AMH, breast cancer, Cancer Kitten, Cathy, chemo, cytoxan, Dana Farber, DCIS, eggs, embryo, fertile hope, fertility, hair loss, in vitro fertilization, Invasive Ductal Carcinoma, IVF, LiveStrong, menopause, oncologist, ovaries, semen analysis, young woman with breast cancer
My oncologist not only broke the news to me that I WILL lose my hair during chemo, but also that I may go into menopause and I may or may not come out of it when chemo is finished. Whoa, what?
So now on top of losing at least half a boob and my hair, I may not be able to have kids? Bing and I stopped using birth control in March. I thought my next big life-altering event was having a child. My mom already gives us baby clothes. Bing and I talk about what room to make a nursery. I can handle breast cancer taking my boobs, causing temporary baldness, scaring me half to death, and forcing me to evaluate what is important in my life, but taking away our ability to have kids?
Cancer, you’ve officially crossed the line.
So Dr. Parker directed us to Brigham & Women’s fertility clinic, to learn what our options are for preserving my fertility. Of course, Bing is amazing and his immediate reaction was “We can always adopt.” (Well actually his immediate reaction was, “Will our IVF babies go fast?” He wants a “race team” of children). Lovely to hear, and I’d like to foster and/or adopt eventually, but I want a little Cathy-Bing hybrid more than anything. I do love our current animal family, but I really want to add some bipedal rugrats to the mix.
The fertility office had an appointment open on Friday, June 22. My sister Kim accompanied me. We met with Dr. Elizabeth Ginsburg, who was straight-forward, kind, and extremely knowledgeable. To start, apparently the Cytoxan which Dr. Parker will prescribe as part of my chemo will kill my eggs. It is unknown whether they all will die and I will remain in menopause. If eggs survive, they will not be damaged. Available studies do not indicate that there is a higher rate of birth defects in children born naturally after a woman has gone through chemotherapy. Menopause typically occurs when women are about 50. I turn 33 tomorrow.
The more eggs I currently have, the better the chance of having eggs when I complete chemo. Dr. Ginsburg sent me to have a blood test for AMH after our meeting. AMH levels are indicative of the number of eggs a woman has remaining, and will be one piece of information that Bing and I can use when deciding whether to proceed with fertility preservation.
Dr. Ginsburg explained that we have two in vitro fertilization (IVF) options: freeze eggs or freeze embryos. She explained the process and hormones used to stimulate my ovaries to produce multiple follicles. Of course, having an estrogen and progesterone positive cancer means that the administration of hormones needs to be counterbalanced with other medications, even though the cancerous mass will be removed by the time I begin the IVF process.
My eggs are harvested when I am under a light general anestheia, using a transvaginal ultrasound with a needle attached. Typically about 10 eggs are “ripe” and harvested (note: how well my ovaries respond to the hormonal stimulation is also indicative of my fertility). Then they are either frozen, or placed in a medium with semen (should we want to freeze embryos) and allowed to become fertilized. Usually 5-7 embryos are obtained and frozen using this method. Apparently there is a higher pregnancy success rate if embryos are frozen. If a semen analysis of Bing’s swimmers shows that they aren’t “good,” then we have to decide if we want to utilize Intracytoplasmic Sperm Injection (ICSI). This is where one good sperm is injected into each good egg. There may be a slightly higher risk of birth defects with this method.
The rate of infertility in a normal population of women is about 15%, while the infertility rate in women after chemo is 43%. That is significant enough for me to want to take action and attempt to preserve our ability to have biological children. The real problem is the unexpected cost, which will range anywhere from $5k to $11k, depending upon a number of variables.
There is an organization, Fertile Hope, which in conjunction with LiveStrong helps cover part of the unexpected IVF costs if I fit certain criteria (which I do, until I get married). Basically, a lot of the hormones and drugs needed for the egg harvest are donated, and the costs for the IVF procedures are lessened due to agreements made between the cancer foundations and fertility clinics. What stinks is that I really want to get married before I lose my hair and boobs, sometime in these next few weeks, but I don’t want to risk not qualifying for this program if we are married. Obviously, the ability to have biological children is more important to me than having hair when I get married, but it’s yet another crappy part of this cancer journey.
So, the cost break-down is something like this:
With Fertile Hope assistance: freezing embryos $5,000 (+ $180 fee); if ICSI is required, the cost is an additional $2,000. There is no additional cost for medications. Total: approximately $5-7k
Without Fertile Hope assistance, freezing embryos is $?? (guessing 7k-ish) (+ $180 fee); plus the cost of medication, which is ~$2,000; if ICSI is required, the cost is an additional $2,000. Total: approximately $9-11k
I am glad that I learned about the effects of chemo on my fertility a little later in my cancer-fighting process. One of the most diffcult tasks with my cancer is regulating the time I spend thinking, talking, and learning about it. I need to make certain that I continue living my life as normally as possible, and not dwell on cancer. I want to absorb information at my own pace and not become overwhelmed with small pieces of unclear information. In this instance, I think processing the fertility bombshell was made easier due to my immediate contact with a doctor. And of course, because of Bing’s unwavering love and support.
Me with my favorite four-legged family member: