Maddie MacLachlan has always wanted children.
As a child, when she played house with her younger sister Skyler, they pretended to birth and nurse their babies.
The now 16-year-old is more focused on her studies than on young children. But she still loves children and wants to be a mother one day.
“I love babysitting,” said Maddie, an energetic young woman with short, curly hair and a quick smile. “I really enjoy it.”
When Maddie found out she had cancer last year, the news came with an added, devastating blow: Her treatments could lead to infertility.
“I had cancer, I lost my hair and now this,” she said.
However, Maddie also learned about a new program available at Spectrum Health Helen DeVos Children’s Hospital — ovarian tissue cryopreservation.
Her ovary could have one ovary removed and frozen for later use, a possible option for future childbearing.
“Very, very seriously ill”
Table of contents
Maddie decided to have the surgery, but it wasn’t an easy decision. She already had so much to absorb.
In the fall of 2020, as a 14-year-old freshman at Mona Shores High School, Maddie was leading a busy life filled with schoolwork, friends, and volleyball.
She went to her doctor and an allergist several times because she had trouble breathing while exercising. She woke up every morning with a swollen face.
“It felt weird. I felt like a thumb was constantly pressing down on my windpipe,” she said. “As I lay down, I sounded like Darth Vader trying to breathe.”
Eating became difficult too. She often vomited after a meal, so she started eating less and less.
She had lost 15 pounds when she arrived for tests at Helen DeVos Children’s Hospital’s Ethie Haworth Children’s Cancer Center in October 2020.
A scan revealed that petite and slim Maddie had a mass in her breast the size of a gallon of milk.
“She was very, very ill,” said Allison Close, MD, her pediatric oncologist. “All the major parts of her airways and the blood vessels in her chest were very compressed.”
Doctors took Maddie to the intensive care unit and she underwent an emergency procedure to drain fluid from her chest and a biopsy.
Because of the severe compression of her airways, she could not be sedated. She received only nitrous oxide and local anesthesia for the procedures.
“Not everyone can do that,” said Dr. Close. “She is a very brave and resilient young lady.”
The biopsy showed Maddie had primary mediastinal B-cell lymphoma, a form of non-Hodgkin’s lymphoma.
Maddie remembers being with Dr. Close had spoken and heard that her cancer could be treated with chemotherapy. That she would be fine.
“But I was in shock,” she said. “I thought no.”
risks of infertility
Maddie received her first chemo session and then went home for two weeks.
In a private conversation with Maddie’s parents, Nicky and Brian, Dr. Close that Maddie would be at increased risk for future fertility issues.
dr Close is Director of Spectrum Health’s Adolescent and Young Adult Services and Oncofertility Program, which provides fertility counseling and risk assessment for young cancer patients.
Chemotherapy can deplete egg stores. It can lead to early menopause, which can occur in a woman in her 20s, 30s, or 40s. And in some cases, a young woman will enter menopause immediately after undergoing chemotherapy.
If they could safely delay treatment, Maddie might consider having eggs removed and frozen.
But that requires injections and a wait of at least two weeks and a medical procedure that involves sedation.
“Clearly the crowd was so large that there was no way we could wait that long and not calm them down,” said Dr. Close.
She explained that in recent years cryopreservation of ovarian tissue has become available to young women at significantly increased risk of fertility problems, including infertility or premature menopause.
“It’s not considered experimental, but it’s still very new and innovative,” said Dr. Close. “There have only been about 200 live births worldwide.”
If Maddie chose that option, the surgery would be done before her next chemotherapy session in two weeks.
At home, Nicky and Brian discussed ovarian tissue preservation with Maddie.
“It was a tough discussion,” Nicky said. “Normally at that age you don’t have to talk about whether you want to have children and what could happen.”
At first, Maddie wasn’t sure what to do.
“I was just freaking out that this was even a problem,” she said.
She knew that even if she did have the surgery, if she decided to one day use the frozen ovarian tissue to have a child, she had no guarantees it would work.
“We let them know that if it doesn’t work, there are other options to have children, like adoption or surrogacy,” Nicky said. “There’s definitely always a way to be a mom.”
Maddie and her parents discussed the pros and cons of the procedure.
Ultimately, Maddie decided, “There are no downsides other than it’s surgery.”
Two weeks later, she underwent laparoscopic surgery at Helen DeVos Children’s Hospital, performed by pediatric surgeon Elliot Pennington, MD.
dr Pennington made three small incisions through which he inserted a camera and long instruments.
He surgically removed an ovary and placed it in a special solution to prepare it for cryopreservation. He cut off a tiny piece to be analyzed by a pathologist to look for obvious cancer cells.
The ovary was shipped to the University of Pittsburgh, where it was cut into small strips and frozen at minus 80 degrees.
“Once everything is processed, it’s stored for years or decades until she’s ready to use it,” said Dr. Pennington.
Bringing this opportunity to young women with cancer “is very gratifying,” he said. “We want to offer them future options for their fertility if they choose to do so. We want to leave all doors open to them.”
Look to the future
The recovery from the surgery was not easy. It hurt to breathe, to walk, to sit up – and most importantly, to laugh.
“It’s not fun,” Maddie said. “You don’t realize how much you’re using your abs.”
But she finds comfort in knowing that the surgery could help her have a child one day.
“It was just always something I wanted,” she said.
If Maddie decides to use the preserved tissue, it can be implanted in her remaining ovary, in her pelvic/abdominal cavity, or possibly used for in vitro fertilization
And it may not be necessary, said Dr. Close.
She can potentially conceive using eggs from her remaining ovary.
“We don’t know everything that leads to why a person’s fertility may or may not be affected,” said Dr. Close. “We want to make sure we have options for interested people.”
Whether to undergo ovarian tissue cryopreservation is an individual decision, and Dr. Close encourages parents and young women to discuss this together.
“There is no right or wrong decision,” she said. “Our job is to educate families whose children are at risk of future infertility so they can make their own decisions about what to do.”
Research shows that future fertility is a top concern for cancer survivors — and having this information available can help them manage it.
“It’s devastating now to be able to talk to patients who have ovarian failure, who didn’t have the option because it didn’t exist then, and who are devastated because there is no way they can have a biological child.” , she said.
For young men facing cancer treatment, sperm banking is an option. Also, an experimental study is testing the use of testicular cryopreservation in boys who have not yet reached puberty.
A new perspective on life
Maddie was undergoing four months of chemotherapy that ended in January 2021.
She has been in remission for a year.
“Maddie had a tremendous attitude about the whole process,” Nicky said. “As parents, that impresses us immensely. We couldn’t believe how strong she was inside.”
Maddie expressed her gratitude for the caring people she met at the hospital – nurses, rescuers, doctors and environmental and ambulance workers.
“There are just a few special people here,” she said.
She’s returned to her wonderfully busy life, playing volleyball, hanging out with friends and completing a challenging curriculum of advanced assessment courses.
Though she’s happy to put her cancer treatments behind her, the experience is now shaping her career aspirations. She plans to become a biomedical scientist with a specialization in cancer research.
This summer, she’s doing an internship two days a week with a biomedical scientist at Michigan State University.
Through her illness and treatment, Maddie said she developed a deeper appreciation for life.
“Life is precious,” she said. “I think I’ve become a better person, I have more understanding of people’s journey. I like who I’ve gotten better at.”