Fertility After Cancer - Part 2

Chemotherapy and cancer drugs

Fertility after cancer 

Woman and baby

The "Miracle" Babies: babies after cancer

Part 2 of our report on ’fertility and cancer’.

By Madeleine Kingsley

Anyone doubting that there is, literally, new life after cancer, should take heart from these cancer patients who went on to become parents, often after seriously toxic treatment. Their tales of triumph over trauma are all the more warming because they are not unique: in 2003 young royal, Lady Helen Taylor, gave birth to a daughter, Eloise - three years after her art dealer husband Tim, went into remission from Hodgkin’s Disease. Portrait painter Jonathan Yeo, son of politician Tim Yeo, also had Hodgkin’s whilst at university. Jonathan endured months of chemotherapy, but 10 years on, his partner, Shebah Ronay, has just had a baby girl, Tabitha.

In July 2003 we featured former "rogue trader" Nick Leeson, who had recovered from bowel cancer and was about to marry again. He and his bride Leona recognised that chemotherapy had left a serious question mark over his fertility. But Leona is now pregnant and due to give birth in May 2004. And it’s not only the guys whose dreams of parenthood come good. In January 2004, 21 year old Kimberly Anderson delivered a son, Connor, in the same Newcastle Hospital where she battled both leukaemia and kidney cancer between the ages of three and 15. Having been told she would never conceive. Kimberly says "I never dreamed that one day I would be holding my baby boy." Her story - and those below - are healthy reminders that after the big C, small miracles can and do occur.

To Jo Nicholson: A Son...

Jo’s son Sam (22 months) is not only the apple of her eye, but the fruit of her instinctive resistance to doctor’s orders. On her 33rd birthday in December 1997, Jo was told that the tumour just removed from her ovary was malignant. "My consultant was adamant that I should have a hysterectomy to prevent spread, but I knew that if I agreed my chances of ever having a baby would be zero. And although it may sound extreme, becoming a mum mattered more to me personally than whether I lived or died."

Open quotesBecoming a mum mattered more to me personally than whether 
                I lived or diedClose quotes

Jo - a North London home care manager - had come off the Pill at 30 only to find that she could not conceive. Her local fertility clinic prescribed Clomid to stimulate ovulation, but three cycles on, Jo was still not pregnant: "This felt extra hard because my sister had used the drug twice and got pregnant at once, each time. But with hindsight I have to say that these problems saved my life. Neither I nor Sam would be here if I hadn’t sought further treatment. My ovarian cancer, known as the silent killer, would never have come to light at a treatable stage"

The following year Jo endured four operations and felt increasingly "blown away" with shock and fright after being told that a cyst had been removed during a routine laparoscopy, Jo learned that it was actually a tumour, though her consultant judged at this point, that it was "pre-cancerous". Querying the delay in dealing with this, Jo was told that the urgent sticker on her medical file had somehow been ignored. Now the rush was on: only two days later she had her left ovary removed. "I didn’t feel very cared for on the ward, and everything seemed bleak". And that was before Jo learned that the tumour was cancer after all, albeit at an early stage.

Around this time Jo contacted Ovacome, who asked if she’d yet seen a specialist in ovarian cancer and suggested a second opinion. "I could tell the difference as soon as I was referred to Barts," says Jo "where I can’t praise Prof. Ian Jacobs enough." Happily Prof Jacobs confirmed that Jo’s cancer was indeed early and contained. The future now changed colour for Jo, not only because she (and Simon) both felt extremely well-cared for, but because, as Jo recalls Ian Jacobs felt it quite reasonable for me to try and have a child. He couldn’t guarantee anything, of course, but be thought I need not rush for a hysterectomy."

Open quotesJo found IVF every bit as emotionally gruelling, if not more so, than         her treatment for cancerClose quotes

Trying for a child now inevitably involved IVF. Jo asked whether the hormonal upheaval might increase the risk of recurrence. The Barts verdict was that there was no definitive evidence to support - or refute the possibility. She would be carefully scanned during the treatment and would undergo a limited three cycles of IVF. Looking back, Jo says she found IVF every bit as emotionally gruelling, if not more so, than her treatment for cancer: the first and third attempts failed and though she became pregnant after the second, no heartbeat was found at the six week scan. Jo, Simon and their families were desolate. However four frozen embryos remained from that sad second attempt, and as a final chance, Jo opted for a further cycle in which she recalls "everything went wrong. It was stop-start with the hormones all the time as they tried to get my womb ready for implantation. Two of the embryos did not survive defrosting, but two remained. The result was Saml"

"The minute I saw Sam my life was turned around" Jo says. "He is pretty much the most spoiled baby ever and certainly the most precious! He’s changed my priorities: I do now plan to have everything removed so there is no chance of my cancer ever coming back. There’s been so much struggle and pain, but Sam has put the heart back in our family."

To Tania Shepheard: A Son and a Daughter

Open quotesMy doctor dismissed the pain in my left calf as a pulled muscle but every day it hurt more to walkClose quotes

Imagine being 17 and full of zest for a life you’re forced to put on hold for a year of intensive chemotherapy. This was the treatment "sentence" confronting Tania when, in 1990, she was diagnosed with osteosarcoma (a rare bone cancer affecting 230 young people in the UK each year). Tania had just started training at cookery college but as a lifelong dancer, was still taking two ballet classes a week: "My doctor dismissed the pain in my left calf as a pulled muscle" she recalls, "but every day it hurt more to walk, so I went back the next week when a second doctor diagnosed stress fracture and sent me for an x-ray.’ Tania’s parents were then told what she was really up against, but decided not to ruin her Christmas, by breaking the nightmare news.

Soon enough, Tania recognised that she bad a life-threatening illness, though I was told right at the onset that I had a very good chance of getting better - provided I completed the chemo. At that stage nobody mentioned an additional six weeks radiotherapy tacked on the end as they rightly concluded it might be the last straw. Even so, it was very hard having such a long stretch of time wiped out, while I concentrated fulltime on getting better. It was tough too, being too old for the children’s unit and too young for the adult ward. I couldn’t have got through without my loving and supportive family, and my mum is still on the committee of the Teenage Cancer Trust who helped me so much.’

Tania’s chemo involved three days as a Middlesex Hospital inpatient for two weeks, followed by three days of injections in the third week, then two weeks off. After the first couple of treatments which shrunk the tumour, Tania had surgery at Stanmore Orthopaedic Hospital to remove it.

It was hardest to remain upbeat when Tania would check in for chemo only to be sent away because her blood count was too low for further "zapping". "I’d get very frustrated and take it out on my mother. I once hurled a shoe at her." Then came a double watershed: a new anti-sickness drug, Andazitron, came along, and the Teenage Cancer Trust opened its first purpose-built ward at the Middlesex. Now Tania’s regular admissions were to a bright and airy unit where the young nurses wore no uniform, where she could stay up as late as she wanted "playing music and watching the movie Dirty Dancing over and over again."

Open quotesI’d get very frustrated and take it out on my mother - I once hurled a shoe at herClose quotes

After the final session of radiotherapy, Tania and a group of friends went for a celebratory meal. "And that was the night I met my husband, Mark" she laughs! She was 19 and Mark a farm management advisor, was 26. "I didn’t want to leap into any deep long relationship. After all I’d been through I just wanted to enjoy life. So we just had fun, and married when I was 25. I don’t think we had any serious discussions about a family. I had been told at the time, that despite the intensity, there was a good chance the chemo would not affect my fertility. So I wasn’t too worried. We focused on our relationship, feeling that if anything happened, well that would be great."

As Tania’s brush with cancer has taught her, "you never know what is around the corner". She became pregnant with Annabel, six and Oliver, three, the first month she tried, each time: "I was fine throughout but they keep a close eye on you because pregnancy takes its toll and your body has already taken a hefty battering. I know how lucky l am to have my kids. So although you have your moments, when they fight and won’t sleep, I try and enjoy every day because realise how precious life is."

To Polly Carnegie: Two Daughters

The night after Polly found she was expecting her first child, she was lying in bed with a pregnancy book. Her thoughts roamed from how brilliant it was for her and husband John to be having a baby to how sore her boobs were. "And that is literally when I found a lump and went in an instant from the highest high to the lowest of lows." It was August 1996, just before Polly’s 30th birthday. At 12 weeks, Polly was preparing for a mastectomy with removal of all the lymph nodes:

Open quotesMy loneliest moment ever was lying alone after the anaesthetist had given me the pre-med, and asked if I’d been told there was a risk I could lose the baby under anaestheticClose quotes

"My loneliest moment ever was lying alone after the anaesthetist had given me the pre-med, and asked if I’d been told there was a risk I could lose the baby under anaesthetic. But as soon as I came round, they wheeled in an ultrasound machine, and there was this tiny foetus flipping around. In the light of what happened next, it was a very special and significant moment. "Wow" I thought "this baby really wants to be here.’ The bad news was that three of Polly’s lymph nodes were affected. Her consultant at the local, West Suffolk hospital, offered two grim alternatives. Polly could save her life with a termination and chemotherapy, or continue with the pregnancy, though it would surely be too late after the birth to save me.

But Polly’s consultant also added that he had never encountered a case like this and suggested a second opinion. The distinguished Professor Michael Baum saw the Carnegies within days, "and it turned out" marvels Polly "that for the past few years he himself had been doing pioneering work on patients just like me, with Dr Ian Smith at the Royal Marsden. They had seen 15-20 patients, but worldwide, about 300 pregnant women had by then received chemotherapy, initally in the last trimester, though I started at 20 weeks. We felt so fortunate to have this option, and it really was luck because nobody at the Suffolk hospital had any idea this was possible.

Polly was warned of the risks that chemo posed: her placenta might not develop fully and her CMF (cyclophosphamide, methotrexate and fluoracil) chemotherapy combo could affect fertility, though youth was in her favour. But unlike most chemo patients, PolIy blossomed. "Pregnancy brought out the most positive side of my health. The baby was scanned every two weeks so we felt in very good hands. But though they stopped the chemo two weeks before delivery (I’d had five months and my blood count was quite low) I was advised not to breastfeed as the drugs could still be concentrated in my milk. Jessica, our daughter arrived perfect and healthy on Easter Monday, 1997, bang on time.

John, says Polly, was an absolute rock throughout this time. "But after all the trauma we both went into periods of shock and depression. It was as though nothing could stop me whilst I’d had this life inside me, and I’d allowed no room for negative thoughts. But now was trailing over to Addenbrookes, Cambridge, for five weeks of radiotherapy when I was desperate to be a normal mum. The Suffolk hospital also thought they ought to be keeping a close eye on Jess and took blood from her every week which I found really upsetting. "Why are they doing that?’ asked Dr Smith when I saw him after three months. "They can stop, because she won’t be affected."

Open quotesMy tumour is still bottled in some hospital lab, but we never did discover if my cancer was oestrogen positiveClose quotes

Jess grew, PoIly went back to work as a school music teacher, and in time the Carnegies breathed easier. They had been advised to wait two years before trying for another baby, and assured that no research suggested a second pregnancy would trigger a recurrence. My tumour is still bottled in some hospital lab, but we never did discover if my cancer was oestrogen positive" says Polly. In the first month of trying, however, they found that Polly’s fertility was impressively unscathed: Anna, now three, was on the way at once. This time Polly relished the chance to breastfeed, albeit as John quipped "firing on one cylinder".

"When you go through such depths of despair," says Polly now, "when illness threatens your own life and your unborn child as well, but you go on to have such huge joy, you’re almost - and it is only almost - thankful for having gone through the experience."

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