June 20, 2024
Young cancer survivor sees IVF as a route to pregnancy and breaking BRCA1 mutation chain that has plagued her family

My diagnosis with breast cancer at the age of 30 shattered my world. It challenged my sense of who I was and who I was becoming. I was young, newly married, healthy (I thought) and ambitious — in other words, thriving — and planning for the future. In fact, at the time of my diagnosis, my husband and I had just started thinking about trying for a baby.

My breast cancer diagnosis was triple-negative invasive ductal carcinoma — a particularly fast-growing and aggressive type. On top of that, I carry a BRCA1 mutation, which puts me at very high risk for breast and ovarian cancer. This genetic legacy was why my father, as a young person, watched his mother die of breast cancer and witnessed his aunt and grandmother suffer through it.

Our family-building hopes were put on hold as I stepped back from work and underwent 16 months of cancer treatment: 26 rounds of chemotherapy, four surgeries, six visits to the emergency room and hundreds of doctor appointments in between.

Fortunately, California had just passed Senate Bill 600, which established coverage for fertility preservation for patients, like me, who might become infertile from needed medical treatments such as chemotherapy or radiation. This law had a profound impact on my life. It allowed me to freeze embryos ahead of my lifesaving chemotherapy treatments, which afforded me hope that one day I might be able to have a biological child of my own, despite the copious amount of toxins my body has endured.

Now that active treatment is behind me, I am looking to my future and to the possibility of having children. For my husband and me, this requires implanting our embryos — a procedure that is not currently covered by my health insurance. This is the only way that we can realize our dream of a family.

Additionally, thanks to scientific advances in preimplantation genetic testing during IVF, this will also be a chance to implant embryos that are free of the BRCA1 mutation, allowing us to break the chain of malignancies that has plagued my family for generations. It is our hope that our children, their future partners and our society will be spared the emotionally, financially and physically difficult process we have endured due to a genetic cancer predisposition.

Now that I am medically cleared to get pregnant, I need to come up with $5,000 to $15,000 (or more, depending on the number of frozen embryo transfers it takes) to pay for moving my cryopreserved embryos out of a freezer and into my uterus and to access the medications, doctor appointments, transvaginal ultrasounds and other essential services I need to build my family. For Californians struggling with infertility who need to start IVF from scratch, the cost is even steeper — starting at around $21,000, with the potential to rise to a six-digit figure.

The California Legislature is considering Senate Bill 729, which would require commercial insurers in the fully insured, large group market to provide coverage for the diagnosis and treatment of infertility, including IVF — the service that my husband and I need. This measure is a compassionate and critical step in helping cancer patients like me realize the promise of starting a family.

Cancer survivors already face incredible challenges to realizing the dream of a family: the risk of recurrence, the risk of permanent physical and emotional effects from cancer treatments, the risk of dying too young. The risk of not being able to afford the substantial out-of-pocket cost of IVF for those who need it to build their family need not be included in this list.

Katie McKnight is an environmental scientist and breast cancer survivor living in Richmond.

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