Blessed is the fruit
“You will be 100% infertile.”
The words reverberated in my skull as I took the receipt from the hospital’s parking deck turnstile. My anger radiating through my knuckles as I gripped the steering wheel tighter with each passing minute. My vexation only heightened by the fact that I just paid $15 for parking.
All to be told my new treatment plan would leave me unable to conceive children on my own.
(Or without at least some third party assistance from Big Embryo or the Easter Bunny. Or however that works. My doctor apparently ran out of or didn’t have any pamphlets on the subject and my Florida Catholic high school sex education wasn’t exactly existent thorough so I’m still a bit confused.)
I’m not sure if I expected warm reassurance that everything would be ok or even a sympathetic frown as a follow up to the verbal dagger I had just received, but I was hoping for more than an indifferent:
“Any more questions?”
Any more questions. As in, “Are we done here?”
As if the summation of my reproductive future had been determined. The prophecy written.
Blessed is the fruit.
(I guess I do remember a bit from sex ed. Or that might have been from my New Testament class. It’s hard to say.)
My anger continued to build with the more distance I put between myself and the examination table. Anger rooted in my doctor’s nonchalance in the concern for my fertility as a 25-yr-old female who has yet to even start to contemplate having a family.
My doctor tossed me a grenade disguised as an egg. Without thinking, I extended my hand to receive the seemingly innocuous offering.
I didn’t know the pin had already been pulled.
I didn’t know I needed to ask if it had.
(I should specify that there was a pregnant pause before asking if there were any more questions… Apparently the only thing that was going to be pregnant in the room.)
Perhaps it was the general sense of nonchalance about the matter that left me wondering, as I sat on the examination table, if I was maybe misunderstanding what I was being told. Maybe I was the one overthinking what weight this bore.
My doctor would surely be alarmed if this was an issue….Right?
He was after all visibly panicked when we discovered that my initial treatment wasn’t working and the next option would require a stem cell transplant.
That grenade wasn’t disguised however. Merely dropped into my family’s lap before he gave vague answers to our questions and exited in a huff of concern. Leaving us to sit alone, in what can only be described as a storage closet, scrambling to put the pin back into its vessel. Scrambling to fix me.
So perhaps this promise of infertility wasn’t as big of a deal as some piece of me felt. A piece that had been allowed to remain asleep, apathetic to its existence. Until now.
After all, I was being told my cancer was diversifying its portfolio at the expense of my life. Instead of being concerned about having a future family, I should just focus on having a future. Period.
Plus, the indifference to my situation probably just stemmed from the fact that the messengers were a middle-aged man and an overworked nurse whose ticket on the Menopause Train - the Menopause Train: Frequently 85-degrees inside and the seats feel like sandpaper - was punched long ago. There were larger issues to tend to than my fertility.
It took me much farther of a drive than the profiteering parking deck turnstile to understand that regardless of my medical team’s personal detachment from the matter, this very nonchalance in the threat to fertility Adolescent and Young Adult patients (AYA: 15-39 yrs old) face is one of the reasons only 46% of AYAs are informed of the impact their cancer treatments may have on their future.
46%.
Less than half of AYA patients are told their treatment may entirely alter what it means for them to have a family.
For those who feel having children is inconsequential, perhaps this news isn’t startling.
For those who do not believe that being informed of potential threats to their reproductive future is a basic right, perhaps this news isn’t concerning.
To those people, let me frame this a different way. Would you want to buy a house without knowing the total cost? Without knowing that the 1920s paint used to lacquer the walls had a high probability of causing infertility that was irreversible?
Even if you had no other option, even if you didn’t have the luxury of time to make preparations prior to moving in, prior to being exposed to the harsh chemicals, wouldn’t you at least like to know?
I think quite often there is a weight placed on patients to be grateful. As if in facing your mortality you should come out on the other side of it thankful for getting one more day. There is an externally perceived shelf-life on your resentment and bitterness for all you might have lost, and it is much shorter than that of gratitude.
And it is reasoning such as this that only helps to perpetuate the paltry numbers of AYA patients who are notified of the additional disruptions their cancer will cause. The part of the iceberg that rests quietly beneath the surface. The part that an unfortunate majority of doctors don’t think is worthy of warning. Or perhaps simply don’t even think to address. Blinders to the peripheral damage caused in their quest to vanquish cancer.
I would have been on the wrong side of that 46% if I hadn’t connected with a Therapist three years prior who happened to specialize in fertility counseling.
I would not have known to ask about the risk my treatment posed to my fertility without my Therapist’s guidance. And my medical team showed no signs of filling in the blanks my ignorance created.
Perhaps it was my lack of babysitting an egg with a classmate or the fact that family planning was not high on my priority list as a 25-yr-old female growing up in a culture dominated by money, success, and the side-hustle, but I lacked the awareness of how closely intertwined the webs of my reproductive health and cancer treatment were. And the fate of my potential children rested squarely on the shoulders of someone enlightening me.
Oh how delicately our futures rest on someone having a good day.
A few months prior to this prognosis of infertility, I was just excited to be standing in front of the freezer eating directly from a pint of Ben & Jerry’s I thought I had already finished.
So why would I worry about family planning when that was a subject long filed away in my brain and awaiting its number to be called?
Friday night reservations? Yes.
When I was going to ask for the promotion I worked hard for? Absolutely.
If I wanted children?
I’m sorry, you cut out there. What was that?
Yet here I was, the number being pulled long before I was ready.
As my doctor confirmed the inevitable scrambling of my ovaries, I was more focused on the anxiety of how I should react. What is the “normal" female response?
Do I collapse to the floor at the news? Too much for my taste. (But mostly my joints were so stiff I don’t think I would have gotten much farther than the edge of the table.)
Do I shed a single tear? It’s been done before. Namely by me. To the point where my tear ducts were now withholding. Did I want to use The Reserve Tear for this? Best we save it for the next inevitable blow.
I dropped my head. The guttural response to bad news you learn to develop at a young age.
Like you did after your friend in 2nd grade told you their hamster was missing. You couldn’t quite contemplate the terror Minkus the Hamster or Katherine the Friend were feeling, but you knew you should feel something.
That was me. Dropping my head while my brain and heart tried to simultaneously grasp what this prognosis meant and how it made us feel.
I’m still not sure we know.
The sound of the crepe paper crinkling underneath me as I shifted uncomfortably on the examination table filled the silence. A silence that felt as heavy as a quilted balloon that pressed against every surface of the room as it absorbed the last bit of air.
I couldn’t tell if the room was spinning naturally or if that was my anxiety. No one else seemed to notice, but I chalk that up to human nature. No one wants to be the first one to break, ya know?
So there I sat, holding an egg in my hands that I was beginning to realize was more fragile than I thought.
An egg whose shell has thinned even more in recent days, as the conversation of Reproductive Justice heads down an uncertain path.
As patients, the barrier to entry of freezing our eggs/sperm is already high. Outside of the inherent lack of conversation surrounding our options, fertility preservation is costly. Another bill to add to the growing pile.
Contemplating the price tag on a family that you don’t know whether you want is a concept for which words fail me. They fail to express the guttural churn and inflamed heart that press against one another as you grasp for the sprout of a seed that was planted mere moments ago by the promise of its loss. The equivalent of words being trapped in your throat as you tilt your head back to scream towards the sky, for you are no longer rooted in the present as your mind races back and forth between your future and the ideals you’ve previously held. Your esophagus vibrates in a mix of shock, fear, judgement, relief, anger, confusion…
Yet there is only silence where the sensation is deafening.
I never thought this would be a contemplation I would have to make, but it was one that led me to debate whether or not I was going to preserve my fertility. I was making a decision for a future self with my current sense of what was important to me. (Which, as I mentioned before, was heavily influenced by frozen dairy product and power suits.) A decision that required me to foot the bill with savings that seemed to be dwindling at a faster rate in recent weeks.
And truthfully, I might not have frozen my eggs it if it hadn’t been for the generosity of organizations like Team Maggie For a Cure and First Steps. Organizations that understand the importance of fertility preservation for cancer patients. Organizations that step up to the counter with you when your number is called earlier than planned.
And though these resources are few, those contemplating fertility preservation due to their cancer diagnosis at least have potential access to some financial support. I can only give you the viewpoint of a female cancer patient who at least had a little rainy-day savings and a couple financial assistance applications with which to contemplate the preservation of her fertility. Not everyone, especially those in marginalized communities, even has the luxury of contemplation.
Contemplation implies a choice, an ability. The margin of ability narrows when the average cost of freezing eggs ranges from $10,000-$15,000, and the average cost of sperm preservation ranges from $500-$10,000 (depending on the procedure). You can add between $300-$500 for annual egg/sperm storage (so yes, you technically have to pay rent for your children even before they are born…).
These are all costs that majority of insurance companies (for those who have access to it) still do not cover. And something insurance companies may be even less inclined to support if the door to the discussion of what constitutes personhood is unlatched and pushed wide open.
This conversation may cause ripple effects into assisted reproductive technologies, opening the industry up to litigation that it had once moved past. Standards of practice that once propelled the industry may now need to be re-evaluated, potentially narrowing even further the avenues of family planning for those whose womb-fruit is not self-pollinating. Potentially narrowing the luxury of contemplation.
We may find ourselves backing down the long and arduous road leading to the current state of assisted reproductive technologies that took decades to pave. A regressive journey that will once again skew access and fog the window of Reproductive Justice.
I hope we do not achieve these potentials, possibles, and maybes.
I hope the egg I cradle in my hand does not detonate.
The light hits the curved shell, revealing the fluid that rests just below its surface. The crystals holding back the liquid now beginning to fracture at the weight that is pressed upon it.
Fractures I was beginning to feel back in that examination room, as my doctor asked if I had any more questions. As I was being told I would need a stem cell transplant and would be infertile at the age of 25.
Words have a funny way of escaping me in moments like this.
“I don’t think so?,” was all I could squeak out.
Clearly on a tight timeline, my doctor handed me a giant stack of consent papers to review and sign so we could begin the marathon of tests that was to come in preparation of my transplant.
I began to wonder if I should finally be the first one to address the increasing velocity of the room when my doctor stepped out, leaving me alone in the room with the overworked nurse and a social worker who seemed like it was her first day on the job. They stared at me with slight frowns weighing down the corners of their mouths.
Before leaving, they handed me a book on stem cell transplants that looked like it was written and illustrated for the average reader of Highlights magazine. (Pretty sure it was titled, “So You Want to Have a Stem Cell Transplant…” or something like that. I can’t quite remember. I burned the book to keep warm one 87-degree morning after my transplant. One of the many unfortunate side effects of a stem cell transplant… They should have put that in the book now that I think about it. Maybe I should have read the book. Damn.)
The Highlights Stem Cell Manual sat next to me in the passenger seat as I pulled up to the stop sign outside of the hospital exit. Alongside it sat the egg, rocking gently with the slight hum of the car as I leaned my head against the steering wheel. I let out a sigh and the remaining Reserve Tear as I looked at the egg I would need to cradle and take care of not merely for a passing grade, but for my future.
It has been almost four years since I was tossed that egg.
There are days I wonder if my future children are sitting in a freezer or still tucked away safely inside me.
There are days I wonder if my future children have already been born. As they experience their firsts, I continue to cradle the egg until I am ready to turn it in.
There are days I wonder if my identity as a parent will end at “Aunt.”
There are days I wonder if I truly am infertile. If I will discover that the ripples of my cancer could not be contained within the few years surrounding my treatment.
The totality of the physical ramifications yet to be felt. Like the rotting of a fruit.
Fruit sprayed with pesticides to ward off outside forces with malicious intent. Fruit that has begun to shrivel. Seeds that have begun to die.
There are days I don’t know.
There are days I do.
Any more questions?
Cited Works:
“Paying for Treatments.” Alliance for Fertility Preservation,
https://www.allianceforfertilitypreservation.org/paying-for-treatments. Accessed 5 May 2022.
Marsh, Margaret and Wanda Ronner. Why new anti-abortion laws make it harder to conceive. The Washington
Post. 15 Aug. 2019. https://www.washingtonpost.com/outlook/2019/08/15/why-new-anti-abortion-laws-
may-make-it-harder-conceive. Accessed 4 May 2022.
Isabel Galic, Olivia Negris, Christopher Warren, Dannielle Brown, Alexandria Bozen, and Tarun Jain. Disparities in
access to fertility care: who’s in and who’s out. F&S Reports, Volume 2, Issue 1, 2021, Pages 109-117.
https://doi.org/10.1016/j.xfre.2020.11.001. Accessed 10 May 2022.