Making the difficult decision to use an egg donor
At the time of writing, my partner and I are about to embark on our first round of IVF using donated eggs.
It was originally suggested to us after miscarriage number three, (when I was thirty-nine) that we might have a better chance of a successful pregnancy if we were to use donor eggs. Egg donation is increasingly being suggested to women of 40+ as our own egg reserves can be quite low, and statistically lower egg reserves result in lower pregnancy rates, and also unfortunately more miscarriages from chromosomal disorders.
With David & I, I seemed to get pregnant easily enough, but the pregnancies themselves often did not appear normal. In fact, of the six natural pregnancies we had to date, two did not show evidence of embryonic growth at all – we could see the embryonic sac and yolk sac on the ultrasound, but no fetal pole, which is evidence of the baby’s spinal growth (this lack of visible embryo is sometimes referred to as a “blighted ovum”). In each case however, my body still thought it was pregnant. It was growing the embryonic sac, and I still had pregnancy symptoms, albeit on the milder side.
We were able to have cytogenetics performed on three of the miscarriages. Two of the pregnancies tested positive for chromosomal trisomies (Trisomy 13, otherwise known as Patau’s Syndrome; and Trisomy 22). We were told that while trisomies can occur with mothers of any age (and while they can occasionally be linked to sperm quality), they are more strongly correlated to egg quality. And they appear to effect the eggs of older women in particular*. All three losses were girls.
The other three miscarriages were not investigated chromosomally. The first one was not because I did not realise that I was finally miscarrying (I had been bleeding for weeks so I had become accustomed to pain and blood most days). I was admitted into hospital for observation late one night and lost the baby at (just under) 11 weeks, down the toilet in a completely dark hospital cubicle. It was so dark that I was not even able to see that what I thought was large blood clots, was actually my baby. I was devastated when it became apparent at ultrasound the following morning, that the baby was no longer there.
Two other pregnancies ended so quickly (within days of positive pregnancy tests) that there was not any sterile tissue to test, and I miscarried at home.**
Finally conceding that our best option might be to to try with donor eggs was not easy, and I struggled with this much more so than David.
He did not have the same difficulties with the idea at all. He just accepted it as the “next step” – the thing we had not yet tried which statistically, would offer us a much better chance of success. He even suggested that we could use both donor eggs and sperm, in an effort to make our genetic investment in our child equal. It was, I felt, a very generous gesture but of course I would never wish him to miss out on the experience of being a genetic parent, so I dismissed the idea immediately. In school I had two friends who were adopted and so knew neither of their biological parents. One of them was perfectly fine with that, but the other really struggled with it. Adoption is not the same thing of course, but I thought it in the best interest of our child (if s/he happened for us) that they should be given the opportunity to know at least one of their biological parents. Why not, if it is possible?
Another consideration forefront in my mind was the knowledge that there is an advantage to knowing your genetic history and background in many medical situations. Certainly it is one of the first things that I was asked when I had my third miscarriage – was there a history of pregnancy loss in my family? Poignantly, I had a cousin who was first diagnosed with Follicular Thyroid Carcinoma (FTC) at the age of just nine. The doctors wanted to know her complete family history. However as her mother (my aunt) was adopted, they could only supply her father’s history. My aunt even went to the trouble and trauma of trying to find her birth family, only to have the whole search end painfully and without any proper answers. My wonderful cousin lived a very full and happy life, but passed away at the age of only thirty-two, leaving two baby daughters and a heartbroken family. In her particular case, having her maternal family history could not have prevented this, but what about others in similar situations? What about the next generation, when we understand much more about the genetic predisposition to some types of cancers and other illnesses?
This leads me to another difficulty I am having, something I am finding hard to reconcile, which is that blood connections have genuinely never actually been important to me. One of the closest people to me is my aunt (mentioned above), who is my father’s sister. She was adopted as a baby. I could not hold her in higher esteem or love her more than I do. She is a perfect mixture of best friend, godmother and confidant. There is no-one in my father’s family who compares to her, and we do not share a drop of blood.
Miscarriage comes with a lot of guilt anyway. Now I feel extra guilty for wanting my own genetic child because I cannot reconcile this feeling with the fact that I don’t care about blood ties.
As a child myself, I didn’t have the prosaic daydreams often ascribed to little girls. I never dreamed of being a princess, or finding a handsome prince, or of being a bride… none of those things ever interested me. I never really understood why they would interest anybody. But the one experience that I did think about sometimes, and that I looked forward to as something that would definitely happen in the future, was the moment of seeing my own child’s face for the first time. It lurked there in the background as a thing that would just happen someday, and which I just assumed with carefree confidence would be the most profound moment of my life. To meet your child for the first time. To see your parents alive and well in him/her (my father died when I was 15). I wanted to trace the wonder of genetic inheritance through my baby and delight in the fact that s/he might have some traits which were maybe not expressed in either David or I, but maybe existed in our parents, or grand-parents, or even great grand-parents. Like a wonderful flower I would watch her/him grow, and experience the wonders of the world all over again through them. And I would have actually created this. Hundreds of generations before me had to survive plague, pestilence, war, disease and everyday accidents to result in my birth. Every one of my ancestors had to survive to at least the age of procreation in order for me to be here. I was not going to be the weak link in a thousand generations.
I would take my place in the world, and pass the baton successfully to the next one.
But now I was the weak link. I couldn’t do what everyone had done before me. I couldn’t do what everyone was doing around me. The only chance our future child might have would be if I was removed from the equation.
I am very much still coming to terms with the fact that I will never be a genetic parent. I wonder if these feelings may possibly also be being exacerbated by the miscarriages. If I had not been pregnant before, if I had not seen my children’s heartbeats on the scans, watched their tiny arm and leg buds growing, imagined what they would look like – would they have my blonde frizzy hair or David’s straight dark brown? – I wonder, would I be as distraught now?
Because I am distraught. I feel beaten, defeated, resentful, and robbed. I am profoundly jealous of every mother I pass on the street who got lucky enough to have her child live. And I hate the person I have become – I don’t know what to do with all this bitterness – I am ashamed of it – and I don’t know how to make it go. Making the decision now to use donated eggs feels the same to me right now as giving up, the final admission of defeat. It is closing the door on all my dead babies, moving on without them, trying to replace them without having given birth to even one of them. I have failed. I am a failure. And now I am casually walking away, like they never existed. They didn’t in a way. We never got to hold any one of them. But they existed for me and David. They were our children.
As I write this, we are now less than a month away from our first Egg Donation cycle, three months since deciding to give up trying naturally, and I am still struggling to process all the emotions I am still having.
I have swung in every possible direction – from despair, to hope, to bereavement, to guilt, to anguish, to anger, to jealousy, and disgust (at myself for many of my feelings, but also for not being more grateful that the option of egg donation is open to us). Many of these feelings I am not proud of and a few I am really surprised by. I have confided in a couple of close friends who told me that they imagine that these reactions are probably normal, but more importantly that they know me – once the baby kicks inside me and I can feel her/him living and growing, I will not care for one moment how s/he got there. Each friend described almost the exact same scenario. But I am lacking their certainty. I am lacking their faith. Even David has alluded to a fear that I might have difficulty bonding with a baby that is not genetically mine – simply because I have been so destroyed by the miscarriages and have only agreed to try egg donation because I feel so beaten. And because we need this not to be the end of our story.
What I am afraid of (in the event that we are successful) is that I might be a candidate for severe post-natal depression. I do not suffer from depression normally, although I grew up in Ireland and believe that I am somewhat susceptible to Season Affective Disorder (SAD) in the winter months. But there is no getting away from the fact that both of us have really suffered over the past three years, most of it in secret. Each miscarriage was a bereavement for us. And in the midst of them all I lost a much-loved family member to cancer too.
Every doctor we spoke to emphasised “time” and my age. All my own research highlighted the same two things. We have had no time to mourn or regroup – if we wanted to keep trying for a baby there was no time to spare, we had to keep going. And so now I am afraid that all the emotions that I have not dealt with, all the trauma, heartbreak and despair is quietly waiting for me, quietly and patiently in the dark. Waiting for the optimal moment to descend, maybe when I least expect it.
* A great source of information on miscarriage and the multiple possible reasons behind it, I have found to be Dr. Leslie Regan’s book Miscarriage: What Every Woman Needs to Know (Orion).
Lesley Regan is Professor and Head of Department of Obstetrics and Gynaecology at Imperial College Healthcare NHS Trust at St Mary’s Hospital, Deputy Head of Division of Surgery, Oncology, Reproductive Biology and Anaesthetics at Imperial College London, a member of the Royal Society of Medicine Steering Group on Global Health, and chairs the Advocacy subgroup of the Royal College of Obstetricians and Gynaecologists (source: Wikipedia).
Professor Regan and her miscarriage clinic were the subject of a BBC (Horizon) documentary in 2006, entitled Waiting for a Heartbeat.
** Of the three pregnancies that were tested, all had sterile samples of tissue collected during ERPC procedures.
Please make sure if you are having an ERPC, that you request for karyotype testing to be carried out (if you wish to check for chromosome disorders), as it will not be done without your direction.
If you would like to read personal stories from women who have experienced stillbirth, please see Stillbirth – I am a mother without a baby (BBC News Resources).