I’ve started this blog post quite a few times and then given up as it’s all a bit too traumatic.
Yep – it’s the one about fertility and kids and fucking cancer potentially ruining everything. The main crux of it all is:
– M and I would like to have kids
– Chemotherapy will potentially make me infertile
…but that is not all.
Oh no, it’s not nearly that simple. There are also other things to consider like the fact I may carry a gene mutation for breast cancer which I could pass on. Or that my cancer is ER+ meaning that oestrogen feeds it. Pregnancy raises your oestrogen levels somewhat. Or that I am supposed to take hormone therapy after all my chemo / surgery is done – for five years. You can’t have kids while on hormone therapy.
When I was first diagnosed with DCIS (non invasive cancer) I was happy that chemotherapy would not be on the cards but consumed by the fact it could be genetic and what that would mean for having kids. I have a huge moral dilemma about whether it would be wrong to even try given the fact I appear to be a genetic disaster. Then I got upgraded to invasive cancer at it all just seemed completely hopeless. I’ll be honest – it is the thing that upsets me the most… apart from the possibility of dying obviously. The thought of dying is quite abstract though. The thought of not having kids is very tangible and just makes me feel like I have no future – even if I manage not to die.
It’s not just me either is it? This is also potentially ruining M’s chances of being a dad. Couldn’t feel more guilty about that.
Now I am four months on from my diagnosis of invasive cancer I go through stages of feeling utterly hopeless about this subject or actually quite hopeful. There is no in between.
I think I’ve covered the negatives but on the hopeful side we have the fact we did IVF treatment between my second surgery and starting chemo. We ended up with three embryos on ice. I am very happy we did the IVF but only getting three embryos was very disappointing for me. Again felt like a huge failure when I read about all these other women who end up with ten embryos and there we are with three. Oh well, three is better than none. IVF not only means a back up plan either. There is such a thing as pre-implantation genetic testing – where embryos can be tested for crap genes. This is part of the reason I was so disappointed by only three embryos – doesn’t give much scope for finding a ‘good one’ if we need to go down this route. The main point though is at least we have an option if I do end up mangled AND barren.
There is also the fact that my oncologist says there is the option to come off of / have a break from tamoxifen (the hormone treatment) after two years to try for a baby. Not that he’d advise it obviously – he’d definitely prefer me to stay on it for the recommended five years but then I would be 39 minimum before we could even start to try.
We also have the fact that even if I do have a known wonky gene (still waiting to hear from genetic clinic about testing) the chance of passing it on would be 50/50 – and even if I do pass something on that is not to say it would certainly lead to cancer. It is not a done deal. I also feel like my life is worthwhile even though I have cancer – and who knows how much treatment will have come on in 25+ years.
Zoladex is next on the list. I have a love / hate relationship with zoladex. I am having a monthly injections of this to try to help preserve my fertility. The idea is that it shuts down your ovaries and so protects them from the chemotherapy. Whether it really adds any benefit is not completely clear but I asked for it and my oncologist was happy for me to have it. I feel like I have to do everything I can to try – even if it only adds a couple of % improved chances. It has horrible side effects though because basically it puts you in a chemical menopause. Just what you need alongside chemotherapy.
Finally – because of my age, my oncologist seems to think there will be a good chance I will retain my fertility, albeit maybe for a shorter period of time than would be normal. No one can say for definite obviously – but I think being under 35 is considered quite hopeful though.
So there you have it – basically a load of uncertainty and shit decisions to make – but there is some hope. Best case scenario:
– I don’t carry any of the known genes. This doesn’t mean my cancer is not genetic, it still could be but the gene itself is unknown. The way I see it though is that I can only go on what is known. Carrying a BRCA gene mutation can mean up to 90% increased chance of developing breast cancer. Carrying an unknown gene means an unknown risk – I feel I would have to discount this as an issue if that is the case.
– I come of tamoxifen after two years and periods / ovulation return to some semblance of normality.
– We get to try naturally and succeed. There is much joy.
– Doing this does not cause recurrence or new primary cancer – or any kind of secondary spread. I don’t die. There is even more joy.
– I go back on tamoxifen, complete the course and we all live happily ever after.
I like this scenario. I like it a lot – even if it involves some difficult decisions and risk. I have to hope this is what is going to happen because the other options are frankly crap.
I know we are lucky to have our back up embryos but frankly, I don’t want to have to use them. For the record I do not wish to consider donor eggs or adoption either at this point. It is interesting how people think these are comforting suggestions. They are not.
Sometimes when I run all of the above through in my brain (which I do pretty much 90% of the time) I just end up thinking ‘who am I kidding?’
Other times I feel quite hopeful and think ‘No, fuck you cancer, not going to ruin the rest of my life’. Problem is, even when I feel like this there is nothing I can do but wait. Wait to finish chemo. Wait to finish surgery. Wait to even start taking tamoxifen let alone wait for two years to come off it again. Wait for tamoxifen to get out of my system once I stop taking it. Wait to see if fertility returns. Wait to see if we have been successful if we can try naturally.
That is an awful lot of waiting.
I hate cancer.