Sunday, November 18, 2012

Decisions, Part 1: Ice, Ice Baby

I've had to make some really big decisions this fall.  Weird decisions.  Life-changing decisions.
I suppose this is common for anyone facing a recent cancer diagnosis, or any illness for that matter.  In my case the decisions started the long list of doctor names -- which ones do I choose?  Which ones are the best?  Which hospitals are they affiliated with?  Male doctor or female doctor?  However, they snowballed into decision after decision, each one increasing in size and heft.

Next I was debating bigger decisions such as "lumpectomy or mastectomy?", "single or double?", "genetic testing or no genetic testing?" and "implants or natural reconstruction?"  And it's not like I had the luxury of time to figure all of these things out either.  But I made each decision one by one, after a little bit of [hastened] soul-searching, rational pros/cons lists, talking to others...and, ultimately, going with - or going back to - my initial gut reactions.

While the decision to have a mastectomy was a very big one, it was one of the easier decisions I had to make.  The medical, practical and aesthetic concerns all pointed me to the same decision, which was to remove the affected breast tissue completely. There were other decisions that were harder to reach, as well as ones that had much broader impact on my life...and the lives of others.

One of the major decisions I faced was whether I wanted to take steps to preserve my fertility - that is, freeze my eggs.  While I'm blessed to have caught my cancer early enough to prevent the need for chemotherapy (i.e., the cancer has/had not yet broken out of the milk ducts or become invasive cancer), which can cause infertility, and I'm most likely avoiding radiation on account of the mastectomy, I will be placed on a hormone-blocking drug called Tamoxifen for 5 years following my surgery.  This drug blocks estrogen, which was fueling the growth of my cancer. It doesn't necessarily rule out my ability to have children, but I am not allowed to become pregnant while taking the drug.  And since, I'm the ripe old young! vibrant! sexy! age of 35 and still very much want to have children, I had to decide if I wanted to take my chances 5 years from now*or if I wanted to freeze my 35-year old eggs now as insurance for the future.

*Or 2-3 years, if I come off the Tamoxifen temporarily and under guidance to try to conceive naturally.  After which, i would go back on the Tamoxifen for another few years.

My gut told me I needed to do it.  Boyfriend, friends and family were supportive and all told me I may regret not doing it. Doctors encouraged me to pursue the option, adding that "after all, 35-year old eggs are both greater in number and less risk of complication than 40-year old eggs" and....tickticktickticktick....Yes, I got it. I'm not getting younger. I already heard that annoying alarm clock in my head before all of this. And now someone threw a little cancer on top of the "childless-35yearold-anxiety" and the ticking grew deafening.  I had to do it.

With referrals from two of my doctors, my boyfriend Michael & I headed to Reproductive Biology Associates (RBA) of Atlanta for a free consult with Dr. Pavna Brahma to discuss what would be involved in cryoperservation for fertility preservation (costs, etc).   I have to admit, I didn't know much about the process at all other than it was expensive and probably not covered by insurance.  After a really great meeting with Dr. Brahma I knew much more about the process to make a more informed decision of whether or not I should cryopreserve my eggs.  I knew the cost (think used-car prices, but financing is available...also like used cars!).  I knew the process (lots of shots and pills followed by an easy surgery).  I knew the side effects (think PMS, but worse). And I knew the rates of success (pretty good for my age, decreasing significantly past 35).

However, i had a new decision on my hands...or on our hands, rather.  I/We were faced with the decision on whether we wanted to preserve embryos instead of, or in addition to, eggs.  Embryos have a higher success rate in the thawing process of cryopreservation than eggs do. So here's the tricky part....Michael and I aren't married.  Had we talked about marriage?  Yes.  Had we talked about our desire to have kids? Yes.  With each other?? Yes, silly, yes. However, here we were skipping a couple of steps. All of a sudden, it was on the table to make babies - or as I began to call them, "maybe babies"....and in a very odd way.  Or at least "odd" in those "This isn't they way I imagined it," and "Dammit, we're skipping the fun step of this process" kinds of ways.

There were many conversations between the two of us about it...about the costs, about how it differed from how we had dreamed we would create a family, and about what our families would think, too.  There was much to consider.  We kept coming back to feeling like it was just right.  It was what we felt we needed to do.  And we - together - were right, so who cares if this particular part of our journey together came somewhat "out of order"?

In the end, we were both really happy - excited, really - about our decision to freeze embryos in addition to my eggs.  It felt like the right decision to maximize our medical chances of success, and it felt like the right decision for our future together.  I'd like to say that was the last big decision we had to make, but it wasn't.  There were more right around the corner.  Though, that's all I'll write about for tonight.  I'll cover "Decisions, Part 2: On Personhood, Property and Possibility" later.

[As an aside, I can't tell you how many Shake and Bake-Later (TM) jokes i made about our maybe-babies. It was a lot. The Vanilla Ice reference from the title only came to me recently, but you better believe that's what I'm singing every time the maybe-babies' icy storage comes up in conversation. BELIEVE.]