Holly Wetzig had wanted to be a mother for as long as she could remember. In childhood photos she was almost always seen cradling a baby doll in her arms. During her college years, she worked at a daycare center, spending hours in the infant room playing mother to other women’s children, eager for the day when she might have one of her own.
Eventually, Wetzig married, and for eight long years she and her husband tried to get pregnant, to no avail. When her friend recommended a highly regarded local fertility specialist, the now 41-year-old—who had unsuccessfully attempted fertility treatment in the past—reluctantly scheduled a visit.
It was there, during a routine procedure, that Wetzig discovered she was suffering from advanced-stage ovarian cancer.
“I remember waking up from my procedure, seeing my husband holding my hand, and thinking that he looked so sad,” she says. “Any time you hear the word ‘cancer’ in relation to yourself it’s hard to accept.” All the more so for Wetzig, who thought her dream of motherhood was over.
That’s when she met a leading gynecological oncologist at Texas Oncology, Dr. Terri Pustilnik, who specializes in treating cancer while simultaneously preserving a patient’s ability to conceive.
“Ten years ago we would have told Holly she needed to have a hysterectomy as soon as possible, ending her ability to give birth,” says the doctor. “Now we talk about options.”
Such options can include anything from egg retrieval to ovarian harvesting, in which a healthy ovary is removed and frozen along with its eggs for later use. Anti-hormonal therapy is another treatment option; it seeks a regression in the cancer so that eggs might be retrieved and a healthy baby delivered before chemotherapy begins.
Newly emerging therapies like these are allowing doctors to make progress in the place where cancer and conception meet. Medical professionals facing this question have long been forced to consider multiple complications, potential lawsuits, and medical disasters involving not just one person, but two.
“Cancer is hard enough,” Pustilnik says. “Adding pregnancy, or the desire for pregnancy, to the mix makes it a lot more complicated.”
The rate of cancer among pregnant women is rising as an increasing number delay having children until their thirties. In a large Australian study involving over 780,000 women who gave birth between 1994 and 2008, researchers found that 192 out of every 100,000 pregnant and postpartum women received a cancer diagnosis — up from 112 per 100,000 women in 1994.
It was around 10 years ago, Pustilnik says, that a new generation of cancer sufferers began pushing their doctors for treatment options less radical than hysterectomy. “These were the pioneers that forced us to change the way we practice medicine,” she says. “We’re always concerned with saving people’s lives, but they wanted everything.”
For these women, “wanting it all” meant not just a career and a family, but a career, and family, and a cure. And the desire to have children is something that Pustilnik, herself the mother of three boys, well understands. It’s important, she says, to understand a patient’s aspirations in life, and then to jointly map out a strategy for treating the obstacles to achieving them, in this case cancer. Sometimes Pustilnik feels more like a therapist than an oncologist, but it’s important that a doctor be both, she says, if one is to treat the whole patient.
“I’ve realized that in this job I have to be interested in people,” she says. “You can’t really treat people as only a body anymore, because when it comes to cancer a patient’s entire life comes into play.”
These days, you have to be interested in technological advances, too. Pustilnik holds the distinction of having performed over 1,200 operations with the da Vinci robotic surgical system, a relatively new tool. She uses it to, among other things, perform non-invasive hysterectomies, which require only a single incision through the navel.
“They say in the world I’m one of the highest-volume people using this surgery,” Pustilnik reports.
Among the many patients on whom she has performed surgery is Holly Wetzig, removing her left ovary shortly after the cancer diagnosis. Following that, Pustilnik told Wetzig she needed to get pregnant within one year, after which her right ovary would need to be removed as well.
With a month left till her deadline and just two viable eggs remaining in her body, Wetzig finally conceived in August 2008. And six months after her daughter was born, she stopped by Dr. Pustilnik’s office to discuss removing that second ovary. The doctor expected resistance from the new mom, but she didn’t get any.
“I’m a mother now, and I have everything to live for,” Wetzig remembers saying as she held the healthy 6-month-old in her arms. “I’ve got everything I want right here.”