A Trip to the Fertility Specialist

I got a call from the BC Cancer Agency the day after hearing the results from the sentinel node biopsy and surgery. They had an appointment for me three weeks later. My initial thought was 3 weeks! Why so long?! I was expecting to get in within a week or so based on my conversation with the surgeon. I tried contacting my surgeon to no avail and then called the cancer agency back to explain that the cancer had spread to the lymph nodes, surely they must want to get me in sooner? The receptionist assured me that my file was reviewed by the oncologist and that was the soonest he would see me. I was devastated and that’s when I really broke down since I was first diagnosed. I felt helpless, like I wasn’t in control anymore of my fate. I was angry that they didn’t want to get me in sooner when they knew the cancer was in my lymph nodes and had to be stopped before it went any further. And I was even more upset and worried that my cancer was spreading while I was sitting here playing the waiting game. It took me a few days to get past the flurry of emotions and then I finally decided that I needed to switch things around and get my mind focused on something else before I started driving myself crazy.

Can I have children after cancer treatments?

There were a couple things I wanted to get in order before I started chemo including getting referred to a fertility specialist. In speaking with the surgeon and others who had been through a breast cancer diagnosis, I knew that my body would likely be put into temporary menopause during chemo and could have long term effects on my ability to get pregnant. Although my husband and I didn’t have plans in the near future to have kids, we wanted to keep the door open and know what our options were should we decide to have kids later on.

My family doctor put in an expedited referral and I was contacted by the Victoria Fertility Clinic within a week to discuss my options with a specialist. As my appointment with the oncologist was quickly approaching, there was some urgency in seeing the specialist in case I decided to look at fertility options pre-chemo. I was required to fill out a lengthy questionnaire asking about my family history, any fertility issues, medical issues, etc. prior to my appointment. When I arrived at the clinic the following week, the specialist reviewed all of this information including how my current diagnosis came to be and how it would impact my ability to get pregnant. Chemo kills fast-dividing cancer cells and can be harmful to the ovaries which also contain rapidly dividing cells that produce eggs. Some people’s ovaries will recover after chemo and others will not. Age can factor into this as well as what types and dosages of medications you have.

We then reviewed both of my options, neither of which would be covered under my extended health benefits. The first option was in vitro fertilization (IVF) which involves egg retrieval, sperm retrieval, fertilization, and then freezing the embryo. However, it would also mean taking hormone pills to stimulate estrogen production which is exactly what my body didn’t want right now. My breast cancer was fueled by estrogen. This procedure is also very expensive (in the thousands) even at a reduced rate for cancer patients and is not guaranteed to work. The second option was to start taking an experimental drug immediately which may help preserve my ovaries throughout chemo with the hopes that they would function normally after treatment. The drug was experimental though which meant they didn’t know whether it was effective, if it would counteract with my chemo drugs, and would also set me back $400 per month during chemo.

Seeing my hesitancy with both the options discussed, the specialist decide to conduct an ultrasound to see how well my ovaries were functioning in order to get a better idea as to whether they may “wake up” and function again after treatment.  Once finished, I returned to his office and he let me know that my ovaries were functioning normal to above normal and felt that I had up to a 75% chance of my ovaries waking up again after chemo. That was great news; however, he also advised that after all of my cancer treatments were finished, I would be placed on a hormone therapy drug called Tamoxifen which shuts down the ovaries’ production of estrogen, taking away my ability to get pregnant for at least five years. So, even if I froze my embryos or took the experimental drug, I wouldn’t have the ability to get pregnant until I was 40.

It was disappointing to think that the opportunity to have children was being ripped away from my husband and I. It was no longer a personal choice anymore. We wouldn’t have the opportunity to have a child in a couple years or possibly ever, depending on whether my ovaries started working again after all of the treatments. The doctor asked me what option I was leaning towards. It was too much of a risk to take either option and both had no guarantee. My health was my top priority as this point and I would rather wait and see what happens then have either option potentially affect my treatment or growth of the cancer. The doctor agreed and told me that my number one goal and focus was to beat this thing.