Patient Stories

Margaret Cieprisz | Lisa Holderby | Iveta Gigova

Margaret Cieprisz

During a routine exam by my gynecologist in April 2001, two months before I was to be married and move to New York, the doctor noticed something was not quite right. During the internal exam, she found that my ovaries were enlarged. A sonogram thereafter revealed what appeared to be cysts in both ovaries. My doctor assured me that ovarian cysts were fairly common, but sent me to a gynecologic oncologist to rule out something more serious. I was relieved but not particularly surprised when the oncologist concluded that given my age, I was 38 at the time, my apparent good health, and the lack of a family history of cancer, a cancer diagnosis was extremely unlikely. Although for a while I’d felt that something was “off” with respect to my health, I thought I’d led too healthy a life to be diagnosed with cancer at 38. I blamed the long hours I put in at work as a federal prosecutor and the stress and anxiety of my upcoming wedding and move for the lethargy I couldn’t shake and the stomach problems I occasionally felt.

After allaying my concerns, the oncologist sent me to a reproductive endocrinologist (RE) to deal with my cysts. The RE prescribed birth control pills in hopes of shrinking the cysts, and ordered a series of sonograms to monitor any changes. In June 2001, in between sonograms, I was married and moved to New York with my husband, Kenny. Throughout that summer, while adjusting to married life, setting up a new household, and finding my way to a new office in downtown Manhattan, I continued to commute back to Washington, D.C., for my periodic sonograms.

Towards the end of the summer, however, my doctor indicated that because my cysts were unchanged, surgery was probably the next step. I was referred to an RE in New York so that I could explore this option closer to home. My first appointment with Dr. Jamie Grifo took place shortly after September 11, 2001. My mind at that time was not on my health. I was not even sure that the appointment would still be on given what had happened to the city. It was on, however, and during my appointment, Dr. Grifo, like the oncologist in D.C., indicated that cancer was unlikely. It was nice to hear this again, but I somehow thought I couldn’t possibly have cancer, so I hadn’t spent much time worrying about it.

A laparoscopy was scheduled for October. The discussion during this appointment also turned to the topic of children. Dr. Grifo asked whether I hoped to have any, and gently suggested that, if so, sooner rather than later was probably a good idea. It was a little jarring to hear this. Although I didn’t want to wait too long to have children, this was the first time I realized that my time to have children might be running out. The night before my laparoscopy, I thought, probably for the first time since my April visit to the gynecologist, about the possibility that something might be seriously wrong with me. Up until that time, I’d had very little anxiety over the discovery of my cysts; it was mainly an inconvenience. Still, I went into the surgery thinking I would finally be able to put this matter behind me.

When I awoke after surgery, my husband was standing next to me. I asked how the operation had gone. He said Dr. Grifo had brought him into the recovery room but hadn’t yet told him anything. A grim-faced Dr. Grifo soon arrived. I recall only snatches of what he said. He’d been surprised by what he’d found. He’d called in another doctor to confirm his diagnosis. Both ovaries would have to be removed. Maybe my uterus as well. I can’t remember whether Dr. Grifo used the word cancer, but I understood. I asked whether I would be able to have children, and began to cry when I heard his response. Two days later, I was in the office of gynecologic oncologist Giuseppe Del Priore, the doctor who’d dropped everything to come to the operating room while I was in surgery. My husband and my younger sister Ann were with me. The plan prior to my surgery was for Ann to take time off from work as a federal prosecutor in D.C. to “nurse me” following the laparoscopy, meaning we planned to treat ourselves to lunch and pedicures. Sitting with me in an oncologist’s office hadn’t been part of the plan.

Dr. Del Priore explained to us that I had stage III ovarian cancer and would need a hysterectomy, then chemotherapy. Tests results would determine whether my uterus would need to go as well. The discussion then turned to children. There was a way, Dr. Del Priore said, to possibly preserve my fertility. At the time of the hysterectomy, my eggs could be removed from my ovaries, and, through in vitro fertilization, embryos might be created, then frozen until I was well enough to use them. If I had to lose my uterus, however, I would need to find a surrogate. Hearing this, Ann immediately volunteered, saying she wasn’t using her uterus then anyway. The one drawback to doing in vitro would be that I would have to delay the surgery and take fertility drugs to maximize the number of eggs produced during my next, my last, menstrual cycle. It seemed that neither the delay nor the use of the fertility drugs would negatively affect my prognosis, but I was not sure whether this was something I should be doing.

Away from my husband and sister, Dr. Del Priore told me what, at least statistically, my prognosis was. The number was dismal. Even if I got through my treatment and the next couple of years, how could I possibly attempt to bring a child into the world when I might not be around to see her Enter pre-school? On Halloween 2001, my husband and I saw another oncologist for a second opinion. The doctor confirmed that I did indeed have ovarian cancer and would need a hysterectomy. When I asked what the doctor thought about efforts to preserve my fertility, he said that this should be the furthest thing from my mind at this point. Although a short delay in surgery would not impact my prognosis, he suggested that I should be focusing only on my health, not on the possibility of having children in the future. He did not believe any reproductive endocrinologist would allow in vitro given the state of my health.

Ignoring the second oncologist’s opinion, and deciding to agonize over my ethical concerns on another day (hopefully), my husband and I decided to try in vitro fertilization. On November 26, 2001, I had a hysterectomy. Thereafter, through in vitro fertilization, eight embryos were created and frozen. Ann had arranged to take two months off from work following my surgery to help care for me during the week and go with me to my chemo appointments. Kenny, still new at his job, could not take much time off. Pretty quickly after my surgery, Ann and I had a comfortable daily routine involving walks, naps, and the occasional lunch in the neighborhood and pedicure. Life was pretty good.

In December, I had my first of six scheduled rounds of intravenous (IV) chemotherapy. By New Year’s Eve, my hair was falling out in clumps. Although I thought somehow I might be one of the lucky few whose hair merely thins rather than falls out entirely, I had purchased a wig just in case. I celebrated the end of 2001 by having Kenny shave off my remaining sad little wisps of hair and unpacking my wig. By my fourth round of chemo, my hands and toes were tingling, an indication of possible nerve damage caused by taxol, one of the chemo drugs used. IV chemotherapy was stopped following my February 2002 round.

I was supposed to participate in a study following my sixth round of IV chemo through which I would receive intraperitoneal (IP) chemotherapy. This second phase of treatment was now moved up. In April 2002, I underwent a laparoscopy, a “second-look” surgery during which Dr. Del Priore looked for any remaining evidence of disease. At the same time, he implanted under the skin over my rib cage a device known as a port, through which the IP chemo would be delivered directly to my abdomen. During the laparoscopy, Dr. Del Priore did find some remaining diseased tissue, which he removed. After recovering from surgery, the first of six rounds of IP chemo began.

Chemo this time around was a three-day affair, with three weeks off between sessions. The side-effects were not as obvious as they were with IV chemo. My hair was not affected; in fact it was starting to grow back. On The other hand, I was much more nauseous and I felt bloated much of the time because of the chemo drugs pumped directly into my abdomen. In addition, the port sticking out of my ribcage made me feel slightly less than human. The sixth and final round of IP chemo ended on August 14, 2002, and a month later, my port was removed. There was much celebrating.

Towards the end of 2002, Kenny and I began thinking the time was right to try to have children. Although the statistics Dr. Del Priore had quoted me during our first meeting still concerned me, I felt so strongly that I was going to be around for a long time to come. Kenny seemed even more sure of this. Having made this decision, Kenny wanted to talk to Ann about it as soon as possible; I wanted to wait until we saw her in person over the Christmas holidays. The truth was, I wasn’t completely sure I wanted to ask Ann to lend us her womb at all. My sister was the only person I could completely trust to carry our baby. But I couldn’t help but think about everything that could go wrong in a pregnancy: preeclampsia, a Cesarean, post partum depression, or worse. How could I put my sister through this? In addition, I wanted Ann, single and in her thirties, to spend her precious time off from work going out and having fun, not rushing to the bathroom with morning sickness Carrying her sister’s baby was sure to interfere with Ann’s social life. In addition, Ann had volunteered to be my surrogate so quickly the year before at a time when we were all so emotional. I worried that Ann might not want to do it now, but thought she couldn’t say no after making the offer. In response to my raging internal battle, Kenny thought we should simply ask her and let her decide. I agreed but resolved to lay out all of the grim possibilities that I could think up.

In Starbucks shortly after Christmas, 2002, Kenny and I popped the question to Ann. But before I could spit out all of the dire possible consequences, Ann said that of course she would do it, that she had given it a lot of thought over the last year, and that she wanted to do it sometime after the next summer. In the months that followed, I occasionally mentioned some awful potential consequence of pregnancy to Ann (“What about stretch marks?!) and frequently told her she could back out if she wanted. But Ann was not Easily Scared off.

On September 20, 2003, I held Ann’s hand as three of our precious embryos were transferred to her womb. Twelve days later, while on a break during a court hearing at work, I retrieved a voicemail message from Ann, “Call me back, Mommy.” I started smiling and have rarely stopped since. On June 16, 2004, Natalie Ann Cieprisz lit up the world, red-faced and crying her heart out. Today she is a bright-eyed happy little girl, ready with a smile and a wave for anyone we happy to pass by. Life is very very good.