Category: fertility

Family Planning After a Cancer Diagnosis

Family Planning After a Cancer Diagnosis

by bridewitt ♥ 1 Comment

As I’ve written many times before, life as a young adult cancer survivor comes with a whole host of unique challenges! One of those, specifically, is the fact that many adolescent/young adult (AYA) survivors have to face possible infertility after their treatments. Though the road may be a bit more winding, there are many options for survivors to have thriving families beyond their diagnoses. I understand that having children isn’t for everyone, but for those of you who do want kiddos, keep on reading to learn more!

*FYI – for this post, I’ll mostly focus on options for those assigned female at birth who are undergoing or have undergone cancer treatment, but know that there are also options for those assigned male at birth as well!

Before and During Treatment

Upon diagnosis, many doctors now recommend fertility preservation prior to treatment. There are a few options and you could choose either or both if recommended by your MD. The first type of fertility preservation would include freezing eggs or embryos before treatment. This is usually done by a reproductive endocrinologist and may require blood work, ultrasounds, and outpatient procedures for egg retrieval itself. Oftentimes, treatment can be delayed just long enough for egg or embryo preservation to allow for future family planning options. These procedures are usually timed with the menstrual cycle for the best results, but it can be done any time if you’re worried about delaying treatment too long or if you’re not cycling regularly!

During treatment, your oncologist may also recommend anti-hormonal treatments (like ovarian suppression) during treatment to try to minimize damage to the reproductive organs. This type of medication can put you into “medical menopause” which is usually reversible once discontinued, but can have side effects similar to those you’d experience during actual menopause (i.e. hot flashes, joint pains, weight gain, etc.).

If you’re newly diagnosed, be sure to ask your doctors about these options and weigh the pros and cons for your unique situation. Remember, there is usually adequate time to figure things out before starting treatment if it’s something that’s important to you!

If you’d like to read more about my personal experience with fertility preservation, click HERE!

Family Building after Cancer Treatment

It’s important to remember that, no matter what happens, there are always options for starting or expanding a family after a cancer diagnosis. Whether you never come out of medical menopause, your eggs/embryos weren’t viable, or you didn’t have time for fertility preservation before treatment, there are many ways to grow your family. Below are a few of the options that many cancer survivors choose. The decision is very personal and there are plenty of reasons why some would choose one option over another.

In-Vitro Fertilization (IVF)

IVF is a type of assisted reproductive technology. A physician would use fertilized eggs (embryos) retrieved prior to cancer treatment and then implant them into your uterus for you to carry your own pregnancy. Of course it’s much more complex than that, but I’m not a reproductive endocrinologist (learn more HERE)!

Partnering with a Gestational Carrier (Surrogacy)

For some who can’t carry their own child, using a gestational carrier can be a good option. Learn more about gestational carriers and surrogacy HERE. This site has a great breakdown of the whole process and outlines the difference between traditional surrogacy and gestational surrogacy!

Fostering/Adoption

In case IVF or partnering with a surrogate aren’t good options, you can always consider fostering or adopting a child. There, again, are many options down this path and each agency and state have varying rules/regulations. HERE is a good overview.

Financial Assistance for Family Building

One of the biggest road blocks in ALL of these processes, however, is the actual cost. For many, the out-of-pocket cost renders nearly all of these options to be out of the question. Most insurances do not cover fertility preservation as the patient (who is otherwise “healthy” – you know, besides the cancer thing) does not have a diagnosis of infertility. Some (but not all) insurances will cover the cost of IVF if a true diagnosis of infertility exists. So then, what?

Many organizations do offer some financial assistance or grants for cancer survivors seeking options for family planning around their diagnosis. Here are a few to look into:

Alliance for Fertility Preservation

A Damn Good Life (For those seeking support during their surrogacy journey)

I personally benefited from the Livestrong Fertility Program and The Heartbeat Program which discounted my fertility preservation costs and covered the costs of the medications required for my egg retrieval ❤

For those considering adoption, there may be grants or loans available as well. Check with the adoption agency you’re using or use THIS site to get you started. Know that there may be more local resources for you as well!

Virtual Family Building Panel – February 2022!

Finally, on February 17, 2022, I’m collaborating with Breast Cancer Hawaii on a virtual Family Building after Cancer Panel to bring information to AYA survivors on options for starting or expanding their families after treatment! (HOW LUCKY AM I?!) This will be a great intro for anyone who is newly-diagnosed, in active treatment, or who’ve completed treatments. We’ll have experts in oncology, reproductive medicine, fostering/adoption, and surrogacy on board to give us the details on what family building after cancer may look like for us survivors! It will be a bit heavy on options for those of us living in Hawaii, but all are welcome to join us and ask questions. For more information, please check out our Eventbrite link HERE!

5 Things I Learned from A Naturopath

5 Things I Learned from A Naturopath

by bridewitt ♥ 0 Leave a Comment

It’s no secret that I am freakishly in-tune with my body and that I also value knowing exactly what’s happening behind the scenes of my symptoms. Even before I was diagnosed with breast cancer, I knew something was off with my body, and I’d started to research root causes and naturopathic/functional medicine approaches to help me with some things I’d been experiencing. Then, cancer came into my life and between the 85 million appointments (not exaggerating…), I decided to hold off on seeing yet another practitioner.

Now that I’m approaching the end of active cancer treatment, I decided it’s time to get some additional support and testing done. A few things I was concerned about include the health of my digestive system, support for my thyroid, and restoring equilibrium for my female hormones. I chose to see a naturopath (ND) based on recommendations from friends and based on her experience level and social media content (never underestimate the power of social media!). Here’s a few things I’ve learned after my initial consultation and lab work:

Get that Good Gut Health

Chemo is designed to destroy cancer cells which are typically rapidly dividing and multiplying in our bodies. Well – guess what else rapidly divides and multiplies? Healthy cells in our digestive tracts! Side effects from chemotherapy tend to hit the GI tract hard and can include mouth sores, nausea/vomiting, heartburn, and diarrhea or constipation. Seeing as I had several of these symptoms during my 16 rounds of chemo, I knew my gut was going to need support and healing.

First of all, the GI tract is full of trillions of happy, healthy bacteria typically referred to as the gut microbiome. These bacteria help us to digest food and maintain a strong immune system. It’s all a bit complex honestly, but a lack in diversity of these bacteria can lead to a whole host of health issues, including mental health concerns.

My ND recommended a few important things to get me started: a good probiotic to promote microbiome diversity and a drink called GI Revive which supports the intestinal lining and promotes regularity. It’s also crucial to eat a diverse, supportive diet that includes plenty of fiber, vegetables and whole grains, and fermented foods.
*Side note – if I’d known GI Revive existed, I would have started it during chemotherapy. However at that time, I did use L-glutamine supplements which helped me prevent issues in my mouth and lower GI tract.

Altogether, I feel like things are coming back around to normal after chemotherapy with this added support. I imagine that the more my gut heals, the more I’ll see my immune system improve and I’ll be able to maintain low levels of inflammation in my body.

Clarity on Chemopause

I started chemo on June 9, 2020, and that was also the first day I received a Zoladex injection. Zoladex is a hormonal therapy designed to stop the ovaries from creating follicles which release estrogen. The ovaries have a high rate of cell turnover like the GI tract, so chemotherapy can lead to infertility if not protected by hormonal therapy. Modern medicine is truly incredible, and I’m grateful that as a 30-year-old woman going through chemo, I had the option to try to save my fertility in this way.

Joke’s on me though, because after 6 months of this hormonal therapy, I am officially in chemopause (a medically-induced menopause), and I have all the symptoms to show for it. I specifically asked my ND for post-chemo baseline labs for my estrogen, progesterone, and testosterone levels. No surprise here, but my labs confirm I’m in a menopausal state and that explains the hot flashes, joint pain, dyspareunia (learn more here), and amenorrhea…

Now, true menopause means a woman has had no menstrual cycle for >12 months. Being only two months out from my last Zoladex injection, I’d say there’s still hope for my ovaries to bounce back. Most women who’ve been on this type of treatment have seen their menstrual cycles return after 5-6 months on average. In the meantime, I need to be supportive of my body! I attempt to exercise 3-5 times per week (walking, resistance training, and stretching) to relieve joint pain and both my ND and OB/GYN have recommended vaginal moisturizers to prevent vaginal atrophy until my estrogen levels improve. (If this is TMI for my family & friends reading this – sorry, but it’s just #RealTalk!)

I’ll continue to monitor my labs every few months to be sure things are trending in the right direction. Chemopause isn’t necessarily permanent, so here’s hoping my body can pull through!

The Thyroid Needs to Thrive

About seven years ago, while I was deep in PT school, I began having unnatural fatigue. I ended up being diagnosed with an underactive thyroid gland (hypothyroidism). The thyroid gland produces hormones which help regulate our metabolism, and if the thyroid isn’t functioning optimally, you can have symptoms like fatigue, dry skin, hair loss, weight gain, constipation, or feeling like you’re always cold. Every body system relies on the thyroid so it’s a priority to take care of it!

Trying to find the root cause of my thyroid dysfunction has always been something I was curious about before my cancer diagnosis, and after treatment I wanted to know if there was: a) any additional support needed for my thyroid after chemo, and b) if there was an underlying cause for my hypothyroidism. After running a full thyroid panel, my ND diagnosed me with Hashimoto’s thyroiditis, an autoimmune condition in which my own immune system is attacking my thyroid. She educated me that Hashimoto’s is actually the most common cause of hypothyroidism and affects about 5 in 100 people.1 It seems that Hashimoto’s is a combination of genetic factors and environmental factors such as food sensitivities or heavy metals toxicity.

My next step is to try to determine what may have triggered this autoimmune condition. The more I know about my condition, the better I can treat it or avoid any sensitivities that may make my condition worse. It might seem like I am seeking out more health problems, but my intent is really to understand my own body and how I can best support it to remain healthy and cancer-free. I will likely always have to be on thyroid medication, but I’d like to try to prevent the condition from progressing as much as I can (I plan on living a long life, you know?!).

Sometimes You Just Have to Supplement

In all honesty, I’ve never been a fan of supplements because I just can’t remember to take them every day! I now understand, however, that there are certain vitamins and minerals that I’m unable to get enough of through a vegan/vegetarian diet (like vitamin B12 which is only found in animal products), and also, based on my recent lab work, we found that some others (like my vitamin D and zinc levels) were significantly depleted for me during chemotherapy.

There are certain supplements I need to be cautious taking during radiation therapy as high levels of antioxidants (like those in vitamins A, C, and E) can interfere with the treatment itself. For now, I am supplementing with:

  • B vitamin complex to improve my energy levels and cognitive functioning
  • Vitamin D3 which promotes bone health and has been shown to reduce the risk of cancer metastasis
  • Omega-3 which helps to reduce inflammation and supports brain and heart function
  • Zinc which supports the immune system
  • A probiotic and the GI drink I mentioned earlier for gut health

It sounds like a lot, but I’m currently finding it very worthwhile. Some of the brain fog that started during chemo has lifted since I started supplementing more regularly, my GI system is more settled, and my hair is growing back much faster than I anticipated! Maybe eventually I won’t need so much supplementation, but I feel now is the time to be very supportive of my body and it’s healing.

The Cost of Collaborative Care is: Priceless.

I know what you’re all thinking – this all sounds expensive! And it is to some extent. Supplements can be pricey & aren’t covered by insurance like most pharmaceuticals. When providers don’t contract with insurance companies, the costs can add up. I don’t need to explain myself, but I just want to let you all in on my thought process at this point.

Seeing an ND and using supplements and acupuncture to support my healing have brought me immense benefits and peace of mind both before and after my cancer diagnosis. I personally feel that seeing a fee-for-service provider is excellent because they are not held to unreasonable standards that insurance companies often dictate. These providers can spend more 1:1 time with their patients, can recommend tests and treatments that can be run through insurance companies, and can provide a more holistic approach to your care. I personally feel it worth every penny to have this kind of care.

If you don’t have your health, you have nothing. This year my body has been through the ringer and besides feeling physically unwell, I saw my mental health and my relationships challenged. I was hardly able to concentrate on anything besides getting through treatment and managing my symptoms. My husband became a “caregiver” and most of our life revolved around what I could and couldn’t do with friends during a pandemic when you’re immunocompromised. I haven’t been able to treat patients for almost a year and so my sense of purpose got a little muddy at times.

Now is the time for me to heal from all of that. I am beyond grateful for good health insurance that got me through treatment without any debt, family and friends who contributed to my GoFundMe so I can seek out alternative care options as I continue to heal, and for my super-supportive coworkers who’ve donated time off and kept me in the loop at work so I don’t feel like a complete outsider. These things may seem small, but they can mean the world to someone living with a complex illness.

Again, my purpose here is to share my journey in case someone else going through this can benefit from what I’ve learned. Much of this info is very personal, and I choose to be open about this. I’ve said this before, but just because someone is considered “cancer-free” doesn’t mean they’re not still experiencing some of the long-term effects of treatment. We use fire to fight fires in cancer care and there are often side effects of side effects!

Please be kind! If you know someone in treatment (or if you know someone who may just need a little extra help), reach out today and see how you can support them – we’ve all got to have each other’s backs.

Aloha ❤

*This post is not intended to provide medical advice or recommendations. I am simply stating what has worked or been recommended to me on my personal journey. For more information, read my full disclaimer here.

A Fertility Update

A Fertility Update

by bridewitt ♥ 3 Comments

How it’s going…

You may remember me posting a while back about the different ways I tried to protect my fertility as I prepared to start chemotherapy. First, I froze some eggs. In case I’m unable to conceive naturally later, I can use them for IVF. I also started monthly Zoladex injections – a medication that halts ovarian function in an attempt to preserve fertility overall.

And so, at age 31, I’ve been in a Zoladex-induced menopause since June. Six whole months later, my estrogen levels have tanked and my joints ache like I’m an 100-year-old lady! Some other fun side effects include amenorrhea (lack of a period), hot flashes, and dyspareunia. So, I’m currently staying as active as possible (mostly walking and stretching when I have the energy) in order to mitigate some of those side effects, and thankfully, my oncologist and I decided it was time to discontinue the Zoladex now that the bulk of treatment is behind me. Today marks one month since my last injection!

For more detailed info about fertility preservation, you can read my earlier post here.

What to expect now?

Typically, the menstrual cycle can take a few months to return as the body figures out its new normal once again. As I have some previous experience with amenorrhea after I came off the birth control pill in 2019, I know that what I eat will play a huge role in how quickly my body gets back to normal. Thus, the plant-based diet continues (plus no dairy, processed sugars, or alcohol) and I will try my absolute hardest to cut back on caffeine to keep my nervous system calm.

I also plan to use seed cycling to help my body regulate the essential hormones it needs for menstruation and ovulation. This is a great article about how to do seed cycling if you’re interested in learning more. Seed cycling is an excellent, natural way to balance hormones, however if you have hormone-positive cancer, please ask your doctor if a daily dose of phytoestrogens is safe for you!

Once I’ve completed radiation therapy, I’ll speak with my medical oncologist and OB/GYN about when it will be safe to start trying to conceive. With that said, I think my body deserves a long break to heal completely before that all happens. Actually, this might be a good time to kindly remind you that it’s just not acceptable to ask a person when they plan to have children. A person’s body is their own to make decisions for and, sometimes, people aren’t capable or willing to have children at all.

My goal for this blog has always been to be as open and honest about my experiences as possible in the hopes that whoever may be reading this can gain some insight for their own health and wellness. Personally, I don’t think there’s ever TMI (too much information) disclosed when it comes to learning about your own body and how it works. This coming from a pelvic floor PT who talks about poop all day… Anyway, I’d love to know what questions you have about:

  • fertility preservation during cancer treatments
  • long-term side effects of the birth control pill
  • nutrition around hormone balance
  • seed cycling

Drop your Q’s in the comments below!

Cancer & Pelvic Pain Conditions

Cancer & Pelvic Pain Conditions

by bridewitt ♥ 1 Comment

On today’s blog, I wanted to bring attention to female pelvic pain and dyspareunia (pain with intercourse) secondary to cancer treatments.

Often, when a woman has gone through adjuvant hormonal treatments, chemotherapy, abdominal/pelvic radiation, or fertility-saving drugs during active treatment, the body goes into a state of menopause or “chemopause” as it’s commonly referred to in the cancer world.

Low estrogen levels during chemopause can cause symptoms like:

  • Amenorrhea (loss of menstrual cycle)
  • Low libido
  • Vaginal dryness or atrophy
  • Hot flashes
  • Mood changes
  • Joint aches and pains

In particular, vaginal dryness or atrophy can have a huge impact on sexual health, emotional health, and relationships post-cancer. If the pelvic floor muscles are compromised by treatment, it can result in pelvic pain (like pain from overactive or tight pelvic floor muscles, pain in the tailbone, lower abdominal pain, or pain around post-surgical scars), bladder/bowel changes, or painful sex.

Thankfully, a pelvic floor physical therapist with specialized training in examination and treatment of the pelvic floor muscles can treat these conditions and are an amazing asset to oncology patients on their road to recovery. Some PT treatments for pelvic pain and dyspareunia may involve:

  • Pelvic floor muscle strengthening or relaxation exercises with or without biofeedback training (computer or ultrasound-based pelvic floor training technology)
  • Stretches for tight muscles around the abdomen, pelvis or hips
  • Manual therapy including general massage, pelvic floor muscle release techniques, or scar tissue mobilization
  • Education and lifestyle strategies surrounding posture, nutrition, bowel and bladder habits, and lubrication options during intercourse
  • Education in the use of vaginal dilators to reduce pain that occurs with tampon insertion, gynecological exams, or sex
  • Encouragement around body image and sexual health (this could include referral to a sex therapist or psychologist when appropriate)

If you’re reading this, and you feel like you could benefit from pelvic floor physical therapy during or after cancer treatment, you can find a qualified pelvic floor PT in your area here or here. Ask your doctor for a referral today!

And a quick reminder for all of us…
The path to recovery from cancer involves a whole host of treatments including chemo, hormonal treatments, surgery, and radiation just to name a few. Each of these treatments can come with significant side effects or long-lasting comorbidities. Just because someone is “cured” from cancer doesn’t always mean they are living without long-term effects from treatment. Keep this in mind, and be kind!

*This blog is part 2 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤

Saving your Fertility during Cancer Treatment

Saving your Fertility during Cancer Treatment

by bridewitt ♥ 3 Comments

When the last thing you expect is to be diagnosed with breast cancer at age 30 (or under 40, honestly), your desire to have (or not have) future children becomes very clear suddenly. I may have been the person who was in no rush to have kiddos, but I took it pretty hard knowing I was about to start chemotherapy that would significantly affect my ability to reproduce, possibly even making it impossible to conceive naturally.

In all the rush of my initial diagnosis, I wasn’t able to write about options to preserve fertility during chemotherapy. Honestly, it was some of the most emotional decision-making I had to do at the time, so maybe I put it off because it was all very overwhelming! Ultimately, I made two important decisions in order to help save my fertility, which I’ll share below with a few other important concepts regarding fertility preservation.

Chemotherapy & Its Effect on the Ovaries

First, you may wonder how exactly chemotherapy affects your ovaries. Chemo medications are designed to target and kill rapidly dividing cancer cells. Unfortunately, those meds can’t differentiate between rapidly dividing cancer cells and rapidly dividing normal cells in the skin, digestive tract, and reproductive organs. Just as you’d expect to see some side effects like skin/nail changes or mouth sores, we expect to see some attack on the ovaries as they also have a known cycle of cell turnover (a.k.a. ovulation). Thus, if you’ve never had children, and your cancer is stable enough to delay treatment for a few weeks to a month, your doctor should recommend all of the fertility-preservation options they have available. If they don’t offer, you better ask!

Egg Preservation Prior to Active Treatment

I was referred to a fertility specialist/reproductive endocrinologist who was excellent. I had the option to extract eggs (unfertilized) or embryos (fertilized) which would be frozen by a process called vitrification until I need them at a later date. I chose to freeze eggs as research now shows no major difference in later IVF success rates whether an egg or embryo is used, per my physician.

The whole process is timed with the menstrual cycle, so specific hormones are injected during the follicular phase (when the ovarian follicles that store the eggs begin to grow and mature) beginning on day 2 or 3 of menstruation. The fertility specialists monitor follicle growth and count every few days with a pelvic ultrasound and bloodwork. As the follicles mature, indicating ovulation to be close, a different medication is given to delay ovulation until the mature eggs can be retrieved.

The retrieval process is done under light anesthesia in the fertility office. A needle is directed into each ovary through the back of the vaginal vault. Suction is used to retrieve the mature follicles, and after inspection of all eggs to determine which are viable, the eggs can be fast frozen (“vitrified”) and stored in an egg bank until needed. Voila! Now, I have a back-up option post-cancer if I’m unable to conceive naturally! Thank goodness for modern medicine.

Throughout all of that, the worst side effects I had were some moderate bloating and cramping after the egg retrieval. I was also given a separate hormone during the follicle-stimulating phase that helped to avoid an estrogen spike so my mood remained stable throughout (I’m sure my husband appreciated that I wasn’t a hormonal monster through it all). Despite having to delay chemo about 4 weeks to complete this process (remember, they like to time it with your natural cycle), I have no regrets on completing this first for peace of mind alone.

The Cost of Fertility Preservation

Whoever my future kids are, I hope they know I reallllllyyyy want them, because fertility options are not cheap! Most insurances do not cover egg/embryo preservation if you do not have a diagnosis of “infertility” even if you get cancer that you never wanted which might render you infertile… (I’ll refrain from saying any more). The egg retrieval process alone usually costs somewhere around $10k which doesn’t include the annual storage fee for the eggs (mine is about $700 per year).

Fortunately, there is a great option for cancer thrivers through the Livestrong Foundation. My fertility specialist had me begin paperwork to apply for their grant which covers about 1/3 of the total cost if you qualify (most cancer patients do unless your insurance covers). Ask your fertility doc if this is an option for you!

Only a Pelvic PT would have their very own pelvis model at home! #SaveTheOvaries

Options to Preserve Ovarian Function during Chemo

Besides the pre-treatment egg retrieval, my medical oncologist also recommended that I go on a gonadotropin-releasing hormone (GnRH) agonist called Zoladex during chemo. This is a monthly injection that essentially halts ovarian function by blocking GnRH (a hormone released from the hypothalamus in the brain that triggers the release of follicle-stimulating and leutinizing hormones which act directly on the ovaries). The cancer community “lovingly” refers to this state of no periods as “chemopause” because it is essentially a medically-induced menopause complete with joint aches and hot flashes. I have been lucky that my side effects have been mild, and I’m very thankful to give my reproductive system this brief pause while I kick cancer’s ass.

After treatment, once I get the ok from docs, I’ll still be able to try to conceive naturally. The chances of conceiving naturally are lower for those of us who’ve gone through chemo or radiation, but it’s definitely possible! If I need a little help, then I’ve got a few tiny frozen eggs lined up for further fertility treatments down the line.

It’s Okay to Be Concerned about Your Fertility

I’m thankful that my OB/GYN and oncology team were very supportive about fertility preservation prior to starting active treatment. For many women, hearing your plans for a family will likely have to change after cancer is devastating. I didn’t expect to be so emotional about this whole process, to be honest. I’ve always wanted kids some day, but I wasn’t a person who constantly planned my life around it. Even still, early into my diagnosis, I found myself mourning the loss of my potential fertility more than the fact that I could die from cancer. I don’t believe it does anyone any good to stop planning for the future and let cancer have all the control, so be sure to tell your doctors how important saving your reproductive health is to you!

My heart goes out to anyone reading this and going through the same decision-making process. My heart goes out to those of you reading this who are struggling to conceive even without a cancer diagnosis. I’m so thankful to have so many options to consider and know that, in the right time, children will be a part of my journey, too. For those of you just starting out on your cancer and fertility journey, be sure to ask your doctors what the best options are for you!

Aloha ❤