Thursday, November 10, 2016

Resolution Reflections: Why I Said No to Fertility Preservation

I remember exactly what I was wearing at my first appointment with my oncologist over six years ago. It was late August and I had introduced long pants into my weekly rotation to accommodate the unseasonably cool weather. I paired my newly acquired (and newly fashionable) ripped, boyfriend jeans with my pale, salmon-coloured, large-knit, short-sleeved sweater. The wide neck of the sweater fell loosely over my bony shoulders and my jeans showed no signs of my typically curvy hips. I had no clue that my weight loss had a sinister source.

In the ten days since a particularly cold thoracic surgeon told me I had cancer, I had prepared for this appointment. I researched everything I could relating to my diagnosis (making sure to casually pass over data on mortality rates). I solicited advice from others I knew who had been through a similar diagnosis before. I made a long list of questions and waited with anticipation to meet my oncologist.

The first question I asked based on the advice from my sister's friend, who had just finished treatment for colon cancer was: "Can I freeze my eggs?"

My oncologist is a kind, focused man who was not at all shaken by my directness.

In his very calm, collected manner, he told me: 
  • We don't freeze eggs. The chances of getting a viable egg after it is frozen is low. 
  • We freeze embryos (a fertilized egg). In order to have my egg fertilized, I would need either a private donor or to select from a catalogue of anonymous donors.
  • Even after fertilizing the egg, not all embryos are viable after being frozen.
  • The process of retrieving my eggs would require delaying treatment for a full menstrual cycle to stimulate ovulation and collect eggs (which could be up to 6 weeks all in).
This information included two dealbreakers:

Dealbreaker 1: The requirement of a sperm donor. My partner and I were only dating one short year. I had given him the out after I was diagnosed - he didn't need to stay with me if this wasn't how he imagined his life as a 26-year-old. We were in no position to begin discussing making an embryo together. The option of a sperm donor fell way too far on the other end of the spectrum. Why would I make an embryo with a stranger when I have access to sperm from a man I know and love?

Dealbreaker 2: Delaying the start of my chemotherapy treatment. I had waited all summer to get to this moment - to sit in front of this oncologist, who knew exactly what kind of cancer I had, who had the keys to all the right treatment, and who held my survival in his hands... After months of powerlessness, patience, and the panic of the unknown, I was finally in control. I had a plan for how to fix the problem. Delaying that plan to preserve my fertility - which came with no guarantees, that raised more questions than it provided answers - was not an option.

What he didn't tell me, that I now know, is the above outlined process costs at minimum $5,000. That would have been a third dealbreaker, considering I didn't have coverage at the time. (There is now, however.) But we didn't get that far in our discussion. 

We agreed that delaying treatment was not an option. I would not freeze an embryo.

My curious, inquisitive disposition only broke that day when my oncologist told me, directly and without any room for question or negotiation: I would lose my hair. And I would gain weight.

I still own the boyfriend jeans I wore that day. I use them as a way to gauge my eating habits. Some years they fit, some years they don't. Last September I was ten pounds lighter than normal after a summer full of running and biking, so the jeans fit me loosely around my hips again. In January of this year, however, I discovered on a trip to Australia (wearing summer clothes during what are normally cozy winter months), the jeans fit snug and tight in all the wrong places. The daily consumption of sweets throughout December had added shape everywhere below my belly button.

The side-effects of chemotherapy are most devastating where they are least visible, however. My ovaries have not shown the same resilience as my hair and hips, leaving me where I am today: 32-years-old, recently married, facing a reality I was not prepared for. And fantasizing about an alternate reality - not one where I agreed to preserve my fertility, I still believe I was right on that - but imagining a world where that young 25-year-old woman, who wanted nothing more than to stay thin and keep her hair, never had to make such a decision.


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