I had to pull up my blog to see how long it had been since I had written an update and was surprised to see: two years and three months. It’s not that nothing has been going on in our lives since then. In fact, the opposite, but I guess while cancer is still very much a part of my life, and I’ve continued to do hormone therapy, check-ups with my oncologist every three months or so, mammograms, MRIs, and ultrasounds religiously, somehow it becomes easier to deal with and a new normal. There isn’t as much to write about, which is good, because no news is good news in the world of a cancer survivor.
However, I decided to do some updating on where we are in life lately, since it is still connected to my cancer and a continuation of my survival to share what many know (spoiler alert!): WE ARE HAVING A BABY!
So, to fill in the gaps, this requires going back to August of 2017, a little over two years since I was diagnosed.
Standard practice for my type of breast cancer is five years of endocrine therapy after chemo, surgery, and radiation. Because having kids has always been a part of my holistic, long-term treatment plan with my oncologist, she suggested I take part in a clinical trial, called the Positive Study that allows patients to pause hormone therapy after 18 months for pregnancy and aims to evaluate “the safety of interrupting endocrine therapy for young women with hormone-sensitive breast cancer who wish to become pregnant.” Since I met the criteria, and we were going to go for it anyway, it made sense. I was also all to happy to pause the treatment as I had incredibly unpleasant side effects with tamoxifen and then switched over to anastrozole and Lupron shots but also experienced similar side effects. Hormone therapy is no joke. To this day, I am dreading resuming the treatment and I can understand why so many women stop the treatment altogether as it can really compromise quality of life. I was ecstatic to take a break and hopefully feel like myself again for the first time in over two years.
It took some time, though, for Nate and me to be comfortable with the decision to try and have kids, despite this always being the plan. It is terrifying when you finally get close to making the actual decision to pause active treatment and do something that potentially can impact your remission. When I felt ready to pull the trigger, Nate was hesitant; when he was ready, I backed out. I spend countless hours shaming myself for selfishly wanting to become a mom to someone I might not be around to raise and see grow up. Is that fair? Is it stupid? Is it worth the risk?
Talking with my therapist at the cancer center helped put things in perspective. We looked at all different possibilities and evaluated how I would feel with each, knowing there is no way to control the outcome.
What if I had a baby and the cancer came back? What if I had a baby but the cancer never came back? What if I didn’t have a baby but the cancer still came back? What if I didn’t have a baby and the cancer never came back?
My oncologist shared studies with me that showed pregnancy does not lead to recurrence in hormone-positive cancers and suggested we do a PET scan to make sure I was as healthy as could be before deciding anything, which further eased my mind.
I prayed about it, talked about it with friends, family, and Nate and finally confirmed I would not be okay with not trying to have a baby. It was worth all the risk, and Nate and I were ready at the same time, so in August of 2017, after a clear PET scan, and just over two years after diagnosis, I paused my endocrine therapy and met with my reproductive medicine doctor who performed our egg retrieval back in June of 2015 before I started chemo.
While we thought the difficult part was the decision itself and that it was behind us, we had no way of predicting how much more difficult it would get. Here is where the story gets long. And frustrating. And depressing. So I will provide the Cliffnotes version, which is still long enough.
We wanted to save our two embryos preserved before chemo as a last resort and try to get pregnant on our own. For an entire year, we tried numerous methods to wake up my ovaries and uterus, which had both been in hibernation pretty much since my first round of chemo. While I had looked forward to the reprieve of endocrine therapy, I didn’t realize that I would encounter some similar and other additional side effects of the hormones used to try to get my body back to doing what it had done before cancer. I took oral pills, vaginal pills, wore patches, did countless blood draws and vaginal ultrasounds, had an incredibly painful hysteroscopy, and an endometrial biopsy, but every time my reproductive medicine doctor would walk into the room with the same look on her face that told me nothing was working and nothing had changed since the last visit. It became mentally, physically, and emotionally exhausting. While my ovaries did eventually wake up, the biggest obstacle was my atrophic uterine lining. The recommended uterine lining for a successful embryo transfer is 8 mm. While, ironically, this happened to be the measurement of my healthy uterine lining before chemo while doing the egg retrieval for embryo preservation, it had not shed since my last cycle before chemo and despite all the hormones we tried, did not thicken beyond 2 mm.
Not only was conceiving on our own now off the table, but a frozen embryo transfer wasn’t even looking to be a possibility.
At this point, my doctor recommended we look into an embryo transfer using a gestational carrier instead. We knew this would be a possibility, but everything we had looked at was overwhelming and complicated. We just weren’t there yet. So, in June of 2018, we made the decision with both my reproductive medicine doctor and my oncologist to seek a second opinion at Mayo Clinic in Rochester.
In July we met with a reproductive medicine doctor there who suggested a pretty aggressive hormone plan that progressed with more frequent and higher doses of hormones as needed until ideal results for a transfer were met. While my doctors had wanted to take the route of the lowest hormones possible, he made the argument that if I were to become pregnant, my body would be producing far more hormones than even his plan and described it as “a drop in the bucket”. This was their standard practice for all of their frozen embryo transfers.
Nate and I were on board, but it took nearly a month for Mayo to send the specific plan to my doctors and for them to agree. Ultimately, we compromised with a plan of trying the first couple weeks of the regimen, and if it looked like it still wasn’t working, we’d stop and begin the process of finding a gestational carrier. If it appeared to be working, we would continue, but maybe not necessarily go all the way through the hormone progression. If we could get my lining to shed and even thicken to 5 or 6 mm, a level at which my doctor had done successful transfers, she would be confident in proceeding with a transfer. Before beginning again, since a whole year had passed, we did another PET scan to make sure there was still no evidence of disease, and, thankfully, everything came out clear.
Our modified plan was promising and by August 29 we were able to force my uterine lining to shed a tiny bit but enough to satisfy my doctor and thicken the lining up to 5.1 mm. We were set up for a frozen embryo transfer exactly one week later.
The reproductive medicine clinic sent us this image of our two embryos that survived the freezing process.
Because of the difficulty in getting to this point, we agreed with our doctor that it would be best to use only one of our two embryos, saving the other to use with a gestational carrier if the transfer was unsuccessful.
We did the transfer on Wednesday, September 5, 2018, followed by bed rest the following two days, then waited the endless nine days after the transfer to hear the results on September 14 that the transfer had indeed been successful and I was pregnant.
After so many dead ends, it really didn’t feel real or even possible, but boy, were we and are we ever thankful for where we are now. In true fashion with our lives since marriage being anything but uneventful, the pregnancy has been one with some complications, but that’s a story for another day that I’ll write and post soon, as I have some time on my hands, hanging out in the antepartum wing at Sanford Family Birth Center.
More on that soon!