Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;30(5):151095.
doi: 10.1016/j.sempedsurg.2021.151095. Epub 2021 Sep 4.

The ethics of offering fertility preservation to pediatric patients: A case-based discussion of barriers for clinicians to consider

Erin E Rowell  1 , Timothy B Lautz  1 , Krista Lai  2 , Erica M Weidler  2 , Emilie K Johnson  3 , Courtney Finlayson  4 , Kathleen van Leeuwen  5
Affiliations

The ethics of offering fertility preservation to pediatric patients: A case-based discussion of barriers for clinicians to consider

Erin E Rowell et al. Semin Pediatr Surg. 2021 Oct.

Abstract

Decisions about fertility preservation can be difficult in general but the recent application of preservation techniques to pediatric patients has ushered in a host of new ethical considerations. Fertility preservation (FP) may be considered for all patients who are at risk for infertility due to their medical diagnosis or treatment, including those undergoing gonadotoxic chemotherapy, those with differences of sex development (DSD) undergoing gonadectomy,1-3 and transgender patients undergoing gender affirming surgery. The focus of this paper is to review the ethical issues involved in offering FP to pediatric oncology patients and, to a lesser extent, the new ethical issues that apply to patients with DSD. Some of the techniques and approach to counseling will also apply to transgender individuals, although that is beyond the scope of this work. We aim to discuss several barriers to offering FP and to advise how to counsel families in the setting of rapid changes in this field. Families should be educated about:Specific guidance for clinicians regarding some of these points was recently published in an American Academy of Pediatrics Clinical Report,1 and we will illustrate the use of these guidelines in four case presentations.

Keywords: Assent; Differences of sex development; Fertility preservation.

PubMed Disclaimer

References

    1. Klipstein S, Fallat ME, Savelli S, et al. Fertility Preservation for Pediatric and Adolescent Patients with Cancer: Medical and Ethical Considerations. Pediatrics. 2020;145(3):e20193994. - PubMed
    1. Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Fertil Steril. 2019;112(6):1022–1033. - PubMed
    1. Oktay K, Harvey BE, Partridge AH, et al. Fertility preservation in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol. 2018;36(19):1994–2001. - PubMed
    1. Meacham LR, Burns K, Orwig KE, et al. Standardizing risk assessment for treatment-related gonadal insufficiency and infertility in childhood, adolescent, and young adult cancer: the Pediatric Initiative Network risk stratification system. J Adolesc Young Adult Oncol. 2020;9(6):662–666. - PubMed
    1. Campo-Engelstein L, Chen D. Ethical Issues in Pediatric and Adolescent Fertility Preservation. In Woodruff T, Gosiengfiao Y, eds. Pediatric and adolescent oncofertility best practices and emerging technologies. Cham, Switzerland: Springer; 2017:259–267.