The Paradox Of Choice

No two donor embryo profiles are alike...which makes picking one near impossible.

But we were past that stage. Or so I thought. We’d signed on for what would likely be a blonde-haired, blue-eyed bundle of joy with West Coast IVF. I made my travel arrangements, scheduled my ultrasounds, and filled my prescriptions. I started drinking fertility tea and popping my prenatal vitamin.

There was just one problem. This was the last remaining female PGS-tested embryo from the profile, which meant that we needed to pick a back-up profile just in case the embaby didn’t survive the thaw on transfer day.

My treatment coordinator sent us a backup profile. The egg donor was a certified massage therapist and a respite care provider. She was older (32) and on the heavy side (BMI: 27). She had checked “yes” for a family history of Down Syndrome but didn’t specify who had it. Obesity seemed to be an issue on the maternal side of her family, too. She had prematurely graying hair and her periods had ceased. One thing she did have going for her: proven fertility. She had two children of her own.

The sperm donor, an aspiring firefighter, had some problematic attributes as well, like a marijuana addiction as well as a congenital heart defect and a respiratory birth defect in his family history.

I won’t go into further detail because who am I to criticize someone’s health history (I wouldn’t even be allowed to donate if someone saw mine). But it wasn’t just the cold hard facts that gave me pause. It was…the aura of the profile. Perusing it, I just felt…sad. There was no joy in it.

This profile was an immediate, unequivocal “no” for me, even as a backup. My coordinator understood my reason for declining, but stated that she was out of PGS-tested female embryo profiles…unless I was interested in a mixed-race profile. Was I?

Infertility will make you consider many a thing you never thought you would, and I suppose this was one of them. I say that not because I wouldn't love a mixed-race baby (I would love any baby to pieces), but because ethically, I didn’t know if I, as a white woman, should raise a child of a race or cultural background other than my own. I wouldn't want the child to miss out on anything related to their culture or suffer identity issues because of my white blinders or ignorance. On the other hand, my teens are half-Latinx (my ex-husband/their dad is from Mexico City), so I already had experience and a comfort level with raising bicultural children.

We talked this through over the course of several family dinners. Ultimately, we all decided, if it meant a healthier baby, yes we were open to mixed-race Latinx-Caucasian profiles.

So the coordinator sent us one. The profile one was better, vibe-wise. The egg donor was Latinx and worked in the criminal justice system. The sperm donor was a science whiz with Turkish and Russian ancestry. Both had proven fertility. But here, too, were some non-negotiables. Instead of checking “no” under “Mental Retardation,” the egg donor had left it blank. Was it just an error? Or an emission? She also had an aunt with schizophrenia.

The sperm donor’s health history was pretty clean, save for red-green colorblindness (a recurring theme, apparently).

There are no perfect profiles. I know this. I just didn’t realize how lucky we had been when we were preparing for the transfer of the embryo that became our new baby. Hers was the very first profile we were offered and there was an extra female embryo so we didn’t need a backup.

This time around, I loved our chosen profile, but I wasn't crazy about the backup options so far. I didn’t want to risk getting coronavirus by traveling to California in what might be the peak of the pandemic only to find there was nothing to transfer – or that there was, but that the embaby might not be healthy.

The whole backup scenario threw me for a loop and made me question if even our original profile was good enough. The egg donor was, after all, nulliparous. She had no baby-making track record. I pressed my coordinator again for information on the success of our chosen profile. She said there were “no current pregnancies or births” from it. 

“This is a fairly new profile and most recipients are looking for brown hair and eyes,” she told me.

Was she trying to be reassuring? Spin our profile more positively? Was there something she wasn’t telling me? Would the clinic really transfer an embryo that they didn’t think had a chance of becoming a baby?

Suddenly unsure of anything, I did what I do best (or at least, most obsessively): I crowd-sourced opinions.

A quick survey of the West Coast IVF Facebook group showed that many women had gotten pregnant from nulliparous egg donors. But when I mentioned that there had been no pregnancies from the profile and that this was the last (female) embryo in the batch, both admins chimed in, saying they would not accept the profile. What good was the “perfect” profile, after all, if it doesn’t get you pregnant?

I pushed my coordinator once more on our chosen profile. How many transfers had there been and what were the outcome of those transfers? Her answer sent my hopes plummeting. There had been two transfers: one BFN (big fat negative) and one biochemical pregnancy (the absence of an identifiable pregnancy on ultrasound despite a positive pregnancy urine test). Most biochemical pregnancies are due to chromosomal issues. But these were supposed to be chromosomally normal embryos. Was a carrier issue, like insufficient endometrial lining, to blame? If so, might my outcome be different? 

My coordinator said the previous cycle outcomes were not indicative of embryo quality, or how my cycle would turn out, but the seed of doubt had been planted. Cue freak-out. I didn’t know what to do. Should we move forward? Was this profile going to work? Was it worth risking coronavirus for? (Was any profile worth risking that?) Was God saying “wait”? I couldn’t tell.

I had already started the birth control pills (and was slogging through some unpleasant side effects, like breakthrough bleeding and depression) and was nearing my first baseline ultrasound, after which I would begin the heavy-duty fertility medication regimen. If we were going to back out, I wanted to do so before inundating myself with drugs. 

But I didn’t want to back out. I had already fantasized about getting pregnant in December and visualized the timing of each trimester up until the birth next autumn. I had pictured our blonde-haired, blue-eyed beauty 1,000 times. (Although I’ll admit that the Spanish name we all adored didn’t really fit my vision of her.)

I couldn’t ignore the fact that our egg donor had yet to produce a single pregnancy – her own or someone else’s. That did not bode well.

In a heartbreaking decision reminiscent of when I canceled our Minneapolis IVF cycle over a year and a half earlier, I emailed my coordinator to tell her we couldn’t move forward with our chosen profile. Was there any way we could keep the transfer date but find another match?

The short answer: no. She told us we were going back on the waiting list, where it would be six months or more before we saw another match.

I felt gutted. I cursed. I called the clinic manager and was told to email her my concerns, which I did, in a long, emotional message. I waited. No response. I spent a night crying like, well, a baby. I hate the saying "You don't know what you have until it's gone," but in this case, it was true.

By morning, I knew what I had to do: try. If I went back on the waiting list, the chances of me getting pregnant spontaneously in the next six months were next to nothing. If I took a leap of faith, however, and did the transfer in December, the chances of me getting pregnant with our blonde-haired, blue-eyed embaby were as high as 60 percent. 

As soon as the clinic opened, my coordinator called me to resolve our conflict. She calmly explained that the clinic would never transfer an embryo they didn't think would stick. She reminded me that everyone has different medical histories and therefore one woman's experience was not indicative of another's. She said it was very rare that anyone had to use a backup profile, but promised to keep an eye out for a better one. For my part, I apologized for all the drama. (Bless these poor coordinators having to put up with hormotional Karens like me all day). I recommitted to our original profile and transfer date.

The baby-making plan set, I began taking steps to help my new baby connect with her genetic half-siblings – and a brand-new little sister...

Are You My Embaby?

It never fails to astound me that when you commit to a course of action, God (or the Universe or the powers that be) conspires to help you. About a week after turning in all the necessary paperwork, labs, and medical records required to get on West Coast IVF’s waiting list for a PGS-tested female embryo, I received an email from my coordinator.

We had a match. And it was perfect.

The egg donor was an active member of the National Guard and a file clerk at a law firm who did flower arrangements on the side. Her favorite movie was The Lion King and her favorite book was The Glass Castle. Though a quiet, shy child, she was very physically active in her youth, participating in everything from cheerleading to dance team to gymnastics to swimming.

Her reason for donating? “I am in a same-sex relationship and know how it feels to want to be a parent, but not be able to get pregnant the old-fashioned way. One day my partner and I will have to get a sperm donor. I want to be able to help a couple become parents.”

The sperm donor was an only child pursing a degree in psychology (which is what I majored in!) who excelled at running (like me!) and bowling (not at all like me).

“I am an easy-going, funny, hard-working individual,” he wrote. “People enjoy being with me because I can always make them smile and have a good time.”

According to the sperm bank’s comments, the sperm donor was “very punctual and has great manners. He is disciplined and trustworthy.”

This sperm donor was from a different sperm bank than our previous sperm donor, and this sperm bank had a lot more information available. For a small price, we could see the donor's childhood photos, creative work, a recording of his voice, and results from a personality test. A quick search on the Donor Sibling Registry showed that he had produced at least two other donor-conceived children. He was also open to contact. This was a major plus now that I knew how important being able to track genetic relatives might be to the embaby in the future.

Both donors were young, fit, and healthy. The baby would undoubtedly be a blonde-haired, blue-eyed cutie. (Not that we cared. Hair and eye color were the least of my concerns.) The only medical hiccup: the sperm donor had red-green colorblindness, a genetic trait. A quick Google search revealed it’s more common in males than females, so I wasn’t too worried.

There was one other hesitation: the egg donor didn’t have any children and had never donated eggs before. How did we know that she was fertile? I emailed the coordinator to ask if anyone had had success with this profile. She didn’t answer.

I was so in love with the profile that I didn’t care. On Election Day, my husband and I signed the profile page that would reserve a female PGS-tested embryo for us and I mailed the check that would pay for the three-transfer package.

My coordinator confirmed receipt of our paperwork, then asked if there were any days I would not be available to travel to California for a transfer. Assuming we were speaking about spring 2021, I listed the birthday of one of my teens as well as the birthday of the new baby.

“I am looking to schedule this before the end of this year, so great to hear that you are available,” she replied. “I will prepare your treatment calendar and send it to you to confirm dates and appointments.”

Before the end of the year? She couldn’t be serious. This had to be a mistake. What happened to the doctor’s insistence that I have around two years between births? Or be on Crestor for six months? Should I say something? Or should I just let her schedule me?

I didn’t want to end up in a situation where I was propped on the table, ready for a transfer, only to have the doctor come in and say, “Wait a minute! I told you not until spring!” So I emailed the coordinator back and fessed up. Cue several emails and phone calls back and forth trying to figure out who was insisting on a spring 2021 transfer. According to a note in my chart, I was the one who wanted to wait, not the doctor.

Finally, a new answer came back from the doctor: he only required one year between deliveries.

OK…?!?! I knew I hadn’t misheard him. He said not until April or May of 2021. But if he was willing to do a transfer sooner, so was I!

I felt all the things: excitement about a transfer so soon, and around the holidays (which made it feel more special). If the transfer was successful, the baby would be born in autumn. This was a godsend because I was not looking forward to bringing a baby home in the dead of winter and being stuck indoors for the first three to four months of her life (which would have been the case if I’d transferred in April or May). My two donor-conceived babies would be only 16 months apart, almost exactly the same age difference between my teens. This was everything I hoped for!

But I was also afraid. Coronavirus was still raging – harder than ever, according to the news. Was flying to California safe? What about staying in a hotel? And the Uber rides to and from the airport? It would be incredibly stupid to end up with coronavirus in pursuit of a pregnancy when I could technically wait until a vaccine was available.

My husband, who had initially said that if we were going to do another transfer, we should do it as soon as possible (because we weren’t getting any younger and we were already in baby mode) suddenly backpedaled. December felt too fast for him. He thought he had six more months to make peace with the idea of another little one under our roof. Now, he had emotional whiplash.

To add to this dizzying time, my period – a real period, my first real one since the birth – came, which meant I could start on the birth control pills that marked the first step in my medication treatment calendar. The fertility train conductor was shouting, “All aboard!” If we were doing this, it was time to get going.

I started popping The Pill, and as each day passed, my husband and I got more comfortable with the idea of a December transfer. Though I’d already picked a biblical name for the next baby, a new one of Spanish origin entered my head one day – and it stuck. I shared it with my teens and my husband and they all agreed that that was the baby’s name. No deliberation necessary.

Just as I was starting to imagine what our next little baby would look like, my coordinator sent us another profile. She explained that there was only one PGS-tested female embryo from the profile we’d selected. She recommended having a back-up profile in case the one we wanted didn't survive the thaw. That way, all my ultrasounds, fertility medications, and travel didn’t go to waste.

It was considerate of the clinic to give us a back-up option. But instead of reassuring me that I would have an embryo to transfer in December, no matter what, it sent me spinning. Coupled with a new piece of information about our desired profile, it made me reconsider if the embaby we chose was really perfect for us after all…

O Aunt Flo, Where Are Thou?

My heart and my mind were on board with trying for a second donor-conceived baby. My body, however, was another story.

One of the first things you need to start infertility treatment is a period. It marks Cycle Day 1, and without it, I couldn’t schedule the saline-infused sonogram (SIS) that I needed to get on West Coast IVF’s waiting list for a match.

Dr. Baby-Maker had told me that at the two-month postpartum mark, if I didn’t have my period yet, I should take a pregnancy test. I didn’t have the former, so I did the latter, and it was negative. (No surprise.) By three months postpartum, I still wasn’t seeing red, and the pregnancy test again came up negative. Dr. Baby-Maker said I could make an appointment for four months postpartum, but reassured me that my period would probably come by then and I could just cancel the appointment.

Well, the four-month mark came and my period didn’t. Leave it to Aunt Flo to crash the party when you don’t want her to and to go off the grid when you desperately need her.

I trekked to Dr. Baby-Maker’s clinic. While I waited in the exam room, I could hear her and another woman discussing an egg retrieval that apparently didn’t go well, judging by the intermittent gasps. It made me glad I was skipping that part of IVF and going straight to the embryo transfer.

Finally, Dr. Baby-Maker came in, bright and bushy-tailed as always. We got right down to business.

“I want to get back on the fertility train,” I told her. “We want to give our baby a little sister.”

“Are you ready?” she asked.

“If I could transfer today, I would,” I said.

She seemed surprised, but happy to help. I explained that I was moving forward with the donor-donor embryo program at West Coast IVF and that I needed to schedule a SIS. There was just one problem: I was supposed to do it on certain days of my cycle, but how was I supposed to know when to schedule it if I didn’t have a period?

“I’ll put you on Provera for 10 days,” Dr. Baby-Maker said. “That will bring on a period. Then you can schedule the SIS. This could take two to three weeks until you’re all done.”

I couldn’t believe how well-versed she was in infertility. I mean, it’s her job, but still. Competent doctors are rare.

In addition to the labs West Coast IVF required for its program, Dr. Baby-Maker ordered a whole lotta bloodwork.

“I’m curious to see what your AMH is now,” she said. “I’d also like to check your FSH again. I imagine it’s higher than last year.”

“And what would that mean?” I asked, though I suspected I already knew. “Not…menopause?”

“Perimenopuase,” she said. “But if your FSH is over 30, that is considered menopause.”

The possibility of perimenopause wasn’t a complete shock. A few years back, I’d written a newspaper article about creative women coping with peri/menopause…and realized I had many of the same symptoms as they did. But post-pregnancy, I actually felt better than I did back then. I was now thinner, had more energy, and was rarely depressed. But I did still have some perimenopausal symptoms. One of them was high cholesterol, which made me wonder if I didn’t have Familial Hypercholesterolemia but instead was in menopause – not that I liked that idea any better. (Isn’t aging fun?!)

“Any questions?” she asked as we wrapped up.

“Is menopause going to prevent me from getting pregnant again?” I wondered silently. (Because one would think that it would make getting pregnant, well, impossible.) But I wasn’t ready to confront that situation yet. I would just have to wait on the bloodwork.

And the wait was worth it. Not only was my FSH in the normal range (11.3), it was lower than it had been pre-pregnancy! My estradiol, prolactin, and TSH were all normal, too. It was almost as if pregnancy had been good for me. I was all balanced.

The one bummer: my AMH was indeed lower than last time. It was 0.08, down from 0.24. But with numbers that low, and the fact that I wasn’t even going to attempt to procreate with my own eggs, did it really matter?

“Your labs are not indicative of menopause,” Dr. Baby-Maker wrote on my online chart. “I am OK with you going ahead with another donor embryo transfer.”

The Provera produced a period as promised, though as far as my periods went, it was pretty lackluster. It was two days long and mostly rust-colored (read: old) blood. On day six of my cycle, I went to Dr. Baby-Maker’s clinic for the SIS.

Unlike my previous SIS with Dr. Gerber at the Minneapolis IVF clinic, this one was performed by a sonographer and a nurse, not by a doctor – and therefore, was not the quicky, easy, and painless in-and-out procedure I’d had before.

The sonographer started with an abdominal ultrasound to make sure that everything was where it was supposed to be, anatomically speaking. Then she switched to a pelvic ultrasound.

“You’ve had these before, right?” she asked.

“Oh, lots,” I said.

And yet, this time, it was really uncomfortable. The wand felt twice as big as I remembered it and the pressure was intense as she examined each ovary. But everything looked normal, so she brought in a nurse to do the SIS.

There was a disconcerting moment as the two of them stood over the tray of tools and surveyed them all with perplexed expressions, as if they’d never done this before.

“Sorry,” the nurse finally said. “They gave us all new equipment.”

They futzed with the catheter for a moment and one of them mentioned a balloon.

“No!” I thought. “Not the balloon!” (I was still traumatized from my HSG.)

As they discussed which attachment the saline went in, I had a terrifying vision of them blowing up my uterus with air instead of saline. Could a uterus burst like that? For a second, I thought about bolting. Did they really know what they were doing?

They turned out the lights and put a hot spotlight on my lady parts. The speculum had a tight grip on me, though I didn’t feel the catheter or the saline.

The sonographer and the nurse both peered at the monitor. They didn’t say anything alarming, but they didn’t exactly reassure me, either. A couple of times, the sonographer said, “Oh, is that something?” and then a minute later, “No, I guess not.” It seemed like she was looking for abnormalities and was disappointed when she didn’t find any.

Just being in the ultrasound room brought back a lot of anxiety, reminding me of those early pregnancy days, watching the screen, holding my breath, trying to decipher shadows and light on the screen.

“We got some really detailed pictures,” the nurse said at the end. “You did really well.”

I wasn’t sure what that meant. It wasn’t like Dr. Gerber at Minneapolis IVF triumphantly declared that I had “textbook perfect uterus.”

I asked the sonographer if she could send the results to West Coast IVF.

“The doctor needs to review the images and write a report. It could be a few days. How soon do you need it?” she asked.

“No hurry,” I said in that stupid, Minnesota Nice way of mine.

“You aren’t transferring for a few months yet, right?” she said.

“Right,” I said, though I immediately realized that West Coast IVF wouldn’t put me on the waiting list until they received the SIS results.

Rather than reassuring me that I had checked off one more box from the onerous to-do list for West Coast IVF’s program, the SIS made me question if I was really up for another pregnancy. The procedure had made me uncomfortable, and resulted in hours of cramping afterward, and as we know, humans don’t like discomfort. Humans wants to be cushy and comfortable and stay with the status quo.

Part of me wondered: “What am I doing? Why am I messing with perfection? Maybe I should just leave well enough alone. Maybe my body isn’t up for this again.”

I wasn’t ready to give up yet, though. I figured the best way to fight the fear was to check out every angle imaginable of my health. Assuming a match was months away, I started taking care of things I’d been putting off, like dental work and gum surgery, as well as preventative appointments, like my annual mammogram. I met with a genetic counselor and spit in a tube for a 47-gene cancer panel (which came back negative on all fronts, though because of family history, I am still considered high-risk for breast cancer).

I also followed up with Dr. Cardio. After three months on Crestor (and, to my credit, some hard-won diet changes), my total cholesterol was down to 188! Out of an abundance of caution, I also requested a calcium score test, which is a CT scan of the arteries to check for plaque buildup. My score was a 0 (which meant no buildup). 

“My husband and I are moving forward with a donor embryo transfer next year,” I told Dr. Cardio, who was unusually chipper during our conversation. “I will be OK off Crestor for a year, right?”

“If it’s just a year, I’m not concerned,” he said. “You gotta do what you gotta do.”

And I was going to do it. My body seemed to be saying, “All systems go!”

By late October, West Coast IVF had all my paperwork, labs, and the SIS report. My coordinator confirmed we were on the waiting list for a PGS-tested female embryo. Just as I settled in for a long, six-month wait for a match, I received an email. West Coast IVF had news for me – and it was very, very good…

Baby, One More Time?

I had discovered that my new donor-conceived baby had a multitude of genetic siblings all across the country; unfortunately, none of them lived nearby and the two siblings she shared a home with would soon be leaving for college.

I never thought I would be the kind of woman who wished she could spend the next 10 years barefoot and pregnant, popping out babies. Now I was that woman, but it was too late. I envied celebrities like Hilaria Baldwin and Kim Kardashian who got to have big broods. If I was lucky, I would get to have one more, for a total of four girls. I could be like Marmee in Little Women! (The 1994 Susan Sarandon version, not the Greta Gerwig travesty.)

Knowing how important genetic relations might be to my baby in the future, I contacted West Coast IVF to ask if there were any more embryos from her profile. The reply back from my coordinator read: “We do not have any more embryos for the profile. I checked on any half-sibling embryos and there are none. We have reached out to the egg donor to see if she is interested in donating again and she has been non-responsive which indicates she is not interested in donating again.”

So a full genetic sibling was impossible – but maybe we could swing a half-sibling? I called the sperm bank (blushing all the while; I don’t know why I was so embarrassed) to ask if my sperm donor had any vials left. Turns out he did; plenty of ‘em. And they were only available to families who already had a baby with his genes, which meant I could buy as much as I wanted.

But to make embryos with that sperm would require going through an egg donor program, where once again we were looking at prices of $30 - $40K. Even if we could afford that (we couldn’t), we would likely end up with multiple embryos, which would force us to choose to destroy them (unthinkable), freeze them indefinitely (to what end?), or donate them to another couple (which went against my new conviction that farming out genetically similar embryos to different families was unethical).

Once again, a donor-donor embryo seemed the only way to grow our family. We could re-enter the program at West Coast IVF, but we’d have to go through all the hoops – paperwork, transfer of medical records, physician consult, bloodwork, saline-infused sonogram – everything except the therapist consult – before we could get on the waiting list for a match. According to the West Coast IVF Facebook group, it was taking clients up to six months to receive a PGS female profile.

We didn’t want to go through all that again…did we?

I was torn, for so many reasons.

1) I recognized that at 39, there were things in life that I was not going to (be able to) do anymore. Having babies might be one of them. Sometimes, I felt too old to be thinking about another baby. At the same time, I also knew there were plenty of women contemplating another kid (or even their first kid) at my age.

2) I questioned if it was ethical to bring another donor-conceived child into the world given that I now knew about the trauma some donor-conceived adults experienced. The donors would be anonymous again; what if we couldn’t find them in the future? Had I learned nothing from all my deep dives into the donor-conceived Facebook group?

3) I didn't want to rob time, attention, and resources away from the new baby in order to give her a little sister. Even just exploring all the options to make a sibling for her was stealing me away from her.

4) I was worried about my health. I felt fortunate to have had a pretty normal pregnancy and a beautiful birth experience, to have survived the hospitalization with endometritis, and that my body bounced back so quickly. Would it be dangerous to go off my cholesterol medication to go through pregnancy again? What about coronavirus? The pandemic showed no signs of slowing down; in Minnesota, we were nearing a third wave.

My husband shared all of these concerns.

“Of course I want our baby to have a little sister,” he said. “But more than anything, she needs to have her mom.”

He wondered if trying for another baby was asking too much from life, if this would turn out to be a “careful what you wish for” scenario, if another kid would further strain our relationship.

These were all good points. We didn’t want to test our luck…but isn’t luck for those who have no faith?

Every now and then, as I went about my daily routines, I did check-ins with myself, imagining how I would handle a baby plus a toddler. How would feeding time, bath time, and bedtime unfold? It’s not like I hadn’t handled two kids under 2 years old before – my teens are only 15 months apart – but when I had them, I hadn’t been working, too.

I would often feel overwhelmed imagining how much juggling I would have to do…but then I’d see my daughters helping each other with homework, chatting about whatever was trending on social media, or embarking on baking projects together, and I’d think that giving my baby a sisterly bond like that would be worth whatever hardship I would have to endure.

Of course, in this case, the sisterly bond might be different. These two girls would not be genetically related. Did that matter? I conjured all the people I knew, trying to figure out what made sibling relationships close. Was it being the same sex? Close in age? Genetically related? I couldn’t tease apart the various influences.

I turned to the West Coast IVF Facebook group to ask if anyone had donor-conceived babies from different profiles. Over 10 women responded in the affirmative, many of them detailing their big, blended family structures. One woman said she had nine kids, a combination of bio children, foster kids, and donor-conceived twins! No one reported a lack of bonding.

The next time my husband and I were alone, I made my case. I reminded him that we didn’t have to drop the big bucks until we accepted a match – and that would be months away. In the meantime, I could jump through all the medical hoops. I had hit my health insurance’s out-of-pocket max for the year with the birth, so it wouldn’t cost us anything to proceed. He said he would think about it, but within minutes, he caught me filling out the West Coast IVF forms on the computer. He just smiled and shook his head, too smart to stand in my way.

“No more after this one!” he said.

Just like the first time around, the administrative part of West Coast IVF’s program was frustratingly slow. I sent a lot of “checking in” emails and “circled back” more times than I could count. Finally, I got to the medical consultation part of the process. The same doctor who did my first transfer called me from California.

“What can I do for you?” he asked.

“Probably the same thing every woman wants from you,” I thought. “Put a baby in me!”

I explained that I’d had a baby through West Coast IVF’s donor-donor embryo program in May.

“How soon would it be safe for me to do another transfer?” I asked.

“I prefer two years, birth to birth, but I’d be willing to do another transfer for you in April or May of next year,” he said. “You need to get your cholesterol down and stay on the Crestor for six months.”

While I knew this was a totally reasonable medical recommendation, it was not what I wanted to hear. I knew there were women on the West Coast IVF Facebook group – one who’d had twins and another who’d had a C-section – who offered transfers at nine months post-partum. Even that seemed to me like an insufferably long time. I fumed for a few days, then called West Coast IVF and left the doctor a message asking him to reconsider the transfer date, but he wouldn't budge.

I searched for other donor-donor embryo options. There was a clinic in Las Vegas that was willing to do a transfer at six months postpartum, but their available profiles were all leftover embryos from other couples’ IVF cycles. This meant older donors (as old as 41) and medically concerning family histories with conditions like schizophrenia, Parkinson’s, and dementia. So while I could potentially get pregnant faster, the baby might not be as healthy. And because the Las Vegas clinic didn’t do PGS testing, I’d be tempted to transfer two embryos (to increase the success rate), and we wouldn’t know the sex. All the other donor-donor embryo options I investigated led to dead ends.

So that was that. The only way to go was through West Coast IVF. I would just have to be patient. I tried to comfort myself with the thought that maybe, while waiting for our match, my husband and I might conceive on our own spontaneously. But then I’d remember my bad genes, our ages (and subsequent increase in risk for Down Syndrome, autism, and other birth defects), and the fact that we didn’t want to be surprised by the sex of the baby, and natural conception lost its luster all over again.

Getting pregnant, no matter how I went about it, was still null and void, however, because at four months postpartum, my period was still MIA…

Your Children Are Not Your Children

One afternoon, shortly after my diagnosis of Familial Hypercholesterolemia (or FH, high cholesterol due to genetics, not lifestyle), I found myself finished with work, a sleeping baby in my arms, and an open laptop. I clicked over to the Facebook group for West Coast IVF…where a woman was debating whether or not to reject a donor embryo profile. I can’t remember the exact bugaboo, but it was not genetic. When someone questioned why she cared about a non-genetic trait, she said the egg donor didn’t seem like someone she would want to “get to know.”

“Get to know?” I wondered. “Why would you want to get to know your donor? The whole point of anonymous donors is to not know them.”

I thought she was being “extra.” Turns out, I was naïve. But I didn’t realize that yet.

I soon found another discussion about locating genetic siblings of donor-conceived babies. Someone mentioned that many sperm banks have private Facebook groups where you can search for a sperm donor’s name to see if there are other offspring from the same donor.

I love me a good rabbit hole. Down I went. Within a matter of clicks, I was accepted to a private sperm bank group on Facebook. I searched for my sperm donor’s name and within seconds, a little girl’s face came up on my screen. The resemblance to my baby was uncanny. They had the same shade of brown hair, the same nose shape, a similar mouth. Beneath the photo, there were comments and photos from other women who also conceived with the same sperm donor.

My baby had a slew of half-siblings. And they had a private Facebook group of their own for sharing personal info and photos. Did I want to make our family known to them? Did I have to?

I had always imagined that I would reach out to my baby’s genetic relatives at her request, much later in life. But now I had seen the half-siblings. I knew they existed. Would my baby ever forgive me if, when she grew up, she knew I was looking right at them and I didn’t get as much information as I could about them?

I couldn’t answer all these questions on my own. So I crowd-sourced the answer, on yet another Facebook group – the largest one (to my knowledge) for donor-conceived (DC) adults, recipient parents (RPs), and gamete donors.

My post went something like this: “I am the mother of a 3-month-old baby conceived with a double-donor embryo. I’ve just located some of her half-siblings on Facebook, but I am unsure if I should reach out now or wait until my daughter wants to initiate contact. For the RPs out there, when did you decide to initiate contact?”

That would be the first and last time I ever posted something on this particular Facebook group. My post was slammed with comments, primarily from angry DC adults, saying how dare I deny my child the opportunity to know “her family.” (“She already knows her family!” I wanted to scream at the screen. “She lives with us!”)

Many RPs said they’d connected with their children’s genetic siblings and half-siblings when their children were little; the ones that didn’t regretted not doing so sooner. They exchanged photos, growth updates, and medical information with the other families. Some even went on vacations together!

I didn’t see myself going that far. I didn’t want to make friends, per se, I just wanted to know the identities of the half-siblings in case my daughter wanted to find and connect with her genetic relatives someday.

But apparently, that was not an option. It was all or nothing.

As I scrolled through the endless comments on my post, I encountered the great divide between DC adults and RPs – at least in this particular group. To grossly generalize, DC adults thought that anonymous donor conception was unethical and felt bitter that they’d been lied to and/or denied relationships with their genetic relatives. They found RPs’ so-called dilemmas incredibly annoying and self-centered. (“It’s not about you!” one DC adult commented on my post. “OK, it’s not all about me, but it is a little about me! I am her mom!” I wanted to reply.)

RPs were fond of saying “Genes don’t make a family; love does!” They thought that all the infertility hell they went through to bring their DC children into the world was proof of how much they wanted them, that the amount of love they showered upon their children would somehow compensate for not knowing their genetic relatives.

The language in the group was so loaded. DC adults abhorred terms like “diblings” (donor siblings) while RPs took offense at being called “social parents.” Everyone argued. There was no dialogue, no space for listening or understanding – just the internet equivalent of shouting over one another. 

DC adults seemed unable to empathize with how gut-wrenching infertility is – and how limited family-building options are depending on the infertility diagnosis. The DC adults grieved the loss of their genetic connections and said that their conception stories traumatized them, but didn’t see that RPs experienced grief and trauma, too. (Studies have found that infertility challenges can be as stressful as dealing with a cancer diagnosis.) I don’t think any RPs choose donor conception believing that they might harm their DC children. I certainly didn’t.

Call me a coward, but I could only take so much meanness. I deleted my post to stop the comments. But I kept coming back to the group – to read the DC adults’ rants, to see the photos of genetic relatives gleefully reunited, to sift through other RPs’ well-intentioned questions about how to navigate all this.

What was clear to me was that no one can understand the choices infertility compels you to make unless you've experienced infertility yourself. And no one can understand the emotional toll of being donor-conceived might take, unless you are donor-conceived yourself. 

I underestimated how important genes were when I chose donor conception. Genes do matter – to some people, some of the time. They didn’t matter to me. I loved my DC baby just as much as my bio daughters (I don’t even like differentiating them as such). I wanted to be my baby’s only mother, or at least be considered her “real” mother, but now I understood that she might have a different interpretation. I didn’t want her to be angry like some of the DC adults raging on the Facebook group, but I also acknowledged that I had no control over her feelings. 

“I hope we didn’t do something ‘wrong’ with the way we brought the baby into this world,” I wrote in my journal. “All I can see is the joy and happiness and giggles and love that she brings. I can’t imagine her ever hating me. I think we are as bonded as a baby and mama can be.”

What frustrated me is that the DC adults seemed to assume that knowing and being raised by your genetic family was a panacea. That simply isn't true. I am not close to my parents or my brother, though we all share DNA.

Genetically related or not, no child gets to choose their conception story or their family structure. We all have to come to terms with the families we are raised in. I didn’t want divorced parents or a step-dad or step-siblings, but that’s what I got. My teens struggled to accept my and their dad’s divorce as well as our respective remarriages and new siblings, but they’ve come through it OK.

And yet. This was not a divorce or even a blended family situation. It was something new; uncharted territory for me as a mom. To process all this, my husband and I did another session with the infertility therapist, Dr. Midler, who we saw while in the process of signing up with West Coast IVF. She was not surprised that we were only just now considering the ramifications of donor conception.

“Everyone has blinders on when they’re trying to get pregnant,” she said. “Having a baby is primal, not logical.”

She suggested connecting with the half-sibling group, taking an “open, with filters” approach to communication.

Armed with that advice, I went back to the sperm bank group and commented on my baby’s half-sister’s picture saying that I used the same donor. That comment yielded a friend request, then screening questions from the half-sibling group admin. By the time she granted me access to the group, I felt exposed, unsure if I wanted everyone there to know me and my baby. But introduce us I did, and then everyone in the group responded with warm greetings and photos of their children.

It was weird. It was wonderful. It was overwhelming. It was hard to fathom that one man had helped create all these look-alike children – over a dozen of them. The sheer number kind of creeped me out. How many babies was one sperm donor legally allowed to genetically contribute to anyway? Are there even laws about such things? Because it seemed like this sperm donor needed to be stopped.

“Did you go through West Coast IVF?” the group admin asked me in a private message.

I confirmed I had.

She told me that another member was expecting my baby’s full genetic sibling – a girl. When I looked again at my messages, I saw one waiting in the “other” folder. The expecting mom had emailed me weeks ago, saying she suspected we had the same embryo profile based on some comments I made on the West Coast IVF Facebook group. We compared notes and indeed we did share the same embryo profile. She was due in the fall. Ours were, as far as either of us knew, the only pregnancies from our profiles. The babies would be full genetic sisters, only five months apart; practically twins.

I don’t know how one is supposed to feel in this situation, but my first reaction was sadness. I felt like her embryo “belonged” to me, that her baby should have been mine. I was mad at myself for not foreseeing how important a genetic sibling might be to my baby, for not transferring two embryos, for not asking West Coast IVF if I could “reserve” her genetic siblings somehow. Now I had to confront the reality that my baby only had one full genetic sibling in the whole wide world – and she was going to be born into, and grow up with, another family halfway across the country.

I don’t believe donor conception is unethical. I believe it is a godsend to many people struggling with infertility. But there are parts of it that are problematic. Anonymity is one (though as Dr. Midler liked to say, there is no anonymity these days thanks to genetic testing and social media). Another is the practice of separating genetically-related embryos. Adoption agencies don’t separate siblings anymore because of the trauma that such separation causes; why should fertility clinics get to rip siblings apart just because they are in the embryo stage?

Though my baby had more genetic siblings than most people could even fathom, I began to worry about her feeling alone – not just because she was the only donor-conceived member of our household but because my older daughters would be leaving the nest soon. While I had romanticized the idea of a cozy, three-person family, I now wondered if it was good for the baby to essentially be an only child under our roof. Wouldn’t she be lonely?

I knew trying for another baby the old-fashioned way was not only futile, but cruel, given my FH diagnosis. If we wanted to give our baby a sibling, we would have to be intentional about it. Meaning: we would have to get back on the infertility treatment treadmill…

Matters Of The Heart

With a brand-new, long-awaited baby at home, my heart was full.

It was also in trouble. 

Back in 2009, I had a cholesterol lipid panel done. My numbers came back high. The doctor repeated the test three times, thinking it was a fluke, but they didn't budge. She recommended I see a specialist. I was 28 at the time. And a marathon runner! If anything about me was healthy, it had to be my heart. So I ignored her advice.

Fast forward to 2020. My baby had given me new motivation to take better care of myself. I also had excellent health insurance. There was no reason not to follow up on my high cholesterol, other than fear.

One thing that pregnancy does to most women is raise their cholesterol – sometimes astronomically. I had asked Dr. Baby-Maker if we should check it while I was pregnant, and she said no, because there was nothing we could do about it while I was pregnant anyway. She told me to wait until at least six weeks postpartum. So I did. Then I found a top-tier cardiologist, scheduled an appointment, and had my blood drawn. My hope was that somehow over the past 11 years, the problem would have corrected itself.

Yeah, no. What came back was terrifying.

Normal total cholesterol is under 200. 

Mine was 454.

Normal LDL (or “bad”) cholesterol is under 130. 

Mine was 330.

These numbers were not only abysmal, they were worse than all my previous cholesterol readings.

“You’re in the top one-half percent of people with high cholesterol,” said the cardiologist, who we’ll call Dr. Cardio. 

This wasn’t my fault, though. Dr. Cardio explained that I had Familial Hypercholesterolemia (FH). It’s genetic and isn’t influenced by exercise or diet, which is a shame because I’m maniacal about the former and pretty good about the latter. But I didn't need to tell Dr. Cardio that. He could tell from my HDL (“good”) cholesterol levels that I was working out plenty and my triglycerides indicated that my diet was relatively healthy.

Regardless of what caused my high cholesterol, treatment was crucial. Untreated women with FH have a 30 percent risk of a fatal heart attack by age 60. Dr. Cardio said he was putting me on statins, STAT. The highest dose of Crestor, to be exact.

“You want to be around for your kids,” he said. “The only thing about Crestor is that you can’t get pregnant on it.”

Cue gut thump. My itty bitty, barely begun dream of maybe, just maybe having one more kid got squashed just like that.

“But what if I wanted to get pregnant again, you know, in the future?” I asked (as if I were 29 rather 39 and had all the future in the world). “Would going off the meds to have a baby put me at risk of a heart attack or a stroke?”

“No,” he said. “You’d be OK for nine months. But I wouldn’t wait more than three months postpartum to get back on it, so you’d have to stop breastfeeding at that point.”

As I’d learned with my new baby, not breastfeeding was not a deal-breaker for me. Still, until I got my numbers down, pursuing another pregnancy would be reckless. Dr. Cardio said we’d redo the bloodwork in three months and talk again.

“Your daughters should get their cholesterol tested, too,” he said. “There’s a 50-50 chance they have FH.”

He recommended I check out the FH Foundation for more information. I did, and ended up in a Facebook group affiliated with the foundation. I was hoping to get some support around my diagnosis and maybe some book recommendations or diet advice. What I got instead was a lot of scary stories. There were posts from people who’d had heart attacks, a pic of a woman who’d just had surgery, women who found out their children had high cholesterol even though they were still in grade school, and plenty of complaints about statins and their side effects.

I hadn’t felt too worried after talking to Dr. Cardio, but after scrolling through those Facebook posts, I felt like I had been given a death sentence.

In an introductory post, I explained that I’d just been diagnosed and that I was supposed to start taking Crestor. “I’m afraid of taking the drug but I’m more afraid of what might happen if I don’t take it,” I wrote through tears. I asked for encouragement and success stories. Then I closed my laptop because I couldn’t dwell anymore on my mortality.

In addition to feeling scared and sad, I was also mad – at myself for ignoring the high cholesterol a decade ago, at my family for not informing me of a potentially fatal genetic condition, at my previous doctors for not impressing upon me how serious high cholesterol could be (and that no amount of running or clean eating could lower mine). 

I tried talking to my husband about the diagnosis but he was unhelpful. He refused to accept reality and was skeptical of the medical establishment.

“I just don’t understand how someone who exercises as much as you do could have high cholesterol,” he said. “It just isn’t fair!”

The night of my diagnosis, I went for a walk with the baby and watched some dumb TV until she fell asleep. Staying off the internet definitely helped keep the fear at bay. 

“This might be a case where too much information hurts more than it helps,” I wrote in my journal. “But I want to be around to see my baby grow up. I don’t want to be dead mom.”

I started taking Crestor every night, and thankfully had no side effects. While my body seemed to be adapting fine to the diagnosis, my mind was not. I became obsessed with reading about unexpected deaths online – especially of young women, pregnant women, and new moms. There was no shortage of these stories, either. I wasn’t sure if my radar was more attuned to them or if there actually was a rash of these kinds of deaths happening. Either way, I couldn’t stop clicking. An actress drowned while on a boating excursion with her 4-year-old son, a 24-year-old YouTube star who was 8-months pregnant died from a heart attack, a 57-year-old celebrity mom died of breast cancer. Locally, a 39-year-old woman who was 8-months pregnant died in a car crash. Another pregnant woman was shot.

“I do not want to be one of these tragic stories,” I wrote in my journal. “I want to have a boring death at a very old age.”

Though Dr. Cardio said my diet didn’t make a bit of difference in lowering my cholesterol, I asked to speak with his clinic’s nutritionist anyway. She was an elderly, kind lady who went over everything I ate in an average day on the phone with me. I’ll admit, I fudged the numbers a bit when it came to my chocolate consumption and my potato consumption (by which I mean waffle fries and tater tots). “Well, you have three kids,” she said regarding the latter. “Yeah,” I should have responded, “but they don’t eat that garbage.”

Even with those dietary flaws, she told me I was the healthiest eater she had spoken to in a long time. Still, she had some suggestions: eat only one egg yolk per day, add fish twice a week, eat one serving of tree nuts daily, and incorporate more whole grains into my diet. Little by little, I made every one of her suggested changes. I also switched from peanut butter to almond butter, swapped potatoes roasted in olive oil for processed potato products, and cut out red meat for good measure.

I told my dad via email about my diagnosis. He nonchalantly said he'd had high cholesterol for 20 years and had tried various medications. But his doctor had never mentioned FH. My dad said it must have come from my mom's side of the family. So one day, when my mom came over to get my teens for lunch, I asked if she had high cholesterol.

“Yup. I’m on Lipitor.”

“Hello! You could have told me!” I thought.

“Once you get to a certain age, everyone has high cholesterol,” she continued. “Mine was borderline.” Then she casually mentioned that her dad had had a few strokes and “maybe those were caused by high cholesterol.”

“Where has this information been my whole life?!” I wanted to scream.

“I just found out that my cholesterol is ridiculously high,” I told her.

“Bummer,” she said.

After my mom left with my teens, I turned to my husband. “I love how my family is like, ‘Oh, yeah, I have high cholesterol. No big deal!’ It’s not like it can kill you or anything!”

Then I started crying because my family’s lack of communication, which has always been just an annoying trait, could, in this case, have been lethal.

“Whatever,” I said, drying my tears. “It’s fine. I guess I’m the only one worried about dying!”

Unable to get the kind of acknowledgment or comfort I needed from my family, I scheduled a virtual session with my therapist Shania. Among the helpful things she said was that I was grieving life as I formerly knew it. She also said that sometimes, when people get discouraging information about their health, it prompts them to act on things they've been putting off.

“Is there something you want to do?” Shania asked.

I had been toying with the idea of starting a blog about how my new baby came to be. Shania thought a blog was a good idea, that it would be helpful for me to process my feelings about infertility.

“Take care of yourself and love your baby,” Shania said in signing off.

It was exactly what I needed to hear.

After one of my teens was also diagnosed with FH (though not so severe that she needed medication yet), I started thinking a lot about genes. My new baby had dodged a bullet by not being genetically related to me. But whose genes did she have? Who did she share them with?

As I would soon discover, you can find anything – or anyone – on Facebook if you dig deep enough…

Who's Afraid Of The Fourth Trimester?

They call the early months with a newborn the “fourth trimester” because of the intense physical and emotional adjustments required of a new mom.

What surprised me, however, was that it wasn’t as rough of a transition as I expected. Maybe parenting is like riding a bike; the muscle memory was still there even though it had been 16 years since I’d had a newborn.

The baby was sleeping better than I was. And when she did wake up in the middle of the night, she had a bottle and went right back to sleep. I made “feeding time” into “reading time,” so it was less of a sleep interruption and more of a treat for me because I got some uninterrupted time to catch up on my ever-growing book pile. And speaking of reading – she loved books, too, which was wonderful because I loved reading to her.

Every day the baby seemed to have a new nickname: Little bean. Snuggle bug. Nugget. Peanut. Milk piggy. My husband and I couldn’t get enough of her. Whenever anyone asked how I was doing, I said, “I’m having a love affair.” I was ga-ga over Grace. But even that wasn’t accurate because it was the kind of love that made the word “love” seem insufficient. There was nothing sweeter than watching her heavy-lidded eyes give way to sleep, her limp-limbed body warm against me.

We soon developed a routine of morning walks. It was our special time together, greeting the sunrise each day as I sang along to songs on Spotify (Dave Simonett, Bon Iver, Keren Ann, Daughter, Lana del Rey, Meiko, and Rachael Yamagata seemed to be some of her favorites). I felt so blessed to finally be a mom pushing a stroller. It was something so simple yet so meaningful, especially given all that we went through to get to that point.

My teens weren’t as enamored (or as helpful) with the baby as I’d anticipated (they got there as time went on), but they did take on extra chores around the house. My husband stepped up, too, assuming the grocery shopping duties and caring for the baby in spurts so I could do self-care or errands.

I went back to work right away (I’d been working full-time from home long before the pandemic) and found that with a little strategizing, I was just as productive – some days more so – as I’d been pre-baby.

My pre-baby body came back, too – slowly at first, then all at once. My legs and feet were where I initially noticed a huge difference. It was like an optical illusion; I now had feet, ankles, calves, knees, and thighs where there once were just two meaty extremities. My stomach deflated (yay!), as did my breasts (boo!), and without altering my diet, I was soon swimming in my pre-pregnancy clothes.

Coronavirus quarantine was both a blessing and a curse with a new baby. On the one hand, being in lockdown meant that my husband was working mostly from home, and that we could tag-team when necessary. Appointments were mostly virtual. There was nowhere we had to go, no one we had to see. I didn’t have to constantly pack and unpack a diaper bag or lug the car seat around. On the other hand, the baby missed out some experiences I’d hoped she’d have, like going to church every week, being baptized, and spending time with grandparents.

Of course, there were low points, too. My tried-and-true soothing tricks didn’t work for the new baby. Pacifiers made her gag. She didn’t like facing inwards in the Baby Bjorn (and she didn’t have the neck strength yet to face outwards). She didn’t sleep long in the swing. She got constipated and wailed for what felt like hours – unless she was soaking in the tub. She lost all of her hair in the front (totally normal and hormonal, but that’d never happened to one of my babies before); then the hair grew back but she developed a bald patch on the back of her head.

There were days I was so bored I could cry. Some days I felt so depressed, I did cry. I would rock the baby to sleep while Googling things like, “Does my baby love me?” because I wasn’t sure. Once, in the middle of the night, trying to navigate around the house in the dark with a sleeping baby, I bonked her head on the wall. (We now have night lights everywhere.) Sometimes it felt like those same walls were closing in. Often, as soon as we figured out the baby’s rhythms, they would change, and we had to adapt all over again.

But adapt we did, and by the time she was six weeks, dare I say we were back to normal – or rather, embracing a new normal.

“It’s like you weren’t even pregnant!” Dr. Baby-Maker exclaimed at my postpartum visit. “And you were really big at the end there.”

It’s true – I had not only lost the baby weight, but I was also now 6 pounds thinner than I was pre-pregnancy.

“I haven’t even been trying! It just happened!” I said.

“Don’t tell anyone that,” she replied with a side-smile. Then she said she was taking me off the Synthroid because she suspected it turned my metabolism up too high. (I lost another 4 pounds after she did that, so I guess that wasn’t it.)

After an internal exam, Dr. Baby-Maker declared me all healed. She gave me the OK to start running again (which I was psyched about) and to resume sex (which I was indifferent about).

“Would you like to be on birth control?” she asked. “I’ve seen spontaneous pregnancies happen, even in a situation like yours.” (Meaning my low AMH and the failed vasectomy reversal.)

“We’re going to use condoms,” I said, though I suspected this was unlikely. (Does anyone who says they’re going to use condoms actually use them?)

The truth was, I was hoping that my husband wouldn’t insist on any protection, and that we could leave the door open for a miracle. I actually missed being pregnant. I missed the awe, the sensuality, the sense of purpose. I was so in love with the baby (my Google searches were now to the tune of  “Can I be too attached to my baby?”) that I was fantasizing about having another, though I suspected we couldn’t afford it. Besides, the chances that I could get pregnant naturally were slim to none. (As far as I knew, I hadn’t even started ovulating again yet.)

When my husband and I resumed relations, he didn’t insist on using anything, and even seemed turned on by the idea that maybe, just maybe, the stars (or our gametes) would align. Being intimate was a little painful, and it felt so foreign in my slimmed-down body. I had gotten used to having that big belly (and those beautiful boobs). Postpartum sex didn’t hold a candle to second-trimester pregnancy sex. The only reason I was still interested was the possibility of pregnancy, and for a while, it was an aphrodisiac.

But as I soon discovered through a new, disturbing diagnosis, passing on my genes to another human being would be inadvisable at best and cruel at worst…