Since my port placement, I haven’t had a lot of specifically “cancer stuff” happening. Rene and I enjoyed a nice, long weekend for Memorial Day last week. We did our fair share of laying around the house, and Rene’s parents also came down from Waco and we went to the zoo, played Fact or Crap, made a frozen yogurt trip, and ate at a German restaurant (the land of Rene’s & his mother’s births). I was able to go back to work on Tuesday for most of the week, and I have to say I was ready! Although I do enjoy my “cancer uniform” of sweats and over-sized button downs, it was nice to feel well enough to go to work and have somewhat of a routine for a few days.
What brings me to the topic of this post is that while I haven’t had any cancer-specific appointments since my port placement, I have been undergoing fertility treatments. Since I chose to blog so publicly, I waited awhile to make this entry because its such a sensitive topic to so many people, I wasn’t sure if/how I wanted to approach it. I also wanted to have as much information as possible to share with you, in case this blog turns into an early resource for someone who just found out their own diagnosis. Unfortunately, possible infertility is just one of the many harsh realities that both male and female patients have to deal with, and my goal with this blog is to be as open and honest about the experience as possible.
I was extremely fortunate that the possibility of infertility was brought up with me early on. From what I understand, not everyone is given that information beforehand and have since struggled to have children. The pulmonologist was the first doctor I saw after my diagnosis and he made sure to put it on my list of things to ask the oncologist about. The oncologist also made an appointment for me with a fertility specialist the same week I saw her. Fortunately, the fertility outlook for the form of chemo I’ll be taking is fairly positive, however, the chance was still high enough to be a concern. Rene and I always wanted to be parents, and although I’m open to adoption, having biological children isn’t a door I want to risk closing just yet. In addition to chemo, I’ll also be doing radiation during my treatment which also has its own set of risks. Since we can’t predict how well I’ll respond to the initial treatment, it’s always possible they could try something that might be less friendly to fertility as well.
Being in our mid-20s and only having been married about 2 years, Rene & I had never attempted to conceive before. My knowledge of ultrasounds was based on one surface ultrasound I had a couple years ago when someone suspected I had ovarian cysts, and I was told to have a full bladder so they could more easily read the ultrasound. So I went to my first fertility consultation appointment thus, and quickly discovered I would be having a vaginal ultrasound and a full-bladder is actually not a good thing to have. It was uncomfortable for me and the doctors kept complaining that my bladder was “in the way.” Just a head’s up for anyone going in for fertility counseling, but I digress…
Once they determined I was otherwise healthy and fertile, the doctor explained to me that there’s several options:
Egg harvesting: I take hormone shots that encouraged my body to release a large quantity of eggs and then the doctors go in and get them. Afterward they cryofreeze them until Rene & I are ready to have a baby, and then they thaw them, fertilize them and implant them.
In vitro fertilization (IVF): Egg harvesting + using sperm to actually fertilize the eggs and create embryos. The embryos are then frozen until we’re ready for them and then they’re implanted.
Lupron: A monthly shot that basically shuts down the ovaries. Studies indicate that women who are on lupron during treatment have a higher chance of fertility afterward.
My doctor recommended IVF because its the most reliable method, and also using lupron throughout my treatment. If any other Grey’s Anatomy fans recall, Izzy & Alex did IVF a couple of seasons ago for the same reason. (Maybe they’ll bring Izzy back for this potential plot line for the future?) Although egg harvesting and storage is now becoming more available, there’s just not a lot of research on how well those eggs fertilize after being cryofrozen for a time. A lot of women are in the process of freezing eggs, but not a lot of women have retrieved them yet. The research they do have indicates that embryos are more likely to result in viable pregnancies than the eggs being fertilized after being frozen. However, a lot of people do choose egg harvesting because its more affordable and because many women are single and would rather save their egg’s for Prince Charming’s sperm rather than donor sperm. Whatever the situation, people choose different methods for different reasons.
I’d love to say we did a lot of research, soul searching and praying before making our decision, but that just wasn’t the case. Given the fact that I a) have cancer, and b) was about to start my menstrual cycle, we had to make a decision extremely quickly and we opted for IVF. It just felt like the “right” path for us. To allude to Hunger Games, the odds have NOT been in my favor thus far in the sense that I’ve been diagnosed with cancer at 25 period. We always wanted to be parents and I wanted to increase our odds at having little Rene’s and Laura’s in the future as much as possible. Unfortunately, IVF is not a cheap route to take and right now most American insurance companies don’t cover it– including TRICARE– which is the military insurance that I have because Rene is active-duty. IVF is generally between $10-15K per treatment, and our experience has fallen into that. Luckily, TRICARE will cover everything else related to my cancer treatment and we decided it was a cost that was worth it for us.
The nurse did refer me to several charity programs out there for people who are undergoing fertility treatments due to cancer though, so I definitely recommend anyone in a similar situation to check them out. Lance Armstrong’s LiveStrong Foundation (which happens to be based locally in Austin, TX) has a whole program dedicated to fertility called FertileHope.org. FertileHope works by offering a list of participating clinics that offer discounted fertility services. In addition to the FertileHope discount, we also qualified for a military discount, and the estimate we received for IVF at the Austin-area clinic was around $7,500. Coincidentally, my friend (Jersey City) Amy had connected me with her friend Victoria St. Martin who went through IVF last year due to breast cancer. She did IVF through another charitable program, the Sher Institute (HaveABaby.com) and referred me to their participating clinic in Dallas (about 3.5 hours away). If you’re interested in learning more about her journey, you can visit her website at breastcancerat30.com. She’s been an amazing resource for me throughout this experience.
The quote we received from the Dallas clinic was about $5,500. Unfortunately, the charitable programs weren’t able to offer long-term storage of the embryos and future implantation was going to be at least $3,000. In the end, we opted to stay with our physician at our current healthcare system since we already had a relationship built with them and they were able to offer us a payment plan on a package that included harvesting, storage and future implantation for about the same total price. We also were not up to driving to and from Dallas due to cost and time constraints. So although it was more money upfront, it will probably pay off for us in the future and be more convenient since we won’t have to travel as far. We still have to travel about 45 minutes north to our healthcare system’s headquarters. Again, this is just the route Rene & I chose, it’s really specific to the situation. I would say that if I had been single or didn’t have TRICARE to cover my additional expenses, or lived in Dallas, etc. I probably would have gone with the charitable organizations. I think it also was a great option for those interested in egg harvesting, which was around $1,000 or less. The additional resources page on FertileHope was also a tremendous help, http://www.fertilehope.org/financial-assistance/additional-programs.cfm. They also offer information about options for men going through cancer treatment as well.
Before I even left the office at my first consultation, we started the IVF process. They decided to go ahead and give me my first lupron shot. As mentioned earlier, women can receive this shot to help preserve fertility. Lupron also serves a purpose in IVF because it prevents early ovulation. The doctor decided to go ahead and give me the lupron shot because even if we opted against IVF, it would be good to have a lupron shot in my system for when I started chemo. The second step was my doctor personally wrote a letter himself to my husband’s commanding officer. The essential message of the letter was, “I need Rene’s sperm!” Not a topic your doctor usually has to discuss with your husband’s boss, but there’s the Army life for you. Rene was still in Kuwait at the time, and his leadership had been waiting for a treatment plan for my cancer before they decided if/when to send Rene home from deployment early. Luckily, the letter worked its magic and Rene was back home within 48 hours! I don’t think I’ve expressed enough gratitude to the Army for this, so thank you thank you thank you!
The next step was waiting for my period to start which was a couple days later (TMI, I know). They had my fertility meds shipped to me the next day. The meds really have been an adventure unto themselves. The primary med is Bravelle. Bravelle comes in a powder form that we then have to mix together with sodium chloride and administer the shot ourselves. Upon learning this, our first thought was, “Uhh…… are we qualified to do this?” FreedomPharmacy also sent us a how-to video that we watched the night before (and rewatched the day of the first shot) to help calm our nerves. Luckily I had Victoria as a resource to give me tips. We also called the nurse twice for reassurance that small air bubbles wouldn’t kill me, etc. The Bravelle comes in boxes with five vials to take a day. Fortunately, the nurse informed that I didn’t have to take five separate shots a day, but can mix the vials together for two shots a day. I take 150 iu (two vials) in the morning, and 225 iu (three vials) in the evening for a period of 10 days. They can either go in the fatty tissue of the stomach, or the thighs. My friend Victoria swears by the thigh, but I found that the tummy was easier. So again, it’s just a situational thing. Victoria found it easier to do the mixing herself and have her boyfriend do the shot. Since Rene felt qualified given his experience of administering a grand total of one IV for deployment training, we had initially planned to take this route as well. However, when push came to shove I preferred to do the shot myself. I liked having control of where it was going and when! I started last Thursday and today is my last day. Tonight at exactly 8 p.m. I have to give myself a shot of Novarel (HCG), which basically will tell my body its time to ovulate. I’m pretty intimidated by it as the needle is quite a bit longer, and I’ll have to use more solution, which means it’ll take longer to inject. Those milliseconds really seem like a long time when you’re giving yourself a shot!
My egg retrieval will be Monday morning. I’ll know that day how many eggs they’re able to retrieve, and by the end of the week we’ll know how many fertilized. Unfortunately, IVF is not an exact science. They might not be able to get every egg that is released, and not every egg will fertilize, and not every embryo will implant, etc. There’s also the tragic situation that I’ll ovulate early and they won’t be able to get any eggs. As my doctor explains, ovulation is one of mother nature’s greatest instincts and she doesn’t always like it when we try to mess around with her. However, all my tests and ultrasounds (of which I’ve had many the past two weeks), have been positive, so I’m very hopeful by this time next week I’ll be able to tell you how many embryos we have. We also made the decision that any embryos that we have that go unused will be donated to other couples. Although it will be weird to have biological children out there that we don’t even know about, I’d be happy knowing we may have been able to help another couple have a family. Again, it’s a personal decision people going through IVF might have to consider.
Interestingly. when I went to Voodoo Fest in New Orleans in 2006, a psychic told me I would have a set of fraternal boy/girl twins. At the time I rolled my eyes because no one in my family has ever had twins to my knowledge, but now I’m seeing how it might be a possibility since IVF increases the chance of multiples.
Victoria was also told she would have twins by a different psychic. Maybe this is a go-to prediction psychics give young women? Who knows. The odds of that prediction being correct for most women are certainly not in their favor! Only time will tell I guess!