Wendy Martin Specialist Fertility and Miscarriage Counselling
General Counselling

Blogs. George, the dragon and the maiden in distress

. ~ 2. George, the Dragon and the Maiden in Distress ~

Take a look at this picture for a moment. To me this is an iconic image that epitomises the nature of the relationship between a couple when they are facing adversity.

We see a maiden in distress with a dragon breathing fire over her. The dragon can represent infertility, the inability to have a baby due to miscarriages - or in fact any kind of serious challenge faced by the couple.

Worse still – you see the cave in the background – and in the maiden’s mind is the ever present threat that the dragon could carry her off into his cave and devour her – fulfilling her worst fear that she may never have a baby and may never be a mother - or any other worst fear.

The damsel is very distressed and is weeping copiously.

Then George comes into the scene on his trusty white steed.

He has on his armour, his helmet and his breastplate and he carries a shield – all the things to protect him from the emotional difficulties the world may face him with. And in his hand he wields a lance.

Now there are two things we need to know about George: -

One is that he cannot bear to see his damsel in distress. It pains him enormously to see her like this.
And two . . . . he needs to fix it – to rescue her from the thing that is causing her such heartache, grief and fear (not least because he can’t bear it himself and wants it to stop).

So George tries to slay the dragon. But this dragon is invincible. It will not die. He cannot make his wife or partner pregnant. He realises he actually has no control over the situation and feels powerless in the face of this unconquerable foe. He doesn’t know what to do. He’s tried everything. He’s said everything he knows to say many times before and it clearly hasn’t worked – she’s still crying and upset – again and again.

So what is he to do?

Well he has several options: -

1. He can gallop off and leave her to it – go and play on his PlayStation, go to the pub or watch the telly

2. He can go into the cave himself, shut down and become incommunicative

3. Sometimes he even gets angry with the damsel because she won’t stop crying and it faces him with his own powerlessness and inability to make things better. He waves his lance at her in a threatening way. He just wants her to stop going on about it and stop being so unhappy and miserable (he just wants the return of the bubbly happy-go-lucky, sociable maiden he knew before all this baby making malarkey started

4. But the fourth option – and listen up here fella’s because this is the one that dies the trick – he gets off his horse, he take puts down his lance and shield, he takes off his armour and he goes to the maiden. He takes out a clean white hanky from his pocket and hands it to the maiden then gives her a hug., laying her head on his shoulder and allowing her to cry and sob until the wave of distress passes, saying "There there, it's OK . . . . . We will be OK no matter what happens."

Believe it or not, it is that simple . . .

Now I grant you, George, that sometimes the maiden may not be weeping, she may be in a bad mood, irritated with you and everything and everyone – and she seems to you like a prickly pear – and the last thing you want to do is give her a hug. But if I were you, I’d give it a go – ask her if she’d like a cuddle – an d if she says yes – make it a good one.

~ 3. MISCONCEPTIONS ABOUT STRESS AND PREGNANCY ~

We all know that stress affects the ability to get pregnant and remain pregnant, right?

Wrong.

“But surely,” I hear you say, “everyone knows that you need to be stress-free in order to conceive or maintain a pregnancy?” Why else would everyone you know tell you to relax and reduce your stress levels when you explain to them you’re struggling to conceive, or finding it difficult to stay pregnant?

Many women who are experiencing fertility issues or multiple miscarriages believe that emotional stress and distress, or the tensions arising from difficult life-events, are factors in them not getting pregnant naturally, or succeeding with fertility treatment, or maintaining a pregnancy.

This view is largely based on anecdotal evidence and fertility myths such as 'don't think about it and you'll get pregnant', or “you just need to take a holiday/work less/relax more/think more positively/be less pessimistic” etc. Plus there’s loads of information on the internet that supports these widely-held beliefs.

Nonetheless there is little scientific evidence to support such notions.

Misconceptions about stress and natural conception

It is a widely held belief that if a woman is stressed then this will affect her ability to get pregnant. "You're working too hard" or "You're trying too hard" people will say "You're just too stressed and that's why you're not getting pregnant."

NHS Choices website analysed a scientific study which claimed that the levels of two stress hormones – cortisol and an enzyme produced in response to adrenaline levels (alpha amylase) – affected the likelihood of getting pregnant. 

The researchers did find that women with higher salivary alpha-amylase levels were less likely to fall pregnant, compared with women with lower levels, but this was only of borderline statistical significance and they concluded that the study failed to prove the effects of stress on natural conception and fertility.

So why do so many people truly believe that stress can affect natural conception? I regularly hear people say that cortisol and adrenaline produced from being stressed must have a negative impact on the woman's reproductive system and that this is why you shouldn't be stressed if you are trying for a baby.

You know what? If a couple are very stressed for some reason (for example one or both of them are experiencing difficulties in their work life - like facing redundancy, or overwhelming work pressures or interpersonal difficulties with bosses etc; or maybe they are facing severe financial difficulties in their lives and are very anxious about how they will cope; or maybe there are serious health problems with a family member etc) then the stress they are experiencing causes them to go off sex. They are simply too emotionally exhausted, physically tired or too worried to feel like doing it. The failure to get pregnant when stressed is therefore a mechanical thing - and has nothing to do with stress hormones affecting fertility.

Which is why, when a couple go on holiday, or have a nice meal and a glass of wine and relax then they are more likely to have sex . . . and therefore more likely to get pregnant!

Misconceptions about stress and miscarriage

The NHS Choices website outlines some misconceptions about miscarriage and concluded that “increased risk of miscarriage is not linked to a mother's emotional state during pregnancy, such as being stressed or depressed”.

In the Guidelines of the European Society of Human Reproduction (ESHRE) on Recurrent Pregnancy Loss in November 2017 they state that 'Stress is associated with RPL, but couples should be informed that there is no evidence that stress is a direct cause of pregnancy loss."

In my infertility work I see many, many women in the very early stages of pregnancy, having become pregnant after a couple of years of trying naturally (without success) and then after various numbers of assisted reproductive treatments (IUI, IVF, ICSI). They are of course highly delighted and utterly thrilled that finally, at last, they are pregnant. They are over the moon and feel so relieved and happy that they are now on their way to having the baby they have so longed for. They are not at all stressed - quite the opposite. And yet, tragically, after a few weeks they can lose the pregnancy or find at the six-week scan that the pregnancy is not viable and that, for some reason, the foetus has stopped growing. Sadly a miscarriage inevitably follows.

These women were not stressed at all, far from it, and yet they lost their pregnancy. Possibly no reason can be given but, sadly, this does not stop them trying to attribute the loss of their baby to something they've done. This seems to be a natural human response to tragedy. But of course, it is absolutely nothing they've done.

Equally I have seen extremely anxious women who worry every minute that something will go wrong - sometimes for the best part of their entire pregnancy - and yet they deliver a healthy full-term baby. These women could not be more stressed, they could not have more stress hormones in their bloodstream and yet this does not result in pregnancy loss.

So what to make of it all? I guess it is hard for women to accept that they are not in control of the one thing that is more important to them than anything they have ever wanted in their whole life. Perhaps women's assertion that stress can affect pregnancy and cause miscarriages is a way of imagining they might be able to gain some control over it - by de-stressing themselves. Who knows?

But if it were me I would try and accept that it truly was nothing I had done. It is hard enough to experience such a loss without blaming yourself for it as well.

Misconceptions about stress and fertility treatment

Again, the notions about stress affecting the outcome of fertility treatment also do not stand up to scientific scrutiny.

Professor Jacky Boivin from the Cardiff Fertility Studies Research Group, investigated links between stress and the success of fertility treatment. She undertook a large-scale review (known as a ‘meta-analysis) of all the studies that had been done on the impact of stress and distress on fertility treatment outcome. *

Fourteen studies with a total of 3,583 infertile women were included in the review. The women were assessed before fertility treatment for anxiety and stress. The authors then compared data for women who achieved pregnancy and those who did not.

The results show that emotional distress was not associated with whether or not a woman became pregnant.

Professor Boivin therefore argues that "these findings should reassure women that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise their chance of becoming pregnant."

My comment

It is an understatement to say that it’s stressful trying for a baby when all around you seem to do it so quickly and effortlessly, but stressing yourself about getting stressed and fearing your stress levels are the cause of your difficulties is soul-destroying and only serves to make women feel responsible and to blame for their lack of a family.

It is of course a good idea to reduce stress in your life if you can – through mindfulness, yoga, relaxation, gentle exercise, counselling or whatever helps you cope with the difficulties you are experiencing – but only because it makes a sometimes long and emotionally difficult journey more bearable. And the better you cope with this challenging and testing life-event the more likely you are to keep going until you succeed in the end.

So the one thing you can do is stop stressing about the stress your difficulties are causing you and tell anyone who says otherwise where to get off!

*J. Boivin, E. Griffiths, C. A. Venetis. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ, 2011


~ 4. WHY DO WOMEN DONATE THEIR EGGS? ~

Somebody asked me the other day “What do you think motivates a woman to donate her eggs?”

It got me thinking about all the egg donors I have met over the last 20 years or so. What I write is based on my own personal experience. I know there are currently advances in ‘fertility technology’ whereby some clinics now provide frozen eggs, sometimes sourced from donors abroad, but I know little of this. What I do know is that, in my experience, there are three kinds of egg donors.

ALTRUISTIC DONORS

The first are the ‘altruistic donors’- i.e. women who come forward, out of the goodness of their hearts, and voluntarily offer to donate their eggs and the second are the ‘egg sharers’ and the third are ‘known egg donors’ where a sister or niece donates their eggs directly to the couple who need an egg. I can safely say they are all lovely, bright, amazing women. I have also learned over that time that there is specific ‘Egg Donor Profile” for those women who become altruistic donors, and that there are about eight qualities or characteristics that typify those women who put themselves forward.

1. They have to be aware that such problems exist

The women who come forward as donors somehow have come to know that there are people on this planet who cannot have a baby because the woman, for some reason, has no eggs at all, or such a low egg reserve in her ovaries that it is very unlikely she will ever get pregnant naturally. Often these women have directly known somebody in this situation (a sister, a best friend or close colleague at work) who has had trouble conceiving a child because she doesn’t have eggs and that this friend or relative has let them into their painful and distressing world. The truth is, few people even know that conditions such as ‘Premature Ovarian Insufficiency’ (POI) or ‘Early Menopause’ even exist. For most of us, what we have been instilled with growing up is the knowledge that it is very easy to get pregnant and efforts have to be made to prevent that from happening at all costs. I am not aware that infertility is ever discussed in schools (although I do know there is now a movement to include it his subject in the sex education curriculum).

2. They have to know is possible to donate eggs

Most people know about blood donation and organ donation, but how many people in ordinary everyday life know that it is possible for a woman to donate her eggs? As I said, egg donors will usually know somebody who has told them they need donor eggs in order to have a baby, or they will have read something in a magazine, or heard about the need for egg donors on the radio or TV and will have been intrigued or interested in it as a possibility for them. They will often have ‘Googled’ it to see how and where they can donate their eggs and to find out what is involved before coming to the clinic.

3. They are empathic and feel keenly for any woman or couple that cannot have a child

It is always clear that prospective donors really ‘get’ how hard it is for those who are struggling to conceive a child. They somehow know and understand that this is an extremely painful thing to go through and they genuinely want to do something to help. Donors will say ‘If I was in that situation and I knew that egg donation was the only way I could have children then I would hope someone would do the same for me’, a kind of reciprocal empathy. Sometimes donors who have young children will say ‘I can’t imagine what it would be like if I could never have had my children’ and this is the incentive for them to help others try and achieve a family like they are so lucky to have.

4. They have to see their eggs as ‘cells’ and not as a potential baby of their own

In my experience, none of the egg donors I see believe that any baby conceived is ‘their child’. Not at all. They are very clear that they are not ‘the mother’ of any baby that might be born as a result of their donation. They know, beyond a shadow of a doubt, that the woman who bears the child, who gives birth to it – and who brings it up – is the child’s mother. They often will say ‘I am just giving away a few cells – and they would have gone down the toilet anyway – so if someone can make use of them then I am really happy to help.’ Conversely, the women who would most definitely see any child born from their egg as ‘their child’ never donate their eggs. Even though it is just one cell, they would see it as ‘giving their baby away’ and so just cannot contemplate the idea of doing such an impossible thing.

5. They have an altruistic side to their nature

Up until fairly recently, donors gave their eggs entirely altruistically. They got expenses for any costs they may have incurred, but nothing more. Then in October 2011 it was agreed in the UK that donors could be given a flat fee of £750 to cover their expenses and time. Contrary to what I thought might happen, this announcement did not cause a rush of women to the clinic wanting to donate their eggs in exchange for £750 and, in fact, the impression I get is that donors want it to be known that they are not doing this for the fee at all. The egg donors I see definitely donate their eggs out of a desire to help others – and the old adage ‘It is in giving that we receive’ seems to apply to them. I wonder sometimes if there was a much more substantial ‘payment’ would it entice more women to come forward – those who perhaps would do it ‘if there was something in it for me’ - but I somehow don’t think so. It seems to me that egg donors have part of their character that just wants to help others and knowing they have given a couple a chance of a baby, let alone an actual baby, is reward enough for them.

6. They are willing to go through IVF treatment

The donors are always sent information about the process they will need to go through before they come to the clinic so, if they are put off by the thought of injecting themselves for ten days or having a medical procedure under general anesthetic, then they don’t book their first appointment. Those who do will first see a nurse who will go through the medical side of the treatment in some detail so they are very clear what’s involved. The ones who make it through that and are not daunted by the idea of doing and IVF treatment are the ones I see. For these women, the idea of ‘having IVF’ is nothing like it would be if they were trying desperately for their own baby. There is not the same emotional charge and intensity for them as there is for women who are going through the same treatment but for whom the failure to conceive would be catastrophic.

7. They are willing and able to fit IVF treatment into their busy lives?

Egg donors are no less busy than any of us and yet they are willing to come for a couple of doctor’s appointments, an appointment with the nurse and a counselling appointment with me, as well as a number of scans during treatment and the egg harvesting procedure at the end. And yet, they do not seem in any way put off by what this will all take. Some of them are mums with young children and yet they are very willing to fit all of this into their busy daily schedules. They are happy to do it – because they really want to and are motivated to do whatever it takes, readily and willingly. I have never heard a prospective egg donor say ‘I don’t think I’ll have time for all that’.

8. They are happy to have contact with any donor-conceived adults that were interested in finding out about their genetic origins

They are happy to have contact with any donor-conceived adults that were interested in finding out about their genetic origins
Up until 2015 anyone who donated their eggs or sperm would remain anonymous. Then the law changed because a powerful lobby group of donor-conceived adults managed to make the government see that it was not OK for the authorities to keep the information about their genetic origins a secret from them by law. They argued that everyone should have a right to find out ‘where they came from’ and so in 2015 the law was changed and anyone donating their eggs or sperm had to agree that their identifiable details such as name, date of birth, last known address and any other identifying information, would be given, on request, to any donor conceived person once they reached the age of eighteen. In my experience, donor women (and their partners if they have one), appear to be completely comfortable and relaxed with this. They say things like ‘Well, if they want to come and see me, to see what I look like, or ask me any questions about their genetic heritage, their medical history, or why they might be the way they are - then I’ll be very happy to oblige.’ They don’t necessarily have any sense of what, if any, relationship might come from that initial contact, but they are open to seeing how things unfold.

The fact is, donors have to possess every one of these eight characteristics or qualities and if they fall down on any one of them it is unlikely they will come forward to offer their eggs. For example, if they don’t feel they have sufficient time and can’t fit it all into their hectic and demanding life; or if they don’t feel the £750 would be sufficient incentive for them to make that much effort; or if they are not happy to meet any future adults conceived from their eggs; or if they are terrified needles – or any other of the many reasons why they couldn’t face doing it, they simply don’t come forward.

That is why egg donors are so rare and special and such sought after human beings.

EGG SHARERS

This group of egg donors come from couples who are given the opportunity to have very low cost IVF treatment in exchange for sharing their eggs with a couple or a single woman who needs eggs in order to conceive.

Egg sharers can come from couples who, for example, have needed to have assisted conception treatment because the male partner has a very low sperm count. These couples have to have a form of IVF known as ICSI (where each egg is fertilised manually by an embryologist by injecting one sperm into each egg in turn). The first ICSI treatment is free on the NHS, but if the couple are unsuccessful and they want to try again it can cost them about £6,000 for a privately-funded ICSI treatment. If the couple don’t have that kind of money in savings, or have no parents or grandparents that can lend them the money, or they do not have the ability or willingness to borrow this amount, they can consider the possibility of getting treatment for about 10% of the cost if they are willing to give away half of their eggs.

The other group of women who share their eggs are lesbian couples. Lesbians are not able to access any NHS funded fertility treatment because, on the whole, they don’t have a medical fertility problems, rather they simply need donor sperm in order to conceive. Simple donor insemination treatment (IUI) can cost about £1,500 per go and usually more than one attempt at insemination is needed to get a pregnancy as the chance per cycle is not that high - between 10% and 25% per IUI depending on the age of the woman. However, at some clinics they are given the opportunity to go for a free IVF cycle if they are willing to share their eggs. This arrangement benefits both the couple themselves and the other couple on the clinic’s egg donation waiting list.

Women who share their eggs are treated in exactly the same way as altruistic egg donors and have to be within the same age criteria and have to have the same level of fertility required of an altruistic egg donor (as measured by their hormone levels). Both go through the same genetic screening and medical history checks in the same way.

There are, however, some ethical concerns and considerations that affect egg sharers which don’t apply to altruistic egg donors. Although these women are not actually being paid for donating their eggs they are being given a substantial ‘payment in kind’ and, when a woman is desperate to have a child of her own, or if she is in a lesbian relationship and the couple are not willing to risk the legal and medical issues associated with self-insemination in a private arrangement, then the egg-sharing option can seem very attractive. It is this incentive that might lead a woman to do something that deep down in her heart she might not have chosen to do if she was simply asked if she wanted to be an altruistic egg donor.

In my experience, the majority of women who offer to share their eggs are very similar to altruistic egg donors. They do not consider themselves to be the mother of any child and feel sure that the woman who conceives, carries and delivers the baby that results from their donation will be that child’s mother. They also say that they would accept it if the other woman got pregnant and they didn’t – and express sentiments like ‘At least I know I will have helped another woman or couple to have a baby’. They genuinely feel it is a win-win situation. They will get very low-cost treatment, whilst the other couple get the chance to try for a baby.

Occasionally, however, I get the sense that the couple who are considering egg-sharing are not entirely comfortable with some of the consequences of egg-sharing. Sometimes I even think they might be consider doing it, not because they don’t have the £6,000, but because they see it as a way of saving themselves a lot of money. Those who do not feel truly easy with the implications might say they are OK that the child will have the right to identifying information about them when they reach eighteen, but they may ask ‘Do I have to have anything to do with that person?’ and ‘Can I refuse to meet them if I don’t want to?’ Even more serious is the possibility that, if the egg-sharer is unsuccessful and never has a genetic child of her own (and either remains childless or adopts) whilst the couple to whom she donates her eggs go on to have a baby, that this child, when it becomes an adult and is able to seek her out then this will be the only genetic offspring this woman has.

I discuss this and any other implications for them of going ahead with them very carefully in order to help them make as informed a decision as they can. Ultimately my view is that they are adults who, if given good clear information and good sources for further exploration on the topic (like the Donor Conception Network. The National Gamete Donation Trust) have to make their own informed decision as to whether or not they want to go through with it – or whether they might, somehow, try and find the money from somewhere. Of course, I never know the outcome. I don’t know, in the end, what they decide to do as my job is simply to discuss the emotional and ethical implications of such a decision with them as best I can in the limited time allowed. The rest is up to them.

KNOWN EGG DONORS

Very rarely a couple will come to the clinic with the proposal that the woman’s sister or niece or cousin is willing to donate her eggs to them. Both parties will have been sent a lengthy questionnaire asking a wide range of searching questions about their views and feelings on all the complexities of embarking on such a path. I then see them separately – the couple and the donor (including the partner of the prospective donor if she has one) and together if needed. I go over everything with them again very thoroughly to be sure they have talked and thought everything through properly. These topics include things like whether or not they will tell the child that their aunty or mummy’s cousin helped them to have them by giving them an egg – and when and how they will tell.

This is a more interesting and complex way to have a child but if all parties agree and are sure that is going to work for them as a family it can be a good way of keeping the family genes if this is important to them. Anecdotally, a colleague from a clinic who had had a fair bit more experience of known donation than me, said she had the sense that the chances of success seemed to be higher if the woman had used the egg of her sister or other member of the family. This was never verified but we had an interesting conversation as to why this might be the case – if it was the case.

So there, in a rather large nutshell, is what I know about egg donors, egg sharers and what motivates them to do such an unusual and wonderful thing.

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