Saving my future children:

One day after my breast tumor was removed in my first of two surgeries to remove cancer from my breast and lymph nodes, I began fertility treatments known as IVF (in vitro fertilization). Over the next two and half weeks I would give myself daily injections of very expensive fertility drugs that would eventually cause me to super ovulate 10 eggs at once which were harvested by my fertility doctor under twilight anesthesia. Those eggs would be put into a pietre dish and combined with my husband’s sperm. If the eggs fertilized, they would be immediately cryopreserved (i.e. frozen). The treatments were not without risk to me, and that risk was duly noted by my husband and doctors. You see my type of cancer is receptive to estrogen. That means that it responds and grows more rapidly with exposure to estrogen. The fertility treatments caused my estrogen to spike to very high levels during the 10 days that I injected myself with fertility drugs. However, after much discussion with my oncologist, we decided that due to the temporary duration of the estrogen spike, it was an acceptable risk to take in order to harvest and preserve some of my eggs. Unfortunately, only 3 of my 10 eggs properly fertilized with my husband’s sperm, leaving me with a less than a 30% chance of getting pregnant in the future using these frozen embryos. I was devastated. The thought of not having any more children seemed to crush my soul. Was it not enough that my cancer was taking away half of one of my breasts, all the lymph nodes (and the sensation under one of my arms), not to mention the temporary loss of all of my hair? After three of the darkest days in my life, I decided that I was not going to take this lying down. I was going to fight. I decided to fight for the lives of those unborn children that I knew were inside me. So I began to research again. I knew that I would have to put off my chemotherapy for a couple weeks if I were to try to do anything else to preserve my fertility. Also, I knew that spiking my estrogen posed an undefined risk to me. So, I went back to http://www.fertilehope.org/ and found the name of a doctor in New York that specializes in fertility treatments for cancer patients. In a phone consultation he told us that our best option was to repeat another IVF cycle prior to my chemotherapy. This time, however, he would put me on a drug called Letrazol that he had been using for a clinical trial. The Letrazol would suppress my estrogen during the IVF cycle. This was very exciting news. Even better news was that he could supervise the cycle by phone in coordination with my fertility doctor in Austin. So we began again after receiving approval from my oncologist that postponing chemotherapy did not pose any serious risk to my life. I again produced 10 eggs. However, this time 9 of the 10 were fertilized and frozen. That meant that I had a total of 12 frozen. I was joyful! My doctor assured me that I now had enough embryos for at least two pregnancies. Now I could face what lye ahead with a clear mind. So two days after surgery to harvest my second set of eggs, I began chemotherapy.

My breast surgeries:

As I have alluded to in previous entries, I opted to simply have my tumor removed instead of my entire breast tissue. This procedure is called a lumpectomy. It is not an option for all breast cancer tumors and requires radiation to the effected area. However, the survival rates are the same as a full mastectomy. Approximately two weeks after my initial diagnosis I was wheeled into surgery for this procedure. At the time of the lumpectomy the surgeon also removed my sentinel lymph node. The sentinel lymph node is the one to which the cancer would move first if it had spread. It is determined by injecting radioactive dye around the cancer tumor prior to surgery. In my case the pathology report indicated that yes, my cancer had spread into that lymph node. It was still microscopic, but it was there. The report also indicated that my surgeon had not gotten a clean margin around my tumor. This meant that I had to have another surgery. My surgeon advised that he would go back into my incision and remove more skin and breast tissue in an attempt to get the rest of the cancer around my tumor. In this same surgery he would remove the remaining lymph nodes under my left arm so they could also be checked for cancer. Finally, he would insert something called a port-a-cath in my chest. The purpose of the port was to provide a safe place to inject the chemotherapy. A port is a permanent IV site under the skin which connects directly to one of the major veins running through my chest. It provides easy and safe access for the chemotherapy infusions which are too toxic and damaging to be injected into a small vein in the arm. So one week after my initial surgery I went back to the hospital for another surgery. Unlike my first surgery, this one really hurt. When I awoke I felt like I had been hit by a Mack truck. I was told that I now had two 5 inch incisions, one across my breast and one under my arm. In addition, I had a drain under my arm for the excess lymphatic fluid that would continue to drain from my body for the next week. My doctor advised me to stay in the hospital over night, but I insisted on going home. I wanted so badly to see my son and be reassured that life would go on and that I would survive this. His smile always seemed to provide the reassurance that I needed. At home my husband carefully cared for me, and within just days I was up and about and in fact insisted on going shopping with one of my friends just 4 days post surgery (tucking my drain up under the big blouse I had to wear to cover all my bandages). Also, we received very good news from the surgeon after this second surgery. My margins were now clean and none of my other lymph nodes contained cancer. Finally, the first piece of good news we had received since this ordeal began.

Preserving my fertility:

After meeting with my surgeon and oncologist, my next stop was an appointment with the local fertility doctor. Since we had no trouble conceiving our son, my husband and I were unfamiliar with the world of fertility treatments and procedures. Also, unlike all the other medical issues surrounding my breast cancer, this one required direct involvement by my husband (I am sure you know where I am going with this). In these next few entries I am going to be completely honest and candidate about a subject that is deeply private and personal in hopes that this information will help other women make a decision about this very important subject before it is too late. You see, when you are diagnosed with breast cancer all your doctors are in a rush to get things done (as they should be). If you have surgery before chemotherapy it usually occurs within a couple weeks of your diagnosis with chemotherapy scheduled a few weeks later. Once you have chemotherapy it is too late. Your ovaries shut down during chemotherapy and may never work again. So you basically have a very small window in which do anything to preserve your fertility. Thus, if you don’t have the right information within days of your diagnosis, you may not be able to do anything about it. So in my case after gleaning every possible piece of information from my fertility doctor, he referred me to a wonderful website called http://www.fertilehope.org/. This website contains the absolute latest in fertility options for cancer patients, both pre and post chemotherapy. It also offers grants for those with financial need to cover the cost of the fertility treatments, because most insurance does not cover these treatments (even when you are doing the treatments due to cancer and not due to infertility). My husband and I knew we wanted more children, so we had to agree on the extent of the measures we were willing to take to preserve my fertility. After many thoughtful discussions we agreed that if we were to have more children, they would have to be our biological children (i.e. my egg and his sperm) and that I would bear the children (i.e. we would not use a surrogate). This was all very logical and made sense, but for me there was another aspect of this whole fertility business that drove me to investigate every possible option: All I could think about was the very toxic chemotherapy penetrating my ovaries and killing, one by one, my eggs (and what amounted to my future children). I admit this was not very logical and possibly irrational thinking on my part. The truth is: although the chemotherapy does damage your eggs, they do heal after a period of time. And if your body cooperates and starts ovulating again before your eggs are too old, you are back in business. However, I just could not stop myself from thinking about the chemotherapy in terms of killing my eggs and thus my future babies. Many nights I would cry myself to sleep thinking about it, and asking, “Why, why, why….why must I do something albeit life saving for me (i.e. the chemotherapy) that might kill my future children?”