REI (Reproduction Endocrinology and Fertility clinic)

Hello everyone,

I had an appointment with the reproductive/infertility clinic doctor (my regular OB knows her and said that she was very good).

First I'd like to report that it was very easy to find a parking spot.

This doctor (she's the director of the women's health center there) made an excellent impression on me. She seems to be knowlegeable, understanding of how I might be feeling and also asked peripheral questions, such as "do you have any family living here as you go through this?" - which was much more human than what I got w/ my first oncologist. She hasn't had a patient with my type of cancer but she deals with patients that have uterine or cervical cancer all the time. She was very worried that I didn't have a partner to help me through this. I said that was very sorry about that and that I was thinking about putting up an ad on Craiglist.

"Fairly short, neutered female cancer patient, with a blood pressure of 120/70 and a heartrate of 60 seeks some local guy with some kind of degree and basic language skills for sperm donation and maybe more"

She was also concerned that my family was far away. I blamed it on local Real Estate prices.

She also took the best part of an hour to sit down with me, understand my condition and situation (the oncologist wrote a 3-page long report as a referral though, so she must have had a ton of info already) and patiently take me through the various options, as well as associated risks and timeline. We even talked about things that haven't been invented yet.

Our little chat started with her saying that I have seen quite a few doctors by now - I politely replied that I loved the service (they do come and check up on you every HOUR) and the food (I mean those ice chips are delicious) and that I was thinking about requesting a membership card. In fact, even if you walk 50 yard to another building at the same Medical Center, they check your blood pressure, temperature, weight and height again. I'd love to be able to gain a few extra inches over a couple of days...

Anyway...onto the lecture.

She first freaked me out by saying that when doctors perform surgery on cancer patients, they get you to sign a consent form that allows them to remove a lot more than what was initially planned if they find anything suspicious (eg if it is worse that what they initially thought). This could mean in my case, that they could remove the ovaries for instance. So here's what we talked about in chronological order.

- We need to ask the oncologist if a) it's OK to wait for ~ 3 weeks to harvest some eggs and b) if it's dangerous or not to do this. The needle that they would use for eggs would go through the cervix and the fertility doctor is worried that this might bring some of those flea-like cancer cells where we don't want them to be, eg the ovaries.

- If the oncologist says it's all fine, then we will proceed with this to keep as many options as possible. They would work as an insurance policy. If the ovaries can be conserved, then fresh eggs will be better. This means that I need a lot of blood tests, ultrasound scans, pills and I need to learn to inject some ovary stimulant myself as I will have to do this for a few days...(I expressed some concerns that I would mess things up, she replied that 21-yr old girls can manage this just fine - what's that supposed to mean????). She also recommended to use 50% frozen eggs and 50% frozen embryos.
I asked about the difference in success rate but apparently, it's partly due to the fact that very few people choose the frozen egg method, over the frozen embryo method. So there isn't a lot of data and there isn't a lot of expertise...

- After the cervix is removed (she explained to me the circlage thing, obviously had to find a French term for it) since this doesn't seem to be debatable anymore, then she said that we would have to wait for 2/3 months for the cervix to heal. Then, and assuming that the oncologist feels that it is safe, we could consider a pregnancy. She said that women have a 55% chance to get pregnant/hold a pregnancy without a cervix. Most pregnancies end up with early labor, however, in the majority of the cases, and with thorough medical care, the babies are old enough to survive in an incubator. So assuming I can get pregnant and can go through the first few months, the changes of a successful pregnancy would be high, certainly enough to justify a trial. Sarcomas, in her experience, are not hormone-sensitive so a pregnancy should not alter the risk profile of the cancer, however, obviously, time is of major concern here.
So next steps is for me to talk to the oncologist (Thursday) after she hears back from the tumor board. The fertility doctor thought that it was great that they accepted to look at my case.

Now, there are several possible complications in my case...
a) even if I chose a natural method to get pregnant, if the cervix doesn't heal right (and there's no guarantee that it will), the opening that's left will be too damaged/small to let a lot of sperm go through...makes it just a bit more challenging for those little guys to swim all the way through to the ovaries.
b) the uterus might not function properly because of cancer
c) if they use insemination, they might not be able to go through the new "opening" and reach the uterus
d) if they use IVF, they might not be able to put the embryo back in what's left of the uterus for that same reason.
and of course, she kindly reminded me that we have not done any test re: my reproductive system and there will probably be no time for a full battery of test, and it is possible that there are other problems that have not been found yet

Now if that was the case, then it would close this option since there is only so much time allowed for trial and the hysterectomy would happen faster...

- She also agreed that this cancer is so rare that she would understand why the oncologist would want to be conservative. On the other hand, if the lab really thinks that it is really early, there might be a real chance that waiting for a year would not affect negatively my prognosis. She also said that this partly explained why the oncologists had differing views. She agrees that if radiation can be avoided, it would be better from a reproductive standpoint. Chemo apparently may or may not affect the ovaries but radiation most certainly turns them into French fries (well French in my case)...She also said incidently that one of the side effect of radiation is cancer. That's hilarious!

- The question of the father is a very good question in my case. At the tender age of 1 and peanuts, my cats are a little young to assume parental responsibilities. She did talk about sperm donors (imagine putting some sperm into your shopping cart on Amazon.com...Apparently, they do offer overnight deliveries!) - and she said that if I wanted to ask a friend to be the donor, then there would be some tests which could be done while I recover from the surgery, and insemination could be used.

Now, if pregnancy is not an option but the ovaries are intact, at least for a little while, then it is possible to harvest more eggs of course, or to use fresh eggs to do IVF (that's in vitro) and a gestational carrier (eg a surrogate).

She also said that if the oncologist decided to remove the ovaries, then she would freeze them anyway. No one has invented how to get them to work outside of the human body, but hey, it could happen during my lifetime...

Then, she left me the "back number" that I need to call after I talk with the oncologist. If we go down the "harvest the eggs as an insurance policy" path, it means that we would be starting the whole cycle in ~ 1.5 weeks...

Next steps in this little saga:
- Wednesday: discussion with my OB and the renowned Tumor Board (I didn't get invited!!! But a portion of my cervix will be present, I'll ask it to take some notes for me)
- Thursday: discussion with oncologist #2 (I asked her if she would agree to take me on as a patient)

Next step with fertility doctor depends on the Thursday chat...

How do you feel about the suspense in this little story?