Opinion: Motherhood is joy, but also grief. Cancer taught me how to live with both

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6 months ago

Opinion: Motherhood is joy, but also grief. Cancer taught me how to live with both 1

Farrah Khan and Kristyn Wong-Tam have a son, now 4, thanks to in vitro fertilization. A frozen supply of embryos could have given him a sibling, but a cancer diagnosis threw a wrench in those plans.Eden Graham

Farrah Khan, executive director at Action Canada, is currently on medical leave.

“Do you want to continue your embryo storage?”

The e-mail landed in my inbox, sounding off an internal alarm.

The deadline to pay the annual fee for keeping our embryos frozen was looming.

My spouse and I sat at a crossroads.

Years ago, we welcomed our son through in vitro fertilization (IVF). With more embryos in storage, we began contemplating having a second child. But life threw us an unexpected curveball. Last spring, as we prepared to celebrate my son’s fourth birthday, I received a diagnosis of breast cancer and a rare form of aggressive small-cell cervical cancer. These diagnoses changed everything and made my experience of queer motherhood even more complex.

I wanted so desperately to get pregnant again, even though the process for a queer couple like us would again be invasive, time-consuming and expensive. But with chemotherapy and radiation looming, this dream became infinitely more challenging to realize. I grappled not just with the weight of my potentially life-threatening illness, but also with the profound potential loss of my dream of being pregnant again.

It is a joy and privilege to be a mother, and an act of hope to make a family. It is also a daily practice of letting go of expectations – from career goals to birthing plans to ideas of what parenting will look like (I became a mother right before the pandemic, and the support system I thought I would have wasn’t there for many reasons). To decide to become a mother is to navigate the ache of comparison, the sorrow of missed opportunities. Since having my son, I’ve learned an uncomfortable, universal truth: Motherhood is joy, but it is also grief. It can manifest in many ways: the heart-wrenching death of a child; the longing to be a mother unfulfilled; estrangement from children; the anguish of miscarriage.

As I began my cancer treatment, grief took centre stage. I mourned my plans for the future. I grieved the time I was missing with my son.

Too often, we are expected to hold onto our grief and release it at the “right” time. We scream into pillows and cry in the shower so as to not be a burden – to not be “too much.” Lately, I have caught myself thinking: I have a wonderful family, how dare I be sad? Yet my throat constricts at the sight of a friend’s pregnancy announcement, or a drawer holding my son’s baby clothes. I don’t know where to put my grief, and I have been scared to share it. We live in a world where we’re supposed to keep miscarriages private – how could anyone begin to explain the sadness, anticipatory or otherwise, of no longer being able to get pregnant? Grief, as they say, is love with no place to go.

Our four-year-old son likes to practise crying right now. He will hold my face and say, it’s your turn to make tears run down it, like a game. I love how public my son’s grief is – the sharing of playground tragedies or frustration about the way the sun slipped into his room in the morning without asking. I wish it could always be that way – that we all had the space and time to share our grief openly without fear of judgment. My spouse and I always try to make space for our son’s big feelings, and when no solution feels right, we hug him, syncing our breathing to each other’s heartbeats. I wish the grief I feel right now had that much permission to be seen and held.

When potential parents decide to freeze their eggs, what does that involve? Why is the process so increasingly popular, and why are some experts sounding notes of caution about that? Alison Motluk, writer of the newsletter Hey Reprotech, explains the basics.

“How did you do it?”

As soon as my spouse and I publicly announced our pregnancy five years ago, this question emerged many times over, alongside a flood of inquiries characterized by curiosity and judgment. An acquaintance who knew my spouse asked who the father was. I responded firmly, “Me,” while rubbing my stomach.

Any wanted pregnancy should be celebrated. Yet our joyful moment felt marred in some ways by the disturbing reactions of some members of my family, people in our community, and strangers. Most of the negative comments on an online post we made hinged on the idea that having a family is “unnatural” for us – the audacity of this queer couple to become parents!

At a community event held shortly after the announcement, a woman I had never met leaned toward me in front of a group of people to ask, rather bluntly, how I’d gotten pregnant. I felt a surge of discomfort.

I gently pushed back. “I don’t feel comfortable answering that, just like you would probably not feel comfortable telling me the sexual position you were in when you got pregnant with your child.” She paused momentarily and thankfully started laughing, saying, you’re right, that was rude.

Her curiosity stemmed from a place of genuine interest, she confessed. She admitted she’d never encountered a pregnant queer person before. She didn’t know my history of being asked repeatedly, and I didn’t realize how small her world was.

Though queer families have gained more rights and visibility over the generations, there is still much that the public misunderstands about them.KENA BETANCUR/AFP via Getty Images

Queer families, we were reminded in the wake of our announcement, are still a mystery to many, shrouded in misconceptions and assumptions. Despite strides forward, queer and trans joy is still overshadowed by systemic and individual discrimination and hatred.

People’s ignorance is, in some ways, understandable given the lack of comprehensive sexual-health education in Canada. Without investment in and support of transparent discussions in the classroom, prejudice will continue to permeate into adulthood, even as many of us take diverse pathways to parenthood. It should be incredibly alarming to everyone that children’s rights, sexual-health education and gender-affirming care are consistently under threat across the country, from Alberta and Saskatchewan to Ontario and New Brunswick.

Queer and trans families encounter significant hurdles on our journeys to creating a family. The hostility stemming from pervasive hate and discrimination not only manifests in social settings but translates into tangible barriers within the health care system and in obtaining fertility treatments, adoption services and other essential family-planning services, all of which can be further exacerbated by legal obstacles. For instance, up until February in Nova Scotia, if a child were born to a same-sex couple through assisted reproductive technology (or ART, an umbrella term that includes any fertility treatment in which eggs or embryos are handled, such as IVF) and there was a known sperm donor, any parent who did not physically give birth to the child had to legally adopt their child before being listed on the birth certificate. The impact of this kind of practice can cascade into future challenges with passport applications, daycare registration, medical care and more.

Fertility clinics can also often feel unwelcoming to LGBTQ+ family structures and identities; my spouse and I had to constantly revise the medical forms, scratching out the boxes reserved for “husband” or “wife,” “man” or “woman.” At various times, I had to remind the nurses that no matter what my spouse and I did, a baby would not be conceived from us having sex.

Such systemic discrimination contributes to heightened stress and anxiety among LGBTQ+ communities, indirectly affecting their fertility and overall well-being. The fear of raising children in an environment that may not fully accept their family leads some to postpone or altogether abandon their dreams of parenthood. My spouse and I were extremely worried about sending our son to school. How would he feel if protests outside the school condemned our family’s existence? What would the playground look like for him when classmates knew about the makeup of his family?

Keeping embryos in cryogenic storage can be a lifesaver for people who struggle to get pregnant, but it it also expensive, time-consuming and not guaranteed to work.Roselle Chen/Reuters

When we started the ART process, I thought the fertility clinic’s waiting room would be filled mostly with queer families like ours. Instead, it was a mix of straight, queer and trans people, and, overwhelmingly, heterosexual couples. I had assumed that straight couples had it so much easier in the baby-making department, but here we all were.

According to a 2023 World Health Organization report, almost one in six people on the planet may experience infertility at some point in their lives. The same statistic is true of Canadians, yet there is still a ridiculous myth that all babies born in this country were conceived “naturally” (according to the Canadian Assisted Reproductive Technologies Register, nearly 7,000 babies were born using ART in Canada in 2019). The belief that conception comes effortlessly to heterosexual couples perpetuates a harmful narrative that overlooks the complexities of reproductive health and family planning. It leads to shame and stigma for anyone, straight or otherwise, who uses reproductive technology to become a parent. This is harmful not only to queer families but to all families.

I believe queer families can serve as possibility models, challenging outdated norms and expanding the definition of what it means to be a family, whether through adoption, IVF, surrogacy, kinship or chosen family. Each journey is valid, and each family deserves recognition and support.

The ART process is all-consuming and costly, fraught with many unexpected effects on mental health, relationships and career goals. My spouse and I chose to do IVF, including the process of egg retrieval, which is, heart-achingly, something of a numbers game. Each individual patient will have different metrics of success, but fertility clinics will often look to gather between 10 and 20 eggs during one round of retrieval, and that amount is not guaranteed. Depending on your age and other factors, 70 per cent to 80 per cent of the eggs gathered will fertilize, on average, and a smaller number of those resulting embryos will be viable enough to become live births. I vividly recall the anxiety of hovering over the phone the day after my egg retrieval, eager to know if we had a chance. The internal thoughts were relentless: If this attempt fails, can we endure the process again?

A single IVF treatment cycle can range, roughly, between $7,700 and $13,000, plus medication, potential genetic testing and other auxiliary costs that can add up to thousands of dollars. Using donor sperm adds more expense, including purchasing it for anywhere from hundreds to thousands of dollars, with some prices in U.S. currency, and additional fees required for embryo storage. The wide range in pricing comes down to varying rates across clinics.

Inseminating a frozen egg is a calculated risk: Only a few might be viable enough to mature into a fetus that can be delivered to term.IVAN COURONNE/AFP/Getty Images

Access to reproductive health care in Canada should not be a privilege, yet it is. Only some provinces publicly fund the use of IVF, for instance. This year, British Columbia announced it would join Ontario, Manitoba and Quebec in providing total funding for one round of specific ART treatments beginning in April, 2025. It’s a good start, but Canada still has a long way to go in publicly funding comprehensive reproductive health care.

Some grief in motherhood is inevitable, but some of it is preventable. (If the HPV vaccine had been available when I was younger, for example, I likely wouldn’t have had cervical cancer.) We must go beyond platitudes on Mother’s Day, especially for marginalized mothers. In Nunavut, women outside of Iqaluit are prevented from giving birth in their own communities (aside from emergency situations). Last month, an undocumented woman says, she was denied an emergency C-section at an Edmonton hospital. The Canadian Institute for Health Information reports that women living in rural areas are at “increased risk of poor maternal and infant birth outcomes.” Black women in Canada have a preterm birth rate of 8.9 per cent, compared with 5.9 per cent for white women. A 2017 study found infant mortality rates “were more than twice as high for each Indigenous group [First Nations, Métis and Inuit]” compared with Canada’s non-Indigenous population.

Mothers deserve better. We must leave no family behind.

For Inuit babies like the ones at this mothers’ meeting in Rankin Inlet, being born in Nunavut is not easy: Iqaluit, home to the territory’s lone hospital, is the only place with non-emergency birthing services, so most delivering parents have to go there or leave the territory.Fred Lum/The Globe and Mail

“Are you pregnant?”

The radiation technician asks the question matter-of-factly, but it still feels like a sharp jab.

“No, my ovaries are dead,” I quip.

The question has been asked throughout my cancer treatment. At each MRI, CT scan or radiation session, I hear it like a screech, reminding me of what I never will be again. It’s emotionally draining, constantly stirring up sadness.

Seeking relief, I asked one of my health team members for a note to be added to my chart stating there was no need to ask about pregnancy. But it’s standard practice, he explained: Health care providers must ask it before treatments to ensure the safety of the patient and any potential fetus.

In some ways, IVF had prepared me for cancer treatment – the regular blood draws, the internal exams, the seemingly endless procedures, the isolation, the many medications, the needles. I learned how to mentally tread water with the hope of making it to the next step of the process, and carried this practice into cancer treatment. Throughout both journeys, I meditated on one hope: to walk in the sunshine holding my child’s hand. I would breathe into this dream during every blood draw, IV placement or invasive test.

The aggressive treatment I underwent for cervical cancer, including chemotherapy and radiation, undoubtedly saved my life. For that, my gratitude toward my health team at Toronto’s Princess Margaret Cancer Centre knows no bounds. However, the treatment also rendered me unable to conceive another child biologically. Motherhood is grief, but cancer brought with it a new version: mourning never being pregnant again.

Before cancer, I had walked the edges of grief; it was something I didn’t fully allow myself to feel – always too sharp, too raw to touch.

Navigating these illnesses has allowed me to befriend grief. I sit within it, preparing for the waves so I can ride them.

Farrah Khan’s cancer treatment concludes this week as she and her family move on with their lives.Eden Graham

Re: “Do you want to continue your embryo storage?”

As the e-mail from the clinic languished in my inbox, we knew the answer. Despite our initial hopes, the reality of our situation – my health, the ever-increasing cost of living, and broader life circumstances – led us to make the difficult decision. We could not give my son a sibling from those embryos.

The answer was no. No, we did not want to continue with storage.

It was heartbreaking. Since cancer was the deciding factor in our case, I felt like the choice was made for us – a devastating lack of control. Saying goodbye to the embryos felt like saying goodbye to future possibilities and aspirations, all of it amplified by the emotional toll of coping with illness, adding layers of loss to an already difficult journey.

The day we let go of the embryos, I packed up the baby things I had been saving for our second child in a frenzy. I placed all the blankets, toys and clothes in bags and called a friend to pick them up. It felt impossible that this was happening, but at least the decision was ours. That is what we should want for anyone: the right to choose if, when and how.

This week marks the end of my treatment, hopefully forever. Cancer robbed me of the ability to get pregnant again, yet it expanded my family threefold. The support system that was challenging to build when my son was first born came together this past year. There is now so much family – biological and chosen family that show up for me, my spouse and our son. I learned from them that my grief and I are not a burden. With their care, I was able to navigate this painful moment of motherhood. This summer, I will have the joy of holding my son’s hand in the sunshine.

Now, I catch my breath. And heal.