Conceiving After Cancer

Hi Amy,

Since I love your blog and think that you give such wonderful advice that really looks at things from all angles, I thought I’d write and ask for your input…if you decide to print this, feel free to edit and take out as much as you see fit. Also, I am really sorry if this is TMI or grosses you out, I just don’t know who else to ask, as everyone that I would be comfortable asking is Fertile Myrtle.

I am 30 years old and a childhood cancer survivor, off therapy for 24 years next week. I had Wilms’ Tumor, which is a kidney cancer, so I am missing my left kidney. Six months after I completed treatment, I relapsed in my lower bowel, that time they were able to remove the just the tumor. I am in really good health otherwise, and consider myself so lucky that this is really the first late effect I have ever had to deal with. I am a normal weight for my height and never had to deal with learning disabilities that a lot of childhood cancer survivors, especially survivors that have a reoccurrence. Almost two years ago, a pediatric endocrinologist that heads up a long term survivorship program scared the BEH-JEEZUS out of me at our initial (and only…It was a transitional appointment and I have since transferred over to an Adult Long Term Survivorship Program) appointment and told me that I needed to start trying to get pregnant yesterday. My husband and I immediately started trying, and here we are 20 months later and we’re not pregnant.

A year ago, we met with a reproductive endocrinologist and everything was within the normal range, my FSH, LH, my ovaries were both developed the way that they were supposed to be (which really surprised everyone), my uterus looked good, my cycles are very regular and his sperm count was normal and had normal motility. Since everything was normal, my husband and I decided to give it another year on our own. We’ve tried everything that we can without going back to the doctor, OPKs, “not trying”, etc. *I* think that I have a hostile environment due to the fact that there is never any egg white CM.

So, in this past year I have taken it upon myself to see a cardiologist, oncologist, and nephrologist and get their okays for getting pregnant and carrying a baby to term. All of them are totally on board. Since I have everyone’s okay and my husband has recently caught TEH BABEH FEVER, we’ve made another appointment with the reproductive endocrinologists. I am kind of terrified at the idea of using clomid, but not opposed to it either, but sort of don’t see the point of going on it without doing something like IUI or doing something like IUI without the clomid.

Am I getting way ahead of myself? What questions should we ask that may not be thinking about? What are some things that you wish you had known when you went to see fertility specialist?

I would really appreciate insight you might be able to give!

H

On the contrary, I don’t think you’re getting ahead of yourself at all. Despite getting the “all-clear” from all your doctors, I think going with a reproductive endocrinologist is the best choice for you, or for anyone who has ANY inkling or reason to believe that their ability to conceive and carry a child might be in any way considered different or high-risk. I’m not saying your (eventual) pregnancy will be high-risk — it sounds incredibly likely that you’ll be JUST FINE — but hey, your body has been though a lot. More than most. I don’t see any reason why you should take on an ounce more risk than necessary, be it with your trying-to-conceive timeframe or with the pregnancy itself.

That said, you’ve been scared and rattled in the past, but I want you to take a deep breath and look at your soon-to-be-RE as not just another figure in a white coat who is going to poke and prod and give you bad news. This person is going to be your partner in Making This Happen. And believe me, you are NOT going to be the first couple he or she has seen with perfect “everything” (FSH, LH, cycles, sperm count) that are still struggling to get pregnant. Chances are you won’t even be the first couple he or she sees THAT DAY in the same boat. There’s a reason so many of women end up in the large, fuzzy, frustrating category of “unexplained.”

I don’t know what your doctor will recommend. I don’t know if he or she will suggest waiting or more temperature charting (just to determine if the lack of CM means your regular cycles are still, in fact, annovulatory), or if he or she will be immediately more gung-ho on the interventions like Clomid or an IUI. You should know that medicated IUIs have a MUCH higher rate of multiples, which I imagine might not be recommended for you. (Kate Gosselin is perhaps the most famous face of an over-responsive medicated IUI cycle — she did not do IVF.) That’s why many women start with Clomid without an IUI at first, though I would insist that your cycle and follicle count be monitored at the clinic all month either way. This can be frustrating if you produce TOO MANY eggs and your cycle gets canceled, but it’s safer than plodding ahead and getting high-order multiples. (My doctor essentially sent me home with a Clomid prescription and a calendar. I didn’t get pregnant. I also didn’t end up with quadruplets. So…yay?)

But again, your course of action is something you and your RE should plan together. You know your medical history and probably have a good sense for when doctors are a good “fit” for you or if you should thank them for their time and find someone else. You are not at all being hysterical by looking at your stack of all-clears and “perfect” results and still saying, “My circumstances are special. Bring on the experts because I’m not messing around.” You have the right to listen to your doctor’s options and to ask a zillion tough questions about them (success rate? risk of multiples? could I carry a twin/triplet pregnancy or would reduction be recommended? side effects of medication? how much monitoring? what else could a lack of CM indicate? if X procedure doesn’t work, would we move on to Y or Z?).

And I think you know all this — I think you know more about your health and the world of infertility than your anxiety about it all is letting you take credit for. You’ve kicked cancer’s ass, for crying out loud. Infertility has NOTHING on you, lady. I wish you nothing but the best of luck at your appointment and a speedy, non-invasive-as-possible, completely healthy pregnancy.