It takes a village to make an embryo

Nothing can be “shot from the hip” when it comes to egg donation and surrogacy. If you talk to any family who is going through a fertility journey, they will speak to the careful planning and logistics that goes into each step. My partner and I are no different. I’ve known for a long time that I be unable to have biological children, and this process has still been much more complicated than I expected. We are working with at least half a dozen parties who each demand that we attest through time and money that we want a child. Matt and I don’t get the intimacy of keeping our hopes for a family to ourselves while we wait for a missed period or a positive test. We have to declare clearly and consistently to strangers for months, if not years, that we deserve to be parents. There can be nothing casual about this decision, no happy chance encounter that leads to a miracle. We are hoping for a miracle born out of patience and careful planning. We need a cohort of professionals to work in lockstep with us to make it happen. Since I do not have any viable eggs, my primary role in this process is to coordinate the people we are hiring to help us. At this stage, that includes an egg bank, fertility clinic, insurance company, social worker, lawyer, and surrogacy agency. Let’s get into the details. It takes a village to make an embryo.

Because I was dignosed with Turner Syndrome as a young teen, our first appointment with a fertility clinic was fairly straightforward. We explained my history and our doctor ordered some tests to confirm that Matt does not have any fertility issues on his end. They gave us a list of surrogacy agencies and egg banks to look through. They also gave us the names of a few counslors in the area. Our clinic requires that we speak with a counselor specifically to discuss third-party reproduction before moving forward with them. They hold us accountable for that requirement by having the counselor write a letter to them for on our behalf. I’m grateful for how easy the counselor made this part. She was extremely flexible in her schedule. She ended up talking to us on labor day weekend. She set us at ease quickly by making it clear that this session was designed for her to provide us with some education around egg donation and surrogacy. She was not making judgements about our qualifications to be parents.

Finding an actual egg donor was far more challenging. The first donor we matched with fell through after several months of waiting. My takeaways from this are twofold: First, trust your gut. The egg bank we were working with at the time was not responsive or organized from fairly early on in our communication. We decided we liked the donor enough to be patient and continue working with them. That was a mistake. Second, I wish we had just chosen a donor with frozen eggs from the beginning. A fresh cycle offers the possibility of more eggs and better results if the eggs never have to be frozen. The fact that we were working with national egg banks, however, basically negated both of these benefits. We still were only going to recieve the number of eggs that insurance and the egg bank agreed were likely to lead to one child. These groups of eggs are known as cohorts. The agency would make any additional eggs available to other recipients as frozen cohorts. The donor also lived in another state, so she was going to have her retrieval done elsewhere and we were not going to be able to coordinate the retrieval with fertilization anyway. Please bear in mind, this bank was one recommended by both our fertility clinic and our insurance company. I spent weeks trying to communicate effectively with egg bank representatives in another state and time zone who were slow to respond to my phone calls. In multiple instances, it took them a week to respond to a simple email.

This experience left Matt and I both a little nervous. I dreaded having to go back to the on-line profiles of egg donors. I was pleasantly surprised when I found someone that Matt and I agreed on within a few days. I was committed to making this donor work. The new egg bank was responsive, and the frozen cohort was available and ready for us! And so I began my day off from my full-time job on the phone with a representative at our new egg bank. Matt and I are lucky enough to have fertility insurance coverage. Our egg bank filed the claim with our insurance, but the representative wanted to let me know that there was a small problem. We had requested two cohorts of eggs from the same donor in order to allow us to potentially have more than one child. Great! No problem! Our donor had enough eggs to allow for that possibility. But our insurance was asking us to fill out a form identifying the medical justification for purchasing two cohorts at once. Oh my goodness, I get salty about this kind of nonsense. What is the “medical justification” for wanting more than one child? Same-sex couples apparently also have to jump through this extra hoop if they hope for more than one child with the same donor. Our rep at the egg bank kindly let me know that she couldn’t move forward until I addressed this with our insurance.

Next, I had a phone call with our fertility clinic. They work with our egg bank frequently and both sides had assured us the working relationship was good. My goal was to make sure that they were aware of the new donor. They have to provide their own medical clearance of the donor before we move forward. Unfortunately, we encountered a delay with this medical clearance as well. In his initial medical screening, Matt underwent an extensive panel of genetic carrier testing to ensure that he wouldn’t pass on any avoidable inherited illnesses, as had our egg donor. Somehow, though, they hadn’t gotten the same carrier screening panel. The different medical providers had ordered slightly different tests. The single rare condition that popped up in our donor’s panel was one that Matt hadn’t been tested for. That meant he had to undergo another round of blood work, wait two more weeks, and discuss the results with a genetic counselor before our clinic would sign off. At least we didn’t expect the outcome to change. The odds of both Matt and our donor having one of these conditions was low. It was just one more obstacle placed to test our resolve, just a little bit more of our time and energy.

That afternoon, I called the insurance company to make sure our claims could go through and I completed the necessary paperwork. As my justification for consecutive egg cohorts, I wrote that I have Turner Syndrome. I’m still not sure how that’s different from my justification for the first cohort, but the egg banks can’t let infertile couples get too greedy. Matt and I also hopped on a video conference with a lawyer to review our contract with the surrogacy agency. Finally, I sent our surrogacy agency an email letting them know that we were getting close to having embryos. While some surrogacy agencies allow you to select a surrogate in tandem with embryo creation, we’ve selected an agency that works sequentially. We won’t be eligible to match with a surrogate until we have the embryos. I took a breath. The egg bank, insurance, fertility clinic, and surrogacy agency were all on the same page. We all knew our next steps.

I wish that Matt and I could do more of this in private. It feels very sterile and impersonal to be maintaining professionalism while working towards something as intimate as making a baby. As challenging as this is, I am still grateful that we have the science to make this family building possible. Most of the people we work with are so helpful and kind. IVF is an absolutely astounding scientific achievement for which we will always be grateful. The fact that we are able to bring all of these different people and organizations together to make our embryo feels like it’s own every day miracle.