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Breast cancer is the most common cancer for women age
15 to 39, and women ages 15 to 34 die more frequently from breast cancer than any other cancer.
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about the options in preserving their fertility.” Indeed, with her treatment options potentially jeopardizing her ability to have a family, Jessica met the next day with G. Wright Bates, M. D., professor of reproductive endocrinology, and his team.“ Many available therapies, while very successful in treating cancer, can impact the egg quality and number or a woman’ s ability for future fertility,” Dr. Bates says.“ For this reason, the initial consult with the oncology team is absolutely crucial to the patient.”
As with her cancer treatment, Jessica had options on how to preserve her fertility. But just like other women in her situation, what she did not have was a lot of time. Treatment for breast cancer typically does not have to start immediately, but she did not have months to wait either. After consulting with Dr. Bates’ team, she decided to have her eggs harvested and frozen. She had a three-week period to accomplish that before she started chemotherapy.
“ It takes at least two weeks to prep the ovary with hormonal stimulation and harvest the eggs,” Dr. Bates says.“ It’ s a fairly simple procedure; there are no incisions. It’ s an ultrasound-guided needle biopsy of the ovary with anesthesia, so the patients are very comfortable. We’ re actually now freezing both eggs and embryos or fertilized eggs, very successfully, and Jessica’ s case is a prime example.”
Cancer treatment
A woman who is diagnosed with breast cancer at UAB meets with an oncologist, surgeon and radiation oncologist as quickly as possible after diagnosis to discuss treatment options.
In Jessica’ s case, she met with oncologist Andres Forero, M. D., radiation oncologist Jennifer de los Santos, M. D., and Dr. Krontiras. A breast cancer diagnosis in young women like Jessica is rare; estimates from the Young Survival Coalition are that 13,110 cases of breast cancer are diagnosed in women under the age of 40 each year. However, breast cancer is the most common cancer for women age 15 to 39, and women ages 15 to 34 die more frequently from breast cancer than any other cancer.
“ Patients as young as Jessica usually don’ t have as good a prognosis as patients who develop cancer in older ages, because often those cancers in younger patients tend to be more aggressive,” says Dr. Forero, a Cancer Center senior scientist.“ Unfortunately, we are seeing more and more younger patients being diagnosed with breast cancer.”
UAB’ s team of physicians came up with a plan for Jessica that included three different types of therapy, including local therapy of the breast cancer with surgery and radiation therapy. They also treated Jessica systemically with chemotherapy.
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The physicians gave Jessica all of her treatment options on that visit. She ultimately chose to take part in a clinical trial, a research study that for her consisted of 12 chemotherapy treatments for 14 weeks. When that was completed, she had four treatments of Adriamycin and cytoxan every other week. She then had her lumpectomy on March 7, 2012, six months after her diagnosis.
“ I discussed in detail whether I should have a lumpectomy or a mastectomy, and if I had a mastectomy, should it be one side or two,” Jessica recalls.“ Dr. Krontiras was pretty emphatic that the research has shown that there really wasn’ t much difference— at least in my case— so we did the lumpectomy. It’ s an easier procedure with a shorter recovery time, and if the outcome is going to be the same, then that made more sense to me.”
Freezing embryos of frozen eggs
Two years later, after Jessica and Will had married, and following successful cancer treatment, the happy couple decided to pursue a family.
Dr. Bates’ team thawed Jessica’ s eggs, fertilized them with Will’ s sperm and planned to do an embryo transfer. But for whatever reason, Jessica’ s endometrium did not respond to where Dr. Bates felt comfortable enough to transfer the embryos.
“ We have several markers that we use for receptivity with the goal of our giving the patients the optimum chance for pregnancy,” Dr. Bates says.“ Occasionally, the endometrium is not ready, and that’ s what happened with Jessica.”
Wes Edmonds, Ph. D., scientific director of Assisted Reproductive Technologies who oversees the operation of UAB’ s In Vitro Fertilization Laboratory, prepared Jessica’ s eggs as though her body would be ready. When the egg cells were fertilized, they grew in the lab for a few days until they became embryos. It was at that point Dr. Bates decided it was not ideal to transfer them to Jessica’ s uterus. So, the team opted to freeze the embryos and try again a few months later.
It is not uncommon to freeze embryos in this scenario, but it is extremely rare to freeze embryos that were frozen as oocytes, or egg cells. Dr. Edmonds says that research— and previous successes with this method at UAB— gave Jessica and Will a good chance to realize a pregnancy.
“ With recent advancements in cryopreservation technologies, we’ re seeing more and more of these success stories,” Dr. Edmonds says.“ Our per-transfer pregnancy rates for cryopreserved embryos are currently equal to, or even slightly better than, those we see with fresh, same-cycle embryo transfers. What this means is that our cryopreservation techniques are having minimal, if any, negative impact on the quality
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of the embryos. Fortunately, we were able to achieve this success for Jessica too, which really gives us great personal satisfaction. The elation we feel when this is successful is off the charts because we know we’ re helping our patients achieve their goals of becoming parents. It’ s exceptionally rewarding.”
With the embryos refrozen, the reproductive team gave Jessica’ s uterus two more months to respond to treatment and hit those markers for receptivity before proceeding with the embryo transfer.
In November 2014, two months after the first attempt to transfer the embryos was put on hold, two embryos were transferred to Jessica’ s uterus, and one of them“ took.” Finally, it was official. Jessica was pregnant and due to give birth in July 2015.
It was a long, hard-fought journey to get to pregnancy, but Jessica says she was never skeptical that the fertility preservation process was going to work.
“ I have the utmost faith in Dr. Bates and his entire team and their abilities,” Jessica says.“ That said, Will and I still knew there was a chance it wouldn’ t work. Nothing is ever 100 percent. And if it didn’ t work— and we only had two embryos, so this was it; this was our one shot— I would have been sad about it, but there are other ways to have a family. You can adopt embryos. You can adopt babies. I would have been disappointed, but it wouldn’ t have been the end of the world. And I had to at least try.”
The pregnancy
Jessica’ s pregnancy was about as smooth as she could have hoped. She never had any nausea. She started to get tired easily toward the end, which is normal in many pregnancies. And when you’ re carrying a big baby in the Alabama summer heat, it makes it even easier to understand.
But the result on July 28, 2015, was everything Jessica and Will could have hoped after overcoming so many obstacles: William Cooper Sparks was born in UAB’ s Women and Infants Center as a 10-pound, 4-ounce, healthy baby.
“ It was so surreal,” Jessica says.“ If you had told me back when I was diagnosed that one day I’ d be a mom, I don’ t think I would’ ve believed you. But the whole experience was just amazing. Being able to hold my little boy is the best feeling in the world.”
Jessica is quick to thank her physicians and caregivers for their expertise, help and guidance all the way through her treatment to Cooper’ s birth and beyond. She continues to receive mammograms every six months, and she will be on a hormone receptor blocker for 10 years as a continuance of treatment for the breast cancer.
While she says she is forever grateful for how her physicians were able to treat the cancer, she’ s also
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thankful that they encouraged her to look beyond her immediate diagnoses four years ago and consider what her life might look like down the road.
“ Obviously, they want to save your life, but you do have to think about what happens after you’ re treated,” Jessica says.“ It’ s all well and good to live, but what about the 50 years of life or more you may have once your treatment is completed? That’ s something they didn’ t ignore. I’ m very glad that at that first appointment Dr. Forero said,‘ If you want to have a baby, you need to talk to Dr. Bates.’”
For the physicians, they couldn’ t be happier for Jessica’ s successful cancer treatment and journey to motherhood. After she completed treatment, Dr. Forero got to know Jessica as a colleague, when she worked as a registered nurse in UAB’ s Infusion Therapy clinics.
“ Helping her go through this difficult process and deal with all of these issues is very rewarding,” Dr. Forero says.“ Finishing the therapy and knowing we gave her a chance, based on research, that she can be cured. And the most rewarding part, seeing her be a mother and helping her go through the process and get to that point, getting past the anxiety of stopping her medication and seeing her have a wonderful, lovely baby. It’ s rewarding. It’ s amazing. It would touch the heart of anybody.”
“ Jessica’ s case is a prime example of a woman’ s persistence and desire to be a mom,” Dr. Bates adds.“ We were fortunate to provide her some hope in the wake of a breast cancer diagnosis. And it’ s especially satisfying for my team and me to see the end results. It makes us even more committed to fertility preservation and even more thankful that we are a part of a great institution like UAB that is at the forefront of technology yet takes the time to care for the individual and treat the whole person.”
Jessica, who has been a student in UAB’ s School of Nursing and a patient in many UAB specialties, and is now a nurse practitioner at UAB, hopes her story may inspire others to explore their options.
“ The one thing I hope this story gives others is hope,” she says.“ It’ s an amazing story, an incredible one, that a lot of people had a hand in writing. These are all amazing people, who helped give me hope in my most desperate time. I hope this story is able to do the same for others.”
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