Focusing on the Present: Cancer, Pregnancy and the Fertility Conversation

I was just six weeks pregnant with my first child when I was told I had cancer. Hodgkin's lymphoma. I was stage 2 and I needed chemotherapy, while pregnant. I was not a candidate for fertility preservation methods being currently pregnant. Although many studies found the chemotherapy regime to be "relatively" safe during pregnancy, there were higher incidences of complications, including preterm labor and birth. What if I lost this pregnancy? What if there complications and my child died? As someone who was always looking towards the future, I was not only concerned with how this would affect my current pregnancy outcome, but what of my future fertility? When I brought it up I was told the risk was small and the conversation turned to the current plan of care. And how could it not? I knew I was in the hands of an outstanding, evidence–based oncologist, but I felt a bit helpless. I felt a loss of control. There was nothing I could do but focus on the present.

But the thoughts still invaded my thinking. I never imagined myself to just be the mother of one (and at that point I was unsure if that was even going to happen). I recall feeling guilty and selfish for wanting more when I should just be focusing on the now. Although my husband and family were supportive, the reactions to my concerns over future fertility were perceived more as "we have bigger things to worry about now." And they were right. I received chemotherapy throughout my pregnancy, from weeks 15 to 33. I experienced hair loss, intractable nausea and vomiting, and at times, almost insurmountable fatigue. At 33 weeks I delivered via emergency cesarean section for non–reassuring fetal heart tones and continued several treatments after delivery. Although premature, my son thrived and was able to come home with us after several weeks of feeding and growing. He was healthy and soon after I received the news I was cancer free.

Eighteen months after being cured, my husband and I began trying for another child using traditional family planning techniques. I had some concerns that we may have trouble given my history, and we did. After nearly a year we were finally pregnant, however six weeks later, there was no heart beat fluttering on the ultrasound screen at a routine doctor's visit. After recovering from a dilation and curettage (D & C) to remove the baby and placenta, we continued trying and faced the same difficulty even becoming pregnant as before. Each month there was excitement, hope, apprehensiveness, I think I see a faint second line, dread, and always disappointment. And each month internal guilt that maybe I caused this by selfishly having treatment while pregnant. I know that's not rational thinking, but it doesn't make the thoughts any less pertinent. Again, the feelings of loss of control were present.

We had at first been hesitant to even have a discussion about what could be causing my infertility and the options because frankly, I was tired of medicine in general. Biopsies, port placement, chemo, scans, lab draws, appointments with this specialty and that specialty—it was exhausting. My husband was uncertain about even having more children because of the first pregnancy. Did the pregnancy hormones feed the cancer? Maybe, but the whole cancer association with pregnancy was difficult for him to shake. I now was beginning to wish I would have pushed the fertility conversations further when I was undergoing chemo. I kind of just accepted the response and my support systems reactions and focused on the present. Maybe there was nothing that could have been done, but at least I would have done my due diligence.

I did speak with my OB about what were the beginning steps for exploring reasons behind our troubles and given my history he recommended checking labs for premature ovarian failure (POF). I asked myself, would the results matter? Meaning, if they did indicate an issue, how far would I/we go to have another baby? Not really knowing where my line was at...