Thursday, September 15, 2011

The Infertile Egg Hunt Part 2 of 4 : Egg Donation

In the past three years my husband and I have suffered four miscarriages and have had 28 embryos genetically tested, only to find out they were not viable. This is because I have a translocation, a genetic mutation which causes the vast majority of my eggs to be genetically unsound. Egg donation, embryo donation and adoption are the only options left for my husband and I if we want to expand our family. This week I talked to Dr. Michael Blotner, Medical Director of Westchester Fertility, about egg donation. Dr. Blotner and his caring staff helped me get pregnant with my daughter four years ago. He was gracious enough to answer ten questions I had about the process. Egg donation is a viable option for women like myself, who can carry a baby to term, but cannot provide quality eggs.

What type of fertility issues would cause a woman to consider egg donation?The primary reason for a woman to seek an egg donor would be infertility caused by a very low egg reserve, which also implies a decreased egg quality. This will be reflected in an elevated FSH (follicle stimulating hormone) or a low AMH (anti-mullerian hormone). Also in the cases where in vitro fertilization has failed multiple times, eggs from a donor may be appropriate.

What is a snapshot of the “typical” egg donor like?
The typical egg donor is a woman over 21 years of age, commonly in graduate school or pursuing a career. While financial compensation is a central motivation, there is often an altruistic desire to help other women conceive.

Does health insurance cover any of the costs of retrieving eggs from the donor?Unfortunately, health insurance can only be used for tests and procedures that involve the recipient(not the donor). The costs include those for mandatory laboratory screening; intake appointment and physical exam; medications involved in stimulation of the donor; monitoring hormone levels and ultrasound development of the follicles; the actual egg retrieval with anesthesia and donor compensation for going through the process.

How extensive is the screening for egg donors? Are donors checked for genetic abnormalities that could cause miscarriage or life threatening illnesses in the baby?The donors are screened for sexually transmitted diseases (HIV, Hepatitis B and C, etc) as well as genetic testing for chromosome analysis, cystic fibrosis, and hemoglobin abnormalities. Other genetic tests may be obtained when applicable(ie: Tay-Sachs screening for Ashkenazi Jewish descent).

How are donor eggs retrieved?The egg donor is stimulated with injectable hormones (FSH and LH) on a daily basis from the early phase of the menstrual cycle, and she is monitored every few days by serum estrogen levels and ultrasound evaluation of the ovaries. At the same time the recipient’s uterus is being prepared with hormone supplements to ultimately receive the embryos. When the eggs are deemed mature, the donor undergoes general anesthesia for 15-20 minutes while the eggs are retrieved by transvaginal ultrasound and a needle aspiration of the eggs from each ovary.

What happens to the donors’ eggs after they are retrieved?The donor eggs are isolated in the laboratory and injected with the sperm of the recipient’s male partner (or sperm donor, as indicated). The resultant embryos are monitored and allowed to develop to an appropriate stage for transfer into the recipient’s uterus. Often extra embryos may be present to be cryopreserved (frozen) as a back up for additional attempts or future pregnancies.

Can the egg donor donate multiple times? Do the couple receiving the eggs know about the other babies that have been born using the same donor?Egg donors are allowed to cycle several times. Information regarding prior successes is available, but the specific information regarding other patients and their offspring is protected under HIPAA.

How does a person choose an egg donor?Egg donors are recruited by agencies specifically for this purpose, and are generally selected by the recipients based on shared physical characteristics, desired educational or ethnic backgrounds. Extensive family history screens are also presented for review.

What are the challenges in using a donor’s egg? (monetary, physical, emotional)Donors may be local, which makes monitoring easier, or they may need to commute or even fly from their place of origin. This requires coordination with a fertility center in their locale. This also requires lodging and accommodations for the donor during the time of the egg retrieval. This adds to the financial burden of the entire process. The recipient and her partner must also be emotionally ready to abandon the idea of conceiving with her own eggs.

What are the benefits of the egg donation process?While adoption is an option for many couples, the use of an egg donor provides the opportunity for the male partner to contribute to the genetics of the offspring. The recipient is also able to experience pregnancy and childbirth and bond with their child in that time. The chance of conceiving through donor eggs is approximately 50-60% per transfer, as opposed to less than 5% using her own eggs.

At the end of the day, egg donation is a viable option for couples in our situation. But as Dr. Blotner mentioned, there are many challenges to this option. The expense of using an egg donor is huge, costing anywhere from $25,000 to $30,000. Also dealing with the loss of the dream of having a child with your genetic makeup is something the egg donor recipient has to come to terms with. In the coming weeks, I will explore both embryo donation and adoption.

Michael Blotner, MD, is board certified in obstetrics and gynecology and reproductive endocrinology. For over 15 years, he has been helping patients in his care achieve their goal of having a child through state-of-the-art infertility treatment. Dr. Blotner has dedicated himself to providing personalized professional care in a relaxed environment.

Sunday, September 11, 2011

Volunteering Post September 11th, Then and Now

I have been having such a difficult time writing about my experiences on September 11th. I usually don’t write about something difficult or painful until I have perspective and understanding of the situation. I have realized that no matter how much time will pass, I probably never will understand the events of September 11th. I don’t have any have perspective. All I can think about is the pain and suffering of all of those families who lost loved ones that day. I also think about the first responders who have since died or have life threatening illnesses due to inhaling toxic fumes at Ground Zero as they selflessly worked night and day to recover the victims from the rubble. As my husband went into work this past Friday in Lower Manhattan, blocks from the site, I also still have the fear and sense of powerlessness as security is heightened due to threats made to New York City.

But in darkness, there is always light. The light I choose to think about is the heroic acts that saved lives that fateful day. I think about the amazingly strong wives and husbands who have carried their families through the loss of their spouse. I think about the countless individuals who have channeled their loss and personal tragedy into creating non-profits that strive to make the lives of those affected by September 11th more tolerable. All of these souls inspire me. They are my heroes and I feel encouraged to participate in acts of kindness and volunteerism on September 11th in their honor and in honor of those lost.

Like every person in America, I remember exactly where I was when I heard about the twin towers being attacked on September 11th. I was sitting in one of my Graduate Social Work classes at Fordham University Lincoln Center in New York City. An administrator came into class to say that two planes hit into the twin towers and was believed to be a terrorist attack. I immediately called my parents on a pay phone to let them know I was okay. I also called my weirdly calm fiance who was still sitting at his desk in his office, in the heart of Times Square. He said people were staying at work and he was going to wait and see how things unfolded. I told him I was coming down to get him.

I ran down town to get him, fighting the crowds of people who were walking uptown. When I got to his office building he was standing outside with many others, clearly in shock, watching the recap of the planes hitting the towers on the Jumbo Screen. We ran back uptown to Fordham to get my car and drove home out of the city.

I went back to my future in law’s house and watched the news for hours and felt scared, helpless and powerless. I watched the recap of the towers falling again and again. After two days of sitting watching the news, I needed to do something to help. I heard there were crisis centers set up in lower Manhattan for rescue workers and families of the missing. I thought my social worker skills could be useful. I took the train down the city and walked downtown hoping that through divine intervention I would be led somewhere that I could be helpful.

I found a crisis center at Chelsea Piers. I talked to the woman in charge of mental health there. She first said she was only going to take people already with their masters who were licensed, but for some reason she let me stay. I first worked with families who came looking for information regarding their missing loved ones. We tried to comfort them and gave them the latest information on where to go and who to call to try and locate the missing. Sadly as more and more time passed, and the search went from rescue to recovery, there was a greater understanding of the unimaginable casualties that were the result of this horrendous attack.

I spent my days at the crisis center listening to rescue workers who were seeing unspeakable scenes of devastation at the site. I also talked to people who were at the scene during the fall of the towers and witnessed horrific images that will haunt them for the rest of their lives. I worked along side caterers, massage therapists, other mental health workers and other people who came because they felt like I did, helpless and powerless. Helping, even in a small way, made us feel less helpless and more in control. I set up a paper wall outside of the Pier which people could sign and write prayers and tributes to those lost.

I know the volunteer work I did following September 11th was so insignificant compared to the work many did following the attack. I am in awe of those selfless firefighters, police officers and other emergency responders who gave their lives to help others that day(and every day). I would like to think though that all of the small acts put together added some goodness into a suffering, broken and devastated city. I think doing special acts of kindness on a day that signifies such a deep, painful loss for so many is something small that can honor the memory of lost loved ones. Love, resilience, strength and compassion brought New Yorkers together on September 11th. These traits still bring light to our mighty, yet still healing city today.

Friday, September 2, 2011

The Value of Having Fun

"You've gotta dance like there's nobody watching,
Love like you'll never be hurt,
Sing like there's nobody listening,
And live like it's heaven on earth."
— William W. Purkey
This is one of my most favorite quotes. I love it so much because it encourages everyone to live life to the fullest and with your whole heart. Practically speaking, it seems almost impossible to live in this way every moment. Life is complicated and stressful, and sometimes our journey requires us to protect our heart and just “get through” the day, instead of celebrating every second of it.

After having surgery for endometriosis in July, I had been feeling stressed and overwhelmed with life. During my recovery, I was taking life one minute at a time and trying to make it through the day. I hadn’t been out of the house much since my surgery. I really wasn’t even talking much to friends and family. The little energy I had to spare was devoted to taking care of my daughter. Slowly, I started to feel better.

My mom, a devoted Bruce Springsteen fan, called me to tell me there was a Bruce Springsteen and the E Street cover band, Tramps Like Us, playing at a local bar. She told me to get out of the house and come along. I hesitated. Was I really feeling up for it? Was I ready to be out in public?

I was worried because when you are in pain or have low energy, pretending as if you are feeling good takes an incredible amount of energy. My mom persisted, and soon enough I had two of my oldest and dearest friends on board to go out too. My aunt, who recently battled a serious form of uterine cancer, was also coming out. I had no excuse. I brushed my hair, put contacts in, put makeup on, and even put on a tube top. I don’t think I have worn a tube top since 1999. I don’t think I have worn makeup since March.

My dear friend came and picked me up and we were on our way. I started feeling anxious as I walked into the bar. I hadn’t been out in a long, long time. We entered the crowded outdoor patio where the band was playing and I spotted my parents and my aunt who were seated around a picnic table. Within seconds I was presented a beer by my aunt and could hear my mom shouting over the band, “If you close your eyes, it’s like you are at an actual Bruce concert!”

I couldn’t have predicted the fun we had that night. Due to the volume of the music, I was able to “sing like nobody’s listening” to my favorite Bruce songs. After a few beers, the pain from my surgery faded and I was able to “dance like there’s nobody watching” (although I did pay for my excessive dancing the next morning as my inactive muscles protested the festivities). By having fun, we had all escaped our difficult weeks for just a little while.

I forgot how important having fun was. When I am stressed to the max at a difficult point in my journey, having fun can seem trite and meaningless. When I was a little girl and even straight on through college, it seemed life was centered around having fun and hanging out with friends. Now if I see my friends once a month it is a big deal. Life gets hard and complicated. Going out and having fun sometimes seems like it would take a lot of energy to accomplish. Why go out when I can collapse on my couch in my sweat pants?

I came home from that night of fun feeling so good. I felt energized emotionally and spiritually. It felt good to dance and sing and laugh. I was so grateful and proud to be there with my aunt who has gone through hell to fight her cancer. She looked happy and healthy after being so sick for so long. The truth is that all of us out that night have been through our own personal hells, but having fun made life a little brighter. I made a promise to myself to make having fun a new priority in my life. I was incredibly grateful for that night out. I always took having fun for granted but now I know that it's a special thing that I have to make time for.

Tramps Like Us played Bruce Springsteen’s song “Tunnel of Love” that night. My mom had that album on tape and would play it constantly in her 1980 red Toyota Corolla when it first got released in 1987. I was just 8 years old when it was being blasted in our car. Although I knew all the words, they had little meaning to me then. As I sat out on the patio that night, listening to the cover band sing the lyrics, “You've got to learn to live with what you can't rise above,” the song suddenly had meaning to me. There are certain things we cannot overcome. Life brings us some sadness that will be with us forever. There will always be stress and overwhelming parts of our journey. But as William W. Purkey states, we still need to manage to have moments where we “live like it's heaven on earth,” because even through the hardships, it is only one life we get to live.