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Onco-Infertility and IVF

Onco-Infertility and IVF

Posted by WarriorWoman on Apr 26, 2019 11:00 pm

2019 was the year. 

We would go on a vacation for Valentine's as a couple, leave our preschooler with grandma and have our last vacation before having another baby. By the end of 2019, the beginning of 2020, we would do the whole shebang once again: diapers, puke, sleepless nights, cooing, cutey pie eyes, midnight babbles...the whole works. 

When I received a diagnosis of Stage 3, multi-focal breast cancer with right axillary lymph nodes involved, I could totally handle it. No biggie: chemo, radiation, whatever, as long as I have a plan and don't have an allergic reaction to chemo, it will all be well. Then the bomb dropped! Chemo may cause infertility. That is not a detail mentioned on TV dramas and in the movies. I had no idea! I wrestled with my doctors, almost begged them to let us have a baby and then come back and do the treatment. It was very clearly explained that with hormone positive breast cancer, a pregnancy would advance the already aggressive tumors. I was told to think about being present to raise the child I already have. 

I felt so guilty.

I had specifically asked my husband to wait 5 years between kids. I got the IUD and it was all planned out. How was I to know that my schedule would lead us right into a conversation on chemo? He, of course, being the gentleman he is, said his only concern was making sure I was healthy and that he would have me for as long as possible. God bless him.

Then we were offered a ray of light by the medical oncologist at the time. (I switched hospitals subsequently). She presented us with the fertility preservation option. We were referred to CReATe Fertility Centre, downtown Toronto. For women under 40 years old facing oncoinfertility, OHIP covers the fees for the first attempt at IVF. OHIP does not cover storage fees or the actual medication you need to complete the process. OHIP covers the cost for retrieval of eggs but not of embryos. The latter has higher success rates. Our work insurance did not cover the medications either. Fortunately, the folks at CReATe have been doing this for a while, and they were able to get me "Compassionate Meds". This means that they submitted a request to the drug manufacturers, who then provided generics free of cost. CReATe was very efficient and wasted no time, knowing that all other treatments would be held until IVF had been completed. For all medications remaining to be paid for after the compassionate meds were received, any other tests not covered by OHIP and the first year of storage, CReATe referred us to Fertile Future which reimburses out of pocket costs with various caps depending on their criteria. 

The IVF process itself was very interesting. First things first, they use a pill that was previously used to treat breast cancer, and so it actually begins the treatment process as opposed to making things worse, in the case of hormone positive breast cancer. Ovary stimulation was observed as a side effect of that drug. Now it is used primarily in this manner. Once we did the blood test to get a definite on my Cycle Day, we set a schedule to begin cycle monitoring on the first day of my next period....which came a week early..yay!...while we were on a weekend getaway...double yay!

Cycle monitoring feels like cows in a barn. You show up super duper early in the morning to get a high number and avoid spending your entire morning mulling from station to station: Blood work, empty your bladder, ultrasound, doctor consultation, nurse consultation. This is where they make sure all of the little eggies are doing their thing. Daddies to-be often skip this process, but some company is nice. I did this for about 10 days. I opted to learn how to self inject to avoid the bus and train fiasco everyday for nearly two weeks. (Shout out to my support team who took my little girl to school on those early mornings).

Thanks to that week early period, my dates for egg retrieval coincided with the mastectomy. I had the mastectomy on Tuesday, was in the IVF clinic early Wednesday morning, took the trigger shot on Wednesday night and had the eggies removed on Friday morning. Needless to say, I was souped up on drugs for a week!! Slept like a dream, and apparently had some comical conversations, none of which I can recall. 

We had refused the doctor's suggestion to try for two cycles due to financial pressures. We wouldn't have known until the end of the process exactly how many drugs would have been covered and what exactly our out of pockets costs would be. We cast all our chips on giving it the one shot. I also found out that my egg reserves were low anyways. The explanation is that chemo ages the ovaries by 5 years, and given my low reserves, I was headed for early menopause on my own. Regardless, we could only give it one shot. Plus, that doctor had no idea how determined our zygotes were to procreate. My husband did not have a lot of fun in the "self stimulation" room, but he was pretty proud of the final result:

6 objects were retrieved
1 was a cyst
1 was too immature for fertilization
4 were successfully fertilised and are awaiting for us in the freezer!

These rates, we were told, are unheard of. Usually, it would take 20 retrievals to produce 4-5 successfully fertilised embryos which also make it to the blastocyst stage.

We may be able to take a 2-year break during hormonal treatment after radiation to try for the Frozen Embryo Transfer (FET). That will be the decision of the medical oncologist. Otherwise, we will need to complete the five years first. The fertility clinic makes you think of some morbid stuff, like what to do if a parent dies before the FET or what to do in the case of separation or divorce, so one way or another, you know what will happen to the tiny being in the freezer. 

I hope this helps anyone who is wondering about fertility preservation. If it's important to you, I encourage you to ask a million questions and make the best decision for your family. I can tell you, it gives me great hope to know that whether or not my fertility is compromised, modern science has my back and we have a shot at still having another baby.

 

Re: Onco-Infertility and IVF

Posted by Lacey_adminCCS on May 1, 2019 3:13 pm

WarriorWoman‍ 

I can't thank you enough for sharing about this process with our community. I  know others will find it helpful to know that there are organizations that can help and they don't have to give up on their dreams of having (more) children in all cases. Talking to the Doctor about your individual situation is key. It is evident from your post that you have asked a lot of questions and done a lot of research.

"If it's important to you, I encourage you to ask a million questions and make the best decision for your family". This is great advice 😊. I am so glad that you had an unheard of amount of success and everything came together so well. I wish you all the best with your future family planning. 

I love modern science 😊

Lacey

Re: Onco-Infertility and IVF

Posted by WarriorWoman on May 1, 2019 8:03 pm

It is my absolute pleasure, Lacey_adminCCS‍.

There is so much information coming at us all at once, so many emotions and we understand so little at that time. The decision on IVF has to be made quickly because it comes before treatment. Hopefully this will help clarify the process, the steps and even help others figure out what questions to ask so they can decide. It is a major undertaking and it adds another procedure to the treatment plan. If expanding the family, or just leaving the option available for the future is important to the individual, then it is absolutely worth it. 

There are also real risks and even more unpredictable emotions to add to the mix. I believe it is worth investigating, even if nothing else. Infertility from chemo is at least one risk we can mitigate against, thanks to science!