Finding the Joy in Plan G - The Search for the Right Egg Donor
I met Bethany in a fertile grounding yoga class. We were both in the middle of our fertility journeys at the time and had each had two miscarriages, which gave us an immediate connection. Bethany is a gracious, positive and patient woman. These qualities along with her faith served her well during her fertility journey. When I asked her if she would share her fertility journey and relive some of her most difficult times, she said, “For me, I don’t want to forget, it’s important to feel those things and remember the struggles as well as what came out of it and the things that we gained from it.”
Like many couples, Bethany and her husband Ryan spent years together before they decided to begin their fertility journey. They dated for 7 years, got married, went to grad school, got a dog, and made a couple of cross-country moves. By the time they decided to start trying to have a family at the beginning of 2013, Bethany was more than ready. She laughed as she said, “I feel like I was ready for kids long before our lives felt ready. It’s something I grew up anticipating and excited for.”
One afternoon, about 5 months after Bethany and Ryan actively started trying to conceive, Bethany had a sudden onset of pain and sickness as she was preparing to join the other coaches to lead track practice. As she struggled to make it out to the field, the head coach quickly responded and drove her 25 miles to the nearest hospital. When she was admitted, the staff asked if she was pregnant - to which she responded “possibly,” because according to her calculations she would be able to know one way or the other at the end of that week. They ran some tests and it turned out Bethany had 3 ovarian cysts that ruptured, which were causing her symptoms. By this time Ryan joined Bethany at the hospital. It was at this point her nurse made a nonchalant comment about Bethany being pregnant. Bethany and Ryan both paused as they heard and processed the news, and then confirmed it with the nurse. She assumed the doctor had already alerted them, and she quickly congratulated them. An ultrasound was done, where they got to see the flicker of a strong heartbeat, and they were told their baby was measuring 5 weeks 6 days and was looking okay at that point. As they were being discharged, the ED doctor gave them some grim news, explaining that all the blood pooled from the ruptured cysts increased their risk of miscarriage, and he gave them a 20% chance of the pregnancy surviving.
Bethany and Ryan left the hospital feeling excited and hopeful, but also worried and on edge. They were pregnant as they had long hoped! They told their immediate family Bethany had ovarian cysts that ruptured and decided to keep their pregnancy news to themselves for the time being. In Bethany’s mind, if the pregnancy survived then they would wait the “customary” first trimester to reveal the news, something she now regrets. In the following couple weeks Bethany started spotting, and as the bleeding steadily increased she became concerned about the possible miscarriage she was warned about. Finally, she and Ryan decided to call the OB department a few days before her 8 week appointment, because she was bleeding more heavily. They said she could come in to be examined. Bethany contacted her sisters and parents and told them she was pregnant but had been bleeding and they were going to the hospital. The midwives there confirmed she was having a miscarriage. After being given several options for assisting the process, Bethany decided she wanted to let her own body do the work and go home to miscarry naturally. Shortly after arriving home she easily passed a golfball-sized sac. Bethany told me she was fascinated by the sac - that her body had created this and a life had started. She inspected and marveled at it, and then not knowing what else to do, flushed it down the toilet.
“I had never talked to anyone that had had a miscarriage. I had vaguely known of someone that had had a miscarriage, but I had never heard detailed stories about them, so at that point I didn’t have an answer of what to do.”
Bethany remembered a mix of emotions during this time. In the days following, Bethany and Ryan sent an email to close family to let them know about their miscarriage. Their families were comforting and expressed hope for their future and were excited to hear that they wanted a family. Bethany told me she was glad that she told their family that they were pregnant and had a miscarriage, but also felt going forward that all eyes were on them as their families awaited news of a future pregnancy. About two weeks after the miscarriage Bethany went in for a follow-up with an OB who told her that up to 1 in 4 pregnancies ends in miscarriage and said, “I would anticipate very much that you would go on to get pregnant and have a healthy pregnancy and baby.” At that time, Bethany felt a mix of sadness but also had a lot of hope for the future. They had achieved a pregnancy on their own after all, which had felt like the biggest hurdle up until that point.
Following their miscarriage, Bethany and Ryan decided to try again as soon as nature would allow. Bethany was motivated by a fact she had heard the most likely time to get pregnant after a miscarriage is within the first three months. Ryan had to spend the weekdays that summer in a neighboring state, 3 hours away for his graduate school clinical placement. Bethany closely monitored her cycle using the helpful, but also aggravating OPKs (ovulation predictor kits). The blinking smiley faces became particularly annoying and she felt they were mocking her. One week she found her fertile window was going to be during the week while Ryan was away and she was determined not to “waste” a single month. So, with Ryan’s bemused approval, one day she made the six-hour round trip drive to see him and try to conceive. He thought she was a bit crazy, but went with it. Although they didn’t get pregnant that cycle, Bethany was glad she made the effort and said, “this is how badly I had my eyes on the prize.” Trying to conceive, especially following a miscarriage, felt like a constant stress and constraint on their lives and relationship, and Bethany couldn’t help but worry and wonder about what the future would bring.
“Women want their bodies to work, they want to be able to get pregnant as they were designed to do. Throughout adolescence, we’re raised to be afraid of pregnancy, and then there’s this weird mind shift when you want to get pregnant. You become frantic about it when it’s not happening, no matter how long you’ve been trying. When it’s not happening, there’s this feeling of failure and being broken.”
By November of 2013 Bethany started to worry that they hadn’t gotten pregnant again after all their efforts and reached out to the OB she had met with following her miscarriage. He said it sounded like they had been diligent and it wouldn’t hurt to start some fertility testing.
“Going in for these tests I had a ton of anxiety; there was the underlying worry of something being wrong and if they would find something, but at the same time I wanted to know if there was a problem.”
Bethany recalled the HSG (hysterosalpingogram) procedure to make sure her fallopian tubes were clear was invasive and a little traumatic to go through. Following that and her blood test, she was able to pull up the results on her online charts. She was scanning the blood test results and part way down there was a red exclamation point next to one of her numbers. “I didn’t even know what it meant yet, but all I saw was this glaring red exclamation point and I crumbled, seeing it as a huge red flag. I just knew something was wrong,” Bethany recalled. She and Ryan did some googling, and it appeared her AMH (Anti-Mullerian Hormone) levels which correlate with egg quality were very low. In addition, her FSH (Follicle Stimulating Hormone) levels were very high - also abnormal. She emailed her doctor right away and he responded and said he’d call her the next day. When they spoke he agreed that her numbers weren’t great and she was showing signs of diminished ovarian reserve, which is an egg quality issue (previously called POF or premature ovarian failure). Her AMH levels were basically undetectable, which aligns with a woman in her forties going through menopause. At the time Bethany was only 29 and this was devastating news. Bethany remembers the OB mentioning the idea of an egg donor, and he referred them to the reproductive endocrinology and infertility department for a consult. Timing is funny sometimes because right after receiving this heartbreaking news, Bethany and Ryan had scheduled to meet up with friends of theirs who had just had a new baby. Pretending things were fine on the outside was about to become a habit they would learn to perfect over the next couple of years.
The endocrinologist they met with explained the pieces required to have a baby - Ryan had healthy sperm, Bethany’s uterus and tubes were intact, but the part they were missing was a viable egg. Based on the statistics at that time, they had less than a 5% chance of becoming pregnant naturally, along with an increased risk of miscarriage. The endocrinologist mentioned an injection method option but stated there was a 0% success rate for women with Bethany’s numbers. They were given options to consider including continuing to try with poor odds, adoption, or pursuing IVF (in vitro fertilization) with the use of an egg donor - the clinic didn't recommend pursuing IVF with Bethany's eggs based on their condition. Bethany wanted to experience pregnancy and childbirth and to be able to carry a baby if that was at all possible. Ryan felt the same way, that he would love to see Bethany pregnant and carrying their child(ren). Bethany and Ryan started exploring the idea of an egg donor, both anonymous and known (friends or family). Bethany was drawn to the idea of a known donor, either a family member or friend having a biological or emotional tie, a relationship that could be cherished and celebrated.
“It took me a little while to accept that I wasn’t going to have a baby with my own eggs. Someone I could look at and see a small version of myself. That was a big hurdle I had to get over and accept, my own DNA being gone. At the same time, I clung to the possibility that I could still experience pregnancy and childbirth and that my body could still give life to, grow, and leave an imprint on a baby.”
At this point in time, partly due to a lack of insurance coverage for fertility procedures due to Ryan being a student, Bethany began focusing inward on herself and her health. She revved up her diet to eat cleaner, used cleaner products, started Traditional Chinese Medicine practices with weekly acupuncture, herbs, and dietary supplements, practiced fertility yoga, got regular massages and found a faith-based therapist to help her through the depression and anxiety-ridden roller-coaster ride. She recalled, “It is a struggle and an awakening when you choose to focus on yourself.”
Through her acupuncture services, Bethany monitored and charted her cycle using her daily BBT (basal body temperature). They saw some positive improvements, but Bethany didn’t know if it was enough to correct her medically diagnosed infertility. To Bethany’s surprise, her period was later than expected in June of 2014, and she decided to take a test. Bethany was nervous, as by now pregnancy tests were anxiety provoking and she had started fearing them. She took the test, put it on the bathtub ledge behind the curtain so she couldn’t see it, and came back a few minutes later to find a blank screen - the fancy digital test had somehow malfunctioned! Ryan was about to leave town with friends for the weekend and there were no other home pregnancy tests in the house. So after Ryan left, Bethany went to buy another test and took it back at home, hands shaking. When she went back in to see the results, there was a clear positive. She was completely alone in her house, and remembers crying, trembling, and saying “thank you” over and over. She called Ryan to tell him the news and she could hear the happiness in his voice. They had achieved what they had been told there was a slim chance of happening once, let alone twice.
“I had a ton of confidence going into that pregnancy after that year of focusing on me and my health...I thought, this is a rock solid egg and this is going to be a strong baby.”
Bethany felt so much joy, as well as disbelief that they had gotten pregnant again, especially since she knew their chances were limited with her diminished ovarian reserve (DOR) diagnosis. She called their reproductive endocrinologist to see if she should do anything special this time around, and they said no since she had gotten pregnant naturally. Bethany and Ryan told their parents and siblings the news and were able to experience the joy of announcing a pregnancy. At 8 weeks, Bethany and Ryan went in for an ultrasound. After trouble finding the baby via standard ultrasound, they were brought in for a transvaginal ultrasound and this time a heartbeat and yolk sac were found - but the heartbeat was below the normal range and the baby was measuring small for its gestational age, about two weeks behind, the same measurement of their last pregnancy. They were told the pregnancy could go either way at that point, to be hopeful, and go on their beach vacation as planned the following day. They would see Bethany in two weeks to check in on the baby’s growth. Bethany and Ryan were worried but remained as hopeful as they could. They told their families about the low heart rate and growth concern and received supportive and optimistic responses, and then set off on their trip to North Carolina that they’d planned with friends months before.
On the flight to North Carolina, Bethany felt nauseous and this gave her hope. Once there they met up with 4 other couples and spent the week together at the beach. Bethany and Ryan decided to keep the pregnancy and associated concerns to themselves. They hadn’t shared their first pregnancy with their friends, and being in such a vulnerable position with this pregnancy, Bethany didn’t want to change the dynamics of the house by sharing their news when the future felt so uncertain. A few days later, Bethany saw the most minuscule shade of pink on the toilet paper while using the bathroom, and immediately her anxiety skyrocketed. She tried to put it out of her mind and enjoy the time with their friends, but it was nearly impossible not to fear the worst. From there on out, Bethany dreaded every bathroom stop, as she slowly saw a little bit more blood each time - it was a slow, brutal, emotional experience. By midweek the amount of blood was beyond spotting.
“I remember being in the ocean and feeling so buoyant and knowing I was likely losing this baby bit by bit. Part of that realization was peaceful to me, but mostly my insides were panicking and being wrenched around. In the meantime, on the outside, I was pretending everything was normal. I was in this beautiful location experiencing the worst. It was a torturous paradox.”
One morning Bethany sought solitude and went to walk the beach at sunrise before the others were awake. The beach was empty except for one person way off ahead of her in the distance. When she turned to head back, she noticed distinct footprints in the sand going that direction already, but there were no return footprints and she didn’t see anyone ahead of her. At that moment she recalled a poem entitled Footprints, and knew God was there with her giving her a direct message in this time of struggle and despair.
“You promised me Lord, that if I followed you, you would walk with me always. But I have noticed that during the most trying periods of my life there has only been one set of footprints in the sand. Why, when I needed you most, have you not been there for me?” The Lord replied, “The years when you have seen only one set of footprints, my child, is when I carried you.”
Footprints / Footprints in the Sand poem
Bethany uttered a simple prayer for the remainder of her walk, “Carry me. Please carry me through this.” The following week they returned from vacation and went in for what would have been their 10 week ultrasound. Bethany’s bleeding was a constant now. As feared, there was no heartbeat, confirming the miscarriage. Bethany was given options again for how to move forward.
“I decided I wanted to let my body do the work rather than having a medical procedure. I had done it before, and I could do it again. For me, that was part of the healing; to know that my body could begin a life and then also clear the remains away.”
A nurse gave her a collection kit for the remains so a fetal autopsy could be performed. Included with this was a small cinch sack made of baby flannel with a satin ribbon tie to bring it back in, along with an angel pinned to a square piece of fabric with a message of condolence. Bethany recalled, “It was comforting and heartbreaking. The nurse was nearly in tears herself giving me the instructions. I was in a daze thinking of having to walk back into the OB department without a pregnant belly and with the remains of our baby in that bottle instead.” Bethany was told to expect something like a heavy period, which couldn’t have been farther from the truth.
Bethany experience heavy bleeding for 5 days after the ultrasound confirmed the baby had no heartbeat, during which time they attended an out-of-town family wedding. Late on the fifth day is when things intensified; the physical miscarriage itself ended up being very painful. Bethany described it as feeling what she would expect of labor - constant contractions, shortness of breath, and a need to continue pacing to deal with the pain - she had no idea a first trimester miscarriage could be so physical. She tried to remain at home, but the amount of pain and bleeding became unbearable so they drove to the hospital and were admitted to the OB department. Upon an excruciatingly painful examination, the midwife was able to retrieve the fetal sack that Bethany’s body had been working on passing. The maroon mass was shown to Bethany and Ryan and then put into a collection bottle to be sent to pathology. They were told if they wished, the remains could then be buried in a mass grave in a cemetery in town and their name added to the list of babies memorialized by the marker there. Bethany explained, “This was another pregnancy that I was proud of. It only happened twice that we created life, by ourselves, together, so it’s something that I definitely want to celebrate and honor.”
“The second miscarriage was much more traumatic, physically and emotionally. That pregnancy was something we had worked so hard for and we were up against such slim odds that it was a bigger blow to lose. Afterwards, [there was] not a lot of hope left. Between that summer losing the baby and that winter was my lowest point.”
Shortly after their second miscarriage Bethany and Ryan refocused on an egg donor. Conversations had been had here and there, and a humbling number of friends had made comments about being willing to donate, but nothing serious or definite had been decided. Bethany had at one point perused the World Egg Bank website, putting in her physical characteristics, and only finding one green-eyed, blond-haired match. She started to become more comfortable with the idea of an anonymous donor, but something still tugged at her about wanting to have a personal connection and relationship with the donor who would be giving them the greatest gift. Bethany’s first choice was to use a known donor - potentially a family member, and she explained, “I wanted a connection and I wanted to know who it was. I wanted to treasure the gift that it was and celebrate that connection with somebody.”
Communicating and making this request to their female family members was a long and emotional process for everyone involved. It was filled with hopes and disappointments, as well as tragedy when Bethany’s step-sister (who had offered to donate after her current pregnancy) lost the baby she was carrying to stillbirth the day before their scheduled C-section at 39 weeks in November of 2014. Their whole family mourned this deeply. Memories of Ryan and Bethany’s pregnancies and miscarriages resurfaced for them and became even more raw and real for Ryan who had felt somewhat removed during them. Their families helped them remember and honor their lost babies, who they refer to as the Baby Bs and are represented to them by images of bumblebees. Bethany’s step-brother even got a tattoo in memory of his niece lost to stillbirth and included two stars by it representing Bethany and Ryan’s babies. Gestures like this meant the world to them.
After all of this, and having the last available family member of Bethany’s fall through, it became clear to Bethany and Ryan that if they wanted to use a known donor they would need to expand their circle.
“The hardest parts were the times of the unknowns - when we didn’t know if we would get pregnant when we didn’t know if that pregnancy would last, when we didn’t know if we had a donor. Anytime there was a big unknown was when it was the hardest - the waiting and knowing to trust and put everything into your faith that it was going to work out.”
Throughout her journey, Bethany kept in contact with a close friend, sharing her struggles with her and receiving emotional support. This friend had at one point mentioned that she told her husband she would donate in a second because she couldn’t think of two people more deserving to be parents. At that point, Ryan and Bethany were in the process of proceeding with one of Bethany’s family members, so it was a side note. However, in the spring of 2015, after this last family option fell through medically after beginning the initial steps, Bethany and Ryan both intrinsically felt like this friend was the right choice, Bethany explained, “It just made sense and felt good.” After checking back in on her comment and asking her to seriously consider her offer, her friend emphatically agreed, and they began moving forward. Bethany and Ryan chose to keep the identity of their donor to themselves for now. Bethany said they will certainly share their donor’s identify with any children they have, they will grow up knowing their special path, and explained, “It’s something super special and I want it to be treated with care. It’s not a secret, but it is definitely private.” Together they completed the required steps for their donor's egg retrieval and Bethany’s embryo transfer with no major hiccups.
On the day of the egg retrieval, Bethany sat in the hospital room with her friend and was overcome with gratitude. With tears brimming in her eyes, she was amazed and humbled to watch her friend go through the whole process for her and never bat an eye at all the big injections, hormones, and strict medication administration schedule that an egg retrieval entails. Bethany tagged her friend ‘Donor G’ as she was literally Plan G in their whole journey to start a family; G, she decided, for Godsend.
Five days later they had a good number of healthy embryos that had made it to day 5, the blastocyst stage. They moved forward with Bethany’s transfer, transferring one of those embryos to Bethany, and the wait to hear if they were pregnant began. Bethany was cautiously optimistic waiting those 9 days. Bethany went in for a blood pregnancy test the ninth morning, and they knew they would be getting the results later that day. Bethany and Ryan decided to call in to hear the results together after both their work days were done that evening. Bethany picked Ryan up from work, they got home, sat on the couch, and called the results line to listen to the voicemail waiting for them. Bethany told me the first thing the nurse said was “I’m happy to report”, and as soon as Bethany heard the word “happy” she knew it was good news - they were pregnant! Bethany recalled so much joy during this time; there was some cautiousness because they hadn’t made it beyond 8-9 weeks during their previous pregnancies, but this time things continued to progress and 8 weeks came and went uneventfully.
“Before I was in the middle of the infertility world and knew nothing about it, I think I looked at it naively with unfeeling eyes. I remember thinking that people just went to the doctor and the doctor helped get them pregnant. A very straight-forward, sterile, non-emotional experience. And now after going through it myself, is why I want to share about it. Because it was such an emotional and special process. Never at one point did I feel like it was some cold, sterile process. It was very meaningful and everybody that we met and worked with that guided us through it was invested and cheering us on and hoping for the best. Everything about our journey is so special to us.”
Bethany recalled 10 weeks being a big milestone when they graduated from the infertility department and returned to the regular OB department with the midwives and their pregnancy continued to progress. By the end of May 2016, 3 years after their first miscarriage, Bethany and Ryan welcomed their daughter into the world. The nurse assisting the c-section came over the second after the baby was out and told Bethany, “She looks just like you!” Bethany smiled to herself thinking, a bonus perk and knowing deep down that those small details mattered so much less now that they had a healthy baby in their arms. I asked Bethany if there was a point during her search for an egg donor when she and Ryan felt like they had found the donor that they were meant to have, and she told me,
“I knew we chose the right person when she said to me that she was honored that we chose her to be our donor. That solidified that we had found the right person to do this for us. We were equally as honored to have her. The feelings were very mutual.”
Bethany and her donor viewed the egg donation in the same way. Her friend gave a part of herself as a gift to Bethany, she was their missing link. Bethany explained, “Our friendship hasn’t changed. It is strengthened and it is extremely special and it remains a friendship that we treasure, but it hasn’t changed.”