Within 48 hours of arriving back in Dublin from Barcelona, I was on the phone to my cousin, Wendy (not her real name) in Brisbane, Australia. I had telephoned her from Barcelona and we had agreed to speak again once DH and I were home. It may have seemed crazy to have moved on to organising a new IVF cycle on the other side of the world less than 48 hours after the horrible outcome of the cycle in Barcelona, but my despair and panic was such at the time that the only thing that could possibly hold it at bay was ACTION and forward movement; planning of a new line of attack. To pause and reflect and take the time to mull over what came next would only increase the terror I was feeling that I would never, ever be a mother. Every month that passed counted against us and was a painful marker of failure. And….. I always calculated how old my lost babies would be at any given point in time.
Within 5 days of returning home to Dublin from Barcelona, my cousin had been onto the egg donation coordinator at the Queensland Fertility Group (QFG) in Brisbane, Queensland, Australia. [I had previously had a consultation with a fantastic and very experienced fertility specialist at QFG called Dr Warren De Ambrosis when I had been home in Brisbane the previous year; he appeared to be one of the most experienced doctors in Australia in treating women with ovarian reserve issues and was now in fact, treating my younger sister, (who after offering to donate eggs to me, subsequently discovered that she too suffered from premature ovarian failure).] In fact, Wendy (and her husband) had attended QFG as part of its egg donation programme back in November 2008 to put in train arrangements to facilitate egg donation to DH and myself if things did not work out in Barcelona in summer 2009.
I cannot exactly recall the precise moment when Wendy offered to first donate her eggs to DH and myself. Both she and her husband, Dean (not his real name), were close to DH and myself. All four of us loved hanging out together and we regularly met up, despite living on opposite sides of the world. We had started spending Christmas Day together in Brisbane and had taken holidays together. DH and Dean got on well and were good mates, independent of mine and Wendy’s relationship. Wendy and Dean were childless by choice and by 2009, had been married for over 10 years. They were the same ages as us, (Wendy and I were born just 2 months apart), and for me, were probably the two people in the world that I always feel the most relaxed and comfortable around – I could always be myself with them no matter what. They had listened to DH and I go on and on over the previous 5 years as we (mostly, I) recounted all the trial and tribulations of miscarriage and fertility treatment. Wendy had been with me when I bought maternity jeans during my second pregnancy and we had talked at length about plans for when that baby was due to be born. Wendy had always felt strongly, from as young as childhood, that she did not want to be a mother. She thought it was unfair that I so desperately wanted motherhood and could not produce viable eggs, but that she could and did not want or need them. I often told her that I was envious that she felt so strongly that she did not want to be a mother and that I wished I could flick a switch or re-programme my brain to make myself feel the way she did. She explained to me that it was a no-brainer to donate eggs to me – but she would not do it for a stranger – maybe only for a close friend. And Dean needed to be comfortable about it – because Wendy was his wife. For me, she appeared to have no hesitation and her offer was made to repeatedly over many months- “remember, you can have my eggs if you want them!”.
By August 2009, I knew that she was sincere about her offer, that Dean was supportive of her donating eggs, that both our husbands were on board and that Wendy could be counted on not to let us down.
I had learnt after my younger sister had offered to donate eggs to me that sometimes, whilst people genuinely wanted to help, that for various, complicated reasons, it was not always the right thing to do to take them up on their offer. In hindsight, it would have been inappropriate (and fraught with difficulties) to accept eggs from a younger sister who was recently married and both wanted a family but had not started one yet. In fact, in early 2009 it became painfully clear, that even if my younger sister had still been prepared to give me some of her eggs, she was now fighting her own uphill battle to have a genetic child of her own. She had been diagnosed with premature ovarian failure (POF) in February 2009, aged 29. Pretty shocking really. Perhaps the only thing that made it slightly easier for her was that she had some warning of the possibility due to my earlier diagnosis. And although I would not have thought it possible, she actually performed worse at her first IVF than I had done in 2006. Although she produced 4 eggs (I produced 3 for my first IVF), none of them fertilised. My younger sister's second IVF cycle, that occurred 6 weeks later (in keeping with aggressive fertility treatment protocols for POF) produced just 2 eggs – both of which were ‘atretic’ (i.e. dead, incapable of fertilisation; when looked at under a microscope, all of the cells within the structure of the egg were black). I had never heard of the term ‘atretic’ until this time. I was shocked and heart-broken for my younger sister and angry at the random bad luck visited upon my family. What had we done to deserve this cruel prognosis? Why did we now have to endure yet another crisis? Wasn’t it enough that our precious mother had been taken from us too soon by cancer?
I was also worried what affect my younger sister’s diagnosis would have on my older sister. How would my older sister feel knowing that both of her younger sisters had premature ovarian failure? My older sister is a very private person and I was never able to openly discuss with her any fears or anxiety she may have experienced about her situation. I nonetheless felt sad for her, as well as for my younger sister and guilty in the knowledge that it was me who first broke the bad news to them both about my situation and its implications for them both. It was oh so painful and complicated - and relationships between sisters can be complicated enough at the best of times.
Another cousin had also offered to donate eggs to me in 2007 after my ectopic pregnancy and I had contacted her again in 2008, with a view to discussing things with her more seriously, but her life circumstances had also changed since she first approached me about donation. She was running a small business of her own, with no sick leave entitlement, two young children to care for and living in a remote area of Australia. An IVF cycle with us would negatively impact on her life and was difficult to make happen in practical terms. I understood that asking her to be our egg donor was asking too much of her in the circumstances. But genetic heritage and connection still meant everything to me, and so, whilst I was able to, finally, in my head, take a step towards organising an egg donation cycle, I was not yet able to accept unknown or ‘stranger’ egg donation. It felt too impersonal to me and like I would be losing too much of myself.
An article that I found online explains well the process of giving up on a genetic child:
“[Giving up]…is usually the most painful step in the process. In giving up, there is a sense of failure, loss and despair. It seems that nothing will ever come close to being able to replace your genetic child. As you mourn the loss of your genetic child, you may view your future with bleakness and negativitiy, and you may wonder if you will ever recover from this loss. …It is common during this phase to reflect on your own genetic strengths and to despair over the fact that these traits will not be passed down to your children. Without a genetic link to the future, you may feel a sense of disconnection. You may fear that your uniqueness in this world will ‘die out’, and that nothing of your existence in the world as less significant. In addition to the loss of your genetic child, you may feel a loss of the opportunity to love the “baby you”. The loss of the opportunity to love a part of you (your genetic child) in the way that you wish you would have been loved as a child, is very painful”
by Laurel T. Kline from “Infertility and Emotional Aspects of having a child through donor eggs”.
Those words really resonated with me with. That fear of obliteration and that my ‘uniqueness in this world will die out’ is what prompted me to give this blog the title “lastoneofmykind” when I first started writing it.
My journey towards considering a known, genetically-related egg donor had started with the possibility of my younger sister, a 100% DNA match to myself, followed by my first cousin, who I shared 50% DNA with on my father’s side (although the loss of connection with my mother’s DNA was especially painful to me as she was the parent who had died prematurely in 2000, whilst I had an ongoing relationship with my father) and finally, through Wendy, my second cousin, a 25% DNA match was now possible. And although Wendy and I are second cousins, our relationship is such that I am closer to her than any of my first cousins, of which I have many. Our relationship, which I dwelt on often, during the days and months ahead as we prepared for our donation cycle together, was pretty special and I love her dearly. We share some great childhood memories together, despite not growing up in the same town. Wendy’s grandfather and my grandfather (who died before I was born) were fraternal twins, who lived next door to each other with their wives and families in a small country town where Wendy grew up. My school holidays were spent visiting my grandmother in the country and the prospect of getting to ride my bike, build cubby houses and fish for tadpoles in the local creek with Wendy meant that I was ALWAYS happy to go to my grandma’s house. Our grandmothers lived next door to each other and would have a daily cup of tea together and Wendy’s grandfather, my dead grandfather’s brother, was a real sweetie, who once told me he would be my granddad too, as well as Wendy’s.
In short, I knew Wendy through and through and where she was from and what she was like as a child (sweet, carefree, full of curiosity and always ready for adventure)...my childhood photo albums were full of pictures of us together over the years and this was something that I could share with my future baby. I wanted my future baby to know where he or she came from and his or her family's story.
Although Wendy was only going donate eggs to me, her cousin, and not some random stranger that required to be 'matched' through QFG, she still had to fill out pages and pages of paperwork about her personality, lifestyle, medical history as a formality, as if she were going to be matched with a stranger. She laughed a bit at some of the questions and I helped her complete the personality profile. What were her strengths she asked me? Well, I told her, she is one of the sweetest, kind-hearted, relaxed and easy-going people I know. In fact, the more I thought about it, a baby made from her and DH’s genetic material would be likely to be the sweetest, happiest, gorgeous little thing imaginable. Maybe it was a blessing not to pass on my anxiety and disposition to worry (not to mention the premature ovarian failure gene) to a little creature. Wendy had won a “bonny babe” competition as a six month old baby! She was a cute baby and little girl – as evidenced by the many photos in family albums of her and I together, as babies, toddlers and little kids splashing in the blow-up paddling pool during hot Australian summers. I poured over these photos many times during the days that we were arranging the donor cycle, each day becoming more and more reconciled to it (rearranging all images in my head of what my baby would have looked like and replacing them with images of Wendy as a baby) and slowly allowing myself to feel a sense of excitement and hope about this particular special baby that we were hoping to bring into the world.
DH and I had a 7.00 am Dublin time phone consultation with Dr Warren at the end of August 2009, despite the 9 hour time difference between countries, to take medical histories and to discuss arrangements for the egg donation cycle planned for December 2009 (which was when DH and I both could next take annual leave over the Christmas/New Year period). Two weeks later, in mid-September 2009, DH and I had to dial into a conference call required by QFG with Wendy and Dean and a registered psychologist, Gloria Hynes, who had to do a group interview with all 4 of us before preparing a report with either a recommendation (or not) that the egg donation proceed. This seemed to be a legal requirement in Queensland, where there were laws to regulate egg donation. Prior to the call, Wendy and I knew it would be an issue that she and Dean did not have children of their own and that they could expect to be grilled about it. In all the literature you ever read on egg donation in Australia, the guidelines for a suitable donor stress that the egg donor should have completed her own family prior to donating. There is sound reasoning behind this guideline; being the emotional well-being of the donor and her having a sense of regret or loss if there exists egg donor children with her DNA, but she was never able (for whatever reason) to go on to have children of her own. Wendy had to be very clear during the group counselling session that Dean and herself had discussed the idea of children many times and were decided against it. I felt bad that they had to justify their life choices to a stranger just to be given the green light to help DH and I, but Gloria was quite nice in her probing and the whole session was painless.
In the meantime, DH and I arranged more blood tests in Dublin (DH would yet again, have to give a sperm sample in Brisbane prior to the cycle commencing), Wendy had blood tests in Brisbane, we sent deposits for the cycle costs by cheque to Brisbane, we booked airfares to Brisbane from Dublin, made arrangements with a kennel for canine baby to be looked after over Christmas/New Year. The management of a donation cycle kept me busy and was not without its stresses. We found out a month after booking and paying for our return flights to Australia that the embryology lab at QFG was actually closed down over the Christmas period and that despite being told we could do an IVF cycle on our Christmas holidays, we would actually have to come out from 23 January 2010 onwards, as the earliest egg collection could take place was 29 January! IVF it seemed, never flowed smoothly for us – we paid the fees to change our flights and book new ones, in addition to my having to tell my boss a porky pie about ‘going to the wedding of a very close family member in Australia that I had been asked to be a bridesmaid for’ so as to get the time off work so soon after the Christmas/New Year period (the Irish always give you time off for weddings and funerals….must be Catholic thing!). There were also certain medications that I simply could not source in Ireland due to a lack of compounding pharmacies. Ethanyl Oestradiol (to increase the thickness of my lining) was one of them. Wendy went above and beyond the call of duty and collected and filled the prescription for this in Brisbane and mailed me over the hormones I needed.
While I waited for January 2010 to roll around, the opportunity to become heavily involved in a high value corporate transaction at work presented itself around this time, which involved me working, often, 14 hour days in the lead-up to the closing of the transaction. These hours continued throughout September/October 2009 and though exhausting, were a life-saver at the time. I threw myself into the work, relished reading emails on my blackberry at all hours and spent weekends drafting contracts. Although the work was stressful, it was also challenging and made me feel a sense of purpose and distracted me from dwelling on the most recent failed IVF. Here was something at last, that I could set my mind to and produce results for. After back to back IVF cycles, there was something reassuring about suiting up in the mornings, jumping on the LUAS and making my way into the corporate world of paid work – a place where talk of babies, pregnancy and motherhood was easily avoided. In fact, it was a distinct advantage when doing the type of hours that were required of me, to be childless. It was all men and younger (in my case, infertile) childfree women working on the deal. The relentless nature of the transaction and the drive to move the deal forward towards contract execution helped numb the pain and constant nawing fear that our next IVF cycle would also fail. Working was also a more productive way to kill the time than the increasingly heavier drinking DH and I were engaging in on the weekends to numb our emotions (in between christenings of his nieces and nephews and birth announcements). DH also found a more meaningful outlet for some of his spare time in the lead-up to the QFG cycle by participating in the Build-It week in Haiti, organised by an Irish charity called Haven that arranged for builders, tradesmen and volunteers to build housing for desperately poor Haitian families north of Port-au-Prince.
Although we were keeping busy and would, hopefully, at the next cycle finally have decent quality eggs from Wendy, that would lead to decent quality embryos, it never escaped my thoughts that I now had a scarred uterus, as confirmed by my surgery at The Rotunda in May 2009. Toward the end of September 2009, DH and I had arranged a meeting with the Master of the National Maternity Hospital (Holles St), Dr Robson and Professor Fionnula McAuliffe, to discuss what Dr Gleeson of The Rotunda had told me was the cause of my Asherman’s syndrome – the exertion of too much force during D&C procedures (both performance at The National Maternity Hospital) after my missed miscarriages were diagnosed. It took many months to get the meeting in person with both of these doctors. I had written a formal complaint to the National Maternity Hospital in June 2009 and I wanted quite direct answers to numerous questions that I had prepared in advance. Most important of all, why was I not warned that dilation and curettage for my miscarriages carried the risk of Asherman’s syndrome and subsequent infertility? If I had known this, I would have been more open to considering allowing the foetuses to come out naturally. When the meeting finally proceeded, both doctors had an answer for everything I put to them and would not concede any wrongdoing. I asked them what other cause could result in “a thick narrow band of scar tissue” in my uterus if not a surgical instrument? The answer: “it could have been caused by anything, such as an infection”. I did not and do not believe this, but being a lawyer, did not expect any other answers really. In all honestly, I was surprised they agreed to the meeting with me in the first place. The only fact I gleaned from the meeting was that Professor McAuliffe said that her notes revealed that I lost a lot of blood in the second D&C and that my uterus did not contract back to its ‘normal size’ immediately after the procedure but rather, took some time to do so. I do not know what the medical significance of this was, but it confirmed to me the deep sense that I became incapable of falling pregnant naturally and was never the same again, after the second miscarriage in 2005. Around this time, DH and I thought long and hard about commencing legal proceedings against The National Maternity Hospital for medical negligence for my Asherman’s syndrome, but came to the conclusion that it would take years and years (and probably involve further invasive gynaelogical examinations for medico-legal reports), for which we did not have the emotional energy or financial resources. We needed to keep these in reserve for the continued fight to become parents.
On 23 January 2010, DH and I kissed our canine baby goodbye (numerous times) and departed Dublin for Brisbane. Close family of DH and our friends knew what we were attempting but I decided not to tell either of my sisters that we were doing a donor cycle with Wendy. It was me who had the close relationship with Wendy (not my sisters) and she preferred for my family not to know what we were doing for the time being, which I respected completely. We also did not want our wider common family knowing, as we felt it was none of their business and did not want people giving their opinions or otherwise.
An egg donation cycle was definitely more stressful than a single person cycling with her own eggs as synchronisation of cycles was critical. Wendy and I were supposed to be on the pill and then stop the pill so as to get bleeds at the same time. Perhaps because DH and I seemed to always encounter problems, Wendy and I did not get bleeds on the dates that we were supposed to and there was some slippage in the dates for egg retrieval. This of course made me mildly hysterical as I was carefully trying to manage annual leave and travel to and from Dublin to Brisbane in between the tight dates we had earlier mapped out.
I pity the admin staff and nurses at QFG that had to deal with my freak-out but by this point I was just about out of my mind with anxiety about anything that might go wrong. I felt I was on the constant offensive and in a seize- mentality - having to battle with every person and science itself to become a mother.
It was strange to attend ultrasounds with Wendy - just she and I went to early morning appointments to with Dr Warren to see how she was responding to fertility drugs that she injected each day. DH was happy to stay away. Dr Warren was super sweet to Wendy which made me feel so grateful and relieved. When someone is taking time to do you such a massive favour and give you the gift of parenthood, you really want the medical staff you are dealing with to show appreciation and sensitivity to that person on your behalf. QFG never let us down on that front and were very good and supportive of Wendy. Wendy was responding pretty well to stimulation for her age - she was 34 the same as me. She showed no signs of over-stimulating which was a huge relief as ovarian hyper-stimulation syndrome is one of the main medical risks associated with IVF - that was one less thing to worry about. By the second ultrasound with Wendy, I was also required to be ultrasounded so that my uterine lining could be checked in preparation for the embryo transfer in the next 10 days or so. My first ultrasound was rather crushing. Dr Warren was blunt when he told me that my lining was fairly 'shithouse' (great Australian term). It should have been around 8 mm as a minimum at that time but was around 5.9 mm. Uterine lining should be plush and springy and form a lovely cushiony sponge into which the embryo will want to attach itself. Dr Warren reassured me that we would throw everything at the problem and do our best. He prescribed nitrodur (nitroglycerine patches) meant for angina but used in IVF to engorge the blood vessels in the womb, viagra pessaries to be taken vaginally (also to increase blood flow to boost uterine lining), estrogen patches and...he told me....as a final measure, injectable estriadol valerate (I had to order this in advance from one pharmacy as it was not commonly used in IVF cycles). Wendy and I went shopping after that appointment and she was concerned that I seemed quiet after getting the bad news about my lining. In truth, I was crestfallen - it had taken me so long to accept egg donation as the way forward. I had taken it for granted that the path would be smoother after making the decision to give up on my eggs but things were clearly not that easy. Wendy reassured me that the medications would do the trick and not to worry.
The rest of the cycle went well. Wendy and Dean came over to where DH and I were staying 2 days before the egg collection so that I could administer her 'trigger' injection - this was a particularly fat (thicker) needle of hcg compared to the small little pen type needle that she did each morning of the fertility drug. The trigger injection was intended to 'ripen' her eggs. This needle hurt her, despite my trying my best to be gentle when pushing it in. I felt oooooh so bad that she was doing it for me. I kept saying sorry and she kept laughing it off and saying it was nothing. She felt very bloated but luckily did not appear to have suffered too many adverse symptoms during the previous 2 weeks of cycling. She never complained about anything but I still felt worried that she was doing so much just for me. I felt particularly nervous on the morning of the egg collection when surgery was scheduled. DH and I attend the day theatre with Wendy (whilst Dean was at work) and sat with her whilst she was weighed and answered questions before sedation. DH got called away for his semen sample and I was left alone, at which point the enormity of someone else undergoing a medical procedure for me really hit home. I thought nothing of and was never nervous about undergoing egg collection surgery myself (I actually loved the sedation and 'going under') but the risks took on a new significance when I could not bear the risk myself and was asking another person to do it on my behalf. I would have cut off a limb for a baby but what if something happened to Wendy whilst she was trying to help me. The only thing that helped quell my anxiety was rationally thinking about how remote the risks of complications were (these were usually limited to blood clots or the aspiration needle piercing an external organ that it shouldn't like the bowel). Wendy was very relaxed about going into surgery but I was never so relieved as when I got the call from the day theatre about 45 minutes later to let me know that she was resting comfortably in a Recovery ward and that I could go in and see her. Dr Warren was there with her when I arrived and he gave us the happy news that 9 eggs had been recovered! Wow! He wrote the number in black ink on her arm (and legs for extra measure to make us laugh) and gave Wendy a hug and a kiss. He was extra sweet and kind to Wendy and we both liked him very very much. What a funny man - what a lovely doctor.
The next day DH and were told that only 8 of the 9 eggs were mature and that 5 fertilised. I was slightly disappointed at 5 embryos as I had my heart set on 6 (go figure!) but we were still full of hope and decided upon a double embryo transfer due to my lining being so poor (by transfer day it had become up to an acceptable level but still was not great - 13 mm I think). Wendy recovered quickly and well and was back at work after another day off work and told me that she though donating eggs was pretty straightforward and that she would even do it again. What a saint. I felt anxious about what could go wrong with the embryo transfer after dwelling many times on the fact that my last embryo transfer at SIMS in Dublin- which had been awkward and painful - resulted in an ectopic pregnancy. I told Dr Warren about my concerns and he sedated me for the ET (lovely......) and also gave me plenty of valium to take back at home. 2 embyros were transferred and we were told soon after that the remaining 3 embryos were not suitable for freezing...oooh. Heart sink (no more chances after this) but hey, let's think positive. We may even have twins!! I did full bed rest for 2 whole days and was in a twilight like delicious valium-induced state of relaxation. I only stood up to go to the toilet for a wee. I continued to take steroids, injected progesterone and used the prescribed estrogen and progesterone vaginal pessaries, as well as two hgc (pregnancy hormone) injections - all meant to support implantation and a positive pregnancy. Around 48 hours post embryo transfer I swear I felt implantation cramping.....3 days post transfer DH and I kissed Dean and Wendy goodbye and headed back to Dublin to await the result.
Back in Dublin, I was supposed to wait a full 14 days before doing a pregnancy test but I knew from past experience that home tests could give a result earlier. I was dying to know whether things had worked and was half demented with distraction. One afternoon at work, 11 days post embryo transfer- I ducked out of the office to buy a test at the nearby chemist and did the urine test in the office toilets - it felt easier to get the bad news by myself - I held the stick to the light inside the cubicle - it was hard to be sure but a faint two lines were visible - a positive result! I could not believe it. I was so shocked that I asked my secretary her opinion and she also thought two lines were present - she hugged me and said "Oh Amelia you are finally going to have a little baby!" But 2 days later, at 13 days post embryo transfer I did a second home test and it was negative.....The next day, on the day I was meant to test, day 14, a second negative test resulted. I decided to give up testing and rang Wendy to let her know. She sounded so disappointed for us and I felt like I had wasted her time entirely and let her down by getting her to go through the whole rigmarole of egg donation for nothing. She very sweetly offered to try again.....I wanted to cry when she said that to me. But I just felt too crushed to think about the future just yet. Things were bad. Way bad. So much so that two very good friends of mine, both very busy lawyers both dropped what they were doing on a Monday night after being informed of the failure of the donation cycle to meet me at The Cellar Bar at the Merrion for drinks and consolation. What good friends. I could see in their faces that they did not know what to say. One friend, who had always been a rock,......totally positive and always uplifting said to me "what are you going to do?". The look on her face struck home to me. We had run out of options. We had lost 3 babies and tried egg donation and things were looking very bleak. Plan A - have genetic baby through IVF - Plan B - have known egg donor baby through IVF - Plan C - adoption?.........I kept wanting to push Plan C to the back of my mind.
As if things were not bad enough, 9 days after the negative pregnancy test, on 26 February 2010, I still had not gotten my period....just spotting.... which started me thinking that maybe I had another ectopic pregnancy on my unhands. Why did I get an initial positive pregnancy test? The hcg injections should not have been enough to cause a positive pregnancy test at 11 days post embryo transfer
according to what I read online. I left work one afternoon, depressed and unsure and went to a nearby GP and explained my history re the ectopic pregnancy and what I thought was shoulder tip pain I was getting that day. I was told to take a taxi to The Rotunda. I waited in emergency not knowing whether I was completely paranoid and hypercondriac or whether I had another ectopic on my hands. When I finally was seen for a ultrasound, the young intern thought she saw a pregnancy sac on the monitor but was not sure so went to get a Registrar. My mind was spinning and in the time that I waited for someone else to come into the treatment cubicle I thought back to the times that I had been told about the babies whose hearts had stopped beating and had died and I thought - oh God - not again - I do not have the strength - I just do not have the strength. The Registrar arrived and took my history and performed an ultrasound. He was very apologetic on behalf of the intern but said there was no pregnancy sac. I was beyond confused at this stage. He said an embryo may have implanted for a short while but there was no sign of it now. The thought finally and severely struck me, as I gathered myself together and got ready to leave the hospital, that my body was not up to the task. I couldn't do anymore. I couldn't mentally cope with my body letting me down anymore.
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