Your Mama’s So Fertile, She Ovulated On The Pill

My new donor is everything I want. She doesn’t look as crazy as the other ones! She isn’t a carrier for genetic disorders, she passed all her psychological and FDA testing requirements, and has the cleanest bill of health across three generations that I can possibly fathom. She’s donated before and was willing to do so again on incredibly short notice, so she’s unlikely to back out or screw the whole thing up. And someone out there is pregnant from her donation, which means she can get people pregnant, and I could be one of those people! (Kid might have to keep an eye out for that local, similarly-aged half-sibling when he/she hits dating age… but that’s what Donor Sibling Registry is for, after all).

There’s only one problem – it seems as though she is a little too fertile. The IVF nurse called me last week to let me know that, despite having been on birth control pills for an extended period of time, the donor had somehow ovulated! What the hell? How does a person do that? During a donation cycle, it’s imperative that the donor ovulate when the doctors say she can. To do a proper donation, you can’t have the usual one-egg-per-month to work with. You’re paying a lot of money for this – you want a good couple dozen eggs. This means that the doctors need to suppress her ovulation for a while, and then give her medications at very precise times that stimulate growth and maturation of a much larger than normal amount of eggs.

This sometimes leads people to believe that donating eggs can substantially reduce the donor’s future fertility. After all, most of us are aware that a woman has a limited number of eggs that gradually deplete over her reproductive lifespan. These eggs are produced before she is even born (which leads to the fact that your grandmother’s health during pregnancy can directly affect your health, because it directly affected the development of your mother’s eggs [e.g. Franklin & Mansuy, 2009]). Therefore, a donor who produces 20 eggs during a donation cycle, rather than 1 egg if it had been a natural cycle, loses 20 months of fertility – right?

What actually happens during the normal ovulation process renders this assumption false. Normally, during ovulation, the female doesn’t produce just one follicle that matures into one egg. The “normal” young woman produces a median of 15 follicles per cycle, and only one will produce a mature egg (Scheffer et al, 2003). The other follicles simply disintegrate. The medications she takes during an egg donation cycle simply stimulate as many of these follicles as possible to mature, rather than just one. And this is why she should definitely, definitely refrain from intercourse during this time…. one can only imagine the potential consequences.

Therefore, the fact that my donor ovulated early means that we have to delay the cycle for two weeks while they put her on super mega birth control pills. I like to picture them as ginormous horse pills and, as I write these words, she is out there somewhere, chopping them into pieces like a responsible mother cutting her small child’s choke-risking hot dog for safety. If we simply moved ahead with the cycle, we would have one measly egg to work with – and if it doesn’t fertilize, we certainly didn’t get our $18K worth.

(Yes, you read that right, you lucky people who have never done this. That’s how much I’m paying for this cycle. That includes all of my check-ups and embryo transfer; the embryologist’s time and expertise while fertilizing, growing, monitoring, freezing, and thawing the embryos; all of the donor’s check-ups and egg retrieval; her FDA, genetic, and psychological testing; my husband’s FDA testing; all of my medications; all of her medications; her health insurance during this process; and a few thousand extra for her time, trouble, and substantial risks. …..This is on top of my first cycle, my frozen embryo transfer, my frozen embryo storage, my hysteroscopy/surgical removal of polyps, my hysterosalpingogram, my husband’s microepididymal sperm extraction and storage, and the testing I needed to do in order to find out about my diagnosis and prognosis. So! Bottom line? If you can manage to make your babies for free, or if you choose not to make any babies at all, I hope you’re enjoying romping around in your piles of money, Scrooge McDuck-style).

Anyway – back to the current state of affairs and my musings about it. It makes me remember back when I used to take birth control. I did a great job taking it consistently for about five years. The last five years were during my first marriage and, though my ex-husband and I weren’t trying to get pregnant, we didn’t care as much about whether I got pregnant accidentally. So I started getting careless and missed, oh, probably 1-5 pills per month. I always kind of wondered how I didn’t get accidentally pregnant. And I took a lot of pregnancy tests, because I missed periods even while on the pill (looking back, that was the beginning of the end, menopause-wise). Later, I got a Paragard IUD. Guess what? IT FELL OUT. What the hell? It. Fell. Out. My reproductive endocrinologist was alarmed at our very first consultation, not only because she was looking at my ovaries and seeing one sad, lonely follicle, but because she saw an IUD. “Umm.. when did you get your IUD removed?” she asked. “I never got it removed. I haven’t tried to get pregnant naturally.” “Well, let me show it to you. See that? That’s your IUD. It’s fallen entirely out of your uterus and starting to fall out of your cervix.”  Guess what? Never got pregnant while my IUD was falling out! (Seriously, what the hell). I probably terrified my ex-boyfriend when I stupidly and weirdly mentioned that to him later. If you’re reading this – sorry, ex-boyfriend. Everything worked out fine for you, friend! Turns out I was alarmingly infertile!

And then there are people who ovulate while they’re on the pill. Hey, it happens – even with perfect use, there’s a 2% failure rate, and that’s why. Some people are just that fertile, I suppose. And maybe those are the people who make great egg donors? I certainly hope so. I’d like this cycle to be the one. Gimme that terribly unlucky between-Christmas-and-New-Year’s baby! (per the IVF due date calculator)

Scheffer, GJ, Brokemans, FJM, Looman, CWN, Blankenstein, M, Fauser, BCJM, de Jong, FH & te Velde, ER. (2003). The number of antral follicles in normal women with proven fertility is the best reflection of reproductive age. Human Reproduction, 8(4), 700-706.

Franklin, TB & Mansuy, IM. (2009). Epigenetic inheritance in mammals: Evidence for the impact of adverse environmental effects. Neurobiology of Disease, doi: 10.1016/j.nbd.2009.11.012

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