On the eve of my final round of chemotherapy, I’m pretty excited. My neutrophils came in at 1.01 – I can’t believe how close to the line I am going into it – and so I know it’s going to be rough. But I can’t help feeling thrilled that it’s the last time (for now, never say never) that I’ll be going through the few days of ridiculousness that follows. I have a double mastectomy and oophorectomy to come so there are some significant hurdles in front of me, but I know it will be a different kind of ouch to this summer’s experience. And because of the chemo, and the upcoming oophorectomy, I thought it was worth talking about eggs. And age. Sorry, gentlemen. But you were warned in the title…
There’s only so much you can do, aged 39. The chances of getting a good haul are pretty low. I was encouraged by my first consultant to harvest my eggs before the chemotherapy, and my instinct was to say no. But it’s difficult to say that without speaking to an expert, so I went to see one before I saw my oncologist.
The problem with all of this chemotherapy is that, in targeting fast-reproducing cells, it hits your eggs. The older you get the more likely you are to be thrown into early menopause, so I’ve been having Zoladex implants to reduce the blood supply and suppress my hormones, so that the eggs become essentially dormant. They’re hiding, really. Studies have shown that Zoladex (Goserelin) doesn’t reduce the effectiveness of the chemo, but can hugely increase your chances of a return to normality afterwards, PMT and all.
However, with the BRCA1 mutation I have a high chance of getting ovarian cancer too, so the plan is to have an oophorectomy next year as a preventative measure. So although I’ll still be able to carry children, unless I freeze my eggs they won’t be my own. This made speaking to the fertility expert doubly important, because that turns from being a possibility to being guaranteed. It also means that the Zoladex is probably pointless because I’ll go through the menopause anyway, but as you don’t know when the operation is likely to take place it at least buys you some time, and given the lack of effect on the chemo, why not.
The fertility expert’s opinion was incredibly detailed, and she was kind but to-the-point. She was clear that I would face several issues, not least the number of eggs they could get, the probability of successful thawing after vitrification, and the chances of any child being born with Down’s Syndrome being higher because of my age. None of these surprised me, but she gave me the chance to get hard facts and statistics.
Her points were clarified as follows:
– Only 70% of eggs withstand the thaw after vitrification (this is based on figures collected since 2009)
– Frozen embryos are more successfully thawed than eggs
– Pregnancy rates following this procedure are low in the UK – according to HFEA, fewer than 20 children had been born up to December 2012 from 580 embryos created from frozen eggs (a 3.5% success rate, not even counting the eggs-to-embryos figures)
– At my age, there is only a 20% chance of a successful harvest (such a horrible term), and “success” would mean only 5 or 6 quality eggs
– The cycle to stimulate egg production pushes your oestrogen production to 7,000 (a level measured in picomoles per litre (pmol/l) – I had to look it up), versus a norm of 400-500, so if you have a oestrogen-receptor positive tumour, this could, in some cases, cause more cancerous cells to develop and reproduce
– Pregnancy itself boosts your oestrogen levels to 3 or 4 times that during the IVF cycle (crikey), so one shouldn’t consider pregnancy until a minimum of 3, and preferably 5 years after chemo finishes, as this is the crucial period during which the chances of recurrence (reoccurrence?) are raised
Then comes the maths. 5 or 6 eggs, successfully frozen, would be a huge, unlikely success. I am a single girl, so the eggs would be frozen unfertilised. At most, 70% of those could withstand the thawing process – 3 or 4 eggs. Given the 3.5% likelihood of embryos surviving to full pregnancy, even if each egg was successfully fertilised, the chances of it ultimately producing a child are minimal. There is also a 50% chance of embryos from those eggs carrying the BRCA1 mutation – would I want biopsies performed on those embryos? Biopsies can damage them, reducing the number again from a maximum of 4, and what would I be “swapping in” in place of a child carrying the same mutation as me? I couldn’t knowingly pass it on, but I also couldn’t happily play Universe in choosing the best-fit embryo. Should the stars align, how much more overprotective would one be of the much-wanted child?
Don’t get me wrong, I know that shows overthinking on a massive scale, but it does illustrate the subconscious thought process behind my initial reaction against freezing. Even so it was vital to see the fertility expert, and brilliant to find someone who was so straight-talking. My tumour was only weakly oestrogen-positive (a score of 3 out of 8) but that is enough for me not to be able to have HRT, so it makes sense to worry about those stratospheric levels of oestrogen, and the bottom-of-the-sea chances of success that would make the hope of it all pretty unbearable, should it come to nothing.
So I find it is possible to be reconciled, happily, with the idea of adoption, or even becoming pregnant from a donor egg with one’s super hot, kind, funny, fertile future boyfriend. But mostly adoption, because some children aren’t being adopted because there is a ruling that says you can’t change their name, and people are snobs. So perhaps a mix of both. In this situation you don’t have to worry about time, now, or of the dangers to the child that come with pregnancy in women of a certain age (although seriously I’m sure I’m 26 now so I’ve got like a gazillion years). It’s important to go all Pollyanna when faced with the inevitable, and I’m sticking with that. If the universe notices, then please can I have some nice Christmas presents. Thanks.
PS – I realise my approach won’t be mirrored by a lot of others, so if you have any advice to anyone facing the same decisions, particularly if you have made different choices, please do comment!
PPS – having had a long chat with one of my oldest friends on the phone, I should also say that I realise these decisions and my personal approach are made a lot easier by being single – I know how powerful the pull of having a child can be when you’re in a relationship. Even if it’s with a proper dickhead.
my new chemical romance 