October 22, 2015

Before breast cancer treatment, 31-year-old preserves hope to have a child

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Jessica Sparks asked many questions when she was diagnosed with breast cancer in 2011 at age 31: Would she survive? Would she need a mastectomy — would it be one breast or both? Would she ever marry? Would she be able to have a child of her own?

All of those questions were answered at the University of Alabama at Birmingham — except the marriage question; that was answered by Will Sparks, who stood by Jessica’s side throughout her fight. He shaved his head when she lost her hair to chemotherapy treatments, and he always tried his best to pick her up when she was down.

Jessica and Will Sparks married Oct. 6, 2012, a year after her diagnosis, eight months after she finished chemotherapy, seven months after her lumpectomy, four months after her radiation treatments ended — and almost one year to the day after Jessica preserved her eggs in hopes that one day, after her body had fought through aggressive cancer treatment, she may carry a child.

Jessica would depend on science, research and the expertise of a team of UAB Comprehensive Cancer Center physicians to guide her down the right path for treatment. The UAB Breast Health Center referred her to UAB’s Reproductive Endocrinology and Infertility Clinic team, which offered cutting-edge treatments to keep alive her hope of having a baby if she survived cancer.

The beginning

Jessica remembers pretty well when she first noticed a lump on her breast. How would any woman not remember that moment? But for the then-31-year-old, her life was on the cusp of taking off.

She was a student in UAB’s School of Nursing, working to get her Nurse Practitioner degree after starting off in the Accelerated Master’s in Nursing Pathway in 2009. Jessica had always wanted to be on the front lines of caring for others in need. She had just gotten a job at a Huntsville hospital and moved there to be closer to Will, who worked in the Rocket City. Needless to say, it was a big moment in their relationship.

And on a Friday, July 29, Jessica was talking to Will on the phone when she scratched an itch on her chest. That’s when she felt a lump.

  If you or someone you love has cancer, encourage them to visit the UAB Comprehensive Cancer Center websiteand find a physician, or connect with UAB Medicine at 800-822-8816. Patients can encourage their physicians to refer them to UAB for second opinions or further treatment by calling 800-UAB-MIST (800-822-6478).
“I remember thinking to myself, ‘You know, as young as I am, this is probably nothing,’” Jessica said. “Still, when you discover something like that, you want to get it checked out.”

Three days later, on Monday, Sparks called her physician Cheré Stewart, M.D., associate professor in the Department of Obstetrics and Gynecology, who told her to come in immediately. Stewart ordered a mammogram and ultrasound, which didn’t reveal the answers the physicians needed, so a biopsy was then performed during her appointment on Aug. 22. Within 20 minutes of the biopsy’s completion, Sparks learned she had breast cancer.

“I went in that morning for a mammogram thinking it was probably benign because I’m so young, and then I left that same afternoon with a cancer diagnosis,” Sparks said. “No one expects to be diagnosed with cancer, ever. And at that age, especially.”

Three days later, on Thursday, Aug. 25, 2012, Sparks spent that day — her 32nd birthday — with her mom and her aunt meeting with a team of physicians from UAB’s Breast Health Center to discuss her options.

“I felt like I was in ‘The Twilight Zone,’” Sparks said. “My mom, my aunt and I had planned a fun day of girl stuff for my birthday. Instead, you’re faced with a ton of decisions that will alter the course of the rest of your life.”

Preserving fertility

The idea of personalized medicine has many meanings, including how to care for a patient long term when the chemotherapy, radiation and surgery treatments are completed. Before any of those treatments began, physicians made sure Sparks considered another important option for her future — preserving her ability to have children. Mindful of Sparks’ place in her life, her team of oncology physicians referred her to UAB’s Reproductive Endocrinology and Infertility Clinic before any of those treatments began.

For more from Dr. G. Wright Bates on Jessica's case, fertility preservation options for young breast cancer patients — and others in need of fertility preservation — watch his full interview.While breast cancer in women as young as Sparks is considered rare, there are other things patients have to take into account and, in turn, make life-altering decisions on within days after diagnosis. Fertility preservation is at the top of that list.

Women who undergo chemotherapy treatments are at a high risk for damaging their reproductive organs permanently, making it impossible to have a child. With the burden of a cancer diagnosis fresh on their psyche and potentially their chance of survival hanging in the balance, the thought of having children in the future might not be top of mind for many women at the moment of diagnosis.

When Sparks met with her doctors three days after her initial diagnosis, they made her aware that, if she hoped to one day be a mom, she needed to meet with UAB’s reproductive team. This is one of the many options and items the physician team shares with their patients when discussing immediate steps.

“It’s reasons like those Jessica was facing that a medical oncologist, radiation oncologist and surgeon all sit down together and review the case and discuss treatment options with patients,” said Helen Krontiras, M.D., UAB breast cancer surgeon and a senior scientist at the UAB Comprehensive Cancer Center. “If the treatment options in these young women are going to include something that may affect their fertility, we refer them to our reproductive endocrinology group. Those patients are seen the same day or the day after to talk about the options in preserving their fertility.”

Indeed, with Sparks’ treatment options potentially jeopardizing her ability to have a family, she 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,” Bates said. “For this reason, the initial consult with the oncology team is absolutely crucial to the patient.”

As with her cancer treatment, Sparks 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 Bates’ team, she decided to have her eggs harvested and frozen. Sparks had a three-week period to accomplish that before she started chemotherapy.

She had to give herself a series of injections to stimulate her ovaries and additional injections at certain specific points so she could produce eggs for harvesting.

“It takes at least two weeks to prep the ovary with hormonal stimulation and harvest the eggs,” Bates said. “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.”

The fertility team harvested and froze Sparks’ eggs prior to her beginning treatment.

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 Sparks’ case, she met with oncologist Andres Forero, M.D., radiation oncologist Jennifer de los Santos, M.D., and Krontiras. A breast cancer diagnosis in young women like Sparks 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,” said Forero, professor of hematology/oncology, senior scientist in UAB’s Comprehensive Cancer Center, and Sparks’ oncologist. “Unfortunately, we are seeing more and more younger patients being diagnosed with breast cancer.”

UAB’s Comprehensive Cancer Center is the only National Cancer Institute-designated comprehensive cancer center in the six-state area that includes Alabama, Mississippi, Louisiana, Arkansas, South Carolina and Georgia, and its cancer services, physicians and researchers are routinely recognized as being among the nation’s best.

UAB’s team of physicians came up with a plan for Sparks that included three different types of therapy, including local therapy of the breast cancer with surgery and radiation therapy. They also treated Sparks systemically with chemotherapy.

“You cannot concentrate only on the treatment of the breast,” Forero said. “In order to treat the rest of the body — the whole body — the patient needs medications that will go all over the body, and wherever the cancer cells are, they will be killed.

“Every patient in this world who is being diagnosed today with breast cancer will need to have three types of treatment — radiation, surgery and systemic therapy.”

The physicians gave Sparks 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. Sparks then had her lumpectomy March 7, 2012, six months after her diagnosis.

The lumpectomy in lieu of a mastectomy may seem like a surprise choice; but Krontiras, Sparks’ surgeon, says each patient is treated differently depending on a number of factors. In Sparks’ case, a lumpectomy was the best option.

“It is personalized medicine — treating patients for their specific type of breast cancer,” said Krontiras. “Gone are the days when patients show up with breast cancer and we proceed to mastectomy and then go to chemotherapy. Because of research done here at UAB and other places, we know we have lots of options for patients, and we know there is more than one type of breast cancer. That enables us to really tailor treatment to each woman and her specific type of cancer. Often, they can have treatment that is likely less toxic and more beneficial which allows them to have excellent outcomes like Jessica did.”

“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,” Sparks said. “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.”

UAB Oncologist Dr. Andrés Forero discusses more details from Jessica’s case and the three specific types of treatment all breast cancer patients need in further detail.

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.

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 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,” Bates said. “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 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. 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,” Edmonds said. “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 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 Bates wanted to see 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 said. “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.”

  Donations to fund breast cancer research at UAB can be made through The Campaign for UAB website or by calling 205-934-1806.

The pregnancy

Jessica’s pregnancy was about as smooth as she could have hoped. She never had any nausea. She started to get really tired very 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 said looking back on his birth a couple of months later. “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 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.

baby sparks“Obviously, they want to save your life; but you do have to think about what happens after you’re treated,” Jessica said. “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, 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,” Forero said. “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 women’s persistence, and desire to be a mom,” Bates added. “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.”

Sparks, 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,” Sparks said. “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.”