Her one-in-a-million baby

Shortly after starting a new job in 2007 as a legal specialist in a technology company, Denise Wong, who was 27 at the time, was diagnosed with breast cancer. The treatment that would save her life—a lumpectomy, four rounds of chemotherapy, 30 days of radiation and five years of tamoxifen—would also decrease her chances of ever being able to conceive a baby.

“At that point, I wasn’t thinking about becoming a mother,” Wong remembers. “But to have the choice stripped away was probably the hardest part.” Over the next 10 years, Wong says, she stayed in remission and life got back to normal.

In 2016, Adolfo Polanco, the boyfriend who had been at her side throughout her cancer diagnosis, treatment and recovery, became her husband. And they began to imagine what had once seemed out of the question: starting a family.

“We always knew it wasn’t going to be high probability,” says Wong. “But we did try for several months after we got married, and it clearly wasn’t working. That’s when we talked about going to Stanford.”

With each month that passed—each cycle releasing one of the limited number of eggs Denise, like all women, was born with—Wong knew that her chances were diminishing. She needed to act quickly.

Wong and Polanco reached out to several fertility treatment centers. Stanford Fertility and Reproductive Health Services was the first to respond. It proved to be a fortunate match since the Stanford team was one of the first to have a fertility program for cancer patients and survivors. On top of that, the program takes care of patients that other centers might deem too risky or unlikely to conceive.

“Stanford prides itself on taking the most unusual and challenging cases,” says Steven Nakajima, MD, director of the Stanford IVF Outreach Program. With the most advanced technology and approaches, he adds, the team is on the cutting-edge of reproductive sciences.

“A lot of times, people will come to us because they’ve already been to three or four other clinicians who won’t take their case, either because of their weight or because they have too many medical risk factors,” he explains. “We don’t have arbitrary cut-off points where we say we won’t take care of someone because we’re afraid it will decrease our pregnancy rates. Our group really embraces the fact that we try to give everyone a chance.”

Nakajima says that while Wong’s case wasn’t unusual medically, her chances of conceiving were very low. Her ovarian reserve test—also known as an ovarian assessment report, or OAR—showed that although she was just 36 years old, she had the ovarian function of someone closer to 42. “In a reproductive sense, this is very depressed function,” states Nakajima. A test of Wong’s anti-Mullerian hormone (AMH)—another indicator of a woman’s remaining egg supply—also came back low at 0.48 nanograms per milliliter.

“Dr. Nakajima said that my chances of having a baby naturally were about 8 percent or less per month,” says Wong. “With intra-uterine insemination (IUI), about 10 percent. The success rate if we went through IVF would be slightly higher but still low, about 15 percent. So, the thinking was, why not jump to the most aggressive path?”

Wong’s insurance company—which, unlike most, covered her fertility treatments—disagreed. They wanted her to begin with less aggressive approaches. But her doctors knew this would cost her precious time, so they appealed the insurance company’s decision on her behalf and received the approval she needed.

“Because of her diminished ovarian reserve, we didn’t know how much longer she’d continue to ovulate or have good-quality eggs,” explains Nakajima. “So, we did . . . a special kind of IVF cycle to prevent her from having a too-high estrogen level that might reactivate her breast cancer.”

Wong was supplied with multiple medications, and had to learn, with her husband, how to do injections at home. She also came to the clinic for twice-weekly blood draws. “IVF is not fun,” Wong confesses. “You’re going through a personal struggle while also trying to manage things logistically. The good news is the nurses are fantastic and help you with scheduling.”

The following month, Wong underwent her egg-retrieval procedure. “The nurses were so warm and sweet,” remembers Wong. “So were all the techs and doctors. It was a very warm experience for something so clinical.”

After the egg retrieval, five eggs were identified and two showed signs of fertilization the next day. Of those two zygotes, one embryo was viable on day five. Nakajima decided to biopsy it to ensure it was chromosomally normal, which it was. “Some people would not have biopsied the embryo because of the fact that it might harm the embryo,” says Nakajima. “But in this case, it was more important for her to know.” They froze Wong’s single embryo in case she wanted to try again. Ultimately, understanding that a second IVF cycle might increase her risk of breast cancer recurrence, she chose to implant their one frozen embryo.

“You have to understand how emotionally trying this is for her,” remarks Nakajima. “She has this one chance as a breast cancer survivor who probably can’t make many more eggs in the future. It’s her one chance, and she’s willing to go through the embryo transfer procedure.”

On May 19, 2017, Nakajima and his team thawed Wong’s single embryo and placed it in her uterus. “You’re holding your breath,” says Wong. “You always have to be cautiously optimistic because you know there are so many obstacles along the way and so many challenges that you have to be prepared for anything to go wrong.”

Four weeks passed, and Wong missed her next period. Her pregnancy was confirmed, but she was hesitant to celebrate knowing that most miscarriages happen in the first trimester. “Once we got past the first trimester, then we fully exhaled,” she discloses. “You have these pictures from the ultrasounds showing the progress your baby is making every couple of weeks, and that’s when it starts to feel more real. I wouldn’t say we celebrated. We exhaled.”

Soon, Nakajima marked another major milestone for Wong and Polanco by graduating them from fertility treatment. “He said there’s no reason for you guys to see us anymore because you’re pregnant and your chances of holding on to this baby are the same as everyone else’s.”

When she was 37 weeks pregnant, Wong sent Dr. Nakajima a photo of herself to update him on her progress. “I was really touched by it,” shares Nakajima. “I thought, I can’t get over this. It’s really something. We knew we weren’t going to have a lot of chances to make this work, but the fact that she had this one embryo that made it through — it was just the perfect storm for her.”

On February 11, 2018, Maxwell Polanco was born at Good Samaritan Hospital in San Jose. When Wong’s labor wasn’t progressing, her doctors opted for a C-section. It was a fortunate choice because Maxwell’s umbilical cord had knotted and wrapped around his neck. They were able to carefully unwrap it, protecting his fragile chances at the final moment, and deliver a healthy baby boy.

“When I first saw him, he just seemed like a little miracle, like a one-in-a-million baby,” says Wong. “He gave three loud cries when he came out of the womb, and then he quieted down and started sucking his fingers. He was born 6 pounds, 7.7 ounces and 19 inches long. He looks like both his mother and father, we think. He’s gaining weight fast. Yeah, he’s perfect.”