Gaining Control & Peace of Mind Through IVF  

In Vitro Fertilization and genetic screening of embryos have provided me with a sense of control and peace of mind during my journey with breast cancer.

The BRCA Gene

After learning that I was a BRCA1 carrier (in my 20s), I decided almost instantly that I wanted to involve genetic screening as a part of my future family planning. I was diagnosed with stage 3 triple negative breast cancer, at the age of 30, and just a day before my scheduled preventative double mastectomy.

I spent years trying to learn about the BRCA gene and had little knowledge of cancer treatment and fertility preservation and so, although I had planned on having IVF in the future, I knew little about the process which added to my stress and anxiety at the time that I had undergone IVF treatment.

It Was A Lot to Process

It is incredibly overwhelming to receive a cancer diagnosis and try to make many important decisions quickly.  After receiving a breast cancer diagnosis, women often have to make important decisions regarding treatment, surgery and reconstruction based on a limited understanding. Fertility preservation can be equally as stressful to think about and something many know little about prior to cancer.

Based on my experiences and knowing what I know now, I would highly recommend IVF and egg preservation to any young person diagnosed with cancer whether they have decided to have children in the future or not. I say this because fertility preservation can spare you from having to make an important decision regarding family planning while under a great deal of stress.

What Our Family Planning Involved

Two weeks following my double mastectomy I began IVF. It felt as though my partner and I were rushed into family planning overnight! We met with fertility doctors to discuss the IVF process and review all our options. After a lengthy, but informative meeting, we decided what option would be best for us.

Something new I learned at the time was that only embryos (not eggs alone) could be screened for the BRCA gene and that preserving embryos, rather than just eggs, would provide us with a greater chance of success. With that understanding, we decided that embryo preservation would be the best option for us.⠀

In simple terms, the more often an egg or embryo is ‘unfrozen’ the greater the risk of losing an embryo. Had I just preserved my eggs at the time, I was told the process of a BRCA-free pregnancy would have looked something like this:

1. Stimulating ovaries and retrieving eggs for preservation
2. Unfreezing eggs for fertilization
3. Fertilizing an egg
4. Taking a biopsy of embryos for genetic testing
5. Freezing the embryo while waiting for test results for several weeks
6. Then again unfreezing an embryo for implantation

While this process can still result in a healthy and BRCA-free pregnancy, we made the decision to preserve embryos (vs eggs) as we learned it would provide us the greatest opportunity for success and we would know the results of genetic screening sooner.

What Happens During My IVF Process

I received both oral medication and injections at home to stimulate my ovaries over two weeks. I was most nervous for this part because I hated needles and we were responsible for injections at home, but my partner learned quickly and he did a great job with this!

During those two weeks, I also had daily blood work to monitor my hormones levels and internal ultrasounds to monitor the maturity of my eggs. Next, my eggs were retrieved. I was under conscience sensation for this procedure which involved a doctor using a needle to drain my follicles and retrieve eggs. I don’t remember much about the procedure, but had a positive experience.

After my egg retrieval procedure, we secured a very healthy number of embryos. The eggs were then fertilized via Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. We opted for this process as it provided the greatest chance of success. As expected, not all embryos were successful at making it to day 5 when they were graded, biopsied (for BRCA testing) and frozen for later use.

It was an Overwhelming at the Time

I struggled with the fertility treatment as it was so soon after my double mastectomy and I was still healing and accepting the cancer diagnosis.⠀

We were excited about family planning, but I struggled to see past the fact that it was another medical procedure. I wanted it to be a positive experience for us both, but I was so sick of being poked and prodded. The injections made me very emotional and my body sensitive. I cried through several of my internal ultrasounds as they were progressively more painful as my ovaries grew. I tried my best not to stress during this time because I wanted my body healthy and strong, but I still had a really hard time.

This was the most emotional stage of my cancer journey, but my partner was incredibly supportive; he researched and planned for IVF, made sure I started my days with a nutritious breakfast and rode the emotional hormone-induced roller coaster with me.

Looking back now, I would do it all over again! IVF can be extremely challenging, especially for those facing infertility challenges. However, it was the best decision I had made.

What I Wish I Knew at the Time

One thing we wish we were educated more about at the time was the rate of success for developing healthy embryos. When ovaries are stimulated, some eggs reach an optimal age of maturity while others do not or pass this optimal point.

I had 12 eggs that were successfully retrieved. Of those 12 eggs, only 5 embryos survived the fertilization phase and matured to day 5 when they are graded and frozen. I was told this was a great result and what was typically expected. Of those 5 embryos, only some were graded high enough to survive a biopsy. We successfully created embryos that do not carry my gene mutation, however, there was always the chance that we would be unsuccessful, requiring us to undergo IVF again.

Genetic Testing of Embryos

Genetic testing involved using DNA samples from myself, my partner and my mother (a BRCA carrier). We received a DNA kit and each had to swab the inside of our cheeks to collect our DNA samples which were then mailed to a testing facility. Our DNA was used and compared with that of each embryo to isolate and screen for the BRCA gene mutation. Several weeks later we received the results of the genetic testing, which also tested for other abnormalities.

I am happy to share that we were successful at starting our family without passing on my gene mutation!

Why I Ultimately Chose Genetic Testing

Despite the potential risk to my health, I believe this decision was best for our family. I find peace in knowing:

• Our children and grandchildren (female or male) will not have to experience the weight of the stress and anxiety that come with being a BRCA carrier.

• Our children won’t have to make this difficult choice when it comes time for them to start their own families.

• It means our daughter would not have to make the difficult decision to have a preventative mastectomy and experience the emotional and physical hardships that come with it.

• It means our son would not have a predisposition for other cancers.

• Any embryos not used for pregnancy will be donated to help find a cure for cancer.

• And I find peace in knowing we have made the lives of our children just that much easier… At the end of the day, isn’t that any parent wants for their child?

— Carmela

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Disclaimer — This blog does not replace medical advice nor should be taken as such. Rethink Breast Cancer highly recommends you speak with your healthcare team about your specific treatment plan and options. Your cancer experience is unique, just like you are!