It’s 7pm on a weeknight when my husband Chris and I open our laptops, pour two glasses of wine and start browsing through profiles of women in their 20s. Attractive, interesting, available women. It’s the spring of 2020, we’ve been living in Los Angeles for a year (having relocated from London for work) and a couple of times a week, this has become our little routine.
I get a good feeling about a pretty blonde yoga teacher, then worry that she’s only 5ft tall. I love the idea of someone who works for Nasa, but I’m put off by her distinctive nose. I am swayed by a sense of humour and spirit for adventure; snobby about hobbies, fussy about ailments and firmly rule out anyone who resembles a party-goer on spring break. It’s an uncomfortable, confronting process. Am I really this superficial or judgmental?
I’m glad my therapist recommended this half-hour, twice a week, wine-in-hand ritual to keep things as lighthearted as possible – without it, this would be arduous, painful and completely overwhelming, and infertility is already all of those things. Because what feels terrifyingly similar to online dating is actually our only hope of conceiving our first child.
There are certain things I imagined about starting a new life in California in my 30s, but they were along the lines of getting a rescue dog and exploring the world of CBD, not buying eggs off another woman. If you had told me even two years ago that I’d need an egg donor, I probably would have laughed. Getting pregnant, I was always led to believe, was only a matter of time.
Our TTC (Trying To Conceive) journey, as it’s referred to by the IVF community on social media, started out unremarkably enough. I came off the pill in 2017 when I was 35 and feasibly ready to have a child. I figured it would take about a year (according to the NHS, 82% of women aged between 35 and 39 conceive after 12 months), as that was the case for my two older sisters.
By the time I’m 36 nothing has happened, so I go to my GP. I’m peeing on ovulation sticks every month, but the results aren’t always visible. “Maybe I’m not ovulating,” I suggest. “Are you having periods?” the doctor asks, and I nod. “If you’re having periods, then you’re ovulating,” dismisses the doctor. I’m referred for blood tests. All appear normal. We are told to “keep trying”.
Another year passes and despite ultrasounds, second opinions and a closer look into Chris’s side of things, there are no concrete answers from the medical profession, just unhelpful suggestions like, “It’s probably the stress of losing your mum” (she died in 2017) and “Hold your legs up in the air for 30 minutes afterwards.”
The last doctor I see before we move to America in the spring of 2019 waves me off with a leaflet about hysterosalpingograms (HSG tests which detect issues with the fallopian tubes). It’s the next recommended stage of investigation. “Give it three more months and then book one of these,” the doctor says, optimistically. “That must be it,” I think, and while frustrated that my infertility is still classed as “unexplained”, I’m secretly hoping a bit of sunshine and a few green juices will do the trick.
After a few months in LA, I book an appointment to see an infertility specialist. I cringe now thinking back to how I charged into the office – folder of NHS notes under my arm – declaring that we’ve had everything looked at apart from my tubes, so could we arrange an HSG test asap? Our doctor – sympathetic but straight-talking and pregnant herself (oh, the irony) – tells us politely that she’d like to run her own tests to get a “full picture”.
In the space of a single appointment, we complete what would take months in the UK (multiple blood tests and an ultrasound for me; a semen analysis for Chris). In fact, she takes one look at my ovaries and explains, rather gravely, that there aren’t as many follicles (which typically release one egg a month) as she “would like to see for a woman of my age”.
To put this into context, to be a viable candidate for IVF treatment, you need at least 10 follicles across both ovaries. My doctor can only see three. IVF is a numbers game, so, in layperson’s terms, the more follicles you have (to be stimulated by drugs), the more eggs you’ll retrieve; the better quality those eggs will be, and the higher your chances of a pregnancy.
A few days later, the results of an Anti-Mullerian hormone (AMH) test confirm our doctor’s suspicions. I have a “severely diminished ovarian reserve”. The typical range for a fertile woman is between 1.0 and 4.0, with 0.5 considered “very low”. Mine reads 0.08. Translation: I’m not yet 38, but I have the ovaries of someone a decade older.
The reason I’m finding this out now – because AMH testing isn’t carried out in the UK until after you’ve been officially referred for IVF (and this can take some time) – only fuels my anger and frustration. So I do what any other infertile person would do and seek to control what few things I can. I remind myself that “it only takes one egg”, read against-all-odds success stories and attempt to boost my ovarian reserve by giving up alcohol and coffee, avoiding toxic beauty products and taking every supplement under the sun.
Three months, one experiment (where my body fails to react to a follicle-stimulating drug) and further blood tests (which confirm I have the hormone levels of a woman approaching menopause) later, our doctor concludes IVF would be a waste of time. Our chance of success (less than 5%) is equal to our chance of conceiving naturally. And we all know how that’s going.
It’s a huge shock, but anyone familiar with the not-so-merry-go-round of infertility will recognise the sense of relief that surpasses my initial devastation. I am relieved to be taken off the ride before it gets going. I am grateful to be spared a turn on the rollercoaster before it breaks down completely. I have seen what failed rounds of IVF can do to people. We are not even three years into our journey and my longing for a child is already turning me into somebody I don’t recognise.
I am tired of welling up around my nieces and nephews, muting WhatsApp conversations about babies and feeling like I’ve been stabbed in the heart every time another friend announces she’s pregnant. My inability to conceive is the elephant in every room I enter and it is stifling. I resolve to channel the energy that’s long powered my bitterness into finding a practical solution. “There are many different ways of starting a family,” our doctor reminds us. In the La La Land of ageless Hollywood celebrities and world-class fertility fixes, there certainly are.
The light at the end of our tunnel is that I’m an “excellent” candidate for donor conception. My tubes are clear, my uterus is normal and with a healthy egg (ideally from a young, fertile donor), my chances of pregnancy increase from 5% to a whopping 60%. It’s an expensive route (that we are privileged to consider as we haven’t spent any money so far). It feels like a no-brainer.
We are advised to see a therapist before we begin the process and finding one who specialises in (and has first-hand experience of) third-party reproduction proves invaluable. It gives me the space to acknowledge everything from feelings of shame (Is this my fault? No: a diminished ovarian reserve is a medical condition) to my biggest fears (Will I feel like my child’s “real” mum? Yes: love, connection and good parenting have nothing to do with genes).
Ultimately I’m forced to confront what I’m most afraid of. That, heartbroken after losing my mum to cancer, I’ve been clinging to the idea that having a baby would be a link back to her. That my child might have her magnetic smile or her brilliant sarcasm and it would somehow keep her spirit alive. I think of what my mum would say to that. She would roll her eyes, that’s for sure.
I need to grieve for the child I can’t have, in order to make room for the one I can. This won’t happen overnight – the loss of genes is, after all, a lifelong loss – but doing my own research into epigenetics (how behaviours and environment can cause changes that affect the way your genes work) and speaking to other women in the same boat (via Instagram) along with an amusing reminder from my therapist to think about “the so-called blood relatives who are a bit shit and don’t even feel like family anyway”, does wonders for my morale.
Our first decision is whether to use a donor agency (where your chosen donor goes through the IVF process and you keep all the eggs retrieved) or an egg bank (where the eggs are already retrieved and frozen and you buy a number of them from a donor you have selected). The latter option is more affordable, but has less chance of success. For example, you might buy 12 eggs but only half of those successfully thaw so you’re left with only six eggs to try to fertilise into embryos. With little information about the egg quality, it’s more of a gamble, versus using an agency where you can choose a donor with a high ovarian reserve (where good- quality eggs are more guaranteed) or even one whose previous donor cycles have resulted in a pregnancy.
The agency route amasses significant fees (as well as paying the agency and the donor herself a fee, you pay for an attorney and for a whole cycle of IVF), but we are enticed by the higher success rate and greater potential to create multiple embryos we could freeze for further rounds if we decided to have another child. If we were in another country we would probably only have the option of an egg bank so it feels prudent to take advantage of what LA has to offer.
Wary of “designer” donor companies who charge more for model looks and Ivy League college degrees, we narrow down a list of eight doctor-recommended agencies and meet with a handful of them. Some feel a bit icky. (One woman refers to her clients as “cute sorority girls”. “She’s a pimp, right?” quips Chris afterwards. “She’s basically the madam?”) Others, like the one we decide on, put us at ease.
We learn to laugh through the discomfort; essential when you’re browsing through online profiles of strangers (complete with photos from birth to current day) that tell you everything from when they started their periods to how much they drink; from what their childhood was like, to why they’re donating their eggs.
So what should we be looking for in a donor? Popular criteria are good health history, similar features and personality, but more pertinent factors are agreeing on the level of anonymity (legally, you need to be on the same page) and whether they’ve been a donor before (there’s more risk with a first-time donor, but you can expect to pay more for a “proven” donor).
Jokes about big noses aside, Chris and I are less motivated by appearance and more driven by our instincts. We come to appreciate having our no-nonsense infertility doctor on hand to go through prospective donor profiles with a fine-tooth comb. Family history of cancer? Red flag. Genetic predispositions? Not approved. And as for proven donors – a previous pregnancy is not enough. Our Dr Ruthless wants to see numbers of eggs, embryos and blastocysts (five-day embryos with the highest chance of implanting). And those numbers need to be high.
In the end we choose the person we believe has the most chance of success – we are, after all, putting our life savings into this – and that’s a woman in her mid-20s whose previous three cycles have all resulted in pregnancy. I’m not looking for a best friend here, but she is grounded, has her own children and hasn’t put her fees up (which I think speaks volumes about her altruism). We will remain anonymous to one another, but she is open to meeting our child if they one day wish.
A few months later, my donor and I are ready to start the cycle of IVF. We both see the same doctor and both prepare our bodies by injecting gruelling hormones, but our paths never cross. She retrieves 31 eggs which result in an astonishing 18 five-day blastocysts (very high-quality embryos which can be frozen), and one is then transferred into my womb in the hope of securing a pregnancy. A text to one of my friends in the dreaded two-week wait perhaps best sums up how I’m feeling: “I’m terrified it hasn’t worked, but I’m also terrified it has.”
A blood test confirms it has worked. Our doctor is happy to report my hormone levels are very high, meaning the pregnancy is viable – and I’m happy to report I feel more excited than terrified. In fact, swept along in the following months by the sheer anticipation and unbridled joy of feeling a new life wriggling around inside me, I’m surprised how little I think about the donor egg that went into making our baby girl.
Of course there are occasional triggers that force me to remember – a 3D scan in which we are able to see the baby’s face leads to a comment about whether she looks more like mum or dad – but then infertility isn’t something you can forget. You need to grieve for it like you would any other loss. It’s not something you’ll ever get over, but it is something you can grow around.
As I write this, four years after we started “trying”, my newborn baby, Maggie (named after my mum), is fast asleep on my bare chest. Before she arrived, I resented the extra baggage her conception would bring with it, fixated on the failure of my genes, and worried about who she would look like. Now she’s here, I realise she deserves much more than that. I look forward to telling her about the amazing way she was brought into the world, because it’s part of what makes her so unique. She doesn’t look like anybody else and doesn’t need to. She is entirely her own person, just like I am, and like her grandmother (who would have adored her) was, too. She is my daughter and I am already looking at her the way my mum used to look at me.
Maggie will read this one day and I hope she feels as proud of herself as I do. Maybe she’ll have a sibling by then, too. We still have 17 other embryos in the freezer, after all.