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Fertility preservation and reproduction in patients facing gonadotoxic therapies: an Ethics Committee opinion (2018 update)

Chemotherapy and radiation therapy often result in reduced fertility. Patients receiving gonadotoxic treatment should be informed of options for fertility preservation and future reproduction prior to such treatment. Reproduction in the context of cancer also raises a number of ethical issues related to the welfare of both patients and offspring.

This document replaces the document titled, ‘‘Fertility preservation and reproduction in patients facing gonadotoxic therapies,’’ last published in 2013. (Fertil Steril. 2018;110:380–6. 2018 by American Society for Reproductive Medicine.)

KEY POINTS

  • Clinicians should inform patients receiving potentially gonadotoxic therapies about options for fertility preservation and future reproduction prior to the initiation of such treatment. A collaborative multidisciplinary team approach is encouraged.
  • Established methods of fertility preservation include embryo cryopreservation for men and women, sperm cryopreservation in men, and oocyte cryopreservation in women.
  • Due to technological advances made in the past decade, oocyte cryopreservation has become a viable option prior to gonadotoxic therapy. It may be appropriate for women whether single or partnered, for postpubertal girls, and for those who have objections to embryo cryopreservation. Data on longterm
    follow-up are still limited.
  • Procedures such as cryopreservation of ovarian tissue in girls and women and testicular tissue in prepubescent males may be offered only in a
    research setting.
  • Data on the use of gonadotropinreleasing hormone analogs (GnRHa) for ovarian suppression have been conflicting; until definitive proof of
    efficacy is established, other fertility preservation options should be offered in addition to considering GnRHa treatment.
  • All available options should be offered and can be performed alone or in combination, often without causing significant delay to cancer treatment.
  • Concerns about the welfare of resulting offspring are not sufficient reasons to deny patients facing gonadotoxic treatments assistance in reproducing.
  • Parents may act to preserve the fertility of cancer patients who are minors and when the intervention is likely to provide potential benefits to the child. Assent of the child should be obtained if possible. Unless written instructions state otherwise, gametes should be discarded if the child does not survive to adulthood.
  • Instructions should be specified about the disposition of stored gametes, embryos, or gonadal tissue in the event of the patient's death, unavailability, or other contingency.
  • Preimplantation genetic testing (PGT) to avoid the birth of offspring with a high risk of inherited cancer is ethically acceptable.