So What's Wrong with the Old Fashioned Way?

So how did we get to where we are now?  Why are we having a woman on the other side of the world carry our baby for us?  What's wrong with the old fashioned way?  It worked for our parents, right?  Our infertility story is very different than any I have read about so far.  We are a heterosexual couple, so we have all the right parts for baby-making.  As far as we know, all of our parts work as designed, more or less.  We have not had the heartbreak of failed IVF cycles or miscarriages.  In fact, as far as we know, we could make the leap and try tonight and have a bun in the oven in the morning.  But it's not that simple.

On June 10, 2010 I got a phone call from my doctor.  It was about 4:30 in the afternoon and I was at work, alone.  She was calling to tell me that the lump in my breast was malignant.  She was calling to tell me I had breast cancer.  I was 30 years old.

My first coherent thought as I hung up the phone was "holy s#*t, life just got so much more complicated."  My second thought was "oh my god, what about kids."  I had quit my "real job" two months before so that I could run the retail end of our business full time, and Mike and I had decided that though we weren't going to actively try to start a family, we weren't going to do anything to get in the way of a happy accident.  That afternoon, all of our plans for everything came to a screeching halt.  Our lives were suddenly on a whole different course.

In the first weeks after my diagnosis, I saw doctor, upon doctor, upon doctor...various specialists and second opinions.  The first question I asked every one of them was, what about babies?  Some doctors passed it off as a question for a different specialist.  Some doctors essentially said "Why are you thinking about babies when you have cancer."  In their defense, we live in small rural community that is a haven for retirees.  These doctors typically see post-menopausal women who have had, or not had their families, and I was diagnosed with a disease that typically occurs in someone at least twice my age.  (As I have since learned, breast cancer in pre-menopausal women is not as uncommon as we would like to believe.)  Bottom line, my fertility was a priority for me, but obviously not for my doctors.

To be fair, the objective of my oncology team was to "cure" (oh, how I hate that word in this context) my cancer, but I was not willing to let cancer take away the possibility of my having a child.  So against my cancer doctors' advice, I decided to preserve my fertility.  I consulted a fertility specialist and after speaking with me over the phone for 2 days, she told me she had consulted with her partners over my situation and they agreed that I could join the IVF cycle they were beginning that week.  That meant a crash course in the process of IVF.  I went to the clinic on my first day of injections, had an ultrasound and spent 6 HOURS with various nurses and administrators learning how to give myself the injections, what the process would be, getting approval from my insurance company to cover the cost, and having them answer all of my questions about what the hormone surge would mean for the cancer.  It was a mind-spinning and exhausting day trying to learn in 6 hours what most couples learn over several weeks or months.  But less than two weeks later, they had collected my eggs and we had 17 embies on ice. (My mom calls them her grand-"pops")

For those of you that don't know much about breast cancer, there are several different kinds of breast cancer.  When they removed the tumor, it was tested to determine which type of cancer it was and to determine my course of treatment.  Very long story, very short...my cancer was estrogen positive.  That means that the cancer "fed" on the estrogen in my body.  One of my doctors described it as miracle grow for my tumor.  Because the cancer was estrogen positive and because I was so young (in cancer years), the cancer was considered aggressive.  My oncologist advised me not to go forward with the fertility treatments for two reasons.  First, he did not want to delay chemo (ultimately, it delayed the start of chemo for about a week) and second, the surge of estrogen from the injections would make any random cancer cooties left over from my surgery go bananas.  I decided it was a risk I was willing to take, knowing that I would start chemo the day after the retrieval.

But that doesn't explain why I can't be pregnant now.  Chemo ended 15 months ago and radiation ended 13 months ago.  Part of the standard of care for my type of cancer is to take a drug called Tamoxifen for 5 years following treatment.  Tamoxifen blocks the estrogen receptors in my body so that if there are any estrogen receptive cancer cooties floating around inside me, the estrogen cannot feed them and they will not grow.  Eventually they will die.  So bottom line, Tamoxifen GREATLY reduces the chance that the cancer will return.  Tamoxifen has many annoying side affects but the one that matters most to me is that it can cause miscarriage and/or severe deformities in a pregnancy.  So my choices are to take the drug and not have a baby and GREATLY reduce the risk of the cancer recurring, or not take the drug and have a baby and live with the very good possibility that my cancer will return.  And the kicker to all of this is that pregnancy itself creates a long term estrogen surge.  So if I get pregnant, a baby may not be the only thing I am growing.

So there is the Tamoxifen which is not good for a fetus, and there is the estrogen during pregnancy that could make the cancer return, but there is also the very real possibility that chemo damaged my ovaries and I am now infertile.  As anyone who has gone through IVF knows, there are tests they can do to determine my fertility.  However, everything is hormone dependent and because of the Tamoxifen, there is nothing normal about my hormones right now.  Tamoxifen mimics (and sometimes causes) menopause.  So the drug has to be out of my system for any of these tests to be reliable.  I may or may not be fertile, but we won't know until I have finished my 5 years of Tamoxifen (4 years to go).  

So that is a very shortened version of how we got to where we are today and why we are taking such a drastic step in starting our family.