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Affdal AO, Salama M, Ravitsky V. Ethical, legal, social, and policy issues of ovarian tissue cryopreservation in prepubertal girls: a critical interpretive review. J Assist Reprod Genet 2024; 41:999-1026. [PMID: 38430324 PMCID: PMC11052756 DOI: 10.1007/s10815-024-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE Despite the increasing number of childhood cancer survivors, significant advances in ovarian tissue cryopreservation (OTC) technique and medical societies' recommendations, fertility preservation (FP) and FP discussions are not always offered as a standard of care in the pediatric context. The aim of this literature review is to understand what ethical, legal, social, and policy issues may influence the provision of FP by OTC in prepubertal girls with cancer. METHODS A critical interpretive review of peer-reviewed papers published between 2000 and January 2023 was conducted, guided by the McDougall's version of the critical interpretive synthesis (Dixon-Woods), to capture recurring concepts, principles, and arguments regarding FP by OTC for prepubertal girls. RESULTS Of 931 potentially relevant papers, 162 were included in our analysis. Data were grouped into seven thematic categories: (1) risks of the procedure, (2) unique decision-making issues in pediatric oncofertility, (3) counseling, (4) cultural and cost issues, and (5) disposition of cryopreserved reproductive tissue. CONCLUSION This first literature review focusing on ethical, legal, social, and policy issues surrounding OTC in prepubertal girls highlights concerns in the oncofertility debate. Although OTC is no longer experimental as of December 2019, these issues could limit its availability and the child's future reproductive autonomy. This review concludes that specific actions must be provided to enable the offer of FP, such as supporting families' decision-making in this unique and complex context, and providing pediatric patients universal and full access to free or highly subsidized OTC.
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Affiliation(s)
| | | | - Vardit Ravitsky
- University of Montreal, Montreal, Canada
- The Hastings Center, Garrison, USA
- Harvard Medical School, Boston, USA
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2
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Coker Appiah L, Fei YF, Olsen M, Lindheim SR, Puccetti DM. Disparities in Female Pediatric, Adolescent and Young Adult Oncofertility: A Needs Assessment. Cancers (Basel) 2021; 13:5419. [PMID: 34771582 PMCID: PMC8582476 DOI: 10.3390/cancers13215419] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
Advancements in cancer screening and implementation of targeted treatments have significantly improved survival rates to 85% for pediatric and AYA survivors. Greater than 75% of survivors will live to experience the long-term adverse outcomes of cancer therapies, termed late effects (LE), that disrupt quality of life (QoL). Infertility and poor reproductive outcomes are significant disruptors of QoL in survivorship, affecting 12-88% of survivors who receive at-risk therapies. To mitigate risk, fertility preservation (FP) counseling is recommended as standard of care prior to gonadotoxic therapy. However, disparities in FP counseling, implementation of FP interventions, and screening for gynecologic late effects in survivorship persist. Barriers to care include a lack of provider and patient knowledge of the safety and breadth of current FP options, misconceptions about the duration of time required to implement FP therapies, cost, and health care team bias. Developing strategies to address barriers and implement established guidelines are necessary to ensure equity and improve quality of care across populations.
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Affiliation(s)
- Leslie Coker Appiah
- Division of Academic Specialists in Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The University of Colorado School of Medicine, Denver, CO 80045, USA
- Pediatric and Adolescent Gynecology, Children’s Hospital Colorado, Denver, CO 80045, USA
| | - Yueyang Frances Fei
- Pediatric and Adolescent Gynecology, Nationwide Children’s Hospital, Columbus, OH 43205, USA;
| | - Mallery Olsen
- Department of Medicine, The University of Wisconsin School of Medicine, Madison, WI 53705, USA; (M.O.); (D.M.P.)
- Pediatric Hematology/Oncology, American Family Children’s Hospital, Madison, WI 53705, USA
| | - Steven R. Lindheim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wright State University, Dayton, OH 45409, USA;
- School of Medicine, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Diane M. Puccetti
- Department of Medicine, The University of Wisconsin School of Medicine, Madison, WI 53705, USA; (M.O.); (D.M.P.)
- Pediatric Hematology/Oncology, American Family Children’s Hospital, Madison, WI 53705, USA
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3
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Mulder RL, Font-Gonzalez A, van Dulmen-den Broeder E, Quinn GP, Ginsberg JP, Loeffen EAH, Hudson MM, Burns KC, van Santen HM, Berger C, Diesch T, Dirksen U, Giwercman A, Gracia C, Hunter SE, Kelvin JF, Klosky JL, Laven JSE, Lockart BA, Neggers SJCMM, Peate M, Phillips B, Reed DR, Tinner EME, Byrne J, Veening M, van de Berg M, Verhaak CM, Anazodo A, Rodriguez-Wallberg K, van den Heuvel-Eibrink MM, Asogwa OA, Brownsdon A, Wallace WH, Green DM, Skinner R, Haupt R, Kenney LB, Levine J, van de Wetering MD, Tissing WJE, Paul NW, Kremer LCM, Inthorn J. Communication and ethical considerations for fertility preservation for patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e68-e80. [PMID: 33539755 DOI: 10.1016/s1470-2045(20)30595-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/06/2023]
Abstract
Patients with childhood, adolescent, and young adult cancer who will be treated with gonadotoxic therapies are at increased risk for infertility. Many patients and their families desire biological children but effective communication about treatment-related infertility risk and procedures for fertility preservation does not always happen. The PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group reviewed the literature and developed a clinical practice guideline that provides recommendations for ongoing communication methods for fertility preservation for patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger and their families. Moreover, the guideline panel formulated considerations of the ethical implications that are associated with these procedures. Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the evidence and recommendations. In this clinical practice guideline, existing evidence and international expertise are combined to develop transparent recommendations that are easy to use to facilitate ongoing communication between health-care providers and patients with childhood, adolescent, and young adult cancer who might be at high risk for fertility impairment and their families.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, Department of Population Health, and Division of Medical Ethics, New York University School of Medicine, New York University, New York, NY, USA
| | - Jill P Ginsberg
- Department of Pediatric Oncology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Karen C Burns
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Claire Berger
- Department of Pediatric Hematology and Oncology Unit, University Hospital of Saint-Étienne, Saint-Étienne, France; Host Research Team EA4607 Autonomic Nervous System, Epidemiology, Physiology, Exercise, and Health, Jean Monnet University of Saint-Étienne, Education and Research Cluster Lyon, Saint-Étienne, France
| | - Tamara Diesch
- Department of Pediatric Oncology and Hematology, University Children's Hospital Basel, Basel, Switzerland
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, Essen University Hospital, Essen, Germany; German Cancer Consortium (DKTK) Partner Site, Essen, Germany
| | - Aleksander Giwercman
- Division of Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Clarisa Gracia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah E Hunter
- Starship Blood and Cancer Centre, Starship Hospital, Auckland, New Zealand
| | | | - James L Klosky
- Department of Pediatrics, Emory University School of Medicine, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Joop S E Laven
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, Netherlands
| | - Barbara A Lockart
- Division of Pediatric Surgery and Division of Hematology, Oncology, and Stem Cell Transplantation, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Sophia Children's Hospital and Pituitary Center Rotterdam, Endocrinology Section, Department of Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Damon R Reed
- Adolescent Young Adult Oncology Program, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Eva Maria E Tinner
- Division of Pediatric Hematology/Oncology, University Children's Hospital, Inselspital, Bern, Switzerland
| | | | - Margreet Veening
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marleen van de Berg
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboudumc Nijmegen, Nijmegen, Netherlands
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Kenny Rodriguez-Wallberg
- Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Erasmus MC, Rotterdam, Netherlands
| | | | - Alexandra Brownsdon
- Children and Young Peoples' Cancer Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Daniel M Green
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Norbert W Paul
- Department of Obstetrics and Gynecology, Department of Population Health, and Division of Medical Ethics, New York University School of Medicine, New York University, New York, NY, USA
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Inthorn
- Institute for the History, Philosophy, and Ethics of Medicine, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
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4
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Eyni H, Ghorbani S, Nazari H, Hajialyani M, Razavi Bazaz S, Mohaqiq M, Ebrahimi Warkiani M, Sutherland DS. Advanced bioengineering of male germ stem cells to preserve fertility. J Tissue Eng 2021; 12:20417314211060590. [PMID: 34868541 PMCID: PMC8638075 DOI: 10.1177/20417314211060590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/01/2021] [Indexed: 12/22/2022] Open
Abstract
In modern life, several factors such as genetics, exposure to toxins, and aging have resulted in significant levels of male infertility, estimated to be approximately 18% worldwide. In response, substantial progress has been made to improve in vitro fertilization treatments (e.g. microsurgical testicular sperm extraction (m-TESE), intra-cytoplasmic sperm injection (ICSI), and round spermatid injection (ROSI)). Mimicking the structure of testicular natural extracellular matrices (ECM) outside of the body is one clear route toward complete in vitro spermatogenesis and male fertility preservation. Here, a new wave of technological innovations is underway applying regenerative medicine strategies to cell-tissue culture on natural or synthetic scaffolds supplemented with bioactive factors. The emergence of advanced bioengineered systems suggests new hope for male fertility preservation through development of functional male germ cells. To date, few studies aimed at in vitro spermatogenesis have resulted in relevant numbers of mature gametes. However, a substantial body of knowledge on conditions that are required to maintain and mature male germ cells in vitro is now in place. This review focuses on advanced bioengineering methods such as microfluidic systems, bio-fabricated scaffolds, and 3D organ culture applied to the germline for fertility preservation through in vitro spermatogenesis.
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Affiliation(s)
- Hossein Eyni
- Department of Anatomical Sciences,
School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Sadegh Ghorbani
- Interdisciplinary Nanoscience Center
(iNANO), Aarhus University, Aarhus, Denmark
| | - Hojjatollah Nazari
- Research Center for Advanced
Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of
Medical Sciences, Tehran, Iran
| | - Marziyeh Hajialyani
- Pharmaceutical Sciences Research
Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah,
Iran
| | - Sajad Razavi Bazaz
- School of Biomedical Engineering,
University of Technology Sydney, Sydney, NSW, Australia
| | - Mahdi Mohaqiq
- Institute of Regenerative Medicine,
School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | | | - Duncan S Sutherland
- Interdisciplinary Nanoscience Center
(iNANO), Aarhus University, Aarhus, Denmark
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5
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Manuel SL, Moravek MB, Confino R, Smith KN, Lawson AK, Klock SC, Pavone ME. Ovarian stimulation is a safe and effective fertility preservation option in the adolescent and young adult population. J Assist Reprod Genet 2019; 37:699-708. [PMID: 31828481 DOI: 10.1007/s10815-019-01639-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/21/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The aim of this study is to describe the multidisciplinary approach and controlled ovarian hyperstimulation (COH) outcomes in adolescent and young adult (AYA) patients (ages 13-21) who underwent oocyte cryopreservation for fertility preservation (FP). METHODS Multi-site retrospective cohort was performed from 2007 to 2018 at Northwestern University and Michigan University. Data were analyzed by chi-square test, t-test, and logistic regression. RESULTS Forty-one patients began COH of which 38 patients successfully underwent oocyte retrieval, with mature oocytes obtained and cryopreserved without any adverse outcomes. To treat this group of patients, we use a multidisciplinary approach with a patient navigator. When dividing patients by ages 13-17 vs. 18-21, the median doses of FSH used were 2325 and 2038 IU, the median number of mature oocytes retrieved were 10 and 10, and median number frozen oocytes were 11 and 13, respectively. Median days of stimulation were 10 for both groups. There was no statistical difference in BMI, AMH, peak E2, FSH dosage, days stimulated, total oocytes retrieved, mature oocytes retrieved, and oocytes frozen between the two groups. Three patients were canceled for poor response. CONCLUSION COH with oocyte cryopreservation is a feasible FP option for AYAs who may not have other alternatives when appropriate precautions are taken, such as proper counseling and having a support team. These promising outcomes correspond to similar findings of recent small case series, providing hope for these patients to have genetically related offspring in the future.
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Affiliation(s)
- Sharrόn L Manuel
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Molly B Moravek
- Department of Obstetrics & Gynecology, University of Michigan Health System, Ann Arbor, MI, 48109, USA
| | - Rafael Confino
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Kristin N Smith
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Angela K Lawson
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Susan C Klock
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA
| | - Mary Ellen Pavone
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Ave, Suite 2310, Chicago, IL, 60611, USA.
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6
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Nahata L, Morgan TL, Lipak KG, Clark OE, Yeager ND, O'Brien SH, Whiteside S, Audino AN, Gerhardt CA, Quinn GP. Conducting reproductive research during a new childhood cancer diagnosis: ethical considerations and impact on participants. J Assist Reprod Genet 2019; 36:1787-1791. [PMID: 31372871 PMCID: PMC6730731 DOI: 10.1007/s10815-019-01546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Research among adults shows benefits and low perceived burden of engaging in behavioral research. However, questions remain regarding the ethics of conducting behavioral research in pediatric populations during sensitive situations, including during a new life-threatening diagnosis or at end-of-life. We examined reactions to participating in a behavioral reproductive research study among male adolescents newly diagnosed with cancer and their parents, as a step towards optimizing fertility preservation utilization in a population where future infertility is common. METHODS Pediatric literature regarding the ethics of behavioral research was reviewed. In our pilot, forty-four participants (19 mothers, 11 fathers, 14 male adolescents newly diagnosed with cancer) from 20 families completed demographic questionnaires and a fertility preservation decision tool developed by the study team. Qualitative interviews exploring the impact of study participation were subsequently conducted. Verbatim transcripts were coded for thematic content using the constant comparison method. RESULTS Literature review showed positive reactions to research participation among youth/caregivers. In our pilot study, 89% (n = 17) of mothers, 64% (n = 7) of fathers, and 71% (n = 10) of adolescents reported at least one benefit of participating. Eleven percent (n = 2) of mothers, 36% (n = 4) of fathers, and 29% (n = 4) of adolescents said they were not affected; none of the participants reported a negative effect. CONCLUSION Consistent with prior literature, our study suggests behavioral reproductive research prior to cancer treatment can offer direct benefits to participants and society, without increasing burden. These findings will inform future interventions to improve long-term psychosocial and reproductive outcomes for youth with cancer.
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Affiliation(s)
- Leena Nahata
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA.
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA.
- The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Taylor L Morgan
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
| | - Keagan G Lipak
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
| | - Olivia E Clark
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
| | - Nicholas D Yeager
- The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah H O'Brien
- The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
- Center for Innovation and Pediatric Practice, Abigail Wexner Research Institute, Columbus, OH, USA
| | - Stacy Whiteside
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Anthony N Audino
- The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, Abigail Wexner Research Institute, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
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7
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Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P, Westphal LM, Inhorn MC, Patrizio P. Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review). J Assist Reprod Genet 2018; 35:1277-1288. [PMID: 29808382 PMCID: PMC6063838 DOI: 10.1007/s10815-018-1181-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Many people travel abroad to access fertility treatments. This growing phenomenon is known as cross border reproductive care (CBRC) or fertility tourism. Due to its complex nature and implications worldwide, CBRC has become an emerging dilemma deserving more attention on the global healthcare agenda. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English during the past 18 years to explore CBRC phenomenon in the new millennium. RESULTS Little is known about the accurate magnitude and scope of CBRC around the globe. In this systematic and critical review, we identify three major dimensions of CBRC: legal, economic, and ethical. We analyze each of these dimensions from clinical and practical perspectives. CONCLUSION CBRC is a growing reality worldwide with potential benefits and risks. Therefore, it is very crucial to regulate the global market of CBRC on legal, economic, and ethical bases in order to increase harmonization and reduce any forms of exploitation. Establishment of accurate international statistics and a global registry will help diminish the current information gap surrounding the CBRC phenomenon.
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Affiliation(s)
- Mahmoud Salama
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany.
- Department of Reproductive Medicine, National Research Center, Cairo, Egypt.
| | - Vladimir Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Evgenia Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Gohar Rahimi
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Lynn M Westphal
- Department of Reproductive Endocrinology and Infertility, Stanford University, Stanford, CA, USA
| | - Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Pasquale Patrizio
- Department of Reproductive Endocrinology and Infertility, Yale University, New Haven, CT, USA
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8
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Abstract
Adult survivors of pediatric cancers are at substantial risk for infertility. Oncofertility is an emerging field in medicine that has focused on the fertility preservation of these patients. As the field continues to develop, there are several areas in which our practice has improved. However, several ethical concerns still exist involving beneficence, nonmaleficence, informed consent, adolescent assent, and posthumous use of reproductive tissues. Because the field is still developing, great disparities exist in available options depending on age, ability to pay, and geographic location. Such discrepancies in access may lead to health disparities in the adolescent patient population. As the science continues to make future fertility more feasible, the ethical questions will continue to be more complex. The purpose of this article is to review some of the developments regarding oncoferility and address future directions for research and inquiry in specific areas.
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9
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Font-Gonzalez A, Mulder RL, Loeffen EAH, Byrne J, van Dulmen-den Broeder E, van den Heuvel-Eibrink MM, Hudson MM, Kenney LB, Levine JM, Tissing WJE, van de Wetering MD, Kremer LCM. Fertility preservation in children, adolescents, and young adults with cancer: Quality of clinical practice guidelines and variations in recommendations. Cancer 2016; 122:2216-23. [PMID: 27175973 DOI: 10.1002/cncr.30047] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fertility preservation care for children, adolescents, and young adults (CAYAs) with cancer is not uniform among practitioners. To ensure high-quality care, evidence-based clinical practice guidelines (CPGs) are essential. The authors identified existing CPGs for fertility preservation in CAYAs with cancer, evaluated their quality, and explored differences in recommendations. METHODS A systematic search in PubMed (January 2000-October 2014); guideline databases; and Web sites of oncology, pediatric, and fertility organizations was performed. Two reviewers evaluated the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II). From high-quality CPGs, the authors evaluated concordant and discordant areas among the recommendations. RESULTS A total of 25 CPGs regarding fertility preservation were identified. The average AGREE II domain scores (scale of 0%-100%) varied from 15% on applicability to 100% on clarity of presentation. The authors considered 8 CPGs (32%) to be of high quality, which was defined as scores ≥60% in any 4 domains. Large variations in the recommendations of the high-quality CPGs were observed, with 87.2% and 88.6%, respectively, of discordant guideline areas among the fertility preservation recommendations for female and male patients with cancer. CONCLUSIONS Only approximately one-third of the identified CPGs were found to be of sufficient quality. Of these CPGs, the fertility preservation recommendations varied substantially, which can be a reflection of inadequate evidence for specific recommendations, thereby hindering the ability of providers to deliver high-quality care. CPGs including a transparent decision process for fertility preservation can help health care providers to deliver optimal and uniform care, thus improving the quality of life of CAYAs with cancer and cancer survivors. Cancer 2016;122:2216-23. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Anna Font-Gonzalez
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Renée L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | - Melissa M Hudson
- Department of Pediatric Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Lisa B Kenney
- Department of Pediatric Oncology, Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jennifer M Levine
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | - Wim J E Tissing
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marianne D van de Wetering
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Leontien C M Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
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10
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Gajjar R, Miller SD, Meyers KE, Ginsberg JP. Fertility preservation in patients receiving cyclophosphamide therapy for renal disease. Pediatr Nephrol 2015; 30:1099-106. [PMID: 25190492 DOI: 10.1007/s00467-014-2897-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/21/2014] [Accepted: 06/24/2014] [Indexed: 12/15/2022]
Abstract
Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.
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Affiliation(s)
- Radha Gajjar
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA,
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11
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Terenziani M, Spinelli M, Jankovic M, Bardi E, Hjorth L, Haupt R, Michel G, Byrne J. Practices of pediatric oncology and hematology providers regarding fertility issues: a European survey. Pediatr Blood Cancer 2014; 61:2054-8. [PMID: 25065353 DOI: 10.1002/pbc.25163] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/02/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fertility is impaired in many survivors of childhood cancer following treatment. Preservation of fertility after cancer has become a central survivorship concern. Nevertheless, several doctors, patients, and families do not discuss fertility and recommendations for fertility preservation in pediatrics are still lacking. Recommendations based on scientific evidence are needed and before their development we wanted to assess the practice patterns of fertility preservation in Europe. PROCEDURES On behalf of the PanCare network, we sent a questionnaire to pediatric onco-hematology institutions across Europe. The survey consisted of 21 questions assessing their usual practices around fertility preservation. RESULTS One hundred ninety-eight institutional representatives across Europe received the survey and 68 (response rate 34.3%) responded. Pre-treatment fertility counseling was offered by 64 institutions. Counseling was done by a pediatric onco-hematologist in 52% (33/64) and in 32% (20/64) by a team. The majority of institutions (53%) lacked recommendations for fertility preservation. All 64 centers offered sperm banking; eight offered testicular tissue cryopreservation for pre-pubertal males. For females, the possibility of preserving ovarian tissue was offered by 40 institutions. CONCLUSIONS There is a high level of interest in fertility preservation among European centers responding to our survey. However, while most recommended sperm cryopreservation, many also recommended technologies whose efficacy has not been shown. There is an urgent need for evidence-based European recommendations for fertility preservation to help survivors deal with the stressful topic of fertility.
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12
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Ruutiainen T, Miller S, Caplan A, Ginsberg JP. Expanding access to testicular tissue cryopreservation: an analysis by analogy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:28-35. [PMID: 23428034 DOI: 10.1080/15265161.2012.760672] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Researchers are developing a fertility preservation technique--testicular tissue cryopreservation (TTCP)--for prepubescent boys who may become infertile as a result of their cancer treatment. Although this technique is still in development, some researchers are calling for its widespread use. They argue that if boys do not bank their tissue now, they will be unable to benefit from any therapies that might be developed in the future. There are, however, risks involved with increasing access to an investigational procedure. This article examines four methods of expanding access to TTCP: (1) expansion of institutional review board (IRB)-approved research trials; (2) offering TTCP as an innovative procedure in hospitals; (3) offering TTCP as a standard practice in hospitals; and (4) commercialization of TTCP. The ethical and practical implications of each are evaluated through a comparison with umbilical cord blood banking (UCBB), a technology that has achieved widespread use based on similar claims of future benefit.
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Affiliation(s)
- Tuua Ruutiainen
- Tulane University School of Medicine, New Orleans, LA 70118, USA.
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13
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Ayensu-Coker L, Essig E, Breech LL, Lindheim S. Ethical quandaries in gamete-embryo cryopreservation related to oncofertility. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2013; 41:711-719. [PMID: 24088162 DOI: 10.1111/jlme.12081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
While cancer rates continue to increase, therapy has dramatically decreased the mortality rates. The increased efficacy of current therapies may unfortunately have profound toxic effects on gamete function in both adolescent and reproductive age groups, with infertility as an expected consequence of cancer therapy. Significant progress in the advancement of fertility preservation therapies provides realistic options for future fertility in cancer survivors. However, a number of challenging issues need to be considered when presenting fertility preservation options. This overview highlights some of these considerations including religious-cultural-ethical values, access to care and cost of services, developmental capacity and consent, and posthumous reproduction.
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Affiliation(s)
- Leslie Ayensu-Coker
- Board certified obstetrician gynecologist with fellowship training in pediatric and adolescent gynecology. Specialist in Family Law, certified by the Ohio State Bar and a founding member of the respected American Academy of Assisted Reproduction Technology Attorneys. Division chief for Pediatric & Adolescent Gynecology at Cincinnati Children's. Medical and Scientific Director at the Arizona Reproductive Institute in Tucson, AZ
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14
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Abstract
As cancer treatment becomes more and more effective, there is greater life expectancy for cancer patients. Because of this, depending upon the modality used in the treatment of cancer, the matter of infertility emerges before us as an issue of increasing significance. Sperm cryopreservation and embryo cryopreservation are well-established methods of fertility preservation (FP). Besides these validated FP options, some FP techniques such as oocyte cryopreservation and ovarian tissue cryopreservation are as yet in the experimental stage. FP medicine has experienced some rapid developments in recent years. The advances in this branch of medicine, however, have also brought about new ethical, medical and legal issues. Some of these include problems with obtaining the informed consent of minors, issues that arise because of the experimental nature of some methods, financial problems and the accessibility of FP methods, and the question of what happens to gametes when a patient dies. This review seeks to discuss, in the light of current literature, some ethical and technical issues and risks related to the implementation of FP methods in women with cancer.
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Affiliation(s)
- Mert Küçük
- Department of Obstetrics and Gynecology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey.
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15
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Salama M, Winkler K, Murach KF, Seeber B, Ziehr SC, Wildt L. Female fertility loss and preservation: threats and opportunities. Ann Oncol 2012; 24:598-608. [PMID: 23129121 DOI: 10.1093/annonc/mds514] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ovarian aging and cytotoxic treatments are the most common causes for fertility loss in women. With increasing numbers of young female survivors following cytotoxic cancer treatments, the issue of fertility preservation has assumed greater importance. METHODS We review the literature on the causes of female fertility loss as well as the recent advances in fertility preservation options and strategies that might be of interest to oncologists. Currently, several methods and techniques exist for fertility preservation of female patients with cancer including embryo freezing, ovarian protection techniques, oocyte cryopreservation, ovarian tissue cryopreservation followed by autotransplantation, and recently in vitro culture of ovarian tissue, follicles, and oocytes. Each method or technique has advantages and disadvantages related to current success rate, required delay in cancer treatment, sperm requirement, and risk of reintroducing cancer cells. RESULTS To date, embryo freezing is the only established method successfully and widely used for fertility preservation of female patients with cancer. The other methods are promising but still considered experimental. CONCLUSION Patient awareness, physician knowledge, early counseling, costs management, international registry, interdisciplinary networks, and research development are necessary to improve the current care in the field of female fertility preservation.
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Affiliation(s)
- M Salama
- Department of Gynecological Endocrinology and Reproductive Medicine, Innsbruck Medical University, A-6020 Innsbruck, Austria
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16
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Küçük M, Bolaman AZ, Yavaşoğlu I, Kadıköylü G. Fertility-preserving treatment options in patients with malignant hematological diseases. Turk J Haematol 2012; 29:207-16. [PMID: 24744663 PMCID: PMC3986744 DOI: 10.5505/tjh.2012.72681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/20/2011] [Indexed: 11/04/2022] Open
Abstract
The number of patients of reproductive age diagnosed with various malignant hematological diseases increases every year. These patients undergo chemotherapy, radiotherapy, and various other treatments that may have gonadotoxic effects. The life expectancy of these patients is increasing rapidly due to the variety of treatment options. As such, an increasing number of patients-as well as their parents and spouses-express their concerns about the patient's fertility post treatment. In the present review it was aimed to provide an overview of current fertility-preserving treatment options and the future of fertility preservation.
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Affiliation(s)
- Mert Küçük
- Adnan Menderes University, School of Medicine, Department of Obstetrics and Gynecology, Aydın, Turkey
| | - Ali Zahit Bolaman
- Adnan Menderes University, School of Medicine, Department of Internal Medicine, Division of Hematology, Aydın, Turkey
| | - Irfan Yavaşoğlu
- Adnan Menderes University, School of Medicine, Department of Internal Medicine, Division of Hematology, Aydın, Turkey
| | - Gürhan Kadıköylü
- Adnan Menderes University, School of Medicine, Department of Internal Medicine, Division of Hematology, Aydın, Turkey
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17
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Di Pietro ML, Virdis A, Gonzalez-Melado FJ, De Luca D. Cryopreservation of ovarian tissue in pediatrics: what is the child's best interest? J Matern Fetal Neonatal Med 2012; 25:2145-8. [PMID: 22489803 DOI: 10.3109/14767058.2012.678430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In paediatric female patients the only option for restoring fertility after chemotherapy and radiotherapy is ovarian tissue banking. Even if this procedure is considered the most promising available, anyway it is still an experimental option due to the paucity of data. The possibility to offer an experimental preventive technique with potential benefits but with known risks arises a dilemma: what is the best interest for suffering child? Is it most important to minimize risk of the disease or to preserve the future fertility? However, if it is right to propose fertility preservation when physical and psychic risks are acceptable, we think it is not in the child's best interest to retrieve ovarian tissue from very young patients whose ovaries are small and for whom surgery is a high risk procedure. Moreover fertility preservation should not be offered if this could increase the risk of disease worsening.
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Affiliation(s)
- Maria Luisa Di Pietro
- Institute of Hygiene, Department of Public Health, University Hospital A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
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18
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Quinn GP, Stearsman DK, Campo-Engelstein L, Murphy D. Preserving the right to future children: an ethical case analysis. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2012; 12:38-43. [PMID: 22650461 PMCID: PMC3642619 DOI: 10.1080/15265161.2012.673688] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report on the case of a 2-year-old female, the youngest person ever to undergo ovarian tissue cryopreservation (OTC). This patient was diagnosed with a rare form of sickle cell disease, which required a bone-marrow transplant, and late effects included high risk of future infertility or complete sterility. Ethical concerns are raised, as the patient's mother made the decision for OTC on the patient's behalf with the intention that this would secure the option of biological childbearing in the future. Based on Beauchamp and Childress's principlism approach of respect for autonomy, nonmaleficence, beneficence, and justice, pursing OTC was ethically justified.
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Affiliation(s)
- Gwendolyn P Quinn
- Moffitt Cancer Center, Health Outcomes and Behavior Program, Tampa, FL 33612, USA.
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19
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Stensvold E, Magelssen H, Oskam IC. Fertility-preserving measures for girls and young women with cancer. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2011; 131:1429-32. [PMID: 21844944 DOI: 10.4045/tidsskr.11.0126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Children and young adults with cancer may be rendered infertile as a result of their treatment. The purpose of this article is to provide an overview of fertility-preserving measures for girls and young women. MATERIAL AND METHODS The article is based on literature searches in the medical databases Medline, Pubmed and Scopus and the experience of a Nordic cooperative group on gonadal preservation in connection with cancer treatment. RESULTS There are several methods for preserving the fertility of girls and young women with cancer. These should form a part of the actual cancer treatment. Cryopreservation of embryos is a well established method for adult cancer patients, also in Norway. Cryopreservation of eggs and ovarian tissue is to be regarded as still at the experimental stage. Research and new methods will improve the options for prepubertal children and young adults with disseminated cancer. INTERPRETATION Multidisciplinary cooperation is necessary to ensure that children and young cancer patients receive thorough information about the risk of infertility after cancer treatment, and about potential fertility-preserving measures.
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Affiliation(s)
- Einar Stensvold
- Clinic for Children and Adolescents, Akershus University Hospital, Norway
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20
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Quinn GP, Murphy D, Knapp C, Stearsman DK, Bradley-Klug KL, Sawczyn K, Clayman ML. Who decides? Decision making and fertility preservation in teens with cancer: a review of the literature. J Adolesc Health 2011; 49:337-46. [PMID: 21939862 PMCID: PMC3179606 DOI: 10.1016/j.jadohealth.2011.01.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 12/03/2010] [Accepted: 01/09/2011] [Indexed: 01/15/2023]
Abstract
PURPOSE The knowledge that cancer treatment may impair fertility in pediatric populations is an emerging aspect of quality of life in this population. However, decision making and use of fertility preservation (FP) among adolescent cancer patients and their families has not been well studied. This review summarizes the available published data on aspects of decision making and FP in adolescent cancer patients. METHODS An electronic search was performed to identify peer-reviewed studies published between 1999 and 2009 using key Medical Subject Heading terms and inclusion criteria. Inclusion criteria limited eligible studies to those that focused on adolescent decision making in cancer treatment or FP, fertility concerns in pediatric oncology, capacity for decision making, and health decision making in pediatrics. Studies that did not meet at least one of these criteria were excluded. RESULTS A total of 29 articles were reviewed and summarized. Three categories of results were seen: a focus on adolescent decision making in oncology, decision making in chronic illness, and decision making in cancer-related infertility and preservation. CONCLUSION Most of the studies showed that adolescents have a strong desire to participate in decisions related to their cancer treatment and many have concerns regarding their future fertility, although barriers often prevented these discussions. More research is needed to explore the role of teenagers and parents in decisions about fertility in relation to cancer treatment.
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Affiliation(s)
- Gwendolyn P Quinn
- Department of Oncologic Sciences, College of Medicine, University of South Florida, Tampa, Florida 33612, USA.
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21
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Hohmann C, Borgmann-Staudt A, Rendtorff R, Reinmuth S, Holzhausen S, Willich SN, Henze G, Goldbeck L, Keil T. Patient Counselling on the Risk of Infertility and Its Impact on Childhood Cancer Survivors: Results from a National Survey. J Psychosoc Oncol 2011; 29:274-85. [DOI: 10.1080/07347332.2011.563344] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Cynthia Hohmann
- a Institute for Social Medicine, Epidemiology and Health Economics , Charité-Universitätmedizin Berlin , Berlin, Germany
| | - Anja Borgmann-Staudt
- b Department of Paediatric Oncology/Haematology , Charité-Universitätsmedizin Berlin , Berlin, Germany
| | - Rosa Rendtorff
- b Department of Paediatric Oncology/Haematology , Charité-Universitätsmedizin Berlin , Berlin, Germany
| | - Simone Reinmuth
- b Department of Paediatric Oncology/Haematology , Charité-Universitätsmedizin Berlin , Berlin, Germany
| | - Steve Holzhausen
- a Institute for Social Medicine, Epidemiology and Health Economics , Charité-Universitätmedizin Berlin , Berlin, Germany
| | - Stefan N. Willich
- a Institute for Social Medicine, Epidemiology and Health Economics , Charité-Universitätmedizin Berlin , Berlin, Germany
| | - Guenter Henze
- b Department of Paediatric Oncology/Haematology , Charité-Universitätsmedizin Berlin , Berlin, Germany
| | - Lutz Goldbeck
- c Department of Child and Adolescent Psychiatry/Psychotherapy , University Ulm, Ulm, Germany
| | - Thomas Keil
- a Institute for Social Medicine, Epidemiology and Health Economics , Charité-Universitätmedizin Berlin , Berlin, Germany
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Abstract
PURPOSE OF REVIEW Fertility in adult life can be severely impaired by gonadotoxic therapies and with remarkable advancements in the treatment of childhood cancers there is a growing population of adult survivors of childhood malignancies. The aim of the study is to review the developments that have been made in spermatogonial stem cell research and potential future utility in fertility preservation. RECENT FINDINGS Whereas intense interest and subsequent research surrounds the regenerative potential of spermatogonial stem cells, a recent article highlights the in-vitro propagation of human spermatogonial stem cells from testicular biopsies for future transplantation and restoration of fertility. Whereas in-vitro propagation of spermatogonial stem cells has been established in animal models this is the first study in humans. SUMMARY Spermatogonial stem cell transplantation began as a theoretical approach that currently is studied ardently by several research groups to make this a valid clinical option. Restoration of fertility following spermatogonial stem cell transplantation in animals suggests therapeutic potential for the technique in humans, and further research is proceeding to address the safety and efficacy of this technique.
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23
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Levine J, Canada A, Stern CJ. Fertility Preservation in Adolescents and Young Adults With Cancer. J Clin Oncol 2010; 28:4831-41. [DOI: 10.1200/jco.2009.22.8312] [Citation(s) in RCA: 240] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Preservation of fertility is important to adolescent and young adult (AYA) survivors of cancer. Many survivors will maintain their reproductive potential after the successful completion of treatment for cancer. However total-body irradiation, radiation to the gonads, and chemotherapy regimens containing high-dose alkylators can place women at risk for acute ovarian failure or premature menopause and men at risk for temporary or permanent azoospermia. The most effective and established means of preserving fertility in this population is embryo cryopreservation in women and sperm cryopreservation in men before the initiation of cancer-directed therapy. Cryopreservation of mature oocytes is also becoming more commonplace as methods of thawing become more sophisticated. The use of in vitro fertilization and intracytoplasmic sperm injection has added to the viability of sperm and oocyte cryopreservation. Cryopreservation and transplantation of gonadal tissue in both males and females remains experimental but continues to be evaluated. Hormonal suppression has not been shown to be effective in males but may have promise in females, although larger scale trials are needed to evaluate this. Providing information about risk of infertility and possible interventions to maintain reproductive potential are critical for the AYA population at the time of diagnosis. Given the competing demands of providing complicated and detailed information about cancer treatment, the evolving information related to fertility preservation, and the ethical issues involved, it may be preferable, where possible, to have a specialized team, rather than the primary oncologist, address these issues with AYA patients.
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Affiliation(s)
- Jennifer Levine
- From the Division of Pediatric Oncology, Columbia University Medical Center, New York, NY; Rush University Medical Center, Chicago, IL; and Reproductive Services, The Royal Women's Hospital and Melbourne IVF, Melbourne, Victoria, Australia
| | - Andrea Canada
- From the Division of Pediatric Oncology, Columbia University Medical Center, New York, NY; Rush University Medical Center, Chicago, IL; and Reproductive Services, The Royal Women's Hospital and Melbourne IVF, Melbourne, Victoria, Australia
| | - Catharyn J. Stern
- From the Division of Pediatric Oncology, Columbia University Medical Center, New York, NY; Rush University Medical Center, Chicago, IL; and Reproductive Services, The Royal Women's Hospital and Melbourne IVF, Melbourne, Victoria, Australia
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24
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Hwang K, Lamb DJ. Re: Fertility Preservation in Adolescent Males: Experience Over 22 Years at Rouen University Hospital. Eur Urol 2010; 57:173-4. [DOI: 10.1016/j.eururo.2009.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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