By Courtney Mitchell, Director of Communications, UNC Women's Care, Courtney.Mitchell@unchealth.unc.edu
When Manda Miller called her parents to tell them she was pregnant, she knew it would be unexpected.
But, starting a family was more than just a life detail on which Manda and Douglas Miller had been mum – Manda was a two-time survivor of Hodgkin’s Lymphoma. The aggressive treatment saved her life, but had taken her chance for children.
Or, so she thought.
In 2014, a meeting with Dr. Jennifer Mersereau at UNC Fertility opened up new possibilities to the Millers. Though chemotherapy had put Manda’s body in early menopause, she could still experience a healthy pregnancy with the help of an anonymous donor egg.
“We hadn’t told anyone we were doing any of this, just in case it didn’t work out the first time. I wasn’t even sure it would work the first time,” said Manda.
Levi Douglas Miller was born November 25, 2015, a true miracle. And, now that Manda is a mother herself, a lot of things make sense.
There’s the way her parents took care of her when she first started to feel “off” in 2002, the fall of her sophomore year at Carolina. They drove from Claremont, N.C., to Chapel Hill every Friday for treatment. They came on a moment’s notice if Manda wanted them nearby.
“I didn’t really understand what they were doing until I had my baby,” said Manda. “That’s why they drove up, no questions asked. If I wanted them, they were there; if I needed space, they would leave. They were always on call.”
Manda stayed in school, but had anticipatory nausea, often beginning to get physically sick during her Friday morning biology class. After class, she’d go to UNC Lineberger Comprehensive Cancer Center for treatment and return home with her parents for the weekend to recover.
By that summer she was well and ready to be a normal college student, again. She graduated, started her career and lived the life of a healthy young adult.
The growing trend of oncofertility
Manda was 27, dating then-boyfriend Douglas and beginning graduate school when she felt a familiar shortness of breath.
“I couldn’t complete a distance run,” she said. “My parents said I looked swollen in my face and hands, and I was talking in my sleep, all things that had happened before.”
Douglas accompanied her to the doctor. When they learned the cancer had returned, they both cried. Manda needed immediate treatment, the tumors pressing on her lungs. Chemotherapy would quickly follow surgery. She would be sicker this time, undergo a bone marrow transplant and need a leave-of-absence from school and work.
“When I was 19, I wasn’t sure what treatment entailed, but the second time, I knew. I was in graduate school, developing my career, trying to progress my life, with someone I knew I wanted to marry. All this had to be put on hold,” she said.
The treatment would render her infertile, and there would be no time to investigate fertility preservation measures. Manda didn’t think too much about it – she needed the treatment to live.
“It just clicked, this was what I would have to do, and there would be no kids,” she said.
Cancer treatment affects fertility in different ways, said Dr. Mersereau, associate professor of reproductive endocrinology and infertility at UNC’s Department of Obstetrics and Gynecology. With diseases such as uterine or ovarian cancer, the organs vital to conception or pregnancy must be removed. Some treatments shut down ovarian function that never returns.
Preserving fertility in the face of cancer is becoming more popular, she said. Sometimes delaying treatment for a few weeks is not an option. But in many cases, a round of in-vitro fertilization (IVF) can be completed quickly before treatment begins.
“In the case of a young woman with cancer, we might try to do a rapid IVF cycle before they start treatment. This can take about two weeks. They take shots to stimulate egg production and we take out those eggs and freeze them as eggs. Or, if they have a partner, we fertilize the eggs with the sperm to make embryos and freeze the embryos for future use.”
Cancer survivors are sometimes counseled to put off starting a family. “For a woman who is 25, waiting until she is 30 is not usually a problem. But, if you’re starting treatment at 38, waiting until you are 43 puts you at risk for reduced fertility and lower egg quality,” said Dr. Mersereau.
Male cancer patients come to UNC Fertility to bank sperm before treatment, as well. Each month, the office sees several cancer patients who are looking to preserve fertility or seek options after their treatment.
“Our IVF success rates at UNC Fertility are among some of the best in the country, and we’ve seen them get better every year. We encourage cancer patients to speak up about their fertility and advocate for themselves if they would like to explore options with us,” she said. “Everyone has a different process, but there are lots of ways we can help someone complete their family.”
‘This is really happening’
Before Manda could think about kids, she had to focus on beating cancer – again.
And, she was right – she was much sicker this time, and for longer. But, she was also determined to get well.
“I have this complex where if you tell me that I can’t do something, then I’m dead set on doing it,” said Manda. “The nurse was saying I’d need to be in the hospital for four weeks after my bone marrow transplant. She said, ‘Only marines get out in three weeks. You’ll be here four.’ I was in there 22 days, just over three weeks.”
In the next two years after Manda recovered, the Millers started their life together. Douglas proposed on a trip to Prague, they married and purchased a home. Manda made one more visit to UNC Lineberger to see if biological children could be a part of that life.
“They put me in touch with Dr. Mersereau at UNC Fertility to talk it over,” said Manda. “I just assumed children weren’t possible, but it had never crossed my mind that with a donor egg, I could carry a child.”
Conceiving with an anonymous egg donor is more common than one might think, said Dr. Mersereau. Young women in their 20’s sign up to anonymously donate their eggs and submit profiles with general information such as height, weight, hair color, ethnic and education background. The recipient couple browses the profiles and chooses donors who might be a good fit.
“For cancer patients who have entered premature menopause, this is a great option for them to conceive and carry a child,” said Dr. Mersereau.
Once the Millers selected a donor, the process went quickly. The anonymous donor took injectable drugs to stimulate her ovaries and grow multiple eggs. Manda began estrogen and progesterone to prepare her uterus for implantation. The donor’s eggs were fertilized by Douglas’s sperm, and one was chosen for transfer. Any extra embryos were frozen.
A little less than two weeks after the embryo transfer, Manda visited UNC Fertility to have her blood tested for pregnancy hormones.
“I went to work, trying to make it a normal day. Kimberly Briley, one of the nurses at UNC Fertility, called me that afternoon. She said, ‘you have a positive pregnancy test.’ I don’t know how to describe it. I just sat there thinking, ‘This is really happening!’
Just like other moms
Manda Miller has beat cancer twice and endured the crippling nausea of chemotherapy. So, the all-day “morning” sickness of her pregnancy was a familiar feeling, and a normalizing factor that made her feel like other mothers-to-be.
“I’m a mom like every other mom. It helps to know that you can beat cancer and you can go on to have a normal life with normal experiences. I realized that being pregnant can be really hard, and feel like chemo, and other women do this all the time.”
It was another moment that made Manda so appreciative of her own mother, and everything she’d done for her.
Levi is now almost a year old. He laughs all the time, and the Millers say he is the happiest baby.
And, he’s made his parents even happier.
“So much can change in such a short amount of time. Five years ago, I was in the hospital and so sick. I thought I’d never have kids. When I have a bad day now, I know it can all change tomorrow. It really puts things in perspective.”
That perspective has helped with one thing that is a universal hardship for all new parents, no matter where their babies come from – the sleepless nights.
“I’ll think to myself, ‘You couldn’t have him, but now you do,’” said Manda. “He really is my miracle baby.”