One Year After Cancer:
“I always thank God for such a lucky day
when He armored my knights as they fell on their knees;
when He opened the heavens and sent me human angels;
and He left me no choice but to be brave.”
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On Antibodies and Getting Better
And so I’m back in the game trying to rule out almost every possible reason why my last IVF failed. Three possible issues are left for me to resolve – embryo quality, adenomyosis, and immune dysfunction. And I have opted to explore the latter.
Unfortunately, my Implantation Failure Panel Test came back with a term Humoral Immune Deficiency. Apparently, my b-cell parameters are decreased and my Oncologists have presented two analysis on this: it could still be the effect of my chemo and it could also be the cause of my lymphoma. I believe both can be true and such immune deficiency must be treated the soonest. And so I have met Dr. Cesar Joseph Gloria, my Reproductive Immunologist.
Reproductive Immunology is totally new to me. It talks about the immune system and its components related to the reproductive system. It talks about cells, antibodies…more complicated subjects that are so hard to understand. And this time, I have given up on researching and have just decided to listen to my doctor and follow his instructions religiously.
Anyway, after further series of tests and tissue crossmatching with my husband, I have been diagnosed of not having good antibodies for reproduction. This means that my embryos will never implant even with IVF treatment. And so I have been given prescription to take probiotics and undergo Lymphocyte Immunization Therapy or LIT. LIT works by injecting my husband’s white blood cells into myself until my immune system fails to see them as foreign. It is believed to block my antibodies which have been trained to see my husband’s sperm as foreign invaders. I have been asked to undergo LIT once a month for four months and the immunization is expected to last for six months. Thereafter, a booster shot (which is good for another six months) can be done if ever I didn’t get pregnant. Upon pregnancy, the immunization can last up to one and a half years and that means I should work it up for another baby before my stats are back to zero. Yes, it can never be cured – the immunization lasts only for a limited period.
On a side note, take a look at my latest AMH. Isn’t it promising? My stats have doubled since July and I am ecstatic! When I had my last ultrasound, Dra. Eileen Manalo saw that I am now ovulating on my own even without the help of fertility drugs. And I am very much happy with the outcome. This is me 9 months after chemo. Slowly, I am getting my life back. And I believe that I’ll get even better very very soon.
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Until the Angels Hear my Music
“Hope is hearing the music in the future. Faith is dancing the music now.” – Caroline Pitre-Oaks
My two weeks wait was finally over and I’ve been coping up from my first IVF failure. It has really been difficult to pick up the pieces as I watch my dreams shatter and catch all of the broken stars with grace. I didn’t know where to begin because I knew I have to start all over again and it was hard to accept. I’ve been through a lot in just a couple of months and sometimes, it was just hard to understand why I was the chosen one.
To my surprise, I just cried once while inside the car after I checked my bHCG online. I was crying because I knew that my next chances would be harder, my next choices would be fewer, my next gamble would be riskier and probably costlier, until it demands something from me which I could no longer give. I was devastated with the bad news. But in less than an hour, I found myself outside the clinic of my doctor; demanded an explanation of the failure; thanked her for trying her best; and gave her the assurance that we will do it again. I ended the day talking to my family over dinner with my pizza treat on the table and laughing until midnight over the bad news with close friends sharing the same fate. The next day, I was so busy reading medical journals. As weeks passed, I found myself looking for answers, logging in support forums, going back to my doctor for more series of blood tests, and monitoring my hormones as closer as possible. I was really surprised of whom I have become. Or perhaps, my cancer has just prepared me to have the strongest arms that could embrace my destiny.
And today, I just bought a new instrument and started playing again after almost 15 years. A new flute was shining on my black and white keys. Something has been telling me that my angels could probably hear my melodies over high and low notes as long as I keep on playing with my heart with all the techniques I’ve learned. After all, I knew it was not the beginning of a song as it could just be a reprise. I will only stop playing my melodies until the angels hear my music and God says its over.
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Sweet Surrender
So here I am, lying in bed for the longest two weeks of my life. Beyond all my anxieties, I am very thankful to God Almighty for bringing me this far to show me that He is my King and everything comes from His power even the most genius discovery of mankind. I have been in awe about everything that has transpired in just a couple of days – amazed by how far science can help me and how far my faith can lead me to believing that God is always in control of when miracles are bound to happen.
OVUM PICK UP DAY. I am very thankful that my Reproductive Endocrinologist, Dra. Eileen Manalo, was able to retrieve 3 eggs from my left ovary after 10 days of stimulation. When I woke up in the recovery room after ovum pick up, Dra. Quintos (my Anesthesiologist) told me that the 3 eggs retrieved were all M2 or of best quality. She said that my RE spent two hours for me (normal was 30 minutes) just to do the best that she can but apparently, the other two follicles retrieved were really empty. After a couple of minutes, we went to my RE’s clinic and received my first shot of Proluton (0.5 ampule) which I should be having every 3 days together with Crinone vaginal gel which should be applied twice a day. Proluton and Crinone both contain progesterone hormone that should help ensure that the lining of my uterus is optimal for embryo implantation. I’ve also been prescribed to take Progynova tablet (twice a day), a synthetic hormone replacement for estrogen, that could also help in building up the lining of my uterus.
The next day, I’ve learned from the clinic that 2 out of the 3 eggs have been fertilized! This is another good news for me. My RE checked my lining and it measured 10mm. She once said that ideally, it must be 8-10mm.
This was taken inside the IVF Room for embryo transfer. The first we had was inside the PET/CT Scan Room for my Ovarian Lymphoma. Hoping that the 3rd picture with my husband would be inside the Delivery Room. Faith tells me: hope never ends.
EMBRYO TRANSFER DAY. We were early for this because I had a schedule with the Acupuncturist pre and post transfer. Approximately an hour before the transfer, I was given Tractocile intravenously to relax my uterus for the procedure. Meanwhile, I have to commend the Anesthesiologists of St. Luke’s CARMI. The insertion of IV cannula in my veins for both ovum pick up and embryo transfer days were very smooth in just one shot. This has been my greatest fear as a cancer patient as my veins usually collapse and get brittle due to chemotherapy. When it was our turn for the transfer, I saw a Day 3 picture of our two fertilized embryos projected on a big screen inside the procedure room – a 5-cell Grade 2 and a 3-cell Grade 2-. Then I saw my RE in her scrub suit smiling at me. Also present in the room was a Sonologist, an Embryologist, 2 Nurses, and my husband Jorel. I remember my Sonologist asking me if I had previous operation as he was locating my uterus from the machine. It was quite uncomfortable as they could not allow me to pee because I have to do it with a full bladder. As usual, I was having a hard time to relax (I am always like this even in a regular transvaginal ultrasound for follicle monitoring). I remember my RE asking to play a zen music for me to relax while she put the speculum. Then when my uterus was located, my RE slowly injected the embryos through the catheter. I was very nervous as I look at the monitor with a few pain and discomfort, in awe about the procedure as I watch the two little embryos approach my uterus. It was very heartwarming as my RE offered a prayer while she was injecting the little embryos. My husband told me that he was also busy praying while holding me. I remember I was crying a bit with my eyes closed because of pain, amazement, and faith. But one thing is sure – there is a great power that guides the advancement of science and I believe that doctors are just instruments of God for His greatness.
And as I write this today, I have no idea where this experience would lead me, how this would affect my life, and what this would make me as a person – as a wife always dreaming of a child or a soon to be mother. Beyond all these, still, only God can tell. And so to Him, I lift all my worries. And to Him, I give my sweet surrender.
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Starting the Ride
My doctor didn’t tell me that it’s going to be easy. But she told me that it’s going to be worth it.
So here I am with my first IVF experience! I still can’t believe that I’m going this route but I am thankful that I am able to go through this faster from just almost 6 months post chemo. I’ve been stimming for the past days now and the hormone injections have been really kicking in. I feel that a part of me is being fooled as something is playing with my hopes from very high to very low to moderate in just a matter of days – a roller coaster ride indeed! Surprised that my husband, Jorel, has been doing his part by changing his role as my nurse and my counselor. I have never expected that he will be very supportive all the way once I started with this fight. With him around, I must say that the ride has been easier because there were really times that I ran out of gas and it was really hard to move!
Here are the updates for the past days:
DAY 1 : My period finally started coming off from birth control pills for 26 days. I had spotting the night before and my Reproductive Endocrinologist, Dra. Eileen Manalo, asked me to see her just to check on me and ensure that I have no cyst to begin with.
DAY 2 : Started stimming with Gonal F (300 IU) and Saizen (0.5 ampule). Gonal F is used to stimulate the production of eggs in my ovary and Saizen is a human growth hormone that should improve the quality of my eggs given that I have a low AMH.
DAY 3-6 : My husband instantly shifted his role as my nurse. He started giving my daily dose of Gonal F and Saizen. My tummy started bruising because of injections.
DAY 7 : It’s Labor Day but my RE’s clinic was open and I’m scheduled for my first follicle monitoring. She initially saw 3 follicles on this day which means that I am a poor responder. Quite devastated on the initial result. My RE told me that we have come this far and I should hold on. She added that most of her patients who do not usually succeed are the ones who easily give up. Forward looking as I am, I have asked for the next plan if ever this cycle fails. She mentioned double stimulation which automatically sounded too taxing to me. Meanwhile, she added Cetrotide (0.25 mg) and Luveris (75 IU) for my daily dose of injections. Cetrotide is a GnRH antagonist that should prevent premature ovulation in a controlled ovarian hyperstimulation for IVF.
DAY 8 : Continued with my 4 injections a day and it’s a lot harder this time. Got the results of my liver profile as advised by my Medical Oncologist and everything looks fine! My estradiol, LH and progesterone levels were also good. My anxieties have started creeping in though. I started reading a lot about double stimulation. I know being wide awake at night was very bad but I couldn’t help it. More reading, more crying, more praying, more hoping…
DAY 9 : This day I cried a lot when I woke up, prayed to God pervently, even talked to my mom in heaven asking to help me pray! I remember telling my husband that it was very dark. Then I fixed myself for my second follicle monitoring and my RE saw 5 follicles this time! Out of the 5, only one looked good so I was not given the trigger shot but was asked to come back instead. Shortly before dinner, Jorel brought me back to the Shrine of Padre Pio. I saw people on wheelchairs, praying with scarves on their heads. In my prayers, I instantly became shy to ask for a child but thanked God for all the blessings instead. The sick people I saw reminded me of how I was a few months ago, enough for me to realize how blessed I was to receive His grace of healing in a short span of time. I am so thankful for this day when I saw hope out of despair.
DAY 10 : Very thankful for my doctor this day as it was a Sunday. My RE was still unhappy with the sizes of my follicles. She added a small amount of Puregon for the stimulation.
DAY 11 : I was given my last injections this day. We were eyeing for a DAY 13 ovum pick up. Thanks to Tita Nits for giving me the Pregnyl shots (10,000 IU) I needed at 10:30pm. Pregnyl is used to stimulate the final maturation of eggs in the ovaries of women having IVF. The eggs will be collected 32 to 36 hours after the injection for fertilization.
Embracing this roller coaster ride was not easy. A part of the ride was spending time waiting for the ups, holding on to it, and needing to close my eyes when I felt that I was falling down or was riding the loops. I could hardly afford to throw my hands up in the air; the most I could do is to relax. I could not even enjoy the ride…and I didn’t know if I could dare ride it again. But one thing’s for sure, the only ones who get hurt in this roller coaster ride are the ones who jump off. Or maybe, just maybe, embracing the ride was just part of my destiny.
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Birthday Blessing
My birthday gift has finally arrived! These IVF drugs are very expensive and on my birthday, God gave me these for free (through my insurance)! My RE will be using the Antagonist Protocol on me.
After cancer, I have learned how to be more thankful for each blessing I receive everyday. And on my birthday, I thank God for the extension of my life with this bonus pack!😍
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When April Comes
“Always be fearless. Walk like lion, talk like pigeons, live like elephants, and love like an infant child.” – Santosh Kalwar
I’ve finally made a decision. My anxieties have taken me to the bravest part of my soul with my decision to go on with the IVF treatment. I am not exactly sure where this would lead me and how long it would take me to finally embrace my heart’s desire. One thing I’m sure though – my body is now ready to face another battle after six months post chemo and it has been telling me to continue my journey and put a little bit of certainty in all of these doubts.
April comes and on this month, I am turning 36. My body has been aching for me to take my chances before I hit the finish line with my belief that my age is the greatest predictor of this game of risk and probability I’m at. I really don’t know how taxing the daily injections would be, how much of me would be exhausted emotionally and financially, how many cycles am I willing to try, and the possibility of cancer relapse while on treatment or even while I’m pregnant.
April is when I do all the tests for my quarterly surveillance for my lymphoma. My blood tests came back with good results, all is well and within the acceptable range. It was my first time to do the CT scan with both oral and intravenous contrast. My abdominal and chest CT scan showed the same small nodules as shown from my PET/CT scan last year – one on my right breast which came back benign from my mammography and ultrasound; and another one in my liver which will be monitored by my oncologist a week after I start with my daily hormone injections. My Medical Oncologist Dr. Gerardo Cornelio was happy to see me after three months with my new look. My hair has been showing up and this time, nobody could recognize that I was once been suffering alopecia due to chemo. It came back quite thicker than my old hair and surprisingly, I love wearing my hair this short as it’s so fast to fix and I have the time to put my make up on.
My baseline test results post chemo. As expected, the alkylating agent included in my RCHOP regimen did the damaging impact on my left ovary. But my stats looked promising while on my way to full recovery.
April is also the month I started with birth control pills. I believe that my Reproductive Endocrinologist Dra. Eileen Manalo is now preparing me on my next treatment. She has been monitoring my hormones since after chemo and we’re both happy with the improving results. My menses are quite irregular post chemo and the pills should regulate my period and should help my ovaries do away with cysts. Once I’m off the pill, my period will come and we’ll start with my daily injections. Meanwhile, my Acupuncturists have been preparing my uterus for this treatment almost twice a week, as it is believed that they can improve the blood flow.
Studies have shown that this IVF treatment could only give me a range of 2-7 oocytes given the chemo that took its toll on my body. I honestly believe that this is indeed a gamble given a very slim chance. It can be a hard battle but I will never know until I started with this fight. April comes each year but tomorrow. And when tomorrow never comes, my battle would be over and I’m off to my next journey.
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When East Meets West
Going back to basics to complement modern science. From chemo to acupuncture, I have learned to make needles my best friends.
I’ve finally started working on my wellness to complement modern science. This month, I went back to the gym at least thrice a week, began with acupuncture once a week, and started the prescribed green juice daily. Trying out the more traditional and natural way of healing is a totally different experience. It calms the mind and relaxes the body. Others choose this medicine over modern science (my insurance even pays for it); others choose it as a last resort.
Here are the ingredients of Green Juice that was prescribed to me by my Acupuncturist. It is believed that this would help me achieve optimal health.
1 green apple
50g sprouts
100g cucumber
1/2 celery
200g lettuce
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Counting my Eggs and Improving my Chances
My first cycle after chemo lasted for 40 days and my second period was Duphaston induced. Dra. Eileen Manalo saw a cyst in my left ovary and was planning to aspirate it. Thankfully, it disappeared on its own. Finally did some blood works in Day 2 of my menses to check my hormones. A lot of acronyms to study this time such as FSH, LH, and AMH. My baseline test results came out and luckily I was not in the early menopause level. My AMH was low though due to chemotherapy and so IVF can’t enter the picture yet.
AMH or Anti Mullerian Hormone is the most accurate indicator of a woman’s ovarian reserve at the moment and the most likelihood that a woman’s ovaries will respond to medication. It is a hormone produced by the granulosa cells of the early developing antral follicles. As a woman runs out of eggs, the number of these small antral follicles declines and as a result, AMH falls. Women with a family history of early menopause, a history of surgery in the ovary, severe endometriosis, and those who have undergone chemotherapy and radiation are at a risk of diminished ovarian reserve. Women with diminished ovarian reserve have diminished fertility and an increased risk of miscarriage.
AMH is recommended to women under infertility treatment from age 35 and to women with history of surgery in the ovary, chemotherapy and radiation. Doctors use the AMH test to determine if a woman is a good candidate for IVF and may help them to know if they should go forward with IVF or not.
AMH levels can be hard to change, much like it is hard to change the aging process. But some factors may play a role to improve it. So while waiting for a good AMH level, I need to help my doctor in preparing myself and regaining my health.
As I’ve started googling online on how to improve AMH level, I’ve learned that this is one topic of modern science that validates Chinese Medicine. In Chinese medical perspective, we are all born with “Jing” which can be described as our life-force essence. We inherit our “Jing” supply from our parents but we can burn and replenish it depending on our lifestyle and dietary habits.
Here are some ways I found online on how to improve AMH naturally:
1. Diet and Exercise
2. Taking Vitamin D and Royal Jelly capsules
3. Avoid Cigarette Smoking
4. Acupuncture
Top foods for egg health include broccoli, berries, dark leafy veggies, salmon, pumpkin seeds, ginger, turmeric, sesame seeds, halibut, ultrgreens and maca. Foods that can damage egg health include processed food, trans fats, soda, alcohol, caffeine, non organic meats and dairy, and sugar.
I still believe that having an extremely low AMH is not the end of the world for me. It is a guide that would allow me to assess any probability of conception while working on my health and wellness at the same time to improve my chances.
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Half Empty, Half Full
So I’m off to a new journey. This, for me, is a more challenging one. A thin line between dreaming and believing. A question of science and at times, a question of faith. When to hold on and when to let go. When brevity is not all that matters but a more accepting heart. A balance of trust, hope and surrender. This is my infertility journey…my life after cancer.
And so I have been back in Dra. Eileen Manalo’s clinic. She has presented the IVF option for us as soon as I got my clearance from my Oncologists. IVF or In Vitro Fertilization is a process by which an egg is fertilized by a sperm outside the body: in vitro. It is recommended to me given my age and condition since all other assisted reproductive methods have failed on me and the chemotherapy could have a damaging impact on my ovary. IVF is not easy…especially for me who will always have the risk of cancer recurrence. My whole family has been totally against it. My husband, Jorel, believes that my body is not yet ready for it especially in the ovarian stimulation part. I, on the other hand, is more than willing to take the risk because I know that delaying the treatment would only increase the risk and decrease my chances. And so I am in limbo in search of all the possibilities that may or may not happen. Praying harder while keeping my love for my husband burning. Because my defeat is not really not having a child but losing my husband. And so I should wait for the right time to come when he is ready to fight with me, and believe in me with a more accepting heart.
People may not probably understand why I’m so into it. I’ve been reading up from journal articles (despite my difficulty digesting some medical terms) to testimonials of couples undergoing the same fate. Googling countless medical acronyms, spending longer consultation hours with my ob, joining infertility and lymphoma forums – arming myself with the best possible knowledge I could grasp so I could understand the kind of battle I am facing and eliminate my fear.
IVF is not a joke. It is expensive and can be very demanding without the assurance of pregnancy. It can steal the sun in me and can strain my body and my relationship. But IVF is not just a technique. It is a treatment. It can be an answer to my prayer which can be short but can also take longer and harder. For I will discover what really is wrong with me in the process and do what needs to be done while I still got the time. And when that time comes that miracles are not bound to happen, I will give my sweet surrender without any regrets.
In my life, I knew that my past has molded me to become who I am right now. I always work hard for my reward and I never give up when I fail. I have witnessed my own story as a student, as a worker, and as a partner. I am always in the waiting game with a failure in between. That was before I became the first MSFE graduate in school, an ADB employee, and a wife. All the good things in my life were never easy at first. And I’m not afraid of failure. For when I look back, they have purpose for me to become a better person. As Dra. Manalo said, I should not be afraid for it’s just a matter of perspective on how I look at a glass if it’s half empty or half full.
My battle is not yet over. I’m just beginning to understand my journey. And I want to look at the glass half full.
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My Teal Life 