I have become friends with countless other moms of multiples since the birth of our twins in 2011, and in doing so, I have learned a lot about the world of infertility. Approximately 1 in 6 couples will battle infertility. Along this journey, they have many options including medical therapy, intrauterine insemination (IUI), and in vitro fertilization (IVF). These reproductive assistance options often result in a successful pregnancy, but occasionally further intervention is required and intended parents may choose to use donor eggs or sperm. This is where egg donors come in.
To understand the donor process, you first need to understand the general IVF process, so I'll give you the most basic rundown. A woman takes hormone injections to stimulate her ovaries to produce more than one egg. She is carefully monitored via vaginal ultrasounds and lab work, and if necessary, the dose can be adjusted based on these results. When the eggs reach the appropriate stage, the egg retrieval is scheduled. She will then take a trigger injection timed precisely before the scheduled retrieval. Approximately 36 hours later, the eggs are retrieved via needle aspiration through the vaginal wall. The retrieval process itself is fairly quick, and as the patient is sedated throughout, it is usually relatively painless. The retrieved eggs are then fertilized in a lab and monitored very closely for the next 3-7 days. When the embryos have reached the appropriate stage (average is day 5 but can be shorter or longer), a select number (usually 1-2) are then transferred into the uterus. Most often they are transferred to the woman from whom the eggs were retrieved, but in the case of egg donors and surrogates, it is not. Following the embryo transfer, the woman must wait approximately 2 weeks before having blood work drawn to confirm whether or not an embryo has implanted. If everything goes as planned, she will then have a positive beta HCG and follow up ultrasound to confirm viability of the pregnancy.
Egg donors may be used if the intended mother has low quality eggs or no eggs of her own to use. The stimulation and retrieval process is essentially identical for egg donors as it is for women hoping to become pregnant using their own eggs via IVF. However, once the egg retrieval is complete, the egg donor's role in the process is complete. Fertilization and transfer will occur along the same timetable, but the embryo(s) will be transferred into the intended mother or a surrogate mother. It can be a long process with many moving parts and opportunities for complication, but fortunately, all of my donation cycles have been fairly smooth.
There is a lot of information out there regarding egg donation, and I did extensive research on the subject before finally deciding to submit a donor application. I researched the application process, what to expect during the donation cycle, compensation, and expenses. I initially chose to register through the fertility clinic closest to me geographically and later applied to be a donor at Egg Donation, Inc. Within a few weeks of completing my donor application, I was contacted by the program coordinator because I had been chosen by my first set of intended parents. It was surreal and exciting! I knew there was always a chance that I would be chosen when I signed up to be a donor, but I also knew the donor pool was very large so I never really expected to be picked for a cycle.
The donor process can be lengthy, and this was no exception. There were a lot of forms to fill out, psychological evaluations to be done, and physical exams and test to be completed. Over the next few weeks, I had several appointments (over an hour away from my house) and countless procedures and lab draws performed. I had a general idea of what to expect when I signed up for the process, but the reality was more intense than I had anticipated.
Once I had been cleared psychologically and physically, we were ready to start the actual donation process. I began taking birth control pills to synchronize my menstrual cycle with that of the intended mother. After one complete cycle, we transitioned into the stimulation phase.
The challenge of giving myself injections was very difficult for me. I've had a fear of needles most of my life, and the first time I had to do an injection was quite the event. When I was supposed to start the Lupron, I mentally prepared for it all day. I came home that evening after work, took one look at the needle and vial, and promptly called my mother (an RN) because I knew I couldn't do it. Like always, she came to my rescue and was happy to help me out. I was embarrassed that I couldn't give myself a tiny shot and relieved that she was there to do it so I didn't have to. I swore I would learn to do it myself the next day, but a big part of me thought it was never going to happen.
The next night, I came home and got the needle and vial out of the bathroom cabinet. I very calmly pulled the medication into the syringe and sat on the side of the tub. I cleaned a small area on my lower abdomen with an alcohol swab and uncapped the needle. I looked at the 27 gauge needle and felt like a fool for being so afraid. It was tiny. Absolutely tiny. Why was I so nervous?! I decided to just bite the bullet and get it over with. I held the skin on my abdomen and began to count. "1... 2... 3." Nothing happened. The hand holding the syringe hadn't moved. I tried again. "1. 2. 3." Again, nothing. In that moment, I was the biggest baby in the world. Another failed counting attempt lead me to believe that maybe that just wasn't an ideal approach for me. Maybe I just needed to control the injection slowly rather than try to sneak up on myself.
I decided that I would slowly and precisely pierce my skin with the needle and then inject the medication. I wiped the area again with a fresh alcohol pad (after 20 minutes of staring at my stomach, I wasn't sure if it was still clean). I carefully placed the tip of the needle against my skin. I pushed. It began to sting a little bit, but it had not broken the skin yet. I pushed harder. My skin began to cave under the pressure, but the integrity of my skin remained intact. I pushed even harder. The combination of the sharp point and the pressure was beginning to cause some pain, but still nothing. How thick is my skin anyway??! Shouldn't it have broken by now?! I started over in a different spot. After another two failed attempts, I gave up and reached for the phone. It was clear I wasn't going to be able to do this. I opened my favorites tab, and my finger hovered over the contact for "Mom." My pride and fear were viciously battling in my head. I was a 25-year-old woman. Surely I wasn't going to call my mommy to come save me for the second time in 24 hours... No. I could do this. I put the phone down.
I picked the syringe up again and cleaned my skin for the fifth time. Sixth time? I wasn't even counting anymore. I knew the slow injection wasn't going to work, and that only left me with one option. I didn't even count. I quickly brought the needle toward my stomach and jabbed inward. Much to my surprise, it easily broke the skin and went all the way down to the hub of the needle. The sensation wasn't exactly painful, but it wasn't pleasant either. Approximately 1/2 a second had passed, and when my brain registered what had happened, it shocked me and I pulled my hand away as I gasped. Unfortunately, I didn't bother releasing the syringe when I reacted, and the needle came out just as quickly as it had gone in. You have got to be kidding me. What the hell just happened?!! I had it! It was in!! I had been sitting on the side of the tub for an hour alternating between coaxing myself into it and trash talking my pansy behavior. I had the needle in, pulled it out, and now I had to start all over?! COME ON!
I wanted to cry. I wanted to quit. Call the agency and tell them I was sorry but I wasn't as tough as I had originally thought. I couldn't do this for 2-3 weeks. We were talking about a minimum of 18 injections, and I couldn't even do it once. This wasn't going to work. And then I remembered why I was doing it. This couple desperately wanted a family. They were giving everything they had just for the chance to have a baby. It certainly wasn't a guarantee. It was just a CHANCE. They were this desperate for the opportunity to have a child. If they could go through infertility and all that comes with it, surely I could give myself a few shots.
At least this time I knew I was capable of sticking myself; I just had to make sure I didn't mess it up again. I needed to regroup. I went to the kitchen and got a glass of water. As I walked through, my husband asked me how it went. I told him that I hadn't done it yet. He asked if I was kidding, and I wish I had been. I went back to the bathroom and sat down. I cleaned my stomach yet again and picked up the needle for what would hopefully be the last time today. I knew what would work, so I quickly punched the needle through my skin. Shock. Surprise. I gasped again and felt my arm pulling away in a knee-jerk-style reaction. My brain screamed LET GO OF THE SYRINGE!!! I did. Sweet Lord, had I done it again? I looked down convinced that I had let go too late and would see the syringe in the floor. Instead I saw it hanging from my abdomen with the needle still mostly buried under my skin. Thank goodness!! It was still in. Just dangling out of me. Suspended only by the needle piercing my soft tissue. I'm going to throw up. And then I realized I wasn't even finished yet. It was in, but that was only half the job... I still had to actually inject the medication.
I wasn't sure if I was supposed to push it fast or slow (or if it mattered), but I knew that in that moment, what I was "supposed" to do was completely irrelevant. There was no way I could quickly inject this. I slowly and carefully grasped the syringe. What had I signed myself up for? I've worked in the medical field for years, and while I could easily and happily inject anyone else with anything, this was a whole new ballgame. What was I thinking?! I tried to ease the plunger forward, but it didn't move. I used a little more force but still nothing. I tried to spin in so it would be easier to move forward, and it worked! I was then able to very slowly, cautiously, and somewhat painfully inject the entire syringe into my stomach. It probably didn't help that I was already sensitive because I had been pinching various places on my lower abdomen intermittently for over an hour. I closed my eyes and continued to slowly inject the medication. Much to my relief, when I opened my eyes several seconds later, the syringe was empty. I quickly pulled the needle out and thought I was going to pass out. It burned and stung, but, thank you sweet Jesus, it was over.
I was a nervous wreck, a couple places on my stomach were oozing blood, and it had taken over an hour, but I had done it. I successfully gave myself a shot in the stomach. I alternated between pride in myself for conquering such a huge fear and absolute embarrassment that it had taken me so long to do something that diabetic patients accomplish in a matter of seconds multiple times a day. I decided I didn't care that other people could do it with so little effort. I had proven to myself that I was capable of giving myself injections. This was a huge accomplishment. Then I remembered that I had to do it all over again tomorrow night. This was going to be the longest month of my life, but at least I knew it was possible.
The injection the following day was significantly easier, and by the fourth day, I could do it with very little time or effort. If you had ever told me that I would be able to give myself any kind of shot, I would've laughed in your face. I couldn't believe how far I had come! I took daily injections of Lupron to suppress my ovaries and induce a temporary menopausal state. After taking the Lupron for 7-10 days, I had an appointment to check my ovaries and then began stimulation injections. For a few days, I had to do two injections each day, and I'm sure you can guess how much I loved that. I used Gonal-F my first cycle, and after several days of taking the stimulation drug, I began having ultrasounds and lab work every two days to monitor the follicles. We continued the daily Gonal-F injections and continued routine monitoring. When they had finally reached the appropriate size, I stopped the stimulation injections and was scheduled for the egg retrieval.
About 36 hours before the egg retrieval, I had to give myself a HCG trigger injection. This shot was different from the ones I had become accustomed to. It was an intramuscular (IM) injection which means the needle has to go all the way into the muscle layer to be injected. I was able to give myself this shot as well, but it was more difficult. I was so very relieved to get it over with because I knew that was the last time I would have to stick myself with a needle. For me, that was absolutely the worst part of the process, and I was thrilled to be finished with it!
My husband drove me to the clinic on a Thursday morning for the retrieval. We came in, I changed, and the pre-op whirlwind started almost immediately. They checked vital signs, started an IV, and gave me pre-op medications for sedation and nausea. Shortly after, I was wheeled into the procedure room where they performed the needle aspiration to retrieve the eggs. I vaguely remember moving to a different table, and at one point I remember saying "That hurt!" but I don't remember feeling any pain. The next thing I remember is waking up and seeing my husband sitting beside me. He didn't leave my side the rest of the day. He is always very attentive, and seeing him nervous about my being sedated and having a procedure done was one of the harder parts of the process for me.
It's hard for me to say how long I was in recovery because I was so groggy, but I've been told it was about an hour. I was able to get up and to the bathroom unassisted and changed my clothes. All of my post-procedure vital signs were stable, and I was reasonably comfortable, so I was released fairly quickly. I was sleepy for most of the day and had some mild bloating that afternoon. I only remember eating lunch and sleeping a lot.
I woke up the next morning, and aside from some mild bloating, felt completely normal. I went to work like usual and other than the bloating getting a little worse, I really didn't notice many side effects. The clinic called to check on me Friday afternoon, and when I mentioned the bloating, she seemed a little concerned. They told me to weigh myself, and when I did, I realized that I had gained 3-4 pounds since the morning before. I hadn't really noticed it that much, so I was surprised when they sounded so concerned. I was having some other symptoms like loss of appetite and some mild nausea. The program coordinator told me to drink extra fluids the rest of the day, and she would call to check on me again in the morning. I was to call or go the my local ER if I started having any respiratory symptoms.
Apparently, bloating and weight gain is a symptom of a post-procedure complication called ovarian hyperstimulation syndrome (OHSS). It is fairly common and usually mild, but severe or critical cases often require medical intervention and if untreated can lead to death. When they performed my egg retrieval, they were able to obtain 35 eggs, so they knew I would likely have some degree of OHSS. Unfortunately, it appeared that my case was in the moderate range with a high possibility of becoming severe.
The next morning, the bloating was worse and my weight gain had increased to a total of 9-10 pounds. I was also having more nausea and decreased urine output. When I talked to the coordinator, she told me to come in immediately because my symptoms had progressed to the severe range, and they needed to do an ultrasound as soon as possible to decide what my treatment plan would be. I told her I would be there as soon as I could, but it would probably be close to two hours. I called my husband to come get me (I was at work), and I immediately went to tell my boss I needed to leave for an emergency medical appointment. She was less than understanding and told me that I would not be allowed to leave because that would leave them short handed. I told her that while I understood that it was an inconvenience for her, it wasn't something I had a choice about. She said I always had a choice and walked away.
Within 15 minutes, her husband (who happened to be a doctor and the owner of the small clinic I worked at) arrived, asked for my keys, and told me to get my things and leave. To say I was shocked would be an understatement. I physically felt too bad to argue the ethical or legal aspects of what was happening, so I simply did as I was told. My husband was already waiting outside, and he was beyond livid when I told him what had happened.
This was obviously the beginning of a completely different problem for me, but I didn't have the time or ability to sort it out then. I told him that I didn't want to get into it right now, and we instead chose to handle the issue of my physical health first. We made the hour drive to the clinic in near silence. He was still fuming at my work situation, and I was feeling worse than when I had gotten up.
When we arrived, they took me straight back for an ultrasound. It showed that my ovaries were both enlarged (as expected) and I had a moderate amount of free fluid in my abdomen. Two of the physicians at the clinic began discussing a treatment plan. They finally decided to put me on bed rest for the next 24 hours with the hope that my body would begin to resolve the issue on its own. If my symptoms persisted or got worse, they would admit me to the hospital for a fluid aspiration. We were given strict instructions to increase my fluid intake, monitor my urine output and weight, and rest. I was nervous but hopeful that my body would adjust and begin eliminating the fluid.
We went home and followed the instructions precisely. My weight gain maxed out at 10 pounds, and by Sunday afternoon, my urine output had increased and I was down to 7 pounds. We were making great progress! The coordinator called me twice a day to check on my physical symptoms and comfort level, and we scheduled a follow up ultrasound the next week to confirm the ascites had resolved. My follow up ultrasound was perfect, and by then, I was feeling almost completely normal. I still had some mild bloating that was expected to go away after my next menstrual cycle, but otherwise things were fine and my donation cycle was officially finished.
It wasn't without challenges or complications, but overall it was a great experience that I was happy to do again. My donation cycle resulted in 35 eggs and 13 embryos, of which, 8 were frozen for future cycles. I don't know if the intended parents were fortunate enough to have a successful pregnancy or not, but I hope they did. Since completing this cycle in 2012, I have been a donor three more times including twice in Encino, California. Each process was emotionally and physically taxing, and while I don't see another donation in my future, I am forever grateful for the opportunity to help those couples have a chance at a family. Most of my experiences were wonderful and joyous, and I'm glad I was able to be a part of something so much larger than myself.
I would highly encourage anyone who is considering it to do some research and explore your options. There are strict guidelines and standards that must be met to be considered for donation, and not everyone is a good candidate. However, if you are a good candidate, it is definitely something worth looking into!
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