Trying for Another Baby - Putting Breast Cancer Treatment on Pause
I was pregnant with my second child when I was first diagnosed with breast cancer. Unfortunately, I lost my unborn child, but not hope in having another baby. I knew that following my chemotherapy and radiation treatment, my doctor planned to put me on the drug tamoxifen for five years. I was already 34 years old. There was a chance that my body would be in permanent menopause at the end of the five years on tamoxifen. My husband and I didn't want to take that chance.
Even though some women go on to have children after a breast cancer diagnosis, with my cancer being hormone-receptor positive (HR+), we weren't comfortable with my carrying another pregnancy. We decided to use a surrogate to carry our baby for us.
Dr. Knopf's Notes on Pregnancy and Breast Cancer:
Pregnancy is tricky after breast cancer because of a concern that the high levels of estrogen produced during pregnancy would stimulate cancer cells to grow. Pregnancy is a time of the highest estrogen a woman naturally produces - very important for pregnancy, but potentially bad for breast cancer.
During my chemotherapy, I put my oncologist on the spot. I made him give me a specific time frame in which he would be "comfortable" allowing me to take a short break from the medicine, just long enough to harvest some eggs from my ovaries. Although he was more comfortable with my staying on the tamoxifen for the standard five-year period with no breaks, my doctor finally relented. He said he would be fine taking me off at about the 2 ½ year mark.
Who Will Carry My Baby?
During those couple years we had to decide who would carry our child for us. Numerous friends and family came forward to offer, but so much can change in those years we had to pick wisely.
As the deadline closed in, a friend and co-worker, Kari, approached me. She had mentioned becoming our surrogate to her husband, and they had agreed it would be something they wanted to do. What an awesome gift they offered to us! After numerous meetings to make sure we agreed on everything, we decided to go ahead and start the process.
I approached my oncologist just shy of the date we had agreed on. He seemed a bit surprised that we still wanted to go ahead with the plan, but he was true to his word. He actually let me stop the tamoxifen immediately.
The next step was finding a reproductive endocrinologist, or a fertility expert, who would be willing to work with us. It was a hard process. I guess it isn't every day that someone walks into your office and asks you to place their growing baby into someone else's uterus. We had many hoops to jump through before they would be willing to work with us.
We needed to have a lawyer draw up a contract, get counseling, do blood work (all four of us), set up life insurance, and write a letter of alternative care to determine who would take the child in case something should happen to us. The list went on and on.
All Those Shots and Ultrasounds for Me and Kari
Finally we were able to start the egg harvesting and surrogacy process.
The first step involved daily shots for Kari in order to shut down her ovaries. We didn't want her own system working while we were trying to prepare it for our child. These injections were painful and often left bruises. I know this part wasn't a walk in the park for our friends, but they continued on.
The next step was waiting to see if my body would come out of, what we like to refer to as, "chemo-pause" or a chemotherapy-induced menopause. The oncologist had told us that the closer you are to 30 when you go through chemo the better chance you have of your menstrual cycles returning. And, the closer you are to 40 the better chance you have of being in permanent menopause. I, of course, was right in the middle.
After coming off the tamoxifen, it only took a few months for my menstrual cycle to return. As soon as this happened, I rushed into the doctor's office for an immediate ultrasound to see if anything was actually happening with my ovaries. These ultrasounds would become very familiar to me over the next nine months.
Once we had an idea of how my body was working, I had to start taking shots to boost the amount of follicles that my ovaries were going to produce. We wanted to optimize the amount of eggs we could get, since we had no idea about the quality my body was producing. As I started the shots every morning and evening to help boost my ovaries, Kari started a new round of shots to start to prepare her uterus for a transfer. The timing had to be perfect. Her uterine lining had to be just the right thickness. If it wasn't thick enough, or even too thick, it could be devastating for our baby. She also had to come in for ultrasounds to make sure everything was doing well.
After we got all the timing down, spent thousands on fertility drugs, gave dozens of shots, and received dozens of bruises, it was finally time to harvest my eggs.
We Went in with Such High Hopes
The doctor had warned us we might not even get to this point. He was concerned that my cycles would never return after all my treatments, but they had. He was concerned my ovaries wouldn't start functioning again, but they had. He was concerned I wouldn't produce any eggs at all. Now we would find out if I had.
After all of this, we produced one egg. One viable egg. We were heartbroken to say the least. Now our prayers centered on this one egg fertilizing and continuing to grow. If it looked good, the doctor would agree to transfer it to our surrogate. Then, we would have to wait and see if the pregnancy took.
My husband and I got the call 24 hours later that our one egg fertilized. We were able to breathe again. Another 24 hours passed, and another call came in telling us that our one egg was now officially an embryo! Our transfer was scheduled and the doctor actually had high hopes. He was amazed at the quality of the egg, even though there was only one. Next step: transfer.
We had started this part of our journey nine months earlier, and we were finally able to attempt a transfer. Kari came in and I was by her side the whole time. I watched as the doctor transferred our little embryo into her body. I watched the ultrasound screen as it was put into her uterus. What an amazing feeling I had as I watched all this happen!
Kari and I stayed in the recovery unit for a few hours until the doctors were satisfied she had stayed on her back long enough. She was then told to stay laying down most of the weekend and could resume light activity the following Monday. She would have blood drawn the following week to see if her hormone levels showed the pregnancy had taken. In the mean time, she would continue the shots until her own body recognized the pregnancy and took over. Ouch.
We're Not Pregnant
Friday, June 18th, 2004 dawned as any other day except we were waiting for that all important call telling us we were pregnant. Unfortunately, it wasn't so. Our one little egg, our one little embryo, didn't stick around. Kari felt awful, as if she were the weakest link in this whole fragile chain. How she could feel that way was beyond me. I was the one whose body had betrayed her. I was the one whose immune system had allowed malignant cells to run rampant without keeping them in check. I was the one who only produced one egg which decreased our chances of a successful transfer dramatically. I do believe I was the weakest link.
What now? The doctor didn't recommend another transfer. He felt that I wouldn't produce anymore viable eggs. I begged him to at least check my hormone levels with my next couple cycles to see if anything would change for the better. He agreed, but I think he was just humoring me at this point. After all was said and done we were never able to do another transfer. My friend Kari remained on the medication for us for almost a year. She was an angel!
We had to make the decision to call it quits and let everyone's life go back to normal again. Normal, what was that? I think at that point in my life I had forgotten what normal even felt or looked like. That said I felt good that we had tried. We had done what we had set out to do, and I was happy we hadn't let anyone talk us out of it. Now we would never wonder, "What if?". We knew the answer.