In molar pregnancy, fertilization goes so haywire that one young woman who’d been trying to get pregnant asked for a hysterectomy. Luckily, her doctor said no.
Kristin Lazure had been trying with her husband, David Horn, to get pregnant for six months before her home pregnancy test finally turned up positive.
At the earliest possible time, the then 33-year-old woman went to see her gynecologist, Dr. Ricky Friedman, at Mount Sinai Hospital in New York.
The ultrasound showed no signs of a baby.
Friedman told Lazure she must have miscarried. He asked her to come back the following week to confirm.
Lazure was sad and frustrated, but she knew miscarriages were a predictable setback on the path to a healthy baby. Many women experience miscarriages in the first trimester of pregnancy. If there’s a genetic problem with the fetus, nature often takes care of it this way.
When it came time for the follow-up appointment, Horn asked if he should come with Lazure. She said no.
“We already know what the news is,” she said.
But later that June day in 2010, Lazure phoned Horn, hysterical, to share some news that wasn’t at all what they’d expected. It was hard to make sense of it.
Lazure had what’s called a complete molar pregnancy. That’s when egg and sperm meet, but don’t combine their genetic payloads properly. Two sperm fertilize the egg, resulting in 46 chromosomes. What develops is not a fetus, but a mass of tissue — basically a tumor.
That’s what Friedman had seen in the second ultrasound.
The tissue in a complete molar pregnancy divides and grows quickly, as if it were a fetus. There’s a 1 in 5 chance it will turn cancerous.
By the time Lazure called her husband, she had been scheduled for an emergency dilation and curettage, better known as a D&C, to clear out the tissue.
Gynecological oncologist Dr. Konstantin Zakashansky was also brought in. The doctors told her that if her pregnancy hormones didn’t drop back to zero after the D&C, it would suggest that there was still tissue in the uterus that the body was mistaking for a fetus.
At that point, it would be considered invasive and possibly cancerous. Lazure would have to start chemotherapy.
Lazure tried to get out a few questions. But the doctors assured her, “Your numbers are going to go down.”
Molar pregnancies are rare — about 1 in 1,000 pregnancies. Friedman told Lazure he sees one or two a year.
Those that aren’t resolved with a D&C are extremely rare. They’re so rare that Dr. Laurie Gregg, a Sacramento OB-GYN and past chair of the California district of the American Congress of Obstetricians and Gynecologists, has only seen one woman need chemotherapy in 20 years of practicing medicine.
Before high-quality ultrasound machines became the norm, a molar pregnancy could look like an actual pregnancy for longer. It was not unheard of for a mole — another name for the abnormal placental tissue — to turn cancerous and metastasize to other parts of the body before doctors caught it.
A woman with a brain tumor and a history of miscarriages remains a common figure in medical school cases studies, Gregg and Zakashansky told Healthline.
Complete molar pregnancy is still so closely linked to textbook learning in OB-GYNS’ minds that nearly the first thing they say about it is that the sonogram looks like “a cluster of grapes.”
Fortunately Friedman’s training was also fresh in his mind, and the sonogram’s resemblance to a cluster of grapes led him to ferry Lazure into an immediate D&C.
Partial molar pregnancies — where there is some fetal development along with a tumor, though the extra chromosomes make the fetus unviable — can be harder to detect but less dangerous.
Gynecologists may know to look for molar pregnancies, but virtually no one in the general public has any idea that this is one of the worst-case scenarios pregnancy can bring.
Lazure is a self-proclaimed “Google doctor.” Even after many fertility-related searches during her efforts to get pregnant, she’d never heard of a molar pregnancy before she was being shuttled into a D&C.
“People getting pregnant and having to go through this, the majority are not aware of such a thing existing,” Zakashansky said.
Lazure’s pregnancy hormone, or hCG, numbers didn’t fall after her D&C, and so she found herself going to Mount Sinai four hours a day, five days a week, every other week for chemotherapy. Horn, who was self-employed, often went with her.
Zakashansky expected to do two or three rounds of chemo, he said. But it took almost five months for her numbers to go down, Lazure said.
The tissue removed in her D&C was not cancerous and a subsequent CT scan showed no cancer elsewhere. But the tissue that hadn’t come out with the D&C could have turned cancerous at any point.
Instead of repeatedly biopsying it, doctors just treat it. The diagnosis is choriocarcinoma.
Methotrexate is well established as the right drug to use for this kind of tumor.
“It’s weird thinking that you’re getting chemo for something that isn’t necessarily cancer,” Gregg acknowledged. “But we know that methotrexate really kills placental tissue and a mole is just a whole bunch of abnormal placental tissue.”
The oncology ward was nevertheless a strange place for an otherwise healthy woman in the heart of her childbearing years to end up. (Molar pregnancies are more common among women at the extreme ends of their fertile years.)
“I knew that even though I’d been dealt this awful hand, I knew I’d be OK,” Lazure said. “That doesn’t mean I didn’t have days where I felt sorry for myself.”
Zakashansky, whom Lazure calls Dr. Zak, had a different perspective. He saw Lazure as one of the lucky ones.
“We actually have very few diseases we know we’re going to cure and this is one of them. For me, this is one disease I can actually cure,” he said.
But while Zakashansky said “methotrexate is usually very well tolerated,” an oncologist’s perception of what tolerating a medication looks like can be distorted.
“I was sick as a dog,” Lazure said. “I had major chemo brain. People would send me books because I’m a big reader, but I couldn’t even focus on words on a page.”
Her veins collapsed from repeated intravenous (IV) drips and she had to have a port surgically implanted in her chest.
Lazure eventually asked Dr. Zak if she could just have a hysterectomy and be done with it. That was the next step, but Zakashansky wasn’t ready to give up on a young woman who very much wanted a family.
At one point, Horn joked that he and Lazure should just get a dog instead of continuing to hope for a baby.
“A dog isn’t going to give us cancer,” he quipped.
But eventually Lazure’s hCG numbers went back to normal and life gradually resumed.
For the first six months, Lazure was considered in remission and the surgically installed IV port remained. But then that came out, too.
“I took some time off and did nothing,” Lazure said.
Women who have experienced a molar pregnancy often experience depression, and Lazure did a few sessions of therapy.
“It was a very isolating experience because it feels like you’re the only person in the world,” she said.
But the therapist told Lazure it seemed like she was dealing with it fine and she didn’t need to come unless she wanted to.
Doctors recommend molar pregnancy patients wait six months after being deemed cancer-free before they try to get pregnant, so that a real pregnancy doesn’t mask the return of the tumor.
A year after her last round of chemo, Lazure and Horn could start thinking about a baby again. But it was hard for them to believe that she would be able to get pregnant. (This is also
“I knew if I got pregnant it would be very healing,” Lazure said.
A few months later, the home pregnancy test lit up again. Daughter Vivian was born in January 2013. By the end of 2014, baby Max had come along, too.
“A lot of people take their children for granted: They want babies, they get pregnant, everything falls into line. David and I consider our past struggles a blessing and we are reminded every day how precious these two are,” Lazure said of her kids.
Zakashansky was right: Lazure’s was one of the happy endings. It just took a while to get there.