The Fire Cancer

Would you prefer to be called Aunt Margaret or Auntie Maggie?" my brother's voice crackles through the line. He and his wife are pregnant with their first. I'm ecstatic, but as I tell my husband he is going to be Uncle Tony, I silently pray that the chemotherapy I just finished won't prevent us from someday having our own children. A text from my brother's wife reads, "Thank you for being so happy for us. I thought you would be sad."

Sad? No. Ecstatically happy? Not entirely. As I held both the glee and the sorrow, the interstitial space between them reminded me that though cancer kills much joy, it cannot kill hope.

My breast cancer diagnosis came the same day my now husband proposed. As such, we were keen to explore fertility preservation. We were building a house, and a fire threatened to burn to the ground a life we hadn't started. We discovered that firefighters, oncologists, and fertility doctors have wildly opposing incentives: oncologists want to keep the house from burning down, whereas fertility doctors want to save a family heirloom or two. We found their respective guidance diametrically opposed on how or if to preserve fertility. The oncologists like to employ fast–paced, aggressive treatment options, while the fertility specialists need time and youth to maximize conception odds. More disconcerting, neither camp offered help determining when to start the fertility process after successful cancer treatment.

"You have stage three aggressive breast cancer; it is imperative to start chemotherapy as soon as possible." My first oncologist would not waver on this point.

No one cares about family heirlooms when there's a house afire.

"You probably have enough time to have a fertility consultation, but any measures you take need to happen within two weeks. We often see fertility loss in cancer patients, but they tend to be older than you. This means the data aren't good, therefore we have no perspective on what may or may not happen to your ability to bear children." My second (and final) oncologist referred me to a fertility doctor.

"It takes four to six weeks for an optimal shot at a successful egg harvest. We recommend freezing embryos, not eggs, for the highest chance of future use." My fertility doctor explained in no uncertain detail that egg–freezing technology is not as advanced as embryo preservation.

Our circumstances necessitated freezing eggs. We did a sub–optimal egg harvest protocol (it took three weeks), and got six eggs.

Fast–forward a year. I made a complete recovery, and asked my oncologist his thoughts on when we might start trying to conceive. "Never. I want you to live for a long time, and I don't love the idea of you trying to conceive. That said, if it's really important to you, maybe explore the idea after five years." He advised that though the cancer I had just survived was not hormone responsive, he could offer no guarantee that hormones wouldn't cause a different type. This firefighter had just prevented a home from being destroyed, and wasn't about to encourage any fire hazards.

"I don't know what your oncologist said, but maximizing your conception chances means that we start trying now. For women with your kind of genetic disorder, you already have low ovarian reserve, which makes fertility harder to attain as you age." My fertility doctor also pointed out that if IVF didn't work, we would want to explore adoption. Any kind of baby–getting endeavor takes time. We wanted the odds stacked in our favor.

Like we had with the fertility preservation options, we weighed the myriad of opinions and options that come with these circumstances. Waiting would be emotionally taxing, and we already felt the tick of age working against us. It would be hard to remain hopeful the longer we had to wait. We decided to strike a compromise and start trying once I had made it one year cancer–free. We hoped for a chance to enjoy the family heirlooms we'd worked so hard to save.

None of...