**Laura has kindly given Cancer and Fertility UK Permission to reblog here. If you would like your blog post featured too (as long as on topic of cancer and fertility) please get in touch!**
Fertility to infertility.
Chemotherapy can make you infertile. As if cancer isn’t enough to deal with and now I have to face the possibility that I may never regain my fertility?!
This is definitely something that I didn’t think I would ever have to consider at 24 years old. With next to no time to contemplate such a significant subject, I was forced into making a decision about whether I wanted to make attempts to preserve my fertility, or proceed with treatment without making any preservation attempts.
I initially met with a consultant in Malvern to discuss my options and underwent some blood tests to check my hormone levels . After explaining my diagnosis and that my cancer was strongly ER+ (estrogen positive/fuelled by estrogen!) he explained that undergoing fertility preservation would put me at higher risk and essentially fuel my cancer as I would have to pump my body with hormones to stimulate egg production in preparation for egg extraction! I was gutted. I mean, I don’t want children at the moment but I would like them at some point in the future. This was just another kick in the teeth for me.
I left feeling a little numb but at the same time, there wasn’t much I could do and I wasn’t going to worry about the future as I had too much to deal with in the present! I chose to push it to the back of my mind and soldier on.
However, meeting with my consultant in Birmingham, there was a slightly different spin on things. Upon discussing my chemo regime, I was asked if I had discussed fertility issues with anyone. I said yes and explained that I had met with a consultant and re-iterated what I had been told. My consultant said that he did not believe the estrogen factor to be of significant concern as they could give me a drug alongside the procedure to block any estrogen stimulating my cancer cells any further! I was quite surprised at this but also slightly hopeful too, so I was given an urgent referral to the Birmingham Women’s Hospital to meet with a fertility consultant there.
Birmingham Women’s Hospital
Arriving at the hospital, I was welcomed by a volunteer doing his happy, smiley “Hello’s” to newcomers of the hospital. I thought this was quite a nice little touch upon arriving. I continued along the corridor past a stall to my right selling knitted baby clothing and accessories. As brilliant at this was, I couldn’t help but make a conscious effort to divert my eyes; it was a little raw for me to see baby things when I knew the potential ‘infertile’ status that was hanging over my head. Winding further on through the corridor, I reached the board listing ward names and locations. By this point I had already passed about three new parents carting their newborns from the maternity unit, which happened to be on that floor… Now I know I’m going to sound bitter here, but I noticed that the more I visited the hospital, the more my senses were heightened to the babies around and I felt slightly envious of them because I knew that it was potentially something I might never be able to have. It’s funny how as soon as you’re told you can’t, or may not be able to have something, even if you don’t want it at that moment, you hope for it more than ever before. (No, I didn’t want to pop a baby out there and then, but just thinking ‘future’…) But I wasn’t a total bitter grump – I did feel a sense of contentment for the new parents; they really are lucky. I think it just goes to show that sometimes we take things for granted.
After several flights of steep stairs, I arrived at the fertility centre. It was a very alien experience sitting in that waiting room. It was filled with several rows of chairs quite cramped together, all facing the far wall and a little TV with the usual daytime home/decorating shows playing. There were mostly couples there, all looking quite anxious, understandably so, and whispering to eachother. Being in such close proximity, we were in the perfect set up for unavoidable eavesdropping – an all too familiar environment by this point.
I was called through to a side room and Mum accompanied me. The consultant discussed my options. These were: 1) Egg collection or 2) Freezing embryos. I didn’t have a partner at this point so embryos was out of the question for me. I was told that I could freeze an embryo with a sperm donor, and that the success rate for embryos was significantly higher than that of freezing eggs alone. I wasn’t keen on the idea, at that time, on the whole sperm donor thing. It’s something that I would have perhaps considered more carefully if I had been about 10 years older, but making such decisions in my early 20’s made things quite a lot trickier and confusing. I had never really thought further than the idea of wanting children in future, and that was that. I hadn’t explored the idea in detail or had a desire to plan all the ins and outs of conceiving! So, feeling under an immense amount of pressure to make a decision, with the added weight in my mind of knowing that I needed to start chemotherapy ASAP, I opted to freeze eggs alone. I thought back to how I felt when I was told initially this wouldn’t have been a safe procedure and how I felt disappointed. That was a tell tale sign in itself to go ahead with the egg collection; at least then I had a tiny bit of hope and would know I had done something to increase my chances of having a child in the future, just that little ounce more. And I really do mean a little ounce more. The success rate for freezing eggs alone and being able to use them in future is an extremely low percentage.
The consultant explained to me the risks involved, which included ovarian hyperstimulation and increased risk of developing borderline ovarian cancer later in life (the lifetime risk being under 7 in 1000). After going through a mammoth load of paperwork and deciding what I would like to do with my eggs in the event of me losing mental capacity or dying, how long I would like them to be stored for, potential research possibilities and various other medical and social issues.. I signed the papers!
I then went for an internal vaginal scan in order for the consultant to get a baseline picture of the lining of my womb and ovaries. This was my first ever internal scan and it felt rather awkward, but it certainly wasn’t going to be my last with me needing to return for more to check the progress! A nurse then came into the room with a “starter kit” to explain the medication I would be taking and how to administer it. The bag contained lots of needles, sharps bin and three drugs; Cetrotide, Menopur and Human Chorionic Gonadotrophin (HCG). I had never self-injected anything into my body before so this was something new for me! And good job I became familiar with it (I’ll explain why later).
The nurse showed me how to draw up the solutions, taking care not to get any air in the syringe and then directed me as I pinched the skin on my lower abdomen and jabbed the needle in. Voila! First one done – easy peasy. Next for the Cetrotide. I had to continue both injections for 6 days, alongside two further scans. My final scan showed a good amount of eggs ready for collection, so I was given an estimate date for surgery! 36 hours before the time of my surgery, I had to take a ‘late night’ injection of HGC. This injection is essential for bringing the eggs to the correct stage of maturity, ready for collection. So with STRICT instructions, I made sure I injected the HGC bang on the time specified!
16th October 2015: 36 hours passed and with hunger setting in from being nil-by-mouth, I found myself waltzing into a small theatre room full of about four or five nurses/consultants! I did not expect there to be so many. Feeling slightly embarrassed, I climbed onto the bed and was told to spread my legs WIDE and place them in the stirrups! By this point, all of the staff that were standing at the end of the bed had a first class view of my lady bits!!! The consultant tried to make me feel at ease and chatted to me about my day. I had been to Malvern Hills the day before and he commented on how he loved it there – and then I talked to him about which University I studied at, and a bit about his daughter… then I was gone! Under the general again!
The procedure itself was very quick. A needle is passed through the vaginal wall into the ovaries to suck out the fluid from the follicles containing the eggs and in all, it took about 20-30 minutes!
I woke up in the smallest recovery bay I had ever seen in my life. My feet were hanging off the edge of the bed almost sticking out of the curtain! A nurse came in to check on me and told me not to be alarmed, but they had placed a GIANT sanitary towel between my legs in the event of any bleeding from surgery. It certainly was the biggest I had ever seen! I stayed in the bay for a short while and after some more pain relief, I felt ready to get up and get dressed. I was moved to a waiting lounge, joined by several other women who had probably undergone similar/ or the same surgery. I had to wait there for approx 2 hours to be discharged. It felt like such a LONG wait and I was so glad when they called my name to go home! OH and 9 eggs were successfully collected and frozen!