Egg Hunt
Ann B. Barshinger Cancer Institute, Lancaster, PA.
My first time meeting with an oncologist was a surreal experience. It was late April, before I had been officially diagnosed, and the heightened restrictions from COVID-19 prohibited me from bringing a support person with me. I arrived alone at Lancaster General’s futuristic, cylindrical cancer center and approached the screening tent.
“Do you have any new cough or fever?”
“Have you or anyone in your household traveled internationally in the last fourteen days?”
“Are you or anyone in your household awaiting test results for COVID-19?”
I answered the screening questions, proceeded to the temperature scanning station and walked through the floor-to-ceiling glass doors to the cancer center’s welcome desk.
After my obligatory wait in the lobby and the standard vitals check, I found myself in a cold, sterile room, waiting to meet my new doctor. When Dr. Balepur arrived, we exchanged the usual pleasantries and began my medical history and physical exam. In the several weeks since I had first noticed it, the gumball sized lump above my clavicle had grown to the size of a tennis ball. The mass and its sprawling offshoots sat nestled in my collar bone, and upon examination, my doctor immediately classified them as “definitely malignant”.
I remember feeling the blood drain from my face at the phrase. Up until this point, no doctor had committed to such a bold statement about the certainty of my cancer. His words chipped away at the last sliver of hope that I might get away with an easier fate.
He said that it looked like a Lymphoma and that considering my age and clinical signs, it was most likely Hodgkin’s. The second shock was hearing that certain treatments for Lymphoma can cause premature menopause and infertility in young women. He recommended that I talk to a reproductive endocrinologist about fertility treatment options if having kids was important to me.
I had always imagined that kids would be a part of my life some day, but as a single, career-focused, twenty-something, my family plans were abstract and distant. It was strange and painful to think that my disease might take away that unfulfilled promise of children. I was prepared to lose weight, my appetite and even my hair, but the thought of losing my fertility hadn’t crossed my mind and it was a hard pill to swallow. The rest of my appointment passed in a blur and before I knew it I was sitting in my car, staring blankly at the windshield and waiting for my brain to tell my feet to drive home.
The next few weeks came head first and at lightning speed. I scheduled my appointment with Penn State Hershey’s Reproductive Endocrinologist team and began my journey into the daunting realm of female fertility treatments.
It’s worth mentioning that men in my situation can also lose fertility, but the process for acquiring sperm samples is considerably less involved- some of you may have even tried it at home! Instead of being handed a magazine and some privacy, I was launched into a strictly-regimented three-week process, complete with $5,000-dollar hormonal injections, and daily 6 am gynecological appointments, which provided me with plenty of early morning drives to reflect on the joys of womanhood.
After my initial consultation, my next appointment was a training session. I sat across a small, linoleum table from a kind and helpful nurse named Lindsay, who I would come to know over the next several weeks. On the table was a tower of papers, a smattering of syringes and vials and a circular, flesh-colored object, the shape and size of a pin cushion.
Lindsay reviewed consent forms, financial aid information and page after page of instructions about the medications I would be injecting into my body over the next several weeks. She showed me how to mix a dose of a medication called Menopur, using a vial of powder and a vial of saline solution and then how to inject it into the fat of my lower belly, using the peculiar, rubber pin-cushion prop to demonstrate.
The Menopur works by overstimulating the ovaries, causing them to release many more egg follicles than they would for an ordinary cycle. However, in order to be effective, I would have to religiously inject myself every morning at 6:30 am and every evening at 6:30 pm. Doctors would also have to closely monitor my progress to determine when it was time to start another hormonal injection called Ganirelix and when I would be ready for the “trigger shot”, which would mature the eggs and prepare them for the retrieval procedure. Sounds fun, right?
She also described the retrieval procedure to me, which is the stuff of nightmares. As it turns out, your ovaries are very nicely tucked away and accessing them involves PUNCTURING THE BACK OF YOUR VAGINAL WALL WITH A 16-GAUGE NEEDLE. I wish I could tell you that it wasn’t as unpleasant as it sounds - but that shit hurt like a bitch.
Besides painful, time consuming and inconvenient, the egg freezing process is also expensive. When all was said and done, the total cost was in the ballpark of $13,000 dollars, and to make matters worse, most health insurances (including mine) do not cover fertility treatments, even for cancer patients in my situation. Thankfully, an organization called The Heartbeat Program, which helps young women with cancer to pursue fertility treatments, paid for all of my medications and my amazing family helped to subsidize the rest.
I went on stabbing myself in the stomach at the crack of dawn for about 10 days as my ovaries took their sweet time pumping out eggs. Meanwhile, my oncologist still needed preliminary test results to determine my baseline lung and heart functions, and a PET Scan to determine the stage of my cancer and the extent of its spread. This part of the process was overwhelming and chaotic. I was having near-daily doctors appointments and spent on average 2-3 hours a day talking on the phone with doctor’s offices and pharmacies. Having cancer was starting to feel like a full-time job.
I also learned that the female reproductive system does not adhere to business hours. When your eggos are ready to pop, it doesn’t matter if it’s Sunday or Christmas - it’s go time. In my case, it was memorial day. The day of the retrieval, I was instructed to arrive at the clinic at 6:15 AM sharp. Before I arrived, they also had me take a Valium to help get a head start on all the narcotics they would be pumping into my system. I was heavily sedated, so most of the actual procedure was a blur and aside from the vivid, stabbing pain of the needle, I don’t remember much. When all was said and done, they had extracted 14 eggs, 12 of which were fully mature (a full carton!) The two baby eggs were placed in a culture overnight to mature and by the next day, I had 14 full-grown eggies, ready to be frozen.
After my procedure was over I went home and slept for about 18 hours, only waking up to bark orders at my incredibly patient parents. I am normally a very mild-mannered person, but something about getting holes punched in your baby-maker can make a person very irritable.
My experience has given me a new found appreciation for women who struggle with infertility. The egg retrieval process is emotional and expensive and it is only the first step for couples pursuing IVF. My overall risk of losing fertility from my cancer treatment is relatively low, but it is nice to have insurance just in case. I am so thankful to the kind, empathetic medical professionals who helped give me 14 extra chances at motherhood.
