Return of the Donor Bump

Day 4... Yes, it's back already. I wasn't expecting to be back to feeling rather... large... so early on, but here we go. It's obvious to see and feel that the Gonal-F and Menopur are doing their job. Yesterday I woke up feeling like I have two tangerines hanging out in my stomach, and today I'm squeezing into my jeans that were loose a few days ago. I've been taking the same doses for the last three days: 5 units of Lupron in the morning, Menopur (1 vial) & Gonal-F (225 units in the evening). I had my first monitoring appointment today to check out the O's, and my Gonal-F is being increased tonight to 263 units. So far the eggs are looking good! Next appointment is on Thursday...

Shot count: 22

Side Effects: Nausea!, Headaches, Loss of appetite, Fatigue (took a three hour "nap" today), Donor Bump (looking about 5 months)

People who have asked if I'm expecting: 0 - This might change soon...

EGG COUNT: 8

SHOTS SHOTS SHOTS!

Cycle 2!

I got the green light today after my FDA panel results came back great! Had my first ultrasound to check on the O's... looking good ladies. I've been taking 10 units of Lupron for two weeks now, and will continue for a couple more days at 5 units. Tomorrow begins Day 1 of taking the "real" shots: 225 units of Gonal F and one vial of Menopur. I'll be taking these dosages for 3 days, and have my first monitoring appointment on Monday :)

Shot Count: 14

Side Effects: Loss of appetite, bloating (no donor bump yet!)

Lupron and Antibiotics

I have been taking 10 units of Lupron in the morning for about 7 days now, mostly side-effect free! The only change I have noticed has been mild nausea in the morning on occasion. I am using insulin needles which are so tiny I barely feel them... No bruises at my injection site (stomach!) or donor bump in site - yet. Now at day 8, I'll take my last birth control pill and continue Lupron shots once in the morning. Lupron is a gonadotropin releasing hormone (GnRH), and basically prevents your brain from sending signals to your ovaries to tell them to make estrogen. The result is a significantly lower level of estrogen in the body, suppressing the natural menstrual cycle. From what I can understand from my own research, it allows the Dr's to better control and sync donor/recipient cycles. It also helps to prevent premature ovulation, which would be a MAJOR catastrophe!

Next week I have my FDA panel again, and then the Menopur and Gonal F shots will be added to the loop. Reminder: The FDA Panel is required by law for all egg donors prior to donation to test for STD's, AIDS/HIV, Hepatitis, and drug use. I think it also involves another ultrasound just to check on the O's.

I was a little concerned the other day when I got a bad case of tonsillitis, and had to start taking antibiotics. (Side note: I LOVE the CVS Minute Clinic... in and out in 15 minutes with Rx in hand. I'll never go back to Patient First if I can help it!) Because antibiotics can decrease the effectiveness of The Pill, I nervous that they might also affect my hormones & cycle as a donor. I would feel so guilty if getting sick meant that I would have to restart my cycle so early in the process. Thankfully my doctor assured me that the amoxicillin would NOT affect my Lupron or my cycle!

Round 2

WOW I didn't think I would be announcing this so soon... I am officially starting my second cycle as an egg donor! I am looking forward to being able to post throughout the entire donation process this time, since I wasn't able to write during my last cycle. I'm pretty shocked that this is all happening again so quickly, but I feel like I'm prepared for round 2.

Now is the easy part. I'll be taking birth control pills normally until my baseline appointment, which will be about a month away. I believe this appointment will consist of the usual - blood work, hormone testing, and ultrasounds. I'm also taking prenatal vitamins for an extra healthy boost. I'll meet with my donor coordinator next week to go over all of my medications and refresh on taking shots. Tentative retrieval date is early July!!

A New Nest

A few days after the break up I started searching for new opportunities as an egg donor. There are plenty of fertility clinics in Maryland, but I had trouble finding one that didn't lead me straight back to Shady Grove's donor application site. I felt as though I had been blacklisted in the entire state. I decided to apply to a clinic in a nearby state, and have had great luck working with them so far. I am officially on their database!

The application process was pretty similar to that of SG, but with a few interesting additions. I went through the typical blood work, ultrasounds, interviews, social worker visits... the works. I also had to get professional photos done - Glamour Shots!! (Paid for by the clinic.) Probably a little excessive, but the donor coordinator assured me that the girls who have them done typically get picked sooner. The most interesting part of the application was the audio interview. The questions were pretty basic - Who is your role model in life? How would you describe your personality? Goals in life? etc... After listening to my tape, and maybe a few from other donors, I realized how much you can really learn about someone just from listening to their voice. What a great idea...

After spending a few months working with the new and improved clinic, I feel a little cold towards SG. I never really felt like the doctors there truly cared about my well being... Saying that I felt exploited might be a little much, but I definitely feel like Clinic B has my interest and the recipient couple's interest equally balanced. During one of my first ultrasounds with SG, Dr. Yazigi noticed a small cyst on my right ovary. Laying vulnerably on the table and hearing this was both scary and shocking. Before I had an opportunity to ask whether I should be concerned, and whether I would still be going through with the donation, the Doc's were pretty much out the door and shooing me off. After doing my own research, and contacting my own OB/GYN I learned it was nothing to be concerned about.

While applying to Clinic B, I requested copies of my entire medical record from SG. Almost 50 pages of paper work documented every phone call, every email, blood test, ultrasound, etc. I knew from a previous blood test that I had high cholesterol, but it had been a few years since I got an updated test. Apparently SG had tested my cholesterol 5 times throughout my time with them, and each time it came back high - I had no clue. Not once was I ever told that I should be concerned by my test results. This was not the case with Clinic B - every time a test result came back good or bad, my donor coordinator emailed me an update with genuine concern.

Needless to say, I am glad I have found a better clinic to work with.

The Break Up

After my donation, I was definitely eager to get back on the donor database. Women who have successfully donated before are deemed "proven donors," and are typically chosen quicker than first timers. I contacted my nurse a month after my retrieval, and she said she would speak to the medical directors about my interest in donating again. Apparently no one can just get back on the list... Waited a few days and no response. So I called back to the main office... and I waited... and waited. Finally a week later I got a call from one of the staff members at SG thanking me for my donation, but that I would not be back on the donor database at Shady Grove. I was shocked to say the least, but their justification shocked me even more.

In one of my previous postings I described Shady Grove's "Shared Donor Program." Basically up to 3 couples can share a single donation from a single donor. In my case, I donated 14 eggs to two couples (each couple got 7 eggs). As a first timer, I was told that this is a pretty good number. However, if I would have been involved in a shared program between three couples (each receiving 4 or 5 eggs), each couple has a slimmer chance of getting viable eggs. Remember that the couples can freeze unused embryos, so they next time they want to try to get pregnant there is no need to call back in the donor... which costs more money. The bottom line is that SG makes more money per cycle when multiple couples are involved, and each couple gets many many eggs. I was told by the staff member that SG wants girls who can consistently produce 20+ eggs, and I just didn't meet the cut. (She worded that a little nicer...) Did your jaw drop too?

Still wanting to donate again... I was back to square one.

The Donation

I got a call one day from the donor coordination at Shady Grove to let me know that I had been finally matched with not one - but two couples! I think I had been on the donor database for about 4 months at that time. I was emailed my medication protocol and very detailed instructions on my dosages. I got a package in the mail with all of my medications, syringes, alcohol swabs, prenatal vitamins, and a sharps box to safely dispose of my needles. Overnight my refrigerator looked more like a  pharmacy... I started out taking my birth control normally, adding a prenatal vitamin once daily, and 7 days of antibiotics. During this time I was being cycled with the other two recipient mothers. This was definitely the easy part... After 18 days I went to SG for blood work and an ultrasound to make sure all was going to plan, which it did. For 7 days I took two shots a day in my stomach. It was definitely difficult to mix the medications at first, and to get the courage to stick myself. I took 225 units of Gonal F, and 75 units of Menopur. I can't remember which - I think it was the Menopur - burned like hell when injecting. Otherwise it was no big deal. As the days passed I started to feel physically a little different. I experienced no emotional/mood changes, but I started to get bloated.... VERY bloated.

I had heard about other girls getting an "egg donor bump" as the egg follicles grow... I definitely looked a little pregnant until the donation. It felt like someone had stuck two heavy oranges in my ovaries. As the days passed and I took more shots, I definitely had some mild bruising as you can see. Since fitting into my jeans was out of the question, I spent about a week living in sweat pants. You think sitting in a 2 hour lecture hall is uncomfortable? Try adding a few extra pounds of water to your belly. Sitting in class was definitely miserable for a few days. After day 7 I added a third daily shot of Cetrotide in the morning. I continued taking 3 shots a day, feeling very very huge, for about 4 more days. Finally, the day before the retrieval I took my trigger shot of Lupron (intramuscular... in the bum. Thanks to the friend who helped me with this one). Although the Lupron shot was HUGE, it was pretty painless. The next day I had a friend drive me to the clinic in Rockville where SG does all of their retrievals, and got ready for surgery. The whole procedure took about 15 minutes under anesthesia, and I don't remember a thing. I woke up feeling a little uncomfortable, mostly crampy, but was able to take pain meds. I slept pretty much the whole day, taking my Vicodin as needed. Over the next few days my bump deflated, and I was back to my old self!

Updates

So much has happened since I stopped blogging about my experience as an egg donor. I thought I would use this opportunity to answer some of the questions that I've been asked over the last few months.
So... Did you donate?
Yes - I was chosen as a donor by 2 recipient couples, and successfully donated my eggs. I produced 14 eggs!
Why did you stop blogging?
To protect my anonymity, SG asked me to stop blogging once I was chosen as a donor. They were receiving a number of calls from people who had read some of my postings - some of who were actually requesting my eggs. Flattering, but not what I had expected to happen.
Will you donate again?
Short answer is YES, I would love to. The shots were no big deal, the pain was minimal after the procedure, and overall it was a good experience. However, I was not invited back on the donor database with Shady Grove... more on that later.
Did the couples get pregnant?
I have no idea - the donation was anonymous, and I might never find out that answer to that question. I am comfortable with never knowing what the result of my donation was.
What now?!
I am currently working with another fertility clinic, and I am officially back on the donor database with that clinic. I hope to donate at least one more time with them. Now that my donation is done and over with, and my relationship with SG has ended I've decided to start writing again about my experience (and continue on with any future donations). Stay Tuned!
 

In the home stretch

I'm sure a lot of you have seen this donor egg child video, but for those who haven't - take a look! 16 year old Allegra gives great insight into what life is like knowing that she was conceived with help from an egg donor. I think it's so important for people to teach their children about their identity at a young age. There are age-appropriate ways to teach kids about egg donors, and my social worker was open enough to share some of these tactics during our first session. A few women have even made kiddie books to help parents talk to their kids about egg donation! Seriously, that book is too cute. I appreciate that Shady Grove takes the time to prepare their recipient parents on the multitude of obstacles they have to overcome - as well as their donors - which makes me even more confident that my eggs will be going to a great parents.

I can't believe the application process is almost FINALLY over. My last social worker appointment is this week, accompanied by my loving boyfriend, and I'm done!... Well, for now - then the real work begins!

"Frozen Angels"

I was browsing through the Netflix library yesterday and came across a documentary about the development of reproductive technology in Los Angeles. "Frozen Angels" gives viewers multiple perspectives of people involved in the art of unconventional baby-making. The film follows a gestational surrogate & her recipient couple, a young man born with help from a Nobel Prize sperm donor (AKA "the Designer Baby"), a blonde haired/blue eyed egg donor (AKA the poster girl), several fertility specialists, and Bill Handel (a radio personality, and father of twin girls who were born through gender selection IVF). The film also examines ethical dilemmas with respect to genetic manipulation, and using egg donors/surrogates.

Kari, the egg donor, is definitely someone I can relate to. She has donated her eggs several times, and now receives up to $8000 for each donation. Described by the clinic as the "ideal donor," it seemed as though she was quickly becoming a hot commodity to couples seeking donors. The clinic she was involved with seemed much less sensitive to her experience as a donor in comparison to Shady Grove. I don't feel like she was as prepared for experiencing side effects from the hormones, and her clinic was more concerned with her making money than being safe and healthy through the process. To put it bluntly, she was treated somewhat like a prostitute in my opinion. It seemed more like she was going through a business transaction, rather than giving a gift as I like to put it. I truly hope that my experience will be much different.

Doron, the product of a Nobel Prize sperm donor, gives a great perspective into life as a donor child. Having an IQ of 180, he definitely takes after his biological father - just as his mother wanted. When asked how he feels about his sperm donor "father," he gave an answer that I thought was very interesting. His donor is just another person in the world, not his Dad, and that is all. I think this is a great way for a person to think about their donor. The donor gives a small piece of themselves for a child to be created, and that is all. I'll be in no way, shape, or form a "mother" to my potential donor child - and that's okay. Being able to give such a huge gift is a gift to me in itself, and I don't desire anything more.

Seeing Amy & Steve, the parents who receive a child from a gestational carrier, was particularly touching. After 15 years of failed IVF treatments, they made the decision to utilize a surrogate to carry their biological child. I can't imagine the pain they felt throughout those - gulp - 15 years, but seeing them with their baby was truly amazing. I went through about half a box of tissues... yeah, I'm a dork. I hope that my gift makes even a fraction of this impact on the lives of a couple struggling to become parents.

There is a lot more covered in the film than I have described here, but being out of the realm of my experience, I'll leave my description short and sweet. If you have Netflix, the movie is available for instant streaming - I highly recommend watching it.

Baby steps

I just got back from my first appointment with my social worker, which was pretty interesting. The whole meeting felt a little bit like a job interview, so I was somewhat nervous. I definitely understand why Shady Grove takes the extra effort to make sure they accept only the most responsible donors, and makes them aware of the magnitude of their decision to donate. I never thought this experience would be so complicated! But almost 3 months into the egg donation process, I am truly glad that I have taken the time to understand what I'm getting myself into.

The social worker spoke with me for almost an hour about things I may experience during and after the egg donation. She basically brought up a few hypothetical scenarios, and asked me how I would feel or react. For example, she asked how I would feel if the recipient couple wanted to meet me, and how I would react if they needed some kind of medical help in the future (like if their child needs a biological relative to donate bone marrow in the case of leukemia). I've thought a lot in the past few months about these type of scenarios, so it was easy to open up and tell her how I was feeling. The last step I have to take is to meet with her once again - with my boyfriend. I hope he's ready!

This whole process is feeling a little more real this morning. It's not out of the realm of possibility that someone could choose me as a donor within the next few months! This idea really sunk today, and I'm thinking about the adjustments in my life I'll have to make. Abstinence, injections, cutting back on physical activities, daily trips to the clinic... it's a lot to deal with. I'm an avid runner, and have a few team races scheduled in the upcoming months that I would hate to back out of, but it's a sacrifice I'm willing to make. The risk of ovarian torsion rises with physical activity and contact sports, so I'll have to hang out on the sidelines for a while. For now, it's back to waiting...

I've got a new favorite pair of jeans

It's official - I'm not psychotic, I have acceptable genes, and no infectious diseases! Hooray! I got "the call" from Shady Grove a week ahead of schedule giving me permission to take the next step in egg donation. I immediately made a call to my social worker to set up an appointment with her. I'll meet with her twice - once alone, and once with my boyfriend - and then I'll enter the donor database. I'm not really sure exactly what we'll discuss in our meetings, but I'm assuming we'll talk about the emotional aspect of egg donation. I am so relieved to have made this huge step... more so that my genetics test came back without any concerns. Big thanks to my Mom and Dad!

This is your brain on eggs:

It's been almost 2 weeks since orientation now, and still no call back. Most of my friends know that I absolutely HATE waiting for surprises. This year I convinced my boyfriend to let me open all of my gifts a full week before Christmas... I know, I have a problem. Needless to say, the suspense is killing me. I know Nurse Connors told me to expect results back in 3 weeks, but I'm really hoping I get a little relief early.

This waiting period has given me a lot of time to think about what I'm hopefully about to do. Lately, I've been thinking about what couples look for in a donor. Is it hair color? Height? Religion? Athleticism? Or do they focus in on the essay portion of the application? What makes ME a good donor? I'm not totally sure, and I would love to get some feedback from women who have looked through the database of donors. If I needed to resort to using donor eggs, I think I would want to use eggs from a woman who looked like me. The essay portion would also weigh in on my choice - Personality definitely matters. Brains definitely matter to me too, so I would definitely take academic background into consideration.

I'm also curious to hear what recipient couples would be curious to know about their donors that isn't covered in the application. Would they want more details about what I look like? My IQ? My personal style? Would they want to see a current picture of me, instead of just my baby pictures? I would personally be interested to know these things... I know this issue is pretty controversial, but I'm also curious to know whether recipient couples would be interested in meeting their donor in person. Part of me thinks it shouldn't really matter what kind of person is donating their eggs, so why bother meeting them? Sure, their kid is getting my DNA, but they're the ones responsible for really molding their child into the person he or she will become - not me. I'm not sure if I would want to meet my donor if I were in the recipients' shoes for privacy reasons, but I would definitely be curious as to who she really is. I appreciate the anonymity of the process, and I don't think I would ever want to meet whoever gets my eggs. I'm donating my eggs, and nothing more, and that in itself is a gift.

Staring doesn't make it boil faster

It's been a week since my Donor Day orientation, and I'm doing my best to restrain myself from checking my phone every 5 minutes for missed calls. I'm feeling confident that my MMPI scored fine, because I haven't received a phone call for a disqualification notification. Hopefully I'll hear back with good news with regards to the genetic tests within the next two weeks so I can schedule my appointments with the social worker. This will be the last step I have to take before I officially enter the donor database! The suspense is definitely weighing down on me.

I've been thinking a lot about the genetic tests this past week, so I did a little research about the diseases that Shady Grove tests for. It's amazing to me that ANY baby is born completely healthy with the multitude of genetic diseases that exist. Some of the conditions are pretty debilitation, or even life threatening. I can't imagine having any of these issues myself, or putting a child at risk of being born with one if I happen to be a carrier of the gene. I'll do my best to decipher all of the medical jargon...

1. Beta Thalassemia is a blood disorder that causes the body to make an abnormal form of hemoglobin. Hemoglobin is a protein that gives red blood cells their distinct color, and enables the cells to carry oxygen. Without normal hemoglobin, a person will develop anemia (lowered capacity for RBC's to carry oxygen to tissues/organs) and may experience hemolysis (premature breakdown of RBC's). This disease can be life threatening, but can be treated with blood transfusions and bone marrow transplants.

2. Bloom Syndrome is a disease that commonly affects individuals of Jewish descent. These individuals have "breaks" in their chromosomes, which causes many physical deformities. The most noticeable symptoms include a red facial rash when exposed to sunlight, narrow face, and short stature. They often have a higher risk for leukemia, other types of cancer, and life threatening infections.

3. Canavan Disease is a metabolic disorder in which an individual lacks an enzyme to break down aspartic acid. This can lead to deterioration of white matter in the brain, leading to severe mental retardation. While some individuals are able to live into young adulthood with this disorder, most die within 18 months of age. The MRI pictured shows significant damage within the brain, in comparison to the normal brain.

4. Cystic Fibrosis is a disease that causes a build up of abnormally thick mucus in the lungs and digestive system. People with CF have a persistent cough and abnormal bowel function, as their body is unable to rid itself of the mucus. The symptoms of CF can be alleviated with respiratory therapies, and diet regulation, but most die by the age of 35 from respiratory complications. I had a childhood friend pass away from CF at age 15, and I know how hard it was to see him & his family endure the struggles associated with his disease.

5. Familial Dysautonomia affects the development of nerves, and commonly affects people of Jewish descent. This disease has a variety of symptoms associated with the central nervous system, and only half of sufferers live to the age of 30.

6. Fanconi Anemia Type C causes individuals to have a lower levels of white blood cells, red blood cells, and platelets (clotting agents). People with this condition have a higher risk of developing leukemia, but are typically able to live normal lives with blood transfusions/bone marrow transplants.

7. Gaucher Disease is yet another metabolic disease that typically affects people of Jewish descent. Individuals lack an enzyme, which causes a toxic build up of substances in the liver, spleen, and bone marrow, thus preventing them from functioning normally. Enzyme replacement therapy has extended the lives of those affected by this disease, but they may also need bone marrow transplants at some point in their lives.

8. Tay Sachs is a disease of the nervous system that is particularly devastating. 1 in 27 people of Jewish descent carries the gene, and those affected typically die by age 5. Tay Sachs causes deafness, blindness, decreased muscle tone, dementia, seizures, and even paralysis. Currently there is no treatment.

9. Mucilipidosis is a genetic disorder that causes mental retardation and progressive loss of vision. People with this disease are unable to break down carbohydrates and lipids normally, which causes a build-up of intermediate substances. Accumulation of the substances can cause organ damage, corneal clouding, and cognitive delays.

10. Niemann-Pick Disease causes lipids (fats) to accumulate in the liver, spleen, and brain. This progressively causes motor skills to decrease, seizures, tremors, intellectual decline, and other neurological issues. Severe cases typically cause death by age 3, but those with mild cases may survive to the age of 20.

11. Sickle Cell Anemia causes red blood cells to form an abnormal crescent shape due to an abnormal form of hemoglobin. The fragile RBC's can't deliver adequate amounts of oxygen to tissues of the body, and can easily clot in small blood vessels. Sickle cell can be treated with dialysis and blood transfusions, but may still be life threatening.

12. Spinal Muscular Atrophy causes muscle degeneration which leads to poor muscle tone, breathing/feeding issues, and progressive muscle weakness. Most individuals only live to 2-3 years of age because of the lack of treatment for this fast acting disease.

13. Fragile X is caused by a defective gene located on the X chromosome, and can affect both men and women. Some with this disease often suffer mental retardation, or experience symptoms similar to those with autism. They often very tall, have long faces, and low muscle tone. Men with Fragile X are typically more drastically affected in comparison to women with the disease because they have only one X chromosome. You can see the "fragile site" located at the bottom of the chromosome, which appears to have broken off.

If I was a carrier for any of these genes, I would definitely want to know. However, awareness of that fact could bring a new set of challenges down the road when I choose to start my own family. It was emotionally painful just to get through this post after seeing photos of people affected with these diseases, and I know I would never want to put a child through that struggle. For now, I'm hoping on good genes!

Protecting The Nest

During Donor Day, Nurse Connors addressed one of my biggest concerns about donating my eggs - ovarian hyperstimulation syndrome (OHSS). I was relieved to hear that only a single woman experienced severe hyperstim at Shady Grove during her time at the clinic. Whew, that's a relief! However, in her next breath I was made aware of another risk even scarier than OHSS - ovarian torsion. Ovarian torsion is basically when an ovary twists in a way that cuts off it's blood supply, which can lead to tissue death or necrosis. After taking the hormones that prepare a woman's body for donation, the follicles of the ovary grow exponentially large in a short amount of time. As a result, the enlarged ovary obviously needs to shift around in the body to get a little more comfortable. If it happens to be pushed in a certain way and twist over on itself, the ovary is in deep trouble. The good news is that if it is caught in time, the ovary can be saved with surgical repair. If a significant amount of necrosis occurs, it may be necessary to remove the ovary. On the bright side, a woman can still become pregnant with one functioning ovary, and torsion usually only happens to a single ovary at a time. Still, it's a pretty big risk to take on. Ironically, something that is intended to increase another woman's fertility could potentially decrease my own.

I've had a lot of people ask if egg donation could potentially affect my fertility. I guess when you consider risks like ovarian torsion, the answer is in the grayer area of yes... Yes the risk exists, I get that. If you were to ask me if egg donation could affect my chances of becoming a parent, the answer is clearly a big NO. Lets say hypothetically I unfortunately experience ovarian torsion, lose my ovaries, or because of the procedure I am consequently unable to get my ovulation cycle back into gear. Would I be devastated by the thought of being unable to have a biological child of my own? Absolutely, but because of these tragic events, I would be able to adopt a child who otherwise wouldn't have been. I find that when I look at the bigger picture with respect to these "risks," I see more opportunity for wonderful things to happen.

Let's Talk Hormones!

I'm going to do my best to follow in the footsteps of my health class teacher to explain the ovarian cycle and how it relates to egg donation. The chart above is a great illustration of what really goes on with respect to hormones. As you can see, there are four main hormones that control the female reproductive system. Follicle Stimulating Hormone(or FSH) stimulates the growth of immature follicles in the ovary. The follicle is an oval shaped structure, filled with fluid and cells, where a single oocyte (or egg) develops. The second hormone is called Luteinizing Hormone (or LH), which triggers ovulation when the egg reaches maturity. As you can see on the chart, there is a huge surge of LH in the middle of the ovarian cycle, which is when the egg leaves the ovary and the woman is able to get pregnant. The third hormone is Estrogen, which is responsible for overall regulation of the female reproductive cycle. Finally, we have Progesterone, which is responsible for preparing the female body for pregnancy. Progesterone levels rise after ovulation, and build up the wall of the uterus to make it more suitable to an embryo if it is fertilized. If a pregnancy does not occur, progesterone levels drop and the woman gets her punctuation. Simple enough right?

When I'm chosen by a recipient couple to donate my eggs, I'll have to take two different injections to prepare my ovaries to develop multiple follicles. The results of my ultrasound indicated that I have 17 follicles available, which makes me a good candidate to donate eggs. (Acceptable donors need to have between 15 and 30 follicles.)By taking shots of pure FSH, marketed under the names Follistim and Gonal-F, my ovaries will grow many more follicles and mature eggs than it normally would. I'm expecting to take a shot of Gonal-F daily, injected by yours truly, for about 2 weeks. During that time, I'll have to make trips out to Shady Grove every 1-3 days so we can monitor the amount & size of my growing follicles. This gives the clinic an idea as to how many eggs I'll be able to donate. There may be some physical discomfort during this phase... If you can imagine, the normal follicle is about 1 centimeter in diameter and only one matures to this size during normal ovulation. However, if I have SEVENTEEN of these babies growing to 1cm each, making my ovary into a huge raspberry-like structure, it's pretty big! When my follicles reach the size the doctor's feel is adequate, I'll give myself a single intramuscular shot in the bum of pure LH, marketed under the names Lupron or Luveris. This triggers my body to plan to release the eggs, and 36 hours after this "trigger shot" I'll be in the stirrups for retrieval.

Side note about my ovarian cyst: Nurse Connors told me that my estrogen levels were slightly higher than average, probably due to the cyst. However, she said I shouldn't be concerned with it's presence, because it is so tiny and they typically go away on their own. A follicle that is larger than normal is deemed a cyst... I think it has to be over 1 centimeters in diameter. Mine is only 1.3cm - pretty tiny. So as for now I'm in the clear!

Donor Day Orientation - Over...Easy!

My day started bright and early at 8am to get ready for my Donor Day orientation at Shady Grove's Rockville location. I set myself up with a GPS, and my brand new XM radio for a little entertainment during the hour and a half drive. My heart was pounding the whole way, and I'm glad I wore a sleeveless top because I would have been drenched in sweat by the time I arrived. I signed in and settled into the cozy waiting room while nurses and doctors buzzed by. After a few minutes, I was greeted by the lovely Margaret Connors, RN., and ushered into her office. Nurse Connors started off by asking me why I chose to apply to the donor program. I explained how I had considered the idea of donating eggs a few years ago, and finally decided to muster up the courage to take on this journey. Maybe I should have told her about the blog... She then told me a little bit about SG's history, and how they have become a leader in the world of IVF with one of the highest number of IVF cycles completed per year & one of the highest percentage of successful births. People from ALL over the world have come to SG because of their reputation, especially those from the UK and Canada. People living in countries who have nationalized health care have to wait about 4 years to utilize IVF with donor eggs! It is illegal for women to receive compensation for their eggs in the UK, so there is a huge shortage of donors compared to the US. It's easy to consider the fact that few altruistic women exist who would go through this lengthy, risky process with zero compensation. I have read a few accounts of British women who have traveled to the US in order to donate to take advantage of the financial perks. They make it sound so scandalous!

Next we made a paperwork exchange - my huge packet for her MMPI (AKA the personality test, woo hoo!). We reviewed my family/medical history, and I shared my career goals and status in school. She left me to start filling out the 567 question MMPI while I waited for the lab to finish up with the other two donor day girls. The test is pretty tedious, and consists of true false questions that seem pretty random. They range from asking if you love your parents, to if you hear voices, to questions of morality, to if you get embarrassed talking about sex (you can guess my answer to that one). Any hint of mental instability will disqualify donors from the program obviously. A social worker, who works independently of Shady Grove, evaluates the MMPI's and will (hopefully!) call me to schedule two future appointments. The first with me alone, to discuss the emotional implications of egg donation, and the second with my boyfriend & me together to make sure he is on-board with the process as well.

After I got through about 40 questions, the lab technician came to whisk me away. My favorite two lab experiences - giving blood (7 vials this time! ouch) and peeing in a cup - were overshadowed by the genetics test. Another thing that can disqualify a donor is testing positive for a marker for about 13 genetic diseases, meaning that they are a carrier for the undesirable gene. I thought initially that I would be simply swabbed on the cheek with a Q-tip, but I was very wrong. I had to spit into a tube, which under normal circumstances wouldn't seem like an unconquerable feat. However, when you aren't allowed to drink for 30 minutes and have to be Chapstick-less, it is pretty difficult to fill up a test tube. The lab tech suggested I think about lemons, which actually helped. After I finished this VERY classy test, I went into another room with the other 2 prospective donors to continue with the MMPI.

I said hi to the girls, and was thrilled when I was greeted with a water bottle by Nurse Connors. We listened to Nurse Connors describe how the donor process works, options for the IVF couples (which I've described in previous posts), and what hormones we'll be taking if we're chosen to donate. I'll go into detail on the hormone talk in the future after I do a little more research. We all learn basic reproductive education in school during health class, but I seriously learned a lot about the female anatomy in this short lecture. I remember thinking at one point how ANYONE gets pregnant with the level of complexity involved in conceiving a child. It's fascinating to me. After the chat, me and the ladies had a pizza party lunch and finally completed our MMPI's while Nurse Connors took a break.

Nurse Connors came back about 45 minutes later with a bag full of syringes and training vials...GULP. It became obvious that this was the moment I have been dreading - Injection Training! We started off by checking out 2 different sizes of needles we'll be working with, and the basics of handling a needle. We learned how to measure our dosage of medicine, how to draw up the liquid, where to inject, and how to combine medicines that require mixing. After we all got this down, we did a test. We had to get a certain dosage of water into our needles correctly without any help. What happened next almost made the girl next to me cry and run out the door. In order to pass our test, we had to give ourselves the injection of water in our stomachs. Truly, it was a piece of cake! I didn't even give myself an opportunity to think about it... I just stabbed it in a pushed the plunger. It was no worse than a pinch. As for the other contestant... it took the poor girl about 10 minutes of convincing and I still thought she was going to lose it. This experience definitely calmed my fear of giving myself an injection.

We ended the day by signing one final consent form. If all goes well, I'll get a call back within 3 weeks saying that my genetics/infection/MMPI tests were all great. The next step is scheduling my social work visits, which will be nothing compared to donor day, and I'll get my profile published on the database! Who knew there would be so much WAITING involved in this process?

Can't I just take a pill?... Please?

I got a pretty extensive packet of paperwork earlier this week, which describes the itinerary for my 5 hour day of orientation on Monday. I filled out yet ANOTHER questionnaire about my medical/family history, and a W-9 tax form. Next I filled out the "Risk Factor Questionnaire," which went into a little more detail about my sex life that I would have liked. I guess I need to get used to people asking about my reproductive organs on a daily basis... The information packet, which was about 20 pages long, answered a lot of lingering questions I had about the donation process. In addition to the Shared Risk Program, Shady Grove offers couples an opportunity to decrease the cost of IVF by opting for a Shared Donor Egg agreement. Basically up to 3 women share the cost of using one donor egg cycle by splitting the eggs retrieved. In addition to relieving some of the financial burden, most (if not all) eggs are used for IVF as opposed to being donated to research or discarded. This definitely makes me even more confident that I am making a good call for choosing SG as my first choice clinic.

One thing in particular has been on my mind about orientation - Injection Training. As part of my homework, I had to watch a few videos. If you can handle it, watch the injection videos on Lupron and HCG. I'm not positive, but I'm pretty sure these are the hormones I'll be taking at some point. I'm curious to see exactly how injection training is gonna go... do I have to practice?! I'm sure once I get over the initial shock of actually giving myself the shot it'll be a piece of cake, but that doesn't make me any less nervous. I'm accepting nurse applications by the way...

IVF means "I'm Very Frightened..."?

I did a little research this week on In Vitro Fertilization to try to understand what women with fertility problems have to endure.

So, what exactly is IVF? IVF is basically when an egg is fertilized out of the womb, in a laboratory dish. The culture in the dish enables the embryo to develop in vitro (literally meaning "in glass"). Much like any other egg being coaxed into "hatching," the embryo is incubated and monitored while it's cells divide. Once they have divided into about 8 cells about 5 days later, they are implanted into the uterus. Up to 4 embryos are usually implanted at one time to avoid producing octomoms. Simple enough right? What is not so simple is the reasons why couples may have to choose IVF...

The majority of average couples are able to conceive within a year of unprotected sex. I can imagine that even a few months of failure can be pretty frustrating and stressful for couples trying to start a family. There are multiple reasons why women may need a little boost to get pregnant when the old fashioned way alone isn't working out. Women with endometriosis, ovulation problems, blocked or damaged fallopian tubes, or an abnormal uterus may all have trouble conceiving a child due to their anatomy. Considering the other team member, women with a partner who has a low sperm count or sperm motility problems (AKA they aren't very good swimmers) may also need IVF to conceive because the man's sperm die before they can reach the egg. Not all women who undergo IVF need to use donor eggs. Just as I will need to take ovulation stimulating hormones to produce multiple mature eggs, women utilizing the IVF procedure take hormones to produce as many eggs as they can. This ensures that they will have a higher chance of producing a healthy embryo to implant after it is fertilized in the lab.

I hope my ability to write about this subject (or lack thereof)didn't confuse you even more. Bottom line - IVF is pretty stressful for couples on multiple levels. The costs, both financially and emotionally, are pretty intense (more than I could ever imagine). I've heard stories about women who are able to conceive naturally after IVF failures, and even adoption. Maybe their bodies just needed a little kick start, or worked a little better once the pressure was off? Who knows. I'm going to try to send mine off with a little love and hope that the couple gets lucky the first time!