Harvest festival

After two weeks of twice daily injections the day had come to harvest my eggs. We’d both awoken really early that day and I wished I hadn’t had the glass of wine the previous evening (although it was very much needed after the news of impending chemo) as my mouth felt really dry. Just what you want when you’re not allowed to drink any fluids! We arrived at the hospital early – 06:30. Pats ate some brekkie in the car and we waited in the reception area. As we sat and waited, teams of people started to trickle through the door, all in pairs. We only waited for about 10 minutes before a lady called my name and showed us to my room.

Well this was a completely different experience – a bed to lay on, a TV and an en-suite bathroom! A lovely lady called Kate introduced herself and asked some medical questions. She had funny sense of humour and had us both laughing! Then another lady came with a menu with a list of lunch options for us to choose from – Pats too!

They’d said I’d be going to theatre at approx 09:20. As the hours passed I felt more and more bloated and really quite uncomfortable. Perhaps it was because I hadn’t had any water that was making it worse (I’d had to drink at least two litres of water a day for the last two weeks). I was relieved when they came to get me and, after kissing Pats goodbye, I waddled down to the theatre with two nurses. The nurse said they would call Pats shortly to perform his half of the procedure!

As I laid on the bed ready to go into theatre I said that I felt really quite swollen. The anaesthetist fitted the cannula to my arm and as the nurse chatted away to me to distract me I gradually felt myself floating off.

I came round to the sound of nurses talking around me and I felt pain in my abdomen. ‘Do you want something for the pain?’ they asked. ‘Yes please’, I said in a daze. She gave me some pethodene which relieved it slightly. A little bit later she asked me again how the pain was and I asked for more, this time it relieved the pain much better.

They wheeled me back up to the room where I was reunited with Pats and they told us that they’d collected 29 eggs. Wow! How amazing we thought. A bumper crop and super harvest festival it seemed! They were surprised that there were an extra six eggs that they hadn’t seen on the scan earlier on in the week. The embryologist asked us what we’d like to do in terms of IVF and ICSI.

In vitro fertilization (IVF) is where the eggs and sperm are mixed in a petri dish and left overnight to fertilise naturally (60-70% eggs fertilise this way). Intra-cytoplasmic sperm injection (ICSI) is where the embryologist selects the sperm to use and, using a very tiny needle, gently injects it into the centre of the mature egg. They wait until the following day to see whether the egg fertilises (typically 70-80% of eggs fertilise via this method).

All along they had said that they would use the ICSI method, however the embryologist said that as there were so many eggs we could do half and half. We asked her what her opinion was and she suggested doing this as IVF is a more natural fertilisation method.

They then bought us a delicious lunch and after a short while I had recovered enough, so got dressed and we made our way home. They said they would call us in the morning to let us know how many of the eggs had fertilised.

The embryologist called us early the following morning and told us that eight of the eggs had fertilised. Eight? Crikey. A friend had already warned me that the numbers would drop off but I really hadn’t anticipated it being that much, especially as there were so many eggs to start with. She asked if we wanted to take all the embryos onto to blastocyst stage.

A blastocyst is an embryo that has been developed for five or six days after insemination, as opposed to conventional IVF where they watch the eggs develop over the next two to three days. With a blastocyst, the embryo has advanced to the five or six-day stage meaning the embryo has divided many more times into more cells over this period. This time-lapse video shows an embryo from the time of fertilisation developing through to the blastocyst stage.

Blastocysts potentially have an increased chance of implantation when they are transferred . The majority of fertilised eggs will develop into a three-day old embryo, but only approximately 40% of these embryos will develop into a blastocyst. They are therefore considered to be a better quality embryo with a higher chance of pregnancy, and as ours were going to be stored in the freezer, they would have a better chance of surviving the freezing and thawing process.

It was a tough call to take as we could have potentially frozen all the embryos we had, but known that they might not be the best quality. Or we could take them all on and risk losing a high percentage of them. At the outset we thought the best option was the blastocyst stage so we agreed for them to take all the remaining ones on.

By Sunday we were down to five embryos – three that were doing well, doing what they should have. The rest were dividing but not as well as they’d like. We’d have to wait and be patient for the remaining ones.

The more I thought about this during the day the more upset I got. Would we end up with enough quality embryos for us to get pregnant? That and the enormity of everything else going on just got on top of me. It wasn’t supposed to be like this, I’d hoped that by now we would have got pregnant naturally…how different it all looked now. I felt absolutely terrible too, I was so bloated, (I’d put on at least 4-5 pounds since having the eggs collected) and it felt uncomfortable to do anything other than sit or lay down. They certainly didn’t pre-warn me that I’d feel like this!

As the days passed and the numbers kept decreasing, I also I also started to wonder if I’d be able to fit in another cycle to harvest more eggs before the chemo starts. I spoke to the nurse at the Nuffield and she said I’d have to go back for a scan to check that my ovaries have gone back to normal levels and that if I was alright they could potentially take me through another short cycle.

Pats was really concerned about pumping me with more oestrogen and said there was no point in having more embryos in the freezer if it was going to put me at risk. I knew he was right but I felt so annoyed that we hadn’t chosen to have all the eggs fertilised via the ICSI method. Fancy asking us, or especially me, when I’ve just literally come out of theatre and am probably not having the clearest of heads to make such a big decision. But of course it was too late, so tormenting myself with the what if’s was just more torture.

By the Wednesday the embryologist called to say that three of our little embryos had reached blastocyst stage – go Moonmins! One of them was slightly lower quality than the other two, but had still made it to blasto stage. She didn’t think the remaining two would make it but they would keep them on until Thursday/Friday as she could be proved wrong.

Whilst we were both pleased that three of our little Moonmins were safely banked in the freezer, I couldn’t help feeling gutted that there weren’t more. This will seem really ungrateful to others as I know some are not lucky enough to have the opportunity to have IVF or to even get three so I must put it into perspective. I’d finally taken the decision that having another round of IVF treatment, especially when there were still cancerous cells left in me after the lumpectomy, wasn’t the right thing to do. This is what we have and we have to pray that will be enough.

I was also gutted that those little Moonmins were going into the freezer. All those other ladies at the clinic would have been having their embryos implanted back into them and they would be onto the next step of their journey. We now had to wait.

IVF treatment

About a week after having the lumpectomy I started the IVF treatment. My hubby had a meeting in the city on the day of the appointment and as I wasn’t yet able to drive, he dropped me off at the clinic and would come and pick me up later.

I met with the nurse who showed me all the kit, the needles and how to mix the drugs together and told me how and when to do the injections. I’d tried my hardest to concentrate on every little detail she was saying so I didn’t get anything wrong. I went on my way with my kit bag containing all the equipment I’d need – needles, plastic tops to open the glass water vials, a sharps box to dispose of the needles and I went down to the pharmacy area to pick up the prescription for the medication. The nurse had prescribed me enough drugs to last for seven days. I would need to go back for a scan the following week and collect the next lot of medication.

As I sat downstairs in the main reception area waiting for Pats, I somehow managed to get myself in a bit of a state and started worrying that I wouldn’t remember what the nurse had told me when we got home. Since my diagnosis I don’t seem to be able to take in or remember information as well as I have previously – slightly frustrating!

Pats arrived at the hospital and saw I was in a bit of a pickle so we went back up to the fertility clinic and the nurse kindly went through the whole procedure again. I felt so silly, but better to be safe in the knowledge of what we were doing – it wasn’t like I was just going to be popping a couple of paracetamols twice a day!

The Menopur injection needed to be taken at the same time each evening, with a 30-minute grace period either side of when you first injected it. There are two vials of drugs that need to have water injected into them, mixed together, and then finally sucked back up into the needle ready for injecting.

We started at 7.30pm that evening and Pats asked me if I wanted him to inject the needle or if I preferred to do it myself. Having already inserted an empty needle into my tummy on a previous visit to the clinic, I felt confident I could do this again. It was the strangest feeling the first time I did this. Not in that it really hurt, more that after our months and months of trying to conceive naturally, here we were mixing up drugs together and injecting me with a needle to be able to create our child. This certainly wasn’t going to be the romantic conception we had hoped for, but bingo the first one was complete.

We did the same the following night and then I had to inject a second drug (Cetrotide) first thing the following morning (there was only 10 minutes grace for this one). I decided 7.30am would be a reasonable hour to do this one and as there was no fiddly mixing between two vials I did this one by myself. Within a matter of days we had both got used to this routine, and whilst I won’t say it was “normal”, it certainly didn’t seem quite so strange.

I continued with the injections, and I must say that having heard other people’s experiences, I expected to be much more hormonal than I was. I’d warned Pats about potential outbursts that might come out. To be honest at that time of the month I’m not usually throwing abuse and saucepans anyway so the prospect of doing so was a little disturbing!

We returned to the clinic the following Monday and the scan showed I was responding well to the treatment and that 17 follicles in total were growing. The nurse said that to put it into perspective, the average number of follicles that ladies have is 8-10. Wow great news! The biggest was 19mm in size and the smallest 9mm. The nurse explained that those that were 14mm or above in size were large enough to contain a mature egg (5 were already at that stage).

Because I have “multi-follicular” ovaries (ovaries which contain many enlarged follicles at the same time) they decided at this point to lower the dose of my medication so that they would continue to grow, but avoid overstimulation, or ovarian hyperstimulation syndrome (OHSS).

We returned to the clinic again on the Wednesday and again the scan showed I was continuing to do well with 23 follicles in total growing nicely. They confirmed that I would go in for the operation on the Friday morning for the egg collection.  I was also prescribed Pregnyl (an injection to be stored in the fridge) and said I would receive a call from the nurse later on that day with a specific time at which I needed to do the injection. The Pregnyl injection basically stimulates the follicles to mature, mimicking the action of luteinising hormone (LH), causing the release of the eggs from the ovary.

As I had responded so well in terms of a large number of follicles, they also prescribed me Cabergoline to reduce my risk of OHSS.

The Nuffield Victoria Wing

At our first consultation appointment we met with a nurse who went through some questions regarding my breast surgery and planned cancer treatment.  She explained that the fertility treatment would commence at the start of my period and that I would be put on a “short protocol” to get me through as quickly as possible.

I had an AMH blood test taken – a hormone test that gives an indication of how many eggs I have left in my ovaries.  The result wouldn’t give a number of how many eggs are actually left, it would be a measure of how strong the hormone is (if the level was not very high it could indicate approaching the menopause). The result of this test would help them get the correct dosing for the medication used for the IVF.

She asked if we were self funding the treatment which we said we were because I wasn’t due to be having chemotherapy and because we were over the age of 34. She said how much of a post code lottery IVF funding is and that had we lived in Surrey we would have been able to have treatment up to the age of 39 and would have been funded for two cycles.  Damn it – we just moved from Surrey!!

We both completed a medical questionnaire each and a whole host of other paperwork and then she scheduled in our next appointment which she said would be approx. 2 hours long. This session would cover how to do injections, how they monitor the cycle with ultrasound scans, how they collect the eggs and then create embryos for us as well as storage of the embryos and the hormone supplements to be taken.

The nurse also explained the two types of fertility treatment . IVF (In vitro fertilisation) where the egg and sperm are put together in a dish and they find each other and fertilise naturally. ICSI (Intra-cytoplasmic sperm injection) where they manually inject a single sperm into an egg which increases fertilisation rates. She said they would rather prepare us for the fact that we may need the latter as it would cost an extra £1,300 rather than shock us on the day. Jesus, this is all so expensive!

She said that the average number of eggs collected is between 8-10, although not all of those would be high enough quality to freeze – they would only freeze the good quality ones as they’re the ones that will survive the freezing and thawing process. As this would be our only shot at having the treatment they would likely freeze as many as possible.  The storage of the embryos would be done in a batch and would cost approximately £400.

We were then introduced to the Doctor for our initial consultation.  He immediately brought up the topic of funding, and said he couldn’t understand why our case hadn’t been look into in terms of funding on the NHS. We explained what the consultant at QA had said to us about my planned radiotherapy treatment and the upper age limit making us not eligible. He said they would apply for funding for us and see what they would say, it was worth the chance and he said in my situation they may be slightly more flexible.

He agreed that the right decision had been made in terms of having the surgery first, and that in the window between having the op and starting treatment they would take me through a cycle. He said that the recommendation after you have been on Tamoxifen for two or three years is that it’s possible to place the embryos back. Current teaching is that Tamoxifen is taken for five years, however he said that conventionally it’s two to three years (this would depend on the staging and type of cancer from the analysis).

The doctor reassured us that they will do their very best to obtain the best quality embryos to maintain my fertility and whilst it may not be my priority in terms of getting through the cancer, once I am through with my treatment that my ability to carry a baby would in no way be compromised.

He said his goal would be to get around 10 eggs, to then have seven to eight embryos, with four to five blastocysts. We would have an approx 30% chance per transfer of each of those embryos.

He offered us their counselling services and also suggested we take Omega 3, Vitamins B, C and D and a supplement called Proxeed. We were already both rattling with about 12 different vitamin supplements we’d been taking so think we were safely covered there!

We walked away feeling positive about the potential results of the treatment and definitely felt like we were in very safe, caring hands.

Back at home later on that day I received an unexpected delivery of flowers from a colleague at work. They were beautiful and I was touched by her kindness and thoughtfulness.

Someone like me

Before we went to meet the consultant on our first trip to the Nuffield, Caroline urged me that it would be crucial to harvest my eggs before my surgery to ensure the best possible chance of saving them. This put me into a huge quandary as the consultant we had seen previously said that my surgery was the most important thing and that the egg harvesting would happen post-op. Pats re-iterated to me what the consultant had said in that having the surgery was paramount – he was adamant that there would be no point in having any of my eggs to preserve if that meant adding risk for me.

Having not spoken to my breast surgeon at all as yet, I then went into a frenzy of trying to speak to someone at the hospital to find out what I should do. I’d left two voicemail messages with his secretary but hadn’t heard anything. The breast care nurses I had been in contact had all been fantastic, however they weren’t able to actually advise me what to do. I felt like I was having to liaise with people separately about what was best for me and wasn’t able to quickly get the answers I needed.  My period was due in the next day or two and I felt like I could be missing the only window of opportunity. This was all so stressful, it was such an important decision to make and to be made so urgently but I couldn’t decide by myself.. what on earth did I know about breast surgery and fertility treatment?!

I looked on forums, websites and did all sort of searches to try and find out more information. I had received literature from the Breast Cancer Care charity which included details of a helpline to call. I had a chat with a really lovely lady who had asked a specialist there for me and they had said there was no clinical reason to have my eggs collected before my op and that surgery and radiotherapy wouldn’t affect my eggs. I also talked over a few other concerns I had with her which was extremely helpful and put my mind at rest.  She recommended the ‘Someone Like Me‘ service where they try to connect you with someone who has had a similar diagnosis and treatment to you.

After my initial phone call to the Someone Like Me number, they put me in touch with a lady called Eileen who very kindly called me for a chat. She had been diagnosed with hormone receptive breast cancer when she was 36, some 10 years ago. She had a lumpectomy, followed by a course of radiotherapy and had also taken tamoxifen. I asked her questions about her surgery and what radiotherapy was like. After surgery she had felt numb and she still feels slightly numbness now and she was less mobile in the affected arm after surgery. Eileen said she felt tired having her radiotherapy and that her skin became itchy/flaky and irritated (a bit like sunburn) and that she regularly put E45/Aqueous cream on to moisturise the area. Whilst taking Tamoxifen she experienced more tiredness, night sweats, hot flushes and she felt bloated – the tablets mimic menopausal symptoms.

I explained my situation around trying to conceive and she said that no one had talked to her about being able to harvest or freeze her embryos back then but that she’d successfully gone on to have a little girl at the age of 41. I felt encouraged by speaking to someone who had been through a similar experience and who had successfully gone on to have a child after her treatment too.

I then finally managed to speak to my breast care nurse, who having spoken to the doctor, recommended not doing anything regarding egg harvesting this side of the surgery – getting the cancer out was the priority and then I could have the fertility treatment afterwards. They said they couldn’t be 100% sure, but that I may not need chemotherapy and that the Tamoxifen tablets would not make me infertile. I felt great relief from this and that someone who knew the history of my diagnosis and treatment was giving me an answer – one which I think deep down inside I knew anyway.

Claire had said that as it seemed I had so many outstanding questions that she’d book me an appointment to meet the doctor on the Monday so we could discuss them together. She also said they recommended I have an MRI scan as due to my age and breast density they couldn’t see clearly see from the mammogram I’d had and that in the unlikely event that the lump was bigger the MRI would be able to give better detail.

Call 0845 077 1893 or email someonelikeme@breastcancercare.org.uk to access the Someone Like Me service.

Finding a fertility clinic …tick tock tick tock

In the short space of leaving the hospital and driving home, we’d both come to the agreement that we would go ahead with the fertility treatment. Finding the money worried us, but we’d spent money on far less important things in the past – I’m sure we could find the money.

Something was troubling me about the letter that the consultant’s secretary had handed us. It looked like the Gynaecologist was affiliated with the Complete Fertility clinic in Southampton. Some close friends of ours had previously received IVF treatment at this clinic and, very sadly, were unsuccessful in their attempts. Amongst this tragedy my friend had told me at the time (and also very recently) what an awful after care experience they’d received there and said that she wouldn’t recommend the clinic at all – this kept playing on my mind. Whilst he seemed like a nice enough chap and very knowledgeable specialist, I felt I didn’t want to put myself in the hands of people who may not treat me in the manner in which I’d expect, especially with everything else going on and also having to pay thousands of the pounds for such care too. I voiced my concerns to Pats and we both agreed that given that we were paying for the treatment ourselves it would be best to find an alternative clinic.

When we got home we called my Mum and Dad to let them know what they’d said at the hospital and to asked if they’d be able to lend us the money for the treatment. They seemed as pleased as we were that there was some hope for a baby at some point in the future and very kindly agreed to lend us the money. That was a huge relief and now knowing that we were going to go ahead with the treatment and with the backing of my parents to help us fund it, all I now had to find a suitable fertility clinic.

Whilst we had experienced difficulties falling pregnant naturally, we hadn’t got to the point of looking into IVF options so I had no experience or knowledge of where to start the search.  I found the Human Fertilisation & Embryology Authority  (HFEA) website – the regulating body that licenses and regulates UK fertility clinics. I put in a search with our postcode and up came a list of clinics. The HFEA website was very good and detailed and had data for a whole host of options but I felt overwhelmed by all the information. I looked at the success rates and thought I’d start a spreadsheet to list them all to determine which would be the best option.

A friend of mine had not so long ago successfully given birth to a beautiful baby girl via IVF treatment and had called up that day to see how I was doing. She works in the pharmaceutical industry and offered to use her contacts to gain some advice for me. I said I didn’t have a clue of how to choose the most suitable clinic and she recommended  asking for success rates for frozen cycles and said that the clinic in Surrey that they had used was very good and she also very kindly offered to help do some research for me. It was good to speak to someone who had been through the same experience and I was grateful for the help.

Not wanting to rely on my friend’s ability to research an option for me, I then started to look at forums to try and find out people’s experiences of clinics –  after all that was the reason why we weren’t going with Complete. I started to feel so stressed with it all, not knowing what to do for the best and knowing we had to make a decision within the next day or two it just all got on top of me. It wasn’t like choosing an energy provider or a plumber, this was such an important choice to make.

Another friend of mine had already had a few rounds of IVF in the UK but unfortunately had been unsuccessful each time, she felt despondent at the treatment she’d received here and was about to embark on a trip to Athens to a clinic called Serum IVF. She’d told me how brilliant they had been with her and that their success rates were really high. The lady, called Penny, there seemed to be quite well known, as when I mentioned this to my dear friend, Kate, previously that week she seemed to know all about her from seeing her on TV. I felt compelled to get in contact with the clinic and after reading all the amazing testimonials on their facebook page I felt like it could be a good opportunity for us. I’d mentioned it to Pats that evening but he laughed and said ‘You are joking aren’t you? You’re not going to be travelling to Athens after you’ve just had surgery Allie!’ It did seem like a crazy idea but one that looked like had been so successful for many others.

The following morning I’d already completed the initial enquiry form for the Serum IVF clinic and they came back to me instantly. I told Pats that they’d replied and that’s when he flipped slightly. He said it was ridiculous for me to be thinking about travelling to Athens after I’d had surgery and to a country that is in such a dire state economically. I felt so upset I burst into tears in the bathroom – I knew deep down inside that he was right but it somehow felt like a better option. He came to kiss me goodbye as he set off for work and saw I was crying. I felt so mean as I know he was just looking out for what was best for me, and he could see I was clinging onto the best chance of us having a baby. He hugged me so tight and the tears eventually stopped – this was all starting to take its toll emotionally on us.

I’d called work that morning in quite a distressed state and said I wasn’t going to be at work – they’d been so supportive of me ever since my diagnosis – they said to take the time so that I could do my research and figure out our options.

Amongst the clinics I rang, I decided to call the Nuffield in Surrey as that’s where our friends had been as well as another friend. I spoke to someone there called Caroline and asked whether it would be possible to transport embryos from there to Athens. She questioned why I wanted to do that and I explained the whole situation to her. She said it would be very costly to transport and that I’d need to arrange the transfer myself via an international courier and the process would be quite complex. She told me that the best place for me was here in the UK, that their clinic had just been audited by the HFEA who were thoroughly impressed by all their working practices and had received an outstanding assessment. She went on to explain similar information that the consultant at QA had and said that acting quickly really was crucial in all of this. Caroline had such a way about her that she made me feel completely at ease and that I could totally entrust our treatment with them.

In the meantime my friend had come back to me and said her contact had recommended the Royal Marsden Hospital in London (I did not know this at the time but this is a leading cancer hospital). I wanted to consider this an option, however the time it would take to drive there and back made it an unsuitable choice for us. After speaking with Pats about the pros and cons of each, we agreed that we would use the Nuffield for our treatment. Caroline went on to book us an appointment with the consultant that Friday. Apparently there is normally is a 6-8 week waiting list, but because of my circumstances we were able to jump the queue – the one and only benefit of having cancer!

She sent me a list of all the tests we’d need to have in place before the appointment.  I then spent the next day or so running from our new doctor’s surgery to have tests and to my old surgery collecting copies of previous smear tests, and Pats and I both had our bloods taken at a separate local hospital .

At last, I could see a way ahead and felt confident we’d chosen a good clinic with people who would take good care of us.

A glimmer of hope

The very next day we were back at the hospital again, this time to meet with the fertility specialist that Claire had arranged. I felt really nervous going back to the hospital that day. What were they going to say to us? Would they burst the bubble on the dream of our little family? Pats and I sat in the waiting room together clutching each other’s hand.

We were greeted by a chap who was a Consultant Gynaecologist. He started off asking us lots of questions about our history, health and my cancer diagnosis and treatment plan. After this he went on to explain that there was a possibility of trying to preserve some embryos before I undergo treatment.

He said if I wasn’t undergoing chemotherapy then my ovaries wouldn’t be affected in a major way by the anti-oestrogen tablets but it would obviously delay matters if I wanted to get pregnant.  ‘And at the age of 39, time is much more of the essence than if you were 32/33 because whilst you’re on the anti-oestrogens you can’t get pregnant – so there will be a delay of a number of years. If you were to get the all clear in 2-3 years’ time you’ll be 41/42 and your chances of getting pregnant then are less than they are now.’ He went on to say that most ladies they see  are having chemotherapy which destroys some of the eggs meaning their chances of getting pregnant are much less than those having the treatment that was planned for me.

‘So it is possible that you’re able to conceive after the treatment, but there will be an effective delay.’ His words brought a sense of relief and I was now starting to feel much better and more confident that there was still a chance for us further down the line – albeit when we are a bit older!

He said if we wanted to go ahead and preserve and store the embryos that would mean the chances of getting pregnant would be from the age of a 39-year old as opposed to someone aged 41-42.  I would need to undergo an IVF cycle which he said was complicated and expensive, because in my circumstances it was unlikely that funding would be available. He said the costs were substantial and would be approximately £4,000 for an attempt at IVF and storing embryos. He stressed that if we wanted to go down that road it would need to be done as soon as possible and that they would try to fit it in between surgery and the medical treatment and that I would need to liaise with my oncologist as it will mean the tamoxifen treatment will be delayed by a number of weeks.

He said the first decision we would need to make is whether we wanted to go down that road and also whether we were prepared to pay for it. I asked him if the funding wasn’t available because of our age or where we lived and he said that IVF funding on the NHS is very limited and is available for some couples, but that we’d need to tick a number of boxes and that unfortunately one of the boxes is that I should not be older than 34. I had heard there was an age limit from friends who had tried for NHS funding but thought that 34 seemed a really low age to cap it and that the tick box criteria seemed a little unfair given our circumstances. He explained that they try to obtain individual funding for special cases but that those are for women having chemotherapy because they have less of a chance of conceiving afterwards.

If we wanted to go down that road, he said they would need to make quite a few arrangements to fit it all in. The treatment wouldn’t be available in Portsmouth, with the nearest clinic being at the unit in the Princess Anne hospital in Southampton. We would both need blood tests for screening, I would need an ultrasound scan plus there would be a lot of paperwork to be completed.  I asked whether that was an NHS unit in Southampton and he said it was but that they also see people who are paying for treatment themselves. He said it wasn’t essential that we go there, if we were paying for the treatment we could go anywhere we wanted.

They would start the treatment on the first day of the period I have following the surgery. I asked if there was any risk of taking the fertility medication. He said that the drugs used will stimulate the ovaries to produce a good amount of eggs meaning they’ll be working on overtime and therefore the oestrogen levels in my blood will be pretty high. With breast cancer there is always a concern that the high oestrogen levels may have a detrimental effect on the cancer itself. He said it wasn’t proven, but it certainly was there and to try and counteract this they would give me an additional drug that they don’t normally use to try to keep oestrogen to a lower level. He said the risk is more theoretical than real but the theoretical risk is certainly there

Pats asked how long we had to decide, what with not being eligible for funding, we’d need to organise how we pay for it if we were to go down this route. He said we’d need to decide before the surgery, and preferably sooner, because we would need the blood tests done and to have results and paperwork in place.

I asked if whether being pregnant in the future would have an effect on whether the cancer would come back. He said I would need to speak to my oncologist about that but in general the risk would be small. ‘They wouldn’t advise you to get pregnant unless they’re happy anyway – they’re not going to tell you to get pregnant 6 months after surgery – it’s going to be a number of years.’ Pats commented that I’d need to take the anti hormone tablets for five years, to which he said that it may not necessarily be as long as that ‘Medicine is not black and white, it depends on individual circumstances and they may be willing to reduce that time period.’  Well that was another positive, perhaps I wouldn’t be as old or have to wait as long as we initially thought.

He went on to say that as part of the treatment I’d need to go onto drugs that would take control of my ovaries allowing them to create more than one egg. During the treatment I would undergo regular scans – 2-3 times a week. The treatment would take 2-3 weeks and involve a small operation to take the eggs out of the ovaries and that on the day Pats’s ‘services would be required’. They would inseminate the eggs with his sample in the lab on the same day. The next day they would know how many have fertilised and they would let them grow into embryos for approx five days and then freeze them. Only embryos of good quality would be frozen – average quality embryos wouldn’t survive the freezing and thawing process. The embryos could then be stored for up to ten years.

Pats asked about what happens when the time comes to put the embryo back in. He said that this would be a much simpler process, where they would give me some drugs – but nowhere near the same amount – and it would then just be a matter of preparing the lining of the womb and then putting them back. He said the chances of it working putting one embryo back with a good quality egg is on average one in three (about 35%). In my case it would be less because of my age, and for a 39-year old it would be around 25% per embryo put back. But he said we may have more than one egg to put back and that each one put back will have the same chance each time (assuming the embryos survive freezing). The charge each time to put an embryo back would be approx £1,000.

He then gave us some more detailed information to take away and think about. He reiterated that there would be financial implications for us and that we’d be expected to pay the cost when we start the treatment itself. He said he only works at the hospital on Tuesday’s and Thursday’s so would try and fit us in the following week and recommended we went in on that Friday to get the blood tests underway.

As we both left the hospital I could tell Pats was still thinking about whether we should do it or not – and at £5,000 it’s certainly not a cheap option. But to me it was our only option and this was the only window in which we could ever do it as there would be no other options further down the line given how old I’d be.

Someone had offered us a chance and to me it was one we should grab with both hands.  The 25% success rate is not amazing but hey, it’s 25 times better than 0.

Shock number two…

As we left the office a breast care nurse, Claire, came and took us into a separate room.  ‘A bit of a shock, not expecting anything like this today, or…?’ she trailed off asking inquisitively. ‘My husband is a really positive person and he refused to believe it would be anything other than a cyst, whereas I certainly had hope but preferred to be prepared for either outcome,’ I replied.

Claire went on to explain a bit more about the cancer, that it was low grade which meant it was very slow, not a quick or aggressive growing tumour and that their plan was to go on and cure and treat this. She said it was obviously very frightening and that I’d clearly want treatment to start as soon as possible but that due to the nature of my tumour, it wasn’t going to change at all in a period of weeks.

Claire said that breast cancers these days are much more treatable and that success rates are very good and for grade one tumours in particular, however it would all depend on the size and grade after surgery and whether the lymph nodes were infected.

Pats asked Claire what lymph nodes were and she explained that they are part of the lymphatic system.  A filter system that gets rid of waste products – debris, infection…and cancer cells.  She said that if anything was in the breast that the lymph nodes might try to get rid of the cancer cells and that it often spreads to the glands under the arm. She pointed out that my glands seemed to be all normal and so were optimistic that it was confined to the breast.

Claire then went on to say that radiotherapy would be likely afterwards.  This is an x-ray treatment that sterilises the rest of the breast. She said I may not need chemotherapy as its a grade one and that the benefit to me would be very minimal, but that they would need more information. I asked again about what effect this would have on my fertility.

As most of our friends and family know, Pats and I had been trying for some time to get pregnant with a little Moonmin but sadly to no avail. I’d already rang a fertility clinic the week before to ask about what options might be available and the lady I spoke to said they would be able to harvest my eggs. Claire also said that this could be done, but that it would very much depend on timing. ‘Often by the time they can harvest eggs we would need to have you in for your treatment but that’s certainly something that we can look into.’

The  cancer I have is hormone receptive (it feeds off of oestrogen) so I would need to take anti hormone drugs. Claire said  that there is a possibility that the medication could potentially switch off the ovaries which would affect my fertility. I’d have to take the tablets for up to five years with a recommendation of being off them for two years before getting pregnant. ‘It’s like a double whammy isn’t it?’ said Claire. I began to cry again.

All our hopes and plans had been on starting our own little family for such a long time, to hear that those dreams could now be taken away from us was just absolutely heartbreaking. It sounds strange but it kind of hurt more than hearing about the cancer diagnosis.

Pats and I had certainly taken our time in deciding when we wanted to have children.  We’d spent many fun-filled years enjoying ourselves, having a great social life, travelling the world together and not marrying until eight years after we’d met. Starting a family was something we’d always said we wanted to do but had left it to a much later stage in our lives than most couples.

I was already rather neurotic about the desire to get pregnant. I constantly read books, websites and blogs on the best tips to maximise success.  I was having regular acupuncture treatment and had spent god knows how much money on ovulation kits, tests, potions and vitamin supplements – you name it, I had it! Poor Pats had felt the pressure from my yearning, especially since moving into our new home which we’d especially chosen as it was perfect for a family. We’d already started investigations into why things hadn’t been working for us…in a way it was a blessing that I wasn’t already pregnant at this stage.

Claire went on to say they had a fertility specialist at the hospital and that she would make an appointment for us so we knew what our options were. She said there were possibilities that we might potentially be able to wait a month or two whilst my eggs were harvested before starting the treatment. She said if my cancer was a higher grade or lots of the lymph nodes were affected we’d be in a different situation, but said that we may have time and might be able to wait one to two months before starting the anti hormone drugs.

Claire said she’s known ladies who have successfully got pregnant after  breast cancer treatment, which raised a smile and some hope within me. However she said they may not want to me to have IVF as that would involve giving me hormones and they would need to be mindful of the breast cancer risk. ‘We’d need to take age into consideration as you would be on the tablets for at least five years, but it may be that you’d be able to take them for two and then…well, that would need to be a consultant decision. We want to give the best treatment for you, what’s safe for you, against the risk of breast cancer returning.’

Claire then went on to book  in my pre-op assessment for 11 May and gave me some blood test forms saying I could have the bloods done that day or if I’d had enough I could get them done when I go back for the mammogram on Monday.

As she left us in the room alone together, Pats gave me a massive hug and said how positive it was and what a good job that I’d caught it early. He said you just don’t ever think it’s going to be that. “It can do one anyway,” I replied, my fighting instincts kicking in. ‘That’s the attitude,’ said Pats. ‘Will you still love me with a deformed breast?’ I asked Pats. ‘I’d still love you with no breasts,’ he lovingly replied.