where she came from and the amazing sacrifice that was made for her by someone who literally owed us nothing.  Even if she came from an anonymous donor, we would still share her story with her regularly and make it part of who she is.  Here is an amazing book I recommend about having the necessary conversations with your donor conceived child. 

I hope that this can give some of you some clarification on the donor egg process.  There can definitely be some challenges and some logistics to figure in depending on your situation.  If you're unsure of the path to take my best advice is to reach out in our community on Instagram or find a donor baby facebook group (there are several) where you can ask specific questions to people who have a variety of different experiences with egg, sperm, and embryo donation.

My friends over at FertilityIQ are working hard to provide this community with helpful information to equip you during your infertility journey, here are some links I found to be helpful PGS testingEmbryo Transfer GuideA Comprehensive Guide to Egg FreezingComponents of a Reliable LabA Dive into ICSIMale Factor InfertilityIVF

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