Document Detail

Choice in fertility preservation in girls and adolescent women with cancer.
MedLine Citation:
PMID:  16921478     Owner:  NLM     Status:  MEDLINE    
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.
Jeffrey Nisker; Françoise Baylis; Carolyn McLeod
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Cancer     Volume:  107     ISSN:  1097-0142     ISO Abbreviation:  Cancer     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-02     Completed Date:  2007-11-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374236     Medline TA:  Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1686-9     Citation Subset:  AIM; IM    
Copyright Information:
(c) 2006 American Cancer Society.
Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
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MeSH Terms
Fertilization in Vitro
Infertility, Female / prevention & control*
Neoplasms / physiopathology*,  psychology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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