Pre-chemo fertility treatment – or putting all your eggs in one basket

So far, I have learnt that being diagnosed with cancer young is all about having a lot of life-altering conversations that you really didn’t expect to have – but then I also didn’t expect to be the kind of person who visits garden centres on a Sunday and actively enjoys descaling the kettle, so there you go; nobody expects the Spanish inquisition.   (I have apparently also become someone who makes Monty Python references – another surprise).  It’s also about making potentially life changing decisions that you didn’t expect to ever have to make, with a limited period of time in which to make them.

Prior to my chemotherapy commencing, I was given the option of freezing eggs, in case the treatment affected my fertility. I’ve been told repeatedly that the chances are very low of it compromising my ability to have children in the future but even 1% risk is too high for me, and given that I had the time and the money (not a cheap process) to go ahead with it, that’s what I chose to do.

I really deliberated about writing about this because it’s a pretty personal choice, but then I thought that there was a fair amount of stuff that I would have liked to have known before I started the process, so here goes…

The expectation vs the reality

Firstly, ‘freezing your eggs’ is a deceptively simple description of what is a highly complicated, delicately balanced medical procedure that takes up to three weeks to carry out. In my head, I would have maybe taken some tablets for a few days, dropped casually into a clinic at a time that suited me, had some eggs removed and popped into the freezer and then gone on my way, like a happy free-range hen. In actual fact, if I must compare this process to poultry (must I?), it’s more like being an intensively reared battery farm chicken in a lab.

Kick off

After you’ve made your decision about whether to freeze eggs, or create embryos with your partner, and had the fairly intense conversations that go alongside that decision making process (sample conversation with my fertility specialist, who was nothing if not straight-talking: ‘Do you have a boyfriend? Do you see yourself being with him for the rest of your life? Do you want him to be the father of your children? You will need to let me know your decision as soon as possible’), you spend upwards of £800 on a box of fertility medication, which arrives a few days later in the post.

DON’T, as I did, have it delivered to work – mine arrived in a colossal box, in which you could have comfortably accommodated a small bear, and at a time when the reception area was filled with a selection of colleagues, most of whom were clearly having a slow day, because there was a collective ‘ooh’ of excitement, followed by ‘what’s in the box?’ Believe me, ‘fertility medication for me to take before I start chemo’ is quite a conversation killer.

Then, to the clinic (I went to CRM Care London, and found them excellent but it mostly depends on who you get referred to by your specialist) for a cheerful hour of signing 10,000 consent forms laying out what will happen to your eggs/embryos if you or your partner dies, followed by some HIV and hepatitis blood tests, to really compound the joy. After this, my nurse took me through the injection procedure.

The injections

Depending on which clinic you go to and what you’re having done, everyone has different injections, so I can only share the experience of what I had. What I don’t have is a fear of needles, which is definitely a good thing, given how many times you need to inject yourself. Don’t know what you’d do if you did have that fear – get over it fairly swiftly I imagine.

Initially, I kicked off with Gonal-F, which, when I initially Googled it, gave me this description:

‘Follicle-stimulating hormone is a gonadotropin, a glycoprotein polypeptide hormone’, which to someone who just about scraped a C in their science GCSE, is about as clear as mud. What it actually does is help your ovaries make multiple eggs.

The Gonal-F (NOT ‘gonad-f’, as I accidentally referred to it in one email) comes in a pre-filled pen, and according to my nurse, is ‘idiot-proof’, but clearly not Georgina-proof, because the first night I used it I stabbed myself in the thumb and bled all over a clean white top. However, the basic idea is that you insert the needle, twist the counter to the correct dosage, pinch as much flesh from your stomach as you can, needles goes in and then you press down to deliver the dosage.  It looks like this:

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Once I’d done this for about a week, in gradually increasing doses, I was told to start a second injection, Cetrotide, which prevents eggs from being released too early. This one involves using a mixing needle to inject water from a pre-filled pen into a powder, and then drawing up the liquid, once combined, into the syringe, changing needles and injecting it into the stomach again.

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Cetrotide

After that – and this doesn’t happen to everyone, -I got asked to start a third injection, Menopur, because of my slow response to the Gonal-F. Menopur is a fiddly bastard to inject because it involves snapping the seal off a vial of water, attaching a syringe to a needle, drawing the water up into the syringe, then injecting it into a separate vial of powder, before drawing it back up into the syringe, changing needles and injecting it, all without air bubbles, which were the actual bane of my life for several weeks.

This whole process, which was just over two weeks in total, involved one morning of running from pharmacy to pharmacy with a prescription of Menopur, only to find out that no one stocked it, which is probably the last thing I felt like doing, being dosed up to the hilt with hormones, knackered and emotional, and several incidents of jabbing myself in the thumb with needles, and subsequently bleeding all over the rest of the needles, like my very own blood-letting tribute to Pete Doherty. Definitely by far the most stressful part of the process – and as the injections needed to be taken at 8pm every night, highly socially inconvenient as well.

The scans

Throughout this process, I was scanned internally every two-three days, to examine how my ovaries were responding to the injections, and given blood tests each time to check the levels of oestrogen in my blood. IVF is not an exact science, and the doctors need to constantly keep an eye on the progress of the medication and fine-tune it as they go, hence the changing doses of the injections.  It’s a balancing act between stimulating your ovaries into producing extra eggs, but stopping short of over-stimulation, which is dangerous, and can make you very ill.

My top tip would be to find a clinic close to your office – mine was a good 40 minute journey away, there and back, and having to be constantly scanned took up huge chunks of my day, which I found frustrating, although I did get to walk past 221b Baker Street, home of the Sherlock Holmes Museum, which was nice.

Also, there is limited awkward conversation that you can make during a scan; I have fully exhausted all the weather-chat I have in my arsenal and frankly, if I never have to discuss it ‘feeling a bit colder now’ while someone internally probes me with a scanner again, it’ll be too soon.

The procedure

After taking two extra, precisely-timed ‘trigger’ injections on Sunday night, amongst dark mutterings of ‘just being a human pincushion really’ and complaining that I felt like ‘a giant hedgehog’, I headed along to the clinic on Tuesday morning for the egg collection. In fairly simple terms, I was sedated by a lovely, slightly camp older gentleman (who actually was the anaesthetist, not just some passing Oscar Wilde enthusiast) and then they removed the eggs with needles in places that you wouldn’t usually want needles to go. (In fact, this is probably the only time in my life where someone will say to me, ‘and then we’ll insert a large needle into your vagina’, and I will respond with ‘ok, good.’)

After that, I haven’t a clue what happened, because I was asleep, and then came round to good news that they had collected all the eggs that were there (not always possible) and I was allowed to go home and rest.

Other stuff

I was lucky enough to have a really good outcome, but it isn’t 100% perfect and it doesn’t work every time.  I don’t know how I’d feel if I went through all the stress of the injections, and the cost of the process, without a good result at the end of it, which is definitely something to consider.  I was also fortunate enough not to suffer too severely from any side effects – the worst it got was a bit of bloating, but I believe some people suffer more than others.

If you’re going to go for it, make sure you have a supportive partner, who can help with the injections, and a nurse you get along well with – you’ll be seeing them every few days, so obviously it’s a lot more pleasant to have one that you can have a chat and a laugh with; mine was lovely, made me a cup of tea and gave me a hug when it all got a bit stressful and that made a huge difference.

Finally, the cost.  It’s not small.  I won’t go into how much exactly, but I could have gone on at least four decent holidays for the cost of the egg collection alone.  Depending on how you react to the drugs you may be required to buy more – one Gonal-F pen alone is £250 and I had to buy several of them when my dosage was increased.  It depends what value you place on having this safeguard – for me, it’s worth every penny.

And if all else fails, it’s a good excuse to have a meltdown, eat a family-sized bar of chocolate and blame it all on the hormones – everyone will still be nice to you.  Every cloud…

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