Step 8 (Optional Bonus Step): OHSS

*Note: This post was much delayed and a long time coming. Probably because it hurt so fucking much to go through it. I needed to get some space from egg donation, some distance so that I could re-evaluate whether or not I wanted to go through this again, whether it was worth the personal, physical cost. So, without further adieu, Step 8 (also known as the Step I hope you never experience).

OHSS. Ovarian Hyperstimulation Syndrome. According to the Mayo Clinic

“Ovarian hyperstimulation syndrome may occur after using injectable hormone medications during in vitro fertilization (IVF), a treatment for infertility. Injectable fertility medications stimulate the development of eggs in the ovaries, but it can be difficult to tell exactly how much medication you might need.
Too much of the hormone in your system can lead to ovarian hyperstimulation syndrome (OHSS), where your ovaries become swollen and painful. A small number of women may develop severe OHSS, which can cause rapid weight gain, abdominal pain, vomiting and shortness of breath”

But describing the problem as the ovaries becoming swollen and painful is not quite accurate, because not only do the ovaries become swollen and painful, but they keep producing fluid, such as that which would fill a follicle. Only now, post retrieval, the fluid does not remain contained in the ovary, but seeps into the ‘third space’ of your abdominal cavity. Here is collects and as it does it draws more fluid from your body, leaving a person with OHSS at serious risk for dehydration (among other potential complications). Persons with OHSS often experience increased pain post retrieval, a sense of fullness, and, in moderate to severe cases, often experience shortness of breath as the build up of fluid impedes your diaphragm’s ability to do its job and limits the amount of space your lungs have to expand. In addition to the shortness of breath this might result in, you may not be able to sleep on your side, will likely experience short term weight gain that is visible in the form of abdominal bloating (I gained 10 lbs of fluid weight and looked about 4 months pregnant when I had OHSS), may experience shooting pain in your shoulder as nerves are pinched, may stop urinating as fluid seeps into your abdomen instead of filtering through your kidneys and into your bladder, and may be unable to move without pain. The fluid buildup can be seen on an ultrasound and though it will go away after you have your first post-retrieval period (generally 7-10 days post-retrieval) because your ovaries are no longer trying to produce eggs and the HCG will have left your system, if your OHSS is moderate to severe you may find that you are back in the clinic getting the fluid drained transabdominally or transvaginally (if this is the case, I highly recommend bringing a companion who can drive you home, because having a giant needle puncture your vaginal wall to suck out the fluid when you’re stone cold sober hurts like hell). OHSS typically peaks 3-5 days post retrieval. But how do you get here?

So the retrieval happened and it’s time to recover. Maybe the clinic has you come in for a follow-up scan to check for early warning signs of OHSS or maybe they don’t. Maybe you’re in a lot of pain, maybe you’re not. Maybe your clinic gave you pain killers, maybe they didn’t (mine didn’t). There is an immense amount of variation in terms of how smooth or rough your post-retrieval recovery could be and there are a variety of factors that contribute to that recovery (though very little research on donors). If your clinic triggers you with a non-HCG trigger, chances are you won’t get OHSS (seriously….chances are next to none), but if you’re clinic used a dual trigger that included HCG or an HCG only trigger, you might end up with OHSS. Of course, the type of trigger is not the only thing that contributes to OHSS, but some of the minimal research available has shown that when non-HCG triggers are used OHSS very rarely happens.

Now, as a donor, your clinic has likely told you that the risk of OHSS is extremely low (around 1-3%). What they might not have told you is that these stats come from studies on IVF patients, not egg donors. The reality is that there is very little research on the short and long term impacts of egg donation on donors themselves, making this statistic not entirely meaningless, but pretty close to it since it is based on a very different demographic. So since the actual risk is unknown, how do you know if you will or won’t get OHSS? It’s hard to know for sure given the lack of research, but based on the research that has been done, there are definitely some things that will put a donor at higher risk of developing OHSS. These include:

  1. High antral follicle count
  2. High AMH
  3. PCOS (poly-cystic ovary syndrome)
  4. HCG trigger
  5. Aggressive stimulation aimed at producing a high number of eggs

Now, number 5 is in bold because in looking at the experiences of donors from various informal sources, OHSS appears to be much more prevalent when donors are stimulated to produce a high number (generally 25+) of eggs. While there are clinics that will argue that you want quality over quantity and that producing a higher number of eggs generally results in lower egg quality and lower fertilization and blast results, the mentality that more is better (more chances to conceive, more chances for siblings, and the ability to ‘share’ the cycle to reduce IP costs by splitting the eggs among multiple IPs) remains extremely prevalent in the world of IVF in North America. If you look to places like Australia where egg donors are (in theory) not compensated for their donations, you will see that the number of eggs retrieved tends to be between 10-15, sometimes closer to 20. In contrast, US numbers tend to be on average significantly higher, with donors regularly reporting egg retrieval numbers above 30 and not infrequently in the 40s and 50s. There are even some fertility clinics that will turn away donors that have what they perceive to be lower antral follicle counts or who have a history of producing between 10-20 eggs because the expectation is that donors will be stimulated to produce an enormous number of eggs and anything less is unacceptable. This mentality is then imposed on donors, with ‘high performers’ being told that they should be proud of themselves and that they/their ovaries ‘did an amazing job’ and ‘low performers’ being discouraged from donating again in the future. This mentality is also prevalent on ivf forums where IPs express alarming levels of anxiety and ungratefulness when their donor produces what they perceive to be a ‘sub-par’ number of eggs, but which, in reality, if the health of the donor is taken into consideration, is an amount of eggs that is significantly less likely to result in painful OHSS and long term health consequences.

While I could go on forever about what contributes to OHSS, the ethics of overstimulating donors, and the heavily commercialized (in some countries) IVF culture that puts the health of egg donors at risk in the quest for more eggs, I’d like to briefly mention a couple of things that can be done to reduce the risk of OHSS:

  1. Number One on this list is closely monitoring and controlling the stimulation of the donor’s ovaries and the donor’s e2 levels. If either of these are rising at a high rate, stimulation (those injections you’re doing) can be scaled back, doses can be reduced, and donor’s can even be ‘coasted’ (meaning they stop injecting stimulants before the trigger date) to reduce the risk of OHSS. Donor’s can also be trigger sooner (for example triggering on day 8 instead of day 10) if there are already a reasonable amount of follicles close to maturity.
  2. Number Two is using a non-HCG trigger. For more details see the post on Step 6 (The Trigger)
  3. Dostinex/Cabergoline. This is given to donors, either preceding their retrieval or beginning on the day of retrieval to reduce the risk of OHSS.
  4. A shot of cetrotide: This is the shot that donors often take to prevent themselves from ovulating too early. It can also be given to a donor post-retrieval to shut down the ovulation process that the trigger has kicked into overdrive and reduce the risk of OHSS.
  5. High Salt, High Protein Diet: This is highly recommended by many clinics and generally includes drinking copious amounts of gatorade or pedialyte or other high electrolyte/salt beverage in place of water, but I have yet to see actual academic research supporting it. I followed this diet plan and still had OHSS, other donors haven’t even heard of it and have never experienced OHSS.

There are also ways that you can monitor your body to detect the early warning signs of OHSS, such as weighing yourself throughout your cycle and seeing if you experience rapid weight gain post retrieval that could indicate fluid build-up, monitoring your urine output to ensure that the liquid you take in is going out and not ending up in your abdomen. Not everyone with OHSS will experience all of these symptoms to the same degree, but if you suspect that you have OHSS please contact your clinic immediately. Some clinics are notorious for not taking OHSS seriously and for down-playing donors concerns, but if you are concerned for your health stay on them. If you are having trouble breathing and/or are significant pain in the days following retrieval and your clinic is not taking your concerns seriously, go to the hospital and be sure to tell them that you have just donated eggs. It is important that in addressing your health concerns post-donation you address them to a nurse and/or doctor that has experience with IVF and/or egg donation, as your local GP/family doctor may not be familiar with the risks and complications.

The bright side, if there is a bright side to OHSS, is that it won’t last forever. It will go away once you get your first post-retrieval period (unless you get pregnant…but as an egg donor this is probably not what you’re planning on post-retrieval. As a side note, those who undergo IVF and end up with OHSS and do get pregnant are at significantly higher risk for OHSS because of the rising HCG levels in their body that result from being pregnant. Such persons may experience OHSS for months). While it may take another menstrual cycle or two for your body to feel fully back to ‘normal’, the OHSS will eventually go away. This doesn’t mean that you should ignore your symptoms  – severe OHSS can be fatal – but more to suggest that there is a light at the end of the tunnel.

One additional thing that donors can keep in mind is how to hold their doctor’s accountable and, if you decide to donate again after experiencing OHSS, how to discuss with a (hopefully new) clinic and doctor how to avoid OHSS in your next cycle.

For more more information on OHSS, here are some links that I’ve found useful when I went through my OHSS (which resulted from being overstimulated, triggered with a dual trigger containing HCG, and being triggered later than I should have):

  1. Wikipedia! (Not because I think wikipedia is generally a great source of information, but because this particular entry provides some basic, useful information).
  2. Mayo Clinic
  3. Advanced Fertility Centre of Chicago (One of my favourite sites for OHSS info)

I experienced OHSS with my first donation and, as a result, refuse to work with that clinic or doctor again. I took some time, after that first donation, to really re-evaluate whether or not I wanted to go through the process again and decided that I did, if only to find out if there is a protocol that would let me donate without severe health complications (ie. OHSS). I’m looking forward to my next donation and hoping that it isn’t as rough as my last one. If it is, it’s unlikely that I’ll donate again.

Have you experienced OHSS? If so, what was your experience like? Let me know in the comments.

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Step 7: The Great Harvest (aka. Egg Retrieval)

So you’ve triggered, had a day off from stabbing yourself with needles, and now it’s retrieval day. If your reaction to the trigger was anything like mine you’ve likely had a couple pretty emotion days, days which may include crying for no reason (because…hormones) and feeling so bloated and tender that even your stretchy pants aren’t doing the trick so you’re hugging a hot water bottle and staying as sedentary as possible. If you’re not like me (and/or have fewer eggs rapidly maturing) then you could be fine and dandy, going about your pre-retrieval time like it’s any other day (if so, consider me jealous). On the day of retrieval you’ll likely be heading down to the clinic in time to be there an hour or so before the retrieval and depending on the clinics protocol you might not have been allowed to eat or drink for a set number of hours prior. For me this meant that I couldn’t eat anything after midnight the night before the retrieval and could only have clear liquids up until 4 hours before the scheduled retrieval time. Needless to say, by the time I got to the clinic I was pretty hungry.

So, cue arriving at the clinic. Protocols will differ depending on the clinic that is doing your retrieval. For me, I arriving about 90 minutes prior to the retrieval time, got all gowned up, and then had to give a urine sample that the nurses used to confirm that I had indeed given myself my trigger shot (yey trust!). Then things got a bit dramatic. Please remember that what follows is based on my personal experiences. Many egg donors have successful retrievals with little pain and no negative experiences. I was not so lucky.

To begin, I’m afraid of needles and while I had gotten over some of the fear during the injection part of the cycle, I definitely know my limits and getting an IV is one of them. In order to ease the process, my doctor and nurse had agreed that I would receive some anti-anxiety meds before the IV was inserted. However, the retrieval nurses had a different opinion and, despite my objections, insisted on putting the IV in first and doing the ativan second. Ugh. As predicted, I prompted fainted after the IV was in and was then no longer allowed any ativan because my blood pressure kept dropping (because of the IV….ffs). So cue me being hooked up to an IV, laid out on a stretcher, and feeling like crap. But hey, I was only supposed to have another hour to wait to how bad could it be? Well, it turns out it got pretty unpleasant. As things got closer to the scheduled retrieval time my pelvic region became really sore. Like terrible cramps where is my wine bottle kind of sore. I was told I was not allowed any painkillers but that the retrieval would start soon. So I laid there. Hurting. Cramping. Hungry. Waiting.

Then came the cherry on top: as the time my retrieval was scheduled to start came and went, I continued to lay on the stretcher. Eventually a nurse told me things were delayed. By the time I was actually taken to the retrieval room we were an hour behind schedule and I felt like my ovaries were trying to push their way through my stomach. Awesome.

Alright. So retrieval time. I went into the small retrieval room, got into the chair and stirrups, and finally received the pain meds + conscious sedation meds to knock me out. Hurray. I remember nothing of the retrieval itself and I’m very happy that way.

Cue being woken up after the retrieval, still in the stirrups, being told I need to walk back to the stretcher room. Cue blinding pain that has me bawling my eyes out and the nurses dismissing it as me being ‘drunk’ on the sedation medication. Cue me curled up in a ball on the stretcher for 30 minutes waiting for the pain killers they gave me right before waking me up to kick in. Cue my pain being continually dismissed as I’m left crying in the room hooked up to a saline IV, my partner extremely concerned because they’ve never seen me cry from pain like this. Cue the nurses giving me side eye as I ask for painkillers to take back to the hotel with me and then begrudgingly giving me a few T3s, telling me to come back tomorrow (I do and am told to go buy some tyelonol).

After about 30 minutes the nurses started pressuring me to the leave the clinic, so I did. Walking at the pace of a snail. I asked for the results of the retrieval and was denied the information. I felt like a commodity that they had squeezed dry and who was now just in the way. There was no support to be found from them, everything now was about the IPs (intended parents). Time for me to leave.

I strongly feel that my retrieval experience could have been incredibly different if I had been treated like more of a human, with real pain and real needs. I strongly feel that I was treated like a number and that the physical pain that I experienced was ignored because egg retrievals are what these doctors and nurses do every day – they see hundreds of IPs undergoing fertility treated, hundreds of donors giving their fertility up for the benefit of others – and my pain was just an ‘over-reaction’. In reality, the pain I was feeling was like that of a bursting ovarian cyst, something that I experienced five days later when I had fluid drained as a result of OHSS. I only learned that this was likely the cause of the pain a week later, when I described my post-draining pain to the doctor and he said it wasn’t from the draining but from a cyst bursting. My pain was real, it was blinding, and I was treated like a whiney nuisance.

Needless to say, I will not be working with that clinic again in the future, but despite the horrible retrieval experience, I will donate again. I also feel more confident that I will be better able to advocate for myself because I now have a much better idea of how my body responds to the medications and what the various potential pains could mean if I experience them again. Something tells me that the nurses would have taken me more seriously if I could have confidently told them that a cyst was bursting (which can be fatal) than just telling them that ‘it hurts’. But I shouldn’t have to. Every egg donor should be treated as an individual and if their body is hurting the cause should be identified and treated, not ignored. Egg donors are literally giving their fertility to others, something that they are applauded for and thanked for at various times and to various ends (such as when IPs, agencies, or doctors are trying to pressure a donor into another donation), but which can disappear completely when egg donors are treated like commodities and tossed aside the minute the eggs have been extracted. The reality is that eggs are a commodity but they also come from people and those people need to be treated with respect and dignity. Their health needs to come first, not the wishes of the IPs. Just because the donor isn’t paying the medical bills doesn’t mean that they don’t deserve the same quality of care that IPs receive. The cost of egg donation is not just something that IPs pay for, it is something that egg donors pay for every day of their cycle and recovery. Egg donors pay with every puncture, every probing ultrasound, every emotional roller coaster, and every day of healing. The cost isn’t something that lines the pockets of fertility clinics or donor agencies, but it is a cost that is paid.

Step 6 – The Trigger

So you’ve been injecting yourself and going for monitoring visits to the point where you officially feel like a pincushion. Your ultrasounds are uncomfortable/painful, maybe you’re bruised or sore from injections, and maybe the inside of your elbows are sporting some pretty sweet bruises from all of those blood draws. You might also have had to go and buy some stretchy pants to accommodate your bloated tummy and if you’re really lucky you might just be waddling. Finally, you go in for your last monitoring appointment before the trigger. Now, at some clinics this ultrasound might be performed by a tech, but at others your doctor will insist on being the one to perform this final, pre-trigger ultrasound, which means you might want to bring a book with you and some food because you could be waiting a while. Take advantage of the time you have to wait to prepare any questions you have for the doc, such as what trigger you’re using, why you may or may not be comfortable with that trigger, and how you plan to advocate for yourself if need be. Also prepare to have this conversation while the doctor is doing the ultrasound….because at some clinics that will be your primary (and maybe only) opportunity to get answers to your questions. This was the case for me and by this point I’d had enough ultrasounds that my modesty was not going to get in the way of me pushing for a trigger I was comfortable with.

So, about those triggers. There are 3 primary kinds of triggers that doctors give. Whichever one is standard varies from clinic to clinic and doctor to doctor and I strongly encourage you to research them and be aware of whether or not you are at high risk for OHSS (ovarian hyperstimulation syndrome), because this should definitely inform what trigger(s) you receive.

  1. HCG only: This trigger has been around for the longest and is arguably the most popular. It is the hormone that the body produces during pregnancy and will show up in your urine (so your clinic will be able to tell if you’ve injected it). It’s common for IVF and the normal amount that is injecting is 10,000 units. It’s extremely important to note that HCG is what causes OHSS, so if you are high risk (PCOS, high AMH, high antral follicle count, high number of follicles stimulated during this cycle, high estradiol/E2, etc.) taking this will almost guarantee that you will get some form of OHSS. Doc’s like to argue that because egg donors are not going on to become pregnant their risk of getting OHSS is lower and so this trigger is legit, but that is absolute crap. You can still get severe OHSS, it’s just that if you also get pregnant after your OHSS can last a hell of a lot longer (we’re talking months), compared to the 1-2 weeks (or more) that it is likely to last in an egg donor. One of the reasons for this is that HCG stays in your system for up to two weeks (depending on the dose) and this means your body continues to be stimulated. So, in short: HCG, arguably the most common, arguably the most dangerous.
  2. Lupron only: Lupron is a GnRH agonist (google is your friend here for more information) and when used as a trigger there is no risk of OHSS. What? That sounds magical! Why would any doc in their right mind still insist on using HCG, especially when egg donors are often being stimulated to produce a high number of eggs and are therefore generally at risk for OHSS? Well, in 1% of cases, lupron does not produce a significant enough LH (leutenizing hormone) surge to trigger the eggs to enter into their final stage of development, resulting in a wasted cycle or a diminished number of mature eggs being harvested. In my opinion, when the risk to the donor is higher than the risk of the lupron only trigger not working, it is medically unethical to put the desires of the IPs so clearly above the health of the donor.
    It has been suggested that a donor’s LH level might be indicative of whether or not the lurpon only trigger will work, wherein low LH indicates lupron not working (but if this is the case why not hold off on administering LH suppressing meds during the cycle?), and there have also been anecdotal reports on ivf forums that I frequent that donors have used the lupron only trigger but when it failed to work the doctor gave them an hcg trigger, but I haven’t found any concrete information on this so I’m not sure.
    Buselerin is another GnRH trigger that some have had success with, but I have not read much about it yet and am not sure if it carries the same 1% failure rate that lupron has. If anyone knows I’d love to learn more about it!
  3. Dual Trigger (Lupron+HCG): This is a trigger that doctors may turn to if a donor is at high risk for OHSS but the doc is unwilling to risk the eggs not maturing and thus is unwilling to part with the HCG. They may also use this as a ‘standard’ way to reduce the risk of OHSS, because a lower dose of HCG is more likely to leave your body sooner than a large one, but the dual trigger in no way eliminates the risk of OHSS the way a lupron only trigger would. Some examples of dosing here are 40 units of lupron + 4,000 HCG or 2,500 HCG. The amount of HCG can be lower than this, such as 1,000 HCG or potentially even lower, with doctors reducing it more the higher at risk you are and (potentially) the more you are able to advocate for yourself. A dual trigger is what I have experience with and I did get moderate OHSS that resulted in me having to have fluid drained transvaginally (ow!), but I’ll write more about OHSS, draining, etc., in another post.

On the night that you inject your trigger you will be given a very specific time to inject at (such as 11pm, 1am, or 3am) and this will correlate with the time that your retrieval is scheduled for, which will be 35-36 hours after you have injected the trigger shot(s). Depending on the shots you are given they will either be subcu or intramuscular and depending on how your body reacts they might burn/sting/hurt/etc. I had to inject lupron subcu into my tummy and then HCG IM in the butt. Both hurt, but the lupron really burned going in for me! So much so that it was hard to keep pushing the plunger. The good news is that it doesn’t hurt for everyone and once the needle was out it was over. You may also be injecting your usual stims earlier in the evening (or at whatever time of day you normally inject them), so prepare yourself for all of the needles and then rejoice that you’ll get the next day off!

While some people report feeling fine the day after the trigger, I felt wretched! I was super bloated, my boobs had swelled up and were killing me, and my grapefruit sized ovaries were full to the max! I basically waddled around when I had to move and otherwise tried not to. I had some sharp shooting pains at times that had me worried but was reassured that this was normal, so I got a hot water bottle and tried to ignore it (easier said then done). On top of this, my moods were seriously out of control (HCG is the pregnancy hormone after all) and I literally cried three different times for absolutely no reason. It was hilarious but also incredibly exhausting. By this point I couldn’t wait for everything to be sucked out of me the next morning during the egg retrieval, though the morning did not bring any relief as I was so bloated and uncomfortable/in pain from my ovaries being so huge that I was waddling along at the pace of a snail!

From here it was onto egg retrieval but I’ll save that adventure for another post. In the mean time, what trigger(s) do you have experience using? Have you found some to be better than others? Have you ever used a lupron trigger and had it not work? Were you waddling around by the end or did you remain relatively un-bloated? Let me know in the comments 🙂

Step 5 – It Begins – Monitoring + Injections for Everyone! (Part 2 – Injections)

Time to banish that needle phobia because shits about to get real: in addition to getting your blood taken at every monitoring visit you will now be giving yourself injections every night until you inject your trigger shot(s)! I’m going to first cover some tips for giving yourself your injections, both intramuscular and subcutaneous, and then discuss dosages, trigger shots, and anything else that comes to mind. Note: This is based on my experiences with a short 10-day injection protocol. Some may experience a ‘long-lupron’ protocol, may stim for longer or shorter, etc. etc. disclaimer disclaimer.

Now, more to the point (get it? needle pun? Oh yeah), the majority of the needles you will be giving yourself will be subcutaneous injections, which means they’re going into your fat, generally on your tummy or thigh. Be sure to follow your nurse’s instructions and get your nurse to demo giving you a shot or do your first shot in front of your nurse so that you can be sure that you’re doing it correctly. I injected in the fatty deposits near my belly button, about an inch+ away and to either side or below. I never injected into my thighs because I found the tummy injections to be very easy to manage (once I got used to doing them) and not very painful. What I did learn (and was surprised to learn) was that injecting on my left side hurt less than injecting on my right side. I have no idea why and peeps are welcome to leave their thoughts in the comments below. This pain dillio reversed when it came time for the butt (aka intramuscular or IM) injections, when I discovered that getting stabbed in the right cheek hurt less than the left.

Ok, so you’ve got some subcutaneous injections to do. Maybe your protocol starts you on just one, for example gonal-f, or maybe you’re started out on multiples right away. Mine went along the lines of gonal-f for 3 nights, then add in cetrotide (to prevent ovulation), then add in repronex/menopur for the rest of the nights, then the night of the trigger I had all of those PLUS the two trigger shots (dual trigger of Lupron + small amount of HCG). Here are some things that worked for me to make these injections a bit easier to bear:

  1. The needle that goes in your tummy will be TINY! and I promise that it will hurt less than you think it will.
  2. If you’re worried about pain, some people ice the skin before injecting. I’ve done both ways and don’t notice too much of a different for the subcu injections.
  3. After you’ve prepped your meds + swabbed your injection site, I found it helpful to gently pinch up a little mound of fat where I intended to insert the needle.
  4. Insert the needle in a quick, dart-like motion! The quicker you stab the less it hurts I promise! Remember that for subcu injections you can put the needle in on either a 45 or 90 degree angle to the skin.
  5. Once the needle is in past the skin you won’t feel much at all, the part that hurts is the puncturing part and it really is just a pinch (this is coming from a needle phobe!)
  6. Once the needle is in, gently release your little fat mound
  7. Inject the fluid slowly and steadily.
  8. Depending on the meds you may or may not experience some burning, itchiness, or irritation as the meds are injection or afterwards. I never had a problem with my gonal-f injections, but the cetrotide, depending on where it was going, tend to give me a bit of hell afterwards. I used ice for this injection to minimize the discomfort both before and after, as well as massaging the area after the needle was removed.
  9. Remove the needle smoothly and quickly and apply pressure for a few minutes.
  10. TADA! Tummy injection given!

One thing I found is that the gonal-f injections would make me dizzy, so I preferred to do the injections at night when I could just go to bed after and not have to worry about driving or doing anything that required effort. Read the information that comes with the medication to make sure that you are aware of the potential side effects.

Time to get it in the butt! Intramuscularly that is. Intramuscular injection were really not great for me and I’m really glad that I didn’t have to do a lot of them. That said, I would have way rather not had to do any! Following the advice of another blogger, I asked my nurse to draw circles or squares on my bum to indicate where the injections should go, on both the left and the right. This was hugely helpful because I didn’t want to stab it in the wrong place and I was worried enough about the injection on its own. Now, there are those that are able to do their own intramuscular injections, but I am not one of those people. By this time my ovaries were already pretty tender and swollen and my range of motion was pretty limited, so I had my partner do the honours. The main thing I was injecting was repronex and then the HCG portion of my trigger and I completed a total of 5 butt shots (ugh). Here’s how I did it:

  1. Prepare all meds
  2. Do tummy injections first
  3. Ice injection site for 5 minutes or so
  4. Lay down on couch or bed
  5. Have partner stretch the skin taught where the needle will go
  6. Work up the nerve to say ‘Ready’ (I used the inhale, exhale method, so that once I said ready I would be given the shot on the next exhale)
  7. Insert needle quickly! using a “swift, dart-like motion” on a 90 degree angle to the skin
  8. Some instructions say to pull back on the plunger gently at this point to check for blood, but I never did this because my nurse never told me too….
  9. Inject medicine!
  10. Remove needle as per usual and apply some gauze and pressure
  11. I found it helpful to massage the area and walk around a bit to disperse the medicine – I’m not sure if this reduced the amount of soreness I felt the next day but I like to think it did. Really though I have no idea since I never did a comparison
  12. Expect your injection site to be tender the next day! Mine bothered me while driving and I also had to be careful carrying my bag on my back
  13. Everyone reacts differently, but omg the butt medication I got was really not a great sensation going in, especially on the left hand side. Also, I think we might have hit a nerve on one of the injections because that time it hurt like nobodies business.

Some people experiences bruising and a lot of irritation from the injections, but this was not my experience. Some meds hurt going in or for a bit afterwards, but overall my reactions were quite mild side-effect wise. In general, I started to feel like quite the pincushion and I definitely became increasingly bloated/poofy as the days went on. By day 5/6 of stimming I couldn’t do my pants up anymore because I was too bloated and my ovaries were making themselves known. That said, everyone is different! You might end up waddling and walking slowly like me or you might be fitting into your favourite pair of jeans like you own the place. Either way, by the time you get to your trigger shot you’ll likely be extremely tired of needles and ready for a break. Speaking of trigger shot(s)….

There are three main trigger shots and you should find out early on which one your clinic favours and what you’ll likely be told to inject – this way you will have lots of time to advocate for yourself if that’s what you need to do. These three types are:

  1. HCG only
  2. Lupron only
  3. Dual trigger (mostly lupron but with some hcg, two separate injections, generally lupron subcu, hcg IM)

I’m not going to get into all of these right now, but I will likely do a later blog post dedicated to discussing triggers and providing links to some useful resources discussing their differences (for now, I trust you to use the power of google). Whichever one you end up using, you will be told to inject it at a very specific time (such as 1am or 3am or 11pm) and this, as your clinic will likely emphasize, is the most important injection ever *dun dun dunnnn*. So set an alarm to go off before the time that you need to inject and have at her. Warning though: While some people found these to be painless, I found both my lupron and hcg shots were definitely not painfree as the meds burned going in. On the upside, once the injection was done, so was the pain! And I got to have a little going away party for my eggs 🙂 Did your trigger shots hurt? Got any injection tips or resources? Also, how many needles did you end up stabbing yourself with (my total was 19! Plus blood tests, plus retrieval related needles)? Let me know in the comments!

Step 5: It Begins – Monitoring + Injections for everyone! (Part 1 – Monitoring)

Time to get ready to stabbity stab stab yourself with needles! Hurray! Once your protocol begins (providing you are doing a short protocol and not a long lupron protocol (I don’t have experience with the longer one so won’t be posting about it)) it’s time to start being monitored and injecting your meds. Since there are two parts to this – the monitoring visits and the injections themselves – I’m going to break my Step 5 post into two smaller ones: Part 1 will discuss monitoring and Part 2 will discuss the injections themselves.

So, what is a monitoring appointment? Monitoring appointments generally involve you going to the clinic (most make you come during a window of time in the morning) and getting an internal ultrasound to count your follicles plus bloodwork to check your estradiol (E2) level, your leutenizing hormone (LH) level, and your progesterone (prog) level. They’ll get all of your hormone levels from one tube of blood so the bloodwork is normally pretty quick, and depending on the clinic they might have to wait a while for the results to come back later that day or they might be able to ‘rush’ the results so that you can hang around and find out the results (and the implication of those results for the meds you are taking) before you leave. So bloodwork happens, it gets sent to the lab (which might be in house), the nurse gets the results and consults with the doctor, and your protocol (injections, next monitoring visit, etc.) is tweaked if necessary. Depending on the clinic you might stay to speak with your nurse in person about your results and any changes to your medication, next visit, etc., or they might send you on your way and contact you by phone or email. At my clinic I always wait for the results to come in (normally takes about an hour, so I just go grab some tea) so that I can discuss everything with my nurse afterwards. I also always ask to find out the results of both the bloodwork and the ultrasound (follicles + sizes if I’ve already started injecting, plus E2, LH, and prog levels).

Note that not all clinics, nurses, or doctors are open or willing to provide egg donors with these results but it is your right as a patient to know them. I’ve been told that I ask “a lot” of questions and want “a lot” of explanations (heck, it’s literally written in my file) and to me this is a bit scary to hear. To me, this sounds like medical professionals presuming what a patient ‘needs’ to or ‘should’ know based on their own assumptions about egg donors and young women in general and the result is that egg donors may not receive adequate information about the significance of their test results, the medications their taking, and other things related to their egg donation. If I wasn’t asking questions I could easily have gone through my entire donation without knowing how many antral follicles I had, how many eggs were growing during stimulation, the side effects of various medications (which I was only told were possible side effects after I experienced them), etc., and to me that’s not ok. Another fun tidbit is that if the IP(s) that are getting your eggs have gone through IVF before, they will likely be asking about all of your test results (your follicle count, your E2 levels, etc.) and that information will generally be provided to them to give them an idea of how your egg donation is progressing. It’s entirely possible that egg donors go through their entire egg donation and recovery knowing less about their own body than the IP(s).

In terms of getting this information from reluctant health care providers, the reality is that it is your body and by law you can request a copy of any and all of your medical files, reports, test results, etc., and the clinic has to comply. This can take the form of requesting a copy once everything has finished, requesting copies along the way, or asking and writing down your results while meeting a doctor or nurse face to face. I ask face to face, but I also request a copy of my complete medical records one a cycle is finished. Remember that health care professionals are humans, they have a lot of patients to meet in a day, and they are used to most of their patients just smiling and nodding along with the limited information that they are given. Also remember that the treatment that egg donors receive is often very different from the time, information, and bedside manner that IPs receive (they are, after all, the ones paying all the bills) and that it’s ok to recognize this and ask for more. Take your time when meeting with your nurse or doctor and try not to be intimidated by them or let them rush you out of the room. You are allowed to ask questions and get answers, you are allowed to be concerned about your health and the toll this process is taking on your body, and you are not being ‘difficult’ when you ask these questions or prompt these discussions.

The ultrasound portion of your monitoring appointments will generally be done by an ultrasound tech, although in many cases the Doctor that will perform the retrieval will insist on performing the last ultrasound before they decide to trigger you. Generally the first monitoring ultrasound appointment happens on day 2, 3, or (sometimes) 4 of your first period after you’ve stopped taking birth control pills. While messy (particularly if, like me, you’re day 2 is pretty heavy in the flow department) this ultrasound should be no more uncomfortable than any other internal ultrasound you’ve had and your follicle count should be similar to the initial antral follicle count that was conducted during your new patient appointment. Your next appointment will depend on your clinic and protocol but may be 2-4 days after you’ve started injecting the stimulants (stims). Expect this next appointment to be more uncomfortable physically, because you’ll likely have started growing follicles (with eggs inside!). Expect the ultrasounds to become more uncomfortable and potentially painful at times as your ovaries grow larger and more tender (and take up more space!) as a result of the numerous follicles maturing within them. It’s ok to let the tech know that if it hurts, though there might not be much they can do about it. For me it felt like cramping pains in my earlier appointments, but the later appointments got pretty painful at times.

Frequency? This depends on your clinic. Mine told me to be prepared to come in every day after day 5 or 6 but then ended up having me come in on every other day and the only back to back visits I had were the second to last and last (Doctor+trigger day) appointment before the retrieval. Some clinics also want you to come in for a post-retrieval monitoring visit to help identify OHSS symptoms, so the number of visits will vary depending on your clinic, your protocol, and how your body responds to the meds.

Another thing to keep in mind as you progress through your protocol is that by day 5 or 7 you’ll probably be very aware of your ovaries and your lower abdomen may be quite tender, uncomfortable, and at times painful, because of how big your ovaries are growing and how much space they are taking up. You may notice that going to the bathroom is a bit more difficult as using your pelvic muscles can make you more aware of the tenderness of your ovaries and the meds you are injecting might make you a bit constipated. Keep an eye on things and take to your nurse if things become problematic – it’s important that things keep moving at this stage because post-retrieval constipation generally worsens! You may also notice that you’re quite bloated in your lower abdomen. I personally couldn’t wear jeans after day 5 because it was too uncomfortable so I bought myself some amazingly comfortable stretchy pants + leggings and they made a world of difference! Dress comfortable, don’t make sudden movements, and take care of yourself! I also had to eat smaller meals more frequently because I became full really quickly as a result of there being less space for my stomach (seriously…those ovaries are real space hogs). Your clinic will likely also have you on a high protein + high sodium (salt) diet during your protocol as well, so follow their instructions and take good care of yourself (I might do a separate post on the diet thing later….).

That’s all for now! Good luck with your monitoring and feel free to share any of your monitoring (mis)adventures in the comments.

Step 4: Off Birth Control and Waiting to Bleed

So in my last post I listed all of the generic steps that one can expect to go through in the egg donation process and, as a result, I wasn’t really sure what to write about next! So rather than not posting anything, I’ve arbitrarily decided to do a post on what happens once your legal is signed (I might write another post about this particular aspect later when I have my contract on hand) and you’re waiting to start injecting.

Things at this stage are pretty straight forward but involve a lot of waiting. Here are the basic stages:

  • Once you are ‘synced’ with whatever womb is getting your eggs, you get a ‘calendar’ from the clinic telling you when to stop taking the birth control pills.
  • Once you stop taking them you then wait to get your ‘true period’, which usually happens within 2-5 days of going off of the birth control, but this can vary depending on your body, you stress levels, how long you were on the pill, etc. Your clinic will tell you to notify them once you get your period and will instruct you to come into the clinic for blood, ultrasound, and your medications on the 2, 3, or 4th day of your period, depending on their protocol.
  • On this visit expect to get an internal ultrasound, blood work (they’ll likely be checking your hormone levels), and to meet with your doctor or nurse to learn how to inject your medication, doses, etc. Use the time with the doctor or nurse to voice any questions and concerns you might have about your ‘protocol’, particularly if you have concerns around how they plan to reduce your chances of OHSS, how the protocol has been specifically tailored to your test results (follicle count, hormone levels, etc.), and/or the trigger they intend to use.
  • You will also get a schedule of what days you will need to come in to the clinic for monitoring (ie. brief ultrasound + bloodwork appointments, generally in the morning, to monitor how you’re responding to the medication(s) and adjust your dosage if necessary) and a potential retrieval date, but be prepared for these to change depending on how you respond to the medication (you may need to be ‘stimming’ longer, have the retrieval sooner, come in more frequently, etc.).

That’s it for this post! More to come as I start my injection-ables in the coming days 🙂 Oh, and don’t forget: Always research, advocate for yourself, and make sure that you are comfortable with everything before agreeing to inject anything into your body. Ask questions, prepare them in advance if that helps you, and remember that while Doctors and other health care professionals might seem intimidating, it is their job to respect your bodily autonomy, needs, and concerns. If you feel that you’re receiving sub-par treatment at any stage in the egg donation process, speak up!, either directly to the clinic or to your agency.

(A note on terminology: Clinics will sometimes use the language of ‘true’ and ‘false’ periods to distinguish between ‘breakthrough’ bleeding, also known as ‘spotting’ although I consider this to be quite the euphemism, and full on shark-week. For those that bleed continuously on birth control, it can be difficult to determine when you level up from ‘false’ or ‘breakthrough’ bleeding linked to the birth control pill and the ‘true period’ that means you have to contact the clinic and get ready to go in. If you’re in this situation keep an eye out for a marked increase in bleeding that continues and is more or less consistent in amount throughout the day. Your ‘true period’ will likely not be as heavy as it normally would be had you not just been bleeding indefinitely while on birth control pills, but the amount of blood and cramping should still be a noticeable increase from the breakthrough bleeding. Also, if you’re unsure, contact your clinic and let them know what’s up).

Step 3: You’ve Been Matched – Now What?

Step 3 is what happens once you’ve been matched. For some it will happen very quickly (this was my experience) and for others it can take a long time. If you’re a Canadian donating in Canada through an agency the chances of you being selected pretty quickly are relatively high since there are a dearth of egg donors in Canada (which makes sense, since you can’t be directly compensated and egg donation puts you through a lot, there aren’t young women lining up around the block to put themselves through something that is both demanding and can put their health at risk). If you’re a Canadian donor donating in the US through an agency I have zero idea how long it might take, but I’ll make a post about it once I’ve gone through it myself. Anywho, back to business. So you’ve been chosen. This means an IP or IPs have selected you and the agency has called to say “Congratulations!” and all of the other stuff they will say. The IPs might also want to speak with you on the phone or meet with you in person – I tell my agencies that I will only consider this on a case by case basis. At this stage you will likely be told that the IPs are ready to move ahead quickly, that they are really excited, etc., etc., and you might walk away with the impression that things were really going to move quickly. Reality? Nope. No matter how excited people are, expect things to move slower than advertised/than you expect/than you wish. Expect the whole process to take at least 3 months if you have not had any of your screening done (first time donor). Things might move a bit more quickly if you’re an experienced donor and the clinic you’re working with is one you’ve donated at before (and the agency is one you’ve donated through before), but expect to spend a lot of time waiting. While you’re waiting, here are some of the milestones you might have to look forward to:

  1. Initial Screening (Counselling/Psych Exam): At this appointment (or appointments depending on the clinic) you will sit and talk with a psychologist or counselor about yourself, egg donation, and all things that overlap those two categories. You may be asked to take a personality test or some other standardized psychological evaluation to screen you for mental health issues (I haven’t had to do this yet) or you might just have a nice chat with the shrink. This will be an opportunity to ask questions, but they will also want to see that you’ve thought things through and are aware of the potential health risks and emotional consequences of egg donation.
  2. Initial Screening (Bloodwork): Make sure you have something to eat before your bloodwork because they are going to take 10-15 tubes from you so that you can be tested for everything under the sun (from HIV to the genetic mutations linked to cystic fibrosis). This is the most blood they will take from you in one sitting and they make it count. Like really. Holy crap. So many tubes.
  3. New Patient Intake Appointment: This appointment will be with the clinic and will involve an internal ultrasound so that they can count your antral follicles (this gives an indication of your egg reserve and an idea of how many eggs they might be able to farm from you). It may also involve an external ultrasound (mine did – external first, then I got to pee, then internal ultrasound). Then you’ll likely get to hang out in the waiting room for a while until a Doctor comes to get you to discuss egg donation and the results. The Doctor may also want to do an internal exam, pap, and swab to test for STIs. For me, the Doctor portion was extremely disappointing as I was fed a rehearsed spiel about egg donation that was not in any way connected to my actual health or test results. I strongly advise doing as much research as you can before this appointment so that you can recognize when risks are being underplayed and advocate for yourself. During my appointment I learned some info about my own health that set off a red flag for me but that the Doc dismissed – it wasn’t until I got home that I realized this red flag was serious and should play a serious role in determining what trigger is used to mature my eggs for retrieval. I was pretty disturbed and disappointed that this wasn’t addressed during my meeting and filed a complaint with both my agency and my cycle nurse (once I had been contacted by her). The good news is, the intake Doc is not going to be my retrieval Doc (bad news I guess is that this means I still haven’t met my retrieval Doc).
  4. Legal: This involves sorting out the donor contract and the process needs to be initiated by the agency and the IP(s). They IP(s) should have a separate lawyer than you to avoid conflict of interest and the IP(s) are also required to pay for your lawyer (which will likely be referred to you by the agency). Make sure you have a separate lawyer! Steps here start with the IP(s) lawyer drawing up the donor contract and sending it to the donor’s lawyer. Then the donor’s lawyer will walk the donor through it. Be sure to read through the contract carefully and flag anything that seems off to you. Your lawyer should clearly advocate for your best interests. This can mean, for example, making sure that in no circumstances will you be on the hook for any of the medical costs associated with the cycle, even if the cycle has to be cancelled. Make sure that you do not inject any medications before this contract is signed by both parties and don’t sign anything you’re not comfortable with – there will always be other IPs who want your eggs!
  5. Birth Control: The clinic will get you to start taking the birth control pill asap so that they can sync you with whomever is receiving your eggs (birth parent or surrogate). They will likely want you to start this before the legal has been completed – only do this if you are comfortable with it and do not let your agency or clinic pressure you into ingesting anything before you are ready! Birth control can have some really unpleasant side effects. For me, I tend to have breakthrough bleeding constantly on low dose birth control (what will likely be given to you) and I’m crampy and moody the entire time. It’s horrible and I hate taking it so when I’m not donating eggs I avoid the pill at all costs (by the time I’m on a high enough dose my moods are out of control! Plus, there are so many other forms that work for me without these side effects). Expect to be taking the pill for at least a month and likely a bit longer (1-2 months is pretty common – I know some donors who have been stuck on the pill for 3+ months as a result of IPs dragging their feet on tests and paperwork).
  6. Synced – Protocol Time: Once you’re synced the clinic will put together your calendar/protocol. This means that they will give you a schedule for when to stop taking the birth control and a rough outline of when you will start injecting and maybe even a potential retrieval date. Once you stop taking the pill they wait for you to get you’re period, then on day 3 you go in for another internal ultrasound and more bloodwork, this time just to test your hormone levels. Then you’ll also get all the injection medications and be shown how to do it. Instructions will be strict and you’ll be instructed to follow them exactly.
  7. Injection time: Expect to be injecting for around 10-14 days. During the first few days you likely won’t have to be back for checkups, but by Day 4 you should be going into the clinic for monitoring (exam+bloodwork to check levels). Based on these results your meds may be adjusted. After the first few days have past expect to be going back every other day or more frequently for these brief monitoring appointments. Once they have a good number of good sized eggs they’ll schedule you’re trigger shot and you’ll likely have a meeting and exam by the Doctor to discuss the trigger and the retrieval.
  8. Trigger time: Inject the trigger! and watch yourself balloon…..
  9. Retrieval: Expect to be sedated to some degree or totally conked out for the retrieval and bring someone with you who can take care of you. (I’ll write more on this once I’ve gone through the process myself)
  10. Follow-up: Some clinics want you to come in the next day for a checkup the day after the retrieval, some only want to see you if you’re having complications. Monitor yourself closely, weigh yourself daily to keep an eye out for fluid gain, and be aware and vigilante regarding OHSS symptoms.

Alright, that’s all for now. Remember that things will progress slowly regardless of how ‘excited’ any IP or agency is and that their excitement is no reason for you to sign things you aren’t comfortable with! Advocate for yourself and do your research too 😉 Also remember that you may go through all of these steps or you might not. Some might happen in a different order and there might be steps you need to take or hoops you need to jump through that are not listed here. Feel free to leave them in the comments! Oh, and if you want to share your own timeline that would be amazing 🙂

Step 2: Applications

Step 2 in the egg donation process is filling out all of the applications. Some things you’re going to need to have on hand/easily accessible include:

1) Genetic + health information for yourself, your immediate family, and your biological parents family (if you’re adopted and aren’t able to access medical information for your biological relations, you may be disqualified at this stage). This includes knowledge of the height, weight, eye colour, hair colour, and any ‘special skills/abilities’ such relations have, education and job information, birth, death, and cause of death information, as well as fairly detailed information on any diseases (such as cancer, auto-immune, etc.) that any of these persons have had (including date of diagnosis, treatment, outcome, etc.).

2) Creativity and some serious (and sometimes random) moments of self reflection. These applications are detailed and on more than one occasion I felt like I was filling out an online dating profile. While I expected to answer health and achievement related questions, I did not expect to be asked my life philosophy, favourite childhood memory, favourite books, or details on challenges that I had overcome and how. The questions can at times feel invasive and/or ridiculous and the agency will tell you that it is all about the Intended Parents (IPs) making a connection with you. You wouldn’t really be wrong in assuming that all of the application questions are for the benefit of the IPs, but that’s to be expected since they’re choosing biological tissue and may want to make that process as meaningful for themselves as possible. Agencies will emphasize that IPs have been on a long, emotional journey and that choosing an egg donor can be one of the biggest decisions they will ever make in their journey. They may not care about some of the answers you give, but many are looking to find little bits of themselves in their egg donor and so egg donors are expected to provide this connection. Some additional notes here: You will be expected to tow the altruism line and the application is in many ways like an interview. Donors that are in higher demand often have original/genuine sounding answers, write their answers well, and take time to craft careful responses. That said, if you’re applying to more than one agency, feel free to copy and paste those careful responses 😉

3) Photos! All of them. Seriously. Some agencies will ask for 6-10, some will ask for 20-30. Some want a specific number of photos of you at various ages, some want pictures of your immediate family, some do not. Either way, I’ve found the easiest thing to do is to create a google drive folder with a good variety of photos in it and just send the link with the application or to the donor coordinator or other point of contact at the agency. They’ll have the best idea of what IPs are looking for photo wise.

4) Time! Seriously, this process takes forever and some of the applications are well over 30 pages when all is said and done. Expect some agencies to have you fill out long applications right away and others to first send you a short one (for screening) and then a longer one once you’ve passed the screening. Most will also want to talk to you on the phone to explain the process to you, answer any questions, and tell you that you are a super amazing person.

5) Other tidbits: I’ve also been asked for transcripts (some want sealed, official ones, others are fine with screen shots), copies of medical test results, and for various other tidbits that I had to go digging for, so be prepared for anything (including having a witness present to sign your application forms when necessary). I also found it helpful to be near a scanner and printer, as well as having a folder on my computer where I could store all of my completed applications.

There are some things that will often automatically disqualify you from being an egg donor, such as having current or previous experience as a sex worker, having had any potential sexual contact with someone who might have or have been exposed to HIV, having had a tattoo in the last 6-12 months (you would have to wait and/or provide proof that you were inked in a sterile environment), having a history of hereditary disease, having a history of illegal substance use, etc. You’ll know these questions when you see them and it’s up to you how to answer them (same goes for all of the questions). Some of the things that would disqualify you are based on discriminatory and inaccurate stereotypes, while others (such as inheritable diseases) can have serious implications for any child that results from your donation. Also, while the application process is incredibly detailed there is actually very little fact-checking that can take place other than what they can gather from blood, pap tests, and any transcripts or other medical information you provide.

Overall, the application process is incredibly time consuming and does require a certain amount of playing into the expectation/rhetoric that egg donors are a magical gift to or saviour of the IPs. Navigate this in whatever way you are comfortable doing so and recognize that there may be positive or negative consequences for a lack of honest and/or attempting to remove your imposed cloak of altruism. It’s also definitely worth noting (and critiquing!) the ways that the application process (the questions you are asked, the answers that you are so clearly expected to give) often work to reinforce socially constructed gender norms and some weird ideas about nature vs. nurture that I’m still trying to wrap my head around.

Feel free to leave me a comment and let me know the weirdest or best application question you’ve ever been asked, how you answered it, and why!

Step 1: Researching Egg Donation – Where and how to donate?

Step 1 for me was to turn to google and start reading everything I could find on egg donation. I read academic articles (note: there is next to no research on egg donors as a population distinct from IVF patients so unfortunately one is left wading through a lot of IVF focused articles which limits the applicability), fertility and ivf websites, IVF forums, egg donor websites, egg donor forums, youtube videos, and blogs – pretty much everything I could get my hands on. I also emailed back and forth with several Canadian egg donors. In doing all this I quickly realized that there are three very different ways of going about donating your eggs if you’re a Canada donor. Whichever way you choose, the first thing you need to know as a Canadian donor is that in Canada the Assisted Human Reproduction Act (AHRA) makes it illegal to ‘sell’ or ‘buy’ eggs or sperm because they are classified as human tissue and the buying/selling of human tissue is illegal. In practice, this means that an egg donor cannot be compensated or paid for their egg donation, they can only be reimbursed for expenses incurred through their egg donation (eg. lost wages, travel expenses, parking expenses, mileage, etc.) and all of their medical care expenses are charged to the IPs (Intended Parents). However, the law against compensating donors (which is legal in the United States, more on this later) has meant that it is very hard for IPs in Canada to find donor eggs because all donors must be ‘altruistic’ (ie. donating out of the goodness of their hearts and expecting absolutely nothing in return for weeks of hormone injections and undergoing the surgery for retrieval). This dearth of donors and almost complete lack of regulation and enforcement of the AHRA has created a grey area around what ‘reimbursement’ can look like. From my digging + a good dose of my own perspective the options for a Canadian donor donating their egg in Canada are:

  1. Agency: You can submit an application to an egg donor agency, Little Miracles and Egg Helpers are two examples of Canadian agencies, and upon being accepted you will be posted on their egg donor database so that IPs can peruse your profile. If selected you move forward to the screening process. Now, reimbursement through agencies is a bit tricky for several reasons: It is almost impossible to get a straight answer out of an agency as to how much you can claim for reimbursement; You do not provide receipts for the expenses you claim (you might fill out a spreadsheet); You submit your expense claim before the egg retrieval (ie. before you know how much time you will actually need to take off work for recovery); and it is in some cases implied that you should fluff up your expense claim to the ‘limit.’ What is the limit? Well, this requires a bit more digging. To find out I had to look at the section of the agency’s website for IPs and look at what they are charged. There I learned that IPs are charged a flat fee or deposit for donor reimbursement. In researching on IVF forums I learned that IPs generally do not receive any of this deposit back. This means several things: Any amount of the deposit that is unclaimed by the donor may be pocketed by the agency; Donors, who are often ill-informed about reimbursement by the agency due to the AHRA restrictions, may be unaware of the fee that IPs are charged resulting in them 1) Not knowing that they can claim the full amount, 2) Not knowing that their is a limit and end up not being fully reimbursed for the expenses they incur as a result of their donation (rate of pay is often a big factor here), 3) Reading between the lines and realizing that ‘reimbursement’, while indeed covering their expenses (hopefully, see 2), is also ‘compensation.’ Either way, this results in a pretty big grey area for donors and IPs. It’s definitely an imperfect system and contributes significantly to the inability of egg donors to directly discuss reimbursement and compensation.
    That said, there are benefits to going through an agency: They take care of the paperwork and coordinating (for the most part, if they’re good) and are supposed to support the egg donor through the process. Depending on how you interpret the reimbursement process, going through an agency can get you a bit of extra cash to compensate for the pain you’re going to go through linked to injecting medication, retrieval, and recovery, or it can put an artificial cap on your reimbursement and leave you with out of pocket expenses.
    Additionally, an agency can provide you with a significant amount of anonymity as an egg donor – something pretty much impossible to achieve through private donation and which may be desirable for multiple reasons.

  2. Private Donation: This is when you connect with IPs without the help or anonymity of an agency. You might already know the IPs, you might connect with them on a forum, you might respond to an add on craigslist. You would negotiate the process in connection with the IPs, including reimbursement, medical expenses, future contact, etc. This might involve travelling repeatedly to where the IPs live, having them travel to you, or traveling together to India or Mexico where IVF is significantly less expensive than Canada or the US. This can be a good option for those who can to connect closely with the IPs, those who don’t like working with an agency because agencies can end up costing IPs more than donating privately (because of agency fees + the reasons listed above, and for those who find themselves with out of pocket expenses as a result of donating through an agency and, as previously mentioned, not being told what the ‘cap’ would be on their reimbursement (a real concern for women in professional occupations where the rate of pay is higher).

  3. Orrrr…….

  4. Donate in the United States
    Now, the other option is to cut through all the potential bs and grey areas of the Canadian system and to apply to US agencies that accept donors from Canada, such as Rite Options, West Coast Egg Donation, Eggceptional, and Fertility Alternatives (please note that I am not recommending any of these agencies, I just know that they, as well as others not mentioned, accept Canadian donors). Because the US does not have the same restrictions on compensating egg donors the financial aspect is much more transparent: In addition to having any travel and medical expenses covered, the donor is compensated an amount that is agreed upon in advance and generally ranges from $5k-10k (USD) and increases according to whether the donor is ‘proven’ (ie. has successfully donated already) and how many times the donor has donated. Some agencies cap the reimbursement amount at $10k, some do not. Some cap the number of times a donor can donate to different IPs at 6, some do not (I know women who have donate 10+ times, though most don’t go beyond 10).
    Potential downsides with donating through the US include potentially having to wait longer to be picked by IPs, having to travel a significant distance for the retrieval and potentially for the monitoring (although depending on where you live in Canada and where the IPs clinic is this could also apply and may not bother you at all – heck, it could be a bonus!), and potentially having to deal with paying taxes on your compensation.
    Potential upsides include being able to have practical, direct conversations about reimbursement and compensation, in addition to actually being directly compensated for the service you are providing (just don’t think this lets you escape the whole altruism rhetoric…it doesn’t so you’ll still need to tow that line at least on the surface of things).

Whichever route you choose, do your research, advocate for yourself, and be aware of the pros and cons of donating privately, through a Canadian agency, or through a US agency. I’m currently donating through a Canadian agency and then intend to give US agencies a go.

An Introduction to Unfiltered

First post! I’m starting this blog because the more involved I get in researching egg donation and participating in egg donor communities the most frustrated I become with the lack of straight forward conversation that occurs. Everywhere I look I’m confronted with “Ooh, you’re donating you’re eggs? Thanks you for being a magical angel/saviour/hero/[insert descriptor for other wonderful/imaginary descriptor here]!” The cloak of altruism that all egg donors, regardless of their own point of view, experiences, or desires, are wrapped (or in my case suffocated) in blows my mind. I really cannot wrap my head around it and the more I try to ask practical questions the more I’m confronted with it and nothing makes this more clear than when it comes time to talk about the money (but I’ll save that for a later rant). There are so many grey areas, so many horror stories, and so much misinformation that I find myself feeling quite isolated and alone in this process where anyone who does not identify as a purely ‘altruistic’ donor is actively discouraged from taking part. The egg donation world is geared towards pressuring women to conform to traditional gendered notions of appropriate female behaviour – be kind, be charitable, be generous, value family above all else, and, in line with these, donate your eggs because creating a family is the most precious thing in the world – and I find the lack of critical analysis and discussion surrounding this to be exceptionally disappointing and the repetition of it to be disingenuous.

So, in response, I’m breaking out of the community, albeit anonymously, to create my own unfiltered space where I can record, talk about, and, when the mood strikes me, rant about my experiences with egg donation. As a first time donor who has removed any rose tinted glasses I do not intend to hold back on any front – applications, finances, screening, clinic appointments, protocols, injections, agencies, retrievals, recoveries – so if you’re looking to read a cute blog where everything is rainbows and sunshine, written by a donor who wants nothing more than to bring life and love into another families arms, I’d strongly recommend looking elsewhere because I am not that donor. I am a donor who became interested in egg donation because I was curious about the experience and because in the US (I’m Canadian) you can make a significant amount of money by donating your eggs, particularly if you’re a ‘desirable’ and ‘proven’ donor, and the added bonus of helping other experience moments of happiness. For me, egg donation is practical: my schedule is highly flexible over the next few years and the extra money will help me save up for things like buying a house, supporting my family, continuing to pay my rent on time, and occasionally pampering myself. I don’t have kids, don’t want kids, and figure that if all my reproductive organs are going to do is give me a monthly period complete with major cramps then they can damn well start paying rent. I don’t think that these are bad reasons for egg donation – I’m not being exploited, I’m not naive about the process, and my practical approach does not devalue my genetic material.

Disclaimer: I don’t speak for all donors (or every claim to) and I often take issue at the way that egg donors are simultaneously treated as commodities, bringing income into an egg donation agency or fertility clinics, and magical, pure of heart, altruistic saviours of Intended Parent(s). There are egg donors out there who fit the idealistic egg donor ‘mold’ to a T, who are donating for a myriad of reasons but chief among them is the desire to help others create a family of their own. I am not that donor. If you are looking for that donor’s experience, I strongly suggest finding another blog. In speaking for myself I will not sugar-coat or hide from the good, the bad, or the ugly. I will not pretend that I am the world’s most altruistic woman, motivated by the sound of babies cooing. I will try to provide practical and insightful information for those looking to navigate the process of becoming and being an egg donor – whatever the reason – but my main goal in writing this blog is to have somewhere to lay out and process my thoughts and to create a log that other donors, frustrated with the imposed cloak of altruism that comes with egg donation, can access.

Welcome to Egg Donation: Unapologetic and Unfiltered.