Cancer Patient to Parent

Cancer therapy needn't preclude parenthood.
Along with the birds and the bees, new reproductive techniques help ensure the transition from a life-threatening illness to making a new life.



Modern-day miracle Ayden Michael Figg with mom, Tammy.

"Bryan and I glanced at our potential child through a microscope and said a prayer."
Tammy Figg

Whenever longtime sweethearts Tammy Monso and Bryan Figg envisioned their life together, the picture included children. But in 2002, just six weeks before their wedding, Tammy, then 27, discovered that some troubling symptoms she had tried to ignore — bleeding, fatigue and weight loss — were signs of Stage III colon cancer. Right away, she would need life-saving surgery, chemotherapy and radiation therapy, and those treatments would render her sterile.

Today, with little Ayden Michael Figg gurgling in the background, Tammy Figg talks about the extraordinary events that led to the fulfillment of their dream.

The birth of the baby whom Tammy and Bryan call their "gift" required cutting-edge reproductive technologies plus the skilled intervention of physicians, nurses, lab technicians and other staff from the Washington University Infertility and Reproductive Medicine Center at Barnes-Jewish Hospital.

"It was exciting," says Valerie S. Ratts, MD, associate professor of obstetrics and gynecology and a staff member at the center, which assists some 2,000 couples a year with infertility issues. "We had all worked hard to get her there, and it is a miracle of modern medicine that this child exists."

Valerie S. Ratts, MD, examines a sample in the lab with andrologist Bridget Maniaci, left.

As Tammy Figg recalls, she asked her oncology team at the Siteman Cancer Center, during the first dazed period after they discovered her tumor, whether there was any way to preserve the option of having a baby. Their priority, they said, was saving her life, but they directed her to Ratts for a fertility consultation. At that meeting, she learned having her eggs harvested, fertilized and frozen — a procedure called in vitro fertilization (IVF) — would give her the option of a later pregnancy, once her physicians said she was ready.

Some 25 couples a year come in for this kind of counseling because one of them is facing cancer treatment. Often the patient is a young man who wishes to bank sperm, but the center has seen patients with breast cancer, lymphoma, Ewing's sarcoma and endometrial cancer as well. Some decide not to pursue IVF but plan to adopt instead.

After surgery, Tammy elected, with the approval of her oncologist, Benjamin R. Tan, MD, assistant professor of medicine, to postpone the rest of her treatment by a few weeks in order to retrieve some eggs. Chemotherapy destroys both eggs and sperm; radiation therapy may have the same effect, depending upon the location of the cancer.

Currently, Washington University is beginning a research protocol that approaches this problem from a new angle that allows women with cancer who do not yet have partners to retain reproductive potential. Unlike embryos, unfertilized eggs do not freeze well. To solve this problem, physicians take biopsies of ovarian tissue embedded with eggs and freeze the entire sample. When the patient is ready, they thaw the tissue, grow the eggs and fertilize them for use.

In Tammy's case, they were able to harvest 14 eggs and freeze 12 embryos before she proceeded with her cancer treatment, which included eight long months of chemotherapy. One difficult part of the IVF was what she refers to as "sticker shock." While some insurance plans, particularly those in Illinois, may cover the procedure, her insurance did not, and the cost of this phase of IVF was close to $12,000.

"The cost can blow some people away," says Tammy, "but young couples are often in debt for many other reasons: a new car, their mortgage, credit card payments. This procedure gave us so much more hope than we had before; we knew we could find a way to make it work."

In their case, five couples they knew decided to help, holding a giant benefit dinner for Tammy and Bryan in November 2002. That event was the genesis of a charitable organization the Figgs have since established, the Figg Tree Foundation, which promotes awareness of colon cancer, offers help to people suffering from the disease and supports the Colondar™ — a calendar produced by The Colon Club of New York featuring young colon cancer survivors.

Meanwhile, the Figgs celebrated their wedding on schedule, before an emotional crowd of friends and family.

"Bryan was my rock," says Tammy of her husband, who remained optimistic and unwavering in his determination to stand by her side.

By 2004, with her cancer in check, Tammy and Bryan felt ready to try for a pregnancy.

Embryologist Sue Scotino assesses egg viability prior to beginning the fertilization process.

"The reason we even have this as an option today is that cancer therapy works and there are more adult survivors," says Ratts. "With childhood cancer, we also have more survivors, so the question is: What other life factors now become an issue? I think it is very important that patients be given the chance to discuss what fertility-preserving options are available to them."

In November 2004, the Figgs made a pregnancy attempt that used several of their embryos, knowing that the success rate was only around 30 to 50 percent. Still, it was heartbreaking when the center called two weeks later to say the effort had failed. By February 2005, they were ready to try again, though they were also more realistic; if it did not work, they felt fully ready to adopt.

Tammy underwent another implantation. "Bryan and I glanced at our potential child through a microscope and said a prayer."

Two weeks later, Tammy was crushed when the center did not contact her in the morning, since she was sure they would call early if they had good news. Instead, the phone rang in the afternoon; the nurse had waited to assemble the staff before she conveyed the happy word that Tammy was pregnant, at last.

Her pregnancy was not easy: She encountered early bleeding, gallstones and the need for modified bed rest from week 23 on. Yet the reward came on September 28, 2005, when their "beautiful son" made his appearance — a month early, but still weighing seven pounds, six ounces.

Tammy and Bryan are hoping to try again in 2007 with their remaining embryos to provide Ayden with a sibling. Even if that does not work, however, they say they are content.

As for the team at the center? "The whole unit was involved from the beginning," says Ratts. "People rallied around to help with her care. When the baby was born, that was really, really wonderful."

Before a female cancer patient can postpone therapy to do an IVF cycle, she must have clearance from her oncologist that she is medically stable. If it is critical for her to start therapy, as it often is in leukemia patients, IVF may not be an option.

To begin, the woman takes daily shots of a medication containing follicle-stimulating hormone (FSH), which promotes egg growth. In breast cancer patients, FSH poses a problem because it causes estrogen levels to rise —— and estrogen will fuel the tumor. Washington University has a new protocol in which these women concurrently take aromatase inhibitors that prevent the estrogen levels from mounting.

Through blood work and ultrasounds, the center staff monitors the growth and size of the eggs, modifying the doses of medicine as necessary and completing the process with a medication that triggers the eggs to finish ma- turing. Thirty-six hours later, the patient comes to the procedure room, where she is sedated; the physician inserts a small needle through her vagina into the fluid- filled spaces of her ovary. This follicular fluid then goes to a waiting embryologist, who searches through it under a microscope to locate the viable eggs.

Meanwhile, her male partner provides a sperm sample, which the staff uses to inseminate the eggs. The next morning, they come back to see whether the eggs have been fertilized successfully; if so, they are frozen. When the patient is cleared by her oncologist, they thaw the embryos and place them in her uterine cavity using a small catheter — two or three at a time. Nine months later, with a little luck, the procedure has a happy outcome.