Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-06-21T01:31:15.008Z Has data issue: false hasContentIssue false

Ethical Quandaries in Gamete-Embryo Cryopreservation Related to Oncofertility

Published online by Cambridge University Press:  01 January 2021


Cancer rates in men and women of reproductive age have continued to increase in recent years; however, therapy has dramatically decreased the mortality rates. Since 1990, the prevalence of cancer survivors in young adults increased from 1 in 1,000 to 1 in 250 patients due to more aggressive therapies. Current therapies may have profound toxic effects on gamete function with infertility as an expected consequence of cancer therapy. Depending on the site and stage of cancer, age of the patient, and the type of treatment, approximately 90% of men and women diagnosed with cancer may be at risk of permanent infertility.

Fertility preservation has emerged as a discipline dedicated to improving the future reproductive potential of cancer survivors. Significant progress in the advancement of fertility preservation therapies and a heightened awareness of the availability of therapies has occurred in the past 10 years. The American Society of Clinical Oncology (ASCO) and the American Society of Reproductive Medicine (ASRM) have advanced these efforts by formally recognizing the importance of fertility awareness.

Copyright © American Society of Law, Medicine and Ethics 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


American Cancer Society, Cancer Facts & Figures 2010, 2010.Google Scholar
Dow, K. H. Kuhn, D., “Fertility Options in Young Breast Cancer Survivors: A Review of the Literature,” Oncology Nursing Forum May 31, no. 3 (2004): E46–E53; Jemal, A. Siegel, R. Xu, J. Ward, E., “Cancer Statistics, 2010,” CA: A Cancer Journal for Clinicians 60, no. 5 (2010): 277300; Leonard, M. Hammelef, K. Smith, G. D., “Fertility Considerations, Counseling, and Semen Cryopreservation for Males Prior to the Initiation of Cancer Therapy,” Clinical Journal of Oncology Nursing 8, no. 2 (2004): 127–131, at 145.Google Scholar
Sonmezer, M. Oktay, K., “Fertility Preservation in Young Women Undergoing Breast Cancer Therapy,” Oncologist 11, no. 5 (2006): 422434; Wallace, W. H. Anderson, R. A. Irvine, D. S., “Fertility Preservation for Young Patients with Cancer: Who Is at Risk and What Can Be Offered?” The Lancet Oncology 6, no. 4 (2005): 209–218.CrossRefGoogle Scholar
ASRM Ethics Committee, “Fertility Preservation and Reproduction in Cancer Patients,” Fertility and Sterility 83, no. 6 (2005): 1622–1628; Lee, S. J. Schover, L. R. Partridge, A. H. et al., “American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients,” Journal of Clinical Oncology 24, no. 18 (2006): 29172931.Google Scholar
de Ziegler, D. Fanchin, R., “Progesterone and Progestins: Applications in Gynecology,” Steroids 65, nos. 10–11 (2000): 671679.CrossRefGoogle Scholar
ASRM, “Mature Oocyte Cryopreservation: A Guideline,” Fertility and Sterility 99, no. 1 (2013): 3743.CrossRefGoogle Scholar
Schenker, J., “Oocyte Donation: Religious Perspective,” in Sauer, M. V., ed., Principles of Oocyte and Embryo Donation (Philadelphia: Springer Verlag, 1998): at 341–360.Google Scholar
Neusner, J., The Babylonian Talmud: A Translation and Commentary. 2006.Google Scholar
Fadel, H. E., “The Islamic Viewpoint on New Assisted Reproductive Technologies,” Fordham Urban Law Journal 30, no. 1 (2002): 147157.Google Scholar
Congregation for the Doctrine of the Faith. Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day: USCCB Publishing; 1987.Google Scholar
Cohen, C. B., “Protestant Perspectives on the Uses of the New Reproductive Technologies,” Fordham Urban Law Journal 30, no. 1 (2002): 135145.Google Scholar
Kerridge, I. H. et al., “Religious Perspectives on Embryo Donation and Research,” Clinical Ethics 5, no. 1 (2010): 3545.CrossRefGoogle Scholar
Keown, D., Buddhism & Bioethics (New York: Palgrave, 2001).Google Scholar
Banu az-Zubair, M. K., “Who Is a Parent? Parenthood in Islamic Ethics,” Journal of Medical Ethics 33, no. 10 (2007): 605609; Benagiano, G., “Human Reproduction: Are Religions Defending the Core of Human Nature, or the Survival of Traditional Cultural Schemes?” Reproductive BioMedicine Online 17, Supp. 3 (2008): 6–8; Grazi, R. Wolowelsky, J., “Use of Cryopreserved Sperm and Pre-Embryos in Contemporary Jewish Law/Ethics,” Assisted Reproductive Technology 8, 1996): 53–62.CrossRefGoogle Scholar
Refworld website, Human Rights Act 1998 (Designated Derogation) Order 2001 [United Kingdom of Great Britain and Northern Ireland], Statutory Instrument 2001 No. 3644, 13 November 2001, available at <>..>Google Scholar
Crawshaw, M. A. Glaser, A. W. Pacey, A. A., “The Use of Pornographic Materials by Adolescent Male Cancer Patients When Banking Sperm in the UK: Legal and Ethical Dilemmas,” Human Fertility (Cambridge) 10, no. 3 (2007): 159163; van Roijen, J. H. Slob, A. K. Gianotten, W. L. et al., “Sexual Arousal and the Quality of Semen Produced by Masturbation,” Human Reproduction 11, no. 1 (1996): 147–151; Wheeler, R. Kohler, J. Paget, J. Major, J., “Sperm Preservation in Children: A Prescription for Consistency with Both Child Protection and the Criminal Law,” Clinical Risk 17, no. 1 (2011): 15–18.Google Scholar, “Sexual Offences Act 2003,” s10 (11)(a-c); s17; s12 (11), available at <> (last visited July 30, 2013).+(last+visited+July+30,+2013).>Google Scholar
See Wheeler, et al., supra note 10.Google Scholar
Nieman, C. L. Kinahan, K. E. Yount, S. E. et al., “Fertility Preservation and Adolescent Cancer Patients: Lessons from Adult Survivors of Childhood Cancer and Their Parents,” Cancer Treatment and Research 138, (2007): 201217.CrossRefGoogle Scholar
Simonstein, F. Mashiach-Eizenberg, M., “How Long Should Women Persevere with IVF?” Journal of Health Services Research & Policy 17, no. 2 (2012): 121123.CrossRefGoogle Scholar
See ASRM Ethics Committee, supra note 4.Google Scholar
See Lee, , supra note 4.Google Scholar
See Nieman, et al., supra note 12; Schover, L. R. Rybicki, L. A. Martin, B. A. Bringelsen, K. A., “Having Children after Cancer: A Pilot Survey of Survivors' Attitudes and Experiences,” Cancer 86, no. 4 (1999): 697709.Google Scholar
Duncan, F. E. Jozefik, J. K. Kim, A. M. Hirshfeld-Cytron, J. Woodruff, T. K., “The Gynecologist Has a Unique Role in Providing Oncofertility Care to Young Cancer Patients,” US Obstetrics and Gynecology 6, no. 1 (2011): 2434; Gracia, C. R. Chang, J. Kondapalli, L. et al., “Ovarian Tissue Cryopreservation for Fertility Preservation in Cancer Patients: Successful Establishment and Feasibility of a Multidisciplinary Collaboration,” Journal of Assisted Reproduction and Genetics 29, no. 6 (2012): 495502.Google Scholar
Quinn, G. P. Vadaparampil, S. T. McGowan Lowrey, K. Eidson, S. Knapp, C. Bukulmez, O., “State Laws and Regulations Addressing Third-Party Reimbursement for Infertility Treatment: Implications for Cancer Survivors,” Fertility and Sterility 95, no. 1 (2011): 7278.CrossRefGoogle Scholar
Hanson, K. Bondurant, E., Cancer Insurance Mandates and Exceptions, National Conference of State Legislatures (August 2009).Google Scholar
See Quinn, et al., supra note 18; Dolin, G. Roberts, D. E. Rodriguez, L. M. Woodruff, T. K., “Medical Hope, Legal Pitfalls: Potential Legal Issues in the Emerging Field of Oncofertility,” Cancer Treatment and Research 156, (2010): 111134.Google Scholar
Cohen, C. B., “Ethical Issues Regarding Fertility Preservation in Adolescents and Children,” Pediatric Blood and Cancer 53, no. 2 (2009): 249–253; Schover, L. R., “Motivation for Parenthood after Cancer: A Review,” Journal of the National Cancer Institute: Monographs 2005, no. 34 (2005): 2–5; Schover, L. R. Brey, K. Lichtin, A. Lipshultz, L. I. Jeha, S., “Knowledge and Experience Regarding Cancer, Infertility, and Sperm Banking in Younger Male Survivors,” Journal of Clinical Oncology 20, no. 7 (2002): 18801889.CrossRefGoogle Scholar
Gracia, C. R. Ginsberg, J. P., “Fertility Risk in Pediatric and Adolescent Cancers,” in Woodruff, T. S. K., ed., Oncofertility Preservation for Cancer Survivors (New York: Springer Verlag, 2007): at 57–68.Google Scholar
Deepinder, F. Agarwal, A., “Technical and Ethical Challenges of Fertility Preservation in Young Cancer Patients,” Reproductive Biomedicine Online 16, no. 6 (2008): 784791.CrossRefGoogle Scholar
Bartholome, W. G., “Informed Consent, Parental Permission, and Assent in Pediatric Practice,” Pediatrics 96, no. 5, Pt. 1 (1995): 981982.Google Scholar
See Cohen, , supra note 21.Google Scholar
See supra note 4; id. (Cohen).Google Scholar
Shefi, S. Raviv, G. Eisenberg, M. L. et al., “Posthumous Sperm Retrieval: Analysis of Time Interval to Harvest Sperm,” Human Reproduction 21, no. 11 (2006): 28902893.CrossRefGoogle Scholar
Barton, S. E. Correia, K. F. Shalev, S. et al., “Population-Based Study of Attitudes toward Posthumous Reproduction,” Fertility and Sterility 98 no. 3 (2012): 735740.e5.CrossRefGoogle Scholar
Quinn, G. P. Knapp, C. A. Malo, T. L. McIntyre, J. Jacobsen, P. B. Vadaparampil, S. T., “Physicians' Undecided Attitudes toward Posthumous Reproduction: Fertility Preservation in Cancer Patients with a Poor Prognosis,” Journal of Supportive Oncology 10, no. 4 (2012): 160165.CrossRefGoogle Scholar
Lipskind, S. T. Gargiulo, A. R., “Computer-Assisted Laparoscopy in Fertility Preservation and Reproductive Surgery,” Journal of Minimally Invasive Gynecology 20, no. 4 (2013): 435445.CrossRefGoogle Scholar
Spoelhof, G. D. Elliott, B., “Implementing Advance Directives in Office Practice,” American Family Physician 85, no. 5 (2012): 461466.Google Scholar
Doukas, D. J. Hardwig, J., “Using the Family Covenant in Planning End-of-Life Care: Obligations and Promises of Patients, Families, and Physicians,” Journal of the American Geriatriatrics Society 51, no. 8 (2003): 11551158.CrossRefGoogle Scholar
Schickedanz, A. D. Schillinger, D. Landefeld, C. S. Knight, S. J. Williams, B. A. Sudore, R. L., “A Clinical Framework for Improving the Advance Care Planning Process: Start with Patients' Self-Identified Barriers,” Journal of the American Geriatriatrics Society 57, no. 1 (2009): 3139.CrossRefGoogle Scholar
Johnson, K. S. Kuchibhatla, M. Tulsky, J. A., “What Explains Racial Differences in the Use of Advance Directives and Attitudes toward Hospice Care?” Journal of the American Geriatriatrics Society 56, no. 10 (2008): 19531958; Welch, L. C. Teno, J. M. Mor, V., “End-of-Life Care in Black and White: Race Matters for Medical Care of Dying Patients and Their Families,” Journal of the American Geriatriatrics Society 53, no. 7 (2005): 1145–1153.CrossRefGoogle Scholar
Ramsaroop, S. D. Reid, M. C. Adelman, R. D., “Completing an Advance Directive in the Primary Care Setting: What Do We Need for Success?” Journal of the American Geriatriatrics Society 55, no. 2 (2007): 277283.CrossRefGoogle Scholar
The Ethics Committee of the ASRM, “Posthumous Reproduction,” Fertility and Sterility 82, Supp. 1 (2004): S260–S262; Pennings, G. de Wert, G. Shenfield, F. Cohen, J. Devroey, P. Tarlatzis, B., “ESHRE Task Force on Ethics and Law 11: Posthumous Assisted Reproduction,” Human Reproduction 21, no. 12 (2006): 30503053.Google Scholar