It’s been five months since I updated you on our fertility journey and our attempt to start a family after breast cancer. I am writing this on Mother’s Day and I am forced to face the emotions that have been building over the past few months.
Emotions of grief, sadness, hope and fear. I share our journey with hesitation, but ultimately in hopes that it will help someone else feel less alone in this process. While it is hard to share this intimate side of our lives and open up about the challenges we face, I know we are not alone.
Fertility History
Photo by Gambol Photography
Back in December of 2017, I wrote a post about Hope for a Family after cancer, detailing my journey thus far and the plan to go off of Lupron and aromatase inhibitors.There were so many unknowns at the time and I was excited to see what my body felt like without the drugs I had become so accustomed to. Discomfort and medical menopause had become my new normal. I had no idea what to expect. Later in January, I shared an update on our decision to not participate in the POSITIVE Clinical Trial. Since that decision we have not felt any regret and I am happy to report that I am actively involved in another study focused on young women and pregnancy after cancer. You can read more about the study in that post and some of the general information about pregnancy after breast cancer.
Starting a New Chapter
We started 2018 hopeful for a new chapter. Though we had been waiting for this moment for so long, everything had changed. We were no longer innocent and naive about starting a family. Cancer shakes you and leaves you hesitant for the unknown. While we were happy to have the “approval” to begin family planning, a part of us was nervous to take this step again. Three years earlier we had taken this step only to be met with my cancer diagnosis.
Will My Cycle Return?
Photo by Samantha Grace Photographer
During the month of January I was scared to hope for my period to return. Everything hinged on my fertility status and I blocked feelings of hope in order to protect myself. I thought that if I didn’t hope for it to return, I wouldn’t be disappointed if it never came back. Of course this is never the case, even without hope there is disappointment.
When we met with our fertility specialist in early February though, she was very confident my period would return. She ran the tests noted below and called me with the amazing news that I was not in permanent menopause. This was a huge relief and determined it was just a matter of time until my hormones balanced out and my cycle returned. She estimated about 1-2 months.
Pre-Pregnancy Test
Rubella – This is a common pre-pregnancy test.
Vitamin D – Femara and other aromatase inhibitors cause Vitamind D deficiency so it was important to confirm my Vitamin D was at a normal level. I take daily Vitamin D to supplement.
AMH (Anti-Müllerian hormone) – This test gives an indication of your fertility and ovarian reserve. A normal range is 1.5 – 4.0. My fertility specialist indicated that if my AMH score came back very low it could indicate that I was in permanent menopause. Luckily, this was not the case. My test came back showing my ovarian reserve was strong.
LH (Luteinizing Hormone) – My LH level came back lower than my FSH, which many fertility specialist attribute to residual Lupron. LH is the same hormone that indicates ovulation. In February before my period returned I had other indications that the ovulation process was occurring. I have not had any additional LH testing aside from drugstore ovulation tests, which I don’t fully trust. After menopause, the LH level will stay very high.
FSH – This came back normal
CBC & Blood Type – The tests confirmed that my blood work was normal and my body is healthy
Cystic Fibrosis Screening – All screenings came back negative (WOOHOO)
Aunt Flow Has Returned
Three months after stopping Lupron (to the day), my period returned. I cried in the bathroom at work thrilled to be given the moment of relief. As crazy as it may seem, I was relieved to have physical proof of my hormones working. For so long, they had been asleep I wasn’t sure if they would come back to life. What has followed has been a roller coaster of hormonal highs and lows. Hormonal acne, oily skin, a host of new emotional challenges, but I try to focus on gratitude. My cycle retuning was proof that the last 3 years of Lupron and subsequent estrogen blocking medication were worth it. All those menopausal systems, discomfort and sadness protected my body and my fertility for this new chapter.
I Forgot What My Body Felt Like Off Drugs
The changes to my body during the past few months have been an amazing surprise. My menopausal symptoms caused by the medications have completely subsided. Most notably, my joint pain is gone and sexual intercourse is not painful for the first time in 3 years and truly enjoyable. I never thought I would say that again. Feeling like a 60 year old women in a 30 year old body is something those of you on endocrine therapy can relate to and it is not pleasant. This temporary relief reminded me that the symptoms truly are medically induced and not something I should blame my body for. I am not my symptoms.
Trying to Conceive
While waiting for my hormones to level out, we have been trying to conceive (TTC). While I thought waiting for my period to return was hard, this stage has been even harder. At first I had no expectations and time was on our side. I was more accepting of my body and the adjustment period. As time goes on though, I have struggled to balance hope, and my fear of disappointment. While I want to hope for this baby and focus on excitement and possibility, I find it hard to trust that my body will cooperate. When you know something like cancer can take over out of the blue, it’s hard to believe that anything else in life will go as you planned or imagined it. I feel like it’s a race against time and I am not sure my body can keep up.
But You’re So Young…
When I express frustration or disappointment, most people want to focus on how young I am. They think I have all the time in the world, but when you’ve had hormone positive breast cancer, it’s a not that simple. My doctors only want me off my Lupron and endocrine therapy for 2 years including pregnancy so our window of time to conceive is truncated. After 2 years I will go back on Lupron and endocrine therapy (Femara) for another 5-10 years to decrease my risk of recurrence.
The increased pressure of this shortened time frame and the dread of having to go back on the drugs, doesn’t help with my stress level. On the one hand I want to forget about all of this, let go and just focus on my hope for this future baby. On the other hand, having to track my temperature, monitor ovulation and be acutely aware of every bodily change keeps me hyper focused on the present. I feel like I am fighting against myself, unsure of where to focus my efforts.
Patience is Not My Strong Suit
For those of you who know me personally, you know patience is not my strong suit. I struggle to accept that my body is still adjusting and getting back to a normal rhythm. Can’t it just hurry up and level out? I guess three years of medical menopause and all my hormones being shut off, does a number on the body.
I am still unsure of how long my cycle is as it’s been different each month. Last month my period lasted 9 days!!!! What a shock compared to my 3 day periods back in the day. Oh the days of birth control. I had no idea back then. All of this hormonal fluctuation makes tracking ovulation and timing quite difficult. We will go into the fertility specialist next week to get an ultrasound and blood work done in hopes of gaining some additional insight about my hormone levels and cycle.
The Checkpoint Approaching
After 3 months of trying, my fertility specialist wants to see us to recheck levels and determine next step. This approaching checkpoint is only adding stress. I keep hoping I will have a baby growing in my stomach, before that date comes, but there are no guarantees. If only it was easy like those people who get knocked up on their honeymoon or get pregnant on the first try, but I guess those situations come with their own set of challenges. It should not be a surprise that it is more difficult for us. We’ve been through so much already, I should expect this. While I try to limit my level of hope, every time my period returns disappointment washes over me. Disappointment for the situation and disappointment that my body did not reward our desires. I struggle to continue to stay hopeful when the outcome is so uncertain.
Plan B
So what is the worst case scenario? Why am I so afraid? While we wish to conceive naturally, we do have 3 embryos on ice. If we are unable to conceive in the 3 month timeframe, our next step will be determined by the results of the fertility tests. Should the fertility tests come back showing normal function then we may continue to try for another 3 months. If the tests come back showing some issues, then we will most likely explore the embryo implantation route. While our Plan B should be reassuring, it just feels like another unknown, another huge expense and more emotional uncertainty.
Focusing on My Body
Photo by Samantha Grace Photography
For now, I will continue to focus on caring for myself. I go to acupuncture weekly, fill my body with healthy foods and started seeing my therapist again to help with the emotional side of things. The biggest challenge for me right now is acceptance. Worry, stress and fear for the future will not change the outcome. As with everything in my cancer journey, this stage has been a lesson in acceptance. Acceptance for what will come, what may change and that which we cannot control.
While I was hesitant to share this side of our journey, I decided to do so because I know I am not alone. I know there are thousands of other women like me facing the prospect of starting a family after cancer, dealing with infertility or coming to terms with the fact that they may not be able to have children. We share our experience in hopes of educating others, and finding comfort for myself. I need to know I am not alone and by sharing our experience with all of you I open myself for your love and support as we continue on this ever change path towards creating a family.
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