By pure accident, Emily Fisch found a lump in her breast. With her wedding a week away, Fisch presumed she had discovered a cyst, and didn’t give it much more thought.
Her focus in June 2019 was on marrying Kyle, her love for seven years. After they exchanged their vows during a mountain wedding in Buena Vista, with family and friends from across the country sharing the excitement, Emily and Kyle jetted off for a honeymoon in Europe. They were excited to begin their lives as husband and wife and start a family.
Then, life changed in an instant. Fisch’s OB/GYN discovered that the lump in her breast was breast cancer, and she received her treatment and education through UCHealth Cancer Center – Memorial Hospital Central. An elementary school counselor in the Ellicott School District east of Colorado Springs, Fisch has always been of strong mind, body and soul.
At 29, even in the early moments of her new reality, she saw a silver lining. “I was grateful to have enjoyed my wedding and my honeymoon without knowing. It was blind ignorance, I guess, and it worked out for me at that time in my life.’’
In the coming weeks and months, Fisch would need all of her strength. She focused on learning everything that she could about surviving cancer and fulfilling her dream with Kyle of starting a family. When doctors learned that she has a small ancestry of Ashkenazi Jewish decent, which made it more likely that she was positive for the BRCA-2 gene, genetic tests were ordered. Sure enough, Fisch had the BRCA-2 gene. Her breast cancer was triple positive for progesterone, estrogen and the HER2 expression. She would need an aggressive regimen of chemotherapy.
Then, her oncologist, Dr. Praveena Iruku, explained that the chemotherapy treatment that would help to save her life would also affect her ability to conceive and have a child. Dr. Iruku let her know that she could preserve her eggs and have them fertilized and implanted, but she would have to act quickly. Dr. Iruku wanted to begin chemotherapy as soon as she could.
Fisch was crushed. She felt insecure. She told Kyle, who was immensely supportive and reassured his new bride that if she wasn’t able to conceive, they would adopt a child. Fisch still found herself in an emotional whirlwind.
“So much of your womanhood is tied up in that and to hear that you are going to go into medical menopause, that you could come out of the treatment never having a period again, or you could come out of it never being fertile again, after just being married, my identity felt pretty crushed,’’ she said.
She tried to give her husband a way out.
“I did have moments when I told him to divorce me, I told him go find a woman who doesn’t have these issues,’’ she said. “I told him that I didn’t mean to lock you down only a month before I was diagnosed with cancer. I would tell him a lot of things to push him away. I wanted to give him a way out, but he didn’t take it of course. And that made me feel like we were more connected because he is going through it with me.’’
Fertility preservation before chemotherapy
Fisch consulted with Dr. Virginia Borges, a medical oncologist at UCHealth, and two days after receiving her cancer diagnosis, Fisch and her husband went to the University of Colorado School of Medicine IFV & Fertility Clinic in Colorado Springs and sat down with Dr. Alex Polotsky, an obstetrician and gynecologist, and division director for Advanced Reproductive Medicine at the University of Colorado School of Medicine.
“They called, and I had an opening. I believe I saw them the same day, which is often what you need to do to go over the process. I saw her just after she was diagnosed with a horrible condition,’’ Polotsky said.
“She was faced with the possibility of starting her chemotherapy very quickly, which would basically fry the eggs. It’s the chemotherapy that will make conception very, very unlikely. In some cases, women will go into menopause. Even if they don’t go into menopause, they will deplete their own eggs, which makes conception a near impossibility. ‘’
Polotsky explained that preserving eggs is a three-part process: counseling about available options; testing and evaluation; and actual treatment. The process, for people who are not ill going through an in vitro fertilization, usually takes as long as six weeks. For Emily and others who are faced with a life-threatening condition, it must be done sooner.
“The stakes are enormous when we present this to an individual who is already overwhelmed with the diagnosis and the impact on her health, chemotherapy and the side effects,’’ Polotsky said.
Fertility preservation options
Fisch could either freeze her eggs – called egg banking – or freeze a fertilized egg, called embryo banking. Embryos have a higher chance of survival than eggs so Fisch chose to have her eggs fertilized by her husband’s sperm. The egg retrieval procedure was done at UCHealth on the Anschutz Medical Campus. The Livestrong Foundation paid for fertility medications to generate egg production. Her eggs were retrieved during a vaginal ultrasound procedure and then fertilized.
Then, the embryos were placed in an advanced laboratory where temperature and oxygen levels are monitored around the clock in an environment with a high chance of survival for each embryo.
Polotsky said it takes nine days after implantation for a positive pregnancy to occur, and within six weeks, he can detect a fetal heartbeat. He said 60% to 70% of implanted embryos result in viable babies at UCHealth. Fortunately for Fisch, a non-profit organization known as Team Maggie, dedicated to providing financial support for fertility treatments for teens and young adults diagnosed with cancer, provided a partial grant for her treatment.
“I have the best job in the world,’’ Polotsky said, noting that he visits parents and babies when they’re born.
The clinical structure needed to care for Fisch is “super sophisticated,’’ Polotsky said, and requires expeditious access for patients, a high-functioning medical laboratory and embryologists who can process the eggs and the embryos.
Breast cancer in young women
Fisch began her first round of chemotherapy in September 2019 and completed it in January 2020. She then had a mastectomy and breast reconstruction. She began a second round of chemotherapy, referred to as immunotherapy, to target the HER2 gene.
“A couple weeks after the first or second cycle of chemotherapy, she asked me if I could give it more frequently than every three weeks,” said Dr. Iruku. “The chemo is actually one of our toughest and I was quite surprised by her determination to get things moving in the right direction. I still tell her that she was the only one who ever said that to me.”
She received a chemotherapy called Kadcyla, made of a monoclonal antibody and chemotherapy. Kadcyla is to bring chemotherapy inside HER2 cells and kill them, while causing less harm to normal cells.
“It’s a treatment you can get for one year after chemotherapy as prevention so that if there is a cancer cell floating around in your body somewhere then the Kadcyla can target it and, hopefully, you won’t have a reoccurrence in the future,’’ Fisch said.
Her last Kadcyla therapy was Oct. 9. She is also taking Tamoxifen and Lupron for ovarian and hormone suppression. A year from now, when she plans to implant an embryo, she’ll take a break from those drugs.
“They said they could possibly use the word ‘cured’ with me,’’ Fisch said. “I’ll have a survivorship meeting with my oncologist – that’s where you go into the survivorship part of your journey – probably in late October. That’s when they will deem me as ‘cured’ and in remission and that’s when they’ll begin maintenance and monitoring from there.
“I am very fortunate that it was found early because most people my age, either they are not looking for it or it is found too late because maybe they have just dismissed it and it’s too far gone. I just really got lucky because it’s purely by chance that I discovered it,’’ she said.
A chance of pregnancy
Fisch said that she knows that one of the biggest predictors of survival is the strength of a patient’s support system.
“I have a huge support system. My work team has been very understanding and supportive. One of my co-workers helped to set up this yoga benefit for IVF treatment and my job gave me the time off that I needed to recover,’’ she said. “My husband and I were together for seven years before we got married so we were already pretty solid at that point. So he has been a wonderful support.
Fisch’s mom is one of 12 children, her aunts and uncles and extended family have been sending cards and care packages and checking on her.
“So I feel as though I have been uplifted by the generosity and love from everyone around me, so I have been just soaring through it all. And I know that is not the case for everyone, but it is the biggest predictor and my ability to get through all of this,’’ she said.
Sometime next year, perhaps in August, she and Kyle will implant one of the embryos in the hopes of having a child.
By that time, she and Kyle will have celebrated their second wedding anniversary. Fisch’s doctors have assured her that her outlook for defeating cancer and having a child are bright. No matter what happens, she’ll have peace of mind, knowing that she’s taken all the right steps to, first and foremost, live happily after.