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Early detection and aggressive chemotherapy/radiotherapy treatments have improved the long-term survival rates for many young women with various types of cancer. The structure of the human ovary is a crucial consideration in the potential success of cryopreservation. Four permeating cryoprotectants, glycerol (GLY), dimethyl sulfoxide (DMSO), ethylene glycol (EG), and propanediol (propylene glycol; PROH), have been used in human and animal ovarian tissue cryopreservation. In contrast to evaluation of outcomes from embryo or gamete cryopreservation, assessing the survival and viability of cryopreserved ovarian tissue poses specific challenges. There are only two morphometric studies of human ovarian tissue which assess cryopreservation, one of which is an evaluation of the most commonly used procedure using DMSO as a cryoprotectant and controlled rate cooling on tissue from six patients. Clinical evidence has established that fertilization and embryo development can occur in oocytes recovered from cryopreserved ovarian tissue transplanted at a heterotopic site.
Nobel Prize winner George Bernard Shaw was quite prophetic when he wrote, “Science … never solves a problem without creating ten more.” The development of assisted reproductive technologies (ARTs) and the subsequent emergence of embryonic stem cell therapy (EST) have illustrated the multitude of questions raised by technological advancement.
This chapter will focus on the dilemmas raised by payment for oocytes extracted from one woman either to assist another individual or couple build their family through ART or to assist researchers in pursuit of the promises of EST. Section A will provide a brief overview of egg donation. Section B will provide a brief overview of EST and how donated oocytes may become integral in stem cell research. Section C will examine the issue of payment to or compensation of donors of oocytes in both the reproductive and the research contexts and why the issue of payment for the same physical act seems so divisive depending on the ultimate purpose for which the oocytes will be used. Finally, the chapter will conclude with a discussion of autonomy and paternalism and the need to reconcile these positions to ensure that the benefits and ART and EST are both maximized and the harms are minimized to women and society overall.
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