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The possibility of infertility looms for cancer patient

A woman in her early 30s should not have to think about infertility. But breast cancer changes everything.

Doctors have highly recommended that I have a hysterectomy, surgery to remove the uterus, and a prophylactic oophorectomy, removal of my ovaries. Both would be a preemptive move against uterine and ovarian cancer, which can develop after breast cancer.

Thinking about it has been difficult, especially faced with a gynecological appointment this week. On Saturday, I had a crying episode that lasted hours. I haven’t had one in months. Three of my best friends, all males, tried to comfort me.

I called Lawrence Pena, 34, who has a 2-year-old girl named Ella. After he heard my trembling voice, he asked, “What happened?”

“I sat in the shower holding my stomach crying this morning,” I said. “I haven’t been able to stop the tears.”

He listened and said, “It’s going to be OK.” I was calm again. He talked for a bit. And then his phone died.

Although the surgery is common, I am scared. Every 10 minutes, 12 hysterectomies are performed in the United States, or about 600,000 in a year. And about one-tenth of 1 percent of those, about 660 women, die from complications.

Also, when the procedures are done before age 45, there is an increased mortality risk associated with cardiovascular disease, osteoporosis, a decline in psychological well-being, and neurologic and mental disorders, such as cognitive impairment, dementia and Parkinsonism, which is similar to Parkinson’s disease. Of course, there are others who don’t experience these issues.

Estrogen treatment may prevent some of these, but for some breast cancer patients, estrogen feeds tumors. To block estrogen, I am taking a chemoprevention drug called Tamoxifen for the next five years. The drug protects me from osteoporosis, but increases the risk of cancer in the uterus.

Even more concerning is that I inherited a genetic mutation known as BRCA2. This increases my risk for breast and ovarian cancer. Hence, my doctors’ recommendation to undergo a hysterectomy and remove my ovaries. Compounding this are uterine fibroids and some “abnormal cells” found in the uterus.

Some women, who are not as high risk, may have the option of undergoing regular pelvic exams, combined with ultrasounds and blood tests to monitor any possible irregularities in their uterus and ovaries.

I called Michael Maryanoff, 26, who has been undergoing treatment for Non-Hodgkin’s lymphoma.

“I don’t want to undergo those surgeries,” I said.

“I didn’t want to have holes drilled into my bones, but I had to,” he said. “They are trying to save our lives.”

Maryanoff thinks the key to coping with the radical changes in our bodies due to cancer treatment is to be accepting.

But I still haven’t come to terms with my new reality.

A call to my friend, Jelle Prins, 29, helped put things in perspective.

A few weeks ago, he had shown me pictures of a couple who adopted a young boy from Kenya. They’re in Kenya now trying to adopt a second child.

“They are a loving family. They love that boy, and they are happy. You can have that too if you stay alive,” Prins said. “You’ve told me how you would love to adopt a Haitian boy. You love children. Think about that.”

I also have excellent news. About nine months after my last chemo, a blood test revealed that menopause hadn’t kicked in. My menstrual cycle returned. And most recently, a test revealed that my ovaries were healthy.

This makes the possibility of freezing my eggs for a possible surrogate birth much more likely, and would also give me time to get through this and have a baby when the time is right.

My phone rang. It was Lawrence.

“Sorry. I have been having problems with my phone Then I was waiting for Ella to fall asleep,” Lawrence said. “Now she is at the park with her mom. I’m blessed. She is everything to me, but you have no idea how difficult it is to be a parent. It’s a lot of work.”

“I couldn’t conceive having that amount of responsibility now,” I told him.

My brother and an editor at work have been urging me to get a dog, but the thought of taking care of it is overwhelming.

“When the time comes and your health is where it needs to be, then you can think about children,” Lawrence said. “There are many ways to have a child, and the man who falls in love with you will adjust to your situation. In the meantime, don’t forget that you mean a lot to a lot of people.”