Friday, November 27, 2020

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...

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