Adopting after cancer

When I turned 37, I didn't celebrate with cake and champagne. Instead, I spent the morning of my birthday tossing down a Tang-colored cocktail of Adriamycin and Cytoxan at Sloan-Kettering's breast center on 64th Street in New York. Not exactly what I had planned.A few months earlier, my husband Evan and I had come home from a romantic vacation to Hawaii, ready to celebrate our upcoming first anniversary by throwing away my birth control pills and getting serious about trying to conceive our first child. After all, I wasn't exactly getting any younger, and the clock was ticking. But when I could no longer tell myself that the hard lump I felt in my breast was just something to do with my period and would soon go away, all those plans were thrown out the window. Instead of getting an ultrasound to check on a growing baby, I was getting one to make sure I didn't have liver metastases. Instead of seeing an ob-gyn or a midwife, I was seeing an oncologist. Instead of wondering what my baby would look like in nine months, I was wondering what I'd look like in nine months. Would I have hair again? Would I even be here?As Evan and I learned to navigate the strange new world called Cancerland, we also had to figure out what we wanted to do about our plans to have children. Obviously, they had to go on hold for now--but what about later? Would I be able to get pregnant after breast cancer treatment? Should I? Did I want to?Many women who have cancer still don't even get the information they need to think about making that choice. Even though the American Society of Clinical Oncology issued recommendations in 2006 that urge their members to discuss fertility preservation with younger patients as early in the course of treatment as possible, many doctors--about a third of them--still don't do that. And a national survey presented at ASCO in 2009 found that among the 2/3 that do, less than 25 percent referred their patients to a fertility specialist, or provided educational materials about what risks cancer treatment might pose to fertility and what options patients might have.Luckily, I didn't have one of those doctors. My oncologist talked with Evan and me at length about what my chemo regimen might do to my fertility. At 37, she told me that the evidence indicated that I had about a 50-50 shot of retaining my fertility after treatment. Women closer to 30 were much better off, while the closer you got to 40, the worse your odds became. She offered to refer me to a specialist on fertility and cancer, so that Evan and I could retrieve eggs before treatment, fertilize them, and freeze embryos until we were ready to become pregnant. I said no.Why? It's hard to explain. Part of it was just a sense of being totally overwhelmed. I was going through what seemed like a million tests a day: biopsies, more biopsies, MRIs, more MRIs, bone scans for bone mets, ultrasounds for liver mets, MUGA scans for heart function, CT scans for...hell, I don't remember what. I was drinking barium and having enough blood taken to supply an entire season of Buffy the Vampire Slayer. And I knew that this was just the beginning--that the diagnostic and preparatory merry-go-round would seem like a day at the beach once chemo and radiation started.So part of me just couldn't face still more tests, more procedures, more medications, more doctor's visits.Another part of me was terrified at the prospect of becoming pregnant after breast cancer. I knew a little about what research said about this issue--that small studies showed that there was no additional risk of recurrence if you got pregnant after completing treatment. But I couldn't help worrying that maybe those studies just weren't big enough. Maybe they'd missed something. And I didn't want to go through this twice.Making that decision wasn't easy. Evan and I had probably the biggest fight of our marriage in the car on the way home, with him frustrated that I was ruling out what might be our only chance for biological children, and me emotionally overwrought and feeling like he was putting his desire for kids ahead of my health.But we got past it. And we realized that what we both wanted was to be parents--however we got there. I spent the better part of my "cancer year"--that ugly year of 2004--researching adoption options, so that when I was declared cancer-free, we were ready to start the adoption process immediately. I finished radiation in December and we began the paperwork in February. Exactly one year later, our beautiful daughter, Annika, was born, and we were in the room with her birthmother when she entered the world. And then, the astounding happened. When we were ready to give Annika a sibling, we decided to throw caution to the wind and try to get pregnant first. I'm not sure what gave me the faith to do it--maybe it was those beautiful words I heard after my lumpectomy, "pathological complete response to treatment." Maybe it was just time healing fear as well as wounds. But for whatever reason, we decided to try--and damned if I didn't get pregnant that first month. Our son, Adrian, is now two, and at the decrepit age of 43, I'm about to give birth to another daughter. (We're done after this one!)During all this, I've spent a lot of time talking to other cancer survivors who've built their families after their diagnosis--through adoption, fertility preservation, surrogacy, and just plain old getting pregnant the old-fashioned way. I've learned one essential truth: If you have love to give to a child, there is a path to parenthood for you, even as a cancer survivor. Even if people tell you there isn't. It may be harder than the one your friends take. (Okay, a lot harder.) It may be totally different from the one you envisioned at 12 or 25. But it's possible. And it's worth it.Gina Shaw is a six-year survivor of breast cancer. She and her husband, Evan, live in Montclair, New Jersey, with their two children and newborn daughter, who was born June 17. Her book, Having Children After Cancer: How to Make Informed Choices Before and After Treatment to Understand Your Options and Build the Family of Your Dreams, is due out in Spring 2011 from Ten Speed Press/Random House.