I also had another problem with the Centrotide - the needle to mix the solution was huge and I had a problem removing the cap. Every time I pulled the cap off, I would slice my fingers with the needle causing a bloody mess. Once I even hit a vein under the skin of my middle finger leaving a nasty bruise under the skin. I felt like a chicken, walking around with all these eggs growing inside of me. That's probably why chickens walk the way they do, because I found myself walking pretty funny by egg retrieval day. I also felt really, really full - like I had just eaten an entire Thanksgiving dinner full.
I did Menopur for about six days before they added in Centrotide. I did shots for about 11 or 12 days total before I was ready for my trigger shot! But that wasn't as easy as I thought.
While ultrasounds showed good results, my blood work was showing high levels of estrogen, indicating a possible risk of ovarian hyperstimulation syndrome OHSS. Lupron triggers are used when you are at risk for OHSS.
Lupron triggers can eliminated the OHSS issue, but also mean that you can't have a fresh embryo transfer once the eggs are incubated. All eggs are frozen and then thawed out when transfer is arranged. The Lupron trigger had to be compounded and shipped from a pharmacy in New Jersey, so it took a few phone calls to get it all squared away and sent to us. It also has a short shelf life so it's not like I can keep it for the future.
The idea of not doing a fresh embryo transfer disappointed me.
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I wanted to get these eggs retrieved, fertilized, incubated and then transferred. I ate. I had family. I had the max amount of people that could be in the room because I have a huge support system. We would play games and try to make light of it as much as we could. Kyle: Dr. Moore, can you talk about some of the injections, the shots, that Brittany received during chemotherapy to help preserve her fertility?
I know you've done research on this topic too. Moore: Yes. Our recommendations for people who want to preserve fertility are both to meet with a reproductive endocrinologist to see if there are options regarding freezing eggs or freezing embryos so that you have those in the future. Actually Brittany took advantage of that option but she also took advantage of a newer treatment option which is to suppress the function of the ovaries with shots, a drug called goserelin. That's given once a month during the course of the chemotherapy treatment with the thought being that by shutting down the ovarian function during chemotherapy they would be less susceptible to the damaging effects of chemotherapy.
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It turns out from our research that indeed this not only reduces the chances of going into early menopause as a result of chemotherapy, but also improves the chances for having successful pregnancies. Brittney: Oh my gosh. They had to ice my stomach beforehand so that was a huge indicator of how it was going to be. When they told me they going to ice my stomach I was like, okay this is not going to be fun. But in the long run I was thinking ahead, like this could possibly prevent me from having some infertility issues.
I had to do it. Kyle: Then afterwards, after chemotherapy is complete, what's the treatment after the fact? Moore, how long after a patient's done with chemotherapy, goes through these injections and any other medications, is it safe to try to conceive naturally? Moore: There's no magic time at which we know it's best to try to conceive. We really individualize these decisions. For somebody with a lower risk breast cancer it might make sense to interrupt treatment earlier in order to conceive. Somebody with a very high risk cancer we may prefer to wait a few years. What we really don't want to see is somebody having a dangerous recurrence of their cancer during pregnancy because that could be very difficult to manage.
Brittany had a lower risk cancer. There's actually a large international clinical trial going on looking at interrupting hormonal treatment for breast cancer in order to attempt pregnancy. In that study, the recommendation is to complete two to three years of hormonal therapy. Then the hope to interrupt treatment for no more than two years, and then get back on to the treatment to finish the plan of five to ten years of treatment which is typical for treating the breast cancer. Kyle: Brittney, so how soon after you were done with chemotherapy did you decide to try to conceive?
Brittney: I did two years on the treatment plan. Every six months I was going to see Halle for my regular checkups. I felt like every time I went I was like itching, itching, itching, but I knew in my head I was minimum two. I knew I had to get some out of the way after everything. It was just more so that everybody in my life was having kids and I wanted a kid type of thing. But yes, I finished the two years on the treatment and then I talked with Halle about it and my family. I talked to everybody and made the decision to take my chances because I did have a lower risk.
My biggest thing was I didn't want to have cancer completely stop every plan from my life.
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Despite everything I went through, I still went through with my wedding. I still did all the things I wanted to do despite getting the diagnosis. Brittney: My Lord, the craziest! I say it was like an aura was around me. It just felt like finally everything was falling into place.
All I've ever wanted was to be a mom so seeing him for the first time was the best. I call him, and my family calls him, my little miracle baby. Moore, it probably gives you joy when you get to see patients come through the other side of this. Moore: It's extremely satisfying to see them both doing so well.
It's interesting because with the clinical trials we were talking about the safety, when is it safe to interrupt your hormonal therapy?
There have been studies looking at the safety of pregnancy in women who have a history of breast cancer. Consistently those studies don't demonstrate any increased risk of recurrence of the cancer even when they specifically look at women with hormone sensitive breast cancers like Brittney.
It's very reassuring and nice to know that you can treat your cancer well and aggressively but still have all those other things in your life. Kyle: Brittney, are there things that you used to take for granted in your life that you cherish now? Brittney: I have a whole new outlook for life in general. I know that sounds so cheesy but I feel like my overall outlook is so much more positive where maybe I was more negative in some instances.
I look at everything. Like how lucky I am to be here, how lucky I am to have a beautiful son, and despite everything I'm happy so that's all that matters. Moore, do you want to open the fishbowl for us? Brittney, these questions are for you so if you want to dig in there. Grab one. Read the question. Then give us your answer. Brittney: What would you like women diagnosed with breast cancer to know about cancer treatments? It would be individualized, for one. The biggest thing would be to just stay positive through everything. That's what helped me through.
I trusted my team that I chose to help with everything. I trusted that in the end I would succeed and everything would be okay.
Kyle: Good answer. Two more questions in there. Brittney: What's the first thing you would tell a young woman recently diagnosed with breast cancer about her dreams of becoming a mom? Talk with your team. You get that cancer diagnosis and it's not the end all be all.
It came in a pen, so I just had to dial the dose and shot myself up in the thigh. The Lupron, however, was a different story.
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Lupron keeps your body from ovulating. Then, when the time is right for ovulation collection, you take a shot of hCG that causes the release of your eggs in a specific window of time. The egg harvest is done under twilight sleep. I got seven. Two of the seven eggs never fertilized. Because of the morphology issues, we had to do a procedure called ICSI, where the doctor takes the individual sperm and injects it into the egg.
Can you say cha-ching!? After all that work, all I had to show for it were only five chances at a baby. After a few days we went back in to the clinic to have our embryos implanted in my uterus. Such a romantic place to get knocked up; me in an exam chair with my legs up in stirrups, a strange man down at the baby end while my husband sat next to me an held my hand.