Almost Famous

Being told that the famous fertility doctor himself was going to conduct my vaginal ultrasound last Tuesday was like learning that one of your friends is bringing a Michelin-starred chef along to the dinner party you are throwing – there’s enough pressure when it’s just the usual crowd, but this heightens the performance anxiety.

“Only one, again,” he says, removing the wand and taking off his gloves. Statistically, five eggs are needed to result in one successful pregnancy later. Silently, I start to question what I have done wrong, why this has failed for the second time in a row. I feel like a 22-year-old who can’t pass her driving test– how can I be so bad at something that comes so easily to others?

The plaques and trophies that adorn the doctor’s office are not as reassuring this time as they were last time. Even one of New York’s 100 Best Doctors can’t give us the frozen embryo insurance policy we were hoping to have so that we could feel better about our chances to have children one, two, or five years from now, after the chemotherapy has done the damage that it inevitably does at the same time it does good.

Normally, women in my situation, who must undergo chemo but who want to get pregnant in the future, just cross their fingers and hope for the best. More recently, some doctors will give Lupron shots to artificially “shut down” the ovaries during chemotherapy, the idea being that it “hides” the egg reserve from the chemicals that are designed to attack fast-growing cells like cancer, hair…and eggs. Once chemo is done and you are off the shots, chances of returning to normal functionality again are greater.

Other women go through a round or two of “normal” IVF, the kind that can result in some women producing as many as 30 eggs at a time. However, there is some fear that the increase in hormones this process triggers may exacerbate a woman’s cancer.

So if you have access to joining a cutting-edge research study, cancer-specific “fertility preservation” is an option. I took a pill to suppress estrogen production at the same time that I injected myself with follicle stimulating hormones. Although this tends to result in fewer eggs (more like 4-8 in one cycle), it is considered much safer for women with cancer, although it is still being studied.

In my case, it only produced one each time, and judging from my estrogen tests, neither one would have been viable if retrieved. The doctor explained that this could be the result of a low egg reserve to begin with, which is unlikely at my age, or it could be due to a mechanical malfunction in the ovary that essentially triggers early production an egg.

He offers a ray of hope: “If it is the second, then you are a good candidate for ovary harvesting.” Sitting in his office 20 minutes after getting the news of my dominant egg, this seems like a reasonable option. It’s a simple laproscopic surgery. It is expensive, but insurance would probably cover it on the grounds that I have an increased risk of ovarian cancer given my BRCA status, and it is advisable that I remove my ovaries to cut my risk before I turn 40 anyway.

I call Michael and he comes right over from work. I start completing the paperwork before he arrives. If I am going to do this, it has to be 48 hours from now, so I fill out the forms that have suddenly become all too familiar – anaesthesia permissions, acknowledgements that all surgeries carry risk of infection, agreements not to sue if something goes wrong.

Michael arrives at the office and we head downstairs for much-needed caffeine and an attempt at clear thinking under pressure. We review the papers and talk about the risks. We are both nervous about the lack of data – it is an incredibly new technology. We joke that in addition to the benefit of being able to have children, we would also be making a major contribution to science. After agreeing that the risks of the initial operation seem low, and that the bigger decisions would come in a year or two when the time arrives to try to get pregnant, we schedule the surgery for Thursday morning.

I wrestle with the decision all day at work. I go through the motions of ordering the medicine I need to take that night from the pharmacy, but I also do more Internet research, both scientific and anecdotal, on women who have children after cancer treatments. It’s impossible to get solid numbers without a clear denominator, but I do read enough to start worrying about what I am doing to my chances of getting pregnant “naturally” after treatment if I remove an ovary.

The procedure itself is enough to freak out the squeamish. The doctor would remove one ovary, cut it into many small strips of tissue, test some and cryopreserve the rest. When the time came, we would implant several of the strips under the skin of my forearm and hope the eggs living inside the tissue would mature there, with the help of stimulating injections. Once mature, the eggs would be harvested from my arm, injected with Michael’s sperm and further matured in a test tube, and then the embryo would be implanted in my body. We would then hope I could carry to term successfully.

That night, both of us are uneasy. “We’ve made the right decision,” I say a few times, out loud, testing to see how it sounds.

It sounds wrong. We look at each other and know. We’ve had six weeks to grow accustomed to the idea that childbearing is likely to be a challenge for us after this, and we have discussed many options. We have accepted that there is more than one way to become parents, not all of which involve passing on what I already know could be a fatally flawed gene.

I have endless respect for my doctor’s work in this area – he is on the cutting edge of the little-examined consequence of premature infertility in young cancer patients. He provides hope for the future to people at a time when they most need it.

But Michael and I realize that hope is something we already have. Ignoring the siren call of being the cover girl for Reproductive Endocrinologist monthly, I cancel the surgery. I schedule my first Lupron shot for four days later, followed by my first round of chemo coming up this Thursday, December 8.