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Breast Cancer and Fertility: To Freeze or Not to Freeze

Posted: 20/10/2012 01:00

By far the most stressful and upsetting part of having breast cancer at 29 years old was having to make the decision over whether to freeze my eggs. Losing my hair would be temporary, but losing my ability to have children would be permanent and devastating.

The first of my concerns was that chemotherapy targets fast-multiplying cells and can mistake eggs in the reproductive system for cancer cells, possibly causing infertility. (Please note, I am not a doctor and I have no medical knowledge apart from what I am reproducing here from my specialists, so please don't take anything in this blog as medical advice).

Secondly, after I finish chemotherapy and radiotherapy, I have to take a drug called Tamoxifen to reduce my oestrogen levels for five years. My breast cancer is oestrogen-receptor positive so my levels of the hormone must be kept down to reduce the cancer recurrence risk. The problem is that doctors advise against pregnancy for the entire five years of Tamoxifen, meaning I will be 35 by the time I can even start trying - by which point I may already be infertile. That said, some specialists are not against women taking a pause after two years of Tamoxifen to have a child before completing the rest of the course.

The final factor is that of genetics. I have been tested for the BRCA1 and BRCA2 breast cancer genes and am currently awaiting the result. Sadly, if I test positive for one of the genes, I will have a 50% chance of passing it onto my children. An IVF process exists that can remove the offending gene before fertilization, but the chances of pregnancy are extremely low with this method and there are obviously ethical issues surrounding any kind of genetic tampering. I feel it would be irresponsible to knowingly get pregnant if I do test positive.

Faced with all these factors, the most important thing for me to do was to try and preserve my fertility before I started chemotherapy. This left me with less than two weeks to make a decision.

To Freeze or Not to Freeze?

My first port of call was St. Mary's Hospital in Manchester, where I had a consultation with a very friendly and helpful oncologist and fertility specialist. She explained the ins and outs of egg freezing, which was, to all intents and purposes, my only option. Because I was single, I didn't have the luxury of freezing an embryo, which would have a higher chance of leading to a successful pregnancy in future. There is such a thing as freezing ovarian tissue, but unfortunately this process is very much in the initial stages, is not readily available and, according to Breast Cancer Care UK, there have been no recorded live human births from it in women with breast cancer.

The egg freezing process, known as oocyte cryopreservation, would involve me taking drugs for 10 days to induce a period, then injecting myself with hormones to stimulate my oestrogen production for a further 10 days before finally returning to the hospital for a procedure to remove my eggs under sedation. The best of the bunch would then be taken away and frozen for up to 10 years, at a cost. Worryingly, the entire 2-3 week process would delay the start of my chemo.

The procedure didn't sound too horrific. Self-injection wasn't a prospect I relished, but I could deal with it if I had to. What complicated things was the idea of stimulating my oestrogen production - the exact opposite of what we needed to do to keep my cancer from recurring. What's more, the egg freezing process only had about a 10% chance of producing a successful pregnancy in future. To make matters even more difficult, the whole process of egg preservation was to cost me about £5,000 and wasn't covered by my insurance. The NHS might fund it, but I would have to commit to the money first because I simply didn't have the time to wait for the decision.

A week or so later, I got an appointment at a clinic called Manchester Fertility Services. I had another consultation with a very friendly fertility specialist who had a more optimistic view of the chances of me having a successful pregnancy through egg freezing, which he still only put at about 30%.

I took all the required tests at the MFS, including an internal ultrasound that involved sitting on a rather interesting-looking, lube-drenched dildo-type device to check my ovaries, then blood tests to help gauge my fertility levels. I was told from the initial findings that my ovaries looked healthy and the chances were that I was fairly fertile. Because of my age, I also stood a very good chance of coming out of chemotherapy still fertile.

Before I left the clinic, I sat down with one of the bubbly Mancunian nurses on the edge of a bed in one of the private rooms. We were going through dates and timings and, as she worked out the day-by-day plan of injections and drugs, I suddenly broke down in tears. I was going to have to start injecting myself in the stomach beginning on my 30th birthday. In the grand scheme of things, it wasn't a big deal, but the significance of my 30th birthday and all that I had hoped I would achieve by that point in my life was enough to break me. The nurse was so kind and comforting, but I felt so alone at that moment - one of the worst in my life.

A Heart-Wrenching Decision

There are few things more heart-wrenching than being told you can't have children. But being in that situation now, alone in the fertility clinic at a point in my life when I wasn't even in a relationship - wasn't even ready to have kids - was surreal. I have always known I might not be able to have kids - no one's fertility is a given - but I never imagined I'd end up alone at a fertility clinic at 29 years old, trying to preserve my chances of having a family because of breast cancer.

I knew the decision ultimately lay with me, but I wanted to know what others would do in my situation. Confusingly, opinions were divided. My father was resolute that my own health had to come top priority, while my mother understood perfectly what it was to want to be a mother above all else. She and I were like a little set of sobbing Dominoes: a tear would come to my eye, she'd look at me and well up, I'd start to cry and soon we would both be wailing uncontrollably.

The day after the MFS consultation, I had an appointment with another oncologist who specialised in fertility at the Christie Clinic. I felt it would help my decision-making process if I knew what the chances were of my cancer coming back at some point. Right or wrong, my thinking was that if there was a high chance of it coming back anyway then the increased oestrogen probably wouldn't make a huge difference and I might as well have a go at freezing my eggs. (Bear with me here.)

The oncologist said there were some online tools she could use to predict the chances of my cancer spreading. After a minute of plugging in numbers, she told me the calculator said that with the chemotherapy and radiotherapy I was to undergo, I would have about a 90% chance of surviving the next ten years. That is, until I'm 39. Puzzled, I looked at her and said "Ok, that's fine, but I didn't ask my chances of surviving, I wanted to know my chances of the breast cancer spreading." It was then that she explained the meaning of Secondary Breast Cancer, a term that was completely new to me.

Secondary Breast Cancer

Secondary breast cancer, or metastasis, is when the cancer cells spread to a different part of the body - the lungs, bones, brain, for example. Unlike getting another breast cancer, or local recurrence, secondary breast cancer is incurable. Up to this point I had assumed if my breast cancer spread in future, I would just be able to go through a second gruelling chemo and radiotherapy regime to get rid of it again. Finally I understood how my chances of survival and my chances of the cancer spreading amounted to the same thing.

This new knowledge was a complete game changer. It was so important to make sure the cancer never came back, and I knew it wasn't worth risking my life for a paltry 10%-30% chance of a future pregnancy. After all, what was the point in being able to have kids if I might not even live to see them grow to five years old?

I made the decision not to freeze my eggs that day and I haven't regretted it for a moment. I am leaving my fertility to fate. The truth is, no woman (or man)'s fertility is guaranteed. Most of us grow up believing we will be able to have kids one day, but many of us struggle for one reason or another. You never really know until you start trying.

I had always thought I'd probably be able to have children and was conscious of my ticking clock as I approached 30, but it's funny how I've stopped worrying now I know my fertility is far from guaranteed. I have five years of oestrogen-surpressing drugs ahead of me, following 19 weeks of egg-damaging chemotherapy. There is absolutely zero I can do, except look after myself and hope for the best. I am completely pro-adoption and if I'm lucky enough to have kids one way or another then I will consider myself blessed.

 

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