Presented at the Pediatric Oncology Group of Ontario Symposium “Walking Two Worlds—Adolescent and Young Adult Oncology,” Toronto, Ontario, Canada, November 2003.
Choice in fertility preservation in girls and adolescent women with cancer†
Version of Record online: 18 AUG 2006
Copyright © 2006 American Cancer Society
Supplement: Walking Two Worlds—Adolescent and Young Adult Oncology. Proceedings of a Symposium held by the Pediatric Oncology Group of Ontario
Volume 107, Issue Supplement 7, pages 1686–1689, 1 October 2006
How to Cite
Nisker, J., Baylis, F. and McLeod, C. (2006), Choice in fertility preservation in girls and adolescent women with cancer. Cancer, 107: 1686–1689. doi: 10.1002/cncr.22106
- Issue online: 18 SEP 2006
- Version of Record online: 18 AUG 2006
- Manuscript Accepted: 20 DEC 2005
- Manuscript Received: 30 AUG 2005
- Canadian Institutes of Health Research
- female fertility;
- informed choice;
With the cure rate for many pediatric malignancies now between 70% and 90%, infertility becomes an increasingly important issue. Strategies for preserving fertility in girls and adolescent women occur in two distinct phases. The first phase includes oophorectomy (usually unilateral) and cryopreservation of ovarian cortex slices or individual oocytes; ultrasound-guided needle aspiration of oocytes, with or without in vitro maturation (IVM), followed by cryopreservation; and ovarian autografting to a distant site. The second phase occurs if the woman chooses to pursue pregnancy, and includes IVM of the oocytes, followed by in vitro fertilization (IVF) and transfer of any created embryos to the woman's uterus (or to a surrogate's uterus if the cancer patient's uterus has been surgically removed or the endometrium destroyed by radiotherapy). For ovarian autografting, the woman would undergo menotropin ovarian stimulation and retrieval of matured oocytes (likely by laparotomy, but possibly by ultrasound-guided needle aspiration if the ovary is positioned in an inaccessible location). The ethical challenges with each of these phases are many of fertility preservation and include issues of informed choice (consent or refusal). The lack of proven benefit with these strategies and the associated potential physical and psychological harms require careful attention to the key elements of informed choice, which include decisional capacity, disclosure, understanding and voluntariness, and to the benefits of in-depth counseling to promote free and informed choice at a time that is emotionally difficult for the decision makers. Cancer 2006. © 2006 American Cancer Society.